1
|
Dongxia L, Li M, Yingying F. Can neurocognition, brain neurotrophic factor, triglyceride, and total cholesterol predict suicidal ideation in first-episode Han Chinese patients with schizophrenia? Brain Behav 2024; 14:e3499. [PMID: 38680078 PMCID: PMC11056701 DOI: 10.1002/brb3.3499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/10/2024] [Accepted: 04/03/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVE Previous studies have suggested that the suicide rate of patients with schizophrenia is high. This study investigates factors influencing suicidal ideation in first-episode schizophrenia patients, focusing on cognitive function, brain-derived neurotrophic factor (BDNF), triglyceride (TG), and total cholesterol (TC) in patients with first-episode schizophrenia. METHODS A total of 123 patients with first-episode schizophrenia and 38 healthy controls were included in the study. The patients were divided into suicidal and nonsuicidal ideation groups based on the Beck Scale for Suicidal Ideation, and they were assessed with Positive and Negative Syndrome Scale (PANSS). Cognitive function was assessed using the Chinese version of the MATRICS consensus cognitive battery (MCCB) and the serum BDNF, TG, and TC were detected. The main statistical methods include t-test, χ2 test, multivariate logistic regression analysis, receiver operating characteristic (ROC) curve analysis, and the DeLong test. RESULTS 26.02% of patients exhibited suicidal ideation. Higher PANSS and TC levels were risk factors, while higher MCCB scores and BDNF levels were protective factors. ROC analysis indicated AUCs of 0.630, 0.724, and 0.762 for serum BDNF, PANSS, and MCCB, respectively, with a combined AUC of 0.870. CONCLUSION Serum BDNF level, PANSS score, and MCCB score can be used as auxiliary predictors of suicidal ideation in schizophrenic patients. Combining these three indicators can effectively predict suicidal ideation in schizophrenic patients.
Collapse
Affiliation(s)
- Li Dongxia
- Wuhan Mental Health CenterWuhan Psychological HospitalWuhan CityChina
| | - Ma Li
- Wuhan Mental Health CenterWuhan Psychological HospitalWuhan CityChina
| | - Feng Yingying
- Wuhan Mental Health CenterWuhan Psychological HospitalWuhan CityChina
| |
Collapse
|
2
|
Chalker SA, Sicotte R, Bornheimer LA, Parrish EM, Wastler H, Ehret B, DeVylder J, Depp CA. A call to action: informing research and practice in suicide prevention among individuals with psychosis. Front Psychiatry 2024; 15:1378600. [PMID: 38711871 PMCID: PMC11073495 DOI: 10.3389/fpsyt.2024.1378600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/22/2024] [Indexed: 05/08/2024] Open
Abstract
Although it is well established that individuals living with psychosis are at increased risk for suicidal ideation, attempts, and death by suicide, several gaps in the literature need to be addressed to advance research and improve clinical practice. This Call-to-Action highlights three major gaps in our understanding of the intersection of psychosis and suicide as determined by expert consensus. The three gaps include research methods, suicide risk screening and assessment tools used with persons with psychosis, and psychosocial interventions and therapies. Specific action steps to address these gaps are outlined to inform research and practice, and thus, improve care and prognoses among persons with psychosis at risk for suicide.
Collapse
Affiliation(s)
- Samantha A. Chalker
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, CA, United States
| | - Roxanne Sicotte
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Center of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Lindsay A. Bornheimer
- University of Michigan, School of Social Work, Ann Arbor, MI, United States
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Emma M. Parrish
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Heather Wastler
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | | | - Jordan DeVylder
- Silver School of Social Work, New York University, New York, NY, United States
| | - Colin A. Depp
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, CA, United States
| |
Collapse
|
3
|
Mulligan LD, Varese F, Harris K, Haddock G. Alcohol use and suicide-related outcomes in people with a diagnosis of schizophrenia: a comprehensive systematic review and meta-analysis. Psychol Med 2024; 54:1-12. [PMID: 37818642 DOI: 10.1017/s0033291723002738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
Suicide is the leading cause of unnatural death among people with a diagnosis of schizophrenia. Alcohol use is a prevalent comorbid feature of schizophrenia and a modifiable risk factor for suicide. We conducted a prospectively registered (PROSPERO, CRD42022358214) systematic review and meta-analysis to quantify the relationship between alcohol use and suicide-related outcomes in schizophrenia.We searched Medline, Embase, and PsycINFO for cross-sectional, case-control and longitudinal studies using exhaustive terms from database inception to December 2022 inclusive. Computation of odds ratios (ORs) and hazard ratios (HRs) were performed using a random-effects model with DerSimonian-Laird estimation. We also evaluated publication bias, study quality, and performed subgroup analysis and meta-regression. Fifty studies, comprising 65 samples, met eligibility criteria. Overall, alcohol use was associated with suicide (OR 1.38, 95% CI 1.21-1.58; HR = 1.32, 95% CI 1.00-1.74), attempted suicide (OR 1.69, 95% CI 1.45-1.98), and suicidal ideation (OR 1.69, 95% CI 1.22-2.34). While there was no evidence of publication bias, between-sample heterogeneity was moderate in analyses of attempted suicide (I2 = 39.6%, p = 0.01) and suicidal ideation (I2 = 56.0%, p = 0.01). Summary effects were significant in all subgroups except for longitudinal studies of attempted suicide (OR 1.60, 95% CI 0.86-3.00) and studies of suicidal ideation using gender combined samples (OR 1.63, 95% CI 0.99-2.67). Alcohol use is significantly associated with suicide-related outcomes in schizophrenia. Clinicians should routinely inquire about alcohol use in mental health services to focus preventative treatment efforts.
Collapse
Affiliation(s)
- Lee D Mulligan
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Filippo Varese
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust (GMMH), Manchester Academic Health Science Centre, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust (GMMH), Manchester, UK
| | - Kamelia Harris
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust (GMMH), Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|
4
|
Parrish EM, Chalker S, Cano M, Harvey PD, Taylor CT, Pinkham A, Moore RC, Ackerman RA, Depp CA. Ecological Momentary Assessment of Social Approach and Avoidance Motivations in Serious Mental Illness: Connections to Suicidal Ideation and Symptoms. Arch Suicide Res 2024; 28:123-140. [PMID: 36377277 PMCID: PMC10183051 DOI: 10.1080/13811118.2022.2137445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM People with serious mental illness (SMI) are at an increased risk for suicide. Social approach and avoidance motivations are linked to social functioning, and social isolation is a risk factor for suicide. This study uses ecological momentary assessment (EMA) to understand social approach and avoidance motivations in relation to symptoms and suicidal ideation (SI). METHODS Participants (N = 128) diagnosed with schizophrenia, schizoaffective disorder, or a mood disorder with psychotic features completed assessments of SI and symptoms at baseline. They completed EMA surveys 3×/day for 10 days. EMA surveys included questions about approach and avoidance motivations and psychotic symptoms. Participants were split into four groups based on the median scores of approach and avoidance. RESULTS Participants with SI at baseline had higher mean social avoidance motivation, t(126) = 2.84, p = .003, and lower mean social approach motivation, t(126) = -2.44, p = .008, than participants without baseline SI. Greater baseline positive symptoms were related to greater mean avoidance, r = .231, p = .009, but not approach motivation. The low approach/high avoidance group had significantly higher current SI than those with high approach/low avoidance (p < .001). Overall, the low approach/high avoidance group reported more EMA-measured voices than the low approach/low avoidance group (p < .001) and the high approach/low avoidance group (p < .001). Similarly, the low approach/high avoidance group reported more EMA-measured suspiciousness than the low approach/low avoidance (p < .001) and the high approach/low avoidance groups (p < .001). CONCLUSION The results of this study point to the role of social approach and avoidance motivations in relation to SI and psychotic symptoms. Clinically, exposure therapies and cognitive behavioral therapies may help to address these social approach and avoidance processes linked to SI.
Collapse
Affiliation(s)
- Emma M. Parrish
- San Diego State University / University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Samantha Chalker
- University of California San Diego Department of Psychiatry, San Diego, California
- Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Mayra Cano
- University of California San Diego Department of Psychiatry, San Diego, California
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| | - Philip D. Harvey
- University of Miami Miller School of Medicine, Miami, Florida, Research Service Miami VA Medical Center, Miami, FL
| | - Charles T. Taylor
- University of California San Diego Department of Psychiatry, San Diego, California
| | - Amy Pinkham
- The University of Texas at Dallas, Richardson, TX
| | - Raeanne C. Moore
- University of California San Diego Department of Psychiatry, San Diego, California
| | | | - Colin A. Depp
- University of California San Diego Department of Psychiatry, San Diego, California
- Veterans Affairs San Diego Healthcare System, San Diego, California
| |
Collapse
|
5
|
Gooding P, Haddock G, Harris K, Asriah M, Awenat Y, Cook L, Drake RJ, Emsley R, Huggett C, Jones S, Lobban F, Marshall P, Pratt D, Peters S. The interplay between suicidal experiences, psychotic experiences and interpersonal relationships: a qualitative study. BMC Psychiatry 2023; 23:873. [PMID: 38001403 PMCID: PMC10668454 DOI: 10.1186/s12888-023-05164-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/04/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Suicidal thoughts, acts, plans and deaths are considerably more prevalent in people with non-affective psychosis, including schizophrenia, compared to the general population. Social isolation and interpersonal difficulties have been implicated in pathways which underpin suicidal experiences in people with severe mental health problems. However, the interactions between psychotic experiences, such as hallucinations and paranoia, suicidal experiences, and the presence, and indeed, absence of interpersonal relationships is poorly understood and insufficiently explored. The current study sought to contribute to this understanding. METHODS An inductive thematic analysis was conducted on transcripts of 22, individual, semi-structured interviews with adult participants who had both non-affective psychosis and recent suicidal experiences. A purposive sampling strategy was used. Trustworthiness of the analysis was assured with researcher triangulation. RESULTS Participants relayed both positive and negative experiences of interpersonal relationships. A novel conceptual model is presented reflecting a highly complex interplay between a range of different suicidal experiences, psychosis, and aspects of interpersonal relationships. Three themes fed into this interplay, depicting dynamics between perceptions of i. not mattering and mattering, ii. becoming disconnected from other people, and iii. constraints versus freedom associated with sharing suicidal and psychotic experiences with others. CONCLUSION This study revealed a detailed insight into ways in which interpersonal relationships are perceived to interact with psychotic and suicidal experiences in ways that can be both beneficial and challenging. This is important from scientific and clinical perspectives for understanding the complex pathways involved in suicidal experiences. TRIAL REGISTRATION ClinicalTrials.gov (NCT03114917), 14th April 2017. ISRCTN (reference ISRCTN17776666 .); 5th June 2017). Registration was recorded prior to participant recruitment commencing.
Collapse
Affiliation(s)
- Patricia Gooding
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kamelia Harris
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Menita Asriah
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
| | - Yvonne Awenat
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Leanne Cook
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Richard J Drake
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Charlotte Huggett
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Steven Jones
- Lancashire and South Cumbria, NHS Foundation Trust, Lancashire, UK
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Fiona Lobban
- Lancashire and South Cumbria, NHS Foundation Trust, Lancashire, UK
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Paul Marshall
- Lancashire and South Cumbria, NHS Foundation Trust, Lancashire, UK
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sarah Peters
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| |
Collapse
|
6
|
Kim JS, Baek SH, Kim H, Kim JW, Kang HJ, Ryu S, Lee JY, Kim JM, Kim SW. Association between suicidal ideation and cognitive function in young patients with schizophrenia spectrum disorder. Front Psychiatry 2023; 14:1276511. [PMID: 37965366 PMCID: PMC10641781 DOI: 10.3389/fpsyt.2023.1276511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction Suicide is a major concern for patients with recent-onset schizophrenia. We hypothesized that preserved cognitive function might be associated with a higher level of suicidality in patients with schizophrenia. We investigated the associations between cognitive function and suicidal ideation (SI) in young patients recently diagnosed with a psychotic disorder. Methods This study analyzed data from a naturalistic clinical cohort study that comprised 402 patients with schizophrenia spectrum disorder. Patients with a treatment duration of ≤5 years and an age range of 15-39 years were enrolled. Participants were categorized into two groups based on SI as assessed by the Columbia Suicidal Severity Rating Scale. We collected demographic and clinical data and administered psychiatric, neurocognitive, and social cognitive measures. Results Among participants, 52% reported experiencing SI. Patients with SI were significantly younger and had a longer duration of untreated psychosis (DUP) than those without it. The Positive and Negative Syndrome Scale-general psychopathology score was significantly higher in the SI group. Scores on the Calgary Depression Scale for Schizophrenia, Perceived Stress Scale, Beck Depression Inventory (BDI), and Beck Hopelessness Scale were significantly higher among patients with SI, while scores on the Subjective Well-being Under Neuroleptics-Short Form and Brief Resilience Scale were significantly lower compared to those without it. Patients with SI demonstrated significantly higher scores on the verbal and visual learning test, false belief task, picture stories task, and Controlled Oral Word Association Test. They also completed the Trail Making Test (TMT) parts A and B in significantly less time than those without it. After adjusting for age, DUP, and scores on the BDI, group differences in scores on the verbal and visual learning tests, TMT (parts A and B), and the false belief task, and the picture story task remained significant. Discussion Our results suggest that along with traditional risk factors, better cognitive function may also be a major risk factor for suicidality in patients with schizophrenia. Providing psychological support and cognitive interventions is essential for young patients with recent-onset schizophrenia spectrum disorders, particularly those with high levels of depression, hopelessness, perceived stress, low resilience, and good cognitive function.
