Low resilience in suicide attempters.

Resilience is an important personality feature that is thought to be protective against the development of psychiatric disorder. However, it appears not to have been previously examined directly in relation to suicidal behavior. Therefore, with the recent development of a resilience scale, the purpose of this preliminary study was to examine resilience in relation to attempting suicide. In order to do this 100 abstinent substance dependent patients were interviewed about whether or not they had ever attempted suicide and completed the Connor-Davidson Resilience Scale. The results showed that patients who had attempted suicide (N=41) had significantly lower resilience scale scores than patients who had never attempted suicide (N=59). This suggests the possibility that low resilience may be a risk factor for suicidal behavior. Longitudinal studies among suicide attempters, including measures of depression, may further evaluate the possible relevance of resilience to suicidal behavior.     

Psychological hardiness and meaning making as protection against sequelae in veterans of the wars in Iraq and Afghanistan

Veterans of the wars in Iraq and Afghanistan are at an increased risk of suicide and other serious psychological sequelae following deployment. Mental health professionals must seek to detect and understand the presence of risk and resilience factors in this vulnerable population so that early intervention and treatment can prevent long-term suffering and suicide. This article explores both psychological hardiness and finding meaning in trauma as factors that can reduce the risk of pathology. Particularly when deployment-related stressors are high, these protective processes may be crucial in fostering hope and resilience. A traumatized individual may interact with the meaning-making process in one of three ways: searching for and finding meaning in the trauma, searching for and never finding meaning in the trauma, and never searching for meaning. These three styles may have a direct effect on a veteran's sense of hope or hopelessness, which likely will strongly influence suicidal tendencies and mental health.     

Suicidal ideation in treatment-seeking Veterans of Operations Enduring Freedom and Iraqi Freedom: the role of coping strategies, resilience, and social support

Background

Recent epidemiologic studies have found an increased risk of suicide among Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF-OIF) with psychiatric disorders. However, little is known about whether variables other than psychiatric conditions, such as coping strategies, resilience, and social support, may be related to suicidality in this population.

Methods

A total of 167 OEF-OIF Veterans seeking behavioral or primary care services completed a survey containing measures of combat exposure, psychopathology, pain, psychological resilience, social support, and cognitive coping strategies.

Results

Thirty-six respondents (21.6%) reported contemplating suicide in the two weeks prior to completing the survey. Compared to suicide non-contemplators, suicide contemplators were older, and more likely to screen positive for depression and posttraumatic stress disorder (PTSD), and to report a deployment-related pain condition or complaint. They also scored higher on measures of worry, self-punishment, and cognitive-behavioral avoidance strategies, and lower on measures of psychological resilience and postdeployment social support. Multivariate analysis revealed that a positive depression screen, and higher scores on measures of self-punishment and cognitive-social avoidance coping were positively associated with suicidal ideation, while higher scores on measures of psychological resilience (i.e., positive acceptance of change) were negatively related to suicidal ideation. Moderator analysis revealed that a positive screen for depression or PTSD significantly diminished the protective effect of postdeployment social support on suicidal ideation.

Conclusions

1 in 5 treatment-seeking OEF-OIF Veterans may contemplate suicide. Interventions to reduce depressive symptoms, and maladaptive cognitive-behavioral coping strategies of self-punishment and cognitive social avoidance, and to bolster psychological resilience may help mitigate suicidality in this population.     

Suicide prevention in military organizations

Suicide is an important public health problem in the demographic group that forms the bulk of military populations, namely young and middle-aged men. Suicide in the military also has special significance: certain aspects of military service can lead to serious mental disorders that increase the risk of suicidal behaviour. Moreover, military organizations have control over a broad range of factors (notably the direct delivery of mental health care) that could mitigate suicide risk. This article will review the literature on suicide risk in military organizations to answer the important question: Are military personnel at increased risk for suicide? Next, Mann et al.'s (2005) model for specific suicide preventive interventions in civilian settings will be reviewed and then expanded, with an emphasis on identifying special opportunities for suicide prevention in military organizations, including: 1) organizational interventions to mitigate work stress; 2) selection, resilience training, and risk factor reduction; 3) interventions to overcome barriers to care; and 4) systematic quality improvement efforts in mental health care. Finally, the evidence behind comprehensive suicide prevention programmes will be reviewed, with a special focus on the US Air Force's benchmark programme.     

