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Brown GK, Wolk CB, Green KL, Nezir F, Mowery DL, Gallop R, Reilly ME, Stanley B, Mandell DS, Oquendo MA, Jager-Hyman S. Safety planning intervention and follow-up: A telehealth service model for suicidal individuals in emergency department settings: Study design and protocol. Contemp Clin Trials 2024; 140:107492. [PMID: 38484793 PMCID: PMC11071175 DOI: 10.1016/j.cct.2024.107492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND The Safety Planning Intervention with follow-up services (SPI+) is a promising suicide prevention intervention, yet many Emergency Departments (EDs) lack the resources for adequate implementation. Comprehensive strategies addressing structural and organizational barriers are needed to optimize SPI+ implementation and scale-up. This protocol describes a test of one strategy in which ED staff connect at-risk patients to expert clinicians from a Suicide Prevention Consultation Center (SPCC) via telehealth. METHOD This stepped wedge, cluster-randomized trial compares the effectiveness, implementation, cost, and cost offsets of SPI+ delivered by SPCC clinicians versus ED-based clinicians (enhanced usual care; EUC). Eight EDs will start with EUC and cross over to the SPCC phase. Blocks of two EDs will be randomly assigned to start dates 3 months apart. Approximately 13,320 adults discharged following a suicide-related ED visit will be included; EUC and SPCC samples will comprise patients from before and after SPCC crossover, respectively. Effectiveness data sources are electronic health records, administrative claims, and the National Death Index. Primary effectiveness outcomes are presence of suicidal behavior and number/type of mental healthcare visits and secondary outcomes include number/type of suicide-related acute services 6-months post-discharge. We will use the same data sources to assess cost offsets to gauge SPCC scalability and sustainability. We will examine preliminary implementation outcomes (reach, adoption, fidelity, acceptability, and feasibility) through patient, clinician, and health-system leader interviews and surveys. CONCLUSION If the SPCC demonstrates clinical effectiveness and health system cost reduction, it may be a scalable model for evidence-based suicide prevention in the ED.
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Affiliation(s)
- Gregory K Brown
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelly L Green
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Freya Nezir
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Danielle L Mowery
- Department of Biostatistics, Epidemiology, & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Gallop
- Department of Biostatistics, Epidemiology, & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Mathematics, West Chester University of Pennsylvania, West Chester, PA, USA
| | - Megan E Reilly
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara Stanley
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shari Jager-Hyman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Clary KL, Murley WD, Ortiz RS, Rogers ML. A step forward in conceptualizing psychological closeness/distance to suicide methods: A qualitative approach. Suicide Life Threat Behav 2024. [PMID: 38634715 DOI: 10.1111/sltb.13075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/04/2024] [Accepted: 03/13/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Suicide is a leading cause of death, making suicide prevention a major public health priority. Increasing understanding of factors influencing suicidal behavior is paramount. Previous research has implicated psychological closeness, characterized by perceptions of how close/distant or attached/detached one feels to a particular object, as a cognitive factor that influences suicidal behavior. However, a better understanding of how psychological closeness to suicide methods is conceptualized by relevant populations is needed to improve its assessment and understand how it may confer risk for suicide. METHODS The goal was to refine the conceptualization of psychological closeness to suicide methods by incorporating feedback from relevant populations. We conducted 30 interviews with those primarily identifying as having lived experience of suicide (n = 10), clinicians who work with suicidal patients (n = 11), and suicide researchers (n = 9). A rigorous thematic approach using NVivo software was used to uncover common themes. RESULTS Primary themes included familiarity, comfort, and attachment, with one emerging theme of symbolism. We define these themes, provide context to their meaning, and share exemplary quotes across diverse participants. CONCLUSION We consider clinical, research, and policy implications from an interdisciplinary lens and discuss the strengths and limitations of this study.
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Affiliation(s)
- Kelly L Clary
- School of Social Work, Texas State University, San Marcos, Texas, USA
| | - William D Murley
- Department of Psychology, Texas State University, San Marcos, Texas, USA
| | - Rachel S Ortiz
- School of Social Work, Texas State University, San Marcos, Texas, USA
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, Texas, USA
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Stanley IH, Anestis MD, Bryan CJ, Moceri-Brooks J, Baker JC, Buck-Atkinson J, Bryan AO, Johnson M, Hunter K, Johnson RL, Xiao M, Betz ME. Project Safe Guard: Challenges and opportunities of a universal rollout of peer-delivered lethal means safety counseling at a US military installation. Suicide Life Threat Behav 2024. [PMID: 38380441 DOI: 10.1111/sltb.13050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
INTRODUCTION The US Department of Defense recommends lethal means safety counseling (LMSC) to promote firearm injury prevention via secure storage of personal firearms. We describe the rollout of a universal, peer-delivered adaptation of Project Safe Guard (PSG)-a brief, single-session LMSC discussion-at a US Space Force installation. METHOD Program evaluation data were collected via anonymous, voluntary, and online surveys. Of approximately 862 eligible active-duty service members and embedded civilians, 324 completed the preprogram survey and 68 and 37 completed the 1- and 2-month follow-ups, respectively. RESULTS At preprogram, 69.1% agreed that peer-delivered LMSC is appropriate. After rollout, 100% of the 222 firearm locking devices available to service members were requested from the on-base Violence Prevention Integrator. The effectiveness of PSG was indeterminable due to the low survey response rates. CONCLUSIONS Despite strong preprogram support for peer-delivered LMSC and behavioral indicators of secure firearm storage (e.g., firearm locking device requests), several challenges limited the uptake and evaluability of the PSG program in this naturalistic environment, including military survey fatigue and competing mission priorities. Additional work is needed to determine the effectiveness of peer-delivered LMSC in a military context. Sustained base support and military-civilian collaborations will be critical.
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Affiliation(s)
- Ian H Stanley
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Center for COMBAT Research, University of Colorado School of Medicine, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michael D Anestis
- New Jersey Gun Violence Research Center, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Department of Veterans Affairs, VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
| | - Jayna Moceri-Brooks
- New Jersey Gun Violence Research Center, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Justin C Baker
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jessica Buck-Atkinson
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - AnnaBelle O Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Megan Johnson
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Mengli Xiao
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
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Rainbow C, Tatnell R, Blashki G, Melvin GA. Perceived Usefulness of Self-Guided Versus Collaborative Suicide Safety Plans in Online Help-Seekers. CRISIS 2024. [PMID: 38319612 DOI: 10.1027/0227-5910/a000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background: Suicide safety plans were originally devised to be paper-based and clinician-guided, but digital self-guided plans are now common. Aim: This study explored whether plan format (paper vs. digital), assistance (self-authored vs. collaboration), and suicide attempt history were associated with differences in suicidal ideation, suicide-related coping, and perceived usefulness. Method: An online sample of safety plan users (N = 131) completed a survey assessing suicidal ideation, suicide-related coping, and perceived usefulness of their plan. t tests compared outcomes by plan format, collaboration, and suicide attempt history. Pearson correlations explored associations between reasons for plan use, suicidal ideation, and suicide-related coping. Results: Suicidal ideation was significantly higher, and perceived usefulness significantly lower in participants with a past suicide attempt (vs. none) and in those who had collaborated to make their safety plan (vs. self-authored). Collaborators were largely health professionals. No significant differences were found between plan formats. Suicide-related coping was associated with higher perceived usefulness overall. Limitations: Our study design was cross-sectional, utilizing a largely young, female, English-speaking, online help-seeking sample. Conclusions: For clients with prior suicide attempts and higher levels of suicidal ideation, meaningful collaboration may be needed to find safety plan coping strategies that are perceived as useful.
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Affiliation(s)
- Christopher Rainbow
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Ruth Tatnell
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Grant Blashki
- Nossal Institute for Global Health, University of Melbourne, VIC, Australia
- Beyond Blue, Melbourne, VIC, Australia
| | - Glenn A Melvin
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Melbourne, VIC, Australia
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Stanley IH, Hom MA, Wright A. Emergency medical services (EMS) clinicians' views on EMS-delivered interventions to promote secure firearm storage practices. Suicide Life Threat Behav 2024; 54:4-14. [PMID: 38243662 DOI: 10.1111/sltb.13005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/18/2023] [Accepted: 09/19/2023] [Indexed: 01/21/2024]
Abstract
INTRODUCTION Lethal means safety counseling (LMSC) to promote secure firearm storage may reduce the risk of firearm-involved deaths, including suicide. We examined if emergency medical services (EMS) clinicians, including emergency medical technicians and paramedics, may be suitable LMSC messengers. METHOD We conducted a web-based survey of 229 US EMS clinicians. RESULTS While few EMS clinicians supported EMS-delivered LMSC to all patients (17.0%), most supported EMS-delivered LMSC to patients in an acute suicidal crisis (64.2%) or with a known suicide attempt history (55.9%). Barriers to EMS-delivered LMSC included lack of training (73.4%), perceptions that LMSC is outside EMS clinicians' scope of practice (58.1%), and lack of standard operating procedures (56.3%). Most reported at least some interest in receiving training on EMS-delivered LMSC (67.7%). Participants holding more accurate beliefs about the link between firearm storage practices and suicide risk, as well as the efficacy of LMSC, were more likely to support EMS-delivered LMSC across patient scenarios (ORs = 2.18-5.21, ps <0.01) and express interest in receiving LMSC training (ORs = 3.78-5.43, ps <0.001). CONCLUSION Given that many EMS clinicians interface with patients at elevated suicide risk, targeted LMSC training may be strategic; however, research is needed to determine if and how EMS clinicians might be viable LMSC messengers.