Collapse
Affiliation(s)
- Ji-Su Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seon-Hwa Baek
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Republic of Korea
| | - Honey Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seunghyong Ryu
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Republic of Korea
| |
Collapse
|
7
|
Harris K, Gooding PA, Awenat Y, Haddock G, Cook L, Huggett C, Jones S, Lobban F, Peeney E, Pratt D, Peters S. Acceptability of a novel suicide prevention psychological therapy for people who experience non-affective psychosis. Psychol Psychother 2023; 96:560-576. [PMID: 36856293 PMCID: PMC10953419 DOI: 10.1111/papt.12456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/01/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVES Suicide is a leading cause of death worldwide. People experiencing psychosis are at increased risk of death by suicide. Talking therapies can alleviate suicidal thoughts, plans, and attempts. Therapies need to also be acceptable to recipients. The aim of this study was to investigate the views on psychological therapy for people experiencing psychosis and suicidality using the Theoretical Framework of Acceptability. DESIGN Qualitative interview study. METHODS Participants were recruited from a randomised controlled trial comparing suicide prevention psychological therapy with treatment as usual. Individuals had a diagnosis of non-affective psychosis and experience of suicidal thoughts, plans and/or attempts. To assess the acceptability of the therapy, semi-structured interviews were conducted with 20 participants randomised to receive therapy. Data were deductively analysed using an adaptation of the Theoretical Framework of Acceptability. RESULTS Interviews (Mean = 45 min) were conducted and audio recorded with 21 participants. Data were organised into six themes: 1. Affective attitude, 2. Burden, 3. Alliance, 4. Intervention coherence, 5. Perceived effectiveness, and 6. Self-efficacy. There was no evidence of issues relating to domains of ethicality and opportunity costs associated with receiving therapy. CONCLUSIONS Talking about suicide was difficult and, at times, distressing, but it was perceived to be useful for understanding experiences. To be acceptable, it is important for therapists to ensure that clients' understanding of therapy aligns with expectations of effectiveness and to invest in building strong therapeutic alliances. Future research will benefit from examining therapists' experiences of delivering therapy through different modes (e.g. online, telephone).
Collapse
Affiliation(s)
- Kamelia Harris
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences Centre (MAHSC)ManchesterUK
- Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Patricia A. Gooding
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences Centre (MAHSC)ManchesterUK
- Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Yvonne Awenat
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences Centre (MAHSC)ManchesterUK
- Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences Centre (MAHSC)ManchesterUK
- Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Leanne Cook
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences Centre (MAHSC)ManchesterUK
- Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Charlotte Huggett
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences Centre (MAHSC)ManchesterUK
- Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Steven Jones
- Lancashire and South Cumbria NHS Foundation TrustLancashireUK
- Department of Health ResearchLancaster UniversityLancasterUK
| | - Fiona Lobban
- Lancashire and South Cumbria NHS Foundation TrustLancashireUK
- Department of Health ResearchLancaster UniversityLancasterUK
| | - Ellen Peeney
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences Centre (MAHSC)ManchesterUK
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences Centre (MAHSC)ManchesterUK
- Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Sarah Peters
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences Centre (MAHSC)ManchesterUK
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health SciencesUniversity of ManchesterManchesterUK
| |
Collapse
|
8
|
Martínez-Alés G, Bello I, Basaraba C, Van der Ven E, Mascayano F, Nossel I, Labouliere C, Susser E, Wall M, Stanley B, Dixon LB. Incidence, prevalence, and trajectories of suicidal ideation among clients enrolled in early intervention services for first episode psychosis in New York State. Schizophr Res 2023; 256:17-25. [PMID: 37120938 DOI: 10.1016/j.schres.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/01/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
Knowledge on how suicidal ideation (SI) varies following first episode psychosis (FEP) onset is scarce. We identified 1-year trajectories of SI and baseline predictors of emergent SI among all 1298 clients aged 16-30 years enrolled between October 2013-December 2018 in OnTrackNY, a program providing early intervention services for FEP across New York State. Clinicians recorded baseline clinical and sociodemographic variables and quarterly assessments of SI over a one-year follow-up. We examined baseline correlates of baseline SI and of 1-year SI trajectory. Among clients not reporting baseline SI, we examined predictors of subsequent emergent SI. Baseline SI was reported by 349 (26.9 %) clients and associated with schizoaffective disorder, previous self-injurious behavior, any alcohol or substance use, higher symptom severity, poorer social functioning, and Non-Hispanic White, Asian or Hispanic ethnoracial background. Two hundred and two (15.6 % overall) clients stopped being suicidal within 6 months of follow-up. Persistent SI was reported by 147 (11.3 % overall) clients and, among clients not discharged before one year of follow-up, was associated with schizoaffective disorder, any alcohol use, being female, and being Hispanic or White Non-Hispanic. Among 949 (73.1 %) clients not reporting baseline SI, subsequent emergent SI was reported by 139 (10.7 % overall) and predicted at baseline by schizoaffective disorder, higher symptom severity, recent homelessness, and not being Hispanic. In conclusion, SI is highly prevalent and varies markedly over time among FEP early intervention clients. These results highlight the importance of ongoing assessment for SI among individuals experiencing FEP - even in the absence of baseline SI.
Collapse
Affiliation(s)
- Gonzalo Martínez-Alés
- Harvard University T.H. Chan School of Public Health, Boston, MA, USA; Columbia University Mailman School of Public Health, New York, NY, USA; Mental Health Network Biomedical Research Center (CIBERSAM), Madrid, Spain; Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
| | - Iruma Bello
- New York State Psychiatric Institute, New York, USA
| | - Cale Basaraba
- Columbia University Mailman School of Public Health, New York, NY, USA; New York State Psychiatric Institute, New York, USA
| | - Els Van der Ven
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Franco Mascayano
- Columbia University Mailman School of Public Health, New York, NY, USA; New York State Psychiatric Institute, New York, USA
| | - Ilana Nossel
- New York State Psychiatric Institute, New York, USA
| | - Christa Labouliere
- New York State Psychiatric Institute, New York, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Ezra Susser
- Columbia University Mailman School of Public Health, New York, NY, USA; New York State Psychiatric Institute, New York, USA
| | - Melanie Wall
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Barbara Stanley
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Lisa B Dixon
- New York State Psychiatric Institute, New York, USA
| |
Collapse
|
9
|
Farah N, Obeid S, Malaeb D, Haddad C, Fekih-Romdhane F, Hallit S. Mediation effect of insomnia symptoms between positive psychotic like experiences and suicidal ideation among Lebanese young adults. BMC Psychiatry 2023; 23:272. [PMID: 37081441 PMCID: PMC10116113 DOI: 10.1186/s12888-023-04778-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/12/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Psychotic symptoms reported by healthy individuals in the general population are referred to as psychotic-like experiences (PLEs) and have been proven to increase the risk of suicidal ideation (SI) in these individuals. As it is well established that PLEs and insomnia share a bidirectional association and also that insomnia is linked to SI, we hypothesized that insomnia may represent a mediator underlying the relationship between PLEs and SI. Our aim was to validate this hypothesis among Lebanese young adults. METHODS A total of 3103 young adults (mean age 21.73 ± 3.80 years; 63.6% females) recruited from all Lebanese governorates completed a self-administered online questionnaire. PLEs were assessed using the CAPE-42 scale, SI using the Columbia Suicide Rating Scale, and insomnia using the Insomnia Severity Index). We conducted a mediation analysis using SPSS PROCESS v3.4 model 4 with three pathways. Variables that showed a p < 0.25 in the bivariate analysis were entered in the path analysis. RESULTS A total of 1378 participants (44.4%) had insomnia; 18.8% had SI; 42.5% reported at least one positive PE 'nearly always', and 30.5% reported at least one negative PE with this frequency. The results of the mediation analysis showed that insomnia severity partially mediated the association between positive dimension and SI; higher positive dimension was significantly associated with more insomnia severity, which was, in turn, significantly associated with more SI. Finally, more positive dimension was significantly and directly associated with more SI. CONCLUSION These preliminary findings might encourage the implementation of new preventive measures to reduce SI among PLEs patients. Treating symptoms of insomnia might help reduce the risk of suicide.
Collapse
Affiliation(s)
- Nour Farah
- Faculty of Science, Lebanese University, Fanar, Lebanon
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Chadia Haddad
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, 2010, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Souheil Hallit
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
| |
Collapse
|
10
|
Misiak B, Samochowiec J, Gawęda Ł, Frydecka D. Association of sociodemographic, proximal, and distal clinical factors with current suicidal ideation: Findings from a nonclinical sample of young adults. Eur Psychiatry 2023; 66:e29. [PMID: 36847110 PMCID: PMC10044310 DOI: 10.1192/j.eurpsy.2023.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Accumulating evidence indicates that a variety of distal and proximal factors might impact a risk of suicide. However, the association between both groups of factors remains unknown. Therefore, in the present study, we aimed to investigate the interplay between distal and proximal correlates of the current suicidal ideation. METHODS A total of 3,000 individuals (aged 18-35 years, 41.7% males), who had reported a negative history of psychiatric treatment, were enrolled through an online computer-assisted web interview. Self-reports were administered to measure: (a) distal factors: a history of childhood trauma (CT), reading disabilities (RDs), symptoms of attention-deficit/hyperactivity disorder (ADHD), lifetime history of non-suicidal self-injury (NSSI), lifetime problematic substance use as well as family history of schizophrenia and mood disorders; (b) proximal factors: depressive symptoms, psychotic-like experiences (PLEs), and insomnia; and (c) sociodemographic characteristics. RESULTS Suicidal ideation was directly associated with unemployment, being single, higher level of RD, lifetime history of NSSI as well as higher severity of PLEs, depression, and insomnia. The association of distal factors with suicidal ideation was fully (a history of CT and symptoms of ADHD) or partially (a history of NSSI and RD) mediated by proximal factors (PLEs, depression, and insomnia). CONCLUSIONS Main findings from this study posit the role of distal factors related to neurodevelopmental disorders, CT and NSSI in shaping suicide risk. Their effects might be partially or fully mediated by depression, PLEs, and insomnia.
Collapse
Affiliation(s)
- Błażej Misiak
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
11
|
Chalker SA, Parrish EM, Martinez Ceren CS, Depp CA, Ilgen MA, Goodman M, Twamley EW, Doran N. Crisis service utilization following completion of a suicide safety plan for Veterans with and without affective and nonaffective psychosis. J Psychiatr Res 2022; 154:219-223. [PMID: 35961177 DOI: 10.1016/j.jpsychires.2022.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Psychosis is associated with increased suicide risk. Safety planning is a suicide prevention practice that is associated with decreased suicidal behavior and psychiatric hospitalizations. A common feature of safety planning is listing of crisis line numbers. The primary purpose of this study was to compare Veterans with and without psychosis who completed a safety plan in terms of their next year crisis service use, including Veterans Crisis Line (VCL) calls, and suicidal behavior. METHODS Data were drawn from the VA San Diego's electronic medical record system for (N = 1602) safety plans from 2018 to 2021. Clinical records of crisis services and suicide attempt/death were recorded for one year after the safety plan. RESULTS Following completion of a safety plan, Veterans with psychosis were more likely to have a next year psychiatric hospitalization (OR = 4.1), emergency department visit (OR = 2.3), and psychiatric emergency clinic visit (OR = 2.2) than those without psychosis. In contrast, there were no group differences in likelihood of calling the VCL. CONCLUSIONS Veterans with psychosis who recently completed a safety plan do not show elevated rates of VCL use that are commensurate with increases in crisis service use. Interventions for this high-risk group may focus on understanding the motivation and ability to call the VCL as ways to enhance safety planning.
Collapse
Affiliation(s)
- Samantha A Chalker
- VA San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA.
| | - Emma M Parrish
- University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| | | | - Colin A Depp
- VA San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Mark A Ilgen
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan, Department of Psychiatry, Ann Arbor, MI, USA
| | | | - Elizabeth W Twamley
- VA San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Neal Doran
- VA San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| |
Collapse
|
12
|
Carruthers SP, Lee SJ, Sankaranarayanan A, Sumner PJ, Toh WL, Tan EJ, Neill E, Van Rheenen TE, Gurvich C, Rossell SL. Psychosis and Hopelessness Mediate the Relationship Between Reduced Sleep and Suicidal Ideation in Schizophrenia Spectrum Disorders. Arch Suicide Res 2022; 26:1862-1879. [PMID: 34225564 DOI: 10.1080/13811118.2021.1944412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Suicide is a major cause of death amongst individuals with schizophrenia spectrum disorders (SSD). Despite numerous risk factors being identified, accurate prediction of suicidality and provision of tailored and effective treatment is difficult. One factor that may warrant particular attention as a contributor to increased psychopathology and suicidality in SSD is disturbed sleep. Sleep disturbances have been reliably linked to greater levels of suicidal ideation and are highly prevalent amongst individuals with SSD. This study aimed to examine if reduced sleep duration and psychopathology are associated with increased suicidal ideation. METHOD One-hundred and eighteen adults with chronic SSD living within the community participated in this cross-sectional study. Psychosis symptoms were assessed using the Positive and Negative Syndrome Scale. Items 4 and 10 from the Montgomery-Asperg Depression Rating Scale and Item 2 from the Calgary Depression Scale for Schizophrenia were used to assess reduced sleep duration, current suicidal ideation, and hopelessness, respectively. All measures were rated concurrently. RESULTS A hierarchical logistic regression revealed that greater acute sleep disturbances were associated with increased suicidal ideation and this relationship was found to be uniquely mediated by both positive symptom severity and hopelessness. CONCLUSION These results suggest that individuals with SSD who exhibited disrupted or disordered sleep, positive symptoms and/or hopelessness should be routinely screened for suicidal thinking. Furthermore, interventions that effectively target sleep disruptions may provide much-needed action against suicidal ideation.HIGHLIGHTSReduced sleep found to be associated with increased suicidal ideationThis was uniquely mediated by both hopelessness and positive symptomsMore regular screening of sleep problems in schizophrenia is needed.