An abbreviated version of the Connor-Davidson Resilience Scale (CD-RISC), the CD-RISC2: psychometric properties and applications in psychopharmacological trials

Resilience may be an important component of the prevention of neuropsychiatric disease. Resilience has proved to be quantifiable by scales such as the Connor-Davidson Resilience Scale (CD-RISC). Here, we introduce a two-item version of this scale, the CD-RISC2. We hypothesize that this shortened version of the scale has internal consistency, test-retest reliability, convergent validity, and divergent validity as well as significant correlation with the full scale. Additionally, we hypothesize that the CD-RISC2 can be used to assess pharmacological modification of resilience. We test these hypotheses by utilizing data from treatment trials of post-traumatic stress disorder, major depression, and generalized anxiety disorder with setraline, mirtazapine, fluoxetine, paroxetine, venlafaxine XR, and kava as well as data from the general population, psychiatric outpatients, and family medicine clinic patients.     

Collective approaches for the control of depression in England

Objective This paper addresses the prevention and treatment of depression in the general population. It argues that the public health burden of depression cannot be effectively tackled solely at the level of the treatment of individuals; in addition, coherent strategies by national governments are required. It summarises some of the public health interventions that were undertaken in England by the government to reduce the risk factors associated with depression in increase detection and treatment and to destigmatise this disorder. Lessons learned from this experience are described. Methods To assess the scope for collective public interventions, a national psychiatric morbidity study was commissioned. The Government set targets for reducing psychiatric morbidity and suicide. Research related to depression was commissioned. A public information strategy was launched to increase understanding and reduce stigma, including a five year ‘Defeat Depression’ Campaign. Particular attention was paid to updating General Practitioners in the recognition, detection and management of depression. Government departments worked with employers and trade union organisations to attempt to reduce work-induced stress. Universal and selective prevention measures aimed to reduce factors associated with depression, such as unemployment. Measures to reduce suicide include education of health and social care professionals, supporting high-risk groups and restricting access to means of suicide. The impact of these strategies is difficult to assess and will not be apparent until the national psychiatric morbidity study is repeated in 2001. The overall suicide rate fell by 11.7% in five years. Accepted: 21 December 2000     

Psychological resilience and postdeployment social support protect against traumatic stress and depressive symptoms in soldiers returning from Operations Enduring Freedom and Iraqi Freedom

Background: A number of studies have examined the prevalence and correlates of posttraumatic stress disorder (PTSD), depression, and related psychiatric conditions in soldiers returning from Operations Enduring Freedom and Iraqi Freedom (OEF/OIF), but none have examined whether factors such as psychological resilience and social support may protect against these conditions in this population. Methods: A total of 272 predominantly older reserve/National Guard OEF/OIF veterans completed a mail survey assessing traumatic stress and depressive symptoms, resilience, and social support. Results: Resilience scores in the full sample were comparable to those observed in civilian outpatient primary‐care patients. Respondents with PTSD, however, scored significantly lower on this measure and on measures of unit support and postdeployment social support. A hierarchical regression analysis in the full sample suggested that resilience (specifically, increased personal control and positive acceptance of change) and postdeployment social support were negatively associated with traumatic stress and depressive symptoms, even after adjusting for demographic characteristics and combat exposure. Conclusions: These results suggest that interventions to bolster psychological resilience and postdeployment social support may help reduce the severity of traumatic stress and depressive symptoms in OEF/OIF veterans. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Community-based Suicide Prevention Research in Remote On-Reserve First Nations Communities

Suicide is a complex problem linked to genetic, environmental, psychological and community factors. For the Aboriginal population more specifically, loss of culture, history of traumatic events, individual, family and community factors may also play a role in suicidal behaviour. Of particular concern is the high rate of suicide among Canadian Aboriginal youth. While the need to develop interventions to reduce suicidal behaviour for First Nations on-reserve populations is evident, there may be an element of distrust of researchers by Aboriginal communities. Furthermore, research in mental health and specifically suicide is much more sensitive than studying medical illnesses like diabetes. Clearly, this issue requires a unique and insightful approach. While numerous suicide prevention/intervention plans and guidelines have been published specifically for work involving Aboriginal people, the literature lacks a comprehensive discussion of the methodological and logistical issues faced by research teams and Aboriginal communities attempting to develop culturally-grounded and community-specific suicide prevention and intervention strategies. This paper outlines the research process, key challenges and lessons learned in a collaborative University-First Nations suicide prevention project conducted with eight north-western Manitoba First Nations communities (Canada).     

