No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Help‐Seeking Behavior Prior to Nearly Lethal Suicide Attempts
Abstract
The association between help-seeking and nearly lethal suicide attempts was evaluated using data from a population-based, case-control study of 153 13- to 34-year-old suicide attempt case-patients treated at emergency departments in Houston, Texas, and a random sample of 513 control-subjects. Measures of help-seeking included whether the participant sought help for health/emotional problems in the past month, type of consultant contacted, and whether suicide was discussed during the interaction. Overall, friends/family were consulted most frequently (48%). After controlling for potential confounders, case-patients were less likely than control-subjects to seek help from any consultant (OR = 0.5, 95% CI = 0.3–0.8) or a professional (e.g., physician, counselor) consultant (OR = 0.5, 95% CI = 0.29–0.8). Among those who sought help, case-patients were more likely than to discuss suicide (OR = 2.6, 95% CI = 1.2–5.4), particularly with professionals (OR = 11.8, 95% CI = 3.2–43.2). Our findings suggest that efforts to better understand the role of help-seeking in suicide prevention, including help sought from family and friends, deserves further attention.
... Moreover, relatives often bear the heaviest responsibility for supporting and keeping people safe, because many refrain from seeking medical assistance after a suicide attempt or an episode of self-harm ( Christiansen and Jensen, 2007 ). People tend to consult their families and friends rather than medical and mental health services ( Barnes et al., 2001 ;De Leo and Heller, 2004 ). However, families are considerably strained by this burdensome responsibility and report substantial psychological distress and low levels of wellbeing ( Morgan et al., 2013 ). ...
... The interactionist concept of 'moral career' was adopted to theoretically frame the identified perspectives. A moral career is a continual process through which people construct and negotiate their perspective on life and self through social interactions with others ( Atkinson and Housley, 2003 ). The concept was fruitful, as it enabled a framework for exploring the processes of learning and becoming a relative to someone suicidal. ...
... Relatives are therefore assumed to be involved in similar trajectories of social interactions and thus to develop similar perspectives on self-identity and the outside world. Hence, these perspectives are presumed to follow a pattern of successive stages ( Hughes, 1937 ;Atkinson and Housley, 2003 ). The present synthesis therefore expresses the sequenced stages in relatives' moral career. ...
Background:
An increasing number of qualitative research articles have reported on relatives' experiences of providing care for individuals displaying suicidal behaviour. To contribute more fully to theory and practice, these reported experiences must be synthesized.
Objectives:
To identify original qualitative studies of relatives' experiences of providing care for individuals with non-fatal suicidal behaviour and to systematically review and synthesize this research using a meta-ethnographic approach.
Design:
Systematic review and meta-ethnography.
Data sources:
Literature searches were undertaken in six bibliographic databases (PubMed, CINAHL, Embase, PsycINFO, Web of Science and Scopus) and limited to peer-reviewed original studies. Eligible studies reported relatives' experiences of providing care for individuals with suicidal behaviour, published in English or a Scandinavian language.
Review methods:
One reviewer screened the titles, abstracts and full texts and then collaborated with another reviewer on excluding ineligible studies. A two-step strategy was used while reviewing publications: 1) appraising study quality, and 2) classifying study findings according to degree of data interpretation. This strategy was used for each study by two independent reviewers who subsequently reached a shared decision on inclusion. Noblit and Hare's methodology for translation and synthesis was followed in developing a novel theoretical interpretation of relatives' experiences. The concept of moral career was adopted in producing this synthesis.
Results:
Of 7,334 publications screened, 12 studies were eligible for inclusion. The synthesis conveyed relatives' moral career as comprising four stages, each depicting relatives' different perspectives on life and felt identities. First, relatives negotiated conventional ideas about normalcy and positioned themselves as living abnormal family lives in the stage from normal to abnormal. The first career movement could be mediated by social interactions with professionals in the stage feeling helpful or feeling unhelpful. For some relatives, this negotiated perspective of abnormality got stuck in an impasse. They did not interact with their surroundings in ways that would enable them to renegotiate these fixed views, and this stage was named stuck in abnormality. For other relatives, career movement took place as relatives re-positioned themselves as negotiating an alternative perspective of normalcy in the stage from abnormal to normal.
Conclusions:
Interactions with other people facing similar difficulties enabled relatives to shift perspectives and alleviated experiences of distress.
... Rates of disclosure of suicidal thoughts and behaviour have varied considerably across studies, with as few as 29% of suicide attempt survivors reporting a disclosure prior to their attempt (Barnes et al., 2001), up to as many as 80% of participants with a serious mental illness disclosing their suicidal thoughts or behaviours (Fulginiti et al., 2016). Within community samples, suicidal thoughts and/or behaviour disclosure rates have been reported to be around 50% (Cukrowicz et al., 2014;De Luca et al., 2014;Encrenaz et al., 2012;Husky et al., 2016). ...
... Within community samples, suicidal thoughts and/or behaviour disclosure rates have been reported to be around 50% (Cukrowicz et al., 2014;De Luca et al., 2014;Encrenaz et al., 2012;Husky et al., 2016). The number of confidants that individuals tend to disclose to is one or two (Chu et al., 2011;Encrenaz et al., 2012;Fulginiti et al., 2016), with family and friends the more likely target of disclosure than health professionals (Barnes et al., 2001;De Luca et al., 2014;Encrenaz et al., 2012;Eskin, 2003;Husky et al., 2016). In a study by Encrenaz et al. (2012), 40% to 43% of participants reported disclosing to a friend or family member, compared to 21% to 38% reporting a disclosure to a health professional. ...
... This finding is in line with previous research, which has found community suicide disclosure rates of approximately 50% (Cukrowicz et al., 2014;De Luca et al., 2014;Encrenaz et al., 2012;Husky et al., 2016), and suggests that a significant number of people are still not seeking any help or support for suicidal thoughts. The tendency for community-based participants to disclose more frequently to informal versus formal sources (Barnes et al., 2001;De Luca et al., 2014;Encrenaz et al., 2012;Eskin, 2003;Husky et al., 2016) was also evident in the current study, as was the propensity to disclose to between one and two sources (Chu et al., 2011;Encrenaz et al., 2012;Fulginiti et al., 2016). ...
This study aimed to identify how frequently suicidal individuals disclosed their ideation, assess which sources were perceived to be most helpful and identify correlates of disclosure and source helpfulness. A cross-sectional survey was conducted with 1,616 Australian adults reporting suicidal ideation in the past 12-months. Participants were recruited from social media and reported on their disclosure of suicidal thoughts to formal and informal sources. 39% of participants did not disclose to anyone, while 47% disclosed to an informal source and 42% to a health professional. The responses of psychologists and counsellors were perceived to be the most helpful, while parents and hospital-based health professionals were perceived to be the least helpful. Severity of suicidal thoughts, younger age, and a suicide attempt in the past 12-months were associated with greater likelihood of disclosure, while participants who were younger, linguistically diverse, had greater suicidal ideation or personal stigma were less likely to perceive the response of a GP to be helpful. This study demonstrates that non-disclosure of suicidal thoughts is frequent and that the response received to a disclosure may not always be perceived to be helpful. Further research is needed to identify how best to support individuals who disclose suicide.
... Compounding the issue, students most likely to contemplate suicide are also least likely to report feelings to mental health professionals. 5 In response, colleges may consider programs where the natural helpers on campus, those "who already have close communication with students either through their ongoing job role or by virtue of personal qualities, such as warmth and empathy," 6(p114) are trained to recognize students-at-risk of suicide and respond. ...
... 13 Instead, students-at-risk are more likely to disclose suicidal thoughts to individuals with whom they have a relationship (eg friend, family, supportive faculty). 5 Consequently, campus-wide suicide prevention programs need to equip staff with the ability to identify the suicide risk of students they regularly interact with. 1 Currently, gatekeeper training is commonly used to educate faculty and staff on how to recognize and respond to students-at-risk of suicide. 3,14 However, the original purpose of gatekeeper training was to give community members the ability to provide suicide first aid to persons-at-risk, rather than referring them for services elsewhere. ...
... While there may be resistance to added trainings or the accompanying pressure at providing response by some employees, 13 in many cases those same persons could be the ones that students-at-risk invite to know about their struggles because of the increased likelihood of those students to disclose to people with whom they have existing connections. 1,5 If friendly faculty, secretarial staff, and student assistants are the first line of defense for a suicide safer campus, and if they can furthermore become proficient at providing suicide first aid through experiential suicide intervention training, we echo Dr. Lester's thoughts "Why don't we [colleges and universities] do more?" 4(p372) When we consider how overworked campus mental health facilities are 17,18 and how underserved and at-risk some groups of marginalized students can be (eg LGBTQ, students of color, native American, veterans, etc) 30,31 the need for change is clear. ...
... Compounding the issue, students most likely to contemplate suicide are also least likely to report feelings to mental health professionals. 5 In response, colleges may consider programs where the natural helpers on campus, those "who already have close communication with students either through their ongoing job role or by virtue of personal qualities, such as warmth and empathy," 6(114) are trained to recognize students-at-risk of suicide and respond. ...
... friend, family, supportive faculty). 5 Consequently, campus-wide suicide prevention programs need to equip staff with the ability to identify the suicide risk of students they regularly interact with. 1 Currently, gatekeeper training is commonly used to educate faculty and staff on how to recognize and respond to students-at-risk of suicide. 3,14 However, the original purpose of gatekeeper training was to give community members the ability to provide suicide first aid to persons-at-risk, rather than referring them for services elsewhere. ...
... subscores for suicide intervention program evaluations may enhance our understanding of how any curriculum, be it ASIST 20 , QPR16 , or Campus Connect19 changes the skills of those trained.Of particular note to the college context, this study demonstrated that with ASIST, university employees from varied vocations all developed increased SI-skills and self-efficacy at suicide intervention. While there may be resistance to added trainings or the accompanying pressure at providing response by some employees, 13 in many cases those same persons could be the ones that students-at-risk invite to know about their struggles because of the increased likelihood of those students to disclose to people with whom they have existing connections.1,5 If friendly faculty, secretarial staff, and student assistants are the first line of defense for a suicide safer campus, and if they can furthermore become proficient at providing suicide first aid through experiential suicide intervention training, we echo Dr. Lester's thoughts "Why don't we [colleges and universities] do more?" ...
Objective:
Suicide remains a pressing issue for college communities. Consequently, gatekeeper trainings are often provided for staff. This study examines the effect of one such program, Applied Suicide Intervention Skills Training (ASIST).
Participants:
51 college employees received ASIST in August of 2014 and were compared to 30 wait-list control participants.
Methods:
Repeated Measures ANOVA were used to analyze pre- and post-training: (a) skills at responding to students-at-risk; (b) attitudes toward suicide; (c) knowledge about suicide; and (d) comfort/competence/confidence at helping a student-at-risk.
Results:
Significant positive training effects were observed for ASIST on self-report measures and also for objectively assessed skill at responding, after adjusting for a potential scoring limitation of the Suicide Intervention Response Inventory, Revised (SIRI-2).
