Regional use of violent suicide methods: an analysis of suicide attempts in Houston, Texas

A number of changes in the demographics of suicide and suicide attempters have occurred in the last 10 to 15 years. To assess some of the factors that may be involved in these changes, this study examines a group of suicide attempters in Houston, Texas, where a large percentage of the attempts were violent. These violent attempters are compared with nonviolent attempters, and the entire population of attempters is compared with suicide attempters in New Haven, Connecticut. Finally, the two attempter populations are compared with the underlying general population demographics of two regions (Houston and New Haven). Several differences emerged between attempters in Houston and in New Haven, including larger proportions of violent attempters, male attempters, and married attempters in Houston. Demographic factors in the general populations for the two regions are different, but these differences are not directly reflected in the nature of the attempter populations. Reasons for observed differences are discussed.     

Stress system alterations and mood disorders in suicidal patients. A review.

Stress system alterations, in particular HPA axis hyperactivations, are fairly well documented in suicide victims and in depressed suicide attempters who subsequently complete suicide. In suicide attempters with no documented completed suicide, the results are more inconsistent. This may depend on differences in studies due to diagnostic heterogeneity among suicide attempters, and the time between the suicide attempt and the examination. Recent data suggests differences in the stress system between depressed patients with a recent suicide attempt and depressed patients in general. The field merits further examination, with thorough examinations of genotypes, actual suicide attempts and stress in combination with examinations of the stress system.     

Military personnel compared to multiple suicide attempters: Interpersonal theory of suicide constructs

The current study aimed to address the discrepancy between suicide rates in the military and general population by comparing facets of the interpersonal theory of suicide between civilians with multiple suicide attempts and U.S. military personnel. Military personnel exhibited higher levels of capability for suicide but lower levels of perceived burdensomeness and thwarted belongingness than civilian multiple attempters. When comparing only personnel endorsing ideation and civilian multiple attempters, the significant difference for capability remained, but the differences for perceived burdensomeness and thwarted belongingness became nonsignificant. Results suggest the emergence of ideation places personnel at a greater risk for suicide than many civilian multiple attempters.     

THE CHILD SUICIDE RISK ASSESSMENT: A SCREENING MEASURE OF SUICIDE RISK IN PRE-ADOLESCENTS

This study documents the initial reliability and validity of the Child Suicide Risk Assessment (CSRA) for children under the age of 13. The revised CSRA retained 18 of 20 original items based on item-specific psychometric data from 140 pre-adolescents in out-of-home treatment programs. The CSRA demonstrated adequate internal consistency (α = .69) for a multi-dimensional scale (3 factors: Worsening Depression, Lack of Support, and Death as Escape). CSRA scores correlated significantly with criterion measures of prior suicide attempts and ideations. A receiver operating characteristic (ROC) curve discriminated significantly between prior attempters and non-attempters and was used to select preliminary CSRA cut-off scores for identifying substantial suicide risk. The CSRA is the first screening measure of suicide risk in pre-adolescents validated by associations with suicide attempts as well as ideations.     

The child suicide risk assessment: a screening measure of suicide risk in pre-adolescents

This study documents the initial reliability and validity of the Child Suicide Risk Assessment (CSRA) for children under the age of 13. The revised CSRA retained 18 of 20 original items based on item-specific psychometric data from 140 pre-adolescents in out-of-home treatment programs. The CSRA demonstrated adequate internal consistency (alpha=.69) for a multi-dimensional scale (3 factors: Worsening Depression, Lack of Support, and Death as Escape). CSRA scores correlated significantly with criterion measures of prior suicide attempts and ideations. A receiver operating characteristic (ROC) curve discriminated significantly between prior attempters and non-attempters and was used to select preliminary CSRA cut-off scores for identifying substantial suicide risk. The CSRA is the first screening measure of suicide risk in pre-adolescents validated by associations with suicide attempts as well as ideations.     

Hopelessness as Mediator of the Link Between Reports of a History of Child Maltreatment and Suicidality in African American Women

Findings from a study comparing reports of a history of child maltreatment and hopelessness in a sample of economically, socially, and educationally disadvantaged young urban African American women suicide attempters (n = 176) and demographically similar nonattempters (n = 185) revealed higher rates of child maltreatment and hopelessness among attempters than those among their nonsuicidal counterparts. Using a mediational model involving both linear and logistic regressions, results indicated that hopelessness partially mediated the link between reports of certain forms of child maltreatment (i.e., physical/emotional abuse and emotional neglect) and suicide attempts, and hopelessness fully mediated the link between child sexual abuse and suicide attempts. Of equal importance, reports of a history of childhood maltreatment significantly predicted the presence of hopelessness in those women who later attempted suicide. These results emphasize the clinical importance of screening for hopelessness in women who report a history of childhood maltreatment and/or current or previous suicidal behavior, as well as the need to target negative views of the future in clinical interventions with African American women abused as children.     