Quelles échelles utiliser pour mesurer la résilience en psychiatrie adulte ?

This communication based on a literature review, summarizes the most appropriate evaluation scales which measure resilience in adult psychiatry, and lists the principal clinical dimensions studied in the articles on the topic. The objective of this communication is to provide psychiatric institutions which receive adult patients with a list of resilience evaluation scales we consider to be the most pertinent to measure resilience in that sector.MethodThe review was done using Pubmed on articles written between 2016 and 2019, using the terms “resilience scales in psychiatry” and “resilience scales in psychology”. Two hundred and seventy-eight articles were found. Fifty articles concerning mental health in adult psychiatry more precisely were kept, and we looked at which resilience evaluation scales were most used in those researches, and which associated clinical dimensions were studied. We started by defining resilience, as defined originally in physics, and how it was then derived in psychology, notably introduced in France by Boris Cyrulnik. We then looked at how resilience is measured in adult psychiatry. Some researchers such as Wagnild used instruments specifically designed to measure resilience. Ionescu & Jourdan-Ionescu did an inventory of the instruments, and Windle, Bennett & Noyes a review.ResultAfter briefly defining what resilience is, particularly in the psychological field, we succinctly summarized the 6 scales we consider to be the most adapted for researches on resilience in adult psychiatry and listed the main clinical dimensions that have been researched in the articles we kept. These six scales, are widely used, validated and adapted to clinical psychiatry. This communication is therefore a mini guide of the most adapted resilience evaluation scales for potential future researches in adult psychiatry. The Wagnild & Young Resilience scale was validated among women aged 53 to 95 and it has a French version widely used to measure resilience among the general and clinical population. The Fryborg et al. RSA also measures adult resilience and is useful to measure protective factors against psychological disorders. The Ponce-Garcia, Madwell & Kennison SPF apprehends a complete measure of resilience and is a reliable scale among survivors of violent trauma. The Roussow & Roussow Predictive 6-Factor Resilience Scale was based on a neurobiological basis of resilience and has also a good consistence with health hygiene scores. It is considered an efficient measure to use in improving resilience. Finally, The Resilience Questionnaire for Bipolar Disorder from Echezarraga, Las Hayas, González-Pinto & Jones specifically measures resilience among a bipolar disorders population. The main clinical dimensions which figured in researches on resilience were varied and numerous. Many refer to post-traumatic stress disorder (PTSD), especially among American veterans. Besides PTSD, dimensions linked to stress, depression and psychiatric disorders were also researched. Scales are the same as those used in general population. However, some are validated for a clinical population. These scales can measure the link between resilience and various clinical dimensions and disorders. This opens the door for researches in adult psychiatry using one or more of the scales described in this article.     

Crucial elements in suicide prevention strategies

Ways of conceptualizing suicide prevention are reviewed briefly, and the preventive model: Universal, Selected, and Indicated prevention (USI) is chosen as the structure for the literature review, and the discussion. Universal preventive interventions are directed toward entire population; selective interventions are directed toward individuals who are at greater risk for suicidal behaviour; and indicated preventions are targeted at individuals who have already begun self-destructive behaviour.On the universal prevention level, an overview of the literature is presented with focus on restrictions in firearms and carbon monoxide gas. At the selective prevention level, a review of risk of suicide in homelessness and schizophrenia and risk factors for suicide in schizophrenia is conducted and possible interventions are mentioned together with the evidence for their effect. Suicide rate and preventive measures in affective disorder are also touched upon. At the indicated prevention level, studies of fatal and non-fatal suicide acts after suicide attempt are mentioned. The evidence of preventive measures to reduce repetition rates is presented.Finally, the state of the art is discussed with regard to prevention at the universal, the selected and the indicated level and clinical and research implications are outlined.     

