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From Understanding Suicide Risk to Preventing Suicide
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From Understanding Suicide Risk to Preventing Suicide

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 January 2017) | Viewed by 137614

Special Issue Editors

Prof. Dr. Rory O’Connor

E-Mail Website
Guest Editor
Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 0XH, UK
Interests: suicide; self-harm; psychological risk and protective factors; intervention; theories of suicide
Prof. Dr. Gwendolyn Portzky

E-Mail Website
Guest Editor
Unit for Suicide Research, Department of Psychiatry, University Hospital, Gent, Belgium
Interests: suicidal behaviour; epidemiology; risk and protective factors; prevention

Special Issue Information

Dear Colleagues,

Suicide and attempted suicide are major public health concerns. Across the globe, at least 804,000 people take their own lives annually. In recent decades, there have been many welcomed advances in understanding and preventing suicide, as well as good progress in intervening with those who have attempted suicide. Despite these advances, though, there are many gaps in our knowledge. There is also general consensus that suicide prevention efforts, to be effective, should be interdisciplinary in nature. In this Special Issue, therefore, we welcome submissions that describe research that is interdisciplinary in its design, conduct or dissemination. We encourage those involved in suicide research and prevention to consider submitting research that addresses a key gap in the field or addresses one of the following topics: risk and protective factors for suicidal ideation or behaviour; psychological, psychosocial or neurobiological interventions to reduce suicide risk; testing theoretical models of suicide ideation and behaviour; and innovative methods to advance the understanding of suicide risk; and examining effectiveness of preventive strategies. Crucially, though, we are keen to publish innovative research irrespective of discipline or research methodology. As noted above, we envisage submissions that span the breadth of suicide research from basic science approaches (including understanding the suicidal process) to the development of preventive strategies and interventions (including public health preventive strategies, as well as interventions delivered to high-risk groups).

Prof. Dr. Rory O’Connor
Prof. Dr. Gwendolyn Portzky
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Suicide
  • Self-harm
  • Risk and protective factors
  • Psychological and psychosocial interventions
  • Primary and secondary prevention
  • Translating evidence into practice

Published Papers (21 papers)