The effects of case management program completion on suicide risk among suicide attempters: A 5-year observational study

BackgroundA prior suicide attempt is known to be the most important risk factor for suicide. Case management programs provide psychosocial support and rehabilitation for suicide attempters. This study aimed to determine whether case management completion is associated with good clinical outcomes for suicide attempters visiting the emergency department (ED).MethodsA cross-sectional observational study was conducted using risk assessment records for suicide attempters visiting the ED from October 2013 to December 2017. We created two groups according to completion of the case management program. The primary outcome was a decrease in suicide risk. The secondary and tertiary outcomes were untreated stressors and lack of a support system. We calculated the adjusted odds ratio (AOR) of the case management completion for study outcomes adjusting for potential confounders.ResultsAmong 439 eligible suicide attempters, only 277 (63.1%) participants completed the case management program. Participants who completed the case management program were more likely to have decreased suicide risk (65.3% vs. 46.9%, AOR: 2.13 (1.42–3.20)) and less untreated stressors (49.8% vs. 61.1%, AOR: 0.64 (0.43–0.96)). However, there was no significant difference in lack of a support system (35.4% vs. 45.7%, AOR: 0.68 (0.45–1.03)).ConclusionCompletion of a case management program was associated with reduction of suicide risk. Multicomponent strategies to increase compliance with a case management program are needed to prevent suicide reattempt and reduce the health burden of suicide.     

Comparison of suicide notes and parasuicide notes

This archival research, a comparison of suicide notes written by individuals who killed themselves and notes—called parasuicide notes—by individuals who attempted suicide, involved two studies. The first study involved a comparison of eight patterns (comprised of individual protocol sentences): unbearable pain, interpersonal relations, rejection-aggression, inability to adjust, indirect expressions, identification-egression, ego, and cognitive constriction. The second study involved a protocol analysis based on previous reviews that compared completers and attempters. Independent judges scored the notes. No differences in the eight patterns were found. However, protocol differences were noted, namely that attempters see themselves more often as too weak to cope with life's difficulties; attempters see their attempt as a style of life; attempters express greater lack of social integration; and completers see themselves as more immature, passive/aggressive, and/or antisocial. There may be important commonalities between attempters, whose attempts are of moderate to high lethality, and completers. A number of significant limitations exist in the current study warranting some caution in generalizing to all suicides and parasuicides.     

Use of the risk-rescue rating scale with adolescent suicide attempters: A cautionary note

The assessment of the medical lethality and intent of suicide attempts has been considered an important area of research for those interested in suicide. The current study examined the usefulness of the Risk-Rescue Rating Scale with 109 adolescent suicide attempters and found a restricted range of variability, which, in turn, resulted in poor interrater reliability on a number of items. Results suggest that the Risk-Rescue Rating Scale is of limited usefulness with adolescents, and alternative approaches to assessing lethality and suicidal intent with this age group are discussed.     

Beck Hopelessness Scale: Psychometric Properties Among Rural Chinese Suicide Attempters and Non-Attempters

The authors recruited 401 suicide attempters from general hospitals and 409 matched non-attempters to evaluate the psychometric properties of the Beck Hopelessness Scale (BHS) in rural China. All participants completed the BHS, Center for Epidemiologic Studies Depression Scale (CES-D), and Trait Anxiety Inventory (TAI). Suicide attempters had higher BHS scores than non-attempters. Cronbach’s alpha coefficients were satisfactory and BHS scores significantly correlated to CES-D and TAI scores. Confirmatory factor analysis supported a four-factor model for suicide attempters and a five-factor model for non-attempters. The BHS is satisfactory in assessing hopelessness among suicide attempters in rural China.     

Switching Suicide Methods in Order to Achieve Lethality: A Study of Greek Suicide Victims

This article focused on the relation between the method of last attempted suicide and the method used during the subsequent completed suicide. Using the method of psychological autopsy, the authors studied all suicide cases from the Athens Greater Area during a 2-year period. Twenty-four percent of the victims had history of previous suicide attempts. The majority of the suicide attempters switched to a different method (p < 0.001) for their final act. This difference is primarily due to the individuals who had chosen self-poisoning or wrist cutting in their last attempted suicide. Both of these groups switched to hanging or jumping from a height for their final attempt. Individuals who attempted suicide by hanging or jumping became completers using mainly the same methods.     