Collapse
|
13
|
Castillo-Sánchez G, Acosta MJ, Garcia-Zapirain B, De la Torre I, Franco-Martín M. Application of Machine Learning Techniques to Help in the Feature Selection Related to Hospital Readmissions of Suicidal Behavior. Int J Ment Health Addict 2022:1-22. [PMID: 35873865 PMCID: PMC9294773 DOI: 10.1007/s11469-022-00868-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/02/2022] Open
Abstract
Suicide was the main source of death from external causes in Spain in 2020, with 3,941 cases. The importance of identifying those mental disorders that influenced hospital readmissions will allow us to manage the health care of suicidal behavior. The feature selection of each hospital in this region was carried out by applying Machine learning (ML) and traditional statistical methods. The results of the characteristics that best explain the readmissions of each hospital after assessment by the psychiatry specialist are presented. Adjustment disorder, alcohol abuse, depressive syndrome, personality disorder, and dysthymic disorder were selected for this region. The most influential methods or characteristics associated with suicide were benzodiazepine poisoning, suicidal ideation, medication poisoning, antipsychotic poisoning, and suicide and/or self-harm by jumping. Suicidal behavior is a concern in our society, so the results are relevant for hospital management and decision-making for its prevention.
Collapse
Affiliation(s)
- Gema Castillo-Sánchez
- Department of Signal Theory and Communications, and Telematics Engineering, Universidad de Valladolid, Paseo de Belén 15, 47011 Valladolid, Spain
| | | | | | - Isabel De la Torre
- Department of Signal Theory and Communications, and Telematics Engineering, Universidad de Valladolid, Paseo de Belén 15, 47011 Valladolid, Spain
| | | |
Collapse
|
14
|
Lopez D, de Mamani AW. The interplay of family cohesion, self-stigma, and suicidal ideation in people of color with psychotic spectrum disorders. Psychiatry Res 2022; 313:114639. [PMID: 35597137 DOI: 10.1016/j.psychres.2022.114639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/20/2022]
Abstract
Individuals with psychotic spectrum disorders (PSDs) are at an increased risk for suicide compared to the general population. Both individuals with PSDs and communities of color are known to experience a high degree of mental health stigma. People of color also have strong family values that emphasize familial obligations and unity. The current study examined relationships between family cohesion, mental health self-stigma, and suicidal ideation among people of color with PSDs. The study sample consisted of 95 people of color with a PSD [Age in years: M = 38.27, SD=11.99; 65.3% male; 62.1% Latinx, 34.7% Black, 3.2% Other/Mixed]. Measures used were the suicidal ideation item from the BPRS interview, family cohesion subscale from the family environment scale, and three items asking participants about shame, guilt, or embarrassment experienced related to their PSD. In general, family cohesion was associated with less suicidal ideation, even when controlling for gender, education, and self-stigma. When examining conditional effects, family cohesion was associated with decreased suicidal ideation only when self-stigma was at or below the mean level observed. Additionally, self-stigma was associated with increased suicidal ideation only when family cohesion was above the mean level observed. Considering interactions between suicide risk and protective factors is paramount, as roles may shift.
Collapse
|
15
|
Hyland P, Karatzias T, Ford JD, Fox R, Spinazzola J. The Latent Structure of Child and Adolescent Psychopathology and its Association with Different Forms of Trauma and Suicidality and Self-Harm : LATENT STRUCTURE OF PSYCHOPATHOLOGY. Res Child Adolesc Psychopathol 2022; 50:1501-1513. [PMID: 35476235 PMCID: PMC9616783 DOI: 10.1007/s10802-022-00925-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/24/2022]
Abstract
The Hierarchical Taxonomy of Psychopathology (HiTOP) is a multidimensional and hierarchical model of the latent structure of psychopathology. While HiTOP has received much support in child/adolescent community samples, fewer studies have assessed this model in clinical samples of children/adolescents. Here, we modelled the latent structure of 45 symptoms of psychopathology from a clinical sample of children/adolescents and assessed how dimensions of psychopathology were related to specific forms of trauma and suicidality/self-harm. Clinician-derived assessments were obtained from 507 people aged 7-18 years. Confirmatory factor analysis was used to determine the optimal fitting model, and structural equation modelling was used to estimate associations with trauma exposure and suicidality/self-harm. The best fitting model(s) included five first-order factors reflecting Fear, Distress, Externalizing, Thought Disorder, and Traumatic Stress, with a higher-order general factor (p) accounting for the covariation between these factors. Unique associations were identified between specific forms of trauma and each dimension of psychopathology. p was strongly associated with suicidality/self-harm, and of the first-order factors, Distress was most strongly associated with suicidality/self-harm. Findings support the predictions of HiTOP that the latent structure of child/adolescent psychopathology can be effectively described by a multidimensional and hierarchal model. Moreover, we found tentative evidence for a unique dimension of Traumatic Stress psychopathology. Our findings also highlight the unique associations between specific forms of early life trauma and specific dimensions of psychopathology, and the importance of Distress related psychopathology for suicidality/self-harm in children and adolescents.
Collapse
Affiliation(s)
- Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland.
| | - Thanos Karatzias
- Department of Psychology, Edinburgh Napier University, Edinburgh, Scotland
| | - Julian D Ford
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Robert Fox
- School of Business, National College of Ireland, Dublin, Ireland
| | | |
Collapse
|
16
|
Weisman de Mamani A, Lopez D. Enculturation and acculturation's relationship to suicidal ideation in Hispanic/Latinx individuals with psychotic spectrum disorders. Psychiatry Res 2022; 307:114298. [PMID: 34864231 DOI: 10.1016/j.psychres.2021.114298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 10/14/2021] [Accepted: 11/19/2021] [Indexed: 11/19/2022]
Abstract
Suicide is a leading cause of premature death in people with schizophrenia (Inoue et al., 2020). Hispanic/Latinx (H/L) individuals, the largest ethnic minority group in the U.S., face potential hurdles (e.g., discrimination, language barriers) when trying to receive care for psychotic spectrum disorders, which may increase their risk for suicidal ideation. Drawing from prior literature, we tested the hypotheses that greater acculturation and lower enculturation would be associated with increased suicidal ideation in a sample of 45 H/L individuals with psychotic spectrum disorders using a linear regression analysis controlling for gender and education. As hypothesized, greater acculturation and lower enculturation were associated with greater suicidal ideation. In line with prior research, results of this study suggest that maintaining beliefs and traditions from one's home culture may be beneficial to H/Ls with psychotic spectrum disorders and may reduce suicidal ideation whereas there may be detrimental aspects of mainstream United States culture on one's desire to live. Thus, encouraging H/L patients with psychotic spectrum disorders to maintain a sense of ethnic pride and stay engaged with practices and values from their culture of origin may help reduce suicidal ideation in this vulnerable population.
Collapse
Affiliation(s)
- Amy Weisman de Mamani
- University of Miami, Department of Psych, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables FL, 33146, USA
| | - Daisy Lopez
- University of Miami, Department of Psych, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables FL, 33146, USA.
| |
Collapse
|
17
|
Sher L, Kilmade ME, Feinberg A, Govindarajulu U, Byne W, Kahn RS, Hazlett EA. Clinical features and psychiatric comorbidities in military veterans with schizophrenia with or without suicidality. J Psychiatr Res 2021; 143:262-267. [PMID: 34517189 DOI: 10.1016/j.jpsychires.2021.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/29/2021] [Accepted: 09/06/2021] [Indexed: 11/25/2022]
Abstract
Suicide is currently among the leading causes of death among individuals with schizophrenia. Reducing mortality from suicide remains a major clinical challenge in the care of veterans with schizophrenia. There is a need to increase our understanding of what elevates suicide risk in veterans with schizophrenia as a first step towards the future development of suicide prevention interventions. This study compared demographic and clinical features of military veterans with schizophrenia with vs. without suicidality to determine specific risk factors for suicidality. The sample consisted of two groups of veterans with schizophrenia: suicide ideators and/or attempters (SIA) and individuals without a history of suicidal ideation or attempts (no-SIA). Participants were interviewed using the Structured Clinical Interview for DSM-5 Axis I disorders (SCID-I), Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Hamilton Depression Rating Scale (HDRS), and Schizotypal Personality Questionnaire (SPQ). In bivariate analyses, the PANSS-Positive Symptom scores, PANSS-General Psychopathology scores, HDRS total score, HDRS-Paranoid symptoms item score, and SPQ total scores were higher among SIA compared with no-SIA patients. In this unique clinical sample of veterans with schizophrenia, SIA patients were more likely to have mood disorders, post-traumatic stress disorder (PTSD), and/or alcohol use disorder in comparison to the no-SIA group. Logistic regression analysis indicated that the HDRS total score and presence/absence of comorbid mood disorder drive the difference between the groups. These results indicate that suicide risk assessment in veterans with schizophrenia should include identifying individuals with comorbid mood disorders/symptoms, PTSD, alcohol use disorder, marked positive symptoms, and schizotypal features.
Collapse
Affiliation(s)
- Leo Sher
- James J. Peters VA Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | - Abigail Feinberg
- James J. Peters VA Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - William Byne
- New York State Psychiatric Institute, New York, NY, USA; Columbia University College of Physicians, New York, NY, USA
| | - René S Kahn
- James J. Peters VA Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin A Hazlett
- James J. Peters VA Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
18
|
Husain MO, Chaudhry IB, Khan Z, Khoso AB, Kiran T, Bassett P, Husain MI, Upthegrove R, Husain N. Depression and suicidal ideation in schizophrenia spectrum disorder: a cross-sectional study from a lower middle-income country. Int J Psychiatry Clin Pract 2021; 25:245-251. [PMID: 34261408 DOI: 10.1080/13651501.2021.1914664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Depression has long been considered a significant feature of schizophrenia and is associated with more frequent psychotic episodes, increased service utilisation, substance misuse, poor quality of life and completed suicide. However, there is a distinct lack of literature on this comorbidity from low- and middle-income countries or non-western cultural backgrounds. METHODS This is a cross-sectional analysis of baseline data from a large randomised controlled trial, examining the prevalence of depression and suicidal ideation in patients with schizophrenia spectrum disorder. A total of 298 participants were recruited from inpatient and outpatient psychiatric units in Karachi, Pakistan. Participants completed the Calgary Depression Scale for Schizophrenia (CDSS), Positive and Negative Syndrome Scale (PANSS), Euro Qol (EQ-5D) and Social Functioning Scale (SFS). RESULTS Data indicate that 36% of participants in the study were depressed and 18% endorsed suicidal ideation. Depression was associated with higher positive symptom scores and reduced quality of life, but no significant difference in negative symptoms and social functioning. CONCLUSIONS Depression and suicidal ideation are prevalent in Pakistani patients diagnosed with schizophrenia spectrum disorder. Evaluation of depressive symptoms in this group may help identify individuals at higher risk of completed suicide, allowing for targeted interventions to improve outcomes.Key pointsTo our knowledge, this is the first study describing the prevalence of depression and suicidal ideation in individuals with schizophrenia from Pakistan.Our data indicate that 36% of individuals with schizophrenia in our sample were depressed and 18% endorsed suicidal ideation.Depression in schizophrenia was associated with poorer quality of life and higher positive symptom burden.This study adds to the scarce literature from low- and middle-income countries where the burden of mental illness is great and where the majority of suicide deaths occur.Addressing social inequality, food insecurity, high rates of unemployment and low levels of literacy in these settings may have a profound effect on population mental health and suicide risk.
Collapse
Affiliation(s)
- M Omair Husain
- Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Pakistan Institute of Living and Learning, Karachi, Pakistan.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Imran B Chaudhry
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK.,Department of Psychiatry, Ziauddin Hospital, Karachi, Pakistan
| | - Zainib Khan
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Ameer B Khoso
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | | | - M Ishrat Husain
- Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| |
Collapse
|
19
|
de Cates AN, Catone G, Marwaha S, Bebbington P, Humpston CS, Broome MR. Self-harm, suicidal ideation, and the positive symptoms of psychosis: Cross-sectional and prospective data from a national household survey. Schizophr Res 2021; 233:80-88. [PMID: 34246091 PMCID: PMC8388846 DOI: 10.1016/j.schres.2021.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 02/17/2021] [Accepted: 06/21/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Schizophrenia is associated with premature mortality, partly through increased suicide rates. AIMS To examine (1) if persecutory ideas, auditory hallucinations, and probable cases of psychosis are associated with suicidal thoughts or attempts cross-sectionally and prospectively, and (2) if such links are mediated by specific affective factors (depression, impulsivity, mood instability). METHOD We analysed the 2000, 2007, and 2014 British Adult Psychiatric Morbidity Surveys (APMS) separately. Measures of psychosis provided independent variables for multi-stage logistic regressions, with suicidal thoughts and attempts as dependent variables. We also conducted analyses to assess mediation by affective variables, and longitudinal analyses on a subset of the 2000 dataset. RESULTS In every dataset, persecutory ideas, auditory hallucinations and probable psychosis were associated cross-sectionally with lifetime suicidal attempts and thoughts, even after controlling for confounders, with a single exception (persecutory ideation and suicide attempts were unconnected in APMS 2014). Cross-sectional associations between auditory hallucinations and suicidal phenomena were moderated by persecutory ideation. In the 2000 follow-up, initial persecutory ideas were associated with later suicidal thoughts (O.R. 1.77, p < 0.05); there were no other longitudinal associations. In the 2007 and 2014 datasets, mood instability mediated the effects of psychotic phenomena on suicidality more strongly than impulsivity; depression was also an important mediator. There were appreciable direct effects of positive symptoms on suicidal thoughts and behaviour. CONCLUSIONS Improving psychotic symptoms and ameliorating co-morbid distress may in itself be effective in reducing suicidal risk in schizophrenia. Given their potential mediating role, mood instability and depression may also be targets for intervention.
