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De Fabritiis M, Trisolini F, Bertuletti G, Fagadau ID, Ginelli D, Lalopa KP, Peverelli L, Pirola A, Sala G, Maisto M, Madeddu F, Lopez-Castroman J, Romano D, Gabbiadini A, Preti E, Micucci D, Calati R. An Internet-Based Multi-Approach Intervention Targeting University Students Suffering from Psychological Problems: Design, Implementation, and Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052711. [PMID: 35270403 PMCID: PMC8910035 DOI: 10.3390/ijerph19052711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
Despite the widespread prevalence of mental health problems, most psychological distress remains untreated. Internet-based psychological interventions can be an essential tool for increasing treatment availability and accessibility. The main objective of the MindBlooming project is to design and implement an innovative Internet-based multi-approach treatment for university students suffering from psychological or physical problems. The intervention will focus on symptoms of depression, anxiety, sleep problems, self-destructive thoughts, job- and study-related stress and burnout, and chronic pain. It will be based on different approaches, primarily psychoeducation, Cognitive-Behavioral Treatment (CBT), and third-wave CBT. At the end of the treatment, user satisfaction and usability will be assessed. In addition, two further aims will be evaluating the treatment efficacy through a randomized controlled trial and tuning a predictive model through Machine Learning techniques. The intervention consists of a 7-week treatment on two problematic areas according to each students’ personal needs, identified through an initial assessment. Besides the treatment assigned following the initial screening, participants will also be assigned to a different module to improve their relational skills. The treatment, which can be accessed through a mobile app, consists of psychoeducational videos followed by related exercises. We expect MindBlooming to be a remarkable tool for promoting the mental health of university students.
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Affiliation(s)
- Marlene De Fabritiis
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
| | - Federica Trisolini
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
| | - Gloria Bertuletti
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
| | - Ionut Daniel Fagadau
- Department of Informatics, Systems and Communication (DISCo), University of Milano-Bicocca, 20126 Milan, Italy; (I.D.F.); (D.G.); (D.M.)
| | - Davide Ginelli
- Department of Informatics, Systems and Communication (DISCo), University of Milano-Bicocca, 20126 Milan, Italy; (I.D.F.); (D.G.); (D.M.)
| | - Katiuscia Pia Lalopa
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
| | - Lisa Peverelli
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
| | - Alessia Pirola
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
| | - Gaia Sala
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
| | - Marta Maisto
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
| | - Fabio Madeddu
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
- BICAPP—Bicocca Center for Applied Psychology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Jorge Lopez-Castroman
- Department of Adult Psychiatry, Nîmes, University Hospital, 30900 Nîmes, France;
- IGF, CNRS-INSERM, Université Montpellier, 34094 Montpellier, France
- CIBERSAM, 28029 Madrid, Spain
| | - Daniele Romano
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
| | - Alessandro Gabbiadini
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
| | - Emanuele Preti
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
- BICAPP—Bicocca Center for Applied Psychology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Daniela Micucci
- Department of Informatics, Systems and Communication (DISCo), University of Milano-Bicocca, 20126 Milan, Italy; (I.D.F.); (D.G.); (D.M.)
| | - Raffaella Calati
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (M.D.F.); (F.T.); (G.B.); (K.P.L.); (L.P.); (A.P.); (G.S.); (M.M.); (F.M.); (D.R.); (A.G.); (E.P.)
- BICAPP—Bicocca Center for Applied Psychology, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Adult Psychiatry, Nîmes, University Hospital, 30900 Nîmes, France;
- Correspondence:
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Strategies to Stay Alive: Adaptive Toolboxes for Living Well with Suicidal Behavior. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158013. [PMID: 34360306 PMCID: PMC8345644 DOI: 10.3390/ijerph18158013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 01/10/2023]
Abstract
Suicidal behavior constitutes a major global problem. Qualitative research utilizing the first-hand experiences of those who have survived attempts to take their own lives can offer much in the way of understanding how to live well despite ongoing suicidal behavior. Given that suicidal intentions and behaviors occur within the person’s subjective construal, the solutions to living—and preferably living well—despite such inclinations must also be subjective and adaptive. The aim of this study was therefore to understand how individuals live with different aspects of their suicidal behavior and their use of effective strategies to protect themselves from future attempts. Thematic analysis of semi-structured, qualitative interviews with 17 participants with lived experience of suicidal behavior from the USA yielded two main themes: (i) the ‘dynamic relationship with suicidal behavior: living with, and through’, and (ii) ‘the toolbox’. Each of these themes had four subthemes. Participants in this study offered important insights into what helped them not just survive ongoing suicidal behavior, but how they created unique toolboxes to continue living, and to live well. These toolboxes contained personalized solutions to dealing with recurring threats to their subjective wellbeing and included diverse solutions from spirituality, pets, peer-support, participating in the arts, through to traditional therapeutic supports. Some participants also discussed the importance of broader social policy and societal changes that help them live. The findings highlight crucial implications for suicide prevention efforts, especially in terms of encouraging collaborations with the lived experience community and furthering a strengths-based approach to mitigating suicidal behaviors. We encourage the clinical community to work in partnership with service-users to enable them to generate effective solutions to living—and living well—through suicidal behavior.
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Testoni I, Piol S, De Leo D. Suicide Prevention: University Students' Narratives on Their Reasons for Living and for Dying. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8029. [PMID: 34360323 PMCID: PMC8345779 DOI: 10.3390/ijerph18158029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/24/2021] [Accepted: 07/25/2021] [Indexed: 11/16/2022]
Abstract
Social isolation and loneliness are increasing in our contemporary western society and seem to correlate with suicide in adolescents and young adults. Social Workers are a potential resource to create such initiatives and projects that promote inclusion and cohesion within communities, a protective factor against suicide. Sixty-two Social Work BA students participated in a Death Education course based on education on suicide prevention. Participants carried out two activities. First, they were invited to complete two written semi-structured interviews on young people's reasons for living and dying. Second, they were invited to design suicide prevention interventions targeted at their peers and adolescents. Data were analyzed qualitatively within the Thematic Analysis framework. As regards the first activity, four main themes were identified: (1) Internet and social media; (2) social isolation and loneliness; (3) the importance of proximal relationships; and, (4) the importance of networking between proximal relationships, educational institutions and mental health services. Whereas, as for suicide prevention interventions, three main ideas were identified: (1) suicide prevention through community and networking between services; (2) academic institutions: high schools and universities; and, (3) suicide prevention through new technologies. To conclude, Death Education as education on suicide prevention can offer young people a space in which to voice their and their peers' reasons for living and dying and to reflect upon their contribution to suicide prevention as students and as future professionals.
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Affiliation(s)
- Ines Testoni
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35131 Padova, Italy;
- Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
| | - Silvia Piol
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35131 Padova, Italy;
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane 4122, Australia;
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Iatrogenic Complications of Compulsory Treatment in a Patient Presenting with an Emotionally Unstable Personality Disorder and Self-Harm. Case Rep Psychiatry 2021; 2021:6615723. [PMID: 34136300 PMCID: PMC8175160 DOI: 10.1155/2021/6615723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/26/2021] [Accepted: 05/03/2021] [Indexed: 11/18/2022] Open
Abstract
Attempted suicide and deliberate self-harm are common and challenging presentations in the emergency department. A proportion of these patients refuse interventions and this presents the clinical, legal, and ethical dilemma as to whether treatment should be provided against their will. Multiple factors influence this decision. It is difficult to foresee the multitude and magnitude of complications that can arise once it has been decided to treat individuals who do not consent. This case illustrates a particularly complex chain of events that occurred after treating someone against their will who presented with self-harm and suicidal ideation. These consequences are contrasted with those of not intervening when similar situations arose with the same patient.
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Allen J, Rasmus SM, Fok CCT, Charles B, Trimble J, Lee K. Strengths-Based Assessment for Suicide Prevention: Reasons for Life as a Protective Factor From Yup'ik Alaska Native Youth Suicide. Assessment 2021; 28:709-723. [PMID: 31538813 PMCID: PMC8359856 DOI: 10.1177/1073191119875789] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Suicide is the second leading cause of death among American Indian and Alaska Native youth, and within the Alaska Native youth subpopulation, the leading cause of death. In response to this public health crisis, American Indian and Alaska Native communities have created strategies to protect their young people by building resilience using localized Indigenous well-being frameworks and cultural strengths. These approaches to suicide prevention emphasize promotion of protective factors over risk reduction. A measure of culturally based protective factors from suicide risk has potential to assess outcomes from these strengths-based, culturally grounded suicide prevention efforts, and can potentially address several substantive concerns regarding direct assessment of suicide risk. We report on the Reasons for Life (RFL) scale, a measure of protective factors from suicide, testing psychometric properties including internal structure with 302 rural Alaska Native Yup'ik youth. Confirmatory factor analyses revealed the RFL is best described through three distinct first-order factors organized under one higher second-order factor. Item response theory analyses identified 11 satisfactorily functioning items. The RFL correlates with other measures of more general protective factors. Implications of these findings are described, including generalizability to other American Indian and Alaska Native, other Indigenous, and other culturally distinct suicide disparities groups.
