Treatment Of Suicidal Behavior Research Articles

FAMIlY-CENTRED HEAlTH CARE IN A PSYCHIATRIC HOSPITAl FOR CHIlDREN WITH SUICIDAl BEHAVIOR PHENOMENON

The study aims at identifying the organizational and methodological aspects of family-centered care in a psychiatric hospital for children with suicidal behavior. The objectives of the study were to assess the readiness of the parents/legal representatives to participate in correctional and rehabilitation activities in the period of hospitalization of the child, identify the key needs of the family, to formulate practical recommendations on organizational and methodological issues of family-centered care for children with suicidal behavior. The study involved all the girls (57), hospitalized in January-October 2014 about suicidal symptoms in the only psychiatric children hospital in Moscow, and 98 of their parents/legal representatives. There were used anamnestic (including the study of family history a suicide), analysis if diseases histories, clinical and psychopathological methods, system analysis of the level of family functioning and parental questionnaire during the child's hospitalization. 98 % of the parents are willing to be involved in medical activities in a varying degree. Main needs of majority of families are as follows: "Information about the state of the child, especially the development, diagnosis and prospects" (98 %) and "Training in new forms of behavior and education, which can be used at home after discharge" (92 %). Methodological basis and recommendations on the formation of organizational conditions of family-centered medical care for children with suicidal behavior were obtained and stages of family therapy were described. Readiness and needs of the family to participate in correctional and rehabilitation activities in children suggests the need to include families into prevention and treatment of suicidal behavior in children. Implementation of the concept of family-centered health care for a child with suicidal behavior suggests revising the rules adopted in the practice of child psychiatrists, psychotherapists and medical aid organization as a whole. Using not only the rehabilitation potential of the child but also his micro-social environment (the family) creates conditions for qualitative changes in the prevention, treatment and social adaptation of children with suicidal symptoms.

Suicide Risk Assessment in Adolescents - C-SSRS, K10, and READ.

Assessment and screening are often the first step in planning interventions to help adolescents at risk of suicide. Causes of suicidal thoughts and behavior are multifaceted and it is important for clinical work that assessment reflects this complexity. To investigate whether a general psychological Resilience Scale for Adolescents (READ) is associated with a validated suicide rating scale (C-SSRS). An observational study of self-reported suicidality (C-SSRS), psychological distress (K10), and resiliency (READ) in three adolescent samples: suicide clinic (N = 147); general psychiatric clinic (N = 85); and a nonclinical sample (N = 92). Resiliency scores were significantly higher (p < .05) in the nonclinical compared with the clinic samples on all READ scales. READ scores were similar in the two clinic samples apart from the family cohesion subscale, which was significantly lower in the suicide clinic sample. READ was predictive of levels of suicidality within all samples independently of general psychological distress (K10). The study did not examine other early childhood factors that may contribute to individual resiliency or suicidality. READ provides a reliable and valid assessment of individual resilience for both clinical and nonclinical settings. Evaluation of protective resources is a useful adjunct to the assessment and treatment of suicidal behavior.

Suicidality in patients with somatoform disorder - the speechless expression of anger?

To identify emotion-associated risk factors for suicidality in patients with somatoform disorders. A sample of 155 consecutive patients diagnosed with somatoform disorders at the Psychosomatic Ambulance of Bonn University Hospital filled in several questionnaires including the Symptom Checklist 90-Revised Version (SCL-90-R), the Toronto Alexithymia Scale (TAS-20), and the State Trait Anger Expression Inventory (STAXI). Our aim was to compare patients with suicide attempts to patients without suicide attempts via a MANCOVA (IV: Group; DV: SCL-90-R, TAS-20, STAXI; covariates: sex, age, depression, borderline personality disorder). Lifetime suicide attempts were documented in 20 patients (12.9%), current active suicidal ideation in 33.6%, and thoughts of death or dying in 55.9%. Patients with lifetime suicide attempts showed significantly more psychological distress, a significantly higher alexithymia sum score, a significantly higher score on trait anger, state anger, and a stronger tendency to express anger. Somatoform disorder patients with lifetime suicide attempts might have greater difficulties in identifying and describing emotions, and a tendency to intensely experience and express anger. Future longitudinal studies should further investigate possible links between difficulties in coping with anger and suicidality to improve prophylaxis and treatment of suicidal behaviour in somatoform disorder patients.

