Archives of Suicide Research

Ammerman, Brooke A.; Gebhardt, Heather M.; Lee, Jacob M.; Tucker, Raymond P.; Matarazzo, Bridget B.; Reger, Mark A.

doi: 10.1080/13811118.2019.1632231pmid: 31213148

The Caring Contacts suicide prevention intervention has been promoted by the Joint Commission, given its effectiveness, high reach, and cost effectiveness. Despite its increased application, no study has examined whether patient characteristics influence perceptions of the intervention, which may inform implementation efforts and ultimately impact effectiveness. One hundred fifty-four veterans were recruited from a Veterans Affairs psychiatric inpatient unit. Participants completed a survey to provide feedback on preferences, including the message correspondent, format (e.g., postcard, email), the importance of handwriting (vs. typed), visual presentation, and schedule for mailings. Results demonstrated that Caring Contacts preferences did not differ by most variables, including military rank, combat deployment history, or most personal technology use characteristics. Some demographic differences were identified, especially by age. More older veterans preferred messages to be sent in a physical letter compared to younger veterans, but if messages were sent via postal mail, younger veterans had a stronger preference for messages to be handwritten and sent using real stamps and colorful envelopes. Overall, findings suggest that few Caring Contacts adaptations are needed based on patient characteristics. Programs targeting older cohorts should consider postal mail formats for Caring Contacts.

Hausman, C.; Meffert, B. N.; Mosich, M. K.; Heinz, A. J.

doi: 10.1080/13811118.2019.1635930pmid: 31248349

Objective: To examine relations between self-report and behavioral measures of impulsivity and cognitive flexibility with suicidal ideation and self-harm and suicide attempt history. Methods: Eighty-seven military veterans who met DSM-5 diagnostic criteria for alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) were evaluated for current suicidal ideation and self-harm, suicide attempt history, impulsivity, and cognitive flexibility. Results: Higher levels of self-reported impulsivity were associated with greater suicidal ideation and self-harm and lower behavioral inhibition was associated with greater likelihood of endorsing a suicide attempt. Conclusion: Use of multi-modal assessment of impulsivity and cognitive flexibility may aid in suicide screening and intervention among vulnerable and high-risk populations.

Defayette, Annamarie B.; Adams, Leah M.; Whitmyre, Emma D.; Williams, Caitlin A.; Esposito-Smythers, Christianne

doi: 10.1080/13811118.2019.1635931pmid: 31248348

Although a history of a suicide attempt is the strongest predictor of future suicide attempts, not all adolescents who make an attempt engage in repetitive suicidal behavior. The present study sought to determine whether certain characteristics of a first suicide attempt (e.g., age of first attempt, method of attempt used, intent seriousness, medical lethality, and receipt of treatment after attempt) can distinguish between adolescents who make single versus multiple suicide attempts. Adolescents (N = 95) who were psychiatrically hospitalized and their guardian completed a diagnostic interview to gather information on all lifetime suicide attempts. A multivariate hierarchical logistic regression was conducted, predicting single attempt versus multiple attempt status. Of the first-attempt characteristics examined, only age of first attempt, OR = 0.33, 95% CI [0.17–0.63], p = .001, and receipt of treatment following attempt, OR = 0.28, 95% CI [0.09–0.88], p = .028, significantly distinguished SA vs. MA status, even after controlling for current age and depression at the time of first attempt. Female and White participants were overrepresented in this sample, which limits generalization to more heterogenous and diverse samples. The cross-sectional nature of data introduces the potential for retrospective recall bias. Younger age of first attempt and lack of receipt of mental health treatment following a first attempt were associated with multiple attempt status. These findings highlight the importance of early mental health screening, parental psychoeducation, and linkage to mental health care after a suicide attempt.

Zhou, Eric; DeCou, Christopher R.; Stuber, Jennifer; Rowhani-Rahbar, Ali; Kume, Kosuke; Rivara, Frederick P.

doi: 10.1080/13811118.2019.1635932pmid: 31248352

Hospital emergency departments (EDs) are important settings for the implementation of effective suicide-specific care. Usual care for suicidal patients who present to EDs remains understudied. This study surveyed EDs in Washington State to assess the adoption of written procedures for recommended standards of care for treating suicidality. Most (N = 79, 84.9%) of the 93 EDs in Washington State participated. Most (n = 58, 73.4%) hospitals had a written protocol for suicide risk assessment, but half (n = 42, 53.2%) did not include documentation of access to lethal means. There was evidence of an association between patient volume and the adoption of suicide-specific protocols and procedures. Our findings suggest the need to enhance the adoption and implementation of recommended standard care in this setting.

Levi-Belz, Yossi; Barzilay, Shira; Levy, Dorin; David, Or

doi: 10.1080/13811118.2019.1632233pmid: 31213144

Therapists’ intense negative emotional responses regarding suicidal patients raise questions about therapists' willingness to treat them; however, this issue has yet to be investigated. The aim of the current study is to examine to what extent the severity of suicidality of a hypothetical patient will influence therapists' willingness to treat and the likelihood of their referring out. Mental health professionals (N = 249) completed a questionnaire that presented a vignette of a hypothetical patient referred for psychological treatment. The vignette contained a manipulation of the severity of suicidality levels of the referred patient, with two randomly assigned conditions: suicidal or depressive symptoms. Participants were then asked about their willingness to treat the hypothetical patient. Our results showed that willingness to treat was significantly lower and the likelihood of referring out was significantly higher among therapists in the suicidal patient condition, relative to the depressive patient condition. Longer professional seniority and previous training in suicide prevention moderated these effects. Our findings highlighted therapists' reluctance, especially among young practitioners, to treat suicidal patients, an inclination that may have a critical impact on patient suicidal outcomes. Findings reinforced the need for specific training on suicide prevention in the mental health curriculum.

