Article

Survivors of Suicide Attempts (SOSA) support group: Preliminary findings from an open-label trial

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Abstract

Suicide attempt survivors represent a high-risk group for death by suicide; however, few empirically supported, tailored interventions exist for this population. One intervention format that may be useful in reducing suicide risk among suicide attempt survivors is support groups co-led by a clinician and peer survivor. This study aimed to evaluate changes in suicidal symptoms and resilience appraisals following attempt survivors’ participation in the Survivors of Suicide Attempts (SOSA) support group. A sample of 92 suicide attempt survivors was recruited to participate in the 8-week SOSA support group. Individuals completed self-report measures of suicidal symptoms (i.e., suicidal ideation, hopelessness, suicidal desire, and suicidal intent) and resilience appraisals immediately prior to and following participation in the SOSA program. Paired t tests were utilized to examine pre-post symptom changes. Participants in this study reported significant reductions in suicidal ideation, hopelessness, suicidal desire, and suicidal intent after completing the SOSA program. Additionally, individuals reported significant increases in resilience appraisals following SOSA group participation. Of note, individuals engaged in concurrent mental health treatment did not demonstrate significantly greater reductions in suicidal symptoms than those not engaged in concurrent treatment, highlighting the potential utility of the SOSA intervention. Findings suggest that the SOSA support group model may be useful in therapeutically impacting suicidal symptoms and increasing resilience among suicide attempt survivors. However, to establish SOSA’s efficacy, further research is warranted to replicate these findings utilizing a randomized controlled trial design to compare outcomes from the SOSA support group to treatment as usual.

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... Unlike traditional therapist-directed groups centred on individual interpersonal issues, the SOSA program focuses mainly on peer-driven conversation, information sharing and psychoeducation, as well as members' emotional and practical needs. A pre-post test conducted by Hom et al. 77 found significant reductions in suicidal ideation, hopelessness, suicidal desire and suicidal intent after completing the SOSA program. Participants who completed the program also reported significant increases in resilience appraisals, although an RCT is required to examine how the outcomes of the SOSA support program compare to treatment as usual. ...
... Due to these confounders, significant findings from studies with pre-post design need to be treated with caution, as observed changes could possibly be explained by factors other than the intervention. For example, Hom et al. 77 reported that participants were able to be concurrently engaged in individual therapy or use psychiatric medications and there was a possibility that changes in suicidal behaviours were due to a placebo effect. ...
... Similarly, several studies with pre-post-test designs were impacted by high attrition rates, which could have led to nonresponse bias whereby participants who are less satisfied with the intervention are less likely to complete follow-up assessments65,72 . Hom et al.77. suggested a detailed assessment of demographic (i.e. ...
Technical Report
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Suicide prevention remains a priority in Australia and internationally. The rate of suicide in Australia is at a 10-year high with 3128 people dying by intentional self-harm in 2017, a preliminary death rate of 12.6 per 100,000. This represents approximately 8.6 deaths per day. Suicide is particularly high among certain groups, notably young people, older adults and Aboriginal and Torres Strait Islander people. Moreover, in the past year 80% of people who died by suicide had a comorbidity, with mood disorders (including depression) being the most common (43%).1 The purpose of this literature review is to provide a foundation for the commissioning agency, Beyond Blue, to inform the future development of a strategic agenda for its policy work in suicide prevention. The context for the review is the Australian political and policy context of the Fifth National Mental Health and Suicide Prevention Plan2, the Australian Bureau of Statistics Causes of Death Data1 outlined above, and the rapidly increase in Federal and State/Territory investments in suicide prevention over the last few years, particularly in multilevel community programs. The World Health Organization’s report,‘Preventing Suicide: A Global Imperative’ 3, highlighted the need for a systematic, multisectoral national response to suicide through strategies such as training for gatekeepers and crisis intervention services, and postvention. Although there may be many strategies in place, the report suggested there was increased need for evaluation and improvement of services. An overview of the approaches to prevent mental ill-health in OECD countries and the evidence base for their effectiveness similarly revealed that there is an uneven distribution of programs and services among countries, particularly for vulnerable subgroups such as unemployed and older populations and also found that pilot programs often failed to be expanded.4 Most recently, in a review of the mental health system, the National Mental Health Commission concluded: “Suicide prevention initiatives currently being implemented in Australia may have a significant impact on the future directions of suicide prevention planning and investment ... The trial sites are an important development, but they do not cover the whole country and do not have the capacity or responsibility to address issues such as data gaps.” 5 (p.8). Against the background of this rapid expansion in investment and program design in suicide prevention in Australia, analysis is required to understand the quality of the existing evidence, assess the existing and new promising programs and identify the gaps in the literature, in order to ensure funding is strategically targeting areas of need.
... The psychoeducation may primarily focus on the nature of the illness or condition they have been diagnosed with, how to live with the condition and strategies or skills that may assist with recovery and living well. Such support groups are organized from those professionally led by a trained facilitator to informal groups managed by peer leaders (Feigelman et al., 2008), with joint facilitation by both professional and peer facilitators also being reported (Hom et al., 2018;Lara-Cabrera et al., 2016). These types of interventions have been found to be highly effective when focused on addressing a single problem or issue (Tyler et al., 2019). ...
... Although psychoeducation is a recognized and important evidence-based intervention often used in the context of support and peer groups (Barber et al., 2008;Castle et al., 2010;Hom et al., 2018;Poole et al., 2015), the specific role of these groups in improving mental health outcomes of participants is rarely examined. In instances where these outcomes are reported show promising results. ...
... To our knowledge only one study examining the effectiveness of support groups in reducing suicidal ideation in suicide attempt survivors has been published to date. This is an open trial reported by Hom et al. (2018) on preliminary findings of the impact of the Survivors of Suicide Attempt (SOSA) support group, run by Didi Hirsch Mental Health Services (2014) in the US, for people who have previously attempted suicide. The SOSA program is an 8-week psychoeducation program, run jointly by professional and peer facilitators dyads. ...
Article
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Psychoeducational groups have been used to address many health needs. Yet, there are few such options available for people who have attempted suicide. This study presents preliminary findings from an open trial of Eclipse, an 8-week closed, psych-oeducational group for people who have attempted suicide. It examined the effectiveness of the Eclipse program in reducing suicidal ideation, depressive symptoms, perceived burdensomeness and thwarted belongingness, and increasing resilience and help-seeking. Results showed statistically significant improvements in depressive symptoms, perceived burdensome-ness, resilience and help-seeking from baseline (T1) to immediate post-test (T2), and in perceived burdensomeness from T1 to 1-month follow-up (T3). A pervasiveness analysis showed that over half of the participants reported improvements in key study outcomes, respectively, as a result of participating in the Eclipse group. Psychoeducational support groups could provide broad application for those who have previously attempted suicide in decreasing severity of suicidal thinking by reductions in depressive symptoms, burdensomeness, and thwarted belongingness.