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Affiliation(s)
- Ian H Stanley
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Center for COMBAT Research, University of Colorado School of Medicine, Colorado, Aurora, USA
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Melanie A Hom
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Angela Wright
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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MacDonald C, Caimino C, Burns-O’Connell G, Hartley D, Lockwood J, Sereda M, Whitmer W, Cima R, Turton L, Hoare DJ. Tinnitus, Suicide, and Suicidal Ideation: A Scoping Review of Primary Research. Brain Sci 2023; 13:1496. [PMID: 37891863 PMCID: PMC10605905 DOI: 10.3390/brainsci13101496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Tinnitus (the perception of sound in the absence of any corresponding external source) is highly prevalent and can be distressing. There are unanswered questions about how tinnitus, suicidal thoughts, and suicidal behaviours co-occur and interact. To establish the extent of scientific literature, this scoping review catalogued primary reports addressing the associations between tinnitus, suicidal ideation, attempted suicide, and death by suicide. We searched OvidSP, Medline, EMBASE, PsycINFO, CINAHL, Google Scholar, EThoS, and ProQuest for all studies and case reports on ideation and/or attempted and/or completed suicide in the context of tinnitus. Twenty-three studies were included, and data were charted according to study type. Several epidemiological and other observational studies gave evidence of risk factors and an association between suicidal ideation, suicidal behaviour, and tinnitus. However, there was no evidence of the direction of causality. Qualitative studies are indicated to explore the patient's experience and understand the dynamics of any interaction between tinnitus and suicidal thoughts and behaviours. A theory-informed model of tinnitus and suicide needs to be developed to inform the development of interventions and how tinnitus patients are supported clinically.
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Affiliation(s)
- Carol MacDonald
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK (D.J.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- Department of Psychology, University of Stirling, Stirling FK9 4LA, UK
| | | | | | - Douglas Hartley
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK (D.J.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - Joanna Lockwood
- NIHR MindTech MedTech Co-Operative, Institute of Mental Health, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK;
| | - Magdalena Sereda
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK (D.J.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - William Whitmer
- Hearing Sciences: Scottish Section, Glasgow, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK;
| | - Rilana Cima
- Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven University, 3000 Leuven, Belgium;
- Tinnitus Center of Expertise, Centre of Expertise in Rehabilitation and Audiology, Adelante, 6432 CC Hoensbroek, The Netherlands
- Experimental Health Psychology, Faculty of Psychology and Neurosciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | | | - Derek J. Hoare
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK (D.J.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
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Bryan CJ, Daruwala SE, Tabares JV, Butner JE, Coccaro EF, Gorka SM. Heightened threat perceptions and reduced stability in anxiety and fear among U.S. adults who carry handguns. J Anxiety Disord 2023; 99:102764. [PMID: 37597342 PMCID: PMC10543589 DOI: 10.1016/j.janxdis.2023.102764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/31/2023] [Accepted: 08/11/2023] [Indexed: 08/21/2023]
Abstract
Firearm carrying is often motivated to provide safety and is correlated with increased anxiety related to elevated perceptions of the world as a dangerous place. No studies have investigated affective states among firearm owners as they occur in their natural environments. This study used ecological momentary assessment (EMA) to examine cognitive-affective states among firearm owners who carry handguns outside their home (n = 35), firearm owners who do not carry (n = 47), and non-firearm owners (n = 62). Participants completed a self-report questionnaire at baseline followed by EMA surveys of mood state with the Positive and Negative Affect Scale (PANAS) 6 times per day for 28 consecutive days. Carry handgun owners reported significantly higher threat perceptions, measured with the negative cognitions about the world subscale of the shortened Posttraumatic Cognitions Inventory (PTCI), than no-carry handgun owners (Mdiff=2.0, 95% CI=0.8-2.0, d=0.45, p = .001) and non-owners (Mdiff=1.8, 95% CI=0.6-2.9, d=0.42, p = .003). Groups did not significantly differ in mean momentary mood ratings assessed via EMA but stability in high-arousal negative arousal was significantly reduced among carry handgun owners (F(2, 150)= 3.7, p = .026). Results suggest firearm owners who carry handguns view the world as especially dangerous, are more likely to experience shifts in anxiety and fear, and take longer to recover from periods of elevated anxiety and fear.
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Affiliation(s)
- Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 3650 Olentangy River Rd, Suite 330, Columbus, OH 43214, United States.
| | - Samantha E Daruwala
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 3650 Olentangy River Rd, Suite 330, Columbus, OH 43214, United States
| | - Jeffrey V Tabares
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 3650 Olentangy River Rd, Suite 330, Columbus, OH 43214, United States
| | - Jonathan E Butner
- Department of Psychology, The University of Utah, 380 1530 E, Salt Lake City, UT 84112, United States
| | - Emil F Coccaro
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 3650 Olentangy River Rd, Suite 330, Columbus, OH 43214, United States
| | - Stephanie M Gorka
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 3650 Olentangy River Rd, Suite 330, Columbus, OH 43214, United States
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Hill RM, Hussain Z, Vieyra B, Gallagher A. Reporting Ethical Procedures in Suicide Prevention Research: Current Status and Recommendations. Arch Suicide Res 2023; 27:1373-1390. [PMID: 36415164 DOI: 10.1080/13811118.2022.2131493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Ethical concerns frequently arise in suicide prevention research regarding participant safety and confidentiality. Despite a substantial literature on managing and navigating ethical concerns in suicide research, little attention has been paid to the reporting of ethical procedures. Furthermore, standard procedures for reporting ethical risk management procedures have not been developed. METHOD A review of the current literature was performed to examine the current state of reporting of ethical procedures within suicide research. Articles published in 2020 (N = 263) from three suicide-focused publications were screened and then coded (n = 131) to identify reporting of procedures for the ethical conduct of research and suicide risk management steps taken by the research teams. RESULTS The majority of articles reported ethical review or approval (84.7%) and reported the use of an informed consent process (77.9%). Only 28.2% included risk mitigation procedures. Of those 29.7% of those articles reported conducting risk evaluation, 66.7% reported resource dissemination, and 51.4% reported an intervention. CONCLUSION As empirical support for brief interventions accrues, suicide prevention researchers should consider establishing standards for the reporting of procedures to ensure the safety of participants with suicidal risk.HighlightsReporting suicide safety protocols helps ensure high ethical standards in research.Fewer than 1/3 of articles reviewed reported risk mitigation procedures in 2020.Standard procedures for reporting safety protocols in suicide research are needed.
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Hoops K, Nestadt PS, Dredze M. The case for social media standards on suicide. Lancet Psychiatry 2023; 10:662-664. [PMID: 37453437 DOI: 10.1016/s2215-0366(23)00222-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Katherine Hoops
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - Paul S Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Mark Dredze
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
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Kleespies PM, Feinman A, AhnAllen CG, Hausman C, Thach T, Woodruff J, Loomis S, Bongar B. A national survey of doctoral psychology education and training in suicide risk and violence risk assessment and management. Suicide Life Threat Behav 2023; 53:666-679. [PMID: 37357810 DOI: 10.1111/sltb.12972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/28/2023] [Accepted: 05/15/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION When, in the judgment of a mental health professional, patient suicide risk and/or patient violence risk are considered imminent, they have been referred to as behavioral emergencies. Past surveys have suggested that education and training with these emergency situations have been inadequate. The present study was undertaken to obtain more current information on the training that psychologists receive in these areas of practice. METHOD All directors of APA-accredited graduate psychology programs and all directors of APA-accredited predoctoral psychology internship programs were asked to complete an online survey inquiring about such training provided in their programs. RESULTS Results indicated that both sets of directors rated such doctoral training in suicide risk assessment and management as very important. Internship directors, however, were significantly more likely than graduate program directors to state that psychologists should be required to complete continuing education courses on other-directed violence risk. Serious gaps in training were identified; that is, only 59.2% of psychology graduate directors reported that their program offered training in safety planning for suicide risk and only 25.4% reported that their program offered training in safety planning for violence risk. CONCLUSION Given that serious injury and even death can occur from patient suicidal behavior and/or a patient violent behavior, the implications of these findings are discussed.