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Affiliation(s)
- James Allen
- University of Minnesota Medical School, Duluth, MN, USA
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Boafo A, Greenham S, Cloutier P, Abraham S, Dumel M, Gendron V, Rowsell D. Development of a Clinical Pathway for the Assessment and Management of Suicidality on a Pediatric Psychiatric Inpatient Unit. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2020; 11:123-133. [PMID: 33061732 PMCID: PMC7522520 DOI: 10.2147/ahmt.s240060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/18/2020] [Indexed: 11/23/2022]
Abstract
Purpose This article describes steps taken by a mental health inpatient multidisciplinary team to develop a clinical pathway for the assessment and management of suicidality in a pediatric psychiatric inpatient unit. Patients and Methods The setting for this project is a 19-bed inpatient psychiatry unit providing care for children and adolescents (6-17 years of age) in a tertiary care pediatric hospital in Ontario, Canada. Three Lean methodologies were used: 1) The A3 process was used to articulate a problem statement and help clarify expectations, determine goals, and uncover, address and encourage discussion of potential issues; 2) Process mapping was used to show how work process activities are sequenced from the time of the patient's admission to discharge; and 3) Standard work, where consideration was given to the breakdown of the work into categories which are sequenced, organized and repeatedly followed. Generally accepted methodologies for developing clinical pathways were used to create a framework and algorithm for the assessment and management of suicidality in psychiatrically hospitalized children and adolescents. Results The clinical pathway development resulted in six steps from admission to discharge: intake process, inclusion/exclusion criteria, data integration and treatment formulation, interventions, determination of readiness for discharge, and the discharge process. Conclusion This framework, developed with the aim to standardize care for psychiatrically admitted suicidal children and adolescents, may serve as a flexible template for use in similar settings and could be adapted according to local realities and resources.
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Affiliation(s)
- Addo Boafo
- Mental Health Program, CHEO, Ottawa, ON, Canada.,CHEO Research Institute, CHEO, Ottawa, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Stephanie Greenham
- Mental Health Program, CHEO, Ottawa, ON, Canada.,CHEO Research Institute, CHEO, Ottawa, ON, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Paula Cloutier
- Mental Health Program, CHEO, Ottawa, ON, Canada.,CHEO Research Institute, CHEO, Ottawa, ON, Canada
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Testoni I, Nencioni I, Ronconi L, Alemanno F, Zamperini A. Burnout, Reasons for Living and Dehumanisation among Italian Penitentiary Police Officers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093117. [PMID: 32365763 PMCID: PMC7246835 DOI: 10.3390/ijerph17093117] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 11/16/2022]
Abstract
The literature on burnout syndrome among Penitentiary Police Officers (PPOs) is still rather scarce, and there are no analyses on the protective factors that can prevent these workers from the dangerous effect of burnout, with respect to the weakening of the reasons for living and de-humanization. This study aimed to examine the relationships between burnout, protective factors against weakening of the reasons for living and not desiring to die and the role of de-humanisation, utilising the Maslach Burnout Inventory (MBI); the Reasons for Living Inventory (RFL); the Testoni Death Representation Scale (TDRS); and the Human Traits Attribution Scale (HTAS), involving 86 PPOs in a North Italy prison. Results showed the presence of a high level of burnout in the group of participants. In addition, dehumanization of prisoners, which is considered a factor that could help in managing other health professional stress situations, does not reduce the level of burnout.
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Affiliation(s)
- Ines Testoni
- FISPPA Department, University of Padova, 35139 Padova, Italy; (I.N.); (L.R.); (A.Z.)
- Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 349883, Israel
- Correspondence: ; Tel.: +39-0498276646
| | - Irene Nencioni
- FISPPA Department, University of Padova, 35139 Padova, Italy; (I.N.); (L.R.); (A.Z.)
| | - Lucia Ronconi
- FISPPA Department, University of Padova, 35139 Padova, Italy; (I.N.); (L.R.); (A.Z.)
| | - Francesca Alemanno
- European and Mediterranean Cultures (DiCEM) Department, University of Basilicata, 75100 Matera, Italy;
| | - Adriano Zamperini
- FISPPA Department, University of Padova, 35139 Padova, Italy; (I.N.); (L.R.); (A.Z.)
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Hennings JM. Function and Psychotherapy of Chronic Suicidality in Borderline Personality Disorder: Using the Reinforcement Model of Suicidality. Front Psychiatry 2020; 11:199. [PMID: 32256412 PMCID: PMC7093558 DOI: 10.3389/fpsyt.2020.00199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/02/2020] [Indexed: 12/12/2022] Open
Abstract
Although great advancements in evidence-based therapies, chronic suicidal patients with borderline personality disorder (BPD) still challenge our mental health system. While BPD patients continue suffering from distress and aversive emotions, therapists and relatives feel often stunned and helpless when confronted with suicidality resulting in interruption of therapies, repeated presentations to emergency rooms and referrals to hospitals. Reviewing the current knowledge of the functions and background of non-suicidal self-injury, we learned that reinforcement mechanisms play an important role to understand why individuals act in deliberate self-mutilation. While individual motives for non-suicidal self-injury and suicidal behavior including suicidal ideations can differ, the principle mechanisms appear to be transferrable. Elucidating the individual motives and function of suicidal behavior is an important therapeutic step, giving us access to very central maladaptive schemes and false believes that we need to address in order to reduce chronic suicidality in BPD patients. This Perspective article aims to give a better idea of what is behind and what are the differences between non-suicidal self-injury, suicidal ideations and suicide attempts. It further integrates recent developments of behavioral science in a reinforcement model of suicidality that can provide therapists a practical armamentarium in their work with chronic suicidal clients.
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Affiliation(s)
- Johannes M. Hennings
- Department of Dialectical Behavioral Therapy, kbo-Isar-Amper-Klinikum Munich-East, Munich, Germany
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Goodman M, Brown GK, Galfalvy HC, Spears AP, Sullivan SR, Kapil-Pair KN, Jager-Hyman S, Dixon L, Thase ME, Stanley B. Group ("Project Life Force") versus individual suicide safety planning: A randomized clinical trial. Contemp Clin Trials Commun 2020; 17:100520. [PMID: 32043013 PMCID: PMC7000793 DOI: 10.1016/j.conctc.2020.100520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 12/20/2019] [Accepted: 01/04/2020] [Indexed: 11/28/2022] Open
Abstract
One in five suicide deaths is a Veteran and in spite of enhanced suicide prevention services in the Veterans Health Administration (VHA), twenty Veterans die by suicide each day. One component of the VHA's coordinated effort to treat high-risk suicidal Veterans, and diminish suicide risk, is the use of the safety plan. The current study aims to examine a novel intervention integrating skills training and social support with safety planning for Veterans at high-risk for suicide, "Project Life Force" (PLF). A randomized clinical trial (RCT) will be conducted examining if Veterans who are at high-risk for suicide will benefit from the novel group intervention, PLF, compared to Veterans who receive treatment as usual (TAU). We plan to randomize 265 Veterans over the course of the study. The primary outcome variable is the incidence of suicidal behavior, during follow-up, established using a rigorous, multi-method assessment. Secondary outcomes include depression, hopelessness, suicide coping and treatment utilization. Exploratory analyses include safety plan quality and belongingness for those in both arms as well as group cohesion for those in the PLF intervention. Strengths and limitations of this protocol are discussed.
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Affiliation(s)
- Marianne Goodman
- James J Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Gregory K. Brown
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA
| | - Hanga C. Galfalvy
- Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY USA
| | | | | | - Kalpana Nidhi Kapil-Pair
- James J Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Shari Jager-Hyman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Lisa Dixon
- Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Michael E. Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA
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Psychotherapy with Suicidal Patients: The Integrative Psychodynamic Approach of the Boston Suicide Study Group. ACTA ACUST UNITED AC 2019; 55:medicina55060303. [PMID: 31238582 PMCID: PMC6631841 DOI: 10.3390/medicina55060303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/06/2019] [Accepted: 06/13/2019] [Indexed: 11/22/2022]
Abstract
Psychotherapy with suicidal patients is inherently challenging. Psychodynamic psychotherapy focuses attention on the patient’s internal experience through the creation of a therapeutic space for an open-ended exploration of thoughts, fears, and fantasies as they emerge through interactive dialogue with an empathic therapist. The Boston Suicide Study Group (M.S., M.J.G., E.R., B.H.), has developed an integrative psychodynamic approach to psychotherapy with suicidal patients based on the authors’ extensive clinical work with suicidal patients (over 100 years combined). It is fundamentally psychodynamic in nature, with an emphasis on the therapeutic alliance, unconscious and implicit relational processes, and the power of the therapeutic relationship to facilitate change in a long-term exploratory treatment. It is also integrative, however, drawing extensively on ideas and techniques described in Dialectical Behavioral Therapy (DBT), Mentalization Based Treatment (MBT), Cognitive-Behavioral Therapy (CBT), as well on developmental and social psychology research. This is not meant to be a comprehensive review of psychodynamic treatment of suicidal patients, but rather a description of an integrative approach that synthesizes clinical experience and relevant theoretical contributions from the literature that support the authors’ reasoning. There are ten key aspects of this integrative psychodynamic treatment: 1. Approach to the patient in crisis; 2, instilling hope; 3. a focus on the patient’s internal affective experience; 4. attention to conscious and unconscious beliefs and fantasies; 5. improving affect tolerance; 6. development of narrative identity and modification of "relational scripts"; 7. facilitation of the emergence of the patient’s genuine capacities; 8. improving a sense of continuity and coherence; 9 attention to the therapeutic alliance; 10. attention to countertransference. The elements of treatment are overlapping and not meant to be sequential, but each is discussed separately as an essential aspect of the psychotherapeutic work. This integrative psychodynamic approach is a useful method for suicide prevention as it helps to instill hope, provides relational contact and engages the suicidal patient in a process that leads to positive internal change. The benefits of the psychotherapy go beyond crisis intervention, and include the potential for improved affect tolerance, more fulfilling relational experiences, emergence of previously warded off experience of genuine capacities, and a positive change in narrative identity.