Peckham, Andrew D.; Jordan, Haley; Silverman, Alexandra; Jarvi Steele, Stephanie; Björgvinsson, Thröstur; Beard, Courtney

doi: 10.1080/13811118.2019.1625831pmid: 31159675

Urgency–rash action during strong emotion–is a robust correlate of nonsuicidal self-injury (NSSI). This study tested whether urgency is associated with time between NSSI urges and NSSI, and sought to replicate the finding that urgency is associated with NSSI history. Participants attending a partial hospitalization program (N = 669) completed self-report measures of urgency, NSSI history and latency, and psychiatric symptoms. Consistent with previous research in clinical samples, rates of lifetime engagement in NSSI were high. Using logistic regression to predict short vs. long latency between urges and NSSI, no significant relationship emerged between negative urgency and latency to self-injure. Negative urgency more than doubled the likelihood of NSSI history (p < .001, OR = 2.39). In addition, exploratory analyses revealed several links between NSSI latency and negative urgency. Results confirm that urgency is robustly related to NSSI, yet also suggest that more research is needed to understand how urgency relates to the parameters of NSSI within those who self-injure. Use of retrospective self-report measures may limit the ability to test links between urgency and latency of NSSI.

Wadman, Ruth; Nielsen, Emma; O’Raw, Linda; Brown, Katherine; Williams, A. Jess; Sayal, Kapil; Townsend, Ellen

doi: 10.1080/13811118.2019.1624669pmid: 31322056

Although UK clinical guidelines make tentative recommendations for “harm minimization” strategies for repeated self-harm, this is in the absence of empirical evidence supporting their acceptability or effectiveness. We explore young people’s views of harm minimization strategies (e.g., snapping elastic bands on skin, drawing on skin with red ink), as a proxy for self-harm. In this mixed methods study we examine data (secondary analysis) from: (1) an online questionnaire (N = 758) observing the frequency of these strategies being used as a form of self-harm, and as a form of alternative coping (viewed as distinct from self-harming), and (2) semi-structured interviews (N = 45), using thematic analysis to identify themes related to harm minimization. Predominant themes suggest that many young people viewed harm minimization strategies as a proxy for self-harm as ineffective. Where such strategies were reported as helpful, their utility was reported to be short-lived or situation-specific. Findings from both studies indicate that some young people described using harm minimization (e.g., elastic band snapping) as a form of self-harm (e.g., to break the skin). Harm minimization strategies should not be recommended in isolation and their use must be monitored. Further research is urgently needed to develop an evidence base that informs practice.

Waitz-Kudla, Sydney N.; Anestis, Michael D.

doi: 10.1080/13811118.2019.1625832pmid: 31216243

This study examined the relationship between religious affiliation, social policy beliefs, and whether individuals spoke with anyone about suicide prior to suicide death. Two hundred sixty-seven suicide loss survivors reported on characteristics of suicide decedents. Binary logistic regressions found those who identified as socially liberal were more likely to have discussed suicide with the loss survivor or to have told someone else they were thinking about attempting suicide than were those who identified as socially conservative. Follow-up analyses indicated Christian affiliation was only associated with a lower likelihood of having discussed suicide with the loss survivor among older men. Results indicated that specific worldviews may serve as obstacles to suicidal individuals discussing their suicidal thoughts prior to death. As such, the findings indicate that public health approaches to suicide prevention that do not rely on open reporting of suicidal ideation may be vital within such communities.

An, Soontae; Cruwys, Tegan; Lee, Hannah; Chang, Melissa Xue-Ling

doi: 10.1080/13811118.2019.1624668pmid: 31159683

There is evidence for cultural differences in mental health symptoms and help-seeking, but no past research has explored cultural differences in how people react to suicidal ideation communicated by others. Layperson reactions are critical, because the majority of people who experience suicidal ideation disclose to friends or family. Participants were 506 people aged 17–65 recruited from Australia and Korea who completed an experiment in which they responded to a friend who was experiencing either subclinical distress or suicidal ideation. Korean participants did not differentiate between the subclinical and suicidal targets, whereas Australian participants showed more concern for the suicidal target. For both targets, Korean participants were more likely to recommend passive coping strategies (“Time will solve everything” or “Cheer up”), while Australian participants were more likely to recommend active coping strategies (“Let’s talk” or “See a doctor”). This study provides the first evidence of cultural differences in the way people typically respond to disclosures of suicidal ideation, and suggests that unhelpful and inappropriate recommendations are commonplace.

Moore, F. R.; Macleod, M.; Starkey, C.; Krams, I.; Roy, T.

doi: 10.1080/13811118.2019.1635929pmid: 31248342

We explored relationships between male mortality and the sex ratio. (We tested relationships across 142 societies and in longitudinal data from Scotland. A male-biased sex ratio was associated with reduced mortality by intentional self-harm across 142 societies. This was replicated in longitudinal Scottish data, and men were less likely to die by suicide and assault when there were more men in the population only when levels of unemployment were low. We argue that this is consistent with a theoretical model in which men increase investment in relationships and offspring as “competition” under a male-biased sex ratio, and that the conflicting results of previous work may stem from divergent effects of the sex ratio on mortality depending upon relative deprivation.