Collapse
Affiliation(s)
- Angharad N de Cates
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Gennaro Catone
- Department of Educational, Psychological and Communication Sciences, Suor Orsola Benincasa University, Naples, Italy
| | - Steven Marwaha
- Institute for Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Paul Bebbington
- Division of Psychiatry, University College London, London, UK
| | - Clara S Humpston
- Institute for Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Matthew R Broome
- Institute for Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's NHS Foundation Trust, UK
| |
Collapse
|
20
|
Large M, Corderoy A, McHugh C. Is suicidal behaviour a stronger predictor of later suicide than suicidal ideation? A systematic review and meta-analysis. Aust N Z J Psychiatry 2021; 55:254-267. [PMID: 32579030 DOI: 10.1177/0004867420931161] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Suicidal ideation and suicidal behaviour are both regarded as important risk factors for suicide, but it is usually believed that suicidal ideation is less strongly linked to suicide than suicidal behaviours. In this study, we assessed and compared the strengths of the associations that suicidal ideation and suicidal behaviour have with later suicide using meta-analysis of primary studies reporting both these independent variables and the dependent variable of suicide. METHODS A total of 51 English language publications describing cohort or controlled studies that reported on both the association between suicidal ideation and suicide and the association between suicidal behaviours and suicide were located using searches for titles in PubMed containing variants of the word suicide (suicid*). Suicides were considered to include reported suicides and open verdicts from mortality registers. The strengths of the two associations were examined in separate random effects meta-analyses and were then compared using mixed effects meta-regression. Subgroups were examined according to study characteristics including the definitions of suicidal ideation or behaviour used, setting (psychiatric or non-psychiatric), diagnostic mix of the study population, study design (cohort or control) and study quality. RESULTS Suicidal ideation (odds ratio = 3.11, 95% confidence interval = 2.51, 3.86) and suicidal behaviours (odds ratio = 4.09, 95% confidence interval = 3.05, 5.49) were both significantly associated with suicide but there was no significant difference in the strengths of association (p = 0.14). Nor were there significant differences in the strengths of the two associations in multiple subgroup analyses. CONCLUSION Suicidal ideation and suicidal behaviour are both moderately associated with suicide. Existing data cannot conclusively demonstrate that suicidal behaviours are more strongly associated with suicide than suicidal ideation. Clinicians should not strongly prioritise suicidal behaviour over suicidal ideation when considering suicide risk.
Collapse
Affiliation(s)
- Matthew Large
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Amy Corderoy
- School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia
| | - Catherine McHugh
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
21
|
Krepel N, Benschop L, Baeken C, Sack AT, Arns M. An EEG signature of suicidal behavior in female patients with major depressive disorder? A non-replication. Biol Psychol 2021; 161:108058. [PMID: 33647333 DOI: 10.1016/j.biopsycho.2021.108058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION A recent study showed hypoactivity in the beta/gamma band in female suicide ideators and suicide attempters diagnosed with depression, relative to a low-risk group. The current study aimed to conceptually replicate these results. METHODS In the iSPOT-D sub-sample (n = 402), suicide ideators and low-risk individuals were identified. Confining analyses to females only, differences between low-risk individuals and suicide ideators were tested for using the electroencephalogram (EEG) frequency bands SMR (Sensori-Motor-Rhythm; 12-15 Hz), beta (14.5-30 Hz), beta I (14.5-20 Hz), beta II (20-25 Hz), beta III (25-30 Hz), gamma I (31-49 Hz) using LORETA-software. RESULTS None of the tested frequency bands showed to be significantly different between suicide ideators and low-risk individuals. CONCLUSIONS The current study could not conceptually replicate the earlier published results. Several reasons could explain this non-replication, among which possible electromyographic (EMG) contamination in the beta/gamma band in the original study. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00693849. URL: http://clinicaltrials.gov/ct2/show/NCT00693849.
Collapse
Affiliation(s)
- Noralie Krepel
- Dept. of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands
| | - Lars Benschop
- Ghent University, Department of Psychiatry and Medical Psychology, Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
| | - Chris Baeken
- Ghent University, Department of Psychiatry and Medical Psychology, Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium; Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZBrussel), Laarbeeklaan 101, 1090, Brussels, Belgium; Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, the Netherlands
| | - Alexander T Sack
- Dept. of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Martijn Arns
- Dept. of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Psychiatry (Location AMC), Amsterdam Neuroscience, Amsterdam, the Netherlands.
| |
Collapse
|
22
|
Chong BTW, Wahab S, Muthukrishnan A, Tan KL, Ch'ng ML, Yoong MT. Prevalence and Factors Associated with Suicidal Ideation in Institutionalized Patients with Schizophrenia. Psychol Res Behav Manag 2020; 13:949-962. [PMID: 33204188 PMCID: PMC7667143 DOI: 10.2147/prbm.s266976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/21/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose The shorter life expectancy and increased risk of suicide in patients with schizophrenia have been well documented. However, study outcomes on suicidality in this special population have been few to date. This study investigated the prevalence and factors associated with suicidal ideation in a population of institutionalized patients with schizophrenia. Methods Two hundred fifty-six patients with schizophrenia between the age of 18 and 65 years were randomly recruited. This cross-sectional study utilised the Calgary Depression Scale for Schizophrenia (CDSS), the Positive and Negative Syndrome Scale (PANSS) and the Psychotic Symptom Rating Scale (PSYRATS-AH). Univariate analysis was performed using an independent t-test or chi-square test, followed by binary logistic regression to determine the factors associated with increased suicidal risks. Results The socio-demographic factors associated with suicidal ideation included level of education (p=0.039); secondary-level education (OR=5.76, 95% CI:1.49, 22.34, p=0.011) and tertiary-level education (OR=9.30, 95% CI: 1.80, 48.12, p=0.008) posed a greater risk. A history of attempted suicide (OR=2.09, 95% CI: 1.01, 4.36, p=0.049) and the presence of co-morbid physical illnesses (OR=2.07, 95% CI: 1.02, 4.21, p=0.044) were also found to be associated with a suicidal ideation. Other significant factors associated with suicidal thoughts were concurrent depression (OR=9.68, 95% CI: 3.74, 25.05, p<0.001) and a higher PSYRATS score in emotional characteristics of auditory hallucinations (OR=1.13, 95% CI: 1.06, 1.21, p<0.001). Conclusion Suicide in schizophrenia appears to be more closely associated with certain socio-demographic factors and affective symptoms. Appropriate screening and treatment addressing these challenges must be emphasized if suicidal thoughts and actions are to be reduced.
Collapse
Affiliation(s)
- Benedict Tak Wai Chong
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Wilayah Persekutuan 56000, Malaysia
| | - Suzaily Wahab
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Wilayah Persekutuan 56000, Malaysia
| | - Arunakiri Muthukrishnan
- Department of Psychiatry, Hospital Bahagia Ulu Kinta, Tanjung Rambutan, Perak Darul Ridzwan 31250, Malaysia
| | - Kok Leong Tan
- Department of Community Medicine, School of Medicine, International Medical University (IMU), Kuala Lumpur, Wilayah Persekutuan 57000, Malaysia
| | - May Lee Ch'ng
- Department of Community Medicine, School of Medicine, International Medical University (IMU), Kuala Lumpur, Wilayah Persekutuan 57000, Malaysia
| | - Mei Theng Yoong
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Wilayah Persekutuan 56000, Malaysia
| |
Collapse
|
23
|
Gooding PA, Pratt D, Awenat Y, Drake R, Elliott R, Emsley R, Huggett C, Jones S, Kapur N, Lobban F, Peters S, Haddock G. A psychological intervention for suicide applied to non-affective psychosis: the CARMS (Cognitive AppRoaches to coMbatting Suicidality) randomised controlled trial protocol. BMC Psychiatry 2020; 20:306. [PMID: 32546129 PMCID: PMC7298803 DOI: 10.1186/s12888-020-02697-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/27/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Suicide is a leading cause of death globally. Suicide deaths are elevated in those experiencing severe mental health problems, including schizophrenia. Psychological talking therapies are a potentially effective means of alleviating suicidal thoughts, plans, and attempts. However, talking therapies need to i) focus on suicidal experiences directly and explicitly, and ii) be based on testable psychological mechanisms. The Cognitive AppRoaches to coMbatting Suicidality (CARMS) project is a Randomised Controlled Trial (RCT) which aims to investigate both the efficacy and the underlying mechanisms of a psychological talking therapy for people who have been recently suicidal and have non-affective psychosis. METHODS The CARMS trial is a two-armed single-blind RCT comparing a psychological talking therapy (Cognitive Behavioural Suicide Prevention for psychosis [CBSPp]) plus Treatment As Usual (TAU) with TAU alone. There are primary and secondary suicidality outcome variables, plus mechanistic, clinical, and health economic outcomes measured over time. The primary outcome is a measure of suicidal ideation at 6 months after baseline. The target sample size is 250, with approximately 125 randomised to each arm of the trial, and an assumption of up to 25% attrition. Hence, the overall recruitment target is up to 333. An intention to treat analysis will be used with primary stratification based on National Health Service (NHS) recruitment site and antidepressant prescription medication. Recruitment will be from NHS mental health services in the North West of England, UK. Participants must be 18 or over; be under the care of mental health services; have mental health problems which meet ICD-10 non-affective psychosis criteria; and have experienced self-reported suicidal thoughts, plans, and/or attempts in the 3 months prior to recruitment. Nested qualitative work will investigate the pathways to suicidality, experiences of the therapy, and identify potential implementation challenges beyond a trial setting as perceived by numerous stake-holders. DISCUSSION This trial has important implications for countering suicidal experiences for people with psychosis. It will provide definitive evidence about the efficacy of the CBSPp therapy; the psychological mechanisms which lead to suicidal experiences; and provide an understanding of what is required to implement the intervention into services should it be efficacious. TRIAL REGISTRATION ClinicalTrials.gov (NCT03114917), 14th April 2017. ISRCTN (reference ISRCTN17776666 https://doi.org/10.1186/ISRCTN17776666); 5th June 2017). Registration was recorded prior to participant recruitment commencing.
Collapse
Affiliation(s)
- Patricia A Gooding
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK.
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK
| | - Yvonne Awenat
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK
| | - Richard Drake
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK
| | - Rachel Elliott
- Manchester Centre for Health Economics, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Richard Emsley
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Charlotte Huggett
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK
| | - Steven Jones
- Lancashire Care NHS Foundation Trust, Lancashire, UK
- University of Lancaster, Lancaster, UK
| | - Navneet Kapur
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK
| | - Fiona Lobban
- Lancashire Care NHS Foundation Trust, Lancashire, UK
- University of Lancaster, Lancaster, UK
| | - Sarah Peters
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK
| |
Collapse
|
24
|
Affiliation(s)
- Gregory Carter
- 1 Centre for Brain and Mental Health Research, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Matthew J Spittal
- 2 Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
25
|
Chang Q, Wu D, Rong H, Wu Z, Tao W, Liu H, Zhou P, Luo G, Xie G, Huang S, Qian C, Yuan Y, Yip PSF, Liu T. Suicide ideation, suicide attempts, their sociodemographic and clinical associates among the elderly Chinese patients with schizophrenia spectrum disorders. J Affect Disord 2019; 256:611-7. [PMID: 31299442 DOI: 10.1016/j.jad.2019.06.069] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/23/2019] [Accepted: 06/30/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND It is still unknown whether many well-identified risk factors of suicide could be applied to the elderly Chinese patients with schizophrenia. METHODS 1-month suicidal ideation and lifetime suicide attempts together with their sociodemographic and clinical associates were analyzed by retrospective data on 263 elderly patients with schizophrenia spectrum disorders at the Kangning Hospital, Shenzhen, China. T-tests and Chi-square tests were used to examine the differences between patients with and without suicidality. Backward stepwise logistic regression was performed to identify the associated factors. RESULTS Among the selected patients, 17.87% had 1-month suicide ideation and 7.60% had lifetime suicide attempts. It was further observed that the elderly patients with schizophrenia who had 1-month suicide ideation were more likely to report lifetime suicide attempts, suffer from severe hopelessness and negative symptoms, and have no pension. However, the backward stepwise logistic regression analyses revealed that lifetime suicide attempts and negative symptoms were most significantly associated with 1-month suicide ideation. In contrast, lifetime suicide attempters were more likely to be men, receive a pension, display symptoms of hopelessness, have longer duration of illness and poor family relationships. The regression analyses also indicated that only hopelessness, relatively long duration of schizophrenia, and poor family relationships were the most significantly associated with lifetime suicide attempts. LIMITATIONS The retrospective design do not allow for causal inferences. CONCLUSIONS Early interventions designed to decrease hopelessness, control negative symptoms, and improve family relationships may result in reduced risks of suicide among elderly Chinese patients with schizophrenia.