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Siddaway AP, Wood AM, O'Carroll RE, O'Connor RC. Characterizing self-injurious cognitions: Development and validation of the Suicide Attempt Beliefs Scale (SABS) and the Nonsuicidal Self-Injury Beliefs Scale (NSIBS). Psychol Assess 2019; 31:592-608. [PMID: 30550331 PMCID: PMC6451640 DOI: 10.1037/pas0000684] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Self-injurious cognitions (SICs) are cognitions about deliberately injuring oneself (self-injurious behavior [SIB]). Existing measures of the content of SICs provide varying coverage, highlighting a lack of consensus regarding which cognitions characterize SIB. Additionally, a central, unresolved conceptual and measurement issue concerns whether to conceptualize suicide attempts (SA) and nonsuicidal self-injury (NSSI), 2 forms of SIB, as separate constructs. We developed the Suicide Attempt Beliefs Scale (SABS) and the Nonsuicidal Self-Injury Beliefs Scale (NSIBS) to clarify which SICs characterize SA and NSSI and what factor structure best explains SA and NSSI cognitions. A series of factor analyses across 6 samples (N = 3,313) revealed that the SABS consists of 7 correlated factors and the NSIBS consists of 10 correlated factors. Both instruments contain factors that describe how SIB relates to oneself and others and demonstrate moderate to excellent test-retest reliability over 2-4 weeks and strong internal consistency; 95% of the correlations between SABS and NSIBS subscales were ≤ r = .5. Both instruments demonstrated small to moderate-sized correlations with a range of clinical variables, measures of well-being, and purportedly similar, existing SIB constructs. Various analyses indicate that SA and NSSI SICs are similar but distinct phenomena, supporting the use of separate terminology and definitions of SA and NSSI, and pointing to the importance of separating SA and NSSI in research and clinical practice. We hope that the development of the SABS and NSIBS may unify the field somewhat in its understanding and measurement of the basic constituent elements of SICs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Alex M Wood
- Department of Psychological and Behavioural Sciences
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Din NC, Ibrahim N, Amit N, Kadir NBA, Halim MRTA. Reasons for Living and Coping with Suicidal Ideation among Adolescents in Malaysia. Malays J Med Sci 2019; 25:140-150. [PMID: 30914870 PMCID: PMC6419889 DOI: 10.21315/mjms2018.25.5.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 09/20/2018] [Indexed: 11/06/2022] Open
Abstract
Introduction The rate of suicide ideation everywhere continues to increase, and adolescents are therefore at risk of displaying suicidal behaviour. This study examined the protective role of the reasons for living and coping strategies in reducing suicidal ideation among young adolescents in Malaysia. Methods A cross-sectional survey was conducted among 176 adolescents aged between 13 and 19 years of age with the majority being Malay and Muslim. The Brief Reasons for Living for Adolescents (BRFL-A), Jalowiec Coping Scale and Suicide Ideation Scale were employed. Results The results showed that the reasons for living and palliative coping strategy correlated negatively with suicide ideation; although, further analysis using multiple regression revealed that family alliance and optimistic and palliative coping strategies were found to be significant reasons for living that protect adolescents from suicidal thoughts. Also, those adolescents who used emotive and evasive coping strategies had higher suicidal ideation. Conclusion Cultural and social values continue to play an important role in protecting adolescents in Malaysia from suicidal behaviour.
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Affiliation(s)
- Normah Che Din
- Health Psychology Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda A Aziz, 50300 Kuala Lumpur, Malaysia
| | - Norhayati Ibrahim
- Health Psychology Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda A Aziz, 50300 Kuala Lumpur, Malaysia
| | - Noh Amit
- Health Psychology Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda A Aziz, 50300 Kuala Lumpur, Malaysia
| | - Nor Ba'yah Abdul Kadir
- Centre of Human and Societal Well-being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor, Malaysia
| | - Mohd Radzi Tarmizi A Halim
- Centre of Human and Societal Well-being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor, Malaysia
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Maino MDLP, Morales S, Echávarri O, Barros J, García A, Moya C, Szmulewicz T, Fischman R, Núñez C, Tomicic A. Suicide risk configuration system in a clustered clinical sample: a generalized linear model obtained through the LASSO technique. ACTA ACUST UNITED AC 2018; 41:112-121. [PMID: 30328960 PMCID: PMC6781676 DOI: 10.1590/1516-4446-2017-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/11/2018] [Indexed: 11/22/2022]
Abstract
Objective: To identify clinical and sociodemographic factors that increase or decrease suicidal risk in a clinical sample of subjects seeking mental health care. Method: A cross-sectional study was performed at three health centers in Santiago, Chile. The Parental Bonding Instrument (PBI), Depressive Experience Questionnaire (DEQ), Outcome Questionnaire (OQ-45.2), Reasons for Living Inventory (RFL), and State Trait Anger Expression Inventory (STAXI-2), in addition to a sociodemographic survey, were applied to 544 participants (333 with suicidal behavior and 211 without current suicidal behavior). Through hierarchical clustering analysis, participants were grouped by similarity regarding suicidal risk. Then, a regression analysis was performed using the Least Absolute Shrinkage and Selection Operator (LASSO) technique, and factors that decrease or increase suicide risk (SR) were identified for each cluster. Results: The resultant clusters were grouped mainly by the age of participants. The most important protective factor was having confidence in one’s own coping skills in difficult situations. Relevant risk factors were major depressive disorder (MDD), poor anger management, and difficulties in interpersonal relationships. Conclusions: Suicidal risk manifests differently throughout the life cycle, and different types of bonds may protect from or increase risk of suicide.
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Affiliation(s)
- María de la Paz Maino
- Departamento de Psiquiatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Santiago, Chile
| | - Susana Morales
- Departamento de Psiquiatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Santiago, Chile
| | - Orietta Echávarri
- Departamento de Psiquiatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Santiago, Chile
| | - Jorge Barros
- Departamento de Psiquiatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Claudia Moya
- Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Santiago, Chile.,Escuela de Enfermería, Universidad San Sebastian, Santiago, Chile
| | - Tita Szmulewicz
- Departamento de Psiquiatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ronit Fischman
- Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Santiago, Chile
| | - Catalina Núñez
- Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Santiago, Chile
| | - Alemka Tomicic
- Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Santiago, Chile.,Escuela de Psicología, Universidad Diego Portales, Santiago, Chile
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Silva C, Hurtado G, Hartley C, Rangel JN, Hovey JD, Pettit JW, Chorot P, Valiente RM, Sandín B, Joiner TE. Spanish translation and validation of the Interpersonal Needs Questionnaire. Psychol Assess 2018; 30:e21-e37. [PMID: 30284876 PMCID: PMC6441959 DOI: 10.1037/pas0000643] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present study reports the multistage development and evaluation of a Spanish translation of the Interpersonal Needs Questionnaire (INQ). The INQ measures the constructs of thwarted belongingness and perceived burdensomeness, which the interpersonal theory of suicide proposes are proximal causes of suicidal desire. Participants were bilingual Hispanic college students in the United States (n = 56), heritage Spanish-speaking college students in the United States (n = 281), college students in Spain (n = 1,016), psychiatric inpatients in Mexico (n = 181), college students in Mexico (n = 239), and Spanish-speaking U.S. adults (n = 104). Results indicated that a 9-item 2-factor solution (INQ-S-9) provided good fit. Multiple group analyses were also consistent with measurement invariance across nationalities and clinical severity. Finally, both subscale scores demonstrated good internal consistency, test-retest reliability, convergent validity, and concurrent associations with scores on measures of suicide ideation. Cultural considerations and implications for use in clinical and research settings are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Caroline Silva
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry
| | | | | | - José N Rangel
- Department of Psychology, Universidad Nacional Autónoma de México
| | - Joseph D Hovey
- Department of Psychological Science, University of Texas Rio Grande Valley
| | | | - Paloma Chorot
- Department of Psychology, Universidad Nacional de Educación a Distancia
| | - Rosa M Valiente
- Department of Psychology, Universidad Nacional de Educación a Distancia
| | - Bonifacio Sandín
- Department of Psychology, Universidad Nacional de Educación a Distancia
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15
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Testoni I, Russotto S, Zamperini A, Leo DD. Addiction and religiosity in facing suicide: a qualitative study on meaning of life and death among homeless people. Ment Illn 2018; 10:7420. [PMID: 30046402 PMCID: PMC6037094 DOI: 10.4081/mi.2018.7420] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/12/2017] [Accepted: 11/13/2017] [Indexed: 11/22/2022] Open
Abstract
This qualitative research explores the relationship between religiosity, suicide thoughts and drug abuse among 55 homeless people, interviewed with interpretative phenomenological analysis. Analyzing the thematic structure of the participants’ narrations, important main themes appeared in order to avoid suicide, among which family, the certainty of finding a solution and the will to live. However, the suicide ideation inheres in about 30% of participants, almost all believers, addicted and/or alcoholics. Results suggest that religiosity and meaning of death neither prevent from substances abuse and alcoholism, nor is a protective factor against suicide ideation. Meanings of life are the most important reasons for living, and when they are definitively considered unworkable, alcohol and drug help to endure life in the street. A specific model is discussed.