Personal Stigma in Suicide Attempters

The aim of this study was to explore suicide attempters’ experiences of personal stigma. This qualitative study included a focus group of 7 experienced clinicians and semi-structured interviews with 8 suicide attempters. Thematic analysis of the data yielded four main themes: seriousness, care, “badness,” and avoidance. Experiences of stigma pervaded all contexts, but were most emotionally upsetting to the participants in interpersonal relationships. The findings show the importance of evaluating stigma for suicide attempters during suicide risk assessment and the need for specifically tailored interventions to combat suicide stigma at the individual level.     

Effects of sentencing options and strict / lenient instructions on convicting suicide attempters

Sentence and strictness of instructions influence juries' willingness to convict. To see whether this result holds for suicide attempters, 240 undergraduates read jury instructions for a suicide attempt that varied sentence (jail term, fine, community service, or mandatory counseling) and instructions, voted guilty/not guilty, and rated their certainty and effectiveness. With sentences of 25 hours mandatory counseling, or strict instructions, more respondents voted guilty. Sentence did not impact certainty or effectiveness, but strictness enhanced certainty. Overall, respondents were neutral that convicting a suicide attempter would reduce future attempts. Consistent with terror management theory, present students were willing to punish regardless of whether they thought that the punishment was preventive.     

EFFECTS OF SENTENCING OPTIONS AND STRICT/LENIENT INSTRUCTIONS ON CONVICTING SUICIDE ATTEMPTERS

Sentence and strictness of instructions influence juries' willingness to convict. To see whether this result holds for suicide attempters, 240 undergraduates read jury instructions for a suicide attempt that varied sentence (jail term, fine, community service, or mandatory counseling) and instructions, voted guilty/not guilty, and rated their certainty and effectiveness. With sentences of 25 hours mandatory counseling, or strict instructions, more respondents voted guilty. Sentence did not impact certainty or effectiveness, but strictness enhanced certainty. Overall, respondents were neutral that convicting a suicide attempter would reduce future attempts. Consistent with terror management theory, present students were willing to punish regardless of whether they thought that the punishment was preventive.     

VOICES IN SUICIDE: THE RELATIONSHIP BETWEEN SELF-DESTRUCTIVE THOUGHT PROCESSES, MALADAPTIVE BEHAVIOR, AND SELF-DESTRUCTIVE MANIFESTATIONS

Findings from empirical studies demonstrating significant relationships between parental introjects or 'voices' and self - destructive behavior are presented In this article. The 'voice' is defined as a systematized, integrated pattern of negative thoughts, accompanied by angry affect, that is the basis of an individual's maladaptive behavior. The studies applied the theoretical construct of the voice to the development of the Firestone Assessment of Self - Destructive Thoughts (FAST). Results of administering the scale to 1, 358 participants (outpatient, inpatient, and nonclinical groups) showed that the instrument distinguished between those individuals with a past history of suicide attempts and those without such a history. An exploratory factor analysis identified three factors representing levels of increasing self destructiveness. This analysis suggested that Factor Composite 3, labeled 'Self - Annihilating, ' and the Suicide Intent Composite, a subset of Factor 3, contained the primary factors distinguishing suicide attempters from those individuals who represent a lesser threat to self.     

How do clinicians and suicide attempters understand suicide attempt impulsivity? A qualitative study

Inconsistencies in the definition of impulsive suicide attempts hamper research integration. To expand the currently limited data on how this construct is used in clinical practice, researchers interviewed eight suicide attempters to create timelines of their suicide process, then had seven experienced clinicians review these timelines. Thematic analysis of the patient and clinician data revealed three themes: “thinking out,” build-up, and unclear intentionality. The results imply that assessing build-up of agitation and exhaustion symptoms can contribute to understanding acuteness of suicide risk. In addition, uncertainty about one’s intentions during the attempt should not be equated to low intent to die.     

综合医院接诊的自杀未遂者有无自杀意念特征比较

目的获得城市综合医院急诊室自杀未遂者自杀意念特征,为预防其再次发生自杀行为提供参考。方法以在沈阳市4所三级综合医院急诊室同一时段内接诊的自杀未遂患者为调查对象,使用自伤情况问卷、贝克自杀意念量表和美国精神障碍与统计手册第4版病人版(DSM-Ⅳ)轴Ⅰ障碍临床定式检查为调查和诊断工具,并比较分析调查资料完整的239例自杀未遂者有无自杀意念特征。结果 (1)两组在年龄、受教育年限等方面差异无统计学意义(均P>0.05);(2)与从无自杀意念组相比,有过自杀意念组有宗教信仰者多(11.45%vs.1.37%,P<0.01),近一个月曾因心理问题而难以从事日常活动或工作者多(57.23%vs.19.18%,P<0.01),本次最早出现伤害自己的想法到自伤所间隔时间超过2h的多(71.69%vs.27.40%,P<0.01),这次自伤最主要的目的是解脱痛苦者多(65.06%vs.26.03%,P<0.01),自杀当时想死程度超过80%者多(61.45%vs.13.70%,P<0.01),对这次自杀认真者多(72.29%vs.23.29%,P<0.01),后悔这次自杀失败者多(17.47%vs.9.59%,P<0.05),...     