Conclusions:
ASIST improved the self-perception of college staff at working with students-at-risk of suicide and also their skills at performing an intervention. Further, analysis of SIRI-2 data provides support for a potential instrument revision.
... In addition, the app provides other valuable resources, including the ability to email the safety plan. It is well documented in the literature that friends and families play a significant role in helping individuals who are seeking assistance when dealing with suicidal thoughts and behaviors [34][35][36][37][38][39]. As suicide-related symptoms worsen and suicidal thoughts and behaviors become more frequent, friends, families, or other trusted individuals can offer emotional support and encourage professional help if necessary [34][35][36][37][38][39]. ...
... It is well documented in the literature that friends and families play a significant role in helping individuals who are seeking assistance when dealing with suicidal thoughts and behaviors [34][35][36][37][38][39]. As suicide-related symptoms worsen and suicidal thoughts and behaviors become more frequent, friends, families, or other trusted individuals can offer emotional support and encourage professional help if necessary [34][35][36][37][38][39]. The Hope app's feature of sending a safety plan is a valuable tool for patients to inform their close social network. ...
Background
Suicide prevention is currently a national health priority in Canada. Emergency departments (EDs) are critical settings for suicide prevention, and in our local psychiatric ED at the Centre for Addiction and Mental Health, we plan to embed an app-based tool called the Hope app to support suicide safety planning intervention. The app is free and available on app stores, and usability tests have been completed. As a next step to embed this new tool into the routine clinical workflow, research is needed to assess determinants of and design strategies for implementation with the end goal of routinization.
Objective
The purpose of this 2-phased research is to implement the app in the routine clinical workflow in our local psychiatric ED. The specific objectives are as follows: (1) understanding ED clinicians’ perceptions and experience of implementing the app in routine practice and identifying barriers to and facilitators of implementation (phase 1) and (2) using findings and outputs from phase 1 and collaborating with service users, families, and ED clinicians to co-design implementation strategies for the app (phase 2).
Methods
We will use an integrated knowledge translation approach throughout this project. In phase 1, we will conduct interviews with ED clinicians to identify implementation determinants using a behavior change framework. In phase 2, a co-design team comprising clinicians, ED service users, and families will design implementation strategies that align with the determinants identified in phase 1.
Results
This protocol presents detailed information about the entire structure of the 2-phased research project. Ethics approval for conducting the qualitative descriptive study (phase 1) has been obtained, and the recruitment and data collection processes will be completed no later than December 2023. Ethics approval for phase 2 is underway.
Conclusions
Involving multiple knowledge user groups early in the research and decision-making process is crucial for successful implementation. Although co-designing is commonly practiced during innovation development, there is often a misconception that the responsibility for implementing what has been designed falls on others. This research aims to fill this methodological gap in the health informatics literature. By the end of this project, we will have developed theory-informed implementation strategies to support Centre for Addiction and Mental Health ED clinicians in adopting the Hope app to complete safety planning intervention. These strategies, guided by a behavior change framework, will target clinicians’ behavior change and seamlessly integrate the app into the routine clinical workflow. In addition, this research project will provide recommendations on how to involve multiple knowledge user groups and offer insights into how the methodology used can be adapted to other areas within the health informatics literature.
International Registered Report Identifier (IRRID)
PRR1-10.2196/50643
... Variability in the measurement of helping resources is a key limitation within this research area. The current study examined a variety of both formal and informal helping resources, whereas other studies examined help-seeking from only formal helping resources (De Leo et al., 2005;Hom et al., 2015) or from limited types of informal resources (e.g., family, friends; Barnes et al., 2001). Service members may have more readily available access to a greater variety of helping resources compared to civilians, including access to behavioral health providers within the MHS, and resources such as chaplains embedded within their unit, which may contribute to greater overall helpseeking rates among this sample. ...
... Despite these limitations, the current study has several strengths. Whereas the majority of existing literature has focused primarily on formal resources (Barnes et al., 2001;Rickwood & Thomas, 2012), the current study examined a variety of formal and informal helping resources, providing a more nuanced understanding of the resources sought by Service members and their perceptions of helpfulness and harmfulness. In addition, this study examined actual help-seeking behaviors rather than help-seeking intentions, which may be influenced by different factors and may not always predict behavior (Nagai, 2015). ...
Introduction:
Promoting help-seeking is a key suicide prevention strategy. Yet, research on help-seeking patterns by high-risk individuals is limited. This study examined help-seeking among United States military Service members admitted for psychiatric inpatient care.
Methods:
Participants were active duty Service members (N = 111) psychiatrically hospitalized for a suicide-related event. Data were collected as part of a larger randomized controlled trial. Reported types and perceived helpfulness of resources sought 30 days before hospitalization were examined. Hierarchical binary logistic regressions were used to examine associations among types of helping resources, mental health treatment stigma, and perceived social support.
Results:
Approximately 90% of participants sought help prior to hospitalization, most frequently from behavioral health providers and friends. Accessed resources were generally considered helpful. Adjusting for covariates, mental health treatment stigma was not associated with seeking help from any resource type. Higher perceived social support was associated with greater likelihood of help-seeking from a friend (OR = 1.08, p = 0.013 [95% CI = 1.02, 1.14]). Marital status, education level, and organizational barriers were associated with specific types of resources, and/or not seeking help.
Conclusion:
Help-seeking is a complex human behavior. Promoting help-seeking among vulnerable subgroups requires further understanding of multiple interconnected factors.
... In addition, a study reported that more than a third of adolescents with suicidal ideation have attempted suicide [5], and a Canadian work-based on a sample of approximately 2000 studentsrevealed that the risk of suicide was 25.5% among those who reported suicidal ideation [6]. However, it often happens that signals of psychological suffering in young people are not recognized; for instance, requests for assistance due to general psycho-physical problems (e.g., psychological interview, psychotherapy, access to a psychiatric unit, eating disorders center, previous hospitalizations, etc.) should not be underestimated because they may be based on a profound malaise that can foster suicidal thoughts and acts [7][8][9][10][11]. ...
... Therefore, it may be useful, for preventive purposes, to pay attention to young people who seek some form of assistance (e.g., psychological interview, psychotherapy, access to a psychiatric unit, eating disorders center, etc.) for general psycho-physical, relational, and/or behavioral problems since such a suffering condition could foster suicidal thoughts [7]. This result is in line with the literature highlighting that people who attempt suicide tend to seek help by confiding in family/friends or contacting mental health services [9], and the request often occurs close to the act [8]. Specifically, a recent study has noted that, in the year before suicide, 25.3% of young people had contacted a mental health service and in 9.7% of cases the reason had been NSSI [10]. ...
Suicide is the second cause of death among adolescents, and nonsuicidal self-injury (NSSI) is one of the main risk factors for suicidal behavior. However, the possible variables specifically associated with suicidal ideation and suicide attempt, as well as the psychopathological characteristics linked to the concomitant presence of suicidal ideation/attempt and NSSI are still under-investigated in youth. The current study aimed to address these issues in a sample of 174 young Italian inpatients (Mage = 14.3 years ± 1.93, 78.2% girls). Sociodemographic and clinical variables were assessed through psycho-diagnostic interviews and ad hoc questionnaires. A binomial logistic regression was performed to identify the predictors of suicidal ideation and suicide attempt. Then, Kruskal–Wallis tests were run to analyze the psychopathological differences between patients with suicidal ideation and suicide attempt considering the coexistence of NSSI. The results highlighted that previous access to child mental health services and general psychopathological problems significantly predicted suicidal ideation, while previous hospitalizations, borderline personality functioning, and affective disorders significantly predicted suicide attempt. In general, inpatients with also NSSI reported higher levels of internalizing, somatic and total problems, impulsiveness, alexithymia, and emotional dysregulation. The clinical implications of our findings in terms of primary and secondary preventive programs are discussed.
... While self-report is an important method to identify suicidal ideation [>60% of people who attempt suicide seek help first (142,143)], subjective markers of suicidality have limitations. People lack conscious awareness of factors that influence their behaviors (144,145), they may have motivation to deny or conceal suicidal thoughts [78% deny these in their last communication prior to death (144,146)], and suicidal thoughts are transient (147). ...
... Evidence exists for machine learning algorithms in the EMR paired with the PHQ-9 question 9 resulting in effective screening for suicide in a college student population (38). Digital phenotyping may also contribute to machine learning and contribute to suicide risk prediction (141,142). ...
Importance
Suicide prevention implementation in primary care is needed due to the increasing rate of suicide in the past few decades, particularly for young and marginalized people. Primary care is the most likely point of contact for suicidal patients in the healthcare system. Attention to the level of medical integration with behavioral health is vital to suicide prevention and is applied throughout this review.
Methods
A narrative review was performed.
Observations
Many interventions help improve suicide prevention care. PCP education, screening, safety planning/lethal means reduction, care transitions, psychotherapy, and medication management are all evidence-based strategies. Additionally, the pragmatic topics of financing suicide prevention, supporting providers, enacting suicide postvention, and preparing for future directions in the field at each level of primary care/behavioral health integration are discussed.
Conclusions and Relevance
The findings are clinically relevant for practices interested in implementing evidence-based suicide prevention strategies by attending to the behavioral health/medical interface. Leveraging the patient/provider relationship to allow for optimal suicide prevention care requires clinics to structure provider time to allow for emotionally present care. Defining clear roles for staff and giving attention to provider well being are also critical factors to supporting primary care-based suicide prevention efforts.
... Led by Beautrais, The Canterbury Suicide Project in New Zealand was one of the pioneer studies in the field of SSAs (13,14). Beautrais (14) examined 125 young (under 25) individuals who made SSAs, and compared them to 151 healthy controls. Also in the framework of this project, Beautrais et al. (61) found that those who executed SSAs had high levels of mental disorders (according to the DSM-III-R diagnoses) and psychiatric comorbidity at the time of the SA. ...
... Several studies emphasized that in instances in which mental pain is combined with an inability to communicate stress, painful feelings remain unaddressed, thereby resulting in more serious forms of suicidal behavior with higher severity levels of the suicide intent's objective components (18,37,38). Put differently, combined with mental pain, interpersonal, and communication difficulties expressed by loneliness, schizoid traits, alexithymia, lack of social support (18), insecure attachment style (39), low-actual social interaction (14), limited help-seeking behaviors (25), and inability to disclose emotions and thoughts (19) interact to facilitate SSAs (18). ...
Background
One of the main obstacles in studying suicide risk factors is the difference between cases in which the individual died by suicide and those in which the individual engaged in suicidal behavior. A promising strategy that overcomes this obstacle is the study of survivors of serious suicide attempt (SSA), i.e., an attempt that would have been lethal had it not been for the provision of rapid and effective emergency treatment. Serious suicide attempters are epidemiologically very much like those who died by suicide, and thus may serve as valid proxies for studying suicides. This paper aims to define the specific risk factors for SSAs by conducting a qualitative data synthesis of existing studies.
Methods
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic search of the literature in PubMed, ProQuest, and Psychlit electronic research-literature databases. Search terms were “serious” “OR” “near lethal,” combined with the Boolean “AND” operator with “suicide*.” In addition, we performed a manual search on Google Scholar for further studies not yet identified.