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16
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Wilks C, Yin Q, Ang SY, Matsumiya B, Lungu A, Linehan M. Internet-Delivered Dialectical Behavioral Therapy Skills Training for Suicidal and Heavy Episodic Drinkers: Protocol and Preliminary Results of a Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e207. [PMID: 29070480 PMCID: PMC5677770 DOI: 10.2196/resprot.7767] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 08/03/2017] [Accepted: 09/10/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The need to develop effective and accessible interventions for suicidal individuals engaging in heavy episodic drinking (HED) cannot be understated. While the link between alcohol use and suicidality is a complex one that remains to be elucidated, emotion dysregulation may play a key role in alcohol-related suicide risk in these individuals. OBJECTIVE In the current study, an 8-week Internet-delivered dialectical behavior therapy (DBT) skills training intervention was developed and preliminarily evaluated for suicidal individuals who engage in HED to regulate emotions. The aim of the study is to evaluate the feasibility and effectiveness of the therapist-assisted and Internet-delivered intervention, and to inform the design of a subsequent full-scale study. METHODS The study was a pilot randomized controlled trial comparing participants receiving immediate-treatment (n=30) to waitlist controls (n=29) over a period of 16 weeks. Intervention effects will be assessed longitudinally using hierarchical linear modeling and generalized estimating equations, along with analyses of effect sizes and clinically significant change. The primary outcomes are suicidal ideation, alcohol problems, and emotion dysregulation. Secondary outcomes include alcohol-related consequences, reasons for living, skills use, and depression. RESULTS The trial is ongoing. A total of 60 individuals returned their informed consent and were randomized, of whom 59 individuals were intended to treat. A total of 50 participants in the study were retained through the 16-week enrollment. CONCLUSIONS There is a dearth of evidence-based treatment for individuals presenting with high risk and complex behaviors. Furthermore, computerized interventions may provide a beneficial alternative to traditional therapies. The particular clinical features and treatment needs of suicidal individuals who also engage in HED constitute key domains for further investigation that are needed to consolidate the design of appropriate interventions for this high-risk population. TRIAL REGISTRATION Clinicaltrials.gov NCT02932241; https://clinicaltrials.gov/ct2/show/NCT02932241 (Archived by WebCite at http://www.webcitation.org/6uJHdQsC2).
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Affiliation(s)
- Chelsey Wilks
- Behavioral Research and Therapy Clinics, Department of Psychology, University of Washington, Seattle, WA, United States
| | - Qingqing Yin
- Behavioral Research and Therapy Clinics, Department of Psychology, University of Washington, Seattle, WA, United States
| | - Sin Yee Ang
- Behavioral Research and Therapy Clinics, Department of Psychology, University of Washington, Seattle, WA, United States
| | - Brandon Matsumiya
- Department of Psychology, University of Central Florida, Orlando, FL, United States
| | | | - Marsha Linehan
- Behavioral Research and Therapy Clinics, Department of Psychology, University of Washington, Seattle, WA, United States
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17
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Eskiyurt R, Ozkan B. The investigation of the relationship between probability of suicide and reasons for living in psychiatric inpatients. Indian J Psychiatry 2017; 59:435-441. [PMID: 29497185 PMCID: PMC5806322 DOI: 10.4103/psychiatry.indianjpsychiatry_31_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIM This study was carried out to determine the reasons of the suicide probability and reasons for living of the inpatients hospitalized at the psychiatry clinic and to analyze the relationship between them. MATERIALS AND METHODS The sample of the study consisted of 192 patients who were hospitalized in psychiatric clinics between February and May 2016 and who agreed to participate in the study. In collecting data, personal information form, suicide probability scale (SPS), reasons for living inventory (RFL), and Beck's depression inventory (BDI) were used. Stepwise regression method was used to determine the factors that predict suicide probability. RESULTS In the study, as a result of analyses made, the median score on the SPS was found 76.0, the median score on the RFL was found 137.0, the median score on the BDI of the patients was found 13.5, and it was found that patients with a high probability of suicide had less reasons for living and that their depression levels were very high. As a result of stepwise regression analysis, it was determined that suicidal ideation, reasons for living, maltreatment, education level, age, and income status were the predictors of suicide probability (F = 61.125; P < 0.001). DISCUSSION It was found that the patients who hospitalized in the psychiatric clinic have high suicide probability and the reasons of living are strong predictors of suicide probability in accordance with the literature.
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Affiliation(s)
- Reyhan Eskiyurt
- Department of Nursing, Mental Health Nursing, Faculty of Health Sciences, University of Ankara Yildirim Beyazit, Ankara, Turkey
| | - Birgul Ozkan
- Department of Nursing, Mental Health Nursing, Faculty of Health Sciences, University of Ankara Yildirim Beyazit, Ankara, Turkey
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18
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Stip E, Caron J, Tousignant M, Lecomte Y. Suicidal Ideation and Schizophrenia: Contribution of Appraisal, Stigmatization, and Cognition. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:726-734. [PMID: 28673099 PMCID: PMC5638189 DOI: 10.1177/0706743717715207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To predict suicidal ideation in people with schizophrenia, certain studies have measured its relationship with the variables of defeat and entrapment. The relationships are positive, but their interactions remain undefined. To further their understanding, this research sought to measure the relationship between suicidal ideation with the variables of loss, entrapment, and humiliation. METHOD The convenience sample included 30 patients with schizophrenia spectrum disorders. The study was prospective (3 measurement times) during a 6-month period. Results were analyzed by stepwise multiple regression. RESULTS The contribution of the 3 variables to the variance of suicidal ideation was not significant at any of the 3 times (T1: 16.2%, P = 0.056; T2: 19.9%, P = 0.117; T3: 11.2%, P = 0.109). Further analyses measured the relationship between the variables of stigmatization, perceived cognitive dysfunction, symptoms, depression, self-esteem, reason to live, spirituality, social provision, and suicidal ideation. Stepwise multiple regression demonstrated that the contribution of the variables of stigmatization and perceived cognitive dysfunction to the variance of suicidal ideation was significant at all 3 times (T1: 41.7.5%, P = 0.000; T2: 35.2%, P = 0.001; T3: 21.5%, P = 0.012). Yet, over time, the individual contribution of the variables changed: T1, stigmatization (β = 0.518; P = 0.002); T2, stigmatization (β = 0.394; P = 0.025) and perceived cognitive dysfunction (β = 0.349; P = 0.046). Then, at T3, only perceived cognitive dysfunction contributed significantly to suicidal ideation (β = 0.438; P = 0.016). CONCLUSION The results highlight the importance of the contribution of the variables of perceived cognitive dysfunction and stigmatization in the onset of suicidal ideation in people with schizophrenia spectrum disorders.
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Affiliation(s)
- Emmanuel Stip
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Jean Caron
- Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
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19
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Morales S, Barros J, Echávarri O, García F, Osses A, Moya C, Maino MP, Fischman R, Núñez C, Szmulewicz T, Tomicic A. Acute Mental Discomfort Associated with Suicide Behavior in a Clinical Sample of Patients with Affective Disorders: Ascertaining Critical Variables Using Artificial Intelligence Tools. Front Psychiatry 2017; 8:7. [PMID: 28210230 PMCID: PMC5289061 DOI: 10.3389/fpsyt.2017.00007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/11/2017] [Indexed: 12/30/2022] Open
Abstract
AIM In efforts to develop reliable methods to detect the likelihood of impending suicidal behaviors, we have proposed the following. OBJECTIVE To gain a deeper understanding of the state of suicide risk by determining the combination of variables that distinguishes between groups with and without suicide risk. METHOD A study involving 707 patients consulting for mental health issues in three health centers in Greater Santiago, Chile. Using 345 variables, an analysis was carried out with artificial intelligence tools, Cross Industry Standard Process for Data Mining processes, and decision tree techniques. The basic algorithm was top-down, and the most suitable division produced by the tree was selected by using the lowest Gini index as a criterion and by looping it until the condition of belonging to the group with suicidal behavior was fulfilled. RESULTS Four trees distinguishing the groups were obtained, of which the elements of one were analyzed in greater detail, since this tree included both clinical and personality variables. This specific tree consists of six nodes without suicide risk and eight nodes with suicide risk (tree decision 01, accuracy 0.674, precision 0.652, recall 0.678, specificity 0.670, F measure 0.665, receiver operating characteristic (ROC) area under the curve (AUC) 73.35%; tree decision 02, accuracy 0.669, precision 0.642, recall 0.694, specificity 0.647, F measure 0.667, ROC AUC 68.91%; tree decision 03, accuracy 0.681, precision 0.675, recall 0.638, specificity 0.721, F measure, 0.656, ROC AUC 65.86%; tree decision 04, accuracy 0.714, precision 0.734, recall 0.628, specificity 0.792, F measure 0.677, ROC AUC 58.85%). CONCLUSION This study defines the interactions among a group of variables associated with suicidal ideation and behavior. By using these variables, it may be possible to create a quick and easy-to-use tool. As such, psychotherapeutic interventions could be designed to mitigate the impact of these variables on the emotional state of individuals, thereby reducing eventual risk of suicide. Such interventions may reinforce psychological well-being, feelings of self-worth, and reasons for living, for each individual in certain groups of patients.