Prevention of psychiatric disorders in children

Mental health professionals have the capability to identify children who are at risk of developing psychiatric disorders. Early intervention with these children can help prevent significant maladjustment and reduce their future need for mental health services. The authors review studies of environmental and temperamental factors associated with children's vulnerability and resilience to psychiatric disorders. The goals and effects of selected prevention approaches designed for preschool children, elementary-school-age children, and parents are discussed. Families in need of prevention services may be more likely to use these interventions if they are integrated into existing school programs and social welfare systems.     

Suicidality among older male veterans in the United States: Results from the National Health and Resilience in Veterans Study

Older men have a higher rate of suicide than the general population, but little is known about the prevalence and correlates of suicidality among older male veterans. In this study, we evaluated the prevalence, and risk and protective factors associated with current suicidal ideation (SI) and past suicide attempt (SA) in a contemporary, nationally representative sample of older male veterans. We analyzed data from 1962 male veterans aged 60 or older who participated in the National Health and Resilience Veterans Survey (NHRVS) between October and December 2011. Bivariate analyses and multivariate logistic regression were used to evaluate risk and protective factors associated with current SI and past SA in the full sample, and separately among combat and non-combat veterans. Six percent of the sample reported past 2-week SI, and combat veterans were more likely to contemplate suicide (9.2%) than non-combat (4.0%) veterans. Lifetime SA was reported by 2.6% of respondents. Major depression and physical health difficulties were the strongest risk factors for SI in combat veterans, while generalized anxiety disorder (GAD) was the strongest risk factor for SI in non-combat veterans. Posttraumatic stress disorder (PTSD) was independently associated with SI in both groups of veterans, and social connectedness was negatively related to SI in both groups. These results suggest that a significant proportion of older male veterans in the United States contemplates suicide, with higher rates of SI among combat than non-combat veterans. Interventions designed to mitigate psychological distress and physical difficulties, and to promote social connectedness may help mitigate suicidality risk in this population.     

Suicidality in High-Risk Psychiatric Patients: The Contribution of Protective Factors

Objective: This study’s objective was determine the incremental association of reasons for living to the lifetime number of suicide attempts in relation to other known risk and protective factors in a sample of psychiatric patients with extensive psychopathology in residential treatment. Methods: Participants (n = 131) completed a demographic questionnaire that also asked for information about lifetime suicide history, psychiatric history, trauma, and abuse history. Additional measures of resilience, reasons for living (RFL), and impulsiveness were completed. Results: A history of sexual abuse was associated with an increasing lifetime number of suicide attempts, while a history of physical abuse and trait impulsiveness were not associated with the lifetime number of suicide attempts. Survival and coping beliefs, a subscale of the Reasons for Living Inventory (RFLI), was found to add incremental predictive validity to the number of lifetime suicide attempts. A composite fear variable, combining fear of suicide and fear of social consequences of suicide, was negatively correlated with lifetime number of attempts but did not add incremental validity to the prediction of lifetime number of suicide attempts. Conclusion: In a sample of participants with significant psychiatric impairment, the protective factor of survival and coping beliefs may be an important barrier to repeated suicide attempts and may be considered a suicide-specific resilience measure. Understanding the psychological processes contributing to the development of such protective factors as resilience, meaning in life, and coping resources is an important area of study and a potential avenue for targeted therapeutic intervention in high-risk populations.     

Suicides in Late Life

Suicide in late life is an enormous public health problem that will likely increase in severity as adults of the baby boom generation age. Data from psychological autopsy studies supplemented with recent studies of suicidal ideation and attempts point to a consistent set of risk factors for the spectrum of suicidal behaviors in late life (suicide ideation, attempts, and deaths). Clinicians should be vigilant for psychiatric illness (especially depression), physical illness, pain, functional impairment, and social disconnectedness. Recent advances in late-life suicide prevention have in common collaborative, multifaceted intervention designs. We suggest that one mechanism shared by all preventive interventions shown to reduce the incidence of late-life suicide is the promotion of connectedness. For the clinician working with older adults, our recommendation is to not only consider risk factors, such as depression, and implement appropriate treatments but to enhance social connectedness as well.     

