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Huen JMY, Osman A, Lew B, Yip PSF. Utility of Single Items within the Suicidal Behaviors Questionnaire-Revised (SBQ-R): A Bayesian Network Approach and Relative Importance Analysis. Behav Sci (Basel) 2024; 14:410. [PMID: 38785901 PMCID: PMC11117767 DOI: 10.3390/bs14050410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
The Suicidal Behaviors Questionnaire-Revised (SBQ-R) comprises four content-specific items widely used to assess the history of suicide-related thoughts, plans or attempts, frequency of suicidal ideation, communication of intent to die by suicide and self-reported likelihood of a suicide attempt. Each item focuses on a specific parameter of the suicide-related thoughts and behaviors construct. Past research has primarily focused on the total score. This study used Bayesian network modeling and relative importance analyses on SBQ-R data from 1160 U.S. and 1141 Chinese undergraduate students. The Bayesian network analysis results showed that Item 1 is suitable for identifying other parameters of the suicide-related thoughts and behaviors construct. The results of the relative importance analysis further highlighted the relevancy of each SBQ-R item score when examining evidence for suicide-related thoughts and behaviors. These findings provided empirical support for using the SBQ-R item scores to understand the performances of different suicide-related behavior parameters. Further, they demonstrated the potential value of examining individual item-level responses to offer clinically meaningful insights. To conclude, the SBQ-R allows for the evaluation of each critical suicide-related thought and behavior parameter and the overall suicide risk.
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Affiliation(s)
- Jenny Mei Yiu Huen
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; (J.M.Y.H.)
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China
| | - Augustine Osman
- Department of Psychology, The University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Bob Lew
- School of Applied Psychology, Griffith University, Mount Gravatt, QLD 4122, Australia
| | - Paul Siu Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; (J.M.Y.H.)
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China
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Teismann T, Siebert AM, Forkmann T. Suicidal ambivalence: A scoping review. Suicide Life Threat Behav 2024. [PMID: 38709556 DOI: 10.1111/sltb.13092] [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] [Received: 12/18/2023] [Accepted: 04/30/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Suicidal ambivalence is considered a characteristic condition of suicidal individuals. At the same time, there is a lack of a uniform definition, conception and assessment of suicidal ambivalence. On this background, the current scoping review aims to explore the extent, range, and nature of research activity on suicidal ambivalence and to summarize research findings. METHODS A systematic literature search was conducted in four different databases (PubMed, Psychinfo, Web of Science, and Google Scholar) using an array of search terms (e.g., ambivalence, internal suicide debate, reasons for living and reasons for dying, wish to live and wish to die). RESULTS In total, 28 articles published between 1977 and 2023 were included in the scoping review. The study situation lacks a clear definition, conceptualization and operationalization of suicidal ambivalence. Nonetheless, suicidal ambivalence is a common experience in persons contemplating suicide and suicidal ambivalence seems to be present before, during and after a suicide attempt. Suicidal ambivalence is associated with diverse markers of negative/positive mental health as well as suicidal ideation and behavior. CONCLUSION Results point to the relevance of suicidal ambivalence. At the same time, there are large gaps in knowledge about the development, impact and therapeutic responsiveness of suicidal ambivalence.
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Affiliation(s)
- Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-University, Bochum, Germany
| | | | - Thomas Forkmann
- Department of Clinical Psychology and Psychotherapy, University of Duisburg, Essen, Germany
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Choi NG, Choi BY, Marti CN. Suicidal intent disclosure among adult suicide decedents: Four age group comparisons. DEATH STUDIES 2023; 47:861-872. [PMID: 36259484 DOI: 10.1080/07481187.2022.2135046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Research on who does/does not disclose suicidal intent (SI) and related factors has important implications for suicide risk management. In this paper based on the 2017-2019 National Violent Death Reporting System, we compared four age groups (18-24, 25-44, 45-64, and 65+ years) of suicide decedents with respect to associations between SI disclosure and (1) suicide contributing/precipitating factors, and (2) suicide means. The results shows that those age 18-44 were more likely to disclose SI than those age> =45, especially among those with relationship problems. Physical health problems and death/suicide of family/friend increased the likelihood of SI disclosure in the 65+ age group.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Dover, Delaware, USA
| | - C Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
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Rogers ML, Bafna A, Galynker I. Comparative clinical utility of screening for Suicide Crisis Syndrome versus suicidal ideation in relation to suicidal ideation and attempts at one-month follow-up. Suicide Life Threat Behav 2022; 52:866-875. [PMID: 35441411 DOI: 10.1111/sltb.12870] [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: 03/05/2021] [Revised: 02/03/2022] [Accepted: 04/05/2022] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Suicidal ideation (SI) has numerous limitations in predicting suicidal behavior. The Suicide Crisis Syndrome (SCS) is proposed as an alternative method of detecting risk. This study compares the relative utility of SI and SCS in statistically predicting SI and behaviors at one-month follow-up. METHODS 382 psychiatric patients (98 inpatients, 284 outpatients) completed baseline measures and provided information about suicide-related outcomes one month later. Participants were grouped based on responses to measures assessing SCS and SI. RESULTS Rates of follow-up suicidal behavior were significantly higher among those reporting both SCS and SI (22.2%) than those reporting SI alone (6.0%) or neither SCS nor SI (0.9%). SCS alone (8.3%) had descriptively, but not statistically, higher rates of suicidal behavior than those with neither SCS nor SI, and did not differ from SI alone and the combination of SCS and SI. Those reporting SI-with and without SCS-had higher levels of follow-up suicidal thoughts than those without SI. CONCLUSION The SCS was equivalent to SI, and incrementally informative alongside SI, in detecting individuals at risk of future suicidal behavior, whereas SI was more strongly related to future SI than SCS. The combination of SCS and SI may be clinically useful in detecting individuals who are at risk for suicide.
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Affiliation(s)
- Megan L Rogers
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA
| | - Anokhi Bafna
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA
| | - Igor Galynker
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA
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Oakey-Frost DN, Harris JA, Roberge EM, Andres WC, Rugo KF, Bryan AO, Bryan CJ. Verbal Response Latency as a Behavioral Indicator of Diminished Wish to Live in a Clinical Sample of Active Duty Army Personnel with Recent Suicidal Ideation. Arch Suicide Res 2022; 26:1046-1059. [PMID: 33275534 DOI: 10.1080/13811118.2020.1848670] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Research on risk factors of suicide attempt has yielded little improvement in imminent risk detection for clinicians, due in part to the inherent limitations of self-report methodologies. Therefore, objective behavioral indicators of suicide risk that can be implemented practically with little cost in clinical settings are needed. METHOD The current study examined verbal response latency, measured as the length of time to answer a question asking about reasons for living (i.e., What are your reasons for living or not killing yourself?), as a potential indicator of suicide risk among 97 active duty Army personnel presenting to an emergency department or behavioral health clinic for current suicide ideation and/or a recent suicide attempt. RESULTS Verbal response latency was significantly correlated with diminished wish to live at the participant level but was not significantly correlated with wish to die or overall severity of suicidal ideation. CONCLUSION Verbal response latency may serve as an objective indicator of suicide risk. HighlightsResponse latency to a life construct may be an objective indicator of suicide riskDelayed response latency is indicative of diminished wish to livePathological mechanisms may manifest within dyadic interactions via verbal behaviors.