... (7) In the longer term, there are few, non-clinical supports for people with prior suicide attempts who may continue to live with persistent suicidal ideation and repeated attempts. (8). ...
... The following research protocol was designed to evaluate the Eclipse group, which is an Australian version of the Didi Hirsch SOSA group (9), the focus of the Hom et al (8) evaluation. ...
Research Proposal
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Background: A research protocol is presented for the evaluation of the Eclipse group, an 8-week closed group for people who have previously attempted suicide, which aims to reduce future suicide and increase resilience and support identification and help seeking.
... Importantly, individuals who have made a nonfatal SA (i.e., SA survivors) are at elevated risk for subsequent death by suicide (Bostwick, Pabbati, Geske, & McKean, 2016;Franklin et al., 2017;Suominen et al., 2004). Thus, increased efforts are needed to understand the psychological and related experiences of SA survivors (Hom, Davis, & Joiner, 2018;Sheehan, Dubke, & Corrigan, 2017;I. H. Stanley, Boffa, & Joiner, 2019;Wulsin & Goldman, 1993). ...
... One such consideration is the Survivors of Suicide Attempts (SOSA) support group, an 8-week program that offers peer support from other SA survivors with a specific emphasis on eliminating perceptions of stigma and shame. Importantly, preliminary evidence indicates that SOSA participants report lower suicidal ideation and intent for a SA at the end of the program (Hom et al., 2018 ...
Article
Objectives: Suicide attempts (SAs), by definition, represent a risk for serious injury or death; thus, one's SA may contribute to the development of posttraumatic stress disorder (PTSD). Yet, empirical data on this topic are lacking. This study aimed to characterize the phenomenology, rate, and associated features of PTSD following one's SA. Method: A total of 386 adult SA survivors recruited from web-based sources participated. Results: Overall, 27.5% (95% confidence interval = 23.1-31.9%) of SA survivors screened positive for a probable SA-related PTSD diagnosis. Individuals with a probable SA-related PTSD diagnosis reported greater current suicidal intent than those without this probable diagnosis; this association was significant at low, but not high, levels of depression symptoms. Conclusions: A substantial proportion of SA survivors may experience SA-related PTSD. SA-related PTSD may be a viable assessment and intervention target to improve the quality of life and to reduce future suicide risk among SA survivors.
... Interventions exist that have been shown to therapeutically impact suicide risk (Brown & Jager-Hyman, 2014;B. Stanley et al., 2018), including among attempt survivors (Hom, Davis, & Joiner, 2018). However, connection to care and treatment engagement persist as challenges in this group. ...
... Other treatment delivery recommendations provided by participants are supported by the extant literature and specific to attempt survivors who seek care. For instance, peer support groups appear to be a promising treatment modality for attempt survivors (Hom, Davis, et al., 2018). The suggestion for providers to help individuals to process prior attempts also complements research revealing that attempt survivors may experience self-stigma associated with attempt survivorship (Rimkeviciene, Hawgood, O'Gorman, & De Leo, 2015) and develop trauma associated with surviving a lifethreatening experience (I. ...
Article
Research indicates that connection to mental health care services and treatment engagement remain challenges among suicide attempt survivors. One way to improve suicide attempt survivors' experiences with mental health care services is to elicit suggestions directly from attempt survivors regarding how to do so. This study aimed to identify and synthesize suicide attempt survivors' recommendations for how to enhance mental health treatment experiences for attempt survivors. A sample of 329 suicide attempt survivors (81.5% female, 86.0% White/Caucasian, mean age = 35.07 ± 12.18 years) provided responses to an open-ended self-report survey question probing how treatment might be improved for suicide attempt survivors. Responses were analyzed utilizing both qualitative and quantitative techniques. Analyses identified four broad areas in which mental health treatment experiences might be improved for attempt survivors: (a) provider interactions (e.g., by reducing stigma of suicidality, expressing empathy, and using active listening), (b) intake and treatment planning (e.g., by providing a range of treatment options, including nonmedication treatments, and conducting a thorough assessment), (c) treatment delivery (e.g., by addressing root problems, bolstering coping skills, and using trauma-informed care), and (d) structural issues (e.g., by improving access to care and continuity of care). Findings highlight numerous avenues by which health providers might be able to facilitate more positive mental health treatment experiences for suicide attempt survivors. Research is needed to test whether implementing the recommendations offered by attempt survivors in this study might lead to enhanced treatment engagement, retention, and outcomes among suicide attempt survivors at large. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
... Although the current article is focused specifically on PTSD symptoms that may follow one's suicide attempt, there are other psychological and related consequences of a suicide attempt that deserve concurrent empirical attention, such as stigma (Hom, Davis, & Joiner, 2018;Sheehan, Dubke, & Corrigan, 2017). Stigma, in turn, might contribute to the maintenance of suicide risk, increased shame, and decreased utilization of mental health care services. ...
Article
Objective: A suicide attempt is at least somewhat life-threatening by definition and is, for some, traumatic. Thus, it is possible that some individuals may develop posttraumatic stress disorder (PTSD) from a suicide attempt. Method: In this article, we consider whether one's suicide attempt could fulfill Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for a PTSD Criterion A event and contribute to the development of attendant PTSD symptoms (e.g., flashbacks, avoidance, shame/guilt, nightmares); discuss theoretical models of PTSD as they relate to suicide attempts; reflect on factors that might influence rates of suicide attempt-related PTSD; highlight methodological limitations that have hampered our understanding of suicide attempt-related PTSD; and posit areas for future scientific and clinical inquiry. Results: Strikingly, the degree to which a suicide attempt leads to PTSD is unknown. Conclusions: We conclude with a call for research to systematically assess for suicide attempts alongside other potentially traumatic experiences (e.g., combat exposure, rape) that are included in standardized PTSD assessments.
... Targeting stigmatizing attitudes toward suicide may serve as another risk reduction strategy. Preliminary evidence supports clinical utility in this prevention approach, especially in a peer support setting among SA survivors (Hom, Davis, & Joiner, 2018). Addressing stigmatizing attitudes may also promote help-seeking and connection to care (Eskin, Schild, Öncü, Stieger, & Voracek, 2015). ...