Aportes de la psicología positiva a la comprensión y abordaje de los comportamientos suicidas

Traditionally, the psychological study and approach of suicidal behaviors aimed to the identification of the associated risk factors. However, progressively in recent decades and in line with developments called salutogenic, research on the subject has begun to turn to the identification and understanding of protective and resilient factors, referring as those that act as buffers against suicidality. By salutogenic approach it is understood the body of theoretical developments oriented to study personal strengths and resources that promote health potential on people and allow to detect individual differences in coping with adversity. Within this approach, it is particularly interesting the positive psychology, so it has been the movement that consolidate these developments, which initiate at mid twentieth century. In this context, the work presented aimed to review the contributions of positive psychology to the conceptualization, assessment and treatment of suicidal behaviors. Basically, they are presented three contributions: optimism and suicidality, theory of positive emotions, and the perspective of the theory of self-determination in relation to the interpersonal theory of suicide. The implications are discussed.

Who gains from suicide risk assessment: Health inspectorate and health insurances, or also psychiatrist and patient?

IntroductionThe number of suicides rises in the Netherlands. In 2008, 1435 suicides were recorded; in 2012: 1753 (CBS). Adequate risk assessment with suicidal behaviour (SRA) is essential for prevention. The Health Inspectorate and Insurances seek to have a stronger grip on the way suicide risk is assessed and insist on using questionnaires. This runs counter to the multidisciplinary guidelines in the Netherlands for diagnosis and treatment of suicidal behaviour, which state that “questionnaires or observation instruments cannot replace clinical diagnostic examination.”ObjectiveDo questionnaires rather than ‘care as usual’ (CAU) in SRA lead to different treatment policies?AimTo determine whether the use of questionnaires rather than CAU in SRA leads to different treatment policies.MethodsPatients who were seen by staff at the department of Psychiatry at the ETS Hospital, either for in-house consultation or at the MPU, in connection with attempted suicide, auto-intoxication, or psychological distress with suicidal statements. Patients were examined by conducting a questionnaire, resulting in treatment policy (admission, discharge with an appointment with patient's own practitioner, discharge with referral to a practitioner, discharge without aftercare). Then, the same patient was again examined by another colleague in a free interview (CAU). The colleague was not informed about the outcome of the first assessment. Again, treatment policy was determined as a result. The two outcomes were then compared.ResultsData collection still continues.ConclusionsThere are signs that there are no differences in the determined treatment policies following SRA based on the use of questionnaires or CAU.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Combined Toxoplasma gondii seropositivity and high blood kynurenine – Linked with nonfatal suicidal self-directed violence in patients with schizophrenia

Toxoplasma gondii (T. gondii) chronic infection and elevated kynurenine (KYN) levels have been individually associated with non-fatal suicidal self-directed violence (NF-SSDV). We aimed to test the hypothesis that the association between T. gondii seropositivity and history of NF-SSDV would be stronger in schizophrenia patients with high plasma KYN levels than in those with lower KYN levels. We measured anti-T. gondii IgG antibodies and plasma KYN in 950 patients with schizophrenia, and used logistic regression to evaluate the relationship between NF-SSDV and KYN in patients who were either seropositive or seronegative for T. gondii. For those with KYN levels in the upper 25th percentile, the unadjusted odds ratio for the association between NF-SSDV history and KYN in T. gondii seropositive patients was 1.63 (95% CI 1.01 to 2.66), p = 0.048; the adjusted odds ratio was 1.95 (95% CI 1.15 to 3.30), p = 0.014. Plasma KYN was not associated with a history of NF-SSDV in T. gondii seronegative patients. The results suggest that T. gondii and KYN may have a nonlinear cumulative effect on the risk of NF-SSDV among those with schizophrenia. If confirmed by future longitudinal studies, this result is expected to have both theoretical and clinical implications for the prevention and treatment of suicidal behavior.