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Rogers ML, Bloch-Elkouby S, Galynker I. Differential disclosure of suicidal intent to clinicians versus researchers: Associations with concurrent suicide crisis syndrome and prospective suicidal ideation and attempts. Psychiatry Res 2022; 312:114522. [PMID: 35378454 DOI: 10.1016/j.psychres.2022.114522] [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] [Received: 01/17/2022] [Revised: 03/11/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
Several patient and setting characteristics have been found to predict disclosure of suicidality to clinicians versus researchers. Less understood, however, is whether differential disclosure of suicidality predicts concurrent indirect indicators of suicide risk and future suicide-related outcomes. The present study examined differential disclosure of suicidal intent in clinical versus research settings as a predictor of (1) concurrent symptoms of the Suicide Crisis Syndrome (SCS); and (2) suicidal ideation and attempts within one month in patients (n = 1039) and their clinicians (n = 144), who completed a battery of self-report and interview measures at baseline. Patients who reported suicidal intent to anyone had higher concurrent SCS symptoms than those who denied suicidal intent, with no differences between those who reported intent to clinicians versus researchers only. Severity of suicidal ideation and rates of suicide attempts at one-month follow-up were higher among those who disclosed suicidal intent to a research assistant than among those who did not-regardless of whether suicidal intent was disclosed to their clinician. Overall, an improved understanding of the factors contributing to differential disclosure will improve both scientific inquiry and patient safety.
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Podlogar MC, Gutierrez PM, Osman A. Optimizing the Beck Scale for Suicide Ideation: An Item Response Theory Approach Among U.S. Military Personnel. Assessment 2022; 30:1321-1333. [PMID: 35575070 DOI: 10.1177/10731911221092420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Beck Scale for Suicide Ideation (BSS) is one of the most used and empirically supported suicide risk assessment measures for behavioral health clinicians and researchers. However, the 19-item BSS is a relatively long measure and can take 5 to 10 minutes to administer. This study used Item Response Theory (IRT) techniques across two samples of mostly U.S. military service members to first identify (n1 = 1,899) and then validate (n2 = 757) an optimized set of the most informative BSS items. Results indicated that Items 1, 2, 4, 6, and 15 provided a similar-shaped test information curve across the same range of the latent trait as the full-length BSS and showed reliable item functioning across participant characteristics. The sum score of these five items showed a linear score linkage with the full-scale score, ρ > 0.87, and was equally as sensitive as the full scale for prospectively predicting near-term suicidal behavior at 74% with a cut score ≥1 (equivalent to full-scale score ≥6). Results are consistent with those from civilian samples. In time- or length-limited assessments, using these five BSS items may improve administration efficiency over the full BSS, while maintaining classification sensitivity.This study suggests that summing Items 1, 2, 4, 6, and 15 of the Beck Scale for Suicide Ideation (BSS) is an acceptable approach for shortening the full-length measure.
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Affiliation(s)
- Matthew C Podlogar
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, USA
- University of Colorado School of Medicine, Aurora, USA
| | - Peter M Gutierrez
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, USA
- University of Colorado School of Medicine, Aurora, USA
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Marzetti H, McDaid L, O'Connor R. "Am I really alive?": Understanding the role of homophobia, biphobia and transphobia in young LGBT+ people's suicidal distress. Soc Sci Med 2022; 298:114860. [PMID: 35231781 DOI: 10.1016/j.socscimed.2022.114860] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/18/2021] [Accepted: 02/22/2022] [Indexed: 01/30/2023]
Abstract
Suicide is the fourth leading cause of death amongst young people aged 15-29 globally and amongst this young population, lesbian, gay, bisexual and trans (LGBT+) young people have higher rates of suicidal thoughts and attempts than their cisgender (non-trans), heterosexual peers. However, despite well-established knowledge on the existence of this health inequality, in the UK there has been a paucity of research exploring why this disparity exists, and this is particularly the case in Scotland. This paper aims to address this gap, reporting on the first study specifically seeking to understand LGBT+ young people's suicidal thoughts and attempts in Scotland. We used a qualitative methodology to explore how young people with lived experience of suicidal distress make sense of the relationship between homophobia, biphobia and transphobia, and suicidal thoughts and attempts. We undertook in-depth, narrative interviews with twenty-four LGBT+ people aged 16-24, and analysed them using reflexive thematic analysis. Drawing on this analysis, we argue that suicide can be understood as a response to stigma, discrimination and harassment, made possible by a cultural climate that positions LGBT+ people as different or other, reinforcing norms regarding gender conformity and sexuality. We suggest in turn, that this cultural climate provides fertile ground from which more explicit acts of homophobia, biphobia and transphobia, such as bullying and family rejection are able to grow. In response to this, LGBT+ young people could begin to experience senses of entrapment, rejection and isolation, to which suicidal thoughts and attempts can be understood as responses. Consequently, we propose that these stigma experiences must be taken seriously and tackled directly in order to reduce LGBT + suicide in the future.
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Affiliation(s)
- Hazel Marzetti
- School of Health in Social Science, University of Edinburgh, UK; MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK.
| | - Lisa McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK; Institute for Social Science Research, University of Queensland Australia, Australia.
| | - Rory O'Connor
- Institute of Health and Wellbeing, University of Glasgow, UK.
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Van Wyk J, Gibson K. An Analysis of Young Clients' Communications About Their Suicidality on a Text Message Helpline: "I'm Scared of What I Might Do to Myself". Front Psychiatry 2022; 13:925830. [PMID: 35911245 PMCID: PMC9333268 DOI: 10.3389/fpsyt.2022.925830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/21/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Youth suicide is a major international concern and prevention is a priority. In most cases suicidal behavior would be preceded by a period of suicidal ideation. Although feeling suicidal is recognized as a risk factor for suicide, there is little research which captures young people's own experience of suicidality in a moment of crisis. AIMS This study aimed to explore young people's own accounts of their suicidality in the moment in which they experienced it. METHOD This qualitative study examined clients' experience of suicidality as communicated during a text message helpline counseling interaction. The data consisted of 125 text transcripts of an interaction during which a client was experiencing suicidality. These were obtained from a New Zealand based youth helpline service. The data was analyzed using thematic analysis. FINDINGS The analysis showed that clients' experienced suicidality as a normal part of their life; that it was understood as a form of coping and that it was seen as a legitimate way to communicate distress. Clients described rapid fluctuations in the intensity of their suicidality and a feeling of being out of control. Despite this, they also communicated ambivalence about acting on their suicidality, and a recognition of the need to get help. CONCLUSIONS This study offered unique insights into young people's experience of suicidality and opens up opportunities for prevention. It underlines the importance of identifying chronic suicidality early and providing intervention and support prior to a suicidal crisis. The findings point to the potential that text counseling services might have in providing support to young people who are experiencing suicidality in the moment that they need this.
