March 2017: Science of Suicidality (SOS)

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March 2017: Science of Suicidality (SOS)

Assessing Suicide Risk: What is Commonly Missed in the Emergency Room?

N. Alavi, T. Reshetukha, E. Prost, K. Antoniak, & D. Groll.

This 2-part study investigated the assessment and documentation of suicide risk by emergency clinicians from reviewing medical records.  The authors also examined the differences between psychiatric and emergency medicine opinions on the importance of various suicide predictors.  They studied these opinions in a sample of 51 psychiatric physicians (23 residents and 28 faculty) and 23 emergency medicine physicians (11 residents and 12 faculty) at Queen’s University, Kingston, Canada.  They report finding significant differences in importance ratings of several suicide predictors between specialties.  The authors report finding suicide predictors viewed as important had low documentation rates in emergency department medical records.  They recommend use of educational interventions and simple assessment tools to help increase documentation of suicide predictors.



Do thought control strategies applied to thoughts of suicide influence suicide ideation and suicide risk?

R. P. Tucker, C. E. Smith, D. W. Hollingsworth, A. B. Cole, & L. R. Wingate.

This study investigated the impact of suicidal thought control strategies on suicide ideation and suicide risk.  The authors studied a sample of 135 adult students at a large, Midwestern university with a history of suicide ideation using the Suicidal Thought Control Questionnaire (STCQ), Hopelessness Depression Symptom Questionnaire – Suicidality Subscale (HDSQ-SS), and Suicidal Behaviors Questionnaire – Revised (SBQ-R).  They report a negative correlation between distraction from suicidal thoughts and suicide ideation and risk and report a positive correlation between self-punishment for suicidal thoughts and worrying about other thoughts on one side and suicide ideation and suicide risk on the other.



Effectiveness of Suicide Prevention Programs for Emergency and Protective Services Employees: A Systematic Review and Meta-Analysis

K. Witt, A. Milner, A. Allisey, L. Davenport, & A. D. LaMontagne.

This quantitative meta-analysis investigated the effectiveness of suicide prevention programs for protective and emergency services employees on suicide rates at post-intervention.  The authors used qualitative analyses to identify program components that may be associated with reductions in suicide rates.  They used a systematic search of 11 electronic databases through June 30, 2015 to identify the 13 studies included in analysis (6 included in the quantitative analysis).  The authors report, “these programs were associated with an approximate halving in suicide rates over an average follow-up period of 5.25 years.”  They recommend further evaluation of these programs.



Family-Based Crisis Intervention With Suicidal Adolescents: A Randomized Clinical Trial

E. A. Wharff, K. B. Ginnis, A. M. Ross, E. M. White, M. T. White, & P. W. Forbes.

This study investigates efficacy outcomes related to family-based crisis intervention (FBCI), an emergency psychiatry intervention designed appropriately stabilize suicidal adolescents within a single emergency department visit.  The authors studied a sample of 139 suicidal adolescents and their families presenting for psychiatric evaluation to a large pediatric emergency department between January 2012 and May 2014.  Participants were randomized to either FBCI (68) or treatment as usual (71).  They used a demographic questionnaire, the Reasons for Living Inventory for Adolescents (RFL-A), Family Empowerment Scale (FES), and Client Satisfaction Questionnaire (CSQ-8).  The authors report significant reductions in inpatient hospitalization rates in the FBCI group compared the treatment as usual group over the 1-month period of study.  They report FBCI may be a viable alternative to inpatient psychiatric hospitalization.

The efficacy of FBCI should be investigated in a larger and more diverse sample of both adults and children / adolescents and their respective families, using longer follow-up end points to determine the lasting impact of FBCI, compared to treatment as usual.



Insight and suicidality in psychosis: A cross-sectional Study

C. Massons, J.D. Lopez-Morinigo, E. Pousa, A. Ruiz, S. Ochoa, J. Usall, L. Nieto, J. Cobo, A. S. David, & R. Dutta.

This study investigates whether specific dimensions of insight are associated with suicidality in patients with psychotic disorders.  The authors studied 143 patients with schizophrenia spectrum disorders, recruited between 2009 and 2014, from a general hospital in Barcelona, Spain.  They used the Calgary Depression Scale for Schizophrenia (CDSS), Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Scale of Unawareness of Mental Disorder (SUMD), Markova and Berrios Insight Scale (MBIS), Drug Attitude inventory (DAI), Udvalg for Kliniske Undersøgelser side effect rating scale (UKU side effect scale), and Screen for Cognitive Impairment in Psychiatry (SCIP).  They report the relationships between the dimensions of insight and suicidality are mediated by other variables, specifically, depression and previous suicidal behavior.



Issues with suicide databases in forensic research

R. W. Byard.

This short 2-page article reviews some of the potential issues of using national or state suicide databases in research.  The author expresses concern over inconsistencies between databases, data reliability, and changes in medical terminology over time.  The author emphasizes the importance of “researchers clearly [stating] the limitations of their data in any subsequent publications.”