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Affiliation(s)
| | - Anna Feinman
- Palo Alto University, Palo Alto, California, USA
| | | | | | - Tina Thach
- Palo Alto University, Palo Alto, California, USA
| | | | | | - Bruce Bongar
- Palo Alto University, Palo Alto, California, USA
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Houtsma C, Powers J, Raines AM, Bailey M, Barber C, True G. Engaging stakeholders to develop a suicide prevention learning module for Louisiana firearm training courses. Inj Epidemiol 2023; 10:3. [PMID: 36631823 PMCID: PMC9832758 DOI: 10.1186/s40621-023-00413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Firearm suicide is a significant public health problem in the United States of America among the general and veteran populations. Broad-based preventive strategies, including lethal means safety, have been emphasized as a key approach to suicide prevention. Prior research has identified ways to improve the reach and uptake of lethal means safety messages. However, few resources have been created with these lessons in mind. METHODS Louisiana firearm owners and instructors were recruited through a larger project, Veteran-Informed Safety Intervention and Outreach Network, as well as a publicly available database of firearm instructors to participate in focus groups to provide feedback on an existing suicide prevention learning module (developed in Utah) for use by firearm instructors. Their feedback was used to adapt the module, which included a brief video and PowerPoint presentation. Firearm owners and instructors were then invited back for another round of focus groups to provide feedback on this adapted learning module. Team-based rapid qualitative analysis was conducted to identify themes across transcripts from these four focus groups. RESULTS Firearm owners and instructors agreed on several key themes, including the importance of messenger relatability and aligning the lethal means safety message with firearm owner values. Feedback suggested these themes were adequately addressed in the adapted learning module and contributed to overall module acceptability. The final theme, present across the original and adapted learning modules (i.e., Utah and Louisiana), was openness to further information and training on firearm suicide prevention. CONCLUSION Consistent with a public health approach to suicide prevention, the current study used stakeholder engagement to develop a suicide prevention learning module perceived as representative, accurate, and acceptable to Louisiana firearm owners and instructors. These findings can be used to inform firearm suicide prevention efforts in other states.
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Affiliation(s)
- Claire Houtsma
- Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70119 USA
- South Central Mental Illness Research, Education and Clinical Center, New Orleans, LA USA
- Louisiana State University Health Sciences Center, New Orleans, LA USA
| | - Jeffrey Powers
- Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70119 USA
- Louisiana State University, Baton Rouge, LA USA
| | - Amanda M. Raines
- Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70119 USA
- South Central Mental Illness Research, Education and Clinical Center, New Orleans, LA USA
- Louisiana State University Health Sciences Center, New Orleans, LA USA
| | - Matthew Bailey
- Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70119 USA
| | | | - Gala True
- Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70119 USA
- South Central Mental Illness Research, Education and Clinical Center, New Orleans, LA USA
- Louisiana State University Health Sciences Center, New Orleans, LA USA
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Lowry NJ, Stanley IH, Mournet AM, Wharff EA, Sullivant SA, Teach SJ, Pao M, Horowitz LM, Bridge JA. Firearms Access among Pediatric Patients at Risk for Suicide. Arch Suicide Res 2022:1-10. [PMID: 35924876 PMCID: PMC9898460 DOI: 10.1080/13811118.2022.2106924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Approximately 2,900 youth who die by suicide each year in the United States use a firearm. To inform lethal means safety counseling efforts, this study aimed to describe firearm access among youth deemed at risk for suicide in pediatric medical settings. METHODS Youth who presented to one of four urban pediatric medical centers were screened for suicide risk and access to firearms. Suicide risk was determined by a positive screen on the Ask Suicide-Screening Questions (ASQ) tool. Firearm access was assessed via a structured questionnaire. RESULTS This secondary analysis analyzed data from 1065 youth aged 10 to 17 years. Overall, 110 (10.3%) participants screened positive for suicide risk. Among those at risk, 28% (31/110) reported guns kept in or around their home, 8% (9/110) had access to a firearm, and 5% (6/110) reported that bullets were not stored separately from the guns. CONCLUSIONS Over a quarter of youth at risk for suicide reported a firearm stored in or around their home. To ensure the safety of young people at risk for suicide, clinicians should assess whether youth have access to firearms and conduct lethal means safety counseling with youths, as developmentally appropriate, and their parent/caregivers.HIGHLIGHTS28% of pediatric patients deemed "at risk" for suicide in this study reported a firearm kept in or around their home.Among youth at risk for suicide, 8% reported having access to a firearm.These results add further evidence that it is important for clinicians to conduct lethal means safety counseling with patients and their families.
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Vélez-Grau C, Romanelli M, Lindsey MA. Adolescent suicide attempts in the United States: When suicide ideation and suicide capability interact. Suicide Life Threat Behav 2022; 52:549-566. [PMID: 35156223 DOI: 10.1111/sltb.12845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Guided by the interpersonal theory of suicide, this study examined whether the relationship between level of suicide ideation and attempted suicide varies as a function of suicide capability. METHODS Cross-sectional data were obtained from the 2017 and 2019 Youth Risk Behavior Survey in which 28,442 respondents were sampled. Confirmatory factor analysis was conducted to create a latent suicide capability variable. Structural equation modeling was used to test the moderating effects of suicide capability on the relationship between level of suicide ideation and attempted suicide, adjusting for sociodemographic characteristics, sadness/hopelessness, and the sampling design. RESULTS Compared to adolescent with no reported ideation, those reporting single and dual ideation experienced increased odds of attempted suicide. The relationship between level of suicide ideation and attempted suicide significantly varied as a function of capability. While adolescents with dual suicide ideation experienced higher rates of attempted suicide at increasing levels of capability, faster rates of change of attempted suicide at increasing levels of capability were observed among those with single and no reported ideation. CONCLUSION Capability may heighten the risk of suicide attempts among youth, suggesting that treatment efforts could be directed at reducing exposure to painful and provocative experiences associated with suicide behaviors.
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Affiliation(s)
- Carolina Vélez-Grau
- New York University, NYU McSilver Institute for Poverty Policy and Research, New York, New York, USA
| | - Meghan Romanelli
- University of Washington, NYU McSilver Institute for Poverty Policy and Research, Seattle, Washington, USA
| | - Michael A Lindsey
- New York University Silver School of Social Work, NYU McSilver Institute for Poverty Policy and Research, New York, New York, USA
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An analysis of suicidal thoughts and behaviors among transgender and gender diverse adults. Soc Psychiatry Psychiatr Epidemiol 2022; 57:195-205. [PMID: 34106286 DOI: 10.1007/s00127-021-02115-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Suicidal thoughts and behaviors (STBs) remain a pressing public health problem for transgender and gender diverse (TGD) persons. The goal of this study was to apply social-ecological and minority stress frameworks to identify individual and interpersonal-level TGD-specific STB risk and protective factors. METHODS This is a secondary analysis of the 2015 United States Transgender Health Survey, a comprehensive cross-sectional health assessment of a national sample of TGD adults (N = 27,658). Chi-square and Analysis of Variance (ANOVA) were used to identify bivariate correlates of 12-month and lifetime suicidal ideation (SI) and suicide attempt (SA). Logistic regression was employed to identify the strongest STB risk and protective factors across levels. RESULTS Sexual minority identification, racial minority identification, and having a disability were lifetime STB risk factors. TGD identity, sexual minority identification, racial minority identification (SA only), lower education, lower income, military experience, having a disability, and being uninsured were 12-month STB risk factors. Psychological distress was the most robust STB risk factor. Workplace discrimination, family rejection, healthcare discrimination, and childhood bias-based victimization were lifetime STB risk factors. All forms of discrimination and victimization (with the exception of family rejection for SI) were 12-month STB risk factors. Family and coworker support were protective factors for lifetime SA (but not SI) and all 12-month STBs. Being less out about TGD identity was a protective factor for STBs (except for 12-month SI). CONCLUSION Findings support social-ecological and minority stress STB risk frameworks. Recommendations are provided for a comprehensive approach to TGD suicide prevention.