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Affiliation(s)
- Jeanne Van Wyk
- School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Kerry Gibson
- School of Psychology, The University of Auckland, Auckland, New Zealand
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Gysin-Maillart AC, Jansen R, Walther S, Jobes DA, Brodbeck J, Marmet S. Longitudinal Development of Reasons for Living and Dying With Suicide Attempters: A 2-Year Follow-Up Study. Front Psychiatry 2022; 13:865831. [PMID: 35633806 PMCID: PMC9133363 DOI: 10.3389/fpsyt.2022.865831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/08/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Clinical interventions for patients after a suicide attempt might include a focus on Reasons for Living (RFL) and/or Reasons for Dying (RFD). The present study examined the longitudinal development of RFL and RFD in patients with and without a suicide-specific intervention - the Attempted Suicide Short Intervention Program (ASSIP). METHODS In this secondary analysis of a 2-year follow-up randomized controlled study, participants completed the Suicide Status Form II to assess RFL and RFD, at baseline, as well as at 6-, 12-, 18-, and 24-months follow-up. Growth models and latent class analysis were used to investigate longitudinal developments in RFL and RFD. Regression models were used to test the association between RFL, RFD and suicidal reattempts and ideation. RESULTS Cross-sectionally and longitudinally, RFD, but not RFL, were associated with suicide reattempts and suicidal ideation. The number of RFD decreased significantly across the 24 month period (from 1.90 at t1 to 1.04 at t5 in the control group and from 2.32 at t1 to 0.51 at t5 in the intervention group), and this decrease was stronger (b = -0.02; p = 0.004) in the ASSIP group than in the control group. There was no overall change in RFL. Three latent trajectories of RFD were identified: a decreasing (n = 77), a steady high (n = 17) and a trajectory with first increasing and then decreasing RFD (n = 26). The proportion of patients in the ASSIP intervention was highest in the decreasing trajectory and lowest in the steady high trajectory. Patients in the steady high trajectory were characterized by worse mental health and fewer social obligations (partner, children) at baseline. CONCLUSION The results confirm the importance of RFD within the suicidal process and show that the number of RFD can be further reduced over the period of 24 months with short interventions such as ASSIP. The relevance of number of RFL in the suicidal process, as protective factor, was not confirmed. In the subgroup of patients whose RFD did not decrease over a long period of time, there is a particularly high risk of suicidal ideation/behavior. Clinical interventions should focus more closely on RFD, their etiology and maintenance.
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Affiliation(s)
- Anja C Gysin-Maillart
- Translational Research Centre, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Unit for Clinical Suicide Research, Department of Clinical Sciences, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Rahel Jansen
- Translational Research Centre, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Centre, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - David A Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, United States
| | - Jeannette Brodbeck
- Institute for Counseling, Coaching and Social Management, School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland.,Department for Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Simon Marmet
- Institute for Counseling, Coaching and Social Management, School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
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Dombrovski AY, Hallquist MN. Search for solutions, learning, simulation, and choice processes in suicidal behavior. WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2021; 13:e1561. [PMID: 34008338 PMCID: PMC9285563 DOI: 10.1002/wcs.1561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/06/2021] [Accepted: 04/07/2021] [Indexed: 12/25/2022]
Abstract
Suicide may be viewed as an unfortunate outcome of failures in decision processes. Such failures occur when the demands of a crisis exceed a person's capacity to (i) search for options, (ii) learn and simulate possible futures, and (iii) make advantageous value‐based choices. Can individual‐level decision deficits and biases drive the progression of the suicidal crisis? Our overview of the evidence on this question is informed by clinical theory and grounded in reinforcement learning and behavioral economics. Cohort and case–control studies provide strong evidence that limited cognitive capacity and particularly impaired cognitive control are associated with suicidal behavior, imposing cognitive constraints on decision‐making. We conceptualize suicidal ideation as an element of impoverished consideration sets resulting from a search for solutions under cognitive constraints and mood‐congruent Pavlovian influences, a view supported by mostly indirect evidence. More compelling is the evidence of impaired learning in people with a history of suicidal behavior. We speculate that an inability to simulate alternative futures using one's model of the world may undermine alternative solutions in a suicidal crisis. The hypothesis supported by the strongest evidence is that the selection of suicide over alternatives is facilitated by a choice process undermined by randomness. Case–control studies using gambling tasks, armed bandits, and delay discounting support this claim. Future experimental studies will need to uncover real‐time dynamics of choice processes in suicidal people. In summary, the decision process framework sheds light on neurocognitive mechanisms that facilitate the progression of the suicidal crisis. This article is categorized under:Economics > Individual Decision‐Making Psychology > Emotion and Motivation Psychology > Learning Neuroscience > Behavior
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Affiliation(s)
| | - Michael N Hallquist
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina, USA
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Denkler N, Teismann T. Suizidalitäts-Barometer: Ursachen und Behandlung suizidalen Erlebens und Verhaltens aus Laienperspektive. VERHALTENSTHERAPIE 2021. [DOI: 10.1159/000515866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Hintergrund:</i></b> Ziel der vorliegenden Untersuchung war es, ein Meinungsbild über Ursachen und Behandlungsmöglichkeiten suizidalen Erlebens und Verhaltens aus Laiensicht zu erstellen. <b><i>Probanden:</i></b> Insgesamt nahmen 879 Personen (58,2% weiblich; Alter (Jahre): Mittelwert = 32,28, SD = 8,41) an einer internetbasierten Fragebogenstudie teil. <b><i>Ergebnisse:</i></b> Mehr als 90% der Befragten messen psychischen Erkrankungen, schwerwiegenden Lebensereignissen sowie den Wahrnehmungen keine Hoffnung zu haben, eine Last für andere und sozial isoliert zu sein, ursächliche Bedeutung für das Verständnis von Suiziden bei. Nahezu 100% halten eine Psychotherapie für eine angemessene Behandlung suizidalen Erlebens und Verhaltens. Die Zustimmungsraten zu verschiedenen Mythen über Suizidalität sind vergleichsweise niedrig (<20%). <b><i>Diskussion und Schlussfolgerung:</i></b> Die Gesamtbefundlage stellt sich als positiv heraus: Sowohl bedeutsame Risikofaktoren für suizidales Erleben und Verhalten als auch zentrale Behandlungsmöglichkeiten sind den Befragten weitgehend bekannt.
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Bornet MA, Bernard M, Jaques C, Rubli Truchard E, Borasio GD, Jox RJ. Assessing the Will to Live: A Scoping Review. J Pain Symptom Manage 2021; 61:845-857.e18. [PMID: 32931906 DOI: 10.1016/j.jpainsymman.2020.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 08/29/2020] [Accepted: 09/04/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT The will to live (WTL) is an important factor to consider in the context of providing resource-oriented palliative care. Until now, there has been no major review of the existing research on this subject. OBJECTIVES The primary objective of this study is to summarize the state of research concerning instruments that assess the WTL. The secondary objective is to explore the theoretical models and psychometric properties of these instruments, in studies where these instruments were initially presented. The tertiary objective is to identify, among all studies where these instruments have been used, the intensity of the WTL, and factors associated with it. METHODS We conducted a scoping review, including studies that were designed to assess the WTL among participants in all settings. Records were systematically searched from seven bibliographic databases with no date limitations up to August 2020. RESULTS Of the 3078 records screened, 281 were examined in detail and 111 were included in the synthesis. A total of 25 different instruments quantitatively assessing the WTL are presented. Most are single-question tools and rate intensity. The underlying concepts and psychometric properties are incompletely explained. Lack of crossreferencing is apparent. The intensity of the WTL is high, even among people with significant health impairment, and is frequently associated with different factors, such as resilience and quality of life. CONCLUSION A considerable yet unconnected body of studies assesses the WTL. Its assessment in clinical routine could promote resource-oriented and patient-centered care.