Cytokines as Suicide Risk Biomarkers

Suicide is a major public health problem as about 40,000 people die by suicide in the United States annually. Prevention and treatment of suicidal behavior are therefore very important. The major problem in the prevention of suicide is early identification and treatment of suicide-prone patients. Suicide is a multifactorial problem involving clinical, genetic, and neurobiological risk factors. The identification of risk factors that could accurately predict completed suicide has been investigated by many researchers. Meta-Analysis of Cytokines and Chemokines in Suicidality: Distinguishing Suicidal Versus Nonsuicidal PatientsBiological PsychiatryVol. 78Issue 1PreviewMajor psychiatric disorders are associated with inflammation. Aberrant cytokine and chemokine levels have been associated with psychiatric disorders and suicidal behavior. We performed a meta-analysis of cytokine and chemokine levels in patients with versus without suicidality and patients with suicidality versus healthy controls. Full-Text PDF

From Social Exclusion to Psychological Pain

From social exclusion to psychological pain. With one million deaths worldwide, suicide is a major health problem. New hypothesis to better understand this complex phenomenon are needed because efficient therapeutic strategies are still lacking. The stress-vulnerability model is largely admitted to understand suicidal act; i.e. only predisposed subjects, under stress condition, will attempt suicide. Unbearable pain, particularly psychological pain, is a frequent theme of suicide notes. Subjects with a higher propensity for mental suffering may be at greater risk of suicidal act. In most cases, suicide attempters have reported psychosocial stress leading to a social devaluation or a feeling of exclusion. Dysfunctional social cognitions could be involved in suicidal behavior through two pathways because it produces pain and increases sensitivity to some social events. Brain imaging is a helpful tool to better understand in vivo the neuroanatomical basis of suicidal vulnerability and its link with social as well as psychological pain. Neuroimaging studies mainly showed the involvement of prefrontal and cingulate cortices in both psychological pain and suicidal vulnerability. In addition, there is increased evidence of an overlap between psychological/social pain and physical pain. By stressing that pain is core to suicidal behaviour, we may provide new avenues for improving the comprehension of physiopathology (i.e. opioid system) and treatment of suicidal behaviour (i.e. pain becoming a therapeutic target).

Introduction to the special issue: Current topics in the assessment and treatment of suicidal behaviors in adolescents.

Introduction to the special issue: Current topics in the assessment and treatment of suicidal behaviors in adolescents.

Satisfacción y utilidad percibidas por pacientes y familiares acerca de la información sobre prevención de suicidio

ObjectiveTo assess the satisfaction of persons with suicidal behaviour and their relatives using patient information material included in the Clinical Practice Guidelines on Prevention and Treatment of Suicidal Behaviour. MethodThe sample was made up of 57 patients with suicidal ideation or behaviour, and 52 relatives. The participants were recruited through a suicide prevention programme (Programa de intervención intensiva en conducta suicida [PII] - Suicidal Behaviour Intensive Intervention Programme) and a family association (Federación de Asociaciones de Familiares y Personas con enfermedad mental de Galicia [FEAFES] - Galician Federation of Associations of Relatives and Persons with mental diseases). An ad-hoc questionnaire was designed to ascertain the degree of perceived satisfaction and usefulness of using the information included in the guidelines. ResultsThe descriptive data of the sample is presented, along with an exploratory factorial analysis of the questionnaire that yielded two dimensions, i.e., format and usefulness. Patients scored significantly lower than the relatives in two dimensions; nevertheless, no significant differences were found between the two groups in the level of general satisfaction. The socio-demographic variables did not influence the results. Similarly, no differences were observed between patients with and without history of suicidal behaviour. Participants stressed that Primary Care was the setting best suited for dissemination of this type of information. ConclusionsIn general, both patients and relatives displayed a high level of satisfaction with the patient information material assessed. Furnishing information of this type to patients with suicidal ideation and/or behaviour could act as a preventive-educational tool.