Results
The preliminary search identified 683 citations. A total of 39 research reports that met the predefined criteria were analyzed. Mental pain, communication difficulties, decision-making impulsivity, and aggression, as well as several demographic variables, were found to be major risk factors for SSAs.
Limitations
We found a variability of definitions for SSA that hamper the ability to draw a model for the risk factors and processes that facilitate it. Moreover, the role of suicide intent and planning in SSA is still unclear. Further studies should aim to clarify and refine the concepts and measures of SSA, thereby enabling more specific and concrete modeling of the psychological element in its formation.
Conclusion
SSA is a distinguishable phenomenon that needs to be addressed specifically within the scope of suicidal behavior. Interpersonal problems, as well as impulsivity and aggression, seem to facilitate SSA when mental pain serves as a secondary factor. Healthcare professionals should be aware of SSA, and familiar with its specific risk factors. Moreover, psychological and suicidal risk assessment should include a designated evaluation of these risk factors as part of intervention and prevention models for SSA.
... [3] Prior to a medically serious suicide attempt, most individuals sought help from the family and friends as compared to healthcare providers. [4] Similarly, a systematic review showed that young people sought help from informal networks during times of suicidality. [5] Young adults preferred to handle suicidal thoughts by themselves. ...
Background
Persistent suicidal ideation, self-harm behaviors, and suicide attempts constitute suicidality and are consistent predictors for future suicides. Research on what protects individuals from harming themselves is equivocal. While factors like impulsivity could increase risk of suicide, research is needed on what stops people from acting out on self-harm thoughts/suicidal ideation.
Aim
To explore the help-seeking behaviors and other protective factors during periods of suicidality in individuals at risk of suicide.
Method
This study aimed to explore help-seeking behavior and other protective factors that prevent or delay self-harm and suicide attempts during suicidality in individuals at risk. We used a qualitative study design and interviewed 15 participants comprising at-risk individuals, caregivers, and mental health professionals (MHPs). We used thematic analysis for deriving themes.
Results
Themes in ‘at-risk individuals’ include mental state during suicidality, handling of oneself during suicidality, and seeking help from support systems. Themes from caregivers included handling of crises and the role of informal and formal support systems. Themes from MHPs included phenomenology of suicidality, handling of suicidality, help-seeking, and support systems.
Conclusion
At-risk individuals handle suicidality by either managing themselves on their own or seeking help from informal sources and formal health systems. Caregivers appear to be crucial stakeholders in help-seeking during self-harm. The involvement of caregivers – in discussion with the at-risk individual – should be a necessary component of suicide risk management. Suicide prevention policies at institutional, regional, and national levels should include strategies to prevent burnout and other occupational health issues in MHPs.
... At the interpersonal level, friends and/or family played a crucial role in facilitating help seeking by offering emotional support and encouragement to seek help (Adler et al. 2020;Chia-Yi et al. 2012;Hagen, Loa Knizek, and Hjelmeland 2020;Hausmann-Stabile, Gulbas, and Zayas 2018;Holt et al. 2023;McKay and Shand 2018). Sometimes, this social support was critical when individuals chose not to, or did not feel able to seek help themselves (Barnes 2002;Heinsch et al. 2020;Rheinberger et al. 2021). In the case of professionals in the army, some stated support from command was instrumental to accessing support; however, some also recognised feeling that they were then treated differently following disclosure (Adler et al. 2020). ...
Introduction
Prior mental healthcare utilisation presents an important window of opportunity for providing suicide prevention interventions. To date, no reviews have consolidated the help‐seeking needs of individuals in contact with mental health services. This warrants further attention given this group may have different needs for interventions compared with the general population who have not sought help previously.
Aim
The purpose of this rapid scoping review was to summarise the available literature on help‐seeking needs related to suicide prevention among individuals in contact with mental health services from healthcare settings.
Method
Cochrane rapid review and Joanna Briggs Institute scoping review methodologies were adapted, and databases, including MEDLINE, Scopus, CINAHL, PsycInfo and EMBASE, were searched.
Results
A total of 42 primary studies were included in analysis. Reported barriers and facilitators to help‐seeking behaviours identified within studies were mapped onto the socio‐ecological model. Barriers and facilitators identified included knowledge and attitudes towards healthcare utilisation, family and peer support, interactions with healthcare professionals, provision of holistic care, and the creation of a supportive atmosphere and safe space to promote open discussions of suicide‐related concerns.
Discussion
The findings of this review offer valuable insights into areas for improvement in addressing help‐seeking needs for individuals who are in contact with health services related to suicide prevention.
Implication for Research
The findings serve as a foundation for shaping mental health initiatives informing approaches and care delivery tailored towards individuals who are in contact with health services. The reported barriers and facilitators offer insights to inform the development of mental health support tools to enhance care and considerations for evaluations.
... Potter, et al. (2001), comparing the nearly healthy attempters with healthy controls, found that the attempters had more often moved residence in the prior 12 months, along with aspects of the move (e.g., distance, and difficulty staying in touch). Again, using the attempers and healthy controls, Barnes, et al. (2001) asked whether they sought help for health or emotional problems. The two groups did not differ much, except that the attempted suicides had sought help more from psychiatrists and had brought up suicidality much more often. ...
Why are we failing to prevent suicide? David Lester 2-3
How should Durkheim’s theory of suicide be modified?
David Lester 4-53
A review of research on suicide in 2000: David Lester 54-109
A review of research using Lester’s Helplessness, Hopelessness
Haplessness (HHH) Scale: David Lester 110-116
Guilt and suicide: a study of suicide notes: David Lester 117-122
Suicide notes from China: Zhao-Xiong He 123-141
A review of research on suicide in 2001: David Lester 142-205
Elderly suicide and the religion of their country: David Lester 206-208
Suicide as a political act: David Lester & Mahboubeh Dadfar 209-211
Suicide and the Menstrual cycle: David Lester 212-221
... Rates for suicidal disclosure prior to suicide attempts vary between 30% and 60% with a recent metaanalysis, suggesting approximately half of those who die by suicide disclosed their thoughts or intent. [1][2][3][4][5] Factors influencing disclosure include stigma-related concerns, fear of judgment, prior mental health treatment, demographic factors, and relational-level factors such as trust and confidentiality. 2,[6][7][8][9][10][11][12][13] It is important to acknowledge that the conceptualization of "failure to disclose" holds significance only in the presence of information that warrants disclosure. ...
Introduction
More than half of those who die by suicide do not communicate about suicide prior to their death. This project describes the emotional state and decision-making among “unplanned” attempt survivors to inform a conceptual model and suicide prevention interventions.
Methods
This qualitative study purposefully sampled patients who reported having no suicidal thoughts on a standardized mental health questionnaire within 60 days (about 2 months) prior to a nonfatal suicide attempt documented in the health record. Participants verbally consented to telephone interview participation. Semistructured audio-recorded interviews elicited suicide attempt survivor descriptions of their emotional state and experiences in the days, hours, and minutes leading up to their suicide attempt. Interviews were transcribed and analyzed using grounded theory. The biopsychosocial theory of emotion regulation informed conceptual model development.
Results
Participants (N = 26) described 2 distinct “phases” prior to the attempt. First, a phase of increasing life stressors, transitory and nonspecific suicidal thoughts, and a reluctance to disclose experiences. Second, an overwhelming emotional state led to a sudden suicide attempt and nondisclosure due to the rapidity and intensity of the experience. These results informed the conceptual model and intervention development to manage unplanned and overwhelming urges to attempt suicide.
Discussion
Qualitative analysis informed the development of an intervention for the high-intensity “hot” period preceding an attempt, including specific steps to manage a highly intense emotional state in combination with overwhelming urges to kill oneself.
Conclusion
Future research is needed to evaluate whether and how this intervention helps support people with a chance of “unplanned” suicide attempts.
... The referral source plays a crucial role in determining the outcomes of individuals in a suicidal crisis, highlighting its contextual significance. Some individuals self-refer to 911 or confide their suicidal intent to friends and family (Barnes Seymour et al., 2001), who may call 911 on their behalf. In some cases, unknown bystanders may call. ...
Background The outcomes of calling 911 for suicide crises remain largely unexplored. Aims To investigate how characteristics of individuals in a suicidal crisis (e.g., age, gender identity, help-seeking source, means, disclosure of historical suicidality, or self-harm) may differentiate outcomes when contacting 911. Method The authors analyzed 1,073 Washington State Police 911 call logs, coding for characteristics and outcome (unknown, monitoring, intervention, adverse outcome). Descriptive and inferential statistics, including multinomial logistic regressions, were used to explore associations. Results When individuals experiencing a suicidal crisis were referred by bystander or associates’ observations, there was a greater likelihood of adverse outcome. Self-referral led to a greater likelihood of intervention. Referral from the suicidal individual contacting a known associate led to a greater likelihood of monitoring. Any disclosure of means led to a greater likelihood of intervention or adverse outcomes. Positive disclosure of historical suicidality or self-harm was more likely to result in monitoring. Limitations The dataset was intended for operational use in acute suicidality triage rather than research purposes. Conclusion This study highlights the importance of supporting first responders with research to enhance their triage of people experiencing suicidal crises.
... Suicidal ideation and suicidal attempts were the primary risk for ended individual's life (Jans, et al., 2018: Health, 2017: Suicide, 2017: WHO, 2015. Evidence showed that 50 to 75% of suicidal ideation and suicidal attempts were reported to primary health care prior to individual's attempts (Law, et al., 2010: Barnes andKresnow 2001, Pagura, et al., 2009). The global lifetime prevalence of suicidal ideation in the general population was ranged from 3.1 to 56% (Nock, et al., 2008). ...
Suicide is a sombre public health predicament amongst youths globally which often results from psychological, social, emotional and economic factors. This study investigated life satisfaction and social maladjustment as predictors of suicidal ideation among undergraduate students, with one hundred (100) undergraduate students with the age range of 17-45 years, mean of 22.02, a standard deviation of 3.38 selected as participants' from four faculties of Enugu State University of Science and Technology (ESUT) which include; twenty-eight (28) from Applied Nature Sciences, twelve (12) from Law, thirty-two (32) from Management Sciences and twenty-eight (28) from Social Sciences and Humanities, using multiple-stage sampling techniques. Neugarten, Havinghurst and Tobin (1961), Life Satisfaction Index Wiggins (1966), social maladjustment scale Beck, Steer and Ranieri (1988), Beck Scale for Suicide Ideation were used for data collection; this is cross sectional research design and multiple hierarchy regression was adopted for data analysis. Findings of this study revealed that social maladjustment did not predict suicidal ideation among undergraduate; sig. = .145, at p<.05 life satisfaction also did not predict suicidal ideation among undergraduate; sig. = .527, at p<.05, social maladjustment and life satisfaction did not jointly predict suicidal ideation among undergraduate; sig. f-change =.284 at p<.05. The result was in congruity with cognitive behavioural theory which postulated that the way people acquire and interpret information impact on their choices and behaviours matters. Therefore, students are encouraged to remain always ositive in their thinking to avert suicidal ideation irrespective of the circumstances around them.
