Archives of Suicide Research

Wafy, Gamal; Ajayi, Lin; Siddiqi, Sara; Saravanamuttoo, Taylor; Shorr, Risa; Solmi, Marco; Colman, Ian; Fiedorowicz, Jess G.

doi: 10.1080/13811118.2024.2394671pmid: 39185957

Abstract Objective Suicide is a major global public health concern. While some progress has been made in understanding risk factors for suicidal behavior, other relevant questions have received less attention. One such question relates to the longitudinal course of suicidal behavior amongst individuals with multiple suicide attempts. This systematic review investigated whether there is an increase in the lethality across multiple suicide attempts. Method This systematic review followed PRISMA 2020 reporting guidelines. A literature search was conducted in MEDLINE, Embase and PsycINFO electronic databases from inception to August 2023 to identify studies with key terms related to multiple suicide attempts and lethality. The review included longitudinal studies with data on multiple suicide attempts, and any rating of their lethality. Covidence was used to guide the screening and extraction process. A narrative synthesis approach was used to descriptively summarize included studies. Results After identifying 828 unique abstracts for screening, 11 studies were included for narrative synthesis. Suicide attempt assessment methods and definitions were heterogenous, often indirectly inferring lethality based on suicide attempt method. Individuals with repeat attempts may be more likely to continue using the same method. Conclusions There was no evidence to support increasing lethality across repeat suicide attempts. However, this should be interpreted along with the fact that the evidence base is scarce, heterogenous, and methodologically limited.

Kleiman, Evan M.; Bentley, Kate H.; Jaroszewski, Adam C.; Maimone, Joseph S.; Fortgang, Rebecca G.; Zuromski, Kelly L.; Kilbury, Erin N.; Stein, Michelle B.; Beck, Stuart; Huffman, Jeff C.; Nock, Matthew K.

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Pauwels, Kirsten; De Jaegere, Eva; Vanderreydt, Patrick; Aerts, Silke; Vande Gaer, Eva; Portzky, Gwendolyn

doi: 10.1080/13811118.2024.2394666pmid: 39177448

Abstract Objective Worldwide helplines are considered an important part of suicide prevention strategies. Nevertheless, evidence regarding the impact of suicide prevention helplines on the suicidality of its users remains limited and is frequently confronted with methodological issues. This study aimed to assess the impact of crisis calls on callers’ levels of crisis and suicidality both immediately after the call and at follow-up compared to before the call. After the call, the satisfaction of the callers with the intervention was also assessed. Methods A pre-post study, generated automatically by a telephone system, was conducted in order to compare the level of crisis and suicidality (operationalized by five indicators: hopelessness, entrapment, controllability, suicidal intent, and social support) experienced by callers before and immediately after the call and at follow-up (one to two weeks after the call). Results Callers (n = 487) showed significant improvement in their level of crisis (p < .001, d = −0.31), hopelessness (p < .001, d = −0.22), entrapment (p < .001, d = −0.25), suicide intent (p < .001, d = −0.37), and social support (p < .001, d = 0.33) after the call compared to before the call. Improvements were also found at follow-up compared to pretest. The satisfaction of callers with the helpline was high. Conclusions This study adds to the growing evidence on suicide prevention helplines and addresses some important methodological issues in helpline research. Furthermore, it shows promising results regarding the potential supportive impact of helplines on callers who feel suicidal.

Sokol, Yosef; Wahl, Yaakov; Glatt, Sofie; Levin, Chynna; Tran, Patricia; Goodman, Marianne

doi: 10.1080/13811118.2024.2394674pmid: 39180493

Abstract Objective The Transtheoretical Model of Change (TTM) is an established model outlining five stages of change within a psychotherapeutic context: pre-contemplation, contemplation, preparation, action, and maintenance. Research shows that these models benefit patients and clinicians by enhancing their understanding of complex processes and identifying optimal therapeutic support for individuals at specific times. This study aimed to apply the TTM to personal recovery following a suicidal episode. Method A meta-synthesis was conducted on qualitative studies that outlined distinct phases or stages of recovery from a suicidal episode. The identified recovery stages were mapped onto corresponding TTM stages. Results Recovery processes followed a pattern aligning with TTM stages, but the action, maintenance, and termination stages were not clearly distinguished in the context of personal recovery. A three-stage model was proposed instead: (1) precontemplation, where recovery is not seen as possible or meaningful; (2) contemplation, during which there is growing awareness and consideration of the possibility of recovery and change; and (3) active growth, which is characterized by ongoing progress and engagement in at least one personal recovery process. Conclusions The proposed three-stage model condenses the later TTM stages and may better reflect personal recovery from a suicidal episode. Applying the model in clinical settings could help with case conceptualization and inform recovery approaches to an individual's current stage. Future research should evaluate the benefits of incorporating stages of change into suicide-focused recovery interventions to develop more effective interventions.