Lithium Levels in Tap Water and the Mental Health Problems of Adolescents: An Individual-Level Cross-Sectional Survey

S. Ando, S. Koike, S. Shimodera, R. Fujito, K. Sawada, T. Terao, T. A. Furukawa, T. Sasaki, S. Inoue, N. Asukai, Y. Okazaki, & A. Nishida.

This study investigated individual-level association between lithium level in tap water and depressive symptoms, anxiety, and aggressive and suicidal behaviors, in a general population of adolescents.  The authors studied a sample of 3,040 students from 24 public junior high schools in Kochi Prefecture who anonymously completed a self-report questionnaire.  They used a questionnaire with multiple look-back timeframes which included the 12-item General Health Questionnaire (month look-back) and questions on interpersonal violence (year), bullying (year), destructive behavior (year), self-harm (month), and suicidal ideation (month).  The authors report the lithium levels were relatively low compared to other studies.  The authors report the different lookback timeframes and low lithium levels may explain their findings that, “lithium level in tap water had an inverse association with depressive symptoms (P = .02) and interpersonal violence (P = .02) but not with […] suicidal ideation, P = .82; [or] self-harm, P = .46.”

Apart from the principal findings, this study reports 3.8% of adolescents surveyed admitted suicidal ideation in the last month and 3.7% admitted self-harm behavior in the last month.  This study should be repeated correcting for the difference between lookback timeframes and enlarging the scope of the findings by sampling students from other regions in Japan with a wider diversity in tap water lithium levels.



Measuring Acquired Capability for Suicide Within an Ideation-to-Action Framework

T. A. Burke, B. A. Ammerman, A. C. Knorr, L. B. Alloy, & M. S. McCloskey.

This study investigated the role of the acquired capability for suicide as motivation for suicidal behavior among individuals along the suicide continuum.  The authors studied a sample of 520 undergraduate students from a large, urban university using the Suicide Behavior Questionnaire–Revised (SBQ-R), Alcohol Use Disorders Identification Test (AUDIT), Drug Use Disorders Identification Test (DUDIT), Eating Disorder Examination–Questionnaire (EDE-Q), Childhood Trauma Questionnaire–Short Form (CTQ-SF), Lifetime History of Aggression (LHA), Form and Function of Self-Injury Scale (FAFSI), Acquired Capability for Suicide Scale (ACSS), and a subset of the ACSS focusing on fearlessness about death (ACSS–FAD).  They report the, “acquired capability for suicide did not distinguish between individuals falling along the ideation-to-action spectrum”.  They report the painful and provocative events “may be most important to assess in determining suicide risk, and, [… they] call into question the utility of acquired capability in differentiating between individuals along the suicide continuum”.



Non-violent and violent forms of childhood abuse in the prediction of suicide attempts: Direct or indirect effects through psychiatric disorders?

N. J. Sachs-Ericsson, I. H. Stanley, J. L. Sheffler, E. Selby, & T. E. Joiner.

This study compared the effects of childhood abuse, both non-violent and violent, in the prediction of suicide attempts.  The authors analyzed data from two waves of the National Comorbidity Surveys including 5,877 in wave 1 and 5,001 in the wave 2, over a 10-year follow-up.  They report both non-violent and violent abuse predicted suicide attempts.  The authors report the influence of non-violent abuse on suicide attempts was indirect and mediated through the psychiatric disorders that occurred during the follow-up.  The authors report, “mechanisms linking childhood abuse experiences to adult suicidal behavior are complex, affecting interrelated biological and psychological domains.”



Perceived Stigma of Sudden Bereavement as a Risk Factor for Suicidal Thoughts and Suicide Attempt: Analysis of British Cross-Sectional Survey Data on 3387 Young Bereaved Adults

A. Pitman, K. Rantell, L. Marston, M. King, & D. Osborn.

This study investigates whether perceived stigma following sudden bereavement is associated with suicidal thoughts and suicide attempt.  The authors analyzed cross-sectional survey data from the UCL Bereavement Study on a sample of 3,387 young adults bereaved by the sudden death of a close contact.  They used the stigma sub-scale of the Grief Experience Questionnaire, several questions from the Adult Psychiatric Morbidity Survey (APMS), and the presence of post-bereavement depression as captured by the Composite International Diagnostic Interview (CIDI).  The authors report an increased risk of suicidal thoughts and suicide attempt by those feeling high stigma by sudden bereavement, even after accounting for prior suicidal behavior.