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Affiliation(s)
- Marc-Antoine Bornet
- Chair of Geriatric Palliative Care, Palliative and Supportive Care Service and Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Mathieu Bernard
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Cécile Jaques
- Medical Library, Research and Education Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eve Rubli Truchard
- Chair of Geriatric Palliative Care, Palliative and Supportive Care Service and Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gian Domenico Borasio
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ralf J Jox
- Chair of Geriatric Palliative Care, Palliative and Supportive Care Service and Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Madsen J, Harris KM. Negative self-appraisal: Personal reasons for dying as indicators of suicidality. PLoS One 2021; 16:e0246341. [PMID: 33529221 PMCID: PMC7853472 DOI: 10.1371/journal.pone.0246341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/15/2021] [Indexed: 11/17/2022] Open
Abstract
Reasons for dying (RFD) are one of the most authentic factors illustrating the lived experience of suicidal individuals. However, the field has been criticized for inadequate evaluation of risk factors and suicidal symptoms, such as RFD, to develop more robust theoretical models and risk assessments. In this study, we aimed to critically examine RFD themes as predictors of suicidal symptoms to improve our understanding of the suicidal mind, test suicide theory validity and improve risk assessment. This cross-sectional mixed-method study included anonymous survey data (N = 713) with a subsample (n = 474; 77% female; age M = 31.48, SD = 13.53) who provided RFD. Participants were asked to write down five RFD (ranked 1st to 5th most important) and completed the Suicidal Affect-Behavior-Cognition Scale (SABCS). Thematic analysis revealed eight valid RFD themes-Negative Self-appraisal, Hopelessness, Desire to Escape, Escape Pain, Relationships, Loneliness, Financial Hardship, and Physical Health. Themes were quantified by rank and total endorsements of the theme. Hierarchical regression modelling, statistically controlling for demographics, showed all RFD themes, except Physical Health, were positive predictors of suicidality, accounting for 26% of variance in suicidal symptoms. Negative Self-appraisal was the strongest predictor. RFD differences were also found by gender, age and education. From these findings, we determined current suicide theories do not fully account for suicidal persons' RFD. There is a pressing need for more critical review of current theories, as current theories only partially represent this key attribute of the suicidal mind, and none of the reviewed theories accurately reflected suicidal participants' RFD. Clinical implications include integrating financial therapies into suicide prevention treatments and incorporating RFD into assessments and treatments. To aid research and risk assessment efforts, we propose a new RFD Index, with eight five-point response items.
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Affiliation(s)
- Julian Madsen
- School of Psychology, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Keith M Harris
- School of Psychology, Charles Sturt University, Wagga Wagga, NSW, Australia.,School of Psychology, University of Queensland, St Lucia, QLD, Australia
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15
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Fox AM, LaCroix JM, Bond AE, Perera KU, Luk JW, Goldston D, Weaver J, Soumoff A, Ghahramanlou-Holloway M. Evaluating Suicide Risk Using the Reasons for Dying-Reasons for Living (RFD-RFL) Index in a Military Psychiatric Inpatient Setting. Psychiatry Res 2021; 295:113576. [PMID: 33307388 DOI: 10.1016/j.psychres.2020.113576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/12/2020] [Indexed: 11/19/2022]
Abstract
The present study aimed to explore reasons for dying (RFD) and reasons for living (RFL) among suicidal inpatients, conceptualize the RFD-RFL index, and examine whether suicide risk indicators were associated with the RFD-RFL index scores. Participants were military personnel (N = 167) psychiatrically hospitalized following a suicide-related crisis who provided baseline data as part of a randomized controlled trial. Family was the most commonly reported RFL (39.7%) and was the top ranked RFL for 65.9% of participants. The most frequently endorsed RFD categories included general descriptors of self (26.9%), general statements about escape (19.7%), and others/relationships (19.1%). Greater RFD-RFL index scores were associated with a greater wish to die relative to wish to live, greater hopelessness, and with a history of lifetime multiple suicide attempts. Endorsing more RFD relative to RFL may indicate heightened suicide risk. Results of this study identify the characteristics of RFD and RFL among a high-risk, military sample, and provide preliminary support for the clinical utility of evaluating the quantities of RFD and RFL. Clinicians are encouraged to explore RFD and RFL when working with suicidal patients. Future research may explore military-specific RFD and evaluate the validity of the proposed RFD-RFL index.
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Affiliation(s)
- Amber M Fox
- Uniformed Services University of the Health Sciences, Suicide Care, Prevention, and Research (CPR) Initiative, Department of Medical and Clinical Psychology (MPS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Jessica M LaCroix
- Uniformed Services University of the Health Sciences, Suicide Care, Prevention, and Research (CPR) Initiative, Department of Medical and Clinical Psychology (MPS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Allison E Bond
- Uniformed Services University of the Health Sciences, Suicide Care, Prevention, and Research (CPR) Initiative, Department of Medical and Clinical Psychology (MPS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Kanchana U Perera
- Uniformed Services University of the Health Sciences, Suicide Care, Prevention, and Research (CPR) Initiative, Department of Medical and Clinical Psychology (MPS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Jeremy W Luk
- Uniformed Services University of the Health Sciences, Suicide Care, Prevention, and Research (CPR) Initiative, Department of Medical and Clinical Psychology (MPS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - David Goldston
- Duke University, School of Medicine, Box 3527 Med Ctr, Durham, NC 27710, USA
| | - Jennifer Weaver
- Fort Belvoir Community Hospital, 9300 DeWitt Loop, Fort Belvoir, VA 22060, USA
| | - Alyssa Soumoff
- Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
| | - Marjan Ghahramanlou-Holloway
- Uniformed Services University of the Health Sciences, Suicide Care, Prevention, and Research (CPR) Initiative, Department of Medical and Clinical Psychology (MPS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
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16
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Pasculli AJ, Harris KM. Suicidal women may risk their lives but not their social relationships. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ashleigh J Pasculli
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia,
| | - Keith M Harris
- School of Psychology, University of Queensland, St Lucia, Queensland, Australia,
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia,
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17
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Obegi JH. Differentiating genuine from feigned suicidality in corrections: A necessary but perilous task. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2020; 71:101573. [PMID: 32768118 DOI: 10.1016/j.ijlp.2020.101573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/11/2020] [Accepted: 05/05/2020] [Indexed: 06/11/2023]
Abstract
Feigning suicidality is common among patients in correctional settings, but there has been little discussion on the differences between genuine and feigned presentations of suicidality. Differentiating suicidality from feigned suicidality is among the riskiest diagnostic challenges. Still, some headway can be made if we compare features of genuine suicidality with those of feigned presentations. To this end, I first describe a typical profile of suicidality. Next, I contrast it with the features that correctional patients who feign suicidality display in California's prison health care system. I also outline the dangers involved in identifying feigned suicidality, and I offer some ways in which to understand feigned suicidality in corrections.
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Affiliation(s)
- Joseph H Obegi
- California Department of Corrections and Rehabilitation, California Medical Facility, 1600 California Dr., Vacaville, CA 95696, USA.