Abnormal Expression Pattern of Notch Receptors, Ligands, and Downstream Effectors in the Dorsolateral Prefrontal Cortex and Amygdala of Suicidal Victims

Recent studies have associated alterations of neuronal plasticity in specific brain areas with suicidal behavior. The Notch signaling pathway plays a relevant role in the control of stem cell maintenance, cell migration, and neuronal plasticity. In the present study, the gene expression of the four Notch receptors (NOTCH1-4), the five canonical ligands (DLL1, DLL3, DLL4, JAGGED1, and JAGGED2), the two non-canonical ligands (DLK1 and DLK2), and the transcription factors (HES1, HEY1, and HEY2) were measured in the dorsolateral prefrontal cortex (DLPFC) and amygdala (AMY) of suicide victims (S; n = 13 males, with no clinical psychiatric history and non-treated with anxiolytic or antidepressant drugs) and their corresponding controls (C; n = 13 males) by real-time PCR. The results revealed a reduction of NOTCH2 and NOTCH1, NOTCH3, and NOTCH4 gene expression in the DLPFC and AMY of S compared with C, respectively. DLL1 levels were increased in the DLPFC and decreased in the AMY, whereas DLL4, JAGGED1, and JAGGED2 were significantly decreased in the regions analyzed. DLK1 was reduced in the AMY, whereas no changes were observed in the DLPFC and in DLK2 expression levels in any of the regions analyzed. HES1 was significantly reduced in both brain regions from S, whereas there were no significant changes in HEY1 and HEY2. This study provides evidence suggesting that the Notch signaling pathway could be a potential key target in the treatment of suicidal behaviors.

Predictors of psychotherapy alliance in Borderline Personality Disorder

To better understand alliance formation with BPD patients, we examined the relationship between pre-treatment patient characteristics and alliance at baseline and 2 months. Thirty-five volunteers who enrolled in a RCT comparing dialectical behavior therapy (DBT) and supportive psychotherapy, with or without antidepressant medication in the treatment of suicidal behavior, were included in this analysis. Participants were administered the SCID-I and II, Beck Depression Inventory, Working Alliance Inventory, Beck Hopelessness Scale, and the State Trait Anxiety Inventory. Results: depression, anxiety and hopelessness predicted poorer patient-rated alliance at 2 months. Depression and anxiety did not correlate with alliance at the start of treatment, but strongly correlated with 2-month alliance, suggesting patient-rated alliance at 2 months was influenced by the course of treatment. Therapist-rated alliance was not associated with either mood or BPD symptoms. Our findings suggest that focusing on BPD patients' mood early in treatment may improve alliance formation

Improving the application of a practice guideline for the assessment and treatment of suicidal behavior by training the full staff of psychiatric departments via an e-learning supported Train-the-Trainer program: study protocol for a randomized controlled trial

BackgroundIn 2012, in The Netherlands a multidisciplinary practice guideline for the assessment and treatment of suicidal behavior was issued. The release of guidelines often fails to change professional behavior due to multiple barriers. Structured implementation may improve adherence to guidelines. This article describes the design of a study measuring the effect of an e-learning supported Train-the-Trainer program aiming at the training of the full staff of departments in the application of the guideline. We hypothesize that both professionals and departments will benefit from the program.MethodIn a multicenter cluster randomized controlled trial, 43 psychiatric departments spread over 10 regional mental health institutions throughout The Netherlands will be clustered in pairs with respect to the most prevalent diagnostic category of patients and average duration of treatment. Pair members are randomly allocated to either the experimental or the control condition. In the experimental condition, the full staff of departments, that is, all registered nurses, psychologists, physicians and psychiatrists (n = 532, 21 departments) will be trained in the application of the guideline, in a one-day small interactive group Train-the-Trainer program. The program is supported by a 60-minute e-learning module with video vignettes of suicidal patients and additional instruction. In the control condition (22 departments, 404 professionals), the guideline shall be disseminated in the traditional way: through manuals, books, conferences, internet, reviews and so on. The effectiveness of the program will be assessed at the level of both health care professionals and departments.DiscussionWe aim to demonstrate the effect of training of the full staff of departments with an e-learning supported Train-the-Trainer program in the application of a new clinical guideline. Strengths of the study are the natural setting, the training of full staff, the random allocation to the conditions, the large scale of the study and the willingness of both staff and management to participate in the study.Trial registrationDutch trial register: NTR3092