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805 KiB  
Article
Functional Coping Dynamics and Experiential Avoidance in a Community Sample with No Self-Injury vs. Non-Suicidal Self-Injury Only vs. Those with Both Non-Suicidal Self-Injury and Suicidal Behaviour
by Emma Nielsen, Kapil Sayal and Ellen Townsend
Int. J. Environ. Res. Public Health 2017, 14(6), 575; https://doi.org/10.3390/ijerph14060575 - 29 May 2017
Cited by 22 | Viewed by 4919
Abstract
Although emotional avoidance may be a critical factor in the pathway from psychological distress to self-injury and/or suicidality, little is known about the relative importance of differing functional coping dynamics and experiential avoidance between people with self-injury histories of differing intent (e.g., Non-Suicidal [...] Read more.
Although emotional avoidance may be a critical factor in the pathway from psychological distress to self-injury and/or suicidality, little is known about the relative importance of differing functional coping dynamics and experiential avoidance between people with self-injury histories of differing intent (e.g., Non-Suicidal Self-Injury only vs. Non-Suicidal Self-Injury plus Suicidal Behaviour; NSSI vs. NSSI + SB). A community-based survey (N = 313; female, 81%; ages 16–49 years, M = 19.78, SD = 3.48) explored self-reported experiential avoidance and functional coping dynamics in individuals with (i) no self-injury history (controls); (ii) a history of NSSI only; and (iii) a history of NSSI + SB. Jonckheere-Terpstra trend tests indicated that avoidance coping was higher in the NSSI and NSSI + SB groups than in controls. Emotion regulation was higher in controls than those with a history of self-injury (NSSI and NSSI + SB). Approach and reappraisal coping demonstrated significant ordered effects such that control participants were higher in these coping dynamics than those with a history of NSSI only, who, in turn, were higher than those with a history of NSSI + SB (Control > NSSI > NSSI + SB). Endorsement of the reappraisal/denial facet of experiential avoidance was most pronounced in those with a history of NSSI + SB (Control < NSSI < NSSI + SB). No significant ordered effects were observed for other dimensions of experiential avoidance. Understanding how the endorsement of functional coping dynamics and which components of experiential avoidance vary between groups with differing self-injury intent histories has important implications for treatment planning. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)
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308 KiB  
Article
Does Unstable Employment Have an Association with Suicide Rates among the Young?
by Chungah Kim and Youngtae Cho
Int. J. Environ. Res. Public Health 2017, 14(5), 470; https://doi.org/10.3390/ijerph14050470 - 28 Apr 2017
Cited by 18 | Viewed by 5020
Abstract
Although a growing body of literature has indicated that unemployment has a positive association with suicide, the dynamic aspects of unstable employment have not yet been considered in suicidology. This study explored the association between employment stability and completed suicide among people aged [...] Read more.
Although a growing body of literature has indicated that unemployment has a positive association with suicide, the dynamic aspects of unstable employment have not yet been considered in suicidology. This study explored the association between employment stability and completed suicide among people aged 25–34 years in 20 OECD (Organization for Economic Cooperation and Development) countries with time-series data (1994–2010). In order to consider the different aspects of unstable employment, we tested the impacts of employment protection legislation indicators as another proxy of job insecurity (employed, but unstable) apart from unemployment rates. Covariates, including economic growth rates, GDP per capita, fertility rates, and divorce rate, were controlled for. The analysis was designed to be gender- and age-specific, where observations with ages of 25–29 were separated from those with ages of 30–34. Random effect models were applied to examine changes over time in suicide rates, and other models were presented to check robustness. The results showed that it is a low level of employment protection, rather than unemployment itself, that was associated with increased suicide rates among all of the studied populations. The magnitude of the effect differed by gender. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)
624 KiB  
Article
Socio-Economic Position and Suicidal Ideation in Men
by Jane Pirkis, Dianne Currier, Peter Butterworth, Allison Milner, Anne Kavanagh, Holly Tibble, Jo Robinson and Matthew J. Spittal
Int. J. Environ. Res. Public Health 2017, 14(4), 365; https://doi.org/10.3390/ijerph14040365 - 31 Mar 2017
Cited by 14 | Viewed by 7601
Abstract
People in low socio-economic positions are over-represented in suicide statistics and are at heightened risk for non-fatal suicidal thoughts and behaviours. Few studies have tried to tease out the relationship between individual-level and area-level socio-economic position, however. We used data from Ten to [...] Read more.
People in low socio-economic positions are over-represented in suicide statistics and are at heightened risk for non-fatal suicidal thoughts and behaviours. Few studies have tried to tease out the relationship between individual-level and area-level socio-economic position, however. We used data from Ten to Men (the Australian Longitudinal Study on Male Health) to investigate the relationship between individual-level and area-level socio-economic position and suicidal thinking in 12,090 men. We used a measure of unemployment/employment and occupational skill level as our individual-level indicator of socio-economic position. We used the Index of Relative Socio-Economic Disadvantage (a composite multidimensional construct created by the Australian Bureau of Statistics that combines information from a range of area-level variables, including the prevalence of unemployment and employment in low skilled occupations) as our area-level indicator. We assessed suicidal thinking using the Patient Health Questionnaire (PHQ-9). We found that even after controlling for common predictors of suicidal thinking; low individual-level and area-level socio-economic position heightened risk. Individual-level socio-economic position appeared to exert the greater influence of the two; however. There is an onus on policy makers and planners from within and outside the mental health sector to take individual- and area-level socio-economic position into account when they are developing strategic initiatives. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)