... Individuals living alone with no close relatives have a significantly higher suicide rate [6]. Additionally, family members can be an essential resource in identifying risk factors and searching for help [31]. Some studies have indicated that most suicide victims have a low educational level (less than 8 years of school) [23,32,33]. ...
The suicide phenomenon involves complex interactions between psychological, biological, cultural and socio-environmental factors. This study aimed to assess the epidemiological and toxicological profiles of officially confirmed suicide victims. A retrospective study was performed using autopsy reports, forensic anthropology examinations and police summaries of all suicide cases that underwent toxicological analysis at an Official Forensic Laboratory (Minas Gerais, Brazil) in 1 year. The sample set was composed of 351 suicide victims, predominantly men (70.32%), most of them were adults between 31 and 64 years old (62.11%), with mixed skin colour (48.89%) and low educational level (66.44%). The most common suicide method was hanging (57.79%), followed by intoxication (30.45%). Most victims presented positive toxicological results (56.41%), especially for the presence of medicines (37.6%), illicit drugs (36.3%) and pesticides (26.1%). Our study corroborated previous data that most suicide victims have low educational levels. The most common toxicological findings were medicines, especially prescription drugs, followed by illicit drugs and pesticides. We hope this study contributes to reflections and planning of preventive suicide programmes, considering the described profiles of victims.
... Negarse a recibir ayuda profesional es un fenómeno comúnmente asociado al comportamiento suicida (Barnes et al., 2002;Rudd et al., 1995). Esta negación puede estar basada en la percepción de barreras para el acceso a servicios profesionales de salud. ...
Los adolescentes tienen un alto riesgo de mortalidad por suicidio, pero su uso de servicios profesionales de salud mental es muy bajo. El objetivo fue indagar las barreras que perciben para solicitar ayuda profesional. Para esto se realizó un estudio observacional de enfoque mixto en el que se evaluó el riesgo suicida mediante la escala Plutchik. Las barreras percibidas se indagaron con una pregunta abierta que se sometió a un análisis temático de codificación abierta. Participaron 403 estudiantes de bachillerato de Aguascalientes cuyo riesgo suicida fue de 19%. Se reconocieron 14 diferentes barreras de las que predominaron las de tipo interno: miedo y vergüenza. A mayor riesgo suicida cobraron más importancia las barreras externas como problemas familiares o las burlas. Al contrastar este con otros estudios queda de manifiesto que la perspectiva cualitativa abona una mejor comprensión de fenómenos subjetivos que subyacen a la prevención del suicidio.
... This line of research shows that only around half of adults with suicide ideation and attempt histories choose to share their suicide ideation with others; those who share are substantially more likely to disclose to informal supports (e.g., friends and family) compared to formal supports (e.g., medical and mental health care professionals), and that they are more likely to share with family compared to friends. This is the case for adults across general (Encrenaz et al., 2012;Mérelle et al., 2018), psychiatric (e.g., Barnes et al., 2002), and mental health treatment seeking (Drum et al., 2009;Hom et al., 2017) samples. Moreover, there is some evidence that adults are more likely to disclose more 'severe' than less 'severe' SITBs, with the greatest likelihood of disclosure of suicide attempts, followed by suicide plans, and suicidal ideation; this pattern was demonstrated across all categories of supports (e.g., close friends or family, health professionals, association or helplines, other; Encrenaz et al., 2012). ...
Disclosure of self-injurious thoughts and behaviors (SITBs) is critical to current treatment and prevention programs. Limited research has examined patterns of and barriers to SITB disclosure in adolescents. This work is critical given the limits of confidentiality in this population. Over 1,000 adolescents aged 13-17 with a history of mental health treatment and SITBs were recruited online. Participants reported their history with disclosing SITBs across a range of relationships, honesty in and barriers to disclosure to health care providers, and their experiences with breaches of confidentiality to parents/guardians. We examined relationships among these experiences and a range of outcomes, including perceived likelihood of future disclosure. Participants reported most frequent disclosure of all SITBs to friends, and more frequent disclosure of nonsuicidal self-injury compared to suicide ideation or attempts. Adolescents were most likely to disclose SITBs when directly asked by health care providers, though many participants reported continued SITB concealment. The most commonly endorsed barrier to disclosure was fear that the provider would tell a parent/guardian. Experiences with confidentiality breaches involving a non-collaborative breach were negatively associated with future disclosure, mental health symptoms, and adolescent-parent relationships. SITB disclosure is a cornerstone to their treatment and prevention. Better understanding of to whom and when, barriers, and the impact of disclosure experiences is critical. Our research suggests that most adolescents do not want their parents to know about their SITBs, and that fear of parent involvement prevents disclosure. Results have several implications for SITB assessment across physical and mental healthcare settings.
... Another study found that individuals displaying low levels of social interaction were more than eight times more likely to carry out SSAs compared with controls (Beautrais, 2003). Moreover, subjects who performed SSAs were less likely than controls to seek help from any consultant, including psychologists and physicians, during the preceding month (Barnes et al., 2001). compared SSA survivors with lesslethal suicide attempters, psychiatric controls, and healthy controls, finding that overall, both attempter groups were characterized by higher levels of most of the schizoid personality disorder features. ...
The study of survivors of a serious suicide attempt (SSA)-an attempt that would have been fatal had it not been for the provision of rapid and effective emergency treatment can help researchers understand the suicidal mind. Serious suicide attemp-ters are epidemiologically very similar to those who died by suicide, and thus can serve as valid proxies for studying suicides. In this paper, our objective was to briefly review the main risk factors that may facilitate more dangerous suicide behavior with high levels of intent. Our review highlights several dimensions of risk factors for SSAs, including psychopathology, mental pain, communication difficulties, decision-making impulsivity, and aggression. Several studies have indicated that the interaction between some of these dimensions, especially between mental pain and interper-sonal difficulties, may serve as major catalysts for SSAs. Suicidal risk assessment should incorporate a designated evaluation of these risk factors as part of suicide prevention models.
... As the period between thinking about suicide and acting on these thoughts may be relatively short (Deisenhammer et al., 2009;Kattimani et al., 2016), the role of another close person may be vital. Though suicidal people are likely to avoid seeking help from others for various reasons (Dada sev et al., 2016), they seek help from informal sources of support more often than from formal ones (Barnes et al., 2001). ...
The aim of the current study is to analyze how relatives understand in retrospect the suicide risk of their next of kin who died by suicide. We interviewed 103 adult relatives who lost their significant others to suicide, using qualitative content analysis to explore the data. Participants expressed difficulties understanding suicide risk by identifying personal traits incompatible with suicide, reasons to doubt the risk, life oriented actions, the situation seemed better than it was, or that the loved one denied suicide risk; only a few recognized suicide risk. Prevalent myths about suicide and denial are possible explanations for these findings.
... By disclosing suicidal thoughts or behavior, individuals may experience relief in distress (Gould et al., 2005) and increase the likelihood that their suicide risk will be accurately assessed and treated (Fulginiti et al., 2016). Rates of disclosure of suicidal ideation vary across studies, ranging from as few as 29% of individuals reporting disclosure prior to a nearly lethal suicide attempt prior to being treated at an emergency center (Barnes, Ikeda, & Kresnow, 2001) to as many as 80% of individuals disclosing suicidal thoughts at a community-based treatment center for those with serious mental illness (Fulginiti et al., 2016). Qualitative studies suggest that individuals may be hesitant to disclose suicidal ideation due to fear of hospitalization, shame, and embarrassment (Blanchard & Farber, 2020). ...
Objective
The current study examined suicide-related disclosure intentions in LGBTQ + youth, and the associations between reporting of lifetime experiences of minority stress and intentions to disclose suicidal thoughts.
Method
A sample of 592 LGBTQ + youth ages 12–24 (22.3% cisgender men, 33.1% cisgender women, 44.6% gender diverse, 75.3% white) who contacted an LGBTQ-specific crisis service, completed a survey.
Results
Youth reported highest intentions to disclose future suicidal ideation to LGBTQ-specific crisis services, a mental health professional, and someone they know who also identifies as LGBTQ. They reported lowest suicide-related disclosure intentions to family, spiritual counselors, and emergency room personnel. Greater lifetime minority stress was significantly associated with lower suicide-related disclosure intentions. When specific domains of minority stress were examined separately, five domains were significantly associated with lower suicide-related disclosure intentions: identity management, family rejection, homonegative communication, negative expectancies, and internalized homonegativity. However, only internalized homonegativity remained significant when they were examined simultaneously. In addition, greater lifetime minority stress was significantly associated with lower suicide-related disclosure intentions to some groups (e.g., family, friends), but not others (e.g., others who have thought about or attempted suicide, others who identify as LGBT).
Conclusions
Minority stress may play an important role in LGBTQ + youth’s suicide-related disclosure intentions. As such, reducing minority stress and its effects may be an important target to promote disclosure of suicidal thoughts and access to treatment among LGBTQ + youth.
... Moreover, work has emerged to support the intuitive notion that a decision to disclose is made on a relationship-by-relationship basis (e.g., Fulginiti, Pahwa, et al., 2016). Studies have repeatedly shown that disclosure varies based on the type of relationship shared with or social position occupied by a potential confidant (e.g., family, friend, healthcare provider; Barnes et al., 2002;Encrenaz et al., 2012;Frey et al., 2016). The most robust finding about relationships can be found among young people-friends, who are usually same-aged peers, are the most common recipients of suicide-related disclosures (Dunham, 2004;Kalafat, Elias, & Gara, 1993;Michelmore & Hindley, 2012;Pisani et al., 2012). ...
Disclosure of one’s suicidal thoughts is a pivotal but under-investigated mechanism for preventing suicide among young adults experiencing homelessness (YAEH). In a sample of 527 YAEH, we adopted a multi-level perspective to assess patterns and correlates of disclosure in their friendship networks. Less than one-third of YAEH disclosed their suicidal thoughts—half of them doing so during a suicidal crisis—and only disclosed to 21% of their friends. Multilevel modeling showed that YAEH who reported a history of unmet mental health needs were more likely to have disclosed to a friend, and friends who were sources of social support were most highly sought out for disclosures. Our findings highlight the need for cultivating safe environments that promote disclosures among YAEH.
... This model could also be an effective first point of contact to identify youth at risk for depression and suicide. Teenagers who self-harm are often reluctant to reach out for help (Barnes, Ikeda, & Kresnow, 2001), and if they do, they are more likely to disclose concerns about depression and self-harm to friends, rather than parents or healthcare providers (De Leo & Heller, 2004;Fortune et al., 2008). A noteworthy number of teens who contacted the hotline self-disclosed their suicidality but did not indicate whether they had shared suicidal thoughts and plans with professional healthcare providers. ...
Background
Peer‐supported youth hotlines have been in operation for many years but studies on the acceptance of this hotline model or on the demographics of the callers are lacking. This study was performed to examine the utilization of a metropolitan peer‐supported youth hotline between 2010 and 2016.
