Additional 2017: Science of Suicidality (SOS)

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Additional 2017: Science of Suicidality (SOS)

Adverse experiences in psychiatric hospitals might be the cause of some postdischarge suicides

D. T Chung, C. J. Ryan, & M. M. Large.

This short commentary on the 2016 article “Postdischarge Suicide: A Psychodynamic Understanding of Subjective Experience and Its Importance in Suicide Prevention” by Schechter, Goldblatt, Ronningstam, Herbstman, and Maltsberger briefly summarizes quantitative literature on post-discharge death by suicide.  The authors question if adverse experiences resulting from psychiatric hospitalization (e.g., humiliation, stigmatization, loss of autonomy, perceived trauma, actual violence, or loss of accommodation or employment) may increase the probability of death by suicide in the time shortly after discharge.

The relationship between adverse experiences from psychiatric hospitalization and death by suicide following discharge merits further investigation.



After a Client Death: Suicide Postvention Recommendations for Training Programs and Clinics

J. C. Veilleux & S. A. Bilsky.

This article provides recommendations for procedures following the death of a patient to suicide who was being treated at a psychology training program or training clinic.  The authors review existing literature on the topics of trainee and therapist experiences when a patient dies by suicide.  They provide recommendations of procedures to notify relevant clinic staff and suggest 2 meetings with any trainee who has a patient die by suicide: the first focused on the trainee’s needs and the second as a critical incident review.  The authors include a template protocol for use after the death of a patient by suicide and suggest other instances where such a protocol may also be helpful (e.g., a significant non-lethal suicide attempt by a patient or a patient who engaged in a homicidal act).

Although the template protocol provided was designed for use in psychology trainee programs and clinics, it could be customized for use in other health professionals and settings and may also be beneficial for non-trainees.



Cyberbullying Involvement Roles and Viewing of Suicide-Related Web-Content

EU Kids Online (UK Team, LSE) & A. Görzig.

This brief, 2-page research highlight provides an overview of a study that investigated the viewing of internet content related to suicide and self-harm by adolescents in various cyberbullying roles (no involvement, victims, bullies, or bully-victims).  The author studied survey results from a random sample of 19,406 11 to 16-year-olds from the LSE EU Kids Online study.  The author reports content relating to suicide was more likely to be viewed by bully-victims and victims.  The author found a history of psychological problems did not influence the relationship between viewing suicide-related internet content and any of the cyberbullying roles identified above.



Dietary magnesium and calcium intake and risk of depression in the general population: A meta-analysis *******

B. Li, J. Lv, W. Wang, & D. Zhang.

This study investigated the dose–response relationship between dietary magnesium (Mg) intake and the risk of depression.  The authors conducted a meta-analysis of 11 studies published before September 2016 and calculated pooled relative risks using random-effects model.  They report dose–response analysis of 6 studies found evidence of a nonlinear relationship between dietary Mg intake and risk of depression.  The authors report the largest of these risk reductions were observed for 320mg Mg a day.

Although this article is not specifically focused on suicidality, others have reported a relationship between magnesium, an NMDA-receptor antagonist, and suicidality.  Additional studies are needed to determine the relationships between: 1. Magnesium and Major Depressive Disorder (MDD) without suicidality; 2. Magnesium and MDD with suicidality; and 3. Magnesium and suicidality without MDD.

******* The editor of the Science of Suicidality and the co-founders of Harm Research Press (the publisher of the Science of Suicidality) and Harm Research Institute (the owner of the website on which the Science of Suicidality is published) have published a case study on the use of magnesium in the treatment of suicidality in Impulse Attack Suicidality Disorder (IASD).



Differential Processing of Physical and Psychological Pain during Acute Suicidality

R. Cáceda, N. C. Kordsmeier, E. Golden, H. M. Gibbs, & P. L. Delgado.

This letter to the editor investigated whether recent suicide attempters show higher experimental pressure pain threshold while endorsing high psychological pain and whether resolution of the suicidal crisis would normalize their pain threshold.  The authors studied 180 subjects divided into 4 groups: 1. Recent suicide attempters with depression (52); 2. Suicidal ideators with depression (64); 3. Non-suicidal patients with depression (24); and 4. Healthy controls (40).  They used the Columbia – Suicide Severity Rating Scale (C-SSRS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Beck Hopelessness Scale (BHS), Trail-Making Test, and the Physical and Psychological Pain Scale.  They found, “increased pressure pain threshold in depressed subjects compared with healthy controls, with the highest threshold in attempters [Group 1 above]; pressure pain threshold in attempters [Group 1] was reduced to ideators’ [Group 2] levels within 5 days; high levels of psychological pain were found in attempters and ideators [Groups 1 & 2], and pressure pain threshold was correlated with hopelessness and psychological and physical pain.”