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Boggs JM, Quintana LM, Powers JD, Hochberg S, Beck A. Frequency of Clinicians' Assessments for Access to Lethal Means in Persons at Risk for Suicide. Arch Suicide Res 2022; 26:127-136. [PMID: 32379012 DOI: 10.1080/13811118.2020.1761917] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE We measured the frequency of clinicians' assessments for access to lethal means, including firearms and medications in patients at risk of suicide from electronic medical and mental health records in outpatient and emergency settings. METHODS We included adult patients who reported suicide ideation on the PHQ-9 depression screener in behavioral health and primary care outpatient settings of a large integrated health system in the U.S. and those with suicidal behavior treated in the emergency department. Two separate natural language processing queries were developed on medical record text documentation: (1) assessment for access to firearms (8,994 patients), (2) assessment for access to medications (4,939 patients). RESULTS Only 35% of patients had documentation of firearm or medication assessment in the month following treatment for suicidal behavior in the emergency setting. Among those reporting suicidal ideation in outpatient setting, 31% had documentation of firearm assessment and 23% for medication assessment. The accuracy of the estimates was very good for firearm assessment (F1 = 89%) and medication assessment in the outpatient setting (F1 = 91%) and fair for medication assessment in the emergency setting (F1 = 70%) due to more varied documentation styles. CONCLUSIONS Lethal means assessment following report of suicidal ideation or behavior is low in a nonacademic health care setting. Until health systems implement more structured documentation to measure lethal means assessment, such as discrete data field, NLP methods may be used to conduct research and surveillance of this important prevention practice in real-world settings.
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Henderson E. Conceptualizing Suicide Prevention in Firefighters Through the lens of the Interpersonal-Psychological Theory of Suicide: A Narrative Review. Arch Suicide Res 2022; 26:28-43. [PMID: 32589858 DOI: 10.1080/13811118.2020.1779152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Suicide is the 10th leading cause of death in the United States and is a significant public health problem. Suicide has also become a major concern among career American firefighters with rates for suicidal ideation and attempts in firefighters two to three times higher than rates in the general population. Firefighter suicide and mental health are major issues facing fire service leaders, mental health professionals, and most recently suicide experts. Despite an increased focus on understanding suicide in the fire service, there is little empirical evidence on the effectiveness of prevention in this population. The juxtaposition of elevated suicide rates with a dearth of empirical prevention data specific to firefighters warrants new approaches and conceptualizations of suicide prevention in this population. Grounded in the framework of the interpersonal-psychological theory of suicide (IPTS), this narrative review integrates select relevant firefighter specific suicide risk/protective factors and multi-level intervention/prevention literature to provide a structured approach to identifying current suicide intervention/prevention efforts with promising transportability to firefighters. Several recommendations for future intervention research specific to firefighters are also proposed.
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David Rudd M, Bryan CJ, Jobes DA, Feuerstein S, Conley D. A Standard Protocol for the Clinical Management of Suicidal Thoughts and Behavior: Implications for the Suicide Prevention Narrative. Front Psychiatry 2022; 13:929305. [PMID: 35903634 PMCID: PMC9314639 DOI: 10.3389/fpsyt.2022.929305] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
The last several decades have witnessed growing and converging evidence from randomized controlled trials (RCT's) that an identifiable set of simple clinical management strategies are effective for those at risk for suicidal thinking and/or suicide attempts. The current article offers a brief review of clinical strategies supported by RCT's targeting suicidality as "commonalities of treatments that work" and related recommendations for use in the delivery of care for suicidal individuals in generic fashion, regardless of any particular treatment, theoretical orientation, or intervention perspective. The article includes eight recommendations that can be easily adapted across the full range of clinical contexts, institutional settings, and delivery systems, recommendations that help frame a broader clinical narrative for suicide prevention. Recommendations cut across five identifiable domains or clinical strategies for the delivery of care: (1) informed consent discussion that identifies risks of opting out of care and emphasizes the importance of shared responsibility and a collaborative process, (2) an explanatory model that emphasizes the importance of individual self-management skills and targeting the causes of suicide rather than describing suicidality as a function of mental illness, (3) the importance of proactively identifying barriers to care and engaging in targeted problem-solving to facilitate treatment adherence, (4) a proactive and specific plan for management of future suicidal episodes, and (5) reinforcing the importance of taking steps to safeguard lethal means and facilitate safe storage of firearms.
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Affiliation(s)
- M David Rudd
- Department of Psychology, University of Memphis, Memphis, TN, United States
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States
| | - David A Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, United States
| | - Seth Feuerstein
- Department of Psychiatry, College of Medicine, Yale University, New Haven, CT, United States
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Hill RM, Gallagher KAS, Eshtehardi SS, Uysal S, Hilliard ME. Suicide Risk in Youth and Young Adults with Type 1 Diabetes: a Review of the Literature and Clinical Recommendations for Prevention. Curr Diab Rep 2021; 21:51. [PMID: 34902071 PMCID: PMC8666467 DOI: 10.1007/s11892-021-01427-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 10/30/2022]
Abstract
PURPOSE OF REVIEW The manuscript reviews the extant literature on suicide-related thoughts and behaviors among youth and young adults with pediatric diabetes. This evidence is presented within the context of current theories of the etiology of suicidal behavior to highlight how diabetes may contribute to suicide risk, and to support providers in understanding the interplay between pediatric diabetes and suicide risk. The manuscript also reviews evidence-based approaches to suicide prevention suitable for use in pediatric healthcare settings, with suggestions for their application to this unique population. RECENT FINDINGS Several recent studies identify heightened rates of suicidal ideation, suicide attempts, and suicide among youth and young adults with pediatric diabetes, as compared with their peers without diabetes. Evidence-based suicide prevention approaches frequently emphasize the importance of reducing suicidal youths' access to potentially lethal means for suicidal behavior. This approach may require special considerations for youth with pediatric diabetes, due to their need to carry sufficient quantities of insulin and the dangers of inaccurate insulin dosing and/or overdose. Suggestions for suicide prevention for this population include risk screening as part of routine diabetes care, early prevention, education for youth and families, and provider awareness of risk factors, warning signs, and implications for diabetes care. Youth and young adults with diabetes reported elevated rates of suicide-related behaviors as compared with their peers without diabetes. Existing suicide prevention approaches may require substantial adaptation for use with youth and young adults with diabetes. Further research is needed to examine how to best prevent suicidal behaviors among this population.
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Affiliation(s)
- Ryan M Hill
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, USA
| | - Katherine A S Gallagher
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Sahar S Eshtehardi
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Serife Uysal
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
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Marzano L, Katsampa D, Mackenzie JM, Kruger I, El-Gharbawi N, Ffolkes-St-Helene D, Mohiddin H, Fields B. Patterns and motivations for method choices in suicidal thoughts and behaviour: qualitative content analysis of a large online survey. BJPsych Open 2021; 7:e60. [PMID: 33622447 PMCID: PMC8058851 DOI: 10.1192/bjo.2021.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Choice of suicide method can strongly influence the outcome of suicidal behaviour, and is an important aspect of the process and planning involved in a suicide attempt. Yet, the reasons why individuals consider, choose or discard particular methods are not well understood. AIMS This is the first study to explore method choices among people with a history of suicidal behaviour and individuals who have experienced, but not enacted, suicidal thoughts. METHOD Via an online survey, we gathered open-ended data about choice of methods in relation to suicidal thoughts and behaviours, including reasons for and against specific means of harm. RESULTS A total of 712 respondents had attempted suicide, and a further 686 experienced suicidal thoughts (but not acted on them). Self-poisoning was the most commonly contemplated and used method of suicide, but most respondents had considered multiple methods. Method choices when contemplating suicide included a broader range of means than those used in actual attempts, and more unusual methods, particularly if perceived to be lethal, 'easy', quick, accessible and/or painless. Methods used in suicide attempts were, above all, described as having been accessible at the time, and were more commonly said to have been chosen impulsively. Key deterrents against the use of specific methods were the presence of and impact on other people, especially loved ones, and fears of injury and survival. CONCLUSIONS Exploration of method choices can offer novel insights into the transition from suicidal ideation to behaviour. Results underscore the need for preventative measures to restrict access to means and delay impulsive behaviour.