Method
The change in demographics, contact channels, and the reasons for contact were analyzed with standard linear regression analysis in 67,478 contacts over 7 years.
Results
The data revealed a significant increase in hotline utilization from 8008 annual contacts in 2010 to 12,409 contacts in 2016 (p = .03). The majority of contacts were made by 15‐year‐old and 16‐year‐old girls, but contacts by children aged 13 years old and younger have also increased significantly over the years (p = .003). In 2016, anxiety and stress were among the leading reasons for contact (20.14%), followed by sadness and depression (17.21%), suicidal ideation (14.18%), and self‐harm (8.15%). Recommendations for follow‐up with outside mental health resources were made in 56.22% of contacts. More than 60% of contacts had found information about the hotline on the Internet. More than 30% used text messaging to reach out to the hotline.
Conclusions
Our data indicate that adolescents increasingly utilize a peer‐supported youth hotline to get help for mental health concerns. Therefore, it should be explored whether this hotline model could also be used for prevention and early intervention.
Key Practitioner Message
Peer‐supported youth hotlines are well accepted and frequently utilized by adolescents to get help for mental health issues.
Our data indicate that peer‐supported youth hotlines could be utilized to identify youth at risk for depression and suicide.
Further research should evaluate whether peer‐supported youth hotlines could serve in the prevention and in early mental health intervention, and how they could be effectively linked to other mental health resources in the community.
... Suicide and suicidal behavior can cause significant premature mortality and have attracted public health concerns because serious impacts and prolonged grief would affect the life of families and friends of the deceased. 1 Approximately one million people died from suicide every year; and 10---20 times more attempted suicide. 2 With previous suicide attempts or acts of self-harm (with or without the intention to die) being major predictors of suicide completion, 3,4 particular attention have been paid to behaviors of 'deliberate self-harm' (DSH). The term DSH was used to refer to people who inflicted harmful acts upon themselves in any form, such as self-poisoning (SP) or self-injury. ...
Background
We investigated health service use patterns before the first self-poisoning (SP) episodes by age groups and genders using a population-based datasets.
Methods
We identified 3465 people with a verified discharge diagnosis of SP from 1997 to 2006. Physical disorders, psychiatric diagnoses, psychotropic prescriptions and health service use one year and one month before the episodes were compared by age groups and genders.
Results
Women younger than 65 years old were found to seek non-psychiatric outpatient services more in the month prior to SP episode (female 61.7% vs. male 50.5%, p < 0.001), while their male counterparts contacted the emergency care more in the previous month (male 9.9% vs. female 6.7%, p = 0.002) and a year before the episode for the ones older than 65 (male 39.8% vs. female 29.3%, p = 0.006). Females younger than 65 years old were prescribed more antipsychotics, antidepressants, and anxiolytics, with nearly half of them receiving anxiolytics in a year prior to their first self-poisoning episodes.
Conclusions
The current analysis suggested age and gender disparities on health service utilizations and prescriptions of psychotropic agents among patients with first self-poison behaviors. Studies about this gender disparity to generate intervention strategies for the prevention of self-poisoning at early stages are warranted.
... Importantly, the majority of those who die by suicide visit their healthcare provider in the weeks prior to death [5], and most youth confide in a trusted adult before a suicide attempt [6]. These data suggest a missed detection of suicide risk by providers and highlight a crucial opportunity for intervention. ...
Purpose:
Youth suicide is a public health emergency, and its prevention is a national imperative. Pediatric providers are critical to risk assessment, triage, and intervention, yet little is known about the content, quality, and perceived adequacy of suicide prevention pediatric residency training. We thus sought to (1) characterize suicide risk assessment and management training practices in pediatric residency programs nationwide and (2) assess areas of training need to guide curricular development.
Methods:
An online nationwide needs assessment was distributed to all 204 pediatric residency program directors (PDs) and 494 pediatric chief residents (CRs) through the Association of Pediatric Program Directors listservs (May to June 2017). Descriptive statistics and comparisons between PDs and CRs are reported.
Results:
Ninety-five PDs and 210 CRs (47% and 43% response rate, respectively) completed the survey. Although 82% of respondents rated suicide prevention training in residency as "very" or "extremely" important, a minority (18% PDs and 10% CRs) reported adequate preparation relative to need. Formal training was not universal (66% PDs and 45% CRs) and practices varied across programs (PD median = 3 hours [interquartile range: 1-4.5 hours], CR median = 1.5 hours [interquartile range: 0-3 hours]). Top-ranked educational priorities included interviewing adolescents about risk, risk factor identification, and locating community resources. Training barriers included limited time, lack of training resources, and need for additional expert faculty to guide training.
Conclusions:
PDs and CRs reported constraints to suicide prevention training for pediatric residents despite high perceived importance and need. Programs may benefit from explicit guidelines and standardized curricula that emphasize educational priorities, building on these findings.
... The professional carer, patient, and family each bring their own expertise, and decide together how the problem will be tackled [10]. In addition, the chances of success of the treatment are found to increase when family are involved [11][12][13]. Family members know things about the patient that may be important for treatment and risk assessment, and often act as the first safety net for the patient [7,[14][15][16]. In addition, family may provide informal care and can take on the role of case manager [7]. ...
Involving patients and families in mental healthcare is becoming more commonplace, but little is known about how they are involved in the aftermath of serious adverse events related to quality of care (sentinel events, including suicides). This study explores the role patients and families have in formal processes after sentinel events in Dutch mental healthcare. We analyzed the existing policies of 15 healthcare organizations and spoke with 35 stakeholders including patients, families, their counselors, the national regulator, and professionals. Respondents argue that involving patients and families is valuable to help deal with the event emotionally, provide additional information, and prevent escalation. Results indicate that involving patients and families is only described in sentinel event policies to a limited extent. In practice, involvement consists mostly of providing aftercare and sharing information about the event by providers. Complexities such as privacy concerns and involuntary admissions are said to hinder involvement. Respondents also emphasize that involvement should not be obligatory and stress the need for patients and families to be involved throughout the process of treatment. There is no one-size-fits-all strategy for involving patients and families after sentinel events. The first step seems to be early involvement during treatment process itself.
... 。ま た， 救急外来に運び込まれた自殺未遂者 (n = 153)と 無 作 為 抽 出 さ れ た 対 照 群( n = 513)を比較した Barnes, Ikeda, and Kresnow( 2001) (Gilat & Shahar, 2007;Latzer & Gilat, 2000;Reese, Conley, & Brossart, 2002 参照) (Alao, Yolles, & Armenta, 1999;Becker et al., 20 04;Prior, 2004;Thompson, 1999Thompson, , 2001 )， 仲間意識や集団の同調圧力が自殺の閾値を下げる (Schmidtke, Schaller, & Kruse, 2003;Lee, Chan, & Yip, 2005;Rajagopal, 2004 ) ( Miller & Gergen, 1998 ) (Richard, Werth, & Rogers, 2000) Kiesler, Siegal, and McGuire( 1984)の社会的手がかり減少(reduced social cues) (Short, Williams, & Christie , 1976 ...
The purpose of this study was to discuss the possibilities of using the internet as a new means to help people who are at a high risk of suicide. First, the help-seeking features of the media were discussed, and a comparison was drawn between the internet and a telephone hotline. As a result, it was shown that the asynchronous communication shared by group members was the unique characteristic of the internet. Second, we studied the relationship between suicide and the internet in Japan. This involved reviewing the results of previous studies on the effects of so-called suicide websites. It was found that suicide websites functioned as a space for self-help activities for people harboring suicidal thoughts. These results revealed that suicide prevention via the internet was not dangerous and could be an effective method of communication. However, further research was required on the divergence between self-help activities and internet suicide pacts—from the perspective of the interaction between the technical characteristics of computer-mediated communication and those of users—in order to provide safe suicide-prevention services on the internet.
... In turn, help seeking can save lives. One study found that civilians at risk of depression or suicide are less likely to attempt suicide if they had sought help from clinicians or other professional caregivers (Barnes, Ikeda, and Kresnow, 2001). ART therefore aims for airmen to integrate stress management and help-seeking behavior into everyday practices so that they are natural and reflexive. ...
... Despite these limitations, several findings of this study are noteworthy. Findings from this study support research indicating high levels of mental health disorders among college students (King et al., 2008) as well as low utilization of hotline services (Gould et al., 2006;Seymour Barnes, Ikeda, & Kresnow, 2001). This study found that nearly half of the participants had seen the NSPL advert; those who reported past exposure to the NSPL advert reported higher levels of perceived helpfulness of the NSPL. ...
Background: Suicide is a leading cause of death among college students. Crisis hotlines play a role in linking suicidal individuals to help. Despite leading to favorable outcomes, low utilization of crisis outlines has been reported. Aims: To explore exposure, knowledge, and utilization of the National Suicide Prevention Lifeline (NSPL) among a sample of university students; to determine if knowledge and perceived helpfulness of NSPL predict intent to use NSPL. Method: The researcher surveyed 560 students attending a Midwestern university to assess knowledge of, and attitudes toward, the NSPL. Results: Those who reported seeing the NSPL advert (50%) perceived the NSPL to be more helpful than those who had not seen the advert. Only 29% (n = 160) were able to identify who would answer the NSPL (a trained, skilled counselor). Only 1% (n = 4) reported utilization. Participants who reported past exposure to the NSPL advert reported higher levels of perceived helpfulness of the NSPL. Perceived helpfulness of the NSPL was a weak predictor of likelihood to use the NSPL. Limitations: The study limitations include its small sample size; participants' likelihood to use the NSPL was assessed using independent symptoms. Conclusion: Further research is needed to identify college students' underlying attitudes toward the NSPL.
... Although around half of those who die by suicide communicate with friends and family about their intention to die, few seek any sort of professional help (Barnes et al., 2001; Hong Kong Centre for Suicide Research and Prevention, 2005). For this reason, innovative approaches to identifying those at risk of suicide and bringing them to the attention of professionals who can help them may be valuable in saving lives. ...
Suicide is a global public health problem, with over 800 000 people worldwide dying by suicide in 2012, according to the World Health Organization (WHO). The WHO South-East Asia Region is especially affected, with 39% of global suicides occurring in the 11 countries in this region. Women are a particularly vulnerable population, for a variety of social and cultural reasons. In India specifically, deaths by suicide for women peak in the age range 15-29 years. There is sufficient evidence to show that reduction of easy access to means of suicide is an effective prevention strategy. A common method of suicide in the region is by ingestion of pesticides. Strategies that have targeted limiting access to pesticides as a means of preventing suicide, such as the use of central storage and locked boxes, have shown promising results. Given the limited human and economic resources in these countries, it is essential to involve all stakeholders, including health services, voluntary and community organizations, teachers, social workers, traditional healers and other gatekeepers, in suicide prevention. A multisectoral approach, specifically targeting women and reducing easy access to pesticides, should be the way forward to reducing suicides in this region. In addition, more research is needed, to identify cost-effective and sustainable strategies.