Domestic Violence Laws and Suicide in Mexico

T. Beleche.

This article investigated the relationship between 3 policies on domestic violence (DV) (2 allowing DV to be grounds for divorce and 1 establishing prevention and assistance programs for victims of DV) on rates of female death by suicide rates in Mexico using a difference-in-difference methodology.  The author found states where DV was criminalized showed a decrease in female death by suicide rates between 22% and 34% compared to states without similar laws.  The author reports data from a survey which suggests that a reduction in physical and sexual violence may contribute to the reduction in death by suicide rates in females.  The author recommends further studies investigating the long-term impact of these DV laws on female death by suicide rates.



Ethical Issues and Practical Challenges in Suicide Research: Collaboration With Institutional Review Boards

M. A. Hom, M. C. Podlogar, I. H. Stanley, & T. E. Joiner.

This commentary reviews and synthesizes literature on Institutional Review Board (IRB) related issues inherent in suicide prevention research.  This article suggests the components to include in IRB applications for suicide research.  The IRB-related topics reviewed in this article include: IRB and researcher responsibilities; informed consent; ethics and management of suicidality; education and training; and study protocols.

This article provides a number of useful considerations related to suicidality for those preparing submissions to an IRB.



Health Professionals’ Explanations of Suicidal Behaviour: Effects of Professional Group, Theoretical Intervention Model, and Patient Suicide Experience

I. A. Rothes & M. R. Henriques.

This study investigated the explanations of suicidal behaviors held by health professionals.  The authors analyzed responses to the Explanations of Suicidal Behaviors Questionnaire (ESBQ) completed by 242 health professionals in Portugal using an exploratory principal components analysis.  They identified 5 explanatory models for suicidal behaviors: adverse life events, psychological suffering, socio-communicational, affective cognitive, and psychopathological.  The authors found the psychopathological and psychological suffering models were more valued than other models.  They found the socio-communicational model was seen as the least valuable model of suicidal behavior.



Suicide Intervention Gatekeeper Training: Modeling Mediated Effects on Development and Use of Gatekeeper Behaviors

P. J. Osteen.

This study investigated potential mediators of skill development and use of the Question, Persuade, Refer (QPR) gatekeeper training.  The author used path analysis to estimate mediated effects of knowledge, attitudes, reluctance, and self-efficacy on behavior outcomes as a secondary data analysis of a randomized trial teaching QPR to Master of Social Work students.  He found gatekeeper behaviors had a strong direct relationship with self-efficacy only.

Although this study was statistically underpowered, the finding that engagement in intervention behaviors before or after training was not predicted by knowledge merits further investigation.  This study should be repeated with a prospective design, looking at mediators of skill development and use of QPR in a larger sample size and across a broader range of trainee professions.



Suicide Prevention in Schizophrenia: Do Long-Acting Injectable Antipsychotics (LAIs) have a Role?

M. Pompili, L. Orsolini, D. A. Lamis, D. R. Goldsmith, A. Nardella, G. Falcone, V. Corigliano, M. Luciano, & A. Fiorillo.

This article provides a literature review of articles related to the use of Long-Acting Injectable Antipsychotics (LAIs) to reduce modifiable risk factors for death by suicide in schizophrenia.  The authors summarize articles on: 1. Patient functioning; 2. Depression and hopelessness; 3. Treatment adherence, relapse, and re-hospitalization; and 4. Risk factors associated with suicidality in patients with schizophrenia, including overviews on insight, aggression and impulsivity, substance abuse, and command hallucinations.  The authors believe treatment using LAIs may indirectly modify risk factors for death by suicide in patients with Schizophrenia.



Support received after bereavement by suicide and other sudden deaths: a cross-sectional UK study of 3432 young bereaved adults

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

This national cross-sectional study investigated the timing and type of support (formal or informal) received by people bereaved by suicide by comparison to people bereaved by other causes of sudden death.  The authors surveyed 3,432 staff and student respondents 18–40 years old bereaved by the sudden death of a close friend or relative (614 bereaved by suicide, 712 bereaved by sudden unnatural causes, and 2,106 bereaved by sudden natural causes) recruited at 37 higher education institutions in the UK.  They report those bereaved by suicide were more likely to report delays in accessing any support and were less likely to receive informal support than those bereaved by other causes of sudden death.  The authors report 64% of those bereaved by suicide received no formal support and 23% received no support at all.



The look of emergency nurse at the patient who attempted suicide: an exploratory study

E. G. de Oliveira Santos, A. K. Silva Azevedo, G. W. dos Santos Silva, I. Ribeiro Barbosa, R. Rebouças de Medeiros, & C. Nogueira Valença.

This small study investigated attitudes of registered nurses in the urgent and emergency sector about the care of suicidal patients.  The authors interviewed 13 nurses from a public emergency room in the state of Rio Grande do Norte using an exploratory-descriptive, qualitative study in June through July 2015.  They report a focus on the clinical, technical nursing care for patients who have attempted suicide.  The authors report nurses felt unprepared to deal with the suffering and psychological motives that accompany a suicide attempt.

This article contains many nurse quotes which highlight difficulties faced by those providing emergency and urgent care to patients following a suicide attempt.  Although this study was focused on a sample of nurses from one emergency room in Brazil, similar issues are likely experienced by emergency care providers around the world and should be considered when planning suicide prevention strategies.


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