May 2017: Science of Suicidality (SOS)

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May 2017: Science of Suicidality (SOS)

A comparative analysis of suicide attempts in left-behind children and non-left-behind children in rural China

H. Chang, Q. Yan, L. Tang, J. Huang, Y. Ma, X. Ye, & Y. Yu.

This cross-sectional study estimates the prevalence of suicide attempts and explores the shared and unique factors impacting suicide risk in left-behind children (LBC) and non-left-behind children (NLBC).  The authors studied 13,952 children (6,034 LBC and 7,918 NLBC) in rural China using sociodemographic information, a question on suicide attempt in the prior year, Chinese version of the Parents-Child Conflict Tactics Scale (CTSPC), Adolescent Self-Rating Life Events Checklist (ASRLEC), and University of California Los Angeles Loneliness Scale (UCLA LS).  The authors found prevalence of suicide attempts in rural China was far less than estimates reported in Western societies.  They report parenting style was significantly associated with suicide attempts even when controlling for age, gender, abuse, and neglect.

This article contains many insights on factors associated with suicide attempts in children and young adults.



Comorbidity and suicidality in patients diagnosed with panic disorder/agoraphobia and major depression

B. Batinic, G. Opacic, T. Ignjatov, & D. S. Baldwin.

This study investigates symptom clusters with the strongest association to suicidality in patients with anxiety and depression.  The authors studied 100 patients with Panic Disorder (PD), Major Depressive Episode (MDE), or Major Depressive Disorder (MDD) at the New Knezevac Hospital for Neuropsychiatric Disease in Serbia between April 2011 and June 2012.  They used the Panic and Agoraphobia Scale (PAS), Beck Anxiety Inventory (BIA), Beck Depression Inventory-II (BDI-II), Beck Scale for Suicide Ideation (BSS), Obsessive-Compulsive Inventory-Revised (OCI-R), Liebowitz Social Anxiety Scale (LSAS), and Whiteley Index of Hypochondriasis (WI).  They report depression had a significant effect on suicidality.  The authors found the obsessive compulsive symptom cluster was the only statistically significant predictor of suicidality in patients with PD, with MDE or MDD, and with PD and either MDE or MDD.



Computer Administered Safety Planning for Individuals at Risk for Suicide: Development and Usability Testing

E. D. Boudreaux, G. K. Brown, B. Stanley, R. S. Sadasivam, C. A. Camargo Jr, & I. W. Miller.

This study examines the initial usability testing of the “Keep Myself Safe” (KMS) web-based, self-administered safety planning application.  This safety planning application has 6 steps: 1. Remove access; 2. Warning signs; 3. Distracting activities; 4. Distracting people and places; 5. Social support; and 6. Professional help.  The authors used the “Think Aloud” protocol testing approach to study the usability of KMS with 30 patients with active suicidal ideation in the past 2 weeks from an urban, tertiary care hospital in Central Massachusetts.  They report, “90% (27/30) of participants complet[ed] at least 5 steps and 67% (20/30) complet[ed] all 6 steps.”  The authors report a reduction in intensity of suicidality and an increase in ability to cope with suicidality after completing KMS.  They recommend use of the app as an adjunct to clinical contact.



Developing implementation strategies for firearm safety promotion in paediatric primary care for suicide prevention in two large US health systems: a study protocol for a mixed-methods implementation study

C. B. Wolk, S. Jager-Hyman, S. C. Marcus, B. K. Ahmedani, J. E. Zeber, J. A. Fein, G. K. Brown, A. Lieberman, & R. S. Beidas.