... Research has indicated that college students experiencing emotional distress or suicidality are most likely to turn to a peer (Drum, Brownson, Burton Denmark, & Smith, 2009). Yet, peers too often do not suggest professional help (Evans, Hawton, & Rodham, 2005), offer sufficient support (Barnes, Ikeda, & Kresnow, 2001), provide helpful consultation (Drum et al., 2009), or even know about their college's mental health resources (Westefeld et al., 2005). Thus, college support staff may be unaware of many students in distress when the first report is made to a peer. ...
The purpose of this phenomenological study was to understand the essence of counselors’ perceived preparedness working with suicidal clients and to provide suicide prevention and assessment recommendations for the counseling profession. We identified a structural-textural description that highlights the perceived amount, quality, and components of training preparedness, as well as suicide assessment and intervention knowledge. This phenomenological investigation included 10 professional counselors who described the degree to which they felt prepared to work with suicidal clients and their perceptions of the suicide prevention and assessment training they have completed during their training program and in their agency work setting. Counselors did not generally feel that their training had been adequate and subsequently sought more through personal learning or on-the-job training. Counselors should seek out evidence-based trainings that best meet the needs of their clients.
Background:
The prevalence of mental health problems is high, and they have a wide-ranging and deleterious effect on many sectors in society. As well as the impact on individuals and families, mental health problems in the workplace negatively affect productivity. One of the factors that may exacerbate the impact of mental health problems is a lack of 'mental health literacy' in the general population. This has been defined as 'knowledge and beliefs about mental disorders, which aid their recognition, management, or prevention'. Mental Health First Aid (MHFA) is a brief training programme developed in Australia in 2000; its aim is to improve mental health literacy and teach mental health first aid strategies. The course has been adapted for various contexts, but essentially covers the symptoms of various mental health disorders, along with associated mental health crisis situations. The programmes also teach trainees how to provide immediate help to people experiencing mental health difficulties, as well as how to signpost to professional services. It is theorised that improved knowledge will encourage the trainees to provide support, and encourage people to actively seek help, thereby leading to improvements in mental health. This review focuses on the effects of MHFA on the mental health and mental well-being of individuals and communities in which MHFA training has been provided. We also examine the impact on mental health literacy. This information is essential for decision-makers considering the role of MHFA training in their organisations.
Objectives:
To examine mental health and well-being, mental health service usage, and adverse effects of MHFA training on individuals in the communities in which MHFA training is delivered.
Search methods:
We developed a sensitive search strategy to identify randomised controlled trials (RCTs) of MHFA training. This approach used bibliographic databases searching, using a search strategy developed for Ovid MEDLINE (1946 -), and translated across to Ovid Embase (1974 -), Ovid PsycINFO (1967 -), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Common Mental Disorders Group's Specialised Register (CCMDCTR). We also searched online clinical trial registries (ClinicalTrials.gov and WHO ICTRP), grey literature and reference lists of included studies, and contacted researchers in the field to identify additional and ongoing studies. Searches are current to 13th June 2023.
Selection criteria:
We included RCTs and cluster-RCTs comparing any type of MHFA-trademarked course to no intervention, active or attention control (such as first aid courses), waiting list control, or alternative mental health literacy interventions. Participants were individuals in the communities in which MHFA training is delivered and MHFA trainees. Primary outcomes included mental health and well-being of individuals, mental health service usage and adverse effects of MHFA training. Secondary outcomes related to individuals, MHFA trainees, and communities or organisations in which MHFA training has been delivered DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. We analysed categorical outcomes as risk ratios (RRs) and odds ratios (ORs), and continuous outcomes as mean differences (MDs) or standardised mean differences (SMDs), with 95% confidence intervals (CIs). We pooled data using a random-effects model. Two review authors independently assessed the key results using the Risk of Bias 2 tool and applied the GRADE criteria to assess the certainty of evidence MAIN RESULTS: Twenty-one studies involving a total of 22,604 participants were included in the review. Fifteen studies compared MHFA training with no intervention/waiting list, two studies compared MHFA training with an alternative mental health literacy intervention, and four studies compared MHFA training with an active or an attention control intervention. Our primary time point was between six and 12 months. When MHFA training was compared with no intervention, it may have little to no effect on the mental health of individuals at six to 12 months, but the evidence is very uncertain (OR 0.88, 95% CI 0.61 to 1.28; 3 studies; 3939 participants). We judged all the results that contributed to this outcome as being at high risk of bias. No study measured mental health service usage at six to 12 months. We did not find published data on adverse effects. Only one study with usable data compared MHFA training with an alternative mental health literacy intervention. The study did not measure outcomes in individuals in the community. It also did not measure outcomes at our primary time point of six to 12 months. Four studies with usable data compared MHFA training to an active or attention control. None of the studies measured outcomes at our primary time point of six to 12 months.
Authors' conclusions:
We cannot draw conclusions about the effects of MHFA training on our primary outcomes due to the lack of good quality evidence. This is the case whether it is compared to no intervention, to an alternative mental health literacy intervention, or to an active control. Studies are at high risk of bias and often not sufficiently large to be able to detect differences.
Disclosure of suicidal ideation and behaviours, defined as thoughts, plans, or attempts, to other people provides opportunity for intervention and prevention. This study is the first to meta-analyze all available studies to estimate the prevalence of disclosure, to whom people disclose, and examine factors that influence disclosure. Databases were searched for studies reporting samples of people who had experienced suicidal ideation or behaviours (including those who had died by suicide) and whether they had disclosed this. Almost 100 studies (k = 94, N participants = 1,044,629) were included in the overall prevalance analysis. The results showed less than half of people disclosed suicidal ideation or behaviour: 45.9% (95%CI 41.9-49.9%, PI 12.3-81.8%; k = 94). High heterogeneity, common to prevalence studies, was found (Q[93] = 130,584, p < .001; I2 = 99.9%). No publication bias was detected. Removing outliers did not change the prevalence estimate, but provided tighter prediction intervals: 45.6% (95%CI 43.4-47.9%, PI 35.8-55.7%; k = 33). Disclosure was related to higher prevalence of psychiatric disorders, female gender, and a longer timeframe of suicidal ideation or behaviour. Prevalence of disclosure was lower among people who died by suicide, relative to community samples, and lower when reported verbally rather than written online. Disclosure, and proportions of disclosures, to family members, was numerically higher than to friends or professionals, but could not be directly compared. In conclusion, between 50 and 60% of people do not disclose their suicidal ideation and behaviours to other people, and therefore remain unidentified and potentially untreated.
Points essentiels
La mise en évidence de facteur de risques des conduites suicidaires permet le dépistage d’individu à risque.
Les facteurs de risques sont classés en trois catégories : primaires, secondaires et tertiaires.
Les facteurs de risques primaires sont liés à l’individu et les facteurs secondaires à l’environnement.
Les facteurs de risque tertiaires n’ont de valeurs qu’en association avec les facteurs primaires et secondaires.
La présence d’une pathologie mentale est un facteur de risque majeur de suicide.
Background
Values associated with neoliberal ideologies are blamed for damaging the social fabric. They may also have deleterious effects on suicidal ideation.
Objective
We investigated whether neoliberal values were associated with the risk for suicidal ideation through a set of mediating factors (suicide stigma, help-seeking attitudes, perceived stress, and suicide acceptability).
Methods
A total of 508 (249 female) adults from the U.S. responded to a self-administered questionnaire that contained measures of suicidal ideation, neoliberal values, suicide stigma, help-seeking attitudes, perceived stress, and suicide acceptability. We tested a path model that linked neoliberal values to suicidal ideation through multiple mediators. We tested total versus partial mediation models.
Results
We found empirical evidence for a full mediation of the association of neoliberal values with perceived stress. Neoliberal values were associated with suicide stigma; suicide stigma was associated with negative attitudes towards help-seeking, which, in turn, were associated with high levels of perceived stress. The association of neoliberal values with suicide acceptability was partially mediated. Perceived stress was positively associated with suicide risk directly and indirectly through suicide acceptability.
Conclusion
Our findings suggest that values related to neoliberal ideologies prepare a context that fosters the risk for suicide. For a contextualized understanding of suicidal behavior, more research is needed that explores the role of social, cultural, political, and economic ideologies in the suicidal process.
Objective:
This study utilized the World Health Organization Disability Assessment Schedule version 2 (WHODAS 2.0) to identify vulnerable students and explore the impact of mental and developmental disorders on disability.
Participants:
A total of 156 undergraduates who visited support service offices at large-scale universities in Japan between April 2018 and March 2020 were included.
Methods:
The 36-item WHODAS 2.0 was administered, and data were gathered regarding mental and developmental disabilities. Mann-Whitney and Kruskal-Wallis tests were conducted.
Results:
Parents/guardians typically initiated consultation with student support services. Students whose parents had initiated consultation did not have higher scores in any WHODAS domain except "Life Activities." In every WHODAS domain except "Cognition," the "Mental Disorder" group scored significantly higher than the "No Disorder" group. The addition of "Developmental Disorders" significantly increased WHODAS scores, except in "Mobility."
Conclusions:
The WHODAS is a useful tool for identifying vulnerable students.
Importance:
Understanding mental health and substance use treatment seeking and suicidality among suicide decedents is important to determine prevention efforts.
Objective:
To evaluate differences in treatment seeking and suicidality between suicide decedents who died by firearms and those who died by other methods.
Design, setting, and participants:
Cross-sectional data were collected on 234 652 suicide decedents from 2003 to 2018. Participant information was reported by their state of residence to the National Violent Death Reporting System. Statistical analysis was performed from July 1, 2021, to January 21, 2022.
Main outcomes and measures:
Main outcomes were treatment for mental health and substance use at time of death, previous treatment for mental health and substance use, history of suicidal ideation or plans, history of suicide attempts, and disclosure of suicidal ideation or plans.
Results:
A total of 234 652 participants (182 520 male [77.8%]; 205 966 White [87.8%]; mean [SD] age, 46.3 [18.2] years [range, 3-112 years]) were included in this study. Compared with suicide decedents who died by another method (n = 117 526 [50.1%]), those who died by firearm (n = 117 126 [49.9%]) were more likely to have disclosed thoughts or plans of suicide within the month prior to death (odds ratio [OR], 1.16 [95% CI, 1.13-1.18]) and were less likely to have previously attempted suicide (OR, 0.44 [95% CI, 0.43-0.46]). Compared with those who died by poisoning, those who used a firearm were more likely to have had a history of suicidal thoughts or plans (OR, 1.19 [95% CI, 1.15-1.23]) and to have disclosed their thoughts or plans of suicide within the month prior to death (OR, 1.06 [95% CI, 1.03-1.10]). Compared with those who died by hanging, those who used a firearm were more likely to have disclosed their thoughts or plans of suicide to another person within the month prior to their death (OR, 1.14 [95% CI, 1.11-1.17]).
Conclusions and relevance:
These findings provide information that suggests who is at risk to die by firearm suicide. Community-based interventions in suicide prevention could help reduce access to firearms during a time of crisis. The finding that firearm suicide decedents were more likely to disclose their suicidal thoughts or plans provides an important avenue for prevention.