Boggs, Jennifer M.; Yarborough, Bobbi Jo H.; Clarke, Gregory; Aguirre-Miyamoto, Erica M.; Barton, Lee J.; Beck, Arne; Bruschke, Cambria; Buttlaire, Stuart; Coleman, Karen J.; Flores, Jean P.; Penfold, Robert; Powers, J. David; Richards, Julie Angerhofer; Richardson, Laura;

Matheson, Laura; Rasmussen, Susan; Moxie, Jessamyn; Cramer, Robert J.

doi: 10.1080/13811118.2024.2400915pmid: 39259004

Abstract Objective Contemporary approaches to suicide assessment and treatment incorporate reasons for living (RFL) and reasons for dying (RFD). This study qualitatively explored individuals’ self-described RFL and RFD in the context of suicidal thinking and behaviors. Method Within a community United Kingdom (UK) sample, adults (N = 331, aged 16+) responded to eight open-ended questions probing their experiences of suicide, defeat, and entrapment. Utilizing these data, which were collected from a larger online survey examining risk and protective factors for suicidal behaviors, this study explored RFL and RFD within these narratives. After the research team established an initial code book, RFL and RFD codes were subsequently analyzed through inductive and deductive thematic analyses. Results The present study identified five complimentary RFD-RFL themes: (1) Hopelessness-Hopefulness, (2) Stress of Responsibilities-Duty to Responsibilities, (3) Social Disconnection-Social Connection, (4) Death as Sin-Desire for an Afterlife, and (5) Temporary Escapes as Coping-Entrapment (i.e., a lack of escape). Three subthemes within the RFD theme Entrapment were General/Unspecified, By Feelings, and Within Self. Conclusions Identified themes reflect the existing quantitative RFL and RFD literature. The identified RFL and RFD themes are discussed with reference to their clinical applications in advancing suicide-specific assessments and interventions. We propose a dimensional framework for RFD and RFL which informs future suicidal behaviors research and practice.

Adrian, Molly; James, Kiera M.; Gallop, Robert; Chu, Phuonguyen V.; Vander Stoep, Ann; McCauley, Elizabeth

doi: 10.1080/13811118.2024.2403491pmid: 39331043

Abstract Objective Understanding patterns of suicide risk over the course of development can aid our ability to prevent suicide. Our community-based study examined changes in suicide risk status and predictors of changes in risk status in a sample of 521 adolescents over six assessments between the start of middle school and young adulthood (ages 12–22). Methods Suicidal thoughts and behaviors (STB) were measured with the Diagnostic Interview Schedule for Children and the Moods and Feelings Questionnaire. Latent transition analysis (LTA) was utilized to evaluate transitions in suicide risk status over the course of development. Nine risk factors’ initial values and change over time were modeled as predictors in the LTA. Results Latent class analysis identified a four-class model of developmental suicide risk patterns: Class 1: Infrequent STB (73–87% of participants), Class 2: Diminishing STB (1–17% of participants), Class 3: Escalating STB (6–16% of participants), and Class 4: Consistently High STB (1–5% of participants). LTA demonstrated that infrequent STB members and escalating STB members were likely to maintain their risk class across time points. Conclusions Classification of STB trajectories demonstrated self-worth and family involvement were salient variables affecting transitions in risk over time and suggest prevention targets early in adolescence that could have impact on suicide risk in adulthood.

Nyakutsikwa, Blessing; Taylor, Peter James; Hawton, Keith; Poole, Rob; Weerasinghe, Manjula; Dissanayake, Kalpani; Rajapakshe, Sandamali; Hashini, Pramila; Eddleston, Michael; Konradsen, Flemming; Huxley, Peter; Robinson, Catherine; Pearson, Melissa