Collapse
|
26
|
Abstract
Suicide is the most common cause of early mortality during the course of schizophrenia. The most recent data in the literature show that the risk of suicide is greater at the beginning of the course of schizophrenia. The risk of suicide during the first year is 12 times higher than that of the general population. Specifically, 2-5 % of people with first-episode psychosis will die by suicide in long-term follow-up studies. Regarding the presence of suicidal ideation that are a major factor of suicide in subjects suffering from psychotic disorders, their prevalence remains extremely worrying, since they are substantial and persistent. Consequently, suicide prevention should be a major and immediate objective in the management of the disease, as soon as the diagnosis has been made. Suicidal ideas are a potential precursor to the evolution towards acting out. Their evolution must be specifically assessed in each individual. Indeed, in the influential Danish OPUS study the authors reported heterogeneity in suicidal ideations in young patients with first episode of psychosis and identified three prototypical trajectories of suicidal ideations over the first 2 years in treatment. Particularly, nearly 40 % of patients with first-episode psychosis have persisting suicidal thoughts over the initial treatment period. Consequently, the authors recommend routine screening for suicidality when providing treatment for first-episode psychosis. The main risk factors for suicidal behavior in patients with a first episode are classical ones. Previous research has suggested that, in addition to young age and early course of illness, other important clinical predictors of suicide in individuals with schizophrenia include presence of depressive symptoms and misuse of substances, which are very common conditions in these patients. Lack of social support, loss, rejection, stigma, insight, fear of future losses, are all negative experiences experienced by patients starting a psychotic disorder. Negative connotations of the diagnosis of psychotic disorders, feelings of being trapped that can be directly related to feeling a burden can lead to suicidal crisis in these individuals. Then, the painful experience of the disease and its consequences associated with self-stigmatization and social rejection may induce hopelessness and suicidal thoughts in these young subjects. The quality of the insight and its evolution may worsen the depressive experience and suicidal risk and they therefore also require to be measured regularly. Thus, the clinical evaluation of patients entering psychosis should focus on those dimensions that are not directly related to the psychotic symptoms. At the precise evaluation of each patient must be associated personalized measures of prevention. It is now proposed that prevention strategies targeting suicidal behaviour in first-episode psychosis should not be universal. On a more general level, evidence-based data to support specific care programs are still lacking, and only few data are in favor of integrated care in patients presenting with first episode. It should also be kept in mind that the risk of suicide is extraordinarily high for all psychiatric patients during the first few months after discharge from hospital. This should encourage caregivers to offer intensive follow-up programs to their patients and to embrace recontact and follow-up initiatives using the tools of e-health. Last, programs for the early detection of schizophrenia seem to be beneficial for the prevention of suicide in these subjects.
Collapse
Affiliation(s)
- P Courtet
- Professeur de psychiatrie, département d'urgence et post-urgence psychiatrique, CHU Montpellier, université de Montpellier, Montpellier, France.
| |
Collapse
|
27
|
Abdeen MS, Shaker NM, Elrassas HH, Hashim MA, Abo Zeid MY. Characteristics of the schizophrenia suicide attempts in comparison with the suicide attempts with other diagnosed psychiatric disorders: An Egyptian study. Int J Soc Psychiatry 2019; 65:368-377. [PMID: 31144567 DOI: 10.1177/0020764019852654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There has been much literature on schizophrenia, but little is known about the characteristic features of suicide attempts with schizophrenia in comparison with the suicide attempts with other diagnosed psychiatric disorders. AIMS The objective of this study was to clarify the specific characteristics and risk factors among suicide attempters with schizophrenia that differentiate them from other psychiatric disorders. METHODS Thirty-three suicide attempters diagnosed with schizophrenia and 87 suicide attempters with other psychiatric disorders were included. Suicide attempts seriousness were appraised by the Beck's Suicide Intent Scale (BSIS). Standardized scales were applied: Suicide Probability Scale (SPS) and Barratt Impulsiveness Scale, Version 11 (BIS-11). The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and The Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) based on the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) was applied to assess the psychiatric status of individuals. Demographic and clinical characteristics, method of suicide and suicide probability scores and impulsivity were compared among both groups (schizophrenia group and other psychiatric disorders group). RESULTS In total, 27.5% of suicide attempts suffered from schizophrenia. The current study found that having more past history of medical diseases, longer duration of illness, using more violent suicidal methods, and having less significant suicidal ideations were the significant factors that differentiated schizophrenia suicide attempts from those diagnosed with other psychiatric disorders. The schizophrenia group did not show more impulsivity or hostility than other psychiatric disorders group. CONCLUSION These results indicated that each group shows its unique characteristics. They give us new perspectives to prevent suicides in schizophrenia according to their different characteristics.
Collapse
Affiliation(s)
| | | | - Hanan Hany Elrassas
- Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | |
Collapse
|
28
|
Clapham E, Bodén R, Brandt L, Jönsson EG, Bahmanyar S, Ekbom A, Ösby U, Reutfors J. Suicide Ideation and Behavior as Risk Factors for Subsequent Suicide in Schizophrenia: A Nested Case-Control Study. Suicide Life Threat Behav 2019; 49:996-1005. [PMID: 30073690 DOI: 10.1111/sltb.12499] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 05/17/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate suicide ideation and behavior as risk factors for suicide in schizophrenia during varying time periods. METHOD Cases were 84 patients who died by suicide within 5 years from diagnosis in a source population of patients discharged for the first time from psychiatric hospitals in Stockholm County, Sweden, with a schizophrenia spectrum diagnosis. One control was individually matched with each suicide case. Data were retrieved from clinical records in a blind fashion. Thoughts of death, thoughts of suicide, suicide plan, and suicide attempt during varying time periods were investigated as risk factors for subsequent completed suicide. RESULTS In adjusted analyses, thoughts of suicide, suicide plan, and suicide attempt were significantly associated with subsequent completed suicide in the following year. The highest suicide risk was found within a year following suicide attempt (adjusted OR 9.9, 95% confidence interval 2.5-39.0). The association between suicide ideation and behavior and subsequent suicide declined over time. CONCLUSIONS Several types of suicide ideation and behavior were associated with suicide, and the association was stronger for suicidal behavior. The clinical significance of suicidal communication appears highest during the following month or/and year. Many suicides occurred without recorded short-term suicidal communication.
Collapse
Affiliation(s)
- Eric Clapham
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.,Department of Medicine Solna, Centre for Pharmacoepidemiology (CPE), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Robert Bodén
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.,Department of Medicine Solna, Centre for Pharmacoepidemiology (CPE), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Lena Brandt
- Department of Medicine Solna, Centre for Pharmacoepidemiology (CPE), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Erik G Jönsson
- Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden.,Institute of Clinical Medicine, Psychiatry Section, NORMENT, KG Jebsen Centre for Psychosis Research, University of Oslo, Oslo, Norway
| | - Shahram Bahmanyar
- Department of Medicine Solna, Centre for Pharmacoepidemiology (CPE), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Ekbom
- Department of Medicine Solna, Centre for Pharmacoepidemiology (CPE), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Urban Ösby
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johan Reutfors
- Department of Medicine Solna, Centre for Pharmacoepidemiology (CPE), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
29
|
Freeman D, Bold E, Chadwick E, Taylor KM, Collett N, Diamond R, Černis E, Bird JC, Isham L, Forkert A, Carr L, Causier C, Waite F. Suicidal ideation and behaviour in patients with persecutory delusions: Prevalence, symptom associations, and psychological correlates. Compr Psychiatry 2019; 93:41-47. [PMID: 31319194 DOI: 10.1016/j.comppsych.2019.07.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/08/2019] [Accepted: 07/05/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To determine the prevalence of suicidal ideation and behaviour - and their correlates - in patients with persecutory delusions. METHODS 110 patients with persecutory delusions in the context of non-affective psychosis were assessed for suicidal thoughts and behaviours over the past month. Symptom and psychological assessments were also completed. RESULTS The severity of suicidal ideation was: no suicidal ideation (n = 26, 23.6%); wish to be dead (n = 21, 19.1%); nonspecific active suicidal thoughts (n = 14, 12.7%); suicidal thoughts with methods but no intent (n = 29, 26.4%); suicidal thoughts with intent but no specific plan (n = 13, 11.8%); and suicidal intent with plan (n = 7, 6.4%). In the past month, five patients (4.5%) had made an actual, interrupted, or aborted suicide attempt. The severity of suicidal ideation was associated with higher levels of depression, paranoia, hallucinations, anger, insomnia, negative beliefs about the self and others, pessimism, worry, and delusion safety-seeking behaviours and lower levels of psychological well-being and reward responsiveness. Severity of ideation was not associated with cannabis or alcohol use, working memory, pain, or meaningful activity levels. CONCLUSIONS Patients with persecutory delusions are typically in a severe state of psychological stress, and at risk of suicide, as indicated by very high levels of suicidal ideation. This exploratory study also identifies correlates of suicidal ideation that could be investigated in causal research designs.
Collapse
Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK.
| | - Emily Bold
- Department of Psychiatry, University of Oxford, UK
| | | | | | - Nicola Collett
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
| | - Rowan Diamond
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
| | - Emma Černis
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
| | - Jessica C Bird
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
| | - Louise Isham
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
| | - Ava Forkert
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
| | - Lydia Carr
- Department of Psychiatry, University of Oxford, UK
| | | | - Felicity Waite
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
| |
Collapse
|
30
|
McHugh CM, Corderoy A, Ryan CJ, Hickie IB, Large MM. Association between suicidal ideation and suicide: meta-analyses of odds ratios, sensitivity, specificity and positive predictive value. BJPsych Open 2019; 5:e18. [PMID: 30702058 PMCID: PMC6401538 DOI: 10.1192/bjo.2018.88] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The expression of suicidal ideation is considered to be an important warning sign for suicide. However, the predictive properties of suicidal ideation as a test of later suicide are unclear.AimsTo assess the strength of the association between suicidal ideation and later suicide measured by odds ratio (OR), sensitivity, specificity and positive predictive value (PPV). METHOD We located English-language studies indexed in PubMed that reported the expression or non-expression of suicidal ideation among people who later died by suicide or did not. A random effects meta-analysis was used to assess the pooled OR, sensitivity, specificity and PPV of suicidal ideation for later suicide among groups of people from psychiatric and non-psychiatric settings. RESULTS There was a moderately strong but highly heterogeneous association between suicidal ideation and later suicide (n = 71, OR = 3.41, 95% CI 2.59-4.49, 95% prediction interval 0.42-28.1, I2 = 89.4, Q-value = 661, d.f.(Q) = 70, P ≤0.001). Studies conducted in primary care and other non-psychiatric settings had similar pooled odds to studies of current and former psychiatric patients (OR = 3.86 v. OR = 3.23, P = 0.7). The pooled sensitivity of suicidal ideation for later suicide was 41% (95% CI 35-48) and the pooled specificity was 86% (95% CI 76-92), with high between-study heterogeneity. Studies of suicidal ideation expressed by current and former psychiatric patients had a significantly higher pooled sensitivity (46% v. 22%) and lower pooled specificity (81% v. 96%) than studies conducted in non-psychiatric settings. The PPV among non-psychiatric cohorts (0.3%, 95% CI 0.1%-0.5%) was significantly lower (Q-value = 35.6, P < 0.001) than among psychiatric samples (3.9%, 95% CI 2.2-6.6). CONCLUSIONS Estimates of the extent of the association between suicidal ideation and later suicide are limited by unexplained between-study heterogeneity. The utility of suicidal ideation as a test for later suicide is limited by a modest sensitivity and low PPV.Declaration interestM.M.L. and C.J.R. have provided expert evidence in civil, criminal and coronial matters. I.B.H. has been a Commissioner in Australia's National Mental Health Commission since 2012. He is the Co-Director, Health and Policy at the Brain and Mind Centre (BMC) University of Sydney. The BMC operates an early-intervention youth services at Camperdown under contract to Headspace. I.B.H. has previously led community-based and pharmaceutical industry-supported (Wyeth, Eli Lily, Servier, Pfizer, AstraZeneca) projects focused on the identification and better management of anxiety and depression. He is a Board Member of Psychosis Australia Trust and a member of Veterans Mental Health Clinical Reference group. He was a member of the Medical Advisory Panel for Medibank Private until October 2017. He is the Chief Scientific Advisor to, and an equity shareholder in, InnoWell. InnoWell has been formed by the University of Sydney and PricewaterhouseCoopers to administer the $30 M Australian Government Funded Project Synergy. Project Synergy is a 3-year programme for the transformation of mental health services through the use of innovative technologies.