Background
The majority of people who die by suicide are unknown to formal mental health services. The current review identified predictors of non-receipt of mental health services among individuals experiencing suicidal thoughts or behaviours. Such data provides insight into the needs and preferences of these individuals and inform improvements to existing services.
Methods
PsycInfo, PubMed/Medline, CINAHL, and Web of Science were systematically searched from 1st January 1980 up to 20th September 2021. Included studies examined predictors of not receiving formal mental health services among people at risk of suicide. Study quality was assessed by adapting the Joanna-Briggs Institute Checklist for Analytical Cross-Sectional Studies. Findings were presented with narrative synthesis. PROSPERO registration: CRD42021256795.
Results
Included studies (n = 35, sample range = 46-19243) were predominately conducted in the United States. Non-receipt of services in nationally representative studies was varied (25.7%-91.8%). Results indicate that non-receipt of mental health services among people with suicidality is associated with minority ethnicity, better perceived general health, lower psychological distress, lower severity of suicidality, no mental health diagnosis, lower perceived need for treatment and lower use of medical services.
Limitations
Limitations included few studies conducted in low-middle income countries, limited literature on key predictors of interest, and exclusion of informal sources of support.
Conclusion
Individuals with suicidality who are unknown to mental health services have diverse attributes. For some, non-use of services may result from low suicidal distress and perceived need for treatment. Further research is needed to understand why these predictors are associated with service non-use.
Background: Due to an increasing suicide rate, risk factors for suicidal thoughts and behaviors (STBs) are an important target for research. Furthermore, individuals experiencing STBs often do not seek help. This highlights the need to assess factors that are associated with help-seeking intentions and behaviors. Aim: The current study examines the role of interpersonal hopelessness in help-seeking intentions and behaviors in suicidal individuals. Method: This was a cross-sectional study. A total of 239 adults (Mage = 32; 57.7% male; 67.8% Caucasian) completed online measures via Amazon’s Mechanical Turk (MTurk). Bivariate analyses were conducted to assess if higher levels of interpersonal hopelessness were associated with lower levels of help-seeking intentions and behaviors in individuals experiencing STBs within the previous 6 months. To distinguish interpersonal hopelessness from other variables that may affect help-seeking, social anxiety, interpersonal problems, general hopelessness, and perceived barriers to treatment were also examined using hierarchical regression. Results: Results showed that interpersonal hopelessness was significantly positively correlated with help-seeking intentions and behaviors. The proportion of variance in help-seeking intentions and behaviors accounted for by interpersonal hopelessness was negligible. Limitations: The data were self-reported and collected retrospectively making them susceptible to biases. Although an important first step, the cross-sectional design also limits examination of temporal or causal relationships between study variables. Furthermore, the use of an MTurk sample introduces additional limitations, as well as the limited psychometric evaluation of two measures. Conclusion: Results indicate that although interpersonal hopelessness may be an important factor in suicide risk, it may not play a compelling role in help-seeking behaviors.
A rationale for the role of crisis hotlines in suicide prevention is that suicidal behaviour is often associated with a crisis. The psychological autopsy research generally supports the association of stressful life events, such as interpersonal losses and legal or disciplinary problems, with suicide. Hotlines are a ubiquitous source of help internationally and the evidence for their effectiveness has grown substantially over the last decade. Recent research provides strong support for crisis hotlines’ role in reducing callers’ crisis and suicidal states. In response to concerns about the extent and quality of suicide risk assessments and crisis interventions by hotline staff, new practice recommendations and training and outreach strategies in telephone crisis centres have been implemented and evaluated.
Objective: People experiencing mental health problems or suicidal thoughts often do not seek help. This study aims to investigate factors associated with help-seeking behaviours for emotional and mental health problems in individuals at risk for suicide.
Method: A community sample was recruited online through Instagram and Facebook advertisements. There were 4277 participants in total, aged 18–84 (72.8% female, 26.8% male and .4% other), of which 1306 were classified as low/medium risk of suicide and 572 as high risk. Regression analyses examined factors associated with past year help-seeking from four categories of help: informal help, general practitioner, mental health professional, and tele/e-health. Predictors included: age, gender, exposure to suicide, psychological distress, suicidal ideation, and knowledge of and attitudes to suicide.
Results: Overall, rates of help-seeking increased as risk for suicide increased. Higher levels of suicidal ideation were associated with a greater likelihood of having previously sought help from a GP and mental health professional, but a lower likelihood of having sought help from informal sources. Younger age was associated with past year help-seeking from informal sources and tele/e-health sources. Men had a significantly lower likelihood of having sought help from general practitioners. Different dimensions of attitudes towards suicide were also found to be associated with different types of help-seeking.
Discussion: Understanding the characteristics and patterns of different forms of help-seeking can have important implications for the development of effective suicide prevention strategies.
Le taux de décès par suicide augmente avec l’âge dans la plupart des pays du monde, en particulier pour les hommes. En revanche, la prévalence des tentatives de suicide (TS) et des idées suicidaires parmi les personnes âgées est moindre que dans les autres classes d’âge. Les facteurs associés au décès par suicide dans la population générale sont surtout les troubles psychiatriques, y-compris les troubles de l’usage de substances, et les antécédents de TS. En ce qui concerne les personnes âgées, on peut y ajouter des facteurs spécifiques, comme l’isolement, les maladies et douleurs chroniques, ou la perte d’autonomie. La démence ne semble en revanche pas constituer un facteur de risque. Les mesures de prévention du suicide les mieux établies sont basées sur la restriction de l’accès aux moyens, le traitement des troubles psychiatriques et les systèmes de maintien d’un suivi après TS. La formation de sentinelles (« gatekeepers ») est une mesure réputée efficace mais qui n’a pas été évaluée indépendamment d’autres interventions avec un bon niveau de preuve. Des interventions s’adressant aux personnes âgées vivant dans la communauté ont également été développées mais leur efficacité sur les comportements suicidaires a rarement été évaluée avec un bon niveau de preuve. En France, comme dans la plupart des pays européens, environ 10 % des personnes de plus de 75 ans et le tiers des plus de 90 ans vivent dans des établissements hébergeant des personnes âgées (EHPA). Les études actuelles ne permettent pas de dire si le fait d’être institutionnalisé augmente le risque suicidaire, déjà très élevé dans ces classes d’âge. Les EHPA ou EHPAD (Établissement d’Hébergement pour Personnes Âgées Dépendantes) pourraient malgré tout constituer un terrain de choix pour valider des interventions visant à diminuer le risque suicidaire parmi les personnes âgées. Dans ce travail de thèse, nous présentons en premier lieu une revue systématique de la littérature portant sur les interventions visant à diminuer le risque suicidaire en EHPA. Nous n’avons retrouvé dans la littérature que six articles, dont quatre portent sur l’évaluation de la formation de sentinelles parmi le personnel. Aucune étude ne présente l’impact des interventions sur les comportements suicidaires. Nous exposons en deuxième lieu une étude visant à mieux évaluer au cours d’un suivi d’un an, les effets de la formation de sentinelles parmi le personnel de douze EHPAD du département du Rhône par comparaison à douze autres dans lesquels aucune formation particulière sur ce sujet n’avait été menée. Nous montrons que la formation de sentinelles a des impacts très larges, amenant les institutions à développer des stratégies de prévention multimodales et à modifier la prise en charge des résidents suicidaires. Cependant, les résultats sont hétérogènes selon le contexte institutionnel. En dernier lieu, nous proposons une étude qualitative menée auprès de membres du personnel de trois EHPAD visant à analyser les représentations sociales qu’ont ces personnes du suicide des personnes âgées. Nous montrons que ces représentations sont similaires à celles de la population générale et tendent à légitimer et banaliser le suicide des personnes âgées. En conclusion, nous proposons plusieurs pistes de recherche. L’une d’entre elles consisterait à évaluer de manière rétrospective les taux de décès et de TS dans un grand nombre d’EHPA, par exemple sur l’ensemble d’une région, afin que cette évaluation puisse servir de comparaison avec les personnes non-institutionnalisées et surtout de base afin de mesurer l’efficacité d’un programme multimodal de prévention du suicide dans certains EHPAD. Par ailleurs, nous proposons de mieux cerner les facteurs associés aux suicides ou aux TS parmi les résidents d’EHPAD par l’étude exhaustive des données issues du dossier médical et des transmissions infirmières, bien plus riches que pour des personnes non-institutionnalisées
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: Our primary objective is to examine mental health and well-being, mental health service usage, and adverse effects of Mental Health First Aid (MHFA) training on recipients of the intervention. We have three secondary objectives: 1. To examine the effects of MHFA training on recipients of the trainees' intervention, in terms of their knowledge about mental health and attitudes towards mental health problems. 2. To examine the effects of MHFA training on trainees' knowledge about mental health, attitudes towards mental health problems, number of encounters with people with mental health problems, and their own mental health and well-being. 3. To examine the effects on organisations, looking at measures of absenteeism and productivity at work.
Background
This study examined the role of aggressive-impulsive variants, and suicide history in predicting the medical severity of follow-up suicide attempts.
Methods
97 consecutive psychiatric in-patients who participated in earlier study 2–5 years previously. Thirty-three had a history of a medically serious suicide attempt (MSSA), 29 had a history of a medically non-serious suicide attempt (MNSSA), and 35 had no history of suicide. Participants completed a battery of instruments measuring aggressive-impulsive variables, hopelessness and communication difficulties. Findings were analyzed in relation to follow-up suicide attempts and their severity.
Results
32 patients (33%) had attempted suicide: 9 (9.27%) (including one death) MSSSA. Of these, 7 patients were MSSAs in the index attempt and 2 were MNSSAs in the index attempt. 23 (23.7%) MNSSA: Of these, 6 were MSSAs in the index attempt; 13, MNSSAs in the index attempt and 4 from the non-suicidal psychiatric group. 65 patients (67%) did not attempt suicide during the period since the index studies. Anger-out, violence impulsivity and hopelessness had significant positive correlations with medical severity of follow-up suicide attempts. Similar correlations were found between anger-out, violence and the amount of follow-up suicide attempts. A hierarchical regression analysis was conducted to determine contribution of study variables to severity
of future suicide attempts. Severity of index attempt, hopelessness aggressive-impulsive variants and two interactions (medical severity of index suicide attempt X impulsivity and self-disclosure X anger-in) accounted for 44.7% of the variance of the medical severity of follow-up suicide attempts
Limitations
(i) Possibly incomplete patient information, as some of the patients who participated in the index studies could not be located. (ii) Relatively small group of patients with an index MSSA.
Conclusions
The major findings of this paper are the predictive value of MSSA vs. MNSSA. The Lethality of future suicide attempt is closely linked to the lethality of former suicide attempt, impulsivity and hopelessness. Thus, patients who have made a suicide attempt should be assessed for medical severity of the attempt, impulsive-aggressive measures hopelessness, and communication difficulties, which are important factors in follow-up attempts.