This article describes the Adolescent Suicide Prevention In Routine clinical Encounters (ASPIRE) study protocol designed to explore implementation of the three firearm components of Safety Check as a suicide prevention strategy in pediatric primary care.  Safety Check is a stand-alone universal evidence-based safety intervention targeted to parents of children aged 2–11.  The 3 firearm components are screening, brief counselling, and provision of firearm locks.  The authors will study this implementation in 2 National Institute of Mental Health-funded Mental Health Research Network systems in the US (Henry Ford Health System and Baylor Scott & White).  They discuss their plans to survey healthcare providers in these systems.  The authors discuss plans to explore the relationships between predictor variables for each provider extracted from their patient records and the provider’s assessment of acceptability and use of firearm safety strategies.



Development and evaluation of a leaflet for concerned family members and friends: ‘It’s safe to talk about suicide’

C. Owens & N. Charles.

This article describes the development, distribution, and evaluation of a simple educational leaflet to help family members and friends recognize and respond to a possible suicidal crisis.  The authors distributed 15,000 copies through a wide range of community agencies in one local authority of the South West of England.  They conducted interviews with the community agencies on their use of the leaflets.  The authors report the leaflets were used in ways not anticipated and by agencies not usually associated with suicide prevention.  This article includes a copy of the leaflet.



Did the suicide barrier work after all? Revisiting the Bloor Viaduct natural experiment and its impact on suicide rates in Toronto

M. Sinyor, A. Schaffer, D. A. Redelmeier, A. Kiss, Y. Nishikawa, A. H. Cheung, A. J. Levitt, & J. Pirkis.

This study investigates the long-term impact of the Bloor Street Viaduct suicide barrier on death by suicide rates in Toronto, Canada.  The authors studied changes in yearly rates of suicide-by-jumping at Bloor Street Viaduct, other bridges, and buildings and other means of suicide in the 11 years before and 11 years after installation of the barrier (1993-2003 and 2004-2014, respectively) as documented by the Office of the Chief Coroner of Ontario.  They report a long-term decline in suicide-by-jumping after the barrier installation with no associated increase in other means of death-by-suicide.



Factors associated with suicidal ideation among university students

H. G. Barros dos Santos, S. Reschetti Marcon, M. Martínez Espinosa, M. Nunes Baptista, & P. M. Cabral de Paulo.

This cross-sectional study examines factors associated with suicidal ideation in university students.  The authors studied 637 students of the Federal University of Mato Grosso using a demographic questionnaire including a question on active suicidal ideation; the Brazil Economic Classification Criterion; Alcohol, Smoking and Substance Involvement Screening Test (ASSIST); and Major Depression Inventory.  They report 9.9% of the students had suicidal thoughts in the past month.  They report sexual orientation, suicide attempts in the family, and depressive symptoms remained associated with suicidal ideation in the adjusted model.  The authors recommend creating academic policies and preventive actions to reduce suicidality in university students.



Long-term Results from the Empowering a Multimodal Pathway Toward Healthy Youth Program, a Multimodal School-Based Approach, Show Marked Reductions in Suicidality, Depression, and Anxiety in 6,227 Students in Grades 6–12 (Aged 11–18)

P. H. Silverstone, M. Bercov, V. Y. M. Suen, A. Allen, I. Cribben, J. Goodrick, S. Henry, C. Pryce, P. Langstraat, K. Rittenbach, S. Chakraborty, R. C. Engles, & C. McCabe.

This article reports findings from a 15-month follow-up of a school-based multimodal program to reduce suicidal thinking in 11- to 18-year-old students, Empowering a Multimodal Pathway Toward Healthy Youth (EMPATHY) program.  The authors studied 1,884 students in the Red Deer Public Schools, AB, Canada, at 4 assessments between February 2014 and June 2015 using the Patient Health Questionnaire adapted for Adolescents (PHQ-A) and Hospital Anxiety and Depression Scale (HAD).  All students judged to have medium or high suicide risk at baseline were referred for additional assessment and received a range of treatments as needed.  The authors report the number of students with active suicidal ideation reduced by nearly 50% between baseline and 15-month follow-up.