Article
Background: Relatively little is known regarding the relationship between attitudes toward suicide, suicide attempt (SA) history, and future suicidal behaviors. Aims: Utilizing a sample of firefighters, this study compared attitudes toward suicide between individuals with/without a career SA history and evaluated whether certain attitudes toward suicide are associated with a greater self-reported likelihood of making a future SA. Method: US firefighters (N = 818) completed self-report measures. One-way ANOVAs and linear regression analyses were utilized to address study aims. Results: Firefighters with a career SA reported significantly greater normalization/glorification of suicide - yet lower attributions of suicide to isolation/depression - than those without this history. More stigmatizing attitudes toward suicide and greater normalization/glorification of suicide were each significantly associated with greater self-reported future SA likelihood. Limitations: Data were cross-sectional and findings may not be generalizable. Conclusion: Firefighters who have made an SA during their firefighting careers may normalize and glorify suicide more than those who have not. These attitudes may be associated with greater self-perceived risk for future SAs. Research is needed to replicate findings and evaluate strategies for targeting potentially harmful beliefs about suicide among SA survivors.
... These programs may be created and administered internally, but a growing number of businesses have developed partnerships with outside organizations that provide external support services. These organizations may provide therapy from a licensed psychologist or even peer-support counseling (e.g., incorporating suicide survivors into supportive programming for others at-risk; Hom et al., 2018). Either route, the goal of these programs is to not only identify and address current problems but also to provide employees with the tools and capabilities to address any issues that may arise in the future. ...
Article
Full-text available
Although organizational scholars have long been interested in employees’ well‐being and occupational health, less work has focused specifically on suicide behaviors among employees. This dearth of research is concerning given that individuals spend a significant portion of their waking hours at work and suicide deaths among American workers are on the rise. To encourage the study of work and suicide with the intent of ultimately reducing mortality, we first provide a theoretical framework that incorporates two eminent theories of suicide: interpersonal‐psychological theory of suicide and psychache theory of suicide. We then report the findings of an interdisciplinary systematic literature review that offers an overview of current research related to work and suicide, including antecedent, mediating, and moderating effects. The results of our systematic literature review are presented via the lens of our theoretical framework, supporting that it is an appropriate perspective to understand the relation of work and suicide. Finally, we conclude by identifying avenues for continued research on the interplay between work and suicide, again incorporating these research directions into our theoretical framework. Together, our manuscript integrates multiple domains of research, while addressing a timely and critical public health crisis that stems, in part, from employees’ workplace experiences.
... Therefore, it is important to investigate former cancer patients' awareness and use of survivorship services to determine their level of identification and engagement with programs that might benefit them. Some research indicates that participation in support groups facilitates recovery from spinal surgery (Strøm et al., 2019), assists individuals who have attempted suicide (Hom et al., 2018), and is beneficial for former cancer patients (Barret, 2005;Stevinson et al., 2010). For example, one study of 958 breast cancer survivors who participated in support groups noted that participants reported high levels of social and overall quality of life satisfaction (Barret, 2005). ...
Article
This study uses social identity theory and communication accommodation theory as lenses to examine former cancer patients’ perspectives of the “survivor” label, replacement labels for their experience, and use of survivor services. Semi-structured interviews of 43 former cancer patients offer insight into their unique cancer experiences and explain how these events influence their perceptions of the term survivor. Coders used constant comparison methods to capture six themes related to the participants’ impressions of the survivor label. When sharing perceptions of the survivor label, participants expressed language that illustrated convergence (It means everything to me), divergence (I don’t like to be called anything), convergence and divergence (Part of me is happy … Part of me is kind of aggravated), and apathy (I have no feelings toward the label). Participants also generated new labels that captured their cancer experiences and six unique themes emerged from these responses. Most of the former cancer patients were aware of survivorship programs; however, relatively few used these programs regularly and cited reasons for nonuse explained by social identity theory.
... This aligns with the format of peer-to-peer interventions, which is receiving growing popularity in suicide prevention. For example, recent studies suggest that participating in the support group led by a clinician and a peer survivor significantly increased resilience appraisals and reduced suicidal behaviors and symptoms, such as suicidal ideation and hopelessness, among those who have survived a suicide attempt (Hom et al., 2018). In addition, it will further underscore the need for long-term psychological services and resources for suicide attempt survivors. ...
Article
Over 48,000 people died by suicide in 2018 in the United States, and more than 25 times that number attempted suicide. Research on suicide has focused much more on risk factors and adverse outcomes than on protective factors and more healthy functioning. Consequently, little is known regarding relatively positive long-term psychological adaptation among people who attempt suicide and survive. We recommend inquiry into the phenomenon of long-term well-being after non-fatal suicide attempts, and we explain how this inquiry complements traditional risk research by (a) providing a more comprehensive understanding of the sequelae of suicide attempts, (b) identifying protective factors for potential use in interventions and prevention, and (c) contributing to knowledge and public education that reduces the stigma associated with suicide-related behaviors.
... For instance, participants detailed how contact with other attempt survivors created learning opportunities (e.g., regarding effective coping skills) and facilitated the development of meaningful social connections. Encouragingly, there is preliminary evidence that peer support groups for attempt survivors may serve to reduce suicidal symptoms and bolster resilience (Hom, Davis, & Joiner, 2018). Though further research is needed to test the efficacy of peer support interventions for attempt survivors, these types of interventions have great promise, particularly in light of the success of peer support models in addressing other often-stigmatized conditions (Greden et al., 2010;Tehrani, Farajzadegan, Rajabi, & Zamani, 2011). ...
... Some programs described their intervention as peer group support, yet the group was led by a health professional [40]. Others had a peer supporter as co-facilitator alongside a leading health professional, therefore not qualifying as a peer-led program [41]. In particular, school-based programs working with students tended to select peers on the basis of age or belonging to the same social group but did not make suicidal experiences part of the condition for becoming a peer supporter [42,43]. ...