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Affiliation(s)
- Susana Morales
- Facultad de Medicina, Departamento de Psiquiatría, Depression and Suicidality Research Group, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
| | - Jorge Barros
- Facultad de Medicina, Departamento de Psiquiatría, Depression and Suicidality Research Group, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Orietta Echávarri
- Facultad de Medicina, Departamento de Psiquiatría, Depression and Suicidality Research Group, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
| | - Fabián García
- Independent researcher, Avenida José Manso de Velasco 6968, Santiago, Chile
| | - Alex Osses
- Independent researcher, Isla Darwin 8726, Santiago, Chile
| | - Claudia Moya
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
- School of Nursery, Universidad San Sebastián, Santiago, Chile
| | - María Paz Maino
- Facultad de Medicina, Departamento de Psiquiatría, Depression and Suicidality Research Group, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
| | - Ronit Fischman
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
| | - Catalina Núñez
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
| | - Tita Szmulewicz
- Facultad de Medicina, Departamento de Psiquiatría, Depression and Suicidality Research Group, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
| | - Alemka Tomicic
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
- School of Psychology, Universidad Diego Portales, Santiago, Chile
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Dennis BB, Roshanov PS, Bawor M, ElSheikh W, Garton S, DeJesus J, Rangarajan S, Vair J, Sholer H, Hutchinson N, Lordan E, Thabane L, Samaan Z. Re-examination of classic risk factors for suicidal behavior in the psychiatric population. CRISIS 2016; 36:231-40. [PMID: 26440619 PMCID: PMC4614877 DOI: 10.1027/0227-5910/a000342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract.Background: For decades we have understood the risk factors for
suicide in the general population but have fallen short in understanding what
distinguishes the risk for suicide among patients with serious psychiatric
conditions. Aims: This prompted us to investigate risk factors
for suicidal behavior among psychiatric inpatients. Method: We
reviewed all psychiatric hospital admissions (2008–2011) to a centralized
psychiatric hospital in Ontario, Canada. Using multivariable logistic regression
we evaluated the association between potential risk factors and lifetime history
of suicidal behavior, and constructed a model and clinical risk score to predict
a history of this behavior. Results: The final risk prediction
model for suicidal behavior among psychiatric patients (n =
2,597) included age (in three categories: 60–69 [OR = 0.74, 95%
CI = 0.73–0.76], 70–79 [OR = 0.45, 95% CI = 0.44–0.46], 80+
[OR = 0.31, 95% CI = 0.30–.31]), substance use disorder
(OR = 1.30, 95% CI = 1.27–1.32), mood disorder
(OR = 1.49, 95% CI = 1.47–1.52), personality disorder
(OR = 2.30, 95% CI = 2.25–2.36), psychiatric disorders due
to general medical condition (OR = 0.52, 95% CI = 0.50–0.55),
and schizophrenia (OR = 0.42, 95% CI = 0.41–0.43). The risk
score constructed from the risk prediction model ranges from −9 (lowest risk, 0%
predicted probability of suicidal behavior) to +5 (highest risk, 97% predicted
probability). Conclusion: Risk estimation may help guide
intensive screening and treatment efforts of psychiatric patients with high risk
of suicidal behavior.
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Affiliation(s)
- Brittany B Dennis
- 1 St. George's University of London, UK.,2 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Pavel S Roshanov
- 3 Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Monica Bawor
- 1 St. George's University of London, UK.,4 McMaster Integrative Neuroscience and Discovery Program, McMaster University, Hamilton, ON, Canada
| | - Wala ElSheikh
- 5 Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada
| | - Sue Garton
- 6 St. Joseph's Healthcare Hamilton, ON, Canada
| | - Jane DeJesus
- 5 Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- 5 Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada
| | - Judith Vair
- 6 St. Joseph's Healthcare Hamilton, ON, Canada
| | | | | | | | - Lehana Thabane
- 2 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Zainab Samaan
- 2 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,7 Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.,8 Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, ON, Canada
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21
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Barros J, Morales S, Echávarri O, García A, Ortega J, Asahi T, Moya C, Fischman R, Maino MP, Núñez C. Suicide detection in Chile: proposing a predictive model for suicide risk in a clinical sample of patients with mood disorders. ACTA ACUST UNITED AC 2016; 39:1-11. [PMID: 27783715 PMCID: PMC7112738 DOI: 10.1590/1516-4446-2015-1877] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/11/2016] [Indexed: 01/18/2023]
Abstract
Objective: To analyze suicidal behavior and build a predictive model for suicide risk using data mining (DM) analysis. Methods: A study of 707 Chilean mental health patients (with and without suicide risk) was carried out across three healthcare centers in the Metropolitan Region of Santiago, Chile. Three hundred forty-three variables were studied using five questionnaires. DM and machine-learning tools were used via the support vector machine technique. Results: The model selected 22 variables that, depending on the circumstances in which they all occur, define whether a person belongs in a suicide risk zone (accuracy = 0.78, sensitivity = 0.77, and specificity = 0.79). Being in a suicide risk zone means patients are more vulnerable to suicide attempts or are thinking about suicide. The interrelationship between these variables is highly nonlinear, and it is interesting to note the particular ways in which they are configured for each case. The model shows that the variables of a suicide risk zone are related to individual unrest, personal satisfaction, and reasons for living, particularly those related to beliefs in one’s own capacities and coping abilities. Conclusion: These variables can be used to create an assessment tool and enables us to identify individual risk and protective factors. This may also contribute to therapeutic intervention by strengthening feelings of personal well-being and reasons for staying alive. Our results prompted the design of a new clinical tool, which is fast and easy to use and aids in evaluating the trajectory of suicide risk at a given moment.
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Affiliation(s)
- Jorge Barros
- Departamento de Psiquiatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Susana Morales
- Departamento de Psiquiatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Orietta Echávarri
- Departamento de Psiquiatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Arnol García
- Centro de Modelamiento Matemático, Departamento de Matemáticas, Escuela de Ingeniería y Ciencias, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Chile
| | - Jaime Ortega
- Centro de Modelamiento Matemático, Departamento de Matemáticas, Escuela de Ingeniería y Ciencias, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Chile
| | - Takeshi Asahi
- Centro de Modelamiento Matemático, Departamento de Matemáticas, Escuela de Ingeniería y Ciencias, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Chile
| | - Claudia Moya
- Facultad de Enfermería, Universidad San Sebastián, Santiago de Chile
| | - Ronit Fischman
- Servicio de Neurología y Psiquiatría, Hospital Dr. Luis Calvo Mackenna, Santiago, Chile
| | - María P Maino
- Departamento de Psiquiatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Extremera N, Rey L. Attenuating the Negative Impact of Unemployment: The Interactive Effects of Perceived Emotional Intelligence and Well-Being on Suicide Risk. PLoS One 2016; 11:e0163656. [PMID: 27685996 PMCID: PMC5042532 DOI: 10.1371/journal.pone.0163656] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 09/12/2016] [Indexed: 11/18/2022] Open
Abstract
A growing body of research has demonstrated that deficits in well-being may be related to increased suicide risk, but there is only a limited number of studies that have focused on specific protective factors that can serve as a buffer against suicidal ideation and behaviours. Given that unemployment may be a factor leading to increased risk for suicide, this study assessed whether perceived EI might be a potential moderator in the relationship between life satisfaction/happiness and suicidal behaviours in a relatively large sample of unemployed individuals. Participants were 1125 unemployed (506 men and 619 women) who completed satisfaction with life and happiness questionnaires, the Suicidal Behaviours Questionnaire and the Wong and Law Emotional Intelligence Test. Consistent with the interaction hypothesis, lower scores in life satisfaction and happiness were associated with higher levels of current suicidal behaviours, and perceived EI scores moderated these relationships. Interventions targeting well-being via the promotion of emotional abilities may be useful in the prevention of suicidal ideation in the unemployed. The implications for these findings for research and practice are discussed.
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Affiliation(s)
- Natalio Extremera
- Department of Social Psychology, University of Malaga, Malaga, Spain
- * E-mail:
| | - Lourdes Rey
- Department of Personality, Evaluation and Psychological Treatment, University of Malaga, Malaga, Spain
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Herta DC, Brîndas P, Trifu R, Cozman D. Risk and resilience factors of persons exposed to accidents. ACTA ACUST UNITED AC 2016; 89:257-66. [PMID: 27152078 PMCID: PMC4849385 DOI: 10.15386/cjmed-547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 09/07/2015] [Indexed: 12/02/2022]
Abstract
Background and aims Resilience encompasses factors promoting effective functioning in the context of adversity. Data regarding resilience in the wake of accidental trauma is still scarce. The aim of the current study is to comparatively assess adaptive, life – promoting factors in persons exposed to motor vehicle accidents (MVA) vs. persons exposed to other types of accidents, and to identify psychological factors of resilience and vulnerability in this context of trauma exposure. Methods We assessed 93 participants exposed to accidents out of 305 eligible patients from the Clinical Rehabilitation Hospital and Cluj County Emergency Hospital. The study used Reasons for Living Inventory (RFL) and Life Events Checklist. Scores were comparatively assessed for RFL items, RFL scale and subscales in participants exposed to motor vehicle accidents (MVA) vs. participants exposed to other life – threatening accidents. Results Participants exposed to MVA and those exposed to other accidents had significantly different scores in 7 RFL items. Scores were high in 4 out of 6 RFL subscales for both samples and in most items comprising these subscales, while in the other 2 subscales and in some items comprising them scores were low. Conclusions Low fear of death, physical suffering and social disapproval emerge as risk factors in persons exposed to life – threatening accidents. Love of life, courage in life and hope for the future are important resilience factors after exposure to various types of life – threatening accidents. Survival and active coping beliefs promote resilience especially after motor vehicle accidents. Coping with uncertainty are more likely to foster resilience after other types of life – threatening accidents. Attachment of the accident victim to family promotes resilience mostly after MVA, while perceived attachment of family members to the victim promotes resilience after other types of accidents.