Background
Depressed individuals often refuse or withdraw from help, a phenomenon termed help-negation, which is a risk factor for poor outcomes. Most previous research has investigated psychosocial factors including stigma as causes of low help-seeking intentions for depression, however these do not adequately explain the problem. We hypothesised that because help-negation worsens with symptom severity, it might be linked to important biological changes associated with depression itself. We investigated the relative contributions of cortisol, a stress hormone linked to depression, and oxytocin, a hormone which mediates social behaviours, alongside psychosocial factors, to help-seeking intentions among depressed and non-depressed individuals.
Methods
Morning plasma cortisol and oxytocin levels, psychopathology, suicidal ideation, help-seeking intentions from informal sources including family and friends, and formal sources including health professionals, and perceived social support were quantified in 63 adults meeting DSM-5 criteria for major depressive disorder (MDD) who were not receiving any treatment, and 60 healthy controls. Between-group analyses of variance, correlations, and hierarchical multiple regressions were employed.
Results
Help-seeking intentions were lower in depressed than healthy participants, negatively correlated to cortisol and positively correlated to oxytocin. Cortisol negatively, and oxytocin positively, predicted help-seeking intentions from informal but not formal sources, after controlling for psychopathology and psychosocial factors.
Conclusions
Neuroendocrine changes associated with depression may contribute to low help-seeking from friends and family, which may have implications for interpersonal support and outcomes. Research and clinical approaches which incorporate biological as well as psychosocial factors may allow for more targeted and effective early interventions to address lack of help-seeking and depression progression.
Competent assessment and management of the risk of harm is a core competency that mental health professionals are expected to possess. However, despite this expectation, adequate training programs have been lacking for decades and, even when risk assessment training is provided, it is often reported as being insufficient. The literature indicates that training delivery methods often include passive and didactic methods during supervision or seminar sessions. To help enhance the learning of suicide risk factors, some authors proposed a visual metaphor that visually and metaphorically depicts all suicide risk factors. The main purpose of this study was to examine the efficacy of the proposed visual metaphor.
A pilot RCT was undertaken to test several hypotheses, all of which predicted that the visual metaphor would demonstrate superior effects when compared with the conventional textual teaching methods. A group of 22 psychology students were randomized into either a control group (who learnt suicide risk factors via the conventional textual teaching methods) or a treatment group (that learnt the risk factors using the visual metaphor in addition to the conventional textual teaching methods). Memory recall, knowledge transfer, cognitive load, and satisfaction were all tested at the end of the learning sessions.
Independent samples t tests indicated that the visual metaphor was effective in improving memory recall and knowledge transfer and reducing the cognitive load. The differences between the two groups’ post-learning scores were significant in each of these outcome measures. The treatment group also expressed higher satisfaction levels in comparison to the control group. Overall the visual metaphor of suicide risk factors was found to be superior to the conventional teaching methods in teaching suicide risk factors to university psychology students. Limitations, implications of this study and directions for future research are discussed.
The rate of adolescent suicide has increased dramatically in the past few decades, prompting several interventions to curb the increase. Unfortunately, many of the intervention efforts have not benefited from current research findings because the communication between researchers and those who develop the interventions is inadequate. Of specific concern are the increasingly popular curriculum-based suicide prevention programs, which have not demonstrated effectiveness and may contain potentially deleterious components. This article reviews the current epidemiological research in adolescent suicide and suggests how this knowledge could be used more effectively to reduce the rate of adolescent suicide. Recommendations include support for integrated primary prevention efforts; suicide prevention education for professionals; education and policies on firearm management; education for the media about adolescent suicide; more efficient identification and treatment of at-risk youth, including those exposed to suicidal behavior; crisis intervention; and treatment for suicide attempters.
Administered a scale designed to quantify hopelessness to 294 hospitalized suicide attempters, 23 general medical outpatients, 62 additional hospitalized suicide attempters, and 59 depressed psychiatric patients. The scale had a Kuder-Richardson-20 internal consistency coefficient of .93 and correlated well with the Stuart Future Test (SFT) and the pessimism item of the Beck Depression Inventory (BDI; .60 and .63, respectively). The scale was also sensitive to changes in the patient's state of depression over time, as evidenced by a correlation of .49 with change scores on the SFT and .49 with the change scores on the BDI. Findings also indicate that depressed patients have an unrealistically negative attitude toward the future and that seriousness of suicidal intent is more highly correlated with negative expectancies than with depression. A principal-components factor analysis revealed 3 factors which tapped affective, motivational, and cognitive aspects of hopelessness. (16 ref)
Many countries have set targets for suicide reduction, and suggested that mental health care providers and general practitioners have a key role to play.
A systematic review of the literature.
Among those in the general population who commit suicide, up to 41% may have contact with psychiatric inpatient care in the year prior to death and up to 9% may commit suicide within one day of discharge. The corresponding figures are 11 and 4% for community-based psychiatric care and 83 and 20% for general practitioners.
Among those who die by suicide, contact with health services is common before death. This is a necessary but not sufficient condition for clinicians to intervene. More work is needed to determine whether these people show characteristic patterns of care and/or particular risk factors which would enable a targeted approach to be developed to assist clinicians in detecting and managing high-risk patients.
This study sought to understand factors that might enhance suicide prevention programs by investigating the responses of adolescents to potentially suicidal peers in analogue situations embodying variables from the social psychological research on bystander intervention. 314 high school students were randomly assigned one of four vignettes about a troubled peer under conditions of high or low diffusion of responsibility (respondent was alone or one of a group) and high or low ambiguity (confronted by a troubled peer or heard an essay written by a peer). Students' statements concerning the likelihood of suicide and their level of concern in the situation provided evidence for the internal validity of the vignettes. Results included significant main effects of ambiguity (more likely to tell an adult than simply talk to the peer in low vs high ambiguous conditions) for males and females, and of diffusion (more likely to ignore or do nothing than talk or tell in high vs low diffuse situations) for males. Students' estimates of how other students would respond corresponded with findings from social comparison research and suggested the operation of an erroneously perceived social norm of no response to a troubled peer by those who indicated that they would ignore the peer. The results have implications for the application of social psychological models to social influence-based prevention efforts to enhance adolescents' roles in the prevention of youth suicidal behavior.
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
Discusses youthful suicidal behavior and its association with major psychopathology. Annually, about 3% of older adolescent girls and 1% of older adolescent boys make a suicide attempt. Suicide in the absence of a major mental disorder is almost as rare among adolescents as it is among adults. In normal populations suicidal preoccupations and suicide attempts tend to be linked strongly to symptoms of a depressive illness. In psychiatric patient populations, comorbid psychopathology and alcohol and drug abuse are the strongest correlates of nonlethal suicidal behavior. Children and adolescents treated for a major psychiatric disorder, particularly major depression, are at greater risk for death by suicide. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The Self-inflicted Injury Severity Form (SIISF) was developed as an epidemiological research tool for identifying individuals in hospital emergency departments who have life-threatening self-inflicted injuries. Data were collected from 715 patients with self-inflicted injuries in two large hospitals. In 295 of these cases, a second set of data was independently collected for assessment of interrater reliability. Validity was assessed by comparing the SIISF results with simultaneously collected Risk—Rescue Ratings. Assessment of interrater reliability found that only 2.4% of physicians disagreed on the suicide method used. The kappa statistic for method used was .94, indicating excellent agreement. The SIISF was found to distinguish between severe and less severe injuries. Thus, it appears to provide a simple method to distinguish patients who have life-threatening self-inflicted injuries.
Experience in providing consultation and survivor counseling to school personnel following student suicides led to the development of a program of prevention through training school personnel. The goal of the program was to increase the ability of resource persons available to adolescents—teachers, counselors and school nurses—to recognize signs of suicidal depression and to respond effectively to suicidal students. This report describes that program, the reaction of the participants and the observations of the project staff, and comments on the feasibility of this approach as a means of helping to prevent suicide among adolescents.
With the aim of aiding primary prevention of parasuicide by Samaritans, a study of 325 parasuicide patients admitted to hospital was undertaken to discover the extent of knowledge about Samaritans, the proportion of patients who had contacted Samaritans and the reasons why the remainder had not done so. Ignorance about Samaritans was found in 28 per cent, such ignorance being significantly more common among teenagers than in other age groups. Only 1.4 per cent had sought help from Samaritans immediately before the present parasuicidal act, though a further 13 per cent had contacted Samaritans previously. Suggestions are made for future public education programmes about Samaritans.
In 1983-1984 the Swedish Committee for the Prevention and Treatment of Depression offered an educational program on diagnosis and treatment of depressive disorders to all general practitioners on the island of Gotland. The program has been carefully evaluated; 1982 was used as the baseline and the main evaluation was carried out in 1985. After the educational programs, the frequency of sick leave for depressive disorders decreased, the frequency of inpatient care for depressive disorders decreased to 30% of that at the baseline; the prescription of antidepressants increased, but prescription of major tranquilizers, sedatives and hypnotics decreased. The frequency of suicide on the island decreased significantly. This study describes the long-term effects. In 1988, 3 years after the project ended, the inpatient care for depressive disorders increased, the suicidal rate returned almost to baseline values and the prescription of antidepressants stabilized. Thus, the effects were strictly related in time to the educational programs, indicating that the effects were real and not only a coincidence with local trends on Gotland. Furthermore, the results indicate that educational programs that can have pronounced effects on the health care system have to be repeated approximately every 2 years if long-term effects are to be expected.
Cognitive therapy research has yielded (1) a taxonomy of suicidal behaviors, (2) scales for assessing suicidal ideation and intent, and (3) a model of suicidal wishes and behavior that identifies hopelessness as a key psychological variable in suicide prediction. The establishment of hopelessness as a suicide risk factor has been supported most strongly by prospective studies of inpatients and outpatients. A cutoff score of nine on the Beck Hopelessness Scale appears to be predictive of eventual suicide. Other cognitive factors associated with suicidal wishes and behaviors are discussed.
To compare the history of psychiatric contacts among young people who have made medically serious suicide attempts and control subjects.
Using a case-control design, the authors contrasted 129 young people who made serious suicide attempts with 153 randomly selected community controls on a series of measures of lifetime, prior year, and prior month contacts with psychiatric services.
Of those who made serious suicide attempts, 78.3% had a lifetime history of contact with health services for psychiatric reasons, 72.1% reported contact within the year preceding the suicide attempt 58.9% reported contact within the month preceding the suicide attempt, and 29.5% had a lifetime history of psychiatric hospital admission. Within the year preceding the suicide attempt, 21.7% had been admitted to a psychiatric hospital and 67.4% had outpatient consultations for psychiatric problems. Multiple logistic regression suggested that the best psychiatric service predictors of risk of serious suicide attempt were admission within the preceding year (p < .005) and outpatient consultation within the preceding month (p < .0001).
Young people making serious suicide attempts had vastly elevated rates of a range of psychiatric contacts including hospital admissions and outpatient consultations. These findings imply that the development of improved treatment and management strategies for young people with psychiatric morbidity may be a very effective approach to reducing youthful suicidal behaviors.
Adolescent suicide prevention: Current research and social policy implications
- Garland
Suicide among children, adolescents, and young adults—United States, 1980–1992
- Centers for Disease Control and Prevention