Article
Full-text available
Background: Peer-led support models have gained increasing popularity in suicide prevention. While previous reviews show positive effects of peer-led support for people with mental health problems and those bereaved by suicide, little is known about the types of lived experience peer support programs in suicide prevention and whether these are effective in improving the health and wellbeing of people at risk of suicide. The aim of this paper is to provide an overview of peer support programs that aim to reduce suicidality and are led by people with lived experience of suicide. Method: We conducted a systematic scoping review, involving a search of three academic (Medline, PsycINFO, Embase) and selected grey literature databases (Google Scholar, WHO Clinical Trials Registry) for publications between 2000 and 2019. We also contacted suicide prevention experts and relevant internet sites to identify peer support programs that exist but have not been evaluated. The screening of records followed a systematic two-stage process in alignment with PRISMA guidelines. Results: We identified 8 records accounting for 7 programs focussed on peer-led support programs in suicide prevention. These programs employed a range of different designs and included a variety of settings (schools, communities, rural and online). Only 3 of the 7 programs contained data on effectiveness. With the small number of eligible programs the findings from this review are limited and must be interpreted with caution. Conclusions: Despite the increased focus of policymakers on the importance of peer support programs in suicide prevention, our scoping review confirms an evidence gap in research knowledge regarding program design, implementation, and effectiveness. More rigour is required in reporting peer-led support initiatives to clarify the underlying definition of peer support and lived experience and to enhance our understanding of the types of current peer support programs available to those experiencing suicidality. Further, we need formal and high-quality evaluations of peer support suicide prevention programs led by people with lived experience to better understand their effectiveness on participant health across different settings and delivery modalities and to allow for comprehensive systematic reviews and meta-analysis in future.
... The good news is that sources of social support have increased for attempt survivors over the past decade [44,45]. The rise of the lived experience movement has created more in-person (e.g., support groups; [46]) and online spaces (e.g., livethroughthis.org) where attempt survivors are empowered to share experiences that might otherwise be concealed. ...
Article
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It is important to explore factors that could help or hinder one's wellbeing following a suicide attempt, which could yield not only negative consequences but also posttraumatic growth (PTG; positive changes following a traumatic event). The present study used a multivariate analysis of covariance (MANCOVA) to test the relationship between disclosure, PTG, and posttraumatic depreciation among suicide attempt survivors when controlling for time since attempt and to test whether these effects remained after controlling for quality of support from family and friends. Suicide attempt survivors (n = 159) completed an online survey about their experiences. Increases in disclosure to family and friends but not to healthcare providers predicted changes in PTG. The effects of family disclosure remained even after controlling for quality of support. Disclosure to healthcare providers demonstrated some statistical effects on PTG, yet in the opposite direction and only after controlling for quality of support. The control variables-time since attempt and quality of support-were the only variables that predicted a change in posttraumatic depreciation. These findings suggest there is value in disclosing one's personal story to family regardless of whether one receives supportive responses and that social support can impact one's PTG.
Article
Understanding the clinical utility of positive client characteristics like resilience can help bring a balanced perspective to psychotherapy in which clinicians work to alleviate distress and foster positive traits. Existing literature documents the value of resilience as a resource to navigate stressful life experiences. However, minimal research has explored the utility of resilience within psychotherapy. The purpose of this meta-analysis was to understand the relationships between clients’ resilience and distress as well as the influence of psychotherapy on resilience. PRISMA procedures led to the identification of ten studies meeting inclusion criteria. We conducted two random-effects model meta-analyses to understand the relationship between clients’ resilience and distress (n = 5) and understand how psychotherapy treatment influences changes in resilience (n = 6). For both analyses, we found moderate effect sizes demonstrating that (a) there appears to be an inverse relationship between resilience and psychological distress and (b) resilience appears to increase during psychotherapeutic intervention. Findings are discussed in light of the role resilience may play in psychotherapy. The disperse operationalization of resilience is also discussed.
Article
On March 11, 2011 ("3/11"), a magnitude 9.0 earthquake in Northeastern Japan triggered a tsunami and nuclear power plant meltdown that killed 16,000 people and displaced more than 470,000 people. Since 2012, a group of volunteer docents from the September 11th Families Association in New York City has traveled throughout Northeastern Japan and held organized meetings where 9/11 and 3/11 survivors share their experiences and stories of trauma as part of an intercultural exchange to promote posttraumatic recovery. We sought to elucidate whether participating 9/11 docents developed a sense of increased resiliency by participating in this international outreach. This study employed photo-taking as well as framing questions, which were developed by 9/11 docents from the August 2016 trip. These questions guided photo-taking and resulting photographs informed discussion in individual and group sharing sessions. This process helped identify codes that guided analysis. Participants acquired a deeper appreciation of their own ability to overcome adversity and experienced a gratifying desire to help 3/11 survivors better cope with their experiences. This narrative photo-taking and group sharing experience demonstrates that a cross-cultural exchange between survivors of different disasters can instill feelings of resilience among participants. It additionally provides early evidence of the efficacy of such an exchange in benefitting disaster survivors in the long term.
Article
Objective The connection of individuals at elevated suicide risk to mental healthcare services represents a critical component of suicide prevention efforts. This article provides recommendations for enhancing the assessment of help‐seeking and mental health service use within the context of suicide prevention research. Method We discuss evidence‐based and theoretical rationale for improving current approaches to assessing help‐seeking and mental health service use among at‐risk individuals. Results Recommendations are offered within three domains: (a) consideration of the spectrum of connection to care, (b) assessment of the degree to which mental healthcare services seek to and effectively target suicidal symptoms, and (c) evaluation of the sources and types of treatment and care sought and received by at‐risk individuals. Conclusions To further our understanding of how to bolster connection to care and improve experiences with mental healthcare services among individuals at elevated suicide risk, it is imperative that stakeholders precisely capture the degree, efficacy/effectiveness, and nature of care sought and received by individuals. In so doing, research gaps might be better identified and, ultimately, mental healthcare services might be better leveraged as tools to prevent suicide and support individuals in creating lives they perceive to be worth living.
Article
Background This PRISMA scoping review explored worldwide research of interventions for suicide prevention delivered within a group setting. Research on group treatments underscores the importance of peer connection in diminishing social isolation and increasing social support. Additional benefits of group treatment include cost efficiency and maximization of staff time. However, the clinical outcomes of group treatments with individuals at risk for suicide are less understood and under researched. Aim This scoping review had two objectives: 1) To identify existing group treatments where suicidal thoughts and behaviors are openly discussed; 2) To examine the outcomes of these identified treatments, with special attention to treatment integrity. Method To address these aims the authors searched Medline (Ovid), Embase (Ovid), and PsycINFO (Ovid), on November 25, 2020. At the Full Text stage, articles were included that were peer reviewed, described a suicide specific group intervention and reported suicide specific outcomes. An additional requirement was open dialogue of suicide in the group intervention. Results Only ten research reports of suicide-specific group treatments were identified in our PRISMA-ScR. In spite of many differences in setting, population, length, and frequency of sessions, all ten groups reported improvements in varying aspects of suicide symptoms. The only adverse impacts were reported by two studies wherein two (of 92) participants attempted suicide and a small number (7%) of adolescents reported feeling triggered with suicidal thinking during a session. Despite our focus on empirical data in this review, the methodological rigor of the studies evaluated was limited. Conclusion Despite the paucity of group treatment research in which suicidal thoughts and behaviors are openly discussed, the outcomes of these treatments were promising in decreasing suicide risk. These results may be due to unfounded fears of contagion. Further implications of these findings are considered along with limitations that may have excluded clinical work from meeting inclusion criteria for this review. Nonetheless, this evidence suggests that, suicide-focused groups have great potential for prevention of suicidal symptoms and should be further expanded in the future.
