Suicidal and violent ideation in acute psychiatric inpatients: prevalence, co-occurrence, and associated characteristics

A Digital Dialectical Behaviour Therapy Intervention for Acute Suicidality in Psychiatric Inpatients: A Feasibility Randomised Controlled Study: Intervention numérique en thérapie comportementale dialectique en cas de suicidabilité aiguë de patients hospitalisés en psychiatrie : Étude de faisabilité contrôlée à répartition aléatoire

ObjectiveTo evaluate the feasibility and preliminary efficacy of a digital dialectical behaviour therapy (d-DBT) skills intervention in suicidal psychiatric inpatients.MethodsA parallel arm, assessor-blinded, randomized controlled trial (RCT) was conducted to compare d-DBT to standard care among psychiatric inpatients. Participants included adults admitted for suicidality (i.e., suicidal ideation or suicide attempt). The intervention group received a d-DBT intervention encompassing 5 online modules completed over 5 to 10 days, covering mindfulness, emotion regulation, and distress tolerance skills. Participants received an initial orientation but no formal therapy sessions. Daily check-ins were available for technical-related queries. Feasibility outcomes included recruitment, adherence (≥3 modules completed), retention, and acceptability (client satisfaction questionnaire-8). Efficacy outcomes included suicidality (Columbia-Suicide Severity Rating Scale [C-SSRS] total score), psychological distress (K10), emotion regulation (Difficulties in Emotion Regulation Scale-16 [DERS-16]), and clinical global impression (CGI). Linear regression models analysed group differences.ResultsA total of 65 participants were recruited, of which 42 were randomized, with high d-DBT adherence rates in the intervention arm (75%). The d-DBT intervention demonstrated significant reductions in C-SSRS scores (Cohen's -1.0) compared to standard of care. No significant group differences were observed in K10, DERS-16, or CGI. High acceptability and satisfaction were reported among participants randomized to d-DBT. Challenges and limitations included maintaining follow-up postdischarge and the small sample size.Conclusiond-DBT is feasible to implement through an RCT and may reduce suicidality and improve mental health among psychiatric inpatients. The study highlights the importance of developing accessible, evidence-based interventions for this population. Future research should focus on long-term efficacy and expanding the intervention's appeal and accessibility.

Applying the Stress Process Theory to Assess Correlates of Suicide Ideation-to-Action Among Persons on Parole in the United States

There is limited knowledge regarding precipitating factors associated with suicidality among persons on parole. Pairing the suicide ideation-to-action framework and stress process theory, the present study aimed to characterize sources of major stress (drug use, physical health, and mental health) and their associations to suicide ideation, planning, and attempt among a national sample of persons on parole. This study included a subsample of persons on parole (N = 1725) using pooled national data from the National Survey on Drug Use and Health (2015-2019). A series of logistic regression results indicate that various drug use, physical health, and mental health factors significantly influenced all three suicidality measures. Due to this population's unique experiences and numerous barriers following release from prison, it is essential to personalize interventions geared toward this population to meet their specific needs and address suicidality based on where they fall on this continuum.

Suicidality in psychiatric emergency department situations during the first and the second wave of COVID-19 pandemic

Psychiatric patients are prone to mental health deterioration during the Covid-19 pandemic. Little is known about suicidality in psychiatric patients during the Covid-19 pandemic. This study is a retrospective chart review of psychiatric emergency department (pED) presentations with present or absent suicidality (5634 pED attendances, 4110 patients) in an academic pED in Berlin, Germany. Poisson regression analysis was performed on the effect of Covid-19 period on suicidality (suicidal ideation (SI), suicide plans (SP) or suicide attempt (SA)) during the first (3/2/2020-5/24/2020 "first-wave") and second (9/15/2020-3/1/2021 "second-wave") wave of the Covid-19 pandemic compared to the same periods one year earlier. During the first-wave the number of pED visits per person with SI, SP and SA was higher compared to one year earlier (SI RR = 1.614; p = 0.016; SP RR = 2.900; p = 0.004; SA RR = 9.862; p = 0.003). SI and SP were predicted by interaction between substance use disorder (SUD) and second-wave (SI RR = 1.305, p = 0.043; SP RR = 1.645, p = 0.018), SA was predicted by interaction between borderline personality disorder (BPD) and second-wave (RR = 7.128; p = 0.012). Suicidality increased during the first-wave of Covid-19 pandemic in our sample. In the second-wave this was found in patients with SUD and BPD. These patients may be at particular risk of suicidality during the Covid-19 pandemic.

Suicidal ideation in patients with mental illness and concurrent substance use: analyses of national census data in Norway

BACKGROUND

Suicidal ideation may signal potential risk for future suicidal behaviors and death. We examined the prevalence of recent suicidal ideation in patients with mental illness and concurrent substance use and explored the clinical and sociodemographic factors associated with suicidal ideation in this patient subgroup, which represents a particular risk group for adverse psychiatric outcomes.

METHODS

We used national cross-sectional census data in Norway collected from 25,525 patients in specialized mental health services. The analytic sample comprised 3,842 patients with concurrent substance use, defined as having a co-morbid substance use disorder or who reported recent regular alcohol use/occasional illicit drug use. Data included suicidal ideation measured in relation to the current treatment episode, sociodemographic characteristics and ICD-10 diagnoses. Bivariate and multivariate analyses were used to examine differential characteristics between patients with and without suicidal ideation.

RESULTS

The prevalence of suicidal ideation was 25.8%. The suicidal ideation rates were particularly high for those with personality disorders, posttraumatic stress disorder, and depression, and for alcohol and sedatives compared with other substances. Patients with suicidal ideation were characterized by being younger, having single marital status, and having poorly perceived social relationships with family and friends.

CONCLUSION

Suicidal ideation in patients with mental illness and concurrent substance use was associated with a number of distinct characteristics. These results might help contribute to an increased focus on a subgroup of individuals at particular risk for suicidality and support suicide prevention efforts in specialized mental health services.