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Teismann T, Brailovskaia J. Entrapment, positive psychological functioning and suicide ideation: A moderation analysis. Clin Psychol Psychother 2019; 27:34-41. [PMID: 31614062 DOI: 10.1002/cpp.2403] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 12/11/2022]
Abstract
The Integrated Motivational-Volitional (IMV) Model of suicide posits that the association between perceptions of entrapment and suicide ideation is buffered by so-called motivational moderators. The present study investigated, whether positive mental health as well as different facets of psychological well-being qualify as motivational moderators. Possible moderator effects were investigated in an online sample (N = 301). Results demonstrated that positive mental health and psychological well-being moderate the association between entrapment and suicide ideation. These findings underscore the importance of entrapment and positive psychological functioning in understanding pathways to suicide ideation.
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Affiliation(s)
- Tobias Teismann
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Julia Brailovskaia
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
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Zhong R, Sisti DA, Karlawish J. Decision-Making Capacity Will Have a Limited Effect on Civil Commitment Practices. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:86-88. [PMID: 31566499 DOI: 10.1080/15265161.2019.1654011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Dominic A Sisti
- Perelman School of Medicine at the University of Pennsylvania
| | - Jason Karlawish
- Perelman School of Medicine at the University of Pennsylvania
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20
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Podlogar MC, Gutierrez PM, Joiner TE. Improving Our Understanding of the Death/Life Implicit Association Test. J Pers Assess 2019; 102:845-857. [DOI: 10.1080/00223891.2019.1663357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Matthew C. Podlogar
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC)
- Department of Psychiatry, University of Colorado School of Medicine
| | - Peter M. Gutierrez
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC)
- Department of Psychiatry, University of Colorado School of Medicine
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Abstract
Inaccurate disclosure of information is a significant limitation when relying on self-report for suicide risk screening. However, allowing for an explicit nondisclosure response option in screening items (e.g., “prefer not to disclose”) may ultimately improve follow-up assessment validity. This study investigated explicit nondisclosure in suicide risk screening among military service members and veterans ( n = 135), men older than 50 years, ( n = 187), and LGBTQ (lesbian, gay, bisexual, transgender, or queer) young adults ( n = 140); all higher risk and lower help-seeking populations. Results indicated that allowing for explicit nondisclosure minimally affected screening sensitivity and specificity. However, its selection was prevalent among higher risk participants, and was associated with experience of past unhelpful reactions and “avoidance of stigmatized consequences.” Allowing for nondisclosure creates potential psychometric and classification advantages, and may be a safe and effective way to encourage discussion of barriers, build trust, maximize patient autonomy, and ultimately facilitate accurate risk disclosure to improve assessment validity.
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Affiliation(s)
| | - Thomas E. Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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Siegmann P, Willutzki U, Fritsch N, Nyhuis P, Wolter M, Teismann T. Positive mental health as a moderator of the association between risk factors and suicide ideation/behavior in psychiatric inpatients. Psychiatry Res 2019; 273:678-684. [PMID: 31207852 DOI: 10.1016/j.psychres.2019.01.091] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 11/27/2022]
Abstract
In recent studies positive mental health has been shown as a resilience factor related to suicide ideation/behavior. It is not known if positive mental health buffers the effect of various risk factors (depression, perceived burdensomeness, hopelessness, childhood maltreatment) on suicide ideation/behavior in psychiatric inpatients-a high risk population. A total of 100 psychiatric inpatients were included in the survey. Four hierarchical regression analyses were conducted to examine, whether positive mental health moderates the association between the four risks factors and suicide ideation/behavior. Positive mental health was shown to moderate the association between perceived burdensomeness and suicide ideation/behavior. The association between the other three risk factors and suicide ideation/behavior was not moderated by positive mental health. Given the cross-sectional nature of the data, conclusions on causality cannot be drawn. The buffering effect of positive mental health suggests that positive mental health may improve the identification of individuals at risk of suicide ideation/behavior and may be an important area to target in the prevention and treatment of individuals at risk of suicide. Further research is needed.
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Affiliation(s)
- Paula Siegmann
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany.
| | - Ulrike Willutzki
- Department for Psychology and Psychotherapy, Universität Witten/Herdecke, Witten, Germany
| | - Nathalie Fritsch
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany
| | | | | | - Tobias Teismann
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany
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Abstract
Background: It is a peculiar fact that the deadliest psychiatric disturbance - suicidality - cannot be formally diagnosed. Suicidal behavior disorder (SBD), a condition for further study in the DSM-5, is the field's first attempt to capture suicidality in a diagnosis. Aims: To provoke discussion about the standing of suicidality as a diagnosable psychiatric condition. Method: I present pragmatic and conceptual rationales for why a diagnosis of suicidality is clinically useful but conclude that SBD does little to aid clinicians in assessing suicidality's symptoms, planning treatment, or monitoring progress. Results: To improve the clinical utility of SBD, I re-conceptualize it from the vantage point of descriptive psychiatry. I hypothesize that this revised SBD is an independent, episodic, and frequently co-occurring condition and propose new cognitive, affective, and behavioral criteria that more completely capture the phenomenology of suicidality. Conclusion: The revised SBD is a starting place for dialogue about whether a clinically significant presentation of suicidality is a mental illness and, if it is, what its defining features should be.
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Affiliation(s)
- Joseph H Obegi
- 1 California Department of Corrections and Rehabilitation, California State Prison, Solano, Vacaville, CA, USA
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24
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Brüdern J, Stähli A, Gysin-Maillart A, Michel K, Reisch T, Jobes DA, Brodbeck J. Reasons for living and dying in suicide attempters: a two-year prospective study. BMC Psychiatry 2018; 18:234. [PMID: 30029631 PMCID: PMC6053763 DOI: 10.1186/s12888-018-1814-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/10/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The internal suicide debate hypothesis assumes that in a suicidal crisis, individuals are involved in an internal struggle over whether to live or die. Reasons for living (RFL) and Reasons for dying (RFD) are important individual reasons for staying alive (e.g. family) or wanting to die (e.g. hopelessness) and reflect this internal motivational conflict of the suicidal mind. The aim of this study was to explore the association between RFL and RFD of suicide attempters and current and future suicide ideation and behavior. METHOD The sample consisted of 60 patients who were admitted at a psychiatric emergency unit in Switzerland following an attempted suicide. They received treatment as usual, participated in an assessment interview and completed self-report questionnaires. Additionally, they were instructed to write down up to five individual RFL and RFD. The number of RFL and RFD responses, depressive symptoms, and suicide ideation were assessed at baseline and 6, 12, and 24 months follow-up. Outcome measures were suicide ideation and repeated suicide attempts. Multiple imputations were used in order to address missing data. RESULTS The number of RFD responses was the strongest predictor for increased suicide ideation at baseline. The number of RFL responses was not associated with suicide ideation and reattempts. RFD, depressive symptoms, and baseline suicide ideation predicted subsequent suicide reattempt up to 12 months later in simple regression analyses. Mediation analyses suggested that RFD mediated the effect of depressive symptoms at baseline on suicide ideation at 12-months follow-up. CONCLUSION RFL were unrelated to the mental health of study participants and did not function as protective factor against suicide risk. RFD may be an important motivational driver in the suicidal process. Clinical interventions should focus more on the reduction of RFD than on RFL in suicidal individuals.