Collapse
Affiliation(s)
| | - Amy Corderoy
- Doctor of Medicine Candidate,School of Medicine,University of Notre Dame Australia,Australia
| | - Christopher James Ryan
- Clinical Associate Professor,Consultation-Liaison Psychiatrist,Westmead Hospital,Discipline of Psychiatry; andSydney Health Ethics,University of Sydney,Australia
| | - Ian B Hickie
- Co-Director,Health and Policy,The University of Sydney Central Clinical School Brain and Mind Centre Faculty of Medicine and Health,University of Sydney,Australia
| | | |
Collapse
|
31
|
Simon GE, Yarborough BJ, Rossom RC, Lawrence JM, Lynch FL, Waitzfelder BE, Ahmedani BK, Shortreed SM. Self-Reported Suicidal Ideation as a Predictor of Suicidal Behavior Among Outpatients With Diagnoses of Psychotic Disorders. Psychiatr Serv 2019; 70:176-183. [PMID: 30526341 PMCID: PMC6520048 DOI: 10.1176/appi.ps.201800381] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Individuals with psychotic disorders are at high risk of suicidal behavior. The study examined whether response to item 9 of the Patient Health Questionnaire (PHQ-9), which asks about thoughts of death or self-harm, predicts suicidal behavior among outpatients with diagnoses of psychotic disorders. METHODS Electronic health records (EHRs) from seven large integrated health systems were used to identify all outpatient visits by adults with a diagnosis of schizophrenia spectrum psychosis or unspecified psychosis from January 1, 2009, to June 30, 2015, during which a PHQ-9 was completed (N=32,982 visits by 5,947 patients). Suicide attempts over the 90 days following each visit were ascertained from EHRs and insurance claims. Suicide deaths were ascertained from state death certificate files. RESULTS Risk of suicide attempt within 90 days of an outpatient visit was .8% among patients reporting no thoughts of death or self-harm and 3.5% among those reporting such thoughts "nearly every day." Over 90 days of follow-up, 47% of suicide attempts occurred among those who reported any recent thoughts of death or self-harm at the sampled visit. Also, 59% of attempts occurred among those reporting thoughts of death or self-harm at the index visit or any visit in the prior year. The number of suicide deaths within 90 days (N=10) was too small to accurately assess the relationship between PHQ-9 item 9 response and subsequent suicide death. CONCLUSIONS Among outpatients with psychotic disorders, response to item 9 of the PHQ-9 accurately identified those at increased short-term risk of a suicide attempt.
Collapse
Affiliation(s)
- Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Bobbi Jo Yarborough
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Rebecca C Rossom
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Jean M Lawrence
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Frances L Lynch
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Beth E Waitzfelder
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Brian K Ahmedani
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Susan M Shortreed
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| |
Collapse
|
32
|
Woodford R, Spittal MJ, Milner A, McGill K, Kapur N, Pirkis J, Mitchell A, Carter G. Accuracy of Clinician Predictions of Future Self-Harm: A Systematic Review and Meta-Analysis of Predictive Studies. Suicide Life Threat Behav 2019; 49:23-40. [PMID: 28972271 DOI: 10.1111/sltb.12395] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 07/05/2017] [Indexed: 11/26/2022]
Abstract
Assessment of a patient after hospital-treated self-harm or psychiatric hospitalization often includes a risk assessment, resulting in a classification of high risk versus low risk for a future episode of self-harm. Through systematic review and a series of meta-analyses looking at unassisted clinician risk classification (eight studies; N = 22,499), we found pooled estimates for sensitivity 0.31 (95% CI: 0.18-0.50), specificity 0.85 (0.75-0.92), positive predictive value 0.22 (0.21-0.23), and negative predictive value 0.89 (0.86-0.92). Clinician classification was too inaccurate to be clinically useful. After-care should therefore be allocated on the basis of a needs rather than risk assessment.
Collapse
Affiliation(s)
- Rachel Woodford
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, NSW, Australia
| | - Matthew J Spittal
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic., Australia
| | - Allison Milner
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic., Australia
| | - Katie McGill
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, NSW, Australia.,Centre for Brain and Mental Health Research, University of Newcastle, Newcastle, NSW, Australia
| | - Navneet Kapur
- Centre for Suicide Prevention, University of Manchester, Manchester, UK
| | - Jane Pirkis
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic., Australia
| | - Alex Mitchell
- Cancer Studies & Molecular Medicine, University of Leicester, Leicester, UK
| | - Gregory Carter
- Centre for Brain and Mental Health Research, University of Newcastle, Newcastle, NSW, Australia
| |
Collapse
|
33
|
Depp CA, Villa J, Schembari BC, Harvey PD, Pinkham A. Social cognition and short-term prediction of suicidal ideation in schizophrenia. Psychiatry Res 2018; 270:13-19. [PMID: 30243127 PMCID: PMC6376982 DOI: 10.1016/j.psychres.2018.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/27/2018] [Accepted: 09/03/2018] [Indexed: 02/08/2023]
Abstract
Despite recent research acknowledging social cognition as an important feature of interpersonal functioning in schizophrenia, little work has evaluated the role of social cognition in suicidal ideation and behavior in psychosis. In a short-term longitudinal study, we evaluated the association between concurrent and near term suicidal ideation with social cognition, including emotion recognition and related biases (ER-40; BLERT), attribution biases (AIHQ), and evaluations of trustworthiness (trustworthiness task) in a sample of 179 outpatients with schizophrenia or schizoaffective disorder. Adjusting for severity of positive and general mental health symptoms, greater reactivity to extreme stimuli (trustworthiness measure), BLERT negative affect accuracy, and AIHQ Blame Scores were associated with suicidal ideation at baseline. AIHQ Blame Scores also longitudinally predicted the presence of ideation 2 weeks later and were highest among participants with ideation across the two time points. The present findings provide support that biased interpretations, and, concurrently with ideation, reactivity and selective accuracy to negative stimuli, are associated with suicidal ideation in schizophrenia. Further understanding the role of social cognitive ability and biases on suicidal ideation could contribute to the understanding of social cognition as a treatment target in prevention of suicidal behavior in schizophrenia.
Collapse
Affiliation(s)
- Colin A Depp
- Department of Psychiatry, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0664, United States; VA San Diego Healthcare System, San Diego, CA, United States.
| | - Jennifer Villa
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | | | - Philip D Harvey
- Research Service, Bruce W. Carter Veterans Affairs (VA) Medical Center, Miami, FL, United States; Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Amy Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| |
Collapse
|
34
|
Adamou M, Antoniou G, Greasidou E, Lagani V, Charonyktakis P, Tsamardinos I, Doyle M. Toward Automatic Risk Assessment to Support Suicide Prevention. Crisis 2018; 40:249-256. [PMID: 30474411 DOI: 10.1027/0227-5910/a000561] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: Suicide has been considered an important public health issue for years and is one of the main causes of death worldwide. Despite prevention strategies being applied, the rate of suicide has not changed substantially over the past decades. Suicide risk has proven extremely difficult to assess for medical specialists, and traditional methodologies deployed have been ineffective. Advances in machine learning make it possible to attempt to predict suicide with the analysis of relevant data aiming to inform clinical practice. Aims: We aimed to (a) test our artificial intelligence based, referral-centric methodology in the context of the National Health Service (NHS), (b) determine whether statistically relevant results can be derived from data related to previous suicides, and (c) develop ideas for various exploitation strategies. Method: The analysis used data of patients who died by suicide in the period 2013-2016 including both structured data and free-text medical notes, necessitating the deployment of state-of-the-art machine learning and text mining methods. Limitations: Sample size is a limiting factor for this study, along with the absence of non-suicide cases. Specific analytical solutions were adopted for addressing both issues. Results and Conclusion: The results of this pilot study indicate that machine learning shows promise for predicting within a specified period which people are most at risk of taking their own life at the time of referral to a mental health service.
Collapse
Affiliation(s)
- Marios Adamou
- 1 South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK.,2 Department of Computer Science, University of Huddersfield, UK
| | | | | | - Vincenzo Lagani
- 3 Gnosis Data Analysis PC, Heraklion, Greece.,5 Institute of Chemical Biology, Ilia State University, Tbilisi, Georgia
| | | | - Ioannis Tsamardinos
- 2 Department of Computer Science, University of Huddersfield, UK.,3 Gnosis Data Analysis PC, Heraklion, Greece.,4 Computer Science Department, University of Crete, Heraklion, Greece
| | - Michael Doyle
- 1 South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| |
Collapse
|
35
|
Murphy AL, Ataya R, Himmelman D, O'Reilly C, Rosen A, Salvador-Carulla L, Martin-Misener R, Burge F, Kutcher S, Gardner DM. Community pharmacists' experiences and people at risk of suicide in Canada and Australia: a thematic analysis. Soc Psychiatry Psychiatr Epidemiol 2018; 53:1173-84. [PMID: 29936597 DOI: 10.1007/s00127-018-1553-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To explore Canadian and Australian community pharmacists' practice experiences in caring for people at risk of suicide. METHODS We conducted a thematic analysis of 176 responses to an open-ended extension question in an online survey. RESULTS Four themes were identified and include referrals and triage, accessibility for confiding, emotional toll, and stigma. Subthemes included gatekeeping the medication supply, sole disclosure, planning for end of life, concerns of support people, assessing the validity of suicidality, gaps in the system, not directly asking, ill-equipped, resources in the pharmacy, relying on others to continue care, and attention seeking. CONCLUSIONS Community pharmacists are caring for patients at risk of suicide frequently, and often with patients seeking the help of pharmacists directly. Pharmacists engage in activities and actions that would be considered outside of the traditional dispensing roles and provide support and intervention to people at risk of suicide through collaboration and other mechanisms. Further research to determine appropriate education and training and postvention supports is required.
Collapse
|
36
|
Murphy J, Shevlin M, Hyland P, Christoffersen M, Elklit A, Bentall R. Reconsidering the association between psychosis and suicide: a suicidal drive hypothesis. Psychosis 2018. [DOI: 10.1080/17522439.2018.1522541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jamie Murphy
- School of Psychology, Ulster University, Derry, Northern Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, Northern Ireland
| | - Philip Hyland
- Department of Psychology, National College of Ireland, Dublin, Republic of Ireland
| | | | - Ask Elklit
- Institute of Psychology, National Centre of Psychotraumatology, University of Southern Denmark, Odense, Denmark
| | - Richard Bentall
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| |
Collapse
|
37
|
Yuan L, Wang DF, Lew B, Osman A, Jia CX. The future disposition Inventory-24: reliability and validity estimates in a large sample of Chinese University students. BMC Psychiatry 2018; 18:299. [PMID: 30236111 PMCID: PMC6149006 DOI: 10.1186/s12888-018-1875-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 09/05/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This study was designed to assess the factor structure, internal consistency reliability, and preliminary psychometric properties of the Chinese version of the Future Disposition Inventory-24 (FDI-24) in a large sample of Chinese university students. METHODS We translated the English version of the Future Disposition Inventory-24 (FDI-24) into Chinese and examined its factor structure, estimates of internal consistency reliability, and psychometric properties in a representative sample of university students. In particular, students (N = 2,074) from two universities in Shandong Province in China were identified using the multi-stage stratified sampling method. In addition to the FDI-24, we collected preliminary data using self-report instruments that included the Beck Hopelessness Scale (BHS) and a general sociodemographic information questionnaire. RESULTS The results of the internal consistency reliability estimates were adequate regarding the scores on the three FDI-24 subscales: Cronbach's alpha = .89-.97, Omega total = .85-.96, Revelle's Omega total = .88-.96, the greatest lower bound (GLB) = .89-.96 and Coefficient H = .86-.94. Bivariate correlation analyses showed evidence for criterion and discriminant validity. The 3-factor oblique-Geomin-rotation solution accounted for 62.92% of the total variance in the exploratory factor analysis (EFA). The exploratory structural equation modeling (ESEM) result showed that the 3-factor model provided adequate fit statistics for the sample data: the robust comparative fit index (R-CFI) was .959, robust Tucker Lewis index (R-TLI) was .946 and robust root mean square error of approximation (R-RMSEA) was .090. CONCLUSION The FDI-24 has a satisfactory factor structure, reliability estimates, and satisfactory evidence of concurrent validity estimates for students with different demographic and cultural backgrounds. The FDI-24 holds promise for use in future investigations with Chinese students.
Collapse
Affiliation(s)
- Lu Yuan
- 0000 0004 1761 1174grid.27255.37Department of Epidemiology, School of Public Health, Shandong University & Shandong University Center for Suicide Prevention Research, Jinan, Shandong China
| | - Dong-Fang Wang
- 0000 0000 9459 9325grid.464402.0Department of Preventive Medicine, School of Basic Medical Sciences, Shandong University of Traditional Chinese Medicine, Changqing, Jinan, Shandong China
| | - Bob Lew
- Department of Social Psychology, Faculty of Human Ecology, Putra University of Malaysia, Serdang, Selangor Malaysia
| | - Augustine Osman
- 0000000121845633grid.215352.2Department of Psychology, One UTSA Circle, The University of Texas at San Antonio, San Antonio, TX USA
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Shandong University & Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China.
| |
Collapse
|
38
|
Reshetukha TR, Alavi N, Prost E, Kirkpatrick RH, Sajid S, Patel C, Groll DL. Improving suicide risk assessment in the emergency department through physician education and a suicide risk assessment prompt. Gen Hosp Psychiatry 2018; 52:34-40. [PMID: 29549821 DOI: 10.1016/j.genhosppsych.2018.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 02/26/2018] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To determine the efficacy of two interventions on suicide risk assessment within emergency departments (EDs) on improving the documentation of suicide risk factors by emergency medicine and psychiatric physicians during suicide risk assessment. METHOD An educational intervention on suicide was provided to all emergency medicine and psychiatry physicians and was followed by the placement of a suicide risk assessment prompt within local EDs. The medical charts of all ED patients presenting with suicidal ideation or behaviours were reviewed immediately and six months after the interventions and compared to pre-intervention. Differences in the documentation of 40 biopsychosocial suicide risk factors between specialties and after the interventions were determined. RESULTS The documentation of 34/40 (p ≤ 0.008) and 33/40 (p ≤ 0.009) suicide risk factors was significantly improved by emergency medicine and psychiatry physicians, respectively, after the interventions and maintained six months later. Immediately and six months after the interventions, the documentation of 8/40 (p ≤ 0.041) and 14/40 (p ≤ 0.048) suicide risk factors, respectively, significantly differed between specialties. CONCLUSION This suggests that providing a brief educational intervention on suicide to emergency medicine and psychiatry physicians followed by placing a prompt for important, yet commonly undocumented risk factors within the ED is a low-cost and effective intervention for improving documentation of suicide risk assessments within the ED.
