Targets For Suicide Prevention Research Articles

Euthanasia and assisted suicide (EAS) in psychiatric patients

IntroductionA legal definition for EAS describes this procedure as “intentionally terminating life by someone other than the person concerned, at the latter’s request”. The number of requests for EAS has been progressively increasing in countries where this procedure is allowed, including concerning psychiatric patients (2% of all requests). EAS for reasons of unbearable suffering raises ethical concerns due to lack of criteria for psychiatric patients.ObjectivesTo discuss the avaliable data about EAS and its controversial value in psychiatric patients.MethodsNon-systematic review of literature on current knowledge about EAS, particularly in patients with mental disorder.ResultsIn terms of sociodemographic and clinical characteristics, these patients were mostly women, with at least two psychiatric conditions; the main diagnosis is a (treatment-resistant) mood disorder, with some medical comorbidity. Psychological suffering was the main motivation, in patients with severe symptomatology associated with psychiatric and physical conditions (26% reported both psychological and physical suffering). These patients tend to be empowered and value self-determination. There is to highlight a high percentage of patients still alive after a not granted pEAS request (69%) and a high rate of pEAS requests withdrawals (37%).ConclusionsSuicide prevention remains a priority in terms of public health. Thus, there is a need to ensure that EAS isn`t a way to increase suicide mortality by giving access to lethal methods to suicidal patients. In some cases, EAS request has a paradoxical value to regain control of life and it`s related to the transient nature of unbearable mental suffering.The actual process provides a continued recovery-oriented care in parallel with the EAS evaluation, and a thorough evaluation which requires a multi-expert panel with the envolvement of mental health professionals. Ethical concerns remains about its paradox: unbearable psychological suffering is a target for suicide prevention and also a required criterion for EAS.Disclosure of InterestNone Declared

Neuroimaging Studies of Nonsuicidal Self-Injury in Youth: A Systematic Review.

Nonsuicidal self-injury (NSSI) is prevalent and affects mainly the youth population. It is prospectively associated with suicide attempts, making it a target for suicide prevention. Recently, several studies have investigated neural pathways of NSSI using neuroimaging. However, there is a lack of systematized appraisal of these findings. This systematic review aims to identify and summarize the main neuroimaging findings of NSSI in youth. We followed PRISMA statement guidelines and searched MEDLINE, APA PsycInfo, and Google Scholar databases for neuroimaging studies, irrespective of imaging modality, specifically investigating NSSI in samples with a mean age of up to 25 years old. Quality assessment was made using the Newcastle–Ottawa and Joanna Briggs Institute scales. The initial search retrieved 3030 articles; 21 met inclusion criteria, with a total of 938 subjects. Eighteen studies employed functional neuroimaging techniques such as resting-state and task-based fMRI (emotional, interpersonal exposure/social exclusion, pain, reward, and cognitive processing paradigms). Three studies reported on structural MRI. An association of NSSI behavior and altered emotional processing in cortico-limbic neurocircuitry was commonly reported. Additionally, alterations in potential circuits involving pain, reward, interpersonal, self-processing, and executive function control processes were identified. NSSI has complex and diverse neural underpinnings. Future longitudinal studies are needed to understand its developmental aspects better.

Depression and Suicidal Behaviors Among HIV-Infected Inmates in Lesotho: Prevalence,Associated Factors and a Moderated Mediation Model.

Depression and suicidal behaviors are two common psychiatric problems observed among people living with HIV. The situation is worse among HIV-infected inmates. The present study aimed to assess the prevalence and associated factors of depression and suicidal behaviors among HIV-infected inmates, and to clarify the mechanisms underlying the impact of HIV-related stigma on suicidal behaviors. The data from 402 HIV-infected inmates in Lesotho showed the prevalence of depression and suicidal behaviors was 53.0% and 8.2%. Female and institution maladaptation were risk factors for depression, and the risk factor for suicidal behaviors was non-participation of institution activities. Moreover, HIV-related stigma indirectly increased inmates' suicidal behaviors through elevated depression. Such indirect effect was stronger for inmates with a lower level of meaning in life. These findings indicate more concern should be given to high-risk subgroups, and both depression and meaning in life are intervention targets for suicide prevention among HIV-infected inmates.