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Affiliation(s)
- Lisa Marzano
- Psychology Department, Middlesex University London, UK
| | | | | | - Ian Kruger
- Department of Computer Science, Middlesex University London, UK
| | | | | | | | - Bob Fields
- Department of Computer Science, Middlesex University London, UK
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20
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Anestis MD, Bryan CJ, Capron DW, Bryan AO. Lethal Means Counseling, Distribution of Cable Locks, and Safe Firearm Storage Practices Among the Mississippi National Guard: A Factorial Randomized Controlled Trial, 2018-2020. Am J Public Health 2021; 111:309-317. [PMID: 33351652 PMCID: PMC7811068 DOI: 10.2105/ajph.2020.306019] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 11/04/2022]
Abstract
Objectives. To examine whether lethal means counseling and provision of cable locks prompt safe firearm storage relative to control among firearm-owning members of the Mississippi National Guard.Methods. This randomized controlled trial utilized a 2 × 2 factorial design (lethal means counseling vs control, provision of cable locks vs no cable locks). Follow-up assessments took place at 3 and 6 months after baseline. Data were collected (n = 232; 87.5% male; mean age = 35.01 years; 77.2% White) from February 2018 through July 2020.Results. Relative to control, lethal means counseling and provision of cable locks resulted in greater adoption of several safe storage methods over time. Lethal means counseling outperformed control (3 months: 55.0% vs 39.0%; odds ratio [OR] = 1.91). Cable locks outperformed control at 3 and 6 months on number of storage methods (1.41 vs 1.11; d = 0.29 and 1.34 vs 1.16; d = 0.15, respectively) and locking devices (59.8% vs 29.9%; OR = 3.49 and 58.4% vs 35.8%; OR = 2.52, respectively)Conclusions. Lethal means counseling and cable locks can result in sustained changes in firearm storage.Public Health Implications. The military may benefit from lethal means counseling, perhaps administering at point of entry.Trial Registration. Clinical Trials.gov identifier: NCT03375099.
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Affiliation(s)
- Michael D Anestis
- Michael D. Anestis is with the New Jersey Gun Violence Research Center and the Department of Urban-Global Public Health, School of Public Health, Rutgers, The State University of New Jersey, Piscataway. Craig J. Bryan and AnnaBelle O. Bryan are with the Department of Psychiatry and Behavioral Health, the Ohio State University Wexner Medical Center, Columbus. Daniel W. Capron is with the School of Psychology, University of Southern Mississippi, Hattiesburg
| | - Craig J Bryan
- Michael D. Anestis is with the New Jersey Gun Violence Research Center and the Department of Urban-Global Public Health, School of Public Health, Rutgers, The State University of New Jersey, Piscataway. Craig J. Bryan and AnnaBelle O. Bryan are with the Department of Psychiatry and Behavioral Health, the Ohio State University Wexner Medical Center, Columbus. Daniel W. Capron is with the School of Psychology, University of Southern Mississippi, Hattiesburg
| | - Daniel W Capron
- Michael D. Anestis is with the New Jersey Gun Violence Research Center and the Department of Urban-Global Public Health, School of Public Health, Rutgers, The State University of New Jersey, Piscataway. Craig J. Bryan and AnnaBelle O. Bryan are with the Department of Psychiatry and Behavioral Health, the Ohio State University Wexner Medical Center, Columbus. Daniel W. Capron is with the School of Psychology, University of Southern Mississippi, Hattiesburg
| | - AnnaBelle O Bryan
- Michael D. Anestis is with the New Jersey Gun Violence Research Center and the Department of Urban-Global Public Health, School of Public Health, Rutgers, The State University of New Jersey, Piscataway. Craig J. Bryan and AnnaBelle O. Bryan are with the Department of Psychiatry and Behavioral Health, the Ohio State University Wexner Medical Center, Columbus. Daniel W. Capron is with the School of Psychology, University of Southern Mississippi, Hattiesburg
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21
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Hom MA, Stanley IH. Considerations in the assessment of help-seeking and mental health service use in suicide prevention research. Suicide Life Threat Behav 2021; 51:47-54. [PMID: 33624881 DOI: 10.1111/sltb.12667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The connection of individuals at elevated suicide risk to mental healthcare services represents a critical component of suicide prevention efforts. This article provides recommendations for enhancing the assessment of help-seeking and mental health service use within the context of suicide prevention research. METHOD We discuss evidence-based and theoretical rationale for improving current approaches to assessing help-seeking and mental health service use among at-risk individuals. RESULTS Recommendations are offered within three domains: (a) consideration of the spectrum of connection to care, (b) assessment of the degree to which mental healthcare services seek to and effectively target suicidal symptoms, and (c) evaluation of the sources and types of treatment and care sought and received by at-risk individuals. CONCLUSIONS To further our understanding of how to bolster connection to care and improve experiences with mental healthcare services among individuals at elevated suicide risk, it is imperative that stakeholders precisely capture the degree, efficacy/effectiveness, and nature of care sought and received by individuals. In so doing, research gaps might be better identified and, ultimately, mental healthcare services might be better leveraged as tools to prevent suicide and support individuals in creating lives they perceive to be worth living.
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Affiliation(s)
- Melanie A Hom
- McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Ian H Stanley
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.,National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
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22
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Titus L, Stephany A, Porada K, McFadden V. Intent, Substance, and Care: Characteristics of Adolescent Ingestion Hospitalizations. Hosp Pediatr 2021; 11:160-166. [PMID: 33468552 DOI: 10.1542/hpeds.2020-0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To characterize the patient population of adolescents hospitalized at a tertiary center for ingestions and identify opportunities to improve health care delivered and resources offered to these adolescents. METHODS Retrospective study of a consecutive sample of adolescent patients (12-18 years old) discharged from the hospitalist service at a large academic pediatric tertiary care center from May 2017 through April 2018. Data were collected regarding patient and hospital encounter characteristics including length of stay, admission service, reason for ingestion, substance(s) ingested, previous suicidal ideation (SI) screening, sexual history documentation, pregnancy testing, disposition at discharge and follow-up with primary care physicians (PCPs). RESULTS Most hospitalizations for ingestions were reported as intentional suicide attempts (79%). Most commonly, adolescents ingested exclusively prescription medications (45%) or over-the-counter medications (32%). Of adolescents with a reported suicide attempt for whom PCP records were available, 56% did not have SI screening documented in the medical record. One-quarter of adolescents hospitalized for an ingestion did not have a sexual history documented, and 11% of female patients were not tested for pregnancy before discharge. A majority (66%) of the adolescents with PCP records available did not follow-up with their PCP within 2 months after their hospitalization. CONCLUSIONS On the basis of our study results, opportunities to improve adolescent health include increased screening for SI and mental health symptoms throughout medical environments, comprehensive risk assessment of all adolescents hospitalized for an ingestion and increased guidance for caregivers of adolescents regarding prescription and over-the-counter medication storage in the home.
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Affiliation(s)
- Lauren Titus
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin; and.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alyssa Stephany
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin; and.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kelsey Porada
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Vanessa McFadden
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin; and .,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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Stanley IH, Sachs-Ericsson NJ, Joiner TE. Suicidal ideation in the context of prospective firearm ownership. Psychiatry Res 2021; 295:113584. [PMID: 33285344 DOI: 10.1016/j.psychres.2020.113584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022]
Abstract
Most suicide deaths in the United States are enacted with a firearm, and recent and first-time purchasers of firearms represent at-risk groups. This study aimed to examine differences in indicators of suicide risk among individuals who either (a) reported current firearm ownership/access or (b) denied current firearm ownership/access but reported an intention to obtain a firearm (i.e., prospective firearm owners). Participants were 96 young adults with a lifetime history of suicidal ideation and firearm ownership, access, or interest. We assessed recent suicidal ideation severity with the Depressive Symptom Index-Suicidality Subscale (DSI-SS) and sought to internally replicate findings with the Patient Health Questionnaire (PHQ-9) item 9. Fifty-two (54.2%) participants reported firearm ownership/access and 44 (45.8%) identified as prospective firearm owners. Prospective firearm owners had significantly greater DSI-SS suicidal ideation severity scores compared with those who already own/have access to a firearm, corresponding to a medium effect size; results were consistent with the PHQ-9 suicidal ideation item. Findings of this initial investigation suggest that the intention to commence firearm ownership might represent an at-risk period, especially for individuals with a history of suicidal thinking. Replication of findings in larger and more clinically severe samples is needed.
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Affiliation(s)
- Ian H Stanley
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32306, USA.
| | - Natalie J Sachs-Ericsson
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32306, USA.
| | - Thomas E Joiner
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32306, USA.
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Suicidality in Chronic Illness: An Overview of Cognitive–Affective and Interpersonal Factors. J Clin Psychol Med Settings 2020; 28:137-148. [DOI: 10.1007/s10880-020-09749-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/18/2022]
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25
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Stanley IH, Hom MA, Marx BP, Reger MA. Post‐traumatic stress disorder and firearm ownership, access, and storage practices: A systematic review. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2020. [DOI: 10.1111/cpsp.12358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hoeflein B, Chiu L, Corpus G, Lien M, Jorden MA, Chu J. Ethnic variations in suicide method and location: An analysis of decedent data. DEATH STUDIES 2020; 46:1282-1286. [PMID: 32790540 DOI: 10.1080/07481187.2020.1805820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study analyzed ethnic variations in suicide method and suicide location for 1,145 suicide deaths in a diverse California county. Hanging was the most common method of suicide death. Latino/a/x and Asian and Pacific Islander (API) decedents were more likely to suicide-by-hanging; White and African American decedents were more likely to suicide-by-firearms. API and African American decedents were less likely than White decedents to die-by-suicide at home. Suicide location can be predicted by the co-occurring influence of ethnicity and suicide method. Implications focus on culturally-informed suicide prevention research, assessment, and risk management.