Collapse
Affiliation(s)
- Taras R Reshetukha
- Queen's University Department of Psychiatry, Providence Care Hospital, 752 King Street West, Postal Bag 603, Kingston, ON K7L 7X3, Canada.
| | - Nazanin Alavi
- Queen's University Department of Psychiatry, Providence Care Hospital, 752 King Street West, Postal Bag 603, Kingston, ON K7L 7X3, Canada; University of Toronto Department of Psychiatry, Centre for Addiction and Mental Health, Department of Psychiatry, 100 Stokes Street, Toronto, ON M6J 1H4, Canada.
| | - Eric Prost
- Queen's University Department of Psychiatry, Providence Care Hospital, 752 King Street West, Postal Bag 603, Kingston, ON K7L 7X3, Canada.
| | - Ryan H Kirkpatrick
- Queen's University Department of Psychiatry, Providence Care Hospital, 752 King Street West, Postal Bag 603, Kingston, ON K7L 7X3, Canada.
| | - Saad Sajid
- Queen's University Department of Psychiatry, Providence Care Hospital, 752 King Street West, Postal Bag 603, Kingston, ON K7L 7X3, Canada.
| | - Charmy Patel
- Queen's University Department of Psychiatry, Providence Care Hospital, 752 King Street West, Postal Bag 603, Kingston, ON K7L 7X3, Canada.
| | - Dianne L Groll
- Queen's University Department of Psychiatry, Providence Care Hospital, 752 King Street West, Postal Bag 603, Kingston, ON K7L 7X3, Canada.
| |
Collapse
|
39
|
Abstract
Deficits in social cognition are present in psychotic disorders; moreover, maladaptive interpersonal beliefs have been posited to underlie risk of suicidal ideation and behavior. However, the association between social cognition and negative appraisals as potential risk factors for suicidal ideation and behavior in psychotic disorders has not been assessed. In a pilot study, we assessed accuracy and error biases in facial emotion recognition (Penn ER-40), maladaptive interpersonal beliefs as measured by the Interpersonal Needs Questionnaire (INQ), and current suicide ideation and history of past attempts in a sample of 101 outpatients with psychotic disorders (75 schizophrenia/schizoaffective; 26 bipolar disorder). INQ scores were positively associated with history of suicide attempts and current ideation. INQ scores were inversely related with emotion recognition accuracy yet positively correlated with bias toward perceiving anger in neutral expressions. The association between biases pertaining to anger and INQ scores persisted after adjusting for global cognitive ability and were more evident in schizophrenia than in bipolar disorder. The present findings suggest that maladaptive beliefs are associated with a tendency to misperceive neutral stimuli as threatening and are associated with suicidal ideation and behavior. Although better cognitive ability is associated with higher rates of suicide attempts in psychotic disorders, biases in misinterpreting anger in others may be a specific deficit related to formation of maladaptive beliefs about others, which, in turn, are associated with history of suicide attempts.
Collapse
Affiliation(s)
- Jennifer Villa
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | | | - Eric Granholm
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - Philip D Harvey
- Research Service, Bruce W. Carter Veterans Affairs (VA) Medical Center, Miami, FL, United States; Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Colin A Depp
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States; VA San Diego Healthcare System, San Diego, CA, United States.
| |
Collapse
|
40
|
Hubers AAM, Moaddine S, Peersmann SHM, Stijnen T, van Duijn E, van der Mast RC, Dekkers OM, Giltay EJ. Suicidal ideation and subsequent completed suicide in both psychiatric and non-psychiatric populations: a meta-analysis. Epidemiol Psychiatr Sci 2018; 27:186-98. [PMID: 27989254 DOI: 10.1017/S2045796016001049] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS Several authors claimed that expression of suicidal ideation is one of the most important predictors of completed suicide. However, the strength of the association between suicidal ideation and subsequent completed suicide has not been firmly established in different populations. Furthermore, the absolute suicide risk after expression of suicidal ideation is unknown. In this meta-analysis, we examined whether the expression of suicidal ideation predicted subsequent completed suicide in various populations, including both psychiatric and non-psychiatric populations. METHODS A meta-analysis of cohort and case-control studies that assessed suicidal ideation as determinant for completed suicide in adults. Two independent reviewers screened 5726 articles for eligibility and extracted data of the 81 included studies. Pooled risk ratios were estimated in a random effects model stratified for different populations. Meta-regression analysis was used to determine suicide risk during the first year of follow-up. RESULTS The risk for completed suicide was clearly higher in people who had expressed suicidal ideation compared with people who had not, with substantial variation between the different populations: risk ratio ranging from 2.35 (95% confidence interval (CI) 1.43-3.87) in affective disorder populations to 8.00 (95% CI 5.46-11.7) in non-psychiatric populations. In contrast, the suicide risk after expression of suicidal ideation in the first year of follow-up was higher in psychiatric patients (risk 1.40%, 95% CI 0.74-2.64) than in non-psychiatric participants (risk 0.23%, 95% CI 0.10-0.54). Past suicide attempt-adjusted risk ratios were not pooled due to large underreporting. CONCLUSIONS Assessment of suicidal ideation is of priority in psychiatric patients. Expression of suicidal ideation in psychiatric patients should prompt secondary prevention strategies to reduce their substantial increased risk of suicide.
Collapse
|
41
|
King CA, Horwitz A, Czyz E, Lindsay R. Suicide Risk Screening in Healthcare Settings: Identifying Males and Females at Risk. J Clin Psychol Med Settings 2017; 24:8-20. [PMID: 28251427 DOI: 10.1007/s10880-017-9486-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Suicide is the tenth leading cause of death in the United States, accounting for more than 42,000 deaths in 2014. Although this tragedy cuts across groups defined by age, gender, race/ethnicity, and geographic location, it is striking that nearly four times as many males as females die by suicide in the U.S. We describe the current regulations and recommendations for suicide risk screening in healthcare systems and also describe the aspirational goal of "Zero Suicide," put forth by the National Action Alliance for Suicide Prevention. We then provide information about suicide risk screening tools and steps to take when a patient screens positive for suicide risk. Given the substantially higher suicide rate among males than females, we argue that it is important to consider how we could optimize suicide risk screening strategies to identify males at risk and females at risk. Further research is needed to accomplish this goal. It is recommended that we consider multi-factorial suicide risk screens that incorporate risk factors known to be particularly important for males as well as computerized, adaptive screens that are tailored for the specific risk considerations of the individual patient, male or female. These strategies are not mutually exclusive. Finally, universal suicide risk screening in healthcare settings, especially primary care, specialty medical care, and emergency department settings, is recommended.
Collapse
|
42
|
Large M, Galletly C, Myles N, Ryan CJ, Myles H. Known unknowns and unknown unknowns in suicide risk assessment: evidence from meta-analyses of aleatory and epistemic uncertainty. BJPsych Bull 2017; 41:160-163. [PMID: 28584653 PMCID: PMC5451650 DOI: 10.1192/pb.bp.116.054940] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Suicide risk assessment aims to reduce uncertainty in order to focus treatment and supervision on those who are judged to be more likely to die by suicide. In this article we consider recent meta-analytic research that highlights the difference between uncertainty about suicide due to chance factors (aleatory uncertainty) and uncertainty that results from lack of knowledge (epistemic uncertainty). We conclude that much of the uncertainty about suicide is aleatory rather than epistemic, and discuss the implications for clinicians.
Collapse
|
43
|
Gao Q, Fan H, Di F, Xia X, Long H, Zhu H. Suicide Behaviors in Adult Inpatients with Mental Disorders in Beijing, China. Int J Environ Res Public Health 2017; 14:E259. [PMID: 28273823 PMCID: PMC5369095 DOI: 10.3390/ijerph14030259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/23/2017] [Accepted: 02/28/2017] [Indexed: 11/24/2022]
Abstract
Background: This study examined the tendency and suicidal behavior rates of Chinese adult inpatients with different types of mental disorders from 2010 to 2015. The aim was to provide some interesting clues for further studies. Methods: Adult patients with mental disorders who were hospitalized in Beijing Anding hospital from 1 January 2010 to 31 December 2015 were included. Chi-square tests were used to compare the difference among inpatients with mental disorders by gender and year. Frequency, trend and suicidal behavior rates of inpatients with mental disorders were graphed. Results: A total of 17,244 psychiatric adult inpatients were included in our study. About 53.2% of the inpatients had mood disorders, followed by schizophrenia, which accounted for 34.6%. The proportion of female inpatients with mental disorders was larger than that of males (52.6% to 47.4%). Of the total, 3296 psychiatric inpatients were recognized as having suicidal behaviors. The rate of suicidal behavior among all inpatients was 19.1%, and it varied over the years. The suicidal behavior rate of female inpatients with mood disorders was much higher than that of the corresponding male inpatients. Conclusions: The presence of suicidal behavior varied among people with different types of mental disorders. For each type of mental illness, identifying the risk of specific suicide behavior would help tailor-make preventive efforts accordingly.
Collapse
Affiliation(s)
- Qi Gao
- School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmenwai, Beijing 100069, China.
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| | - Hua Fan
- Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China.
| | - Fei Di
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, China.
| | - Xue Xia
- School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmenwai, Beijing 100069, China.
| | - Haiying Long
- Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China.
| | - Huiping Zhu
- School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmenwai, Beijing 100069, China.
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| |
Collapse
|
44
|
Núñez D, Arias VB, Campos S. The Reliability and Validity of Liu´s Self-Report Questionnaire for Screening Putative Pre-Psychotic States (BQSPS) in Adolescents. PLoS One 2016; 11:e0167982. [PMID: 27973533 PMCID: PMC5156383 DOI: 10.1371/journal.pone.0167982] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 11/23/2016] [Indexed: 12/31/2022] Open
Abstract
The usage of rigorous analyses based on contemporary methods to enhance psychometric properties of screening questionnaires aimed to address psychotic-like experiences (PLE) is currently being encouraged. The Brief Self-Report Questionnaire for Screening Putative Pre-psychotic States (BQSPS) is a recently created tool addressing PLE beyond attenuated positive symptoms (APS). Its psychometric properties as a screening tool for first step assessment seems to be adequate, but further research is needed to evaluate certain validity aspects, particularly its dimensionality, internal structure, and psychometric properties in different populations. We assessed the reliability, construct validity, and criterion validity of BQSPS in two samples: 727 adolescents aged 13-18 years, and 245 young adults aged 18-33 years. We used exploratory structural equation modeling (ESEM), confirmatory factor analysis (CFA), and Structural Equation Modeling (SEM). The original four-factor structure was not replicated. The best fit in adolescents was obtained by a structure of three-correlated factors: social anxiety (SA), negative symptoms (NS), and positive symptoms (PS). This structure was confirmed in young adult subjects. The three-factor model reached a predictive capability with suicidality as external criterion. PLE are represented by a three-factor structure, which is highly stable between adolescent and young-adult samples. Although the BQSPS seems to be a valid tool for screening PLE, its psychometric properties should be improved to obtain a more accurate measurement.
Collapse
Affiliation(s)
- D. Núñez
- Faculty of Psychology, Universidad de Talca, Talca, Chile
- * E-mail:
| | - V. B. Arias
- Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - S. Campos
- Faculty of Psychology, Universidad de Talca, Talca, Chile
| |
Collapse
|
45
|
Carter G, Page A, Large M, Hetrick S, Milner AJ, Bendit N, Walton C, Draper B, Hazell P, Fortune S, Burns J, Patton G, Lawrence M, Dadd L, Dudley M, Robinson J, Christensen H. Royal Australian and New Zealand College of Psychiatrists clinical practice guideline for the management of deliberate self-harm. Aust N Z J Psychiatry 2016; 50:939-1000. [PMID: 27650687 DOI: 10.1177/0004867416661039] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To provide guidance for the organisation and delivery of clinical services and the clinical management of patients who deliberately self-harm, based on scientific evidence supplemented by expert clinical consensus and expressed as recommendations. METHOD Articles and information were sourced from search engines including PubMed, EMBASE, MEDLINE and PsycINFO for several systematic reviews, which were supplemented by literature known to the deliberate self-harm working group, and from published systematic reviews and guidelines for deliberate self-harm. Information was reviewed by members of the deliberate self-harm working group, and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to successive consultation and external review involving expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest and expertise in deliberate self-harm. RESULTS The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for deliberate self-harm provide up-to-date guidance and advice regarding the management of deliberate self-harm patients, which is informed by evidence and clinical experience. The clinical practice guidelines for deliberate self-harm is intended for clinical use and service development by psychiatrists, psychologists, physicians and others with an interest in mental health care. CONCLUSION The clinical practice guidelines for deliberate self-harm address self-harm within specific population sub-groups and provide up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus.