Insomnia symptom severity is associated with increased suicidality and death by suicide in a sample of patients with psychiatric disorders.

Insomnia is a risk factor for suicidal behavior including attempts and death by suicide. We investigated whether insomnia symptom severity was associated with suicidality and death by suicide in patients with psychiatric disorders. The sample included 180 deceased patients with psychiatric disorders seen at Weber Human Services between 2008 and 2018 who completed the Outpatient Questionnaire-45.2 (OQ) prior to death. Insomnia symptom severity was assessed using item 41 from the OQ. Manner of death was determined by death records and autopsy reports. History of suicidality was determined through electronic medical records. Cases were grouped into four lifetime categories: non-suicidal (n = 30), suicidal ideation (n = 36), suicide attempt (n = 95), and death by suicide (n = 19). Demographic, medical, and psychiatric features of each group were compared using linear regression. Logistic regression was used to determine whether insomnia symptom severity was associated with lifetime suicidality severity grouping, adjusting for psychiatric disorders commonly linked to suicidality. Lifetime suicidality was associated with sleep problems, fatigue, headaches, and psychiatric disorders (i.e. depressive, personality, and trauma-related disorders). Referenced to the non-suicidal group, greater insomnia symptom severity was significantly associated with suicide attempts and death by suicide, with odds ratios (OR) of OR = 2.67, p = 0.011, and OR = 5.53, p = 0.002, respectively, even after adjusting important psychiatric diagnoses. Results suggest that insomnia symptom severity endorsed during a clinical visit is associated with heightened suicidality, especially suicidal behavior. The presence of insomnia symptoms in patients with psychiatric disorders may indicate risk for suicide and is a target for suicide prevention.

0976 Temporal Associations Between Sleep And Suicidality In Ultra-high Risk Adolescents And College Students During An Intensive Longitudinal Study

Abstract Introduction Studies consistently demonstrate a link between subjective sleep disturbances and the continuum of suicidality, although this evidence primarily comes from retrospective, cross-sectional studies using limited items to assess sleep. Longitudinal assessment of well-defined and measured sleep/wake behaviors with high-risk individuals are needed to enhance the specificity of near-term suicide risk detection and render concrete targets for suicide prevention. Methods Participants (N=46) included ultra-high-risk adolescents (N=29 ages 12-18) and college students (N=17 ages 18-24). For up to 12 weeks, participants wore an actigraph to yield objective data on sleep/wake, and concurrently completed daily cellphone-based ratings of subjective sleep and suicidality. Generalized estimating equations were used to examine the association between sleep parameters (subjective and objective) and the odds of next-day suicidal outcomes (i.e., passive death wish [PDW], suicidal ideation, suicidal intent) controlling for age, gender, and depression severity. Results Significant quadratic relationships were observed between actigraphy-derived total sleep time (TST) and probability of next-day PDW (Z=3.7, p=0.0002), suicidal ideation (Z=2.1, p=0.04), and suicidal intent (Z=2.78, p=0.006), with increasing suicidality at low and high values of TST. Low sleep efficiency (<75%) was associated with increased odds of next-day PDW (OR=1.24, Z=2.07, p=0.038). Subjectively (sleep diary measures), low sleep quality (<50 on 100-point scale) was associated with increased odds of next-day suicidal ideation (OR=1.57, Z=3.42, p<0.001), and longer sleep onset latency (>20 minutes) with next-day suicidal intent (OR=3.00, Z=2.37, p=0.018). Conclusion Poor sleep health may signal increasing suicide risk, and are modifiable risk factors. We document a significant temporal association whereby objectively-derived short and long TST and low sleep efficiency, as well as subjective sleep quality and sleep onset latency, predicts next day’s suicidality. Further understanding of the temporal association between sleep and suicidality may hold promise to inform real-time monitoring and preventive strategies. Interventions targeting these factors may therefore help reduce suicidality in high-risk youth. Support American Foundation for Suicide Prevention; University of Pittsburgh Clinical and Translational Science Institute