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Affiliation(s)
- Dana-Cristina Herta
- Medical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj - Napoca, Romania
| | - Paula Brîndas
- Medical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj - Napoca, Romania
| | - Raluca Trifu
- Medical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj - Napoca, Romania; Lucian Blaga Central University Library, Cluj-Napoca, Romania
| | - Doina Cozman
- Medical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj - Napoca, Romania
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Joiner TE, Hom MA, Rogers ML, Chu C, Stanley IH, Wynn GH, Gutierrez PM. Staring Down Death. CRISIS 2016; 37:212-7. [PMID: 27427541 DOI: 10.1027/0227-5910/a000367] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Abstract. Background: Lowered eye blink rate may be a clinically useful indicator of acute, imminent, and severe suicide risk. Diminished eye blink rates are often seen among individuals engaged in heightened concentration on a specific task that requires careful planning and attention. Indeed, overcoming one’s biological instinct for survival through suicide necessitates premeditation and concentration; thus, a diminished eye blink rate may signal imminent suicidality. Aims: This article aims to spur research and clinical inquiry into the role of eye blinks as an indicator of acute suicide risk. Method: Literature relevant to the potential connection between eye blink rate and suicidality was reviewed and synthesized. Results: Anecdotal, cognitive, neurological, and conceptual support for the relationship between decreased blink rate and suicide risk is outlined. Conclusion: Given that eye blinks are a highly observable behavior, the potential clinical utility of using eye blink rate as a marker of suicide risk is immense. Research is warranted to explore the association between eye blink rate and acute suicide risk.
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Affiliation(s)
- Thomas E. Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Melanie A. Hom
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Megan L. Rogers
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Carol Chu
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Ian H. Stanley
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Gary H. Wynn
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Peter M. Gutierrez
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
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Sinniah A, Oei TPS, Chinna K, Shah SA, Maniam T, Subramaniam P. Psychometric Properties and Validation of the Positive and Negative Suicide Ideation (PANSI) Inventory in an Outpatient Clinical Population in Malaysia. Front Psychol 2016; 6:1934. [PMID: 26733920 PMCID: PMC4685108 DOI: 10.3389/fpsyg.2015.01934] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 12/01/2015] [Indexed: 11/13/2022] Open
Abstract
The PANSI is a measure designed to assess the risk and protective factors related to suicidal behaviors. The present study evaluated the psychometric properties and factor structure of the Positive and Negative Suicide Ideation (PANSI) Inventory in a sample of clinical outpatients at a major hospital in Malaysia. In this study, 283 psychiatric patients and 200 medical (non-psychiatric) patients participated. All the patients completed the PANSI and seven other self-report instruments. Confirmative factor analysis supported the 2-factor oblique model. The internal consistency of the two subscales of PANSI-Negative and the PANSI-Positive were 0.93 and 0.84, respectively. In testing construct validity, PANSI showed sizable correlation with the other seven scales. Criterion validity was supported by scores on PANSI which differentiated psychiatric patients from medical patients. Logistic regression analyses showed PANSI can be used to classify the patients into suicidal or non-suicidal. The PANSI is a reliable and valid instrument to measure the severity of suicidal ideation among clinical outpatients in Malaysia.
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Affiliation(s)
- Aishvarya Sinniah
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical CentreKuala Lumpur, Malaysia; School of Psychology, The University of QueenslandBrisbane, QLD, Australia
| | - Tian P S Oei
- School of Psychology, The University of QueenslandBrisbane, QLD, Australia; Department of Psychology, James Cook University SingaporeSingapore, Singapore; Department of Psychology, School of Social and Behavioural Sciences, Nanjing UniversityNanjing, China
| | - Karuthan Chinna
- Department of Social and Preventive Medicine, Julius Centre University of Malaya, University of Malaya Kuala Lumpur, Malaysia
| | - Shamsul A Shah
- Department of Community Medicine, Universiti Kebangsaan Malaysia Medical Centre Kuala Lumpur, Malaysia
| | - T Maniam
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre Kuala Lumpur, Malaysia
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Grant CL, Lusk JL. A multidisciplinary approach to therapeutic risk management of the suicidal patient. J Multidiscip Healthc 2015; 8:291-8. [PMID: 26150725 PMCID: PMC4484669 DOI: 10.2147/jmdh.s50529] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
As health care trends toward a system of care approach, providers from various disciplines strive to collaborate to provide optimal care for their patients. While a multidisciplinary approach to suicide risk assessment and management has been identified as important for reducing suicidality, standardized clinical guidelines for such an approach do not yet exist. In this article, the authors propose the adoption of the therapeutic risk management of the suicidal patient (TRMSP) to improve suicide risk assessment and management within multidisciplinary systems of care. The TRMSP, which has been fully articulated in previous articles, involves augmenting clinical risk assessment with structured instruments, stratifying risk in terms of both severity and temporality, and developing and documenting a safety plan. Augmenting clinical risk assessments with reliable and valid structured instruments serves several functions, including ensuring important aspects of suicide are addressed, establishing a baseline for suicidal thoughts and behaviors, facilitating interprofessional communication, and mitigating risk. Similarly, a two-dimensional risk stratification qualifying suicide risk in terms of both severity and temporality can enhance communication across providers and settings and improve understanding of acute crises in the context of chronic risk. Finally, safety planning interventions allow providers and patients to collaboratively create a personally meaningful plan for managing a suicidal crisis that can be continually modified across time with multiple providers in different care settings. In a busy care environment, the TRMSP can provide concrete guidance on conducting clinically and medicolegally sound suicide risk assessment and management. This collaborative and comprehensive process would potentially improve care of patients with suicidality, optimize clinical resources, decrease unnecessary and costly admissions, and mitigate medicolegal risk. The TRMSP may serve as a foundation for building a standardized, collaborative, stepped-care approach that patients, individual providers, and the health care system can all benefit from.
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Affiliation(s)
- Cynthia L Grant
- Arapahoe/Douglas Mental Health Network, Englewood, CO, USA
- School of Education and Human Development, University of Colorado Denver, Denver, CO, USA
| | - Jaimie L Lusk
- Mental Health Service, VA Portland Health Care System, Portland, OR, USA
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Salami TK, Brooks BA, Lamis DA. Impulsivity and reasons for living among African American youth: a risk-protection framework of suicidal ideation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:5196-214. [PMID: 25988310 PMCID: PMC4454962 DOI: 10.3390/ijerph120505196] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/06/2015] [Accepted: 05/08/2015] [Indexed: 11/17/2022]
Abstract
This study aims to explore the impact of specific facets of impulsivity as measured by the UPPS Impulsive Behavior Scale (UPPS), as well as reasons for living in predicting suicidal ideation among African American college-aged students. The incremental validity of each facet of the UPPS interacting with reasons for living, a construct meant to buffer against risk for suicide, was explored in a sample of African American students (N = 130; ages 18-24). Results revealed significant interactions between reasons for living and two factors of impulsivity, (lack of) premeditation and sensation seeking. Higher levels of sensation seeking and lack of premeditation in conjunction with lower reasons for living was associated with increased suicidal ideation. Neither urgency nor (lack of) perseverance significantly interacted with reasons for living in association with suicidal ideation. These results suggest including elements of impulsivity, specifically sensation seeking and (lack of) premeditation, when screening for suicidal ideation among African American youth. Future investigations should continue to integrate factors of both risk and protection when determining risk for suicide.
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Affiliation(s)
- Temilola K Salami
- Department of Clinical Psychology, University of Georgia, 125 Baldwin St., Athens, GA 30602, USA.
| | - Bianca A Brooks
- Department of Clinical Psychology, Georgia State University, 140 Decatur St., Atlanta, GA 30303, USA.
| | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, 80 Jesse Hill Jr. Drive, Atlanta, GA 30303, USA.
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Surgenor PWG, Freeman J, O’Connor C. Developing the Pieta House Suicide Intervention Model: a quasi-experimental, repeated measures design. BMC Psychol 2015; 3:14. [PMID: 25954508 PMCID: PMC4423104 DOI: 10.1186/s40359-015-0071-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 04/22/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND While most crisis intervention models adhere to a generalised theoretical framework, the lack of clarity around how these should be enacted has resulted in a proliferation of models, most of which have little to no empirical support. The primary aim of this research was to propose a suicide intervention model that would resolve the client's suicidal crisis by decreasing their suicidal ideation and improve their outlook through enhancing a range of protective factors. The secondary aim was to assess the impact of this model on negative and positive outlook. METHODS A quasi-experimental, pre-test post-test repeated measures design was employed. A questionnaire assessing self-esteem, depression, and positive and negative suicidal ideation was administered to the same participants pre- and post- therapy facilitating paired responses. RESULTS Multiple analysis of variance and paired-samples t-tests were conducted to establish whether therapy using the PH-SIM had a significant effect on the clients' negative and positive outlook. Analyses revealed a statistically significant effect of therapy for depression, negative suicidal ideation, self-esteem, and positive suicidal ideation. Negative outlook was significantly lower after therapy and positive outlook significantly higher. CONCLUSIONS The decreased negative outlook and increased positive outlook following therapy provide some support for the proposed model in fulfilling its role, though additional research is required to establish the precise role of the intervention model in achieving this.