Article
Objective Explicitly addressing suicidality in group therapy is often avoided due to the fear of contagion effects. However, there is some evidence that this fear is not valid. Therefore, the present study aims at contributing to this question by investigating the session-specific effects of two modules on suicidality that are part of the Metacognitive Training for Depression (D-MCT/S). Methods Forty-four patients with depression participated in the two modules on suicidality of the D-MCT/S. Before and after each group session, patients filled out a questionnaire asking for symptoms of suicidality, associated cognitions (e.g., hopelessness), and associated emotions (e.g., anger). Data were analyzed by linear mixed-effect models. Results Approximately 84% of the patients had experienced lifetime suicidal ideation. No within- or between-session effects were found for the modules on suicidality. Sample size was large enough to find small to medium effects (within-session analyses) and medium to large effects (between-session analyses). Conclusion The modules on suicidality did not specifically change suicidal symptoms or associated cognitions and emotions immediately or by the next session. Most importantly, our results disconfirm evidence on deterioration when suicidality is addressed in a highly structured group setting. Whether the current findings also apply to other forms of group therapies needs to be investigated in future studies. • HIGHLIGHTS • Session-specific investigations allow a thoroughly examination of an intervention • Metacognitive Training for Depression showed no contagion effect on suicidality
Article
The delivery of psychological services including screening, assessing, and providing interventions to suicidal individuals occurs within all public and organized care settings where psychologists practice. These services are typically the most demanding and important clinical tasks these psychologists will perform. To inform aspects of such practice, the journal issued a call for papers and 16 of the articles received in response are part of this special issue and reviewed in this Introduction. These articles inform three broad psychological service perspectives: conceptual models and assessment, interventions, and special populations and cultures. From female firefighters and adolescent girls with chronic pain, to our veterans and military personnel and those incarcerated, the samples drawn, studied, and written about in this special issue represent an effort to address our current need for actionable knowledge in this area. The opening section presents four papers on models and assessments, the next considers individual and group interventions and perspectives on access to care, and the final section walks us through a myriad of special populations and cultures to understand facets of the prediction and prevention of suicide.
Article
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Suicidal thoughts and behaviors (STBs) are major public health problems that have not declined appreciably in several decades. One of the first steps to improving the prevention and treatment of STBs is to establish risk factors (i.e., longitudinal predictors). To provide a summary of current knowledge about risk factors, we conducted a meta-analysis of studies that have attempted to longitudinally predict a specific STB-related outcome. This included 365 studies (3,428 total risk factor effect sizes) from the past 50 years. The present random-effects meta-analysis produced several unexpected findings: across odds ratio, hazard ratio, and diagnostic accuracy analyses, prediction was only slightly better than chance for all outcomes; no broad category or subcategory accurately predicted far above chance levels; predictive ability has not improved across 50 years of research; studies rarely examined the combined effect of multiple risk factors; risk factors have been homogenous over time, with 5 broad categories accounting for nearly 80% of all risk factor tests; and the average study was nearly 10 years long, but longer studies did not produce better prediction. The homogeneity of existing research means that the present meta-analysis could only speak to STB risk factor associations within very narrow methodological limits-limits that have not allowed for tests that approximate most STB theories. The present meta-analysis accordingly highlights several fundamental changes needed in future studies. In particular, these findings suggest the need for a shift in focus from risk factors to machine learning-based risk algorithms. (PsycINFO Database Record
Article
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The aim of this study was to explore suicide attempters' experiences of personal stigma. This qualitative study included a focus group of 7 experienced clinicians and semi-structured interviews with 8 suicide attempters. Thematic analysis of the data yielded four main themes: seriousness, care, "badness," and avoidance. Experiences of stigma pervaded all contexts, but were most emotionally upsetting to the participants in interpersonal relationships. The findings show the importance of evaluating stigma for suicide attempters during suicide risk assessment and the need for specifically tailored interventions to combat suicide stigma at the individual level.
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Suicidal patients are difficult and challenging clinical problems. Conceptual tools aid the clinician in organizing and evaluating the clinical situation. The authors provide a framework for suicide risk assessment that emphasizes 2 domains–history of past attempt and the nature of current suicidal symptoms–that have emerged in suicide research as crucial variables. These domains, when combined with other categories of risk factors, produce a categorization of risk for the individual patient, leading, in turn, to relatively routinized clinical decision making and activity. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
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Describes the rationale, development, and validation of the Scale for Suicide Ideation, a 19-item clinical research instrument designed to quantify and assess suicidal intention. In a sample with 90 hospitalized Ss, the scale was found to have high internal consistency and moderately high correlations with clinical ratings of suicidal risk and self-administered measures of self-harm. Furthermore, it was sensitive to changes in levels of depression and hopelessness (Beck Depression Inventory and Hopelessness Scale, respectively) over time. Its construct validity was supported by 2 studies by different investigators testing the relationship between hopelessness, depression, and suicidal ideation and by a study demonstrating a significant relationship between high level of suicidal ideation and "dichotomous" attitudes about life and related concepts on a semantic differential test. Factor analysis yielded 3 meaningful factors: Active Suicidal Desire, Specific Plans for Suicide, and Passive Suicidal Desire. (29 ref)
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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)
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This qualitative study examined the questions of what cancer support groups provide that other supportive relationships do not, and what the self perceived consequences are of support group attendance. Nine representative Australian cancer peer support groups, consisting of a total of 93 interviewees, 75 women, and 18 men, with a mean age of 62, took part in participant observation and focus group interviews, with the data analysed using positioning theory. Support groups were positioned by participants as providing a unique sense of community, unconditional acceptance, and information about cancer and its treatment, in contrast to the isolation, rejection, and lack of knowledge about cancer frequently experienced outside the group. Groups were also positioned as occasionally emotionally challenging, in contrast to the experience of normalising support from family and friends. Increased empowerment and agency were positioned as the most significant consequences of group support, consisting of increased confidence and a sense of control in relation to self, living with cancer, and interactions with others, in particular the medical profession. The support group was also positioned as facilitating positive relationships with family and friends because of relieving their burden of care, by providing a safe space for the expression of emotion. No difference was found between professionally led and peer led support groups, suggesting that it is not the professional background of the leader which is of importance, but whether the group provides a supportive environment, mutuality, and a sense of belonging, and whether it meets the perceived needs of those attending. It is suggested that future research should examine the construction and experience of social support in those who drop out of, or who do not attend, cancer support groups, in order to provide further insight into the contrast between social support within groups and support in other contexts.