Medical students’ attitude toward suicide prevention: An exploratory study from North India

N. Nebhinani, A. Jagtiani, S. Chahal, M. Nebhinani, & R. Gupta.

This study investigates attitudes toward suicide prevention in medical students.  The authors studied 205 final‑year medical students at Postgraduate Institute of Medical Science, Rohtak, Haryana using a sociodemographic questionnaire and the Attitude toward suicide prevention scale.  They report 51.7% of students felt comfortable assessing someone for suicide risk and only 2% had clinical exposure on the management of suicidal patients.  The authors recommend incorporation of regular programs on assessment and management of suicidal patients in medical school curriculum.



Pain in methadone patients: Time to address undertreatment and suicide risk (ANRS-Methaville trial)

S. Nordmann, A. Vilotitch, C. Lions, L. Michel, M. Mora, B. Spire, G. Maradan, M.K. Bendiane, A. Morel, P. Roux, P. Carrieri, & the ANRS Methaville study group.

This secondary analysis investigates pain and its interference in daily life, associated correlates, and under-treatment before and during methadone maintenance treatment.  The authors studied data from January 2009 to January 2010 ANRS Methaville trial which used the Brief Pain Inventory (BPI-Short Form), Alcohol Use Disorders Identification Test (AUDIT), Adult ADHD Self-Report Scale (ASRS), Opiate Treatment Index (OTI), Objective Opioid Withdrawal Scale (OOWS), Center for Epidemiologic Studies Depression scale (CES-D), and the Beck Hopelessness Scale (BHS).  They included 168 opioid-dependent patients who had data for either pain intensity or interference for at least one visit.  They found, “suicide risk is a major correlate of pain intensity and pain interference with daily functioning.”  The authors recommend integration of adequate screening and management of pain as standard clinical care for patients using methadone treatment.



Risk of re-attempts and suicide death after a suicide attempt: A survival analysis

I. Parra-Uribe, H. Blasco-Fontecilla, G. Garcia-Parés, L. Martínez-Naval, O. Valero-Coppin, A. Cebrià-Meca, M. A. Oquendo, & D, Palao-Vidal.

This observational study investigates risk factors for a second suicide attempt and dying by suicide following an initial suicide attempt.  The authors studied demographic, clinical, and other factors in 1,241 patients recruited from the emergency department Parc Taulí-University Hospital in 2012 who had just made their first suicide attempt.  Patients were part of a 1-year telephone management program.  During the 5-year follow-up period, data on a second suicide attempt was extracted from patient medical records and data on death by suicide was provided by Institute of Forensic Medicine of Catalonia.  They found younger age, alcohol use, and personality disorders were risk factors for a second suicide attempt, while older age was a risk factor for dying by suicide.

Over 20% of those who had made an initial suicide attempt made subsequent suicide attempt(s) and 1.2% died by suicide in the follow-up period.  Of the patients who died by suicide from a subsequent suicide attempt (n = 15), only 40% were depressed and 27% had no DSM-IV-TR diagnosis at baseline.  These findings warrant further investigation.



Sexual orientation differences in treatment expectation, alliance, and outcome among patients at risk for suicide in a public psychiatric hospital

M. Plöderl, S. Kunrath, R. J. Cramer, J. Wang, L. Hauer, & C. Fartacek.

This study investigates treatment outcome of heterosexual and sexual minority (gay, lesbian, bisexual, or otherwise non-heterosexual) patients at risk for suicide.  The authors studied 633 patients admitted for crisis intervention and suicide prevention at the Christian Doppler Clinic in the City of Salzburg, Austria.  They used a range of assessment scales including, but not limited to, Beck’s Scale for Suicide Ideation (BSS), Beck’s Hopelessness Scale (BHS), Beck’s Depression Inventory (BDI), and Working Alliance Inventory (WAI).  They found, “[sexual minority] and heterosexual patients were comparable in their improvement in suicide ideation, hopelessness, or depression, both quantitatively and in treatment responder analysis.”


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