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Affiliation(s)
| | - Joan Freeman
- Pieta House, 6 Main Street Lucan, Co. Dublin, Ireland
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Abstract
The present study compared Non-Attempters, Recent Attempters, and Distant Attempters on the following three constructs: Acquired capability for suicide, reasons for attempting suicide (internal perturbation based reasons vs. extrapunitive/manipulative reasons), and suicidal ideation. Participants were 40 Non-Attempters, 28 Recent Attempters, and 32 Distant Attempters at three state psychiatric hospitals. The sample consisted of 63 males and 37 females ranging in age from 18 to 63 years (M = 35.84, SD = 11.44). All patients completed the self-report measures. There were significant differences between the groups on suicidal ideation and acquired capability for suicide. The results of the present study indicate that acquired capability and reasons for attempting suicide have considerable importance for understanding suicide risk. Integration of acquired capability for suicide and reasons for attempting suicide into assessment and treatment is warranted.
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Demyttenaere K, Desaiah D, Raskin J, Cairns V, Brecht S. Suicidal thoughts and reasons for living in hospitalized patients with severe depression: post-hoc analyses of a double-blind randomized trial of duloxetine. Prim Care Companion CNS Disord 2014; 16:13m01591. [PMID: 25317365 DOI: 10.4088/pcc.13m01591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 12/20/2013] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To evaluate suicidal thoughts in relationship to depressive symptom severity and reasons for living in patients hospitalized for major depressive disorder (MDD). METHOD A post hoc analysis was conducted of a randomized, double-blind, parallel-group trial involving hospitalized patients with MDD (DSM-IV criteria) who received duloxetine 60 mg once daily or duloxetine 60 mg twice daily for 8 weeks. After 4 weeks, the dose for nonresponders receiving 60 mg once daily could be increased to 60 mg twice daily (double-blind). The study was conducted between February 9, 2007, and August 26, 2008 at 43 centers in 4 countries across Europe and South Africa. Suicidal thoughts were assessed with Montgomery-Asberg Depression Rating Scale (MADRS) item 10, depression severity was assessed with the 6-item Hamilton Depression Rating Scale and the Clinical Global Impressions-Severity of Illness scale, and protective factors were assessed with the patient-rated Reasons for Living Inventory (RFL) assessing 6 domains. Descriptive statistics, correlation, and linear regression analysis were performed. RESULTS At baseline, patients (N = 336) had varying severity of suicidal thoughts: 18% had a score ≥ 4. The proportion of patients with a score ≥ 4 decreased to 7% at week 1 and 1% at week 8 of treatment. The RFL scores at baseline were lower in patients with higher baseline suicidal thoughts and increased significantly during treatment (P < .0001). A regression model revealed that only 16% of variance in baseline total RFL score is explained by the different MADRS items. Eight patients had suicidal behavior or ideation recorded as an adverse event during the study; no consistent pattern was found in the different psychometric scores either at baseline or at the visit preceding the suicidal behavior/ideation. CONCLUSIONS Suicidality rapidly decreased in hospitalized patients with severe depression treated with duloxetine. The RFL scores were low at baseline but increased during treatment, suggesting that they are at least partially state rather than trait variables. Since RFL scores are lower in depressed inpatients, these scores lose the predictive value that they have in a general population sample. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00422162.
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Affiliation(s)
- Koen Demyttenaere
- University Psychiatric Center KU Leuven, Campus Gasthuisberg, Leuven, Belgium (Dr Demyttenaere); Eli Lilly and Company, Indianapolis, Indiana (Dr Desaiah); Eli Lilly and Company, Toronto, Canada (Dr Raskin); Boehringer Ingelheim GmbH (consultant statistician), Oxford, United Kingdom (Dr Cairns); and Boehringer Ingelheim GmbH, Ingelheim, Germany (Dr Brecht)
| | - Durisala Desaiah
- University Psychiatric Center KU Leuven, Campus Gasthuisberg, Leuven, Belgium (Dr Demyttenaere); Eli Lilly and Company, Indianapolis, Indiana (Dr Desaiah); Eli Lilly and Company, Toronto, Canada (Dr Raskin); Boehringer Ingelheim GmbH (consultant statistician), Oxford, United Kingdom (Dr Cairns); and Boehringer Ingelheim GmbH, Ingelheim, Germany (Dr Brecht)
| | - Joel Raskin
- University Psychiatric Center KU Leuven, Campus Gasthuisberg, Leuven, Belgium (Dr Demyttenaere); Eli Lilly and Company, Indianapolis, Indiana (Dr Desaiah); Eli Lilly and Company, Toronto, Canada (Dr Raskin); Boehringer Ingelheim GmbH (consultant statistician), Oxford, United Kingdom (Dr Cairns); and Boehringer Ingelheim GmbH, Ingelheim, Germany (Dr Brecht)
| | - Victoria Cairns
- University Psychiatric Center KU Leuven, Campus Gasthuisberg, Leuven, Belgium (Dr Demyttenaere); Eli Lilly and Company, Indianapolis, Indiana (Dr Desaiah); Eli Lilly and Company, Toronto, Canada (Dr Raskin); Boehringer Ingelheim GmbH (consultant statistician), Oxford, United Kingdom (Dr Cairns); and Boehringer Ingelheim GmbH, Ingelheim, Germany (Dr Brecht)
| | - Stephan Brecht
- University Psychiatric Center KU Leuven, Campus Gasthuisberg, Leuven, Belgium (Dr Demyttenaere); Eli Lilly and Company, Indianapolis, Indiana (Dr Desaiah); Eli Lilly and Company, Toronto, Canada (Dr Raskin); Boehringer Ingelheim GmbH (consultant statistician), Oxford, United Kingdom (Dr Cairns); and Boehringer Ingelheim GmbH, Ingelheim, Germany (Dr Brecht)
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Chen YJ, Tsai YF, Lee SH, Lee HL. Protective factors against suicide among young-old Chinese outpatients. BMC Public Health 2014; 14:372. [PMID: 24739419 PMCID: PMC4020607 DOI: 10.1186/1471-2458-14-372] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 03/31/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is common among the elderly worldwide. However, no literature could be found on the beliefs/expectations that protect young-old people from attempting suicide. The purpose of this study was to explore young-old outpatients' reasons for not killing themselves in Taiwan. METHOD Data for this qualitative descriptive study were extracted from a large research series. From the 83 elderly outpatients in the original sample, 31 were chosen for this study because they were young-old (65-74 years old) and from two randomly selected medical centers in northern Taiwan. Data on participants' reasons for not killing themselves in unhappy situations were collected in individual interviews using a semi-structured guide and analyzed by content analysis. RESULTS Analysis of interview data identified six major themes: satisfied with one's life, suicide cannot resolve problems, fear of humiliating one's children, religious beliefs, never thought about suicide, and living in harmony with nature. CONCLUSION These identified protective factors (reasons for living) could be added to suicide-prevention programs for the elderly. Our findings may also serve as a reference for geriatric researchers in western countries with increasing numbers of elderly ethnic minority immigrants.
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Affiliation(s)
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, 259, Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan 333, Taiwan.
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Szanto K, Clark L, Hallquist M, Vanyukov P, Crockett M, Dombrovski AY. The cost of social punishment and high-lethality suicide attempts in the second half of life. Psychol Aging 2014; 29:84-94. [PMID: 24660798 PMCID: PMC4051315 DOI: 10.1037/a0035339] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Age-related cognitive changes may contribute to impairments in making complex social decisions. Interpersonal conflict is a key factor behind suicidal behavior in old age, with suicidal motivations ranging from escape to revenge. Such conflicts may prove catastrophic for people prone to suicide, in part because of their tendency to make disadvantageous decisions. Yet, little is known about social decision making in older suicidal individuals. We assessed economic bargaining behavior using the Ultimatum Game, where players decide whether to accept or punish (reject) unfair monetary offers from another player. Our sample included depressed older adults with a history of high-medical-lethality suicide attempts, low-medical-lethality suicide attempts, nonsuicidal depressed older adults, and those with no psychiatric history who served as control groups. Participants in all groups punished their counterparts in response to unfair offers. However, low-lethality attempters, nonsuicidal depressed, and nonpsychiatric controls punished less as the cost of punishment increased, accepting more unfair offers as the stakes grew large. High-lethality attempters did not adjust their choices based on stake magnitude, punishing unfair offers without regard to the cost. Two thirds of the difference between the high-lethality attempters and nonpsychiatric controls was explained by individual differences in fairness judgments: the comparison group judged offer fairness as a joint function of inequality and magnitude, whereas the high-lethality attempter participants judged offer fairness on the basis of inequality. In real life, high-lethality attempters' relative insensitivity to the cost of retaliation may lead to uncompromising, catastrophic responses to conflict.