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The National Suicide Prevention Lifeline was launched in January 2005. Lifeline, supported by a federal grant from the Substance Abuse and Mental Health Services Administration, consists of a network of more than 120 crisis centers located in communities across the country that are committed to suicide prevention. Lifeline's Certification and Training Subcommittee conducted an extensive review of research and field practices that yielded the Lifeline's Suicide Risk Assessment Standards. The authors of the current paper provide the background on the need for these standards; describe the process that produced them; summarize the research and rationale supporting the standards; review how these standard assessment principles and their subcomponents can be weighted in relation to one another so as to effectively guide crisis hotline workers in their everyday assessments of callers to Lifeline; and discuss the implementation process that will be provided by Lifeline.
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Individuals with a differing number of past suicide attempts are generally considered a homogeneous group, despite emerging evidence to the contrary. The current study aimed to test the hypothesis that multiple suicide attempters would exhibit a more severe clinical profile than single suicide attempters. A series of self-report batteries and clinical interviews was administered to 39 single attempters and 114 multiple attempters who came to an urban hospital emergency room after a suicide attempt. The participants were predominantly poor and nonwhite. Multiple suicide attempters versus single attempters exhibited a greater degree of deleterious background characteristics (e.g., a history of childhood emotional abuse, a history of family suicide), increased psychopathology (e.g., depression, substance abuse), higher levels of suicidality (e.g., ideation), and poorer interpersonal functioning. Profile differences existed even after control for borderline personality disorder. Results indicate that multiple attempters display more severe psychopathology, suicidality, and interpersonal difficulties and are more likely to have histories of deleterious background characteristics than single attempters. Moreover, these differences cannot be explained by the diagnosis of borderline personality disorder. Results suggest that the identification of attempt status is a simple, yet powerful, means of gauging levels of risk and psychopathology.
Article
Background: Past scholarly efforts to describe and measure the stigma surrounding suicide have largely viewed suicide stigma from the perspective of the general public. Aims: In the spirit of community-based participatory research (CBPR), the current study brought together a diverse stakeholder team to qualitatively investigate the suicide stigma as experienced by those most intimately affected by suicide. Method: Seven focus groups (n = 62) were conducted with suicide attempt survivors, family members of those who died by suicide, and suicide loss therapists. Results: Themes were derived for stereotypes (n = 30), prejudice (n = 3), and discrimination (n = 4). People who attempted suicide were seen as attention-seeking, selfish, incompetent, emotionally weak, and immoral. Participants described personal experiences of prejudice and discrimination, including those with health professionals. Conclusion: Participants experienced public stigma, self-stigma, and label avoidance. Analyses reveal that the stigma of suicide shares similarities with stereotypes of mental illness, but also includes some important differences. Attempt survivors may be subject to double stigma, which impedes recovery and access to care.
Article
Objective: While suicide attempt history is considered to robustly predict completed suicide, previous studies have limited generalizability because of using convenience samples of specific methods/treatment settings, disregarding previous attempts, or overlooking first-attempt deaths. Eliminating these biases should more accurately estimate suicide prevalence in attempters. Method: This observational retrospective-prospective cohort study using the Rochester Epidemiology Project identified 1,490 (males, N=555; females, N=935) Olmsted County residents making index suicide attempts (first lifetime attempts reaching medical attention) between January 1, 1986, and December 31, 2007. The National Death Index identified suicides between enrollment and December 31, 2010 (follow-up 3-25 years). Medical records were queried for sex, age, method, and follow-up care for index attempt survivors. Coroner records yielded data on index attempt deaths. Results: During the study period, 81/1,490 enrollees (5.4%) died by suicide. Of the 81, 48 (59.3%) perished on index attempt; 27 of the surviving 33 index attempt survivors (81.8%) killed themselves within a year. Males were disproportionately represented: 62/81 (11.2% of men, 76.5% of suicides) compared with 19/81 (2.0% of women, 23.5% of suicides). Of dead index attempters, 72.9% used guns, yielding an odds ratio for gunshot death, compared with all other methods, of 140 (95% CI=60-325). When adjusted for covariates, survivors given follow-up psychiatric appointments had significantly lower likelihood of subsequent suicide (odds ratio=0.212, 95% CI=0.089-0.507). Conclusions: At 5.4%, completed suicide prevalence in this community cohort of suicide attempters was almost 59% higher than previously reported. An innovative aspect of this study explains the discrepancy: by including index attempt deaths-approximately 60% of total suicides-suicide prevalence more than doubled. We contend that counting both index and subsequent attempt deaths more accurately reflects prevalence. Our findings support suicide attempt as an even more lethal risk factor for completed suicide than previously thought. Research should focus on identifying risk factors for populations vulnerable to making first attempts and target risk reduction in those groups.
Article
Empirically informed suicide risk assessment frameworks are useful in guiding the evaluation and treatment of individuals presenting with suicidal symptoms. Joiner et al. (1999) formulated one such framework, which has provided a concise heuristic for the assessment of suicide risk. The purpose of this review is to ensure compatibility of this suicide risk assessment framework with the growing literature on suicide-related behaviors. This review integrates recent literature on suicide risk factors and clinical applications into the existing model. Further, we present a review of risk factors not previously included in the Joiner et al. (1999) framework, such as the interpersonal theory of suicide variables of perceived burdensomeness, thwarted belongingness, and capability for suicide (Joiner, 2005; Van Orden et al., 2010) and acute symptoms of suicidality (i.e., agitation, irritability, weight loss, sleep disturbances, severe affective states, and social withdrawal). These additional indicators of suicide risk further facilitate the classification of patients into standardized categories of suicide risk severity and the critical clinical decision making needed for the management of such risk. To increase the accessibility of empirically informed risk assessment protocols for suicide prevention and treatment, an updated suicide risk assessment form and decision tree are provided. © 2015 Wiley Periodicals, Inc.