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963 KiB  
Article
The Promise and the Challenge of Technology-Facilitated Methods for Assessing Behavioral and Cognitive Markers of Risk for Suicide among U.S. Army National Guard Personnel
by Brian R. W. Baucom, Panayiotis Georgiou, Craig J. Bryan, Eric L. Garland, Feea Leifker, Alexis May, Alexander Wong and Shrikanth S. Narayanan
Int. J. Environ. Res. Public Health 2017, 14(4), 361; https://doi.org/10.3390/ijerph14040361 - 31 Mar 2017
Cited by 7 | Viewed by 4921
Abstract
Suicide was the 10th leading cause of death for Americans in 2015 and rates have been steadily climbing over the last 25 years. Rates are particularly high amongst U.S. military personnel. Suicide prevention efforts in the military are significantly hampered by the lack [...] Read more.
Suicide was the 10th leading cause of death for Americans in 2015 and rates have been steadily climbing over the last 25 years. Rates are particularly high amongst U.S. military personnel. Suicide prevention efforts in the military are significantly hampered by the lack of: (1) assessment tools for measuring baseline risk and (2) methods to detect periods of particularly heightened risk. Two specific barriers to assessing suicide risk in military personnel that call for innovation are: (1) the geographic dispersion of military personnel from healthcare settings, particularly amongst components like the Reserves; and (2) professional and social disincentives to acknowledging psychological distress. The primary aim of this paper is to describe recent technological developments that could contribute to risk assessment tools that are not subject to the limitations mentioned above. More specifically, Behavioral Signal Processing can be used to assess behaviors during interaction and conversation that likely indicate increased risk for suicide, and computer-administered, cognitive performance tasks can be used to assess activation of the suicidal mode. These novel methods can be used remotely and do not require direct disclosure or endorsement of psychological distress, solving two challenges to suicide risk assessment in military and other sensitive settings. We present an introduction to these technologies, describe how they can specifically be applied to assessing behavioral and cognitive risk for suicide, and close with recommendations for future research. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)
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900 KiB  
Article
Pathways to Suicide in Australian Farmers: A Life Chart Analysis
by Lisa Kunde, Kairi Kõlves, Brian Kelly, Prasuna Reddy and Diego De Leo
Int. J. Environ. Res. Public Health 2017, 14(4), 352; https://doi.org/10.3390/ijerph14040352 - 28 Mar 2017
Cited by 45 | Viewed by 8658
Abstract
Farmers have been found to be at increased risk of suicide in Australia. The Interpersonal-Psychological Theory of Suicidal Behaviour suggests that the proximal factors leading to the suicidal desire or ideation include an individual’s experiences of both perceived burdensomeness and thwarted belongingness. Suicidal [...] Read more.
Farmers have been found to be at increased risk of suicide in Australia. The Interpersonal-Psychological Theory of Suicidal Behaviour suggests that the proximal factors leading to the suicidal desire or ideation include an individual’s experiences of both perceived burdensomeness and thwarted belongingness. Suicidal desire with acquired capability to engage in lethal self-injury is predictive of suicidal behaviour. This study investigates the pathways to suicide of 18 Australian male farmers in order to understand the suicidal process and antecedents to suicide in Australian male farmers. The psychological autopsy (PA) method was used to generate life charts. Two pathways with distinct suicidal processes were identified: acute situational (romantic relationship problems and financial concerns/pending retirement) and protracted (long-term psychiatric disorder). Long working hours, interpersonal conflicts, physical illnesses and pain, alcohol abuse, access to firearms, and exposure to drought were additional common factors identified. An understanding of the interrelatedness of diverse distal and proximal risk factors on suicidal pathways in the wider environmental context for male farmers is required when developing and implementing rural suicide prevention activities. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)
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1270 KiB  
Article
Improving Suicide Prevention in Dutch Regions by Creating Local Suicide Prevention Action Networks (SUPRANET): A Study Protocol
by Renske Gilissen, Derek De Beurs, Jan Mokkenstorm, Saskia Mérelle, Gé Donker, Sanne Terpstra, Carla Derijck, The SUPRANET (Suicide Prevention Action Network) Research Group and Gerdien Franx
Int. J. Environ. Res. Public Health 2017, 14(4), 349; https://doi.org/10.3390/ijerph14040349 - 28 Mar 2017
Cited by 12 | Viewed by 6474
Abstract
The European Alliance against Depression (EAAD) program is to be introduced in The Netherlands from 2017 onwards. This program to combat suicide consists of interventions on four levels: (1) increasing the awareness of suicide by local media campaigns; (2) training local gatekeepers, such [...] Read more.
The European Alliance against Depression (EAAD) program is to be introduced in The Netherlands from 2017 onwards. This program to combat suicide consists of interventions on four levels: (1) increasing the awareness of suicide by local media campaigns; (2) training local gatekeepers, such as teachers or police officers; (3) targeting high-risk persons in the community; and (4) training and support of professionals in primary care settings. The implementation starts in seven Dutch pilot regions. Each region is designated as a Suicide Prevention Action NETwork (SUPRANET). This paper describes the SUPRANET program components and the evaluation of its feasibility and impact. The findings will be used to facilitate the national implementation of EAAD in The Netherlands and to add new findings to the existing literature on EAAD. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)
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325 KiB  
Article
The Economic Cost of Suicide and Non-Fatal Suicide Behavior in the Australian Workforce and the Potential Impact of a Workplace Suicide Prevention Strategy
by Irina Kinchin and Christopher M. Doran
Int. J. Environ. Res. Public Health 2017, 14(4), 347; https://doi.org/10.3390/ijerph14040347 - 27 Mar 2017