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Affiliation(s)
- Juliane Brüdern
- Hospital of Psychiatry Muensingen, Hunzigenallee 1, CH-3110, Muensingen, Switzerland.
| | - Annabarbara Stähli
- 0000 0001 0726 5157grid.5734.5University of Bern, Gesellschaftsstrasse 49, CH-3012 Bern, Switzerland
| | - Anja Gysin-Maillart
- 0000 0001 0726 5157grid.5734.5Translational Research Centre, University Hospital of Psychiatry, University of Bern, Murtenstrasse 21, CH-3008 Bern, Switzerland
| | - Konrad Michel
- 0000 0001 0694 3235grid.412559.eUniversity Hospital of Psychiatry, Murtenstrasse 21, CH-3008 Bern, Switzerland
| | - Thomas Reisch
- Translational Research Centre, University Hospital of Psychiatry, University of Bern, Hospital of Psychiatry Muensingen, Hunzigenallee 1, CH-3110, Muensingen, Switzerland
| | - David A. Jobes
- 0000 0001 2174 6686grid.39936.36The Catholic University of America, 314 O’Boyle Hall, N.E., Washington DC, 20064 USA
| | - Jeannette Brodbeck
- 0000 0001 0726 5157grid.5734.5University of Bern, Fabrikstrasse 8, CH-3012 Bern, Switzerland
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Teismann T, Brailovskaia J, Siegmann P, Nyhuis P, Wolter M, Willutzki U. Dual factor model of mental health: Co-occurrence of positive mental health and suicide ideation in inpatients and outpatients. Psychiatry Res 2018; 260:343-345. [PMID: 29232575 DOI: 10.1016/j.psychres.2017.11.085] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
Positive and negative mental health are independent but correlated concepts. Yet, it is unknown whether positive mental health does co-occur with suicide ideation. The present study aimed to determine the proportion of patients who have positive mental health as well as suicide ideation. Inpatients (N=100) and outpatients (N=182) completed self-report measures of positive mental health, suicide ideation and lifetime suicide attempts. Eleven outpatients (6%) and ten inpatients (10%) with suicide ideation reported moderate to high levels of positive mental health. Lifetime suicide attempts were less likely in inpatients who suffered from suicide ideation in the presence of positive mental health. Positive mental health does co-occur with suicide ideation and should be considered as a protective factor in suicide risk assessments.
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Affiliation(s)
- Tobias Teismann
- Mental Health Research and Treatment Center, Department of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum, Massenbergstraße 11, 44787 Bochum, Germany.
| | - Julia Brailovskaia
- Mental Health Research and Treatment Center, Department of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum, Massenbergstraße 11, 44787 Bochum, Germany
| | - Paula Siegmann
- Mental Health Research and Treatment Center, Department of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum, Massenbergstraße 11, 44787 Bochum, Germany
| | | | | | - Ulrike Willutzki
- Department for Psychology and Psychotherapy, Universität Witten/Herdecke, Witten, Germany
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Cwik JC, Siegmann P, Willutzki U, Nyhuis P, Wolter M, Forkmann T, Glaesmer H, Teismann T. Brief reasons for living inventory: a psychometric investigation. BMC Psychiatry 2017; 17:358. [PMID: 29110653 PMCID: PMC5674870 DOI: 10.1186/s12888-017-1521-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 10/26/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The present study aimed at validating the German version of the Brief Reasons for Living inventory (BRFL). METHODS Validity and reliability were established in a community (n = 339) and a clinical sample (n = 272). Convergent and discriminant validity were investigated, and confirmatory factor analyses were conducted for the complete BRFL as well as for a 10-item version excluding conditional items on child-related concerns. Furthermore, it was assessed how BRFL scores moderate the association between depression and suicide ideation. RESULTS Results indicated an adequate fit of the data to the original factor structure. The total scale and the subscales of the German version of the BRFL had sufficient internal consistency, as well as good convergent and divergent validity. The BRFL demonstrated clinical utility by differentiating between participants with vs. without suicide ideation. Reasons for living proved to moderate the association between depression and suicide ideation. CONCLUSIONS Results provide preliminary evidence that the BRFL may be a reliable and valid measure of adaptive reasons for living that can be used in clinic and research settings.
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Affiliation(s)
- Jan Christopher Cwik
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Massenbergstrasse 11, 44787, Bochum, Germany.
| | - Paula Siegmann
- 0000 0004 0490 981Xgrid.5570.7Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Massenbergstrasse 11, 44787 Bochum, Germany
| | - Ulrike Willutzki
- 0000 0000 9024 6397grid.412581.bDepartment for Psychology and Psychotherapy, Universität Witten/Herdecke, Witten, Germany
| | - Peter Nyhuis
- grid.440217.4St. Marien-Hospital Eickel, Herne, Germany
| | - Marcus Wolter
- grid.440217.4St. Marien-Hospital Eickel, Herne, Germany
| | - Thomas Forkmann
- 0000 0000 8653 1507grid.412301.5Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen University, Aachen, Germany
| | - Heide Glaesmer
- 0000 0001 2230 9752grid.9647.cDepartment of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Tobias Teismann
- 0000 0004 0490 981Xgrid.5570.7Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Massenbergstrasse 11, 44787 Bochum, Germany
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Siegmann P, Teismann T, Fritsch N, Forkmann T, Glaesmer H, Zhang XC, Brailovskaia J, Margraf J. Resilience to suicide ideation: A cross-cultural test of the buffering hypothesis. Clin Psychol Psychother 2017; 25:e1-e9. [PMID: 28853242 DOI: 10.1002/cpp.2118] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/07/2017] [Accepted: 07/03/2017] [Indexed: 01/07/2023]
Abstract
Depression and suicide ideation are common in student populations across the world. The present study investigated factors buffering the association between depression and suicide ideation. A total of 2,687 Chinese students and 601 German students took part in the investigation. Social support, satisfaction with life, self-efficacy, psychosocial stress resistance, and positive mental health were considered as resilience factors moderating the association between depressive symptoms and suicide ideation within both samples. Positive mental health moderated the impact of depressive symptoms on suicide ideation in German and Chinese students. Life satisfaction moderated the impact of depressive symptoms on suicide ideation in German students. Social support moderated the impact of depressive symptoms on suicide ideation in Chinese students. No interaction effects were found for self-efficacy and psychosocial stress resistance. Positive mental health, satisfaction with life, and perceived social support seem to confer resilience and should be taken into account, when assessing individuals for suicide risk.