Article
The purpose of this article is to describe feasibility, safety, and outcome results from a treatment development trial of the SAFETY Program, a brief intervention designed for integration with emergency services for suicide-attempting youths. Suicide-attempting youths, ages 11 to 18, were enrolled in a 12-week trial of the SAFETY Program, a cognitive-behavioral family intervention designed to increase safety and reduce suicide attempt (SA) risk (N = 35). Rooted in a social-ecological cognitive-behavioral model, treatment sessions included individual youth and parent session-components, with different therapists assigned to youths and parents, and family session-components to practice skills identified as critical in the pathway for preventing repeat SAs in individual youths. Outcomes were evaluated at baseline, 3-month, and 6-month follow-ups. At the 3-month posttreatment assessment, there were statistically significant improvements on measures of suicidal behavior, hopelessness, youth and parent depression, and youth social adjustment. There was one reported SA by 3 months and another by 6 months, yielding cumulative attempt rates of 3% and 6% at 3 and 6 months, respectively. Treatment satisfaction was high. Suicide-attempting youths are at high risk for repeat attempts and continuing mental health problems. Results support the value of a randomized controlled trial to further evaluate the SAFETY intervention. Extension of treatment effects to parent depression and youth social adjustment are consistent with our strong family focus and social-ecological model of behavior change.
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The phrase primum non nocere ("first, do no harm") is a well-accepted credo of the medical and mental health professions. Although emerging data indicate that several psychological treatments may produce harm in significant numbers of individuals, psychologists have until recently paid little attention to the problem of hazardous treatments. I critically evaluate and update earlier conclusions regarding deterioration effects in psychotherapy, outline methodological obstacles standing in the way of identifying potentially harmful therapies (PHTs), provide a provisional list of PHTs, discuss the implications of PHTs for clinical science and practice, and delineate fruitful areas for further research on PHTs. A heightened emphasis on PHTs should narrow the scientist-practitioner gap and safeguard mental health consumers against harm. Moreover, the literature on PHTs may provide insight into underlying mechanisms of change that cut across many domains of psychotherapy. The field of psychology should prioritize its efforts toward identifying PHTs and place greater emphasis on potentially dangerous than on empirically supported therapies. © 2007 Association for Psychological Science.
Article
The use of violence in a suicide attempt and its medical consequences can be used to characterize specific subpopulations of suicide attempters that could be at higher risk of ever completing suicide. A population of 1,148 suicide attempters was consecutively recruited from 2001 to 2010. Violent suicide attempts were classified using Asberg's criteria. An overdose requiring hospitalization in an intensive care unit was considered a serious suicide attempt. In this exploratory study, we retrospectively compared 183 subjects who made a serious suicide attempt, 226 that made a violent suicide attempt, and 739 without any history of serious or violent suicide attempts with regard to demographic, clinical, and psychological characteristics and features of the suicide attempts using univariate and multivariate analyses. In comparison with subjects whose attempts were neither violent nor serious, violent attempters and serious attempters were more likely to make repeated suicide attempts (OR = 3.27 [95% CI, 1.39-7.70] and OR = 2.66 [95% CI, 1.29-5.50], respectively), with higher medical lethality (OR = 6.66 [95% CI, 4.74-9.38] and OR = 3.91 [95% CI, 2.89-5.29], respectively). Additionally, violent attempts were associated with male gender (OR = 6.79; 95% CI, 3.59-12.82) and family history of suicidal behavior (particularly if serious or violent: OR = 6.96; 95% CI, 2.82-17.20), and serious attempters were more likely to be older (OR = 1.49, 95% CI, 1.12-1.99). One of every 3 attempters in our sample had made violent or serious suicide attempts in their lifetime. Violent attempters and serious attempters presented differential characteristics, closer to those of suicide completers, compared to the rest of the sample.
Article
We examined the impact of the implementation of Applied Suicide Intervention Skills Training (ASIST) across the National Suicide Prevention Lifeline's national network of crisis hotlines. Data were derived from 1,507 monitored calls from 1,410 suicidal individuals to 17 Lifeline centers in 2008-2009. Callers were significantly more likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful by the end of calls handled by ASIST-trained counselors. Few significant changes in ASIST-trained counselors' interventions emerged; however, improvements in callers' outcomes were linked to ASIST-related counselor interventions, including exploring reasons for living and informal support contacts. ASIST training did not yield more comprehensive suicide risk assessments.
Article
The usual care for suicidal patients who are seen in the emergency department (ED) and other emergency settings is to assess level of risk and refer to the appropriate level of care. Brief psychosocial interventions such as those administered to promote lower alcohol intake or to reduce domestic violence in the ED are not typically employed for suicidal individuals to reduce their risk. Given that suicidal patients who are seen in the ED do not consistently follow up with recommended outpatient mental health treatment, brief ED interventions to reduce suicide risk may be especially useful. We describe an innovative and brief intervention, the Safety Planning Intervention (SPI), identified as a best practice by the Suicide Prevention Resource Center/American Foundation for Suicide Prevention Best Practices Registry for Suicide Prevention (www.sprc.org), which can be administered as a stand-alone intervention. The SPI consists of a written, prioritized list of coping strategies and sources of support that patients can use to alleviate a suicidal crisis. The basic components of the SPI include (a) recognizing warning signs of an impending suicidal crisis; (b) employing internal coping strategies; (c) utilizing social contacts and social settings as a means of distraction from suicidal thoughts; (d) utilizing family members or friends to help resolve the crisis; (e) contacting mental health professionals or agencies; and (f) restricting access to lethal means. A detailed description of SPI is described and a case example is provided to illustrate how the SPI may be implemented.
Article
The progressively rigorous methodological requirements of conducting clinical trials of behavioral treatments has placed a large burden on individual investigators, as treatment manuals, methods of evaluating treatment quality and fidelity, and persuasive evidence of the treatment's promise are now virtual requirements of receiving support for conducting a clinical trial of a new or adapted treatment. A Stage Model of Behavioral Therapies research, by articulating the progressive stages of development and evaluation for behavioral treatments, recognizes the scientific merit and need for support for treatment development and initial evaluation designated as stage I. This article describes the conduct of stage I research, including issues addressed in stage I research, major design decisions confronted by investigators, the close relationship of stage I to stage II research and proposes a time line for stage I research.
Article
Suicidal behavior is a major problem worldwide and, at the same time, has received relatively little empirical attention. This relative lack of empirical attention may be due in part to a relative absence of theory development regarding suicidal behavior. The current article presents the interpersonal theory of suicidal behavior. We propose that the most dangerous form of suicidal desire is caused by the simultaneous presence of two interpersonal constructs-thwarted belongingness and perceived burdensomeness (and hopelessness about these states)-and further that the capability to engage in suicidal behavior is separate from the desire to engage in suicidal behavior. According to the theory, the capability for suicidal behavior emerges, via habituation and opponent processes, in response to repeated exposure to physically painful and/or fear-inducing experiences. In the current article, the theory's hypotheses are more precisely delineated than in previous presentations (Joiner, 2005), with the aim of inviting scientific inquiry and potential falsification of the theory's hypotheses.