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Affiliation(s)
| | - Lorna Chiu
- Palo Alto University, Palo Alto, California, USA
| | | | - Mego Lien
- County of Santa Clara Behavioral Health Services Department, Suicide Prevention Program, San Jose, California, USA
| | - Michelle A Jorden
- Santa Clara County Medical Examiner - Coroner, Santa Clara, California, USA
| | - Joyce Chu
- Palo Alto University, Palo Alto, California, USA
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27
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Zortea TC, Cleare S, Melson AJ, Wetherall K, O'Connor RC. Understanding and managing suicide risk. Br Med Bull 2020; 134:73-84. [PMID: 32435794 DOI: 10.1093/bmb/ldaa013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Suicidal behaviours and non-suicidal self-harm (NSSH) are global public health concerns that affect millions of lives. SOURCES OF DATA This review is a narrative synthesis of systematic reviews, meta-analyses of randomized control trials (RCTs) and landmark studies published in scientific journals. AREAS OF AGREEMENT Restricting access to lethal means reduces the likelihood of future suicide deaths. AREAS OF CONTROVERSY Our ability to predict future suicidal behaviour is no better than chance. No individual risk prediction instrument offers sufficient sensitivity and specificity to inform clinically useful decision-making. GROWING POINTS Different types of psychosocial interventions may be effective in preventing future suicide attempts; such interventions include clinical assessment, tailored crisis response and safety plans and follow-up contact. AREAS TIMELY FOR DEVELOPING RESEARCH Whilst some psychosocial interventions can be effective in reducing suicide risk, little is known about the mechanisms of recovery from suicidal thoughts and behaviours.
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Affiliation(s)
- Tiago C Zortea
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - Seonaid Cleare
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - Ambrose J Melson
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - Karen Wetherall
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow
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Crowell-Williamson GA, Fruhbauerova M, DeCou CR, Comtois KA. Perceived burdensomeness, bullying, and suicidal ideation in suicidal military personnel. J Clin Psychol 2019; 75:2147-2159. [PMID: 31332803 PMCID: PMC11000627 DOI: 10.1002/jclp.22836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Suicide is a major public health concern among military servicemembers and previous research has demonstrated an association between bullying and suicide. This study evaluated the association between workplace bullying and suicidal ideation via perceived burdensomeness and thwarted belongingness which were hypothesized to mediate this association. METHOD Four hundred and seventy-one suicidal Army Soldiers and U.S. Marines completed self-report measures of suicidal ideation, thwarted belongingness, perceived burdensomeness, and bullying. A series of regressions were used to test the hypothesized mediation model using the baseline data from a larger clinical trial. RESULTS Perceived burdensomeness was a significant mediator of the association between bullying and the level of suicidal ideation, but thwarted belongingness was not a significant mediator. CONCLUSIONS Perceived burdensomeness may represent a malleable target for intervention to prevent suicide among military service members, and should be evaluated further as an intervening variable with regard to suicidality in the setting of bullying victimization.
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Affiliation(s)
- Gavin A Crowell-Williamson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Martina Fruhbauerova
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Christopher R DeCou
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Katherine A Comtois
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
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Butterworth SE, Anestis MD. Political Beliefs, Region of Residence, and Openness to Firearm Means Safety Measures to Prevent Suicide. Arch Suicide Res 2019; 23:616-633. [PMID: 29952717 DOI: 10.1080/13811118.2018.1486250] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Firearms account for approximately half of all suicides in the United States and are highly lethal, widely available, and popular; thus, are an ideal candidate for targeted means safety interventions. However, despite their value as a suicide prevention tool, firearm means safety strategies are not widely utilized, possibly due to factors which impede openness to their use. This study examines the relationship between region, political beliefs, and openness to firearm means safety in a sample of 300 American firearm owners. Overall, firearm owners were more willing to engage in means safety for others than for themselves and to store firearms safely than temporarily remove them from the home. Social policy views and region were significantly associated with openness to firearm means safety measures, however, economic policy views were not. This study provides further context for the development and implementation of efficacious means safety measures capable of overcoming potential barriers to their use.
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30
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Jobes DA, Vergara GA, Lanzillo EC, Ridge-Anderson A. The potential use of CAMS for suicidal youth: building on epidemiology and clinical interventions. CHILDRENS HEALTH CARE 2019. [DOI: 10.1080/02739615.2019.1630279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- David A. Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - Genesis A. Vergara
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | | | - Abby Ridge-Anderson
- Department of Psychology, The Catholic University of America, Washington, DC, USA
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31
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Rojas SM, Carter SP, McGinn MM, Reger MA. A Review of Telemental Health as a Modality to Deliver Suicide-Specific Interventions for Rural Populations. Telemed J E Health 2019; 26:700-709. [PMID: 31502929 DOI: 10.1089/tmj.2019.0083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Despite recent advancements in the development of new suicide prevention interventions, suicide rates continue to rise in the United States. As such, suicide prevention efforts must continue to focus on expanding dissemination of suicide-specific interventions. Methods: This review explores telemental health through two-way synchronous clinical video telehealth (CVT) technologies as one approach to improving access to suicide-specific interventions. Results: Studies were reviewed if (1) the modality of interest was telemental health by CVT and (2) management, assessment, or intervention of suicidal thoughts or behaviors was discussed. A total of 22 studies were included. Conclusions: Findings from the limited existing studies are synthesized, and recommendations are provided for future research, clinical, and educational advancements.
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Affiliation(s)
- Sasha M Rojas
- VA Puget Sound Health Care System, Seattle, Washington.,University of Arkansas, Fayetteville, Arkansas, USA
| | - Sarah P Carter
- VA Puget Sound Health Care System, Seattle, Washington.,Seattle-Denver Center of Innovation for Veteran-Centered Value-Driven Care, VA Puget Sound Health Services, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Meghan M McGinn
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Mark A Reger
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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32
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Florez IA, LoParo D, Valentine N, Lamis DA. Early Identification of Youth at Risk for Suicidal Behavior. CRISIS 2019; 40:326-332. [PMID: 30644775 DOI: 10.1027/0227-5910/a000569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Early identification and appropriate referral services are priorities to prevent suicide. Aims: The aim of this study was to describe patterns of identification and referrals among three behavioral health centers and determine whether youth demographic factors and type of training received by providers were associated with identification and referral patterns. Method: The Early Identification Referral Forms were used to gather the data of interest among 820 youth aged 10-24 years who were screened for suicide risk (females = 53.8%). Descriptive statistics and binary logistic regressions were conducted to examine significant associations. Results: Significant associations between gender, race, and age and screening positive for suicide were found. Age and race were significantly associated with different patterns of referrals and/or services received by youths. For providers, being trained in Counseling on Access to Lethal Means was positively associated with number of referrals to inpatient services. Limitations: The correlational nature of the study and lack of information about suicide risk and comorbidity of psychiatric symptoms limit the implications of the findings. Conclusion: The results highlight the importance of considering demographic factors when identifying and referring youth at risk to ensure standard yet culturally appropriate procedures to prevent suicide.
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Affiliation(s)
- Ivonne Andrea Florez
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Devon LoParo
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Nakia Valentine
- Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta, GA, USA
| | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Brief measures of physical and psychological distance to suicide methods as correlates and predictors of suicide risk: A multi-study prospective investigation. Behav Res Ther 2019; 120:103330. [DOI: 10.1016/j.brat.2018.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/13/2018] [Accepted: 11/05/2018] [Indexed: 12/16/2022]
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Bryan CJ. Cognitive behavioral therapy for suicide prevention (CBT-SP): Implications for meeting standard of care expectations with suicidal patients. BEHAVIORAL SCIENCES & THE LAW 2019; 37:247-258. [PMID: 31119794 DOI: 10.1002/bsl.2411] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/04/2018] [Accepted: 01/31/2019] [Indexed: 06/09/2023]
Abstract
Accumulating evidence supports the efficacy of cognitive behavioral therapy for suicide prevention (CBT-SP) as an empirically supported treatment approach for suicidal patients. In light of these findings, several procedures pulled from CBT-SP have been recommended for standard care with suicidal patients. The present article provides an overview of the procedures used in CBT-SP and discusses how these procedures meet, or even exceed, standard of care expectations for outpatient mental healthcare clinicians. Finally, the relevance of clinician fidelity to the CBT-SP model when evaluating standard of care expectations is discussed.