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Affiliation(s)
- Paula Siegmann
- Department of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum, Germany
| | - Tobias Teismann
- Department of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum, Germany
| | - Nathalie Fritsch
- Department of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum, Germany
| | - Thomas Forkmann
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen University, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University Leipzig, Germany
| | - Xiao Chi Zhang
- Department of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum, Germany
| | - Julia Brailovskaia
- Department of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum, Germany
| | - Jürgen Margraf
- Department of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum, Germany
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Bonnewyn A, Shah A, Bruffaerts R, Demyttenaere K. Factors determining the balance between the wish to die and the wish to live in older adults. Int J Geriatr Psychiatry 2017; 32:685-691. [PMID: 27237707 DOI: 10.1002/gps.4511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 04/16/2016] [Accepted: 04/22/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND The "Internal Struggle Hypothesis" (Kovacs and Beck, ) suggests that suicidal persons may have both a wish to live (WTL) and a wish to die (WTD). The current study investigates whether the three-group typology - "WTL", "ambivalent (AMB)", and "WTD" - is determined by common correlates of suicidality and whether these groups can be ordinally ranked. METHODS The sample comprised 113 older inpatients. Discriminant analysis was used to create two functions (combining social, psychiatric, psychological, and somatic variables) to predict the assignment of older inpatients into the groups WTL, AMB, and WTD. RESULTS The functions "Subjective Well-being" and "Social Support" allowed us to assign patients into these three distinct groups with good accuracy (66.1%). "Subjective Well-being" contrasted the groups WTD and WTL and "Social Support" discriminated between the groups WTD and AMB. "Social Support" was highest in the AMB group. CONCLUSIONS Our results suggest a simultaneous presence of a WTL and a WTD in older inpatients, and also that the balance between them is determined by "Subjective Well-being" and "Social Support". Unexpectedly, the AMB group showed the highest scores on "Social Support". We hypothesize that higher social support might function as an important determinant of a remaining WTL when a WTD is present because of a lower sense of well-being. The study suggests that the groups WTL-AMB-WTD can not situated on a one-dimensional continuum. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Anke Bonnewyn
- University Psychiatric Centre (UPC-KUL), University of Leuven, Leuven, Belgium
| | - Ajit Shah
- University of Central Lancashire, Preston, UK
| | - Ronny Bruffaerts
- University Psychiatric Centre (UPC-KUL), University of Leuven, Leuven, Belgium
| | - Koen Demyttenaere
- University Psychiatric Centre (UPC-KUL), University of Leuven, Leuven, Belgium
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Reevaluating Suicidal Behaviors: Comparing Assessment Methods to Improve Risk Evaluations. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2016. [DOI: 10.1007/s10862-016-9566-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Wiggins S, McQuade R, Rasmussen S. Stepping Back From Crisis Points: The Provision and Acknowledgment of Support in an Online Suicide Discussion Forum. QUALITATIVE HEALTH RESEARCH 2016; 26:1240-1251. [PMID: 26935723 DOI: 10.1177/1049732316633130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Suicide is a global health concern, though little is known about the social practices that might support those who are contemplating suicide. Online forums provide a unique insight into the anonymous discussion of suicide, including sociocultural norms about suicide and the delicate management of online interaction. In this article, we examine the provision and acknowledgment of support in an online discussion forum about suicide, using discursive psychology to analyze the textual interaction. The analysis illustrates how forum threads function as case studies and enable members to gain support on numerous occasions. In this way, members can gain help at crisis points as and when these occur, while still maintaining authenticity as a valid forum member. The analysis also provides additional evidence for models of suicide which highlight the fluid nature of suicidality and contributes to the preventative work on suicide by demonstrating how support can be provided at crisis points.
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Harris KM, Syu JJ, Lello OD, Chew YLE, Willcox CH, Ho RHM. The ABC's of Suicide Risk Assessment: Applying a Tripartite Approach to Individual Evaluations. PLoS One 2015; 10:e0127442. [PMID: 26030590 PMCID: PMC4452484 DOI: 10.1371/journal.pone.0127442] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/15/2015] [Indexed: 11/24/2022] Open
Abstract
There is considerable need for accurate suicide risk assessment for clinical, screening, and research purposes. This study applied the tripartite affect-behavior-cognition theory, the suicidal barometer model, classical test theory, and item response theory (IRT), to develop a brief self-report measure of suicide risk that is theoretically-grounded, reliable and valid. An initial survey (n = 359) employed an iterative process to an item pool, resulting in the six-item Suicidal Affect-Behavior-Cognition Scale (SABCS). Three additional studies tested the SABCS and a highly endorsed comparison measure. Studies included two online surveys (Ns = 1007, and 713), and one prospective clinical survey (n = 72; Time 2, n = 54). Factor analyses demonstrated SABCS construct validity through unidimensionality. Internal reliability was high (α = .86-.93, split-half = .90-.94)). The scale was predictive of future suicidal behaviors and suicidality (r = .68, .73, respectively), showed convergent validity, and the SABCS-4 demonstrated clinically relevant sensitivity to change. IRT analyses revealed the SABCS captured more information than the comparison measure, and better defined participants at low, moderate, and high risk. The SABCS is the first suicide risk measure to demonstrate no differential item functioning by sex, age, or ethnicity. In all comparisons, the SABCS showed incremental improvements over a highly endorsed scale through stronger predictive ability, reliability, and other properties. The SABCS is in the public domain, with this publication, and is suitable for clinical evaluations, public screening, and research.
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Affiliation(s)
- Keith M. Harris
- School of Psychology, University of Queensland, St Lucia, Qld, Australia
| | - Jia-Jia Syu
- School of Public Health, University of Queensland, Herston, Qld, Australia
| | - Owen D. Lello
- School of Psychology, University of Newcastle, Newcastle, NSW, Australia
| | | | - Christopher H. Willcox
- Hunter New England Mental Health, Newcastle, NSW, Australia
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Roger H. M. Ho
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
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Screening for Suicide Risk in the College Population. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2015. [DOI: 10.1007/s10942-014-0203-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Associations between reasons for living and diminished suicide intent among African-American female suicide attempters. J Nerv Ment Dis 2014; 202:569-75. [PMID: 25010106 DOI: 10.1097/nmd.0000000000000170] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
African-American women are at high risk for suicide ideation and suicide attempts and use emergency psychiatric services at disproportionately high rates relative to men and other ethnic groups. However, suicide death rates are low for this population. Cultural variables in the African-American community may promote resilience and prevent fatal suicidal behavior among African-American women. The present study evaluated self-reported reasons for living as a protective factor against suicidal intent and suicide attempt lethality in a sample of African-American female suicide attempters (n = 150). Regression analyses revealed that reasons for living were negatively associated with suicidal intent, even after controlling for spiritual well-being and symptoms of depression. These results indicate that the ability to generate and contemplate reasons for valuing life may serve as a protective characteristic against life-threatening suicidal behavior among African-American women. Implications for research and clinical practice are further discussed.
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Harris KM, McLean JP, Sheffield J. Suicidal and online: how do online behaviors inform us of this high-risk population? DEATH STUDIES 2014; 38:387-394. [PMID: 24666145 DOI: 10.1080/07481187.2013.768313] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
To assist suicide prevention we need a better understanding of how suicidal individuals act in their environment, and the online world offers an ideal opportunity to examine daily behaviors. This anonymous survey (N = 1,016) provides first-of-its-kind empirical evidence demonstrating suicide-risk people (n = 290) are unique in their online behaviors. Suicidal users reported more time online, greater likelihood of developing online personal relationships, and greater use of online forums. In addition, suicide-risk women reported more time browsing/surfing and social networking. The authors conclude that suicide prevention efforts should respond to suicide-risk users' greater demands for online interpersonal communications.