Article
The Schematic Appraisals Model of Suicide (SAMS) suggests that positive self-appraisals may be important for buffering suicidal thoughts and behaviours, potentially providing a key source of resilience. The current study aimed to explore whether positive self-appraisals buffered individuals from suicidality in the face of stressful life events. 78 participants who reported experiencing some degree of suicidality were recruited from a student population. They completed a battery of questionnaires including measures of suicidality, stressful life events and positive self-appraisals. Positive self-appraisals moderated the association between stressful life events and suicidality. For those reporting moderate or high levels of positive self-appraisals, raised incidence of stressful life events did not lead to increases in suicidality. These results support the SAMS framework, and suggest that positive self-appraisals may confer resilience to suicide. Positive self-appraisals may be a promising avenue for further resilience research, and an important area to target for suicide interventions.
Article
This paper reports the results of a pilot study of a 20-week outpatient Psychosocial/Psychoeducational Intervention for Persons with Recurrent Suicide Attempts (PISA) targeting potential risk factors and areas of deficit, including cognitive, affective, and impulsivity known to characterize persons with recurrent suicide-related behavior. One hundred sixty-three persons completed the 20-week intervention. Self-report questionnaires related to psychological deficits and risk factors associated with suicide-related behavior were given to participants before and after the intervention. Descriptive and paired t tests were performed using SPSS 15. This pilot study demonstrated that a 20-week group intervention led to significant pregroup and postgroup reductions in the risk factors associated with suicide-related behavior. Risk factors included cognitive factors: Beck Hopelessness Scale (P=.006), Satisfaction With Life Scale (P=.001), Problem Solving Inventory (P=.008); affective factors: Beck Depression Inventory (P=.018), Toronto Alexithymia Scale (P=.001); and impulsivity factors: Barratt Impulsivity Scale (P=.034). Findings in this pilot study suggest that participants in this short-term intervention report changes in identified risk factors and psychological deficits. These modest changes may be an important first step that facilitates persons at high-risk for suicide to access additional mental health services.
Article
In 1984, Jacobson, Follette, and Revenstorf defined clinically significant change as the extent to which therapy moves someone outside the range of the dysfunctional population or within the range of the functional population. In the present article, ways of operationalizing this definition are described, and examples are used to show how clients can be categorized on the basis of this definition. A reliable change index (RC) is also proposed to determine whether the magnitude of change for a given client is statistically reliable. The inclusion of the RC leads to a twofold criterion for clinically significant change.
Article
To document mortality in a consecutive series of 302 individuals who made medically serious suicide attempts and were followed-up for 5 years. All sources of mortality were examined in a 5 year prospective study of 302 individuals who made medically serious suicide attempts. Mortality data were obtained by checks with the national mortality database and, for suicide and accidental deaths, were confirmed by review of coronial records. Within 5 years of making a medically serious suicide attempt, one in 11 (8.9%) participants had died. Most deaths (59.2%) were by suicide. Comparison of mortality in this series with rates expected in a comparable general population sample showed the excess mortality was attributable to death by suicide and by motor vehicle accidents. Mortality among those who make medically serious suicide attempts is high. These findings imply the need for the development of enhanced and long-term treatment, follow-up and surveillance programmes for those who make medically serious suicide attempts.
Article
Worldwide, almost a million people die by suicide each year. Intentional, nonfatal, self-inflicted injury, including both suicide attempts and acts without suicide intent, also has very high prevalence. This article provides a practice-friendly review of controlled studies of psychosocial treatments aiming to prevent suicide, attempted suicide, and nonsuicidal self-inflicted injuries. Despite relatively small sample sizes for a low-base-rate outcome such as self-inflicted injury, several psychotherapies have been found effective, including cognitive therapy, dialectical behavior therapy, problem-solving therapy, and interpersonal psychotherapy, as well as outreach interventions, such as sending caring letters. The clinical implications of the review are discussed with the goal of translating the science to service-particularly the importance of outreach and treatment of non-compliance, the assessment and management of suicide risk, and competency in effective psychotherapies. These are critical steps for clinical psychology and psychotherapists to take in their role in suicide prevention.
Article
This study was undertaken in order to estimate the incidence of repetition of suicide attempt, suicide and all deaths, and to analyse the influence of psychiatric illness and socio-demographic factors on these. The study is a Danish register-based survival analysis that retrieved personal data on socio-economic, psychiatric and mortality conditions from various registers. Hazards were estimated using Cox regression with a time-dependence covariate. Suicide-attempters (2.614) and non-attempters (39.210)were analysed being matched by gender, age and place of residence. The average follow-up period for suicide-attempters was 3.88 years, during which 271 (10.37%) of them died. By comparison, death occurred four times more often among suicide-attempters than among non-attempters. Suicide was far more common among attempters (61, 2.33%) than among non-attempters (16, 0.04%). A proportion of the attempters (31.33%) repeated their attempt within the follow-up period. The most reliable predictors for suicide and death were repetition, suicide attempt method and treatment for mental illness. The most reliable predictors for repetition were age, gender and mental illness. Individuals with a history of suicide attempts form a well-defined high-risk group for suicide, and are in need of treatment immediately after the episode. Somatic and psychiatric staff must be informed about the risk factors for subsequent suicidal behaviour after an episode of attempted suicide. Furthermore, departments that are in contact with suicidal individuals need action plans to ensure that all such individuals are discharged to proper treatment immediately after the suicide attempt.
Article
The objective of this paper was to evaluate the Cry of Pain model of suicide behaviour as applied to psychosis and to derive theoretically driven guidelines for prevention. Suicide risk in psychotic patients is a serious but poorly understood clinical and social problem. There is a dearth of psychological models to explain suicidal behaviour and to guide effective preventative clinical interventions. Understanding suicidal behaviour in psychosis may be facilitated by utilizing models from depression. The 'Cry of Pain' model of suicide is founded on an evolutionary approach to understanding suicidal behaviour in depression. The model was critically evaluated and relevant literature reviewed. Although strengths of the model were identified, lack of clarity regarding the concepts of defeat, entrapment, and lack of rescue appeared to limit its theoretical and clinical utility. We suggest a modification to this model which replaces concepts of defeat, entrapment, and lack of rescue with a four-stage appraisal process in conjunction with information-processing biases and suicidal schema. Methods of testing this model are suggested and guidelines for a clinical intervention (Cognitive Behavioural Suicide Prevention for Psychosis; CBSPp) are outlined.
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