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.     

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 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.     

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.     

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.     

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.     

Cultural versus classic risk and protective factors for suicide

The current study examined the predictive value of cultural versus classic risk and protective factors for suicide in a community sample of 322 ethnic, sexual, and gender minority adults. Cultural factors played a significant and substantial role in predicting suicide attempts (explained 8% of variance in attempts and correctly classified 8.5% of attempters) over and above the classic factors of hopelessness, depression, and reason for living (which explained 17% of variance in attempts and correctly classified 14.1% of attempters). Findings suggest that cultural factors are important to include in standard suicide practice.     

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.     

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),...     

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.     

Stigma and suicidality among suicide attempt survivors: A qualitative study

Among people with mental illness, stigma experiences can increase suicidality, and suicidality itself is associated with negative stereotypes. Suicide attempt survivors experience both mental illness stigma and suicide stigma, which could contribute to their increased risk for completed suicide. We interviewed 13 suicide attempt survivors regarding experiences and consequences of stigma and identified five stigma-related themes. Stigma led to substantial emotional strain, including loneliness and hopelessness, which are important precursors of suicidality. Our findings suggest that both mental illness stigma and suicide stigma can contribute to suicidality among people with mental illness in general, and in suicide attempt survivors specifically.     

Perceived suicide stigma,secrecy about suicide loss and mental health outcomes

Abstract

Perceived suicide stigma and consequent secrecy about suicide loss could contribute to impaired mental health among suicide loss survivors. Using online survey data from 195 suicide loss survivors, higher perceived suicide stigma was associated with more grief difficulties, higher suicidality, and less personal growth. Secrecy partly mediated the association between perceived suicide stigma and grief difficulties as well as suicidality and completely mediated the association between perceived suicide stigma and personal growth. Our findings suggest that supporting suicide loss survivors in coping with perceived suicide stigma could reduce secrecy about suicide loss and by this improve their mental health outcomes.     

The comparison of psychological scales as hospitalization predictors between adult and elderly suicide attempters

BackgroundDuring the process of managing suicide attempters in the emergency department (ED), the importance of hospitalization has been emphasized. Lethality and intent have been suggested as hospitalization determinants of suicide attempters, but their predictive values remain limited in adult and elderly populations.MethodsUsing prospectively collected the ED-based Suicide Registry, data from suicide attempters over 18 years old was retrospectively studied (2010−2020). The enrolled participants were divided into adult (N = 832) and elderly (>65 years, N = 378) groups. Suicide lethality and intent were assessed by the Risk-Rescue Rating Scale (RRRS) and Suicide Intent Scale (SIS), respectively. The moderating effects of age on the relationship between the psychological scales and hospitalization were examined by entering the interaction terms into a multivariable regression model. The predictive ability of each scale for hospitalization was evaluated in terms of performance and goodness-of-fit.ResultsBoth scales' scores in both age groups were significantly higher in hospitalized patients than non-hospitalized patients. Interaction result indicated that only the odds of RRRS for hospitalization significantly differed by age group. Moreover, the predictive performance for hospitalization significantly differed by age group in RRRS but not SIS. In predicting hospitalization, the AUC of the RRRS was significantly higher than that of the SIS in the elderly group but not in the adult group. Comparing the two groups, the RRRS of the elderly group tended to have higher AUC than the adult group, whereas the AUC of the SIS was similar. The RRRS in both groups had a better overall fit compared to the SIS for hospitalization, but its best overall fit and strength with greater power were observed in the elderly group.ConclusionsThe age-by-RRRS interaction is significantly associated with hospitalization, and the RRRS implementation as a hospitalization determinant is more useful and suitable for elderly suicide attempters than for adult suicide attempters in an emergency setting.     

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.     

Suicide,mental, and physical health condition stigma in medical students

Abstract

The current study aimed to compare the personal stigma of suicide with the personal stigma for other mental and physical health conditions. 116 Australian medical students (58% women), aged between 20 and 41?years (M?=?25.02, SD?=?3.80), completed an online survey. Suicide was more highly stigmatized than most of the other mental and physical health conditions in both attitudes toward suicide and willingness to disclose. The current study highlights the need for further medical student education in suicide, as ongoing negative attitudes could negatively affect patient care and disclosure.     

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.     

Suicide attempters in Abu Dhabi: Is criminal prosecution associated with patients’ guardedness?

The objective of this study was to examine the relationship between legal status and guardedness in patients who attempted suicide in Abu Dhabi, United Arab Emirates. The consultation-liaison team assessed 355 patients admitted for suicidal/self-injurious behavior, recording their guardedness before knowing whether they were legally charged. Patients who were legally charged for the suicidal act (n?=?139) were 1.6 times (p?=?.03) more guarded in volunteering information than patients who were not legally charged. Legally charging suicide attempters might have a negative impact on risk assessment and psychiatric care.     

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.     

Promoting Nursing Students' Positive Attitudes Toward Providing Care for Suicidal Patients

Nurses my encounter patients who are suicidal in most clinical settings, yet many nurses report a negative attitude toward providing care for these patients. Nursing programs, in which students learn about suicide and develop skills in assessing and intervening with patients who are suicidal, are opportune settings for promoting a positive attitude toward providing care for suicide attempters. An experimental study compared the effectiveness of an interactive teaching strategy known as “structured controversy” with a lecture on promoting a positive attitude. A questionnaire based on Ajzen and Fishbein's (1980) theory of reasoned action was used to measure attitude, and was completed by 51 senior nursing students following a suicide class session. Students who had participated in structured controversy on suicide were significantly more positive on the stredfncstration factor extracted from a scale of attitude items. Students who had listened to the suicide lecture held significantly more positive beliefs about providing care for suicidal patients. Implications for education and practice are discussed.