Prevalence of suicidal ideation and attempt: associations with psychiatric disorders and HIV/AIDS in post-conflict Northern Uganda **

J. Mugisha, H. Muyinda, A. Kagee, P. Wandiembe, S. M. Kiwuwa, D. Vancampfort, & E. Kinyanda.

This study investigated prevalence of suicidal ideation, attempt, associated psychiatric disorders, and HIV/AIDS in post-conflict Northern Uganda.  The authors studied a sample of 2,361 respondents (aged 18 and above) and randomly selected in three districts (Gulu, Amuru and Nwoya) between January 2nd, 2013 and June 2nd, 2013.  They used the Mini International Neuropsychiatric Interview (MINI) Plus to assess psychiatric disorders and suicidality.  They used self-report for HIV status.  The authors report suicidality was significantly higher in those with Major Depressive Disorder and Post-Traumatic Stress Disorder.  They report the prevalence rate of suicide ideation (12.1%) and suicide attempt (6.2%) indicate a major public health problem in post-conflict Northern Uganda.  The authors recommend public mental health programs to target suicidality and psychiatric co-morbidities.

** The Mini International Neuropsychiatric Interview (MINI) was used in this study.  Harm Research Press (the publisher of the Science of Suicidality), Harm Research Institute (the owner of the website on which the Science of Suicidality is published), the editor of the Science of Suicidality, and the owners of Harm Research own or receive proceeds from the sale and / or use of the MINI.



Risk Estimates and Risk Factors Related to Psychiatric Inpatient Suicide—An Overview

T. Madsen, A. Erlangsen, & M. Nordentoft.

This article provides a literature review of suicide risk estimates among psychiatric inpatients.  The authors report the quality and generalizability of most studies are compromised due to low power.  They report the statistically significant studies identified unmodifiable risk predictors and had low predictive value.  The authors recommend practices to prevent inpatient suicides.  They also recommend future studies be, “based on large samples while focusing on modifiable predictors over the course of an admission”.



Suicide attempt in mental disorders (MeDi): Association with 5-HTT, IL-10 and TNF-alpha polymorphisms **

V. de Medeiros Alves, A. C. Pereira e Silva, E. V. Martins de Souza, L. C. F. de Lima Francisco, E. Leite de Moura, V. Leão de-Melo-Neto, & A. E. Nardi.

This study evaluates mental disorders and suicide attempts in relation to the presence of rs2020933 (5-HTT), rs1800871 (IL-10), and rs1800629 (TNF-a) polymorphisms.  The authors studied a sample of 306 patients with mental disorders (161 patients with a history of suicide attempt and 145 patients with no history of suicide attempt) along with 175 healthy controls in Arapiraca, Alagoas, Brazil.  They used a brief quality of life assessment (WHOQOL-brief), the Scale of Suicide Ideation (SSI), and the Mini International Neuropsychiatric Interview (MINI).  They obtained genomic DNA from swab oral mucosa cells by the NaCl solution extraction method.  The authors report the TNF-a rs1800629 -308A/G genotype was significantly associated as a protective factor in the control group compared to the group without history of suicide attempt.

** The Mini International Neuropsychiatric Interview (MINI) was used in this study.  Harm Research Press (the publisher of the Science of Suicidality), Harm Research Institute (the owner of the website on which the Science of Suicidality is published), the editor of the Science of Suicidality, and the owners of Harm Research own or receive proceeds from the sale and / or use of the MINI.



The Association Between Gun Ownership and Statewide Overall Suicide Rates

M. D. Anestis & C. Houtsma.

This retrospective study investigated associations between gun ownership and statewide overall suicide rates beyond the effects of demographic, geographic, religious, psychopathological, and suicide-related variables.  The authors studied data from multiple existing databases including the National Surveys on Drug Use and Health, 2014 Pew Research Center Religious Landscape Study, the U.S. Geological Survey (2015), and on gun ownership estimates from an online survey sponsored by YouGov.  The authors report, “the association between the firearm suicide rate and the overall suicide rate (r = .92) was significantly higher than the correlation between the nonfirearm suicide rate and the overall suicide rate (r = .46; t = 5.38; p < .00001).”

It would be of interest to see if these findings hold true in a similar, but prospectively collected sample.



The Reciprocal Relationship between Suicidality and Stigma

B. Carpiniello, & F. Pinn.

This article provides a thoughtful, narrative review of the religious and cultural stigma related to suicidality.  This article also explores relationships between suicidal behavior and stigmatizing attitudes.  The authors reviewed articles collected from an electronic keyword search of PubMed, ISI Web of Knowledge, and Scopus databases.  The authors report: 1. Suicidal people are frequently viewed negatively; 2. Those with a history of depression or suicide report a strong feeling of self-stigma; 3.  Those who had a loved one die by suicide report feeling a higher stigma.  The authors report, “a reciprocal relationship exists between stigma and suicide” and recommend, “greater efforts […] to combat the persisting stigmatizing attitudes displayed toward mental disorders and suicide itself.”



Why not clozapine for the patient with schizophrenia at risk of suicide?

T. Bastiampillai, O. Tonnu, P. Tibrewal, & R. Dhillon.

This letter provides a 1-page overview of the evidence in support of the use of clozapine in the treatment of suicidality in patients with schizophrenia or schizoaffective disorders.  It offers the recommendation that world-wide policies and clinical guidelines should be revised to include this use of clozapine to treat suicidality.


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