Comparative study of suicide potential among Pakistani and American psychiatric patients

This study compared suicide potential and suicide attempts in 50 Pakistani and 50 American psychiatric patients all of whom reported a positive history of suicide attempts during the past 1-5 years. It further explored the role of nationality, gender, diagnosis, and marital status in respondents' potential for suicide and suicide attempts. The American sample reported a higher degree of suicide potential on the Firestone Assessment of Self-Destructive Thoughts (FAST), more suicide attempts, and a larger number of suicide precipitants (family conflicts, work pressure, wish for death, loneliness, financial problems, and mental disorders/drug withdrawal) than did the Pakistani sample. For suicide attempts, effects of 3-way interaction for gender, marital status and nationality were found significant. However, these effects were non-significant for respondent's potential for suicide. In addition, the FAST was found to have a significantly high correlation with suicide attempts. Thus, it may be inferred that the FAST can be used as a valuable screening instrument for the identification of patients at risk for suicide in diverse cultural settings. However, more prospective validity studies are needed to enhance our cross-cultural understanding of suicide; identification of psychiatric patients at risk for suicide by the FAST; and for effective treatment and prevention programs for Eastern and Western societies.     

Prevalence and associated factors of suicide among hospitalized schizophrenic patients

BACKGROUND Previous studies found several factors associated with suicide in schizophrenic patients,such as age,sex,education level,history of suicide attempts,psychotic symptoms,social factors,and substance abuse.However,there might be some additional factors that were not considered in previous studies but may be correlated with a greater likelihood of suicide attempts,such as medication and treatment.AIM To investigate the prevalence of suicide attempts and identify the risk of suicidality in hospitalized schizophrenia patients.METHODS This is a cross-sectional study of schizophrenic patients admitted to a psychiatric hospital who were 18 years of age or more.The outcomes and possible suicide risk factors in these patients were collated.The current suicide risk was evaluated using the mini-international neuropsychiatric interview module for suicidality and categorized as none(0 points),mild(1-8 points),moderate(9-16 points),or severe(17 or more points).This study used ordinal logistic regression to assess the association of potential risk factors with the current suicide risk in schizophrenic patients.RESULTS Of 228 hospitalized schizophrenia patients,214(93.9%)were included in this study.The majority(79.0%)of patients were males.Females appeared to have a slightly higher suicidality risk than males,with borderline significance.With regard to the current suicide risk assessed with the mini-international neuropsychiatric interview,172(80.4%)schizophrenic patients scored zero,20(9.4%)had a mild risk,8(3.7%)had a moderate risk,and 14(6.5%)had a severe risk.The total prevalence of current suicide risk in these schizophrenic patients was 19.6%.Based on multivariable ordinal logistic regression analysis with backward elimination,it was found that younger age,a current major depressive episode,receiving fluoxetine or lithium carbonate in the previous month,or a relatively higher Charlson comorbidity index score were all significantly and independently associated with a higher level of suicide risk.CONCLUSION The prevalence rate of suicide attempts in schizophrenia is high.Considering risk factors in routine clinical assessments,environmental manipulations and adequate treatment might prevent or decrease suicide in these patients.     

Characteristics of Chinese suicide attempters: an emergency room study

Studying the characteristics of attempted suicide is helpful in knowing the background of some completed suicides and improving prevention or intervention strategies. This current study analyzed data of 74 suicide attempters and 92 accident injured patients admitted to 6 hospital emergency rooms in an area of Northeastern China and found both similarities and differences between Chinese and Western suicide attempters. The data show that more women than men attempted suicide. Perhaps because of the unavailability of firearms to Chinese civilians, pesticide was the most lethal means of suicidal behavior. The stressful life events that account for the majority of suicidal incidents were mostly familial or marital problems. Compared with accident victims, these Chinese suicide attempters were younger, poorer, more likely to believe in a religion/superstition,more likely to perceive gender inequality, and less likely to experience support from either family or community. The traditional culture downplaying the status of women coupled with a belief in the transmigration of life may play an important role in the suicide of Chinese young women.