Collapse
Affiliation(s)
- Gregory Carter
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Translational Neuroscience and Mental Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia Department of Consultation Liaison Psychiatry, Calvary Mater Newcastle Hospital, Waratah, NSW, Australia
| | - Andrew Page
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Health Research, Western Sydney University, Richmond, NSW, Australia
| | - Matthew Large
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia
| | - Sarah Hetrick
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Allison Joy Milner
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Population Health Research, School of Health and Social Development, Deakin University, Burwood VIC, Australia Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Nick Bendit
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
| | - Carla Walton
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Psychotherapy, Hunter New England Mental Health Service and Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Brian Draper
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Philip Hazell
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Sarah Fortune
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia The University of Auckland, Auckland, New Zealand University of Leeds, Leeds, UK Kidz First, Middlemore Hospital, Auckland, New Zealand
| | - Jane Burns
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Young and Well Cooperative Research Centre, The University of Melbourne, Melbourne, VIC, Australia Brain & Mind Research Institute, The University of Sydney, Sydney, NSW, Australia Orygen Youth Health Research Centre, Melbourne, VIC, Australia
| | - George Patton
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia National Health and Medical Research Council, Canberra, ACT, Australia Centre for Adolescent Health, The Royal Children's Hospital, Melbourne, VIC, Australia Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Mark Lawrence
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Tauranga Hospital, Bay of Plenty, New Zealand
| | - Lawrence Dadd
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Mental Health & Substance Use Service, Hunter New England, NSW Health, Waratah, NSW, Australia Awabakal Aboriginal Medical Service, Hamilton, NSW, Australia Pital Tarkin, Aboriginal Medical Student Mentoring Program, The Wollotuka Institute, The University of Newcastle, Callaghan, NSW, Australia Specialist Outreach NT, Darwin, Northern Territory, Australia
| | | | - Jo Robinson
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Helen Christensen
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Black Dog Institute, The University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
46
|
Sankaranarayanan A, Clark V, Baker A, Palazzi K, Lewin TJ, Richmond R, Kay-Lambkin FJ, Filia S, Castle D, Williams JM. Reducing smoking reduces suicidality among individuals with psychosis: Complementary outcomes from a Healthy Lifestyles intervention study. Psychiatry Res 2016; 243:407-12. [PMID: 27450743 DOI: 10.1016/j.psychres.2016.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 06/02/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
Abstract
This study sought to explore the impact of smoking reduction on suicidality (suicide ideation and behaviour) among people with a psychotic disorder (n=235) who participated in a randomized trial of a healthy lifestyle intervention trial. Suicidality, measured by item -4 of the Brief Psychiatric Rating Scale (BPRS) was the main variable of interest. Measures were collected by research assistants blind to treatment allocation at baseline, at 15 weeks (mid-intervention) and 12 months after baseline. Mediation analysis, adjusted for confounders, was used to determine the relationship between smoking reduction and suicidality and to explore whether this was mediated through depression. At 12 months, smoking reduction was found to be significantly associated with suicidality change; an association was also seen between smoking reduction and depression and depression and suicidality. After adjusting for depression, the association between smoking reduction and suicidality was attenuated but remained statistically significant; the proportion of the total effect that was mediated through depression was 30%. There was no significant association between suicidality and treatment group (vs. controls) over time. Our study suggests that smoking interventions may have benefits over and above those for improved physical health, by reducing suicidal ideation in people with psychosis.
Collapse
Affiliation(s)
- Anoop Sankaranarayanan
- Hunter New England Mental Health Service, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
| | - Vanessa Clark
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Amanda Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Kerrin Palazzi
- Public Health Program, Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia
| | - Terry J Lewin
- Hunter New England Mental Health Service, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Centre for Translational Neuroscience and Mental Health, University of Newcastle, Australia
| | - Robyn Richmond
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Frances J Kay-Lambkin
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Australia; NHMRC Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Australia
| | - Sacha Filia
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University, Victoria, Australia; Alfred Hospital, 55 Commercial Road, Prahran, Melbourne, Victoria, Australia
| | - David Castle
- St. Vincent's Hospital, PO Box 2900, Fitzroy, Victoria, Australia; The University of Melbourne, Parkville, Melbourne, Victoria, Australia; Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, Queensland, Australia
| | - Jill M Williams
- Division of Addiction Psychiatry, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| |
Collapse
|
47
|
Large M, Kaneson M, Myles N, Myles H, Gunaratne P, Ryan C. Meta-Analysis of Longitudinal Cohort Studies of Suicide Risk Assessment among Psychiatric Patients: Heterogeneity in Results and Lack of Improvement over Time. PLoS One 2016; 11:e0156322. [PMID: 27285387 PMCID: PMC4902221 DOI: 10.1371/journal.pone.0156322] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 05/12/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE It is widely assumed that the clinical care of psychiatric patients can be guided by estimates of suicide risk and by using patient characteristics to define a group of high-risk patients. However, the statistical strength and reliability of suicide risk categorization is unknown. Our objective was to investigate the odds of suicide in high-risk compared to lower-risk categories and the suicide rates in high-risk and lower-risk groups. METHOD We located longitudinal cohort studies where psychiatric patients or people who had made suicide attempts were stratified into high-risk and lower-risk groups for suicide with suicide mortality as the outcome by searching for peer reviewed publications indexed in PubMed or PsychINFO. Electronic searches were supplemented by hand searching of included studies and relevant review articles. Two authors independently extracted data regarding effect size, study population and study design from 53 samples of risk-assessed patients reported in 37 studies. RESULTS The pooled odds of suicide among high-risk patients compared to lower-risk patients calculated by random effects meta-analysis was of 4.84 (95% Confidence Interval (CI) 3.79-6.20). Between-study heterogeneity was very high (I2 = 93.3). There was no evidence that more recent studies had greater statistical strength than older studies. Over an average follow up period of 63 months the proportion of suicides among the high-risk patients was 5.5% and was 0.9% among lower-risk patients. The meta-analytically derived sensitivity and specificity of a high-risk categorization were 56% and 79% respectively. There was evidence of publication bias in favour of studies that inflated the pooled odds of suicide in high-risk patients. CONCLUSIONS The strength of suicide risk categorizations based on the presence of multiple risk factors does not greatly exceed the association between individual suicide risk factors and suicide. A statistically strong and reliable method to usefully distinguish patients with a high-risk of suicide remains elusive.
Collapse
Affiliation(s)
- Matthew Large
- School of Psychiatry, University of New South Wales, Randwick, Australia
- Prince of Wales Hospital, Randwick, Australia
- * E-mail:
| | - Muthusamy Kaneson
- Faculty of Medicine, University of New South Wales, Randwick, Australia
| | - Nicholas Myles
- The Queen Elizabeth Hospital, Woodville South, Australia
| | - Hannah Myles
- Discipline of Psychiatry, School of Medicine, The University of Adelaide, SA, Australia
- Country Health SA Mental Health, SA, Australia
| | | | - Christopher Ryan
- Discipline of Psychiatry and Centre for Values Ethics and the Law in Medicine, University of Sydney, Sydney, Australia
- Department of Psychiatry, Westmead Hospital, Westmead, NSW, Australia
| |
Collapse
|
48
|
Madsen T, Karstoft KI, Secher RG, Austin SF, Nordentoft M. Trajectories of suicidal ideation in patients with first-episode psychosis: secondary analysis of data from the OPUS trial. Lancet Psychiatry 2016; 3:443-50. [PMID: 26948484 DOI: 10.1016/s2215-0366(15)00518-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 11/13/2015] [Accepted: 11/13/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Heterogeneity in suicidal ideation over time in patients with first-episode psychosis is expected, but prototypical trajectories of this have not yet been established. We aimed to identify trajectories of suicidal ideation over a 3-year period and to examine how these trajectories relate to subsequent suicidality. METHODS We used longitudinal data from the prospective 10-year follow-up OPUS trial of young Danish patients with first-episode psychosis. Participants were recruited between January, 1998, and December, 2000, from all inpatient and outpatient mental health services in Copenhagen and Aarhus County, were aged between 18 and 45 years, and had a diagnosis in the schizophrenia spectrum. Randomisation was done by a computer-generated randomisation list, stratified in alternating blocks for five centres. In Aarhus, a secretary drew lots when the researcher phoned her. Patients were randomly assigned to a treatment group (modified assertive community treatment) or a control group (standard treatment at community mental health centres) and assessed at treatment initiation, and after 1, 2, 5, and 10 years. We included all patients' data on suicidal ideation from the first three assessments in a latent growth mixture modelling analysis to empirically identify trajectories of suicidal ideation. Multivariable logistic regression analyses were applied to estimate associations between trajectories and subsequent suicidality. This trial is registered with ClinicalTrials.gov, number NCT00157313. FINDINGS Three trajectories for suicidal ideation were identified in 521 patients. 317 of 521 members (61%) of the largest trajectory, low-decreasing, consisted of patients who initially reported suicidal ideation once-to-a-few-times in the past year followed by a decrease in suicidal ideation. 172 of 521 (33%) members of the frequent-stable trajectory reported suicidal ideation sometimes-to-frequently at the first assessment and remained stable over time. Finally, 32 of 521 (6%) members of the frequent-increasing trajectory reported frequent suicidal ideation initially followed by worsening. Compared with the low-decreasing class, the risk of persistent suicidal ideation was higher for patients in the frequent-stable and frequent-increasing classes at 5 years (Odds ratio=4·5, 95% CI 2·50-8·02 and 4·7, 1·55-14·24 respectively) and at 10 years (4·2, 2·42-7·13 and 3·2, 1·20-8·70 respectively). Also the risk of suicide attempt at 5 years was higher for patients in the frequent-stable (2·8, 1·07-7·43) and frequent-increasing classes (6·6, 1·69-25·54) compared with the low-decreasing class. There was no difference in suicide rate at 5 or 10 years between trajectories. INTERPRETATION Because up to 40% of patients experienced frequent suicidal ideations that persisted or increased during the first years of treatment, our findings warrant special focus on suicidal issues as an integral part of treatment along with treatment to target psychotic symptoms. FUNDING The Danish Council for Independent Research (Medical Sciences), Trygfonden, The Mental Health Services of the Capital Region of Denmark, The Danish Ministry of Health, The Danish Ministry of Social Affairs, the Psychiatry and Social Service Department in Central Denmark Region, and The Lundbeck Foundation.
Collapse
Affiliation(s)
- Trine Madsen
- Psychiatric Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
| | | | - Rikke Gry Secher
- Psychiatric Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stephen F Austin
- Psychiatric Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Merete Nordentoft
- Psychiatric Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
49
|
Depp CA, Moore RC, Perivoliotis D, Holden JL, Swendsen J, Granholm EL. Social behavior, interaction appraisals, and suicidal ideation in schizophrenia: The dangers of being alone. Schizophr Res 2016; 172:195-200. [PMID: 26948502 PMCID: PMC4915940 DOI: 10.1016/j.schres.2016.02.028] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 02/11/2016] [Accepted: 02/15/2016] [Indexed: 10/22/2022]
Abstract
Despite the increasing attention to social appraisals in suicide risk, the interpersonal correlates of suicidal thoughts and behavior in schizophrenia are not well understood. Ecological momentary assessment could reveal whether dysfunctional social appraisals and behavior are evident in people with schizophrenia with suicidal ideation. A total of 93 outpatients with diagnoses of schizophrenia with (n=18, 19%) and without (N=75; 81%) suicidal ideation participated in one week of intensive daily monitoring via mobile devices, generating real-time reports on the quantity of social interactions and appraisals about them, as well as information concerning concurrent affect and symptoms. The presence of suicidal ideation was not associated with the quantity of social interactions or time spent alone, but it was associated with the anticipation of being alone as well as greater negative and lower positive affect when alone. Despite this aversive experience of being alone, people with suicidal ideation reported negative appraisals about the value of recent and potential social interactions. These findings suggest that suicidal ideation in schizophrenia may not be associated with the quantity of social interactions, but with negative expectations about the quality of social interactions coupled with an aversive experience of being alone. Cognitive therapy interventions that address negative expectations and pleasure about social interactions, especially when alone, may reduce suicidal ideation.
Collapse
Affiliation(s)
- Colin A. Depp
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States,VA San Diego Healthcare System, La Jolla, CA, United States,Corresponding author at: Department of Psychiatry (0664), University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0664, United States. (C.A. Depp)
| | - Raeanne C. Moore
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - Dimitri Perivoliotis
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States,VA San Diego Healthcare System, La Jolla, CA, United States
| | | | - Joel Swendsen
- Université of Bordeaux, Bordeaux, Ecole Pratique des Hautes Etudes, La Sorbonne, Paris, France
| | - Eric L. Granholm
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States,VA San Diego Healthcare System, La Jolla, CA, United States
| |
Collapse
|
50
|
Abstract
BACKGROUND The life time risk of suicide among patients with long term psychosis is 5-15%. Suicide prevention in this group is a major clinical challenge. AIMS To capture specific characteristics of suicidal communication and critical events preceding suicide in patients with psychosis. METHODS Medical records were examined and a life event inventory applied to a one-year cohort of 21 cases of suicide in the clinical group in Stockholm county. RESULTS In most cases direct or indirect verbal communication of suicidal thoughts were documented before the suicide. Three months preceeding death, 20 of the 21 subjects had described one or more negative critical experiences, typically physical illness, loss of contact with an important other, loss of "home", and intolerable side effects of medication. In most cases the suicide appeared to be the culmination of prolonged suffering and suicidal deliberations. CONCLUSIONS Suicide prevention among patients with psychosis requires sensitivity, active listening, and responsiveness on the part of the care person to the patient's explicit suicidal communication and perceptions of care-related or other incidents or interactions, even when conveyed in an odd manner or with little emotion. To prevent suicide, attentive and long-term planning in collaboration with the patient is essential.
Collapse
Affiliation(s)
- Anne Stefenson
- 1 National Center for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - David Titelman
- 1 National Center for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| |
Collapse
|