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Affiliation(s)
| | - Luke Clark
- Department of Psychology, University of Cambridge
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Edelstein BA, Heisel MJ, McKee DR, Martin RR, Koven LP, Duberstein PR, Britton PC. Development and psychometric evaluation of the reasons for living--older adults scale: a suicide risk assessment inventory. THE GERONTOLOGIST 2009; 49:736-45. [PMID: 19546114 DOI: 10.1093/geront/gnp052] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The purposes of these studies were to develop and initially evaluate the psychometric properties of the Reasons for Living Scale-Older Adult version (RFL-OA), an older adults version of a measure designed to assess reasons for living among individuals at risk for suicide. DESIGN AND METHODS Two studies are reported. Study 1 involved instrument development with 106 community-dwelling older adults, and initial psychometric evaluation with a second sample of 119 community-dwelling older adults. Study 2 evaluated the psychometric properties of the RFL-OA in a clinical sample. One hundred eighty-one mental health patients 50 years or older completed the RFL-OA and measures of depression, suicide ideation at the current time and at the worst point in one's life, and current mental status and physical functioning. RESULTS Strong psychometric properties were demonstrated for the RFL-OA, with high internal consistency (Cronbach's alpha coefficient). Convergent validity was evidenced by negative associations among RFL-OA scores and measures of depression and suicide ideation. RFL-OA scores predicted current and worst-episode suicide ideation above and beyond current depression. Discriminant validity was evidenced with measures of current mental status and physical functioning. Criterion-related validity was also demonstrated with respect to lifetime history of suicidal behavior. IMPLICATIONS These findings provide preliminary support for the validity and reliability of the RFL-OA. The findings also support the potential value of attending to reasons for living during clinical treatment with depressed older adults and others at risk for suicide.
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Affiliation(s)
- Barry A Edelstein
- Department of Psychology, West Virginia University, Morgantown, WV 26506-6040, USA.
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Oquendo MA, Carballo JJ, Rajouria N, Currier D, Tin A, Merville J, Galfalvy HC, Sher L, Grunebaum MF, Burke AK, Mann JJ. Are high-lethality suicide attempters with bipolar disorder a distinct phenotype? Arch Suicide Res 2009; 13:247-56. [PMID: 19590998 PMCID: PMC3767989 DOI: 10.1080/13811110903044385] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Because Bipolar Disorder (BD) individuals making highly lethal suicide attempts have greater injury burden and risk for suicide, early identification is critical. BD patients were classified as high- or low-lethality attempters. High-lethality attempts required inpatient medical treatment. Mixed effects logistic regression models and permutation analyses examined correlations between lethality, number, and order of attempts. High-lethality attempters reported greater suicidal intent and more previous attempts. Multiple attempters showed no pattern of incremental lethality increase with subsequent attempts, but individuals with early high-lethality attempts more often made high-lethality attempts later. A subset of high-lethality attempters make only high-lethality attempts. However, presence of previous low-lethality attempts does not indicate that risk for more lethal, possibly successful, attempts is reduced.
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Affiliation(s)
- Maria A Oquendo
- Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY 10032, USA.
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Sher L, Milak MS, Parsey RV, Carballo JJ, Cooper TB, Malone KM, Oquendo MA, Mann JJ. Positron emission tomography study of regional brain metabolic responses to a serotonergic challenge in major depressive disorder with and without comorbid lifetime alcohol dependence. Eur Neuropsychopharmacol 2007; 17:608-15. [PMID: 17478085 PMCID: PMC3777232 DOI: 10.1016/j.euroneuro.2007.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Revised: 03/15/2007] [Accepted: 03/26/2007] [Indexed: 11/18/2022]
Abstract
This is the first study contrasting regional glucose metabolic rate (rCMRglu) responses to a serotonergic challenge in major depressive disorder (MDD) with and without comorbid alcohol dependence. In a university hospital, patients with MDD without a history of alcohol dependence (MDD only) and patients with MDD and comorbid alcohol dependence (MDD/ALC) were enrolled in this study. Subjects with comorbid borderline personality disorder were excluded. A bolus injection of approximately 5 mCi of (18)fluorodeoxyglucose was administered 3 h after the administration of placebo or fenfluramine. We found an anterior medial prefrontal cortical area where MDD/ALC subjects had more severe hypofrontality than MDD only patients. This area encompassed the left medial frontal and left and right anterior cingulate gyri. This group difference disappeared after fenfluramine administration. The fact that the observed group difference disappeared after the fenfluramine challenge suggests that serotonergic mechanisms play a role in the observed differences between the groups.
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Affiliation(s)
- Leo Sher
- Division of Neuroscience, Department of Psychiatry, Columbia University, New York, NY 10032, USA.
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Harned MS, Najavits LM, Weiss RD. Self-harm and suicidal behavior in women with comorbid PTSD and substance dependence. Am J Addict 2007; 15:392-5. [PMID: 16966196 DOI: 10.1080/10550490600860387] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
This study examined the frequency, methods, and correlates of self-harm and suicidal behavior in 65 outpatient women with comorbid posttraumatic stress disorder (PTSD) and substance dependence (SD). Results showed high rates of suicide attempts, self-harm, suicidal ideation, and self-harm ideation for the prior three months. The most common methods were overdosing and cutting/scratching. Both PTSD and SD were perceived as contributing to self-harm and suicidal behavior. Women who had and had not engaged in such behavior differed in SD diagnoses and reasons for staying safe, but not in the number or type of traumatic experiences, age at first trauma, or substance abuse diagnoses.
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Affiliation(s)
- Melanie S Harned
- Department of Psychology, University of Washington, Seattle, Washington 98195-5125, USA.
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Dervic K, Grunebaum MF, Burke AK, Mann JJ, Oquendo MA. Cluster C personality disorders in major depressive episodes: the relationship between hostility and suicidal behavior. Arch Suicide Res 2007; 11:83-90. [PMID: 17178644 PMCID: PMC3779124 DOI: 10.1080/13811110600992928] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There is some evidence for an association between Cluster C Personality Disorders (CCPD) and suicidal behavior. We compared depressed inpatients with and without CCPD in terms of suicidal behavior and associated psychopathology. Cluster A or B personality disorder co-morbidity were exclusion criteria for both groups (cases and controls). Depressed inpatients with "pure" CCPD had higher levels of suicidal ideation but not more previous suicide attempts compared with patients without CCPD. Greater suicidal ideation in depressed patients with CCPD in our study was associated with more hostility. Future studies examining the relationship between suicidal ideation and hostility in CCPD may clarify whether treatment focused on hostility might be of use for decreasing suicidal ideation in depressed patients with CCPD (Spitzer, Williams, Gibbon et al., 1990).
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Affiliation(s)
- Kanita Dervic
- Department of Child and Adolescent Neuropsychiatry/University Hospital, Medical University of Vienna, Austria
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Berman ME, Celeste Walley J. Imitation of Self-Aggressive Behavior: An Experimental Test of the Contagion Hypothesis1. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2003. [DOI: 10.1111/j.1559-1816.2003.tb01937.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Eskin M. Swedish translations of the Suicide Probability Scale, Perceived Social Support from Friends and Family Scales, and the Scale for Interpersonal Behavior: a reliability analysis. Scand J Psychol 1993; 34:276-81. [PMID: 8378756 DOI: 10.1111/j.1467-9450.1993.tb01122.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The Suicide Probability Scale (SPS), the Perceived Social Support (PSS) from Friends (PSS-Fr) and Family (PSS-Fa) scales, and the Scale for Interpersonal Behavior (SIB) were translated into Swedish and their reliability was estimated in a university student sample. The reliability coefficients indicated that both subscales and the total scales of the SPS, PSS, and SIB possess highly adequate reliabilities. The intercorrelations among the subscales and between the subscales and the total scales were found to be highly significant. The results of the study supported the use of SPS, PSS-Fr and PSS-Fa, and the SIB as reliable methods for assessing suicide risk, perceived social support from friends and family, and assertive behavior.
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Range L, Antonelli K. A Factor Analysis of Six Commonly Used Instruments Associated With Suicide Using College Students. J Pers Assess 1990. [DOI: 10.1207/s15327752jpa5503&4_37] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Neyra CJ, Range LM, Goggin WC. Reasons for Living Following Success and Failure in Suicidal and Nonsuicidal College Students1. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 1990. [DOI: 10.1111/j.1559-1816.1990.tb01464.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Merz B. 'Deradiating' the former uranium capital. JAMA 1987; 11:e39482. [PMID: 3612975 PMCID: PMC9536525 DOI: 10.2196/39482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022]
Abstract
Background The use of validated instruments means providing health professionals with reliable and valid tools. The Nurses’ Global Assessment of Suicide Risk (NGASR) scale has proven to be valid and reliable in supporting the nursing evaluation of suicide risk in different languages and cultural environments. Objective The aims of our study are to translate and adapt the NGASR scale for the Spanish population and evaluate its psychometric properties in patients with suicide risk factors. Methods The translation, adaptation, and modeling of the tool will be performed. The sample will include 165 participants. The psychometric analysis will include reliability and validity tests of the tool’s internal structure. The tool’s reliability will be assessed by exploring internal consistency and calculating the Cronbach α coefficient; significance values of .70 or higher will be accepted as indicators of good internal consistency. The underlying factor structure of the Spanish version of the NGASR scale will be assessed by performing an exploratory factor analysis. The Kaiser-Meyer-Olkin measure of sample adequacy and the Bartlett sphericity statistic will be calculated beforehand. For the latter, if P is <.05 for the null hypothesis of sphericity, the null hypothesis will be rejected. Results Participants will be recruited between April 2022 and December 2022. Our study is expected to conclude in the first quarter of 2023. Conclusions We hope to find the same firmness that colleagues have found in other countries in order to consolidate and promote the use of the NGASR tool in the Spanish population. The prevention and treatment of suicidal behavior require holistic, multidisciplinary, and comprehensive management. International Registered Report Identifier (IRRID) PRR1-10.2196/39482
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