Psychological resilience and neurocognitive performance in a traumatized community sample

Background: Whether psychological resilience correlates with neurocognitive performance is largely unknown. Therefore, we assessed association between neurocognitive performance and resilience in individuals with a history of childhood abuse or trauma exposure. Methods: In this cross‐sectional study of 226 highly traumatized civilians, we assessed neurocognitive performance, history of childhood abuse and other trauma exposure, and current depressive and PTSD symptoms. Resilience was defined as having ≥1 trauma and no current depressive or PTSD symptoms; non‐resilience as having ≥1 trauma and current moderate/severe depressive or PTSD symptoms. Results: The non‐resilient group had a higher percentage of unemployment (P=.006) and previous suicide attempts (P<.0001) than the resilient group. Both groups had comparable education and performance on verbal reasoning, nonverbal reasoning, and verbal memory. However, the resilient group performed better on nonverbal memory (P=.016) with an effect size of .35. Additionally, more severe childhood abuse or other trauma exposure was significantly associated with non‐resilience. Better nonverbal memory was significantly associated with resilience even after adjusting for severity of childhood abuse, other trauma exposure, sex, and race using multiple logistic regression (adjusted OR=1.2; P=.017). Conclusions: We examined resilience as absence of psychopathology despite trauma exposure in a highly traumatized, low socioeconomic, urban population. Resilience was significantly associated with better nonverbal memory, a measure of ability to code, store, and visually recognize concrete and abstract pictorial stimuli. Nonverbal memory may be a proxy for emotional learning, which is often dysregulated in stress‐related psychopathology, and may contribute to our understanding of resilience. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Mental health promotion: guidance and strategies

Public mental health incorporates a number of strategies from mental well-being promotion to primary prevention and other forms of prevention. There is considerable evidence in the literature to suggest that early interventions and public education can work well for reducing psychiatric morbidity and resulting burden of disease. Educational strategies need to focus on individual, societal and environmental aspects. Targeted interventions at individuals will also need to focus on the whole population. A nested approach with the individual at the heart of it surrounded by family surrounded by society at large is the most suitable way to approach this. This Guidance should be read along with the European Psychiatric Association (EPA) Guidance on Prevention. Those at risk of developing psychiatric disorders also require adequate interventions as well as those who may have already developed illness. However, on the model of triage, mental health and well-being promotion need to be prioritized to ensure that, with the limited resources available, these activities do not get forgotten. One possibility is to have separate programmes for addressing concerns of a particular population group, another that is relevant for the broader general population. Mental health promotion as a concept is important and this will allow prevention of some psychiatric disorders and, by improving coping strategies, is likely to reduce the burden and stress induced by mental illness.     

Preventive interventions for youth suicide: a risk factor-based approach

OBJECTIVE: This review draws on current knowledge of risk for youth suicide to categorize strategies for intervention. Its goal is to identify areas of 'research need' and to provide an evidence base to identify 'best buy' preventive interventions for youth suicide. METHOD: The design, development, implementation and evaluation of prevention strategies ranging from clinical interventions to population-based universal approaches are considered within five risk factor domains: individual, family, community, school and peer. RESULTS: There is a paucity of evidence on the effects of interventions targeting depression and suicidal behaviour. Nevertheless, there are effective indicated, selective and universal interventions for important risk factors for depression and suicidal behaviour. Little evidence has emerged to support the efficacy of some traditional approaches to suicide prevention, such as school based suicide education programs and telephone hotlines. CONCLUSIONS: Youth suicide prevention strategies in Australia have generally employed traditional approaches that focus on clinical interventions for self-harmers, restricting access to lethal means, providing services to high risk groups and enhancing general practitioner responses. Both program development and research evaluation of interventions for many important risk and protective factors for suicide have been neglected.     