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Affiliation(s)
- Craig J Bryan
- National Center for Veterans Studies, Salt Lake City, UT, USA
- Department of Psychology, The University of Utah, Salt Lake City, UT, USA
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35
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Stanley IH, Simpson S, Wortzel HS, Joiner TE. Documenting suicide risk assessments and proportionate clinical actions to improve patient safety and mitigate legal risk. BEHAVIORAL SCIENCES & THE LAW 2019; 37:304-312. [PMID: 31063254 DOI: 10.1002/bsl.2409] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/23/2019] [Accepted: 03/29/2019] [Indexed: 06/09/2023]
Abstract
Few clinical practices are as important for simultaneously augmenting patient safety and mitigating legal risk as the judicious evaluation and stratification of a patient's risk for suicide, proportionate clinical actions based thereon taken by the healthcare provider, and contemporaneous documentation of the foregoing. In this article, we draw from our combined decades of multidisciplinary experience as a clinical psychologist, forensic psychiatrist, medical malpractice attorney, and clinical psychology trainee to discuss the documentation of suicide risk assessment and management as a conduit to patient safety and legal risk mitigation. We additionally highlight documentation as a core clinical competency across disciplines and note areas of improvement, such as increased training, to bolster documentation practices.
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Affiliation(s)
- Ian H Stanley
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | | | - Hal S Wortzel
- Departments of Psychiatry, Neurology, and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver, CO, USA
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Rocky Mountain Regional Medical Center, Denver, CO, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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36
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Teismann T, Forkmann T, Glaesmer H. Risikoabschätzung bei suizidalen Patienten: Geht das überhaupt? VERHALTENSTHERAPIE 2019. [DOI: 10.1159/000493887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hoyt T, Repke DM. Development and Implementation of U.S. Army Guidelines for Managing Soldiers at Risk of Suicide. Mil Med 2019; 184:426-431. [PMID: 30901390 DOI: 10.1093/milmed/usy284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/24/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Despite significant efforts in suicide prevention over the past several years, suicide rates in the U.S. Army remain largely unchanged. This paper describes a collaborative effort between line-unit leaders, medical personnel, and installation services to synchronize suicide risk identification and communication between these disparate entities. METHODS Under the direction of the Installation Director of Psychological Health at Joint Base Lewis-McChord, a Behavioral Health Process Action Team was chartered to identify best practice and formulate policy for identifying and managing service members at risk for suicide. RESULTS Compliance with the new policy reached 100% within 6 months of implementation, as measured by peer review of records. This installation policy was subsequently identified as a best practice and adopted Army-wide as the standard of practice. DISCUSSION Knowledge transfer of research findings into policy and practice is crucial for suicide prevention. The current policy shows good integration of current research with practice in military settings. CONCLUSIONS Combined efforts in crafting policy for risk identification and communication resulted in a policy that was acceptable and feasible from the perspective of commanders and clinicians. Synchronization efforts between commanders, clinicians, and support services are crucial to ensure effective intervention to prevent suicide behavior.
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Affiliation(s)
- Tim Hoyt
- Connected Health Branch, Defense Health Agency, 9933 West Hayes Street, Box 339500 MS 34, Joint Base Lewis-McChord, WA
| | - Diana M Repke
- Department of Behavioral Health, Madigan Army Medical Center, 9040 Jackson Avenue, Joint Base Lewis-McChord, WA
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Non-monotonic temporal variation in fearlessness about death: A latent class growth analysis. Psychiatry Res 2018; 268:46-52. [PMID: 29986178 DOI: 10.1016/j.psychres.2018.06.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/19/2018] [Accepted: 06/27/2018] [Indexed: 11/23/2022]
Abstract
According to the Interpersonal-Psychological Theory of Suicide, fearlessness about death is proposed to increase monotonically (i.e., either increasing or remaining stable) and thus, not be amenable to intervention; however, this assumption has not been explicitly tested. We utilized latent class growth modeling to examine the trajectory of this construct over a brief interval (i.e., data collected every three days over a 15-day time period) among college students (N = 716), and found evidence that fearlessness does not monotonically increase. Specifically, our analyses revealed three classes, each with distinct trajectories over time: a High/Increasing class (i.e., high intercept, significantly increasing slope), Average/Stable class (i.e., average intercept, flat and non-significant slope), and Low/Decreasing class (i.e., low intercept, significantly decreasing slope). The emergence of a Low/Decreasing group is in contrast to the assertion that fearlessness cannot decrease over time. Exploratory results also indicated that lifetime exposure to certain events (e.g., abuse, injury) was associated with membership in the Low/Decreasing class, suggesting that some individuals may be responding differently to painful and/or fear-inducing stimuli than the IPTS predicts. Our findings contradict the current conceptualization of fearlessness about death, and suggest instead that this construct fluctuates upward and downward over a brief interval.
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Suicide Methods According to Age and Sex: An Analysis of Data of 239,565 Suicide Victims in the Republic of Korea From 1991 to 2015. J Nerv Ment Dis 2018; 206:770-775. [PMID: 30273273 DOI: 10.1097/nmd.0000000000000889] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Because suicide is irreversible, prevention is paramount. For the optimal strategy to reduce lethal means, we sought to investigate age- and sex-associated variations in suicide methods. Data on annual causes of death from 1991 to 2015 in the Republic of Korea were used. Major sociodemographic correlates of the five suicide methods were analyzed by multiple multinominal logistic regression analysis. Among a total of 239,565 suicides from 1991 to 2015, hanging was most common. Gas poisoning sharply increased from 2007 to 2015. The gap between hanging and the second most common method of suicide has increased from 659 in 2004 to 4,433 in 2015. Charcoal burning was most commonly used by males younger than 45 years of age, whereas pesticide was commonly used by both sexes ages 55 years and older. Our results suggest that age- and sex-specific suicide prevention strategies are needed, particularly for gas and pesticide poisoning.
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40
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Health Professionals Facing Suicidal Patients: What Are Their Clinical Practices? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061210. [PMID: 29890677 PMCID: PMC6024946 DOI: 10.3390/ijerph15061210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/05/2018] [Accepted: 06/05/2018] [Indexed: 12/15/2022]
Abstract
Clinical work with suicidal people is a demanding area. Little is known about health professionals’ practices when faced with suicidal patients. The aims of this study were to: (1) describe the practices most likely to be adopted by professionals facing a suicidal patient and (2) analyze the differences according to professional characteristics (group, specific training on suicide, and experience with suicidal patients). A self-report questionnaire that was developed for this study was filled out by 239 participants. Participants were psychologists, psychiatrists, and general practitioners who work in different contexts: hospitals, public health centres, schools or colleges, and community centres. Principal components analysis, analyses of variance, and t-tests were used. Four components were identified: (1) Comprehensive risk assessment; (2) protocols, psychotherapy and connectedness; (3) multidisciplinary clinical approach; and, (4) family, explaining a total of variance of 44%. Positive associations between suicide-related variables (training and experience) and practices were found. In general, health professionals’ practices are evidence-based, however a relevant percentage of professionals can benefit from training and improve their practices.
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41
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Sale E, Hendricks M, Weil V, Miller C, Perkins S, McCudden S. Counseling on Access to Lethal Means (CALM): An Evaluation of a Suicide Prevention Means Restriction Training Program for Mental Health Providers. Community Ment Health J 2018; 54:293-301. [PMID: 29185154 DOI: 10.1007/s10597-017-0190-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 11/04/2017] [Indexed: 11/28/2022]
Abstract
This paper evaluates the effectiveness of the Counseling on Access to Lethal Means (CALM) suicide prevention program. CALM trains mental health providers how to counsel suicidal individuals and those who support them on mean restriction during times of crisis. Pre/post/3-month follow-up assessments measured knowledge of lethal means, confidence and comfort in discussing means restriction (self-efficacy), and future intentions to counsel clients on means restriction. Change in the number of clients receiving lethal means counseling was also assessed. All constructs increased significantly at posttest. Confidence and counseling intentions were sustained at follow-up and significantly more clients received means counseling in the 3 months following the CALM training. Knowledge and comfort levels decreased at follow-up but not to pre-training levels. CALM is effective at increasing mental health professionals' comfort, knowledge, and frequency of talking about means restriction with clients. an effective means restriction training program. A template to assess clients for suicidality and lethal means access and booster sessions are recommended to further sustain effects.