doi: 10.1080/13811118.2024.2403499pmid: 39301886

Abstract Objective Socioeconomic status deprivation is known to be associated with self-harm in Western countries but there is less information about this association in Low and Middle Income Countries (LMIC). One way of investigating this is to assess the prevalence of indicators of financial stress in people who self-harm. We have assessed the prevalence and correlates of day-to-day financial hardships amongst individual presenting with non-fatal self-harm to hospitals in Sri Lanka. Methods Data on non-fatal self-harm presentations were collected from an ongoing surveillance project in 52 hospitals in Sri Lanka. A questionnaire captured data on two forms of financial stress: unmet need (i.e., costs and bills that cannot be paid) and required support (i.e., steps taken to cover costs, such as selling belongings). Additional data on demographic, economic and clinical characteristics were also collected. Results The sample included 2516 individuals. Both forms of financial stress were very common, with pawning/selling items (47%) and asking family or friends for money (46%) in order to pay bills or cover costs being commonly reported. Greater financial stress was associated with being aged 26-55 years, limited education, and low socioeconomic position. Financial stress was greater in women than men after adjusting for other factors. Conclusion The results indicate that financial stress is commonly reported amongst individuals presenting to hospital with non-fatal self-harm in Sri Lanka, especially women. The research highlights a need to attend to financial stress both within self-harm prevention and aftercare.

Lord, Kayla A.; Tolin, David F.; Diefenbach, Gretchen J.

doi: 10.1080/13811118.2024.2405732pmid: 39302084

Abstract Objective Psychiatric multimorbidity is a well-documented risk factor for suicide. However, diagnostic heterogeneity and patterns of comorbidity likely exists within the population of those who attempt suicide. Person-centered statistical approaches, such as latent class analysis (LCA), extract distinguishable groups differentiated by prevalence and comorbidity of psychiatric disorders. Method The present study used LCA to identify typologies of psychiatric heterogeneity in a sample of 213 inpatients (M age = 33.04 [SD = 12.67]; 57.3% female; 62.4% White; 23.9% Hispanic/Latino) with a history of suicide attempt who were recruited for a suicide prevention clinical trial. Class differences in suicide history characteristics; demographic characteristics; and cognitive-affective and behavioral risk factors, obtained from an initial evaluation involving the administration of a semi-structured diagnostic interview, suicide risk assessment, and battery of self-report measures, were explored. Results LCA identified three classes in the best-fitting solution: Depressive-High Comorbidity (n = 68), Depressive-Low Comorbidity (n = 86), and Bipolar (n = 59). The Depressive-Low Comorbidity class reported less severe suicidal ideation (p < .001), anxiety (p < .001), stress (p < .001), unlovability beliefs (p = .006), and impulsivity (p < .001). The Depressive-Low Comorbidity class also reported fewer actual attempts than the Bipolar class (p = .001) and fewer interrupted attempts than the Depressive-High Comorbidity class (p = .004). Conclusions The Depressive-High Comorbidity and Bipolar classes consistently endorsed higher levels of suicide risk factors. These findings may help to illuminate typologies of suicide attempters with unique clinical needs, which is an essential step toward personalized medicine.

Zhang, Huifang; Zhang, Lvfeng; Zhang, Hongwei; Guo, Hua

doi: 10.1080/13811118.2024.2405733pmid: 39473369

Abstract Objective Poor sleep quality exacerbates suicidal ideation. Depression, anxiety, and stress may play important roles in this relationship. However, the underlying mechanisms remain unknown. Method A total of 2,598 young men were recruited for a cross-sectional study focusing on a range of sociodemographic factors, emotions, sleep quality, and suicidal ideation. Parallel, serial, and moderated mediation models were used to determine whether depression, anxiety, and stress mediated the relationship between poor sleep quality and suicidal ideation. Results Direct and indirect effects of poor sleep quality on suicidal ideation were observed. Depression, anxiety, and stress mediated the relationship between poor sleep quality and suicidal ideation (β Depression = 0.166, 95% confidence interval [CI]: 0.144, 0191; β Anxiety = 0.153, 95% CI: 0.130, 0.177; β Stress = 0.176, 95% CI: 0.154, 0.200). The serial mediation model indicated that depressive and stress symptoms co-play a serial mediating role in the relationship between poor sleep quality and suicidal ideation (β a = 0.049, 95% CI: 0.036, 0.062; βb = 0.099, 95% CI: 0.080, 0.120). The moderated mediation model revealed that the mediating role of stress on the relationship between poor sleep quality and suicidal ideation was moderated by depression (β = 0.173, 95% CI: 0.150, 0.197). Self-reported measures and the study’s cross-sectional design preclude the causal inferences reported. Conclusions The findings of this study prompt clinical and scientific researchers to consider the interplay among affective disorders when investigating etiological and psychological factors that may contribute to suicidal ideation.