The Paradox of Suicide Prevention

Randomized controlled trial for the Attempted Suicide Short Intervention Program (ASSIP): An independent non-replication study

Following the call for rigorous replication practices in crisis intervention and suicide prevention research, this study re-evaluated the efficacy of a brief intervention (ASSIP - Attempted Suicide Short Intervention Program) for patients with a recent suicide attempt in reducing repeated suicidal behavior. In this open-label, randomized, controlled parallel-group trial, 92 patients were assigned to treatment as usual (TAU) or TAU plus ASSIP. The primary outcome was suicidal behavior (suicide attempts and suicide deaths) during a 12-month observation period. Secondary outcomes included the number of suicide attempts and psychiatric inpatient admissions. Twelve patients in the intervention group and six patients in the control group engaged in suicidal behavior, including one suicide death in each group. The intention-to-treat (ITT) analysis found no significant effect of ASSIP in reducing suicidal behavior or admission to psychiatric hospitals. Surprisingly, the per-protocol (PP) analysis revealed a significantly higher incidence rate of suicide re-attempts in the intervention group. Contrary to the original findings, this non-replication study suggests that ASSIP combined with TAU does not significantly reduce suicidal behavior compared to TAU alone. Further research is needed to refine indications for ASSIP therapy and enhance its effectiveness.

Mental pain and lifetime suicide attempts in early adolescence: a preliminary study

The primary aim of the present study was to examine the association of four complementary measures-suicidal cognitions, entrapment, mental pain, and depression-with past suicide attempts in early adolescence. The sample consisted of 657 adolescents aged 12-15 years (M = 12.68, SD = ± 0.82; 49.16% female, 49.47% male and 1.22% non-binary), all enrolled in the first stage of secondary education (ISCED 2, first year) in schools in Spain. The study employed a three-phase analytical approach: (1) ROC/AUC analysis to evaluate the performance of each measure, (2) logistic regression models to assess their association with past suicide attempts, and (3) validating the first-phase classification results by accounting for the possibility of response imbalances on each of four measures. The results showed that high intensity of mental pain most strongly associated with past suicide attempts, exhibiting the highest sensitivity and reliability across models. Suicidal cognitions and entrapment also showed utility in assessing suicide risk, although their impact was less pronounced than mental pain. Depressive symptomatology showed limited utility distinguishing adolescents with a history of suicide attempts. These findings underscore the importance of incorporating mental pain and related constructs in community-based strategies for suicide prevention with early adolescence-aged children. By combining these factors, practitioners can gain a more comprehensive understanding of risk, facilitating early identification and intervention in adolescents at risk for suicide.

Requirements for effective investigation and learning after suicide: the views of persons with lived experience and professionals

Objective

This study aims to provide a deeper understanding of what persons with lived experience and professionals with experience of patient safety, suicide research, and investigations consider to be most important in investigations of healthcare before suicide to learn and improve the care of suicidal patients.

Method

This is a qualitative study based on 15 semistructured interviews with persons with lived experience of suicidality and professionals. Thematic analysis was used.

Results

The persons with lived experience and the professionals agreed that a holistic approach to the investigations is crucial. They should embrace a longer period of time, involve family and significant others, integrate the perspective and expectations of the patient, and analyze factors of significance for suicidality, suicide prevention, and safety. There is a need to improve the investigations through the involvement of all stakeholders and actors, securing competence in the investigation team and prioritizing cases to investigate.

Conclusions

Substantial changes in the approach and performance of investigations of suicide in healthcare are needed to make these investigations valuable for increasing the safety of the care of suicidal patients. A holistic perspective during the analysis is crucial for understanding the suicidal process, the interacting factors, and the care process preceding suicide. Competencies in suicidality, suicide prevention, and patient safety must be included in the analysis team to ensure high quality and relevance. To improve the value of these investigations, we suggest establishing a template based on current knowledge to ensure attention to variables of significance for a safe care of suicidal patients.

Suicide prevention: reflections on progress over the past decade

Interest in preventing suicides has increased greatly in recent years. In this Personal View, we consider the general global developments related to suicide prevention that have occurred in the decade since The Lancet Psychiatry was first published in 2014. We then review specific advances during this period, first, in relation to public health initiatives, and second, with regard to clinical developments. Finally, we examine some of the challenges that currently confront individuals and organisations responsible for designing and implementing suicide prevention measures.

Reply to Obegi, J.H. Distinguishing Prevention from Treatment in Suicide Prevention. Comment on "Turner et al. The Paradox of Suicide Prevention. Int. J. Environ. Res. Public Health 2022, 19, 14983"

One of the aims of our paper "The Paradox of Suicide Prevention" is to promote greater discourse on suicide prevention, with a particular focus on the mental health models used for the identification of, and interventions with, individuals who come into contact with tertiary mental health services [...].

Distinguishing Prevention from Treatment in Suicide Prevention. Comment on Turner et al. The Paradox of Suicide Prevention. Int. J. Environ. Res. Public Health 2022, 19, 14983

In "The Paradox of Suicide Prevention", Turner and colleagues made an important contribution: they applied Rose's prevention paradox to suicide prevention efforts in healthcare systems. However, in doing so, they conflated prevention and treatment and did not distinguish suicide from suicidality. Their views may confuse efforts to design and implement clinical pathways for preventing suicide.