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Affiliation(s)
- Elizabeth Sale
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 4833 World Parkway Circle, St. Louis, MO, 63134, USA. .,Missouri Institute of Mental Health, 4633 World Parkway Circle, St. Louis, MO, 63134-3115, USA.
| | - Michelle Hendricks
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 4833 World Parkway Circle, St. Louis, MO, 63134, USA
| | - Virginia Weil
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 4833 World Parkway Circle, St. Louis, MO, 63134, USA
| | - Collin Miller
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 4833 World Parkway Circle, St. Louis, MO, 63134, USA
| | - Scott Perkins
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 4833 World Parkway Circle, St. Louis, MO, 63134, USA
| | - Suzanne McCudden
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 4833 World Parkway Circle, St. Louis, MO, 63134, USA
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Suicide Risk Screening in Healthcare Settings: Identifying Males and Females at Risk. J Clin Psychol Med Settings 2018; 24:8-20. [PMID: 28251427 DOI: 10.1007/s10880-017-9486-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Suicide is the tenth leading cause of death in the United States, accounting for more than 42,000 deaths in 2014. Although this tragedy cuts across groups defined by age, gender, race/ethnicity, and geographic location, it is striking that nearly four times as many males as females die by suicide in the U.S. We describe the current regulations and recommendations for suicide risk screening in healthcare systems and also describe the aspirational goal of "Zero Suicide," put forth by the National Action Alliance for Suicide Prevention. We then provide information about suicide risk screening tools and steps to take when a patient screens positive for suicide risk. Given the substantially higher suicide rate among males than females, we argue that it is important to consider how we could optimize suicide risk screening strategies to identify males at risk and females at risk. Further research is needed to accomplish this goal. It is recommended that we consider multi-factorial suicide risk screens that incorporate risk factors known to be particularly important for males as well as computerized, adaptive screens that are tailored for the specific risk considerations of the individual patient, male or female. These strategies are not mutually exclusive. Finally, universal suicide risk screening in healthcare settings, especially primary care, specialty medical care, and emergency department settings, is recommended.
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43
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Hoyt T, Duffy V. Implementing Firearms Restriction for Preventing U.S. Army Suicide. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tim Hoyt
- Intensive Outpatient Program, Madigan Army Medical Center, Joint Base Lewis–McChord—Tacoma, WA
| | - Vicki Duffy
- Suicide Prevention Program Office, Joint Base Lewis–McChord—Tacoma
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Roush JF, Brown SL, Jahn DR, Mitchell SM, Taylor NJ, Quinnett P, Ries R. Mental Health Professionals' Suicide Risk Assessment and Management Practices. CRISIS 2017; 39:55-64. [PMID: 28914092 DOI: 10.1027/0227-5910/a000478] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Approximately 20% of suicide decedents have had contact with a mental health professional within 1 month prior to their death, and the majority of mental health professionals have treated suicidal individuals. Despite limited evidence-based training, mental health professionals make important clinical decisions related to suicide risk assessment and management. AIMS The current study aimed to determine the frequency of suicide risk assessment and management practices and the association between fear of suicide-related outcomes or comfort working with suicidal individuals and adequacy of suicide risk management decisions among mental health professionals. METHOD Mental health professionals completed self-report assessments of fear, comfort, and suicide risk assessment and management practices. RESULTS Approximately one third of mental health professionals did not ask every patient about current or previous suicidal thoughts or behaviors. Further, comfort, but not fear, was positively associated with greater odds of conducting evidence-based suicide risk assessments at first appointments and adequacy of suicide risk management practices with patients reporting suicide ideation and a recent suicide attempt. LIMITATIONS The study utilized a cross-sectional design and self-report questionnaires. CONCLUSION Although the majority of mental health professionals report using evidenced-based practices, there appears to be variability in utilization of evidence-based practices.
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Affiliation(s)
- Jared F Roush
- 1 Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Sarah L Brown
- 1 Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | | | - Sean M Mitchell
- 1 Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Nathanael J Taylor
- 1 Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
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Colborn VA, LaCroix JM, Neely LL, Tucker J, Perera K, Daruwala SE, Grammer G, Weaver J, Ghahramanlou-Holloway M. Motor impulsivity differentiates between psychiatric inpatients with multiple versus single lifetime suicide attempts. Psychiatry Res 2017; 253:18-21. [PMID: 28319787 DOI: 10.1016/j.psychres.2017.03.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 03/01/2017] [Accepted: 03/13/2017] [Indexed: 10/20/2022]
Abstract
A history of multiple suicide attempts conveys greater risk for suicide than a single attempt. Impulsivity may partially explain the association between multiple attempts and increased risk. We examined trait impulsivity, ability to engage in goal-directed behaviors, and impulse control among psychiatrically hospitalized United States military personnel and their dependents. Individuals with a history of multiple versus single attempts had significantly higher motor impulsivity, indicating spur of the moment action. Providers are encouraged to directly assess and treat motor impulsivity among suicidal individuals. Further research should explore whether motor impulsivity is a mechanism of change in psychosocial suicide prevention interventions.
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Affiliation(s)
- Victoria A Colborn
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, USA
| | - Jessica M LaCroix
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, USA
| | - Laura L Neely
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, USA
| | - Jennifer Tucker
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, USA
| | - Kanchana Perera
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, USA
| | - Samantha E Daruwala
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, USA
| | - Geoffrey Grammer
- Walter Reed National Military Medical Center, National Intrepid Center of Excellence, Bethesda, MD, USA
| | | | - Marjan Ghahramanlou-Holloway
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, USA.
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Polychronis PD. Changes Across Three Editions of The Suicidal Patient: Clinical and Legal Standards of Care: Relevance to Counseling Centers. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2016. [DOI: 10.1080/87568225.2016.1254002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Paul D. Polychronis
- Counseling Center, University of Central Missouri, Warrensburg, Missouri, USA
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47
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Continuing Education on Suicide Assessment and Crisis Intervention: What Can We Learn About the Needs of Mental Health Professionals in Community Practice? Community Ment Health J 2016; 52:501-10. [PMID: 25956584 DOI: 10.1007/s10597-015-9884-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 05/02/2015] [Indexed: 10/23/2022]
Abstract
This study examined the impact of a 1-day continuing education training for mental health professionals on knowledge and confidence around suicide assessment and intervention. Data on knowledge, confidence and the utility of information were collected through pretests and posttests at 12 trainings at local community agencies. Findings indicate that a continuing education workshop can increase knowledge and self-confidence. Several participant characteristics were associated with knowledge and confidence at pretest; only being trained as a mental health professional and previous training remained significant at posttest. Participants identified training components which were new and useful. Implications for training and education are discussed.
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48
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Motivational Interviewing for Means Restriction Counseling With Patients at Risk for Suicide. COGNITIVE AND BEHAVIORAL PRACTICE 2016. [DOI: 10.1016/j.cbpra.2014.09.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sheehan CM, Rogers RG, Boardman JD. Postmortem Presence of Drugs and Method of Violent Suicide. JOURNAL OF DRUG ISSUES 2015; 45:249-262. [PMID: 27239069 PMCID: PMC4880407 DOI: 10.1177/0022042615580988] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The link between substance use and suicide is well established. However, little research analyzes how substance use is related to the method of suicide. This paper analyzes how specific drugs are associated with method of suicide, a critical topic because drug use bears on the etiology of suicide and may lead to policies aimed at deterring suicide. We use the COVDRS and logistic regression to examine postmortem presence of drugs among 3,389 hanging and firearm suicides in Colorado from 2004-2009. Net of demographic controls, we find that opiates are positively associated with firearms (OR: 1.92, 95% L: 1.27, 95% U: 2.86]) while antidepressants are positively associated with hanging (OR: 1.45, 95% L: 1.04, 95% U: 2.03). For cocaine and opiates, the association between drug use and violent method vary by educational attainment. Importantly, knowledge of the presence and type of specific drug is strongly associated with the method of suicide.
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Conner KR, Simons K. State of innovation in suicide intervention research with military populations. Suicide Life Threat Behav 2015; 45:281-92. [PMID: 25348613 DOI: 10.1111/sltb.12130] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/21/2014] [Indexed: 11/29/2022]
Abstract
A systematic search was performed to identify active, externally funded randomized controlled trials (RCTs) that target suicidal ideation or behavior as a primary or secondary outcome among U.S. military service members, guard-reservists, and veterans. Twenty-three studies were identified, most funded by the U.S. Department of Defense or U.S. Department of Veterans Affairs. Several innovations were identified based on departures from or modernizations of usual practices and included the targeting of suicide deaths or attempts as primary outcome, delivery of interventions through technology and/or outside clinical settings, and examinations of rarely studied treatments.
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Affiliation(s)
- Kenneth R Conner
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Kelsey Simons
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
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