Reducing patients’ suicide ideation through training mental health teams in the application of the Dutch multidisciplinary practice guideline on assessment and treatment of suicidal behavior: study protocol of a randomized controlled trial

BackgroundTo strengthen suicide prevention skills in mental health care in The Netherlands, multidisciplinary teams throughout the country are trained in the application of the new Dutch guideline on the assessment and treatment of suicidal behavior. Previous studies have shown beneficial effects of additional efforts for guideline implementation on professionals’ attitude, knowledge, and skills. However, the effects on patients are equally important, but are rarely measured. The main objective of this study is to examine whether patients of multidisciplinary teams who are trained in guideline application show greater recovery from suicide ideation than patients of untrained teams.Methods/DesignThis is a multicentre cluster randomized controlled trial (RCT), in which multidisciplinary teams from mental health care institutions are matched in pairs, and randomly allocated to either the experimental or control condition. In the experimental condition, next to the usual dissemination of the guideline (internet, newsletter, books, publications, and congresses), teams will be trained in the application of the guideline via a 1-day small interactive group training program supported by e-learning modules. In the control condition, no additional actions next to usual dissemination of the guideline will be undertaken.Assessments at patient level will start when the experimental teams are trained. Assessments will take place upon admission and after 3 months, or earlier if the patient is discharged. The primary outcome is suicide ideation. Secondary outcomes are non-fatal suicide attempts, level of treatment satisfaction, and societal costs. Both a cost-effectiveness and cost-utility analysis will be performed. The effects of the intervention will be examined in multilevel models.DiscussionThe strengths of this study are the size of the study, RCT design, training of complete multidisciplinary teams, and the willingness of both management and staff to participate.Trial registrationNetherlands trial register: NTR3092

Suicide: Global Perspectives From the WHO World Mental Health Surveysedited by NockMatthew K., BorgesGuilherme, and OnoYutaka. Cambridge, United Kingdom, Cambridge University Press, 2012, 404 pp., $120.00.

Suicide: Global Perspectives From the WHO World Mental Health Surveysedited by NockMatthew K., BorgesGuilherme, and OnoYutaka. Cambridge, United Kingdom, Cambridge University Press, 2012, 404 pp., $120.00.

The observation of essential clinical strategies during an individual session of dialectical behavior therapy.

Dialectical behavior therapy (DBT; Linehan, 1993) is a comprehensive and principle-based cognitive-behavioral intervention initially developed for the treatment of suicidal behavior and later expanded to the treatment of borderline personality disorder and additional psychiatric disorders associated with emotion dysregulation. As a comprehensive treatment, DBT consists of multiple modalities of intervention that include individual therapy, skills training, telephone consultation, team consultation, and the structuring of ancillary treatments. In the present article, we review three essential strategies expected to occur during an individual session of DBT. The three strategies reviewed include structuring the content of the session, core strategies of problem solving and validation, and dialectical strategies and worldview. Associated research data and clinical examples are provided for each strategy.

Suicide Ideation in Jamaican Youth: Sociodemographic Prevalence, Protective and Risk Factors

To determine the prevalence of suicidal ideation and examine the association between suicidal ideation and sociodemographic characteristics, protective and risk factors among Jamaican youth. In this cross-sectional study, an interviewer administered school-based survey was conducted among 2997 students 10-15 years old in Jamaica. Although there were a number of questions on suicide, this paper focusses on one question "During the past year did you ever seriously consider attempting suicide?" as the measure of suicidal ideation. The prevalence rate of suicidal ideation was 9.7%. Logistic regression analysis revealed that significant correlates of suicidal ideation were being female (odds ratio = 1.49), being depressed (odds ratio = 5.78), living in a rural area (odds ratio = 0.62), likes oneself (odds ratio = 0.58), indulging in aggressive behaviour (odds ratio = 1.43), has considered harming others (odds ratio = 3.11), protective factors in the home (odds ratio = 0.62), involvement in risky behaviour (odds ratio = 1.56) and being teased/bullied (odds ratio = 1.69). These findings have implication for prevention and treatment of suicidal behaviour in children and adolescents.