Apport de la génétique dans les études sur la résilience : l’exemple de l’autisme

Resilience refers to patterns of positive adaptation in the context of significant risk or adversity. In the early 1970s, researchers began to discuss the importance of observing why some individuals did not develop psychopathological troubles in spite of being at risk. Over the past 30 years, real advances have occurred in understanding the complexity of causality and the interaction of multiple risks and protective factors in the process of resilience.Two major approaches have characterized the research in this domain: the variable-focused approach and the person-focused approach. Many variable-based models conceptualized interactions and/or correlations between individual environmental risk and protective factors. These models have been extended with recent studies investigating the link between genetic risks and resilience. From a genetic perspective, resilience could be understood as the extent to which an individual who possesses a genetic risk for psychopathology does not develop troubles. But, even if most studies have been concerned with dividing population variance into effects attributable to genes and those attributable to environment, it now seems clear that other effects exist. Examples of correlation models (rGE) underline the need to differentiate the genetic and environmental mediation of risk processes and of moderation or resistance to them.To clarify this new framework, an example of study of resilience in families having an autistic child was proposed. Data from twin studies and family studies offered strong support for the genetic contribution to autism. Studies in relatives of autistic persons extended these results by indicating a similar pattern of social and/or communication difficulties in first degree or more distant relatives of the child (the broader autism phenotype). In addition to genetic factors, growing up with an autistic sibling is expected to cause psychological and emotional difficulties in family members. Studies in siblings of autistic individuals have shown that they were at risk of psychiatric disorders as major depression and anxiety disorders in these subjects have been found to be twofold greater than in controls. However, studies investigating the psychological adjustment in siblings of autistic individuals showed no significant differences with controls. Some of these contradictions may be attributed to methodological issues, but the question remains concerning the validity of employing the term of ’resilience’ in this research domain. There is a growing acceptance of the need to study and question the various methodological hazards that could lead to false impressions of resilience. Studies in the area of resilience should follow interdisciplinary and multiple levels of analysis perspectives. Such investigations may reveal that genes may also serve as a protective function for individuals facing adversity. Resilience could help to broaden the understanding of developmental processes that may not be so evident in normative environments.     

Psychological autopsy studies--a review.

Psychological autopsy is one of the most valuable tools of research on completed suicide. The method involves collecting all available information on the deceased via structured interviews of family members, relatives or friends as well as attending health care personnel. In addition, information is collected from available health care and psychiatric records, other documents, and forensic examination. Thus a psychological autopsy synthesizes the information from multiple informants and records. The early generation of psychological autopsies established that more than 90% of completed suicides have suffered from usually co-morbid mental disorders, most of them mood disorders and/or substance use disorders. Furthermore, they revealed the remarkable undertreatment of these mental disorders, often despite contact with psychiatric or other health care services. More recent psychological autopsy studies have mostly used case-control designs, thus having been better able to estimate the role of various risk factors for suicide. The future psychological autopsy studies may be more focused on interactions between risk factors or risk factor domains, focused on some specific suicide populations of major interest for suicide prevention, or combined psychological autopsy methodology with biological measurements.     

Life-Satisfaction,Engagement, Mindfulness,Flourishing, and Social Support: Do they Predict Depression,Suicide Ideation,and History of Suicide Attempt in Late Life?

ObjectiveSuicide is an outcome arising from a combination of risk and protective factors. Examining psychological resilience traits associated with successful aging may help to better understand late-life suicide and depression. We examined self-reported protective factors including mindfulness, life satisfaction and engagement, flourishing, and subjective and objective social support in a high suicide-risk sample of depressed older adults.MethodsParticipants were 297 individuals aged 55+ (mean age: 64.2): 92 depressed suicide attempters, 138 depressed individuals who never attempted suicide, and 67 non-psychiatric comparisons. Using linear and binomial logistic regression, we examined the effects of a combined Protective Factor value on presence and severity of depression and suicidal ideation, and history of suicide attempt.ResultsRelative to the non-psychiatric comparison group, all depressed participants had significantly lower Protective Factor values. Higher Protective Factor value was associated with lower likelihood of depression, depression severity, and likelihood of ideation, but was not associated with ideation severity or history of suicide attempt. Participants with one standard deviation higher Protective Factor had lower odds of ideation incidence by a factor of OR=0.68 (95%CI=0.48–0.96).ConclusionResiliency characteristics relevant to psychological wellbeing and successful aging may mitigate the emergence of depression and suicidal ideation, as well as the severity of depression in late-life. The Resilience Factor used in this study can help clinicians nuance their appraisal of depression and suicide risk.