Suicidal Ideation Among Female Inmates: A Cross-Sectional Study

Due to their complex mental health needs, female inmates comprise a particularly vulnerable group, at an elevated risk for suicide. Although suicidal ideation—the early stage in the trajectory towards suicidal behavior—represents a valid target for suicide prevention, there has been little research devoted to this outcome among female inmates. In order to address this void and to inform prevention efforts, the present study sought to investigate correlates of recent suicidal ideation among women incarcerated in Flanders, Belgium. A representative sample of prisoners (N = 123; aged 19–70 years) was randomly selected from all Flemish correctional facilities detaining female inmates, representing one in four incarcerated women throughout Belgium. Prevalence estimates for lifetime history of suicide ideation and attempts are 57.7% and 36.6%, respectively. Multivariate analysis indicates that women with recent suicidal ideation while incarcerated are significantly more likely than their non-suicidal peers to report a lifetime history of non-suicidal self-injury (aOR = 7.36), in-prison drug use (aOR = 4.72), and severe psychological distress (aOR = 3.14). The findings highlight the importance of providing adequate mental health services in prison, in order to address women’s unique needs and vulnerabilities, and consequently, to reduce suicide risk.

Suicide ideation among Southern U.S. Sexual minority college students

Sexual minority individuals are at higher risk for suicide ideation compared with heterosexual individuals. We tested whether the interpersonal-psychological theory of suicide explains increased suicide ideation among sexual minority college students living in the southeastern region of the United States. The cross-sectional study assessed correlates of suicide ideation in a convenience sample (n = 82) of sexual minority college students. Perceived burdensomeness and thwarted belongingness correlated with suicide ideation. However, only perceived burdensomeness correlated with suicide ideation while controlling for depressive symptoms. Pending replication, perceived burdensomeness may be a target for suicide prevention and intervention among sexual minority college students.

La sémiologie du suicide au xxie siècle

The epidemiology, risk factors and biological basis of suicidal behaviors have been the object of an ever-increasing research in the last three decades. During this period, researchers all over the world have identified potential biomarkers of risk and developed several theories about the mechanisms leading to suicidal behavior. However, the lack of common terminology, instruments and cooperation has been a major deterrent. Today, the community has established the bases for this collaboration and evidence coming from neuroscientific studies can already be applied to the field of suicidology. We present here a potential semiology based on current evidence coming from biological, clinical and neuroimaging studies. Besides suicidal ideation and warning signs, the clinical features related to suicide risk and revealed by neuroscientific studies include notably: impulsive-aggression and hopelessness as well as high web consumption, sedentary behaviors and reduced sleep time, an enhanced sensibility to social exclusion and loneliness, a decreased sensitivity to detect social support, interpersonal problems related to decision making impairments, difficulties to regulate negative emotional states, a propensity to perceive psychic and also physical pain and to receive opiates treatments. Improving the assessment will also open new targets for suicide prevention. In the short term some of these targets await us: standard protocols for evaluation of risk, healthcare continuity, implication of the family/caregivers, mitigation of social or psychological pain.

A neurosciences based – semiology of suicidal behavior

The epidemiology, risk factors and biological basis of suicidal behaviors have been the object of an ever-increasing research in the last three decades. During this period, researchers all over the world have identified potential biomarkers of risk and developed several theories about the mechanisms leading to suicidal behavior. However, the lack of common terminology, instruments and cooperation has been a major deterrent. Today, the community has established the bases for this collaboration and evidence coming from neuroscientific studies can already be applied to the field of suicidology. We present here a potential semiology based on current evidence coming from biological, clinical and neuroimaging studies. Besides suicidal ideation and warning signs, the clinical features related to suicide risk and revealed by neuroscientific studies include notably: impulsive-aggression and hopelessness as well as high web consumption, sedentary behaviors and reduced sleep time, an enhanced sensibility to social exclusion and loneliness, a decreased sensitivity to detect social support, interpersonal problems related to decision-making impairments, difficulties to regulate negative emotional states, a propensity to perceive psychic and also physical pain and to receive opiates treatments. Improving the assessment will also open new targets for suicide prevention. In the short-term, some of these targets await us: standard protocols for evaluation of risk, healthcare continuity, implication of the family/caregivers, mitigation of social or psychological pain.Disclosure of interestThe author has not supplied his declaration of competing interest.