Gene Expression Changes in the Prefrontal Cortex, Anterior Cingulate Cortex and Nucleus Accumbens of Mood Disorders Subjects That Committed Suicide

Suicidal behaviors are frequent in mood disorders patients but only a subset of them ever complete suicide. Understanding predisposing factors for suicidal behaviors in high risk populations is of major importance for the prevention and treatment of suicidal behaviors. The objective of this project was to investigate gene expression changes associated with suicide in brains of mood disorder patients by microarrays (Affymetrix HG-U133 Plus2.0) in the dorsolateral prefrontal cortex (DLPFC: 6 Non-suicides, 15 suicides), the anterior cingulate cortex (ACC: 6NS, 9S) and the nucleus accumbens (NAcc: 8NS, 13S). ANCOVA was used to control for age, gender, pH and RNA degradation, with P≤0.01 and fold change±1.25 as criteria for significance. Pathway analysis revealed serotonergic signaling alterations in the DLPFC and glucocorticoid signaling alterations in the ACC and NAcc. The gene with the lowest p-value in the DLPFC was the 5-HT2A gene, previously associated both with suicide and mood disorders. In the ACC 6 metallothionein genes were down-regulated in suicide (MT1E, MT1F, MT1G, MT1H, MT1X, MT2A) and three were down-regulated in the NAcc (MT1F, MT1G, MT1H). Differential expression of selected genes was confirmed by qPCR, we confirmed the 5-HT2A alterations and the global down-regulation of members of the metallothionein subfamilies MT 1 and 2 in suicide completers. MTs 1 and 2 are neuro-protective following stress and glucocorticoid stimulations, suggesting that in suicide victims neuroprotective response to stress and cortisol may be diminished. Our results thus suggest that suicide-specific expression changes in mood disorders involve both glucocorticoids regulated metallothioneins and serotonergic signaling in different regions of the brain.

Assessment of suicidal ideation and behavior in clinical trials: challenges and controversies

The association between several psychoactive medications and suicidal adverse events, as well as the recent focus on treatment of suicidal behaviors, has resulted in increased attention on the assessment of suicidal ideation and behavior within clinical trials. Measurement of suicidal adverse events is now required in clinical trials of a range of medications. The Columbia Suicide Severity Rating Scale is the leading measure of suicidal adverse events. It is brief, measures both suicidal ideation and behavior, contains definitions of each term and has promising psychometric properties. While such measures may assist clinical trial staff, suicidal events remain a challenge to assess. Clinical trial design features from studies of interventions for suicidal patients may guide the design of trials in which assessment of suicidal adverse events is now required, including patient selection, safety plans for at-risk patients, flexible treatment algorithms and clear assessment protocols and referral pathways.

Suizidales Verhalten im jungen Erwachsenenalter: Risikofaktoren im Entwicklungsverlauf von der frühen Kindheit bis zum Jugendalter

Suicidal behaviors are prevalent among young people. Numerous risk factors have been implicated in their development. In the framework of the longitudinal Mannheim Study of Children at Risk, 311 young adults (143 males, 168 females) aged 19-23 years were investigated in order 1) to determine the significance of different risk factors during development in predicting suicidal behaviors in young adulthood, 2) to identify potential risk factors discriminating between suicidal ideation and suicide attempts, and 3) to examine whether the effect of early risk factors was mediated by later occurring predictors. Young adults with suicidal behaviors displayed a number of abnormalities during development, including high load of early family adversity, suicidal ideation and psychiatric problems in childhood and adolescence, as well as low self esteem, poor school functioning, higher levels of novelty seeking, and enhanced affiliations with deviant peers in adolescence. Independent contributions to predicting suicidal behaviors in young adults were provided by early family adversity, suicidal ideation during childhood and adolescence, and low self esteem (with regard to suicidal ideation) and novelty seeking (with regard to suicide attempt), respectively. The impact of early adversity was mediated by child and adolescent externalizing disorders and low self esteem in adolescence. Possible implications of these findings for the prevention and treatment of suicidal behaviors are discussed.