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Affiliation(s)
- Keith M Harris
- a School of Psychology , The University of Newcastle , Callaghan , Australia
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Lento RM, Ellis TE, Hinnant BJ, Jobes DA. Using the suicide index score to predict treatment outcomes among psychiatric inpatients. Suicide Life Threat Behav 2013; 43:547-61. [PMID: 23725632 DOI: 10.1111/sltb.12038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 03/27/2013] [Indexed: 11/30/2022]
Abstract
For many suicidal people, the desire to die is moderated by a competing desire to live. This study aimed to demonstrate the ability of a wish-to-live versus wish-to-die index score to measure ambivalence and trichotomize suicidal inpatients into distinct stratified risk groups. Analyses revealed that index scores calculated for patients at treatment start significantly discriminated among the groups at index and uniquely predicted suicidal ideation, hopelessness, and depression scores across treatment. On average, patients with wish-to-live and wish-to-die orientations resolved suicidal ideation by discharge. Changes in suicidal ideation among ambivalently oriented patients were more variable. Clinical and research implications are discussed.
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Affiliation(s)
- René M Lento
- Department of Psychology, The Catholic University of America, Washington, DC, USA
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Harris KM. Sexuality and suicidality: matched-pairs analyses reveal unique characteristics in non-heterosexual suicidal behaviors. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:729-737. [PMID: 23657812 DOI: 10.1007/s10508-013-0112-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 01/06/2012] [Accepted: 03/02/2013] [Indexed: 06/02/2023]
Abstract
The present findings offer new perspectives on differences between suicide-risk heterosexuals and non-heterosexuals (lesbian, gay, bisexual, and questioning: LGBQ). Results from an anonymous online survey, employing standardized scales, showed that LGBQ participants reported significantly greater suicide-risk than heterosexuals. Seventy-nine matched pairs of suicide-risk LGBQ and heterosexuals were examined by individual suicide risk factors. Results showed no significant differences on separate measures of suicidal ideation; however, LGBQ participants were more likely to report suicide attempts, disclosure of suicidal intentions, and prediction of future suicide attempts. The LGBQ group also indicated greater likelihood of going online to develop new personal relationships. Multiple regression modeling was conducted to guide outreach and support efforts, revealing unique factors predicting help-seeking denial of suicide-risk LGBQ. Implications include the importance of online support and considering sexual minorities not just as a potential high-risk group, but also as a population with unique suicide risks and behaviors.
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Affiliation(s)
- Keith M Harris
- School of Psychology, The University of Newcastle, Behavioural Sciences Building (W210), University Drive, Callaghan, NSW, 2308, Australia.
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Corona CD, Jobes DA, Nielsen AC, Pedersen CM, Jennings KW, Lento RM, Brazaitis KA. Assessing and treating different suicidal states in a danish outpatient sample. Arch Suicide Res 2013; 17:302-12. [PMID: 23889578 DOI: 10.1080/13811118.2013.777002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The studies presented compare two methodologies for categorizing suicidal patients based on clinical data. Discussion follows regarding implications for risk assessment and treatment. In these studies, 52 outpatient subjects were placed into different groups based on coding their "suicidal motivation" (Study 1) and their "internal struggle" ratings (Study 2) using data collected at intake. Self-report ratings of 6 Suicide Status Form (SSF) Core Constructs (Psychological Pain, Stress, Agitation, Hopelessness, Self-Hate, and Overall Risk of Suicide) recorded both at intake and at completion of treatment were then compared to determine differences in Core Construct ratings among groups at different time points. In Study 1, overall differences among motivation groups (Life-motivated, Ambivalent, and Death-motivated) were significant for ratings at treatment completion of Overall Risk of Suicide, Self-Hate, and Psychological Pain. In Study 2, overall differences among groups (Wish to live, Ambivalent, and Wish to die) were significant for ratings at intake of Overall Risk of Suicide. At completion of treatment, overall differences among groups were significant for ratings of Overall Risk of Suicide, Hopelessness, and Self-Hate. In addition, significant interactions were found between test time and group for Overall Risk of Suicide and Self-Hate. Results suggest that categorizing suicidal patients by motivation and by the nature of their internal struggle could be beneficial to differential risk assessment with implications for clinical treatment.
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Affiliation(s)
- Christopher D Corona
- Department of Psychology, The Catholic University of America, Washington, DC 20064, USA.
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Jobes DA. The Collaborative Assessment and Management of Suicidality (CAMS): an evolving evidence-based clinical approach to suicidal risk. Suicide Life Threat Behav 2012; 42:640-53. [PMID: 22971238 DOI: 10.1111/j.1943-278x.2012.00119.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The Collaborative Assessment and Management of Suicidality (CAMS) is an evidence-based clinical intervention that has significantly evolved over 25 years of clinical research. CAMS is best understood as a therapeutic framework that emphasizes a unique collaborative assessment and treatment planning process between the suicidal patient and clinician. This process is designed to enhance the therapeutic alliance and increase treatment motivation in the suicidal patient. Central to the CAMS approach is the use of the Suicide Status Form (SSF), which is a multipurpose clinical assessment, treatment planning, tracking, and outcome tool. The original development of CAMS was largely rooted in SSF-based quantitative and qualitative assessment of suicidal risk. As this line of research progressed, CAMS emerged as a problem-focused clinical intervention that is designed to target and treat suicidal "drivers" and ultimately eliminate suicidal coping. To date, CAMS (and the clinical use of the SSF) has been supported by six published correlational studies and one randomized clinical trial (RCT). Currently, two well-powered RCTs are under way, and various new CAMS-related projects are also being pursued. The clinical and empirical evolution of CAMS-how it was developed and what are the next steps for this clinical approach-are described here.
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Affiliation(s)
- David A Jobes
- Department of Psychology, The Catholic University of America, Washington, DC 20064, USA.
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Abstract
This article is a review of several of the most concerning side effects of psychotropic medications in children and adolescents. An emphasis is placed on review of the prevalence, presentation, monitoring, and evidence-based management of these side effects.
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O'Connor SS, Jobes DA, Yeargin MK, Fitzgerald ME, Rodríguez VM, Conrad AK, Lineberry TW. A cross-sectional investigation of the suicidal spectrum: typologies of suicidality based on ambivalence about living and dying. Compr Psychiatry 2012; 53:461-7. [PMID: 22104555 DOI: 10.1016/j.comppsych.2011.09.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 09/08/2011] [Accepted: 09/14/2011] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the validity of assigning suicidal individuals into differing typologies of suicidality based on their reported wish to live and wish to die. METHODS One hundred five inpatients who reported suicidal ideation in the previous 48 hours completed a battery of assessments during inpatient psychiatric hospitalization. An algorithm was used to assign participants into 1 of 3 typologies of suicide: wish to live, ambivalent, or wish to die. Discriminant function analysis and group classification were used to predict group membership, followed by multiple analysis of variance and follow-up contrasts to measure between-group differences. MAIN RESULTS Group classification resulted in 76% accuracy for predicting typology of suicidality based on scores from suicide-specific measures. Self-perceived risk of suicide and hopelessness were the strongest variables at differentiating between the 3 groups. Patients in the wish to die typology were less likely to report having never made a suicide attempt. CONCLUSIONS Creating typologies of suicidality may prove useful to clinicians seeking to better differentiate among suicidal patients within a limited period of assessment.
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Affiliation(s)
- Stephen S O'Connor
- Department of Psychiatry and Behavioral Sciences, Harborview Injury Prevention and Research Center, University of Washington, Box 359960, Seattle, WA 91804, USA.
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Wu GH, Tsao LI, Huang HC. Struggle Between Survival and Death: The Life Experiences of Taiwanese Older Adults with Suicidal Ideation. J Gerontol Nurs 2012; 38:37-44. [DOI: 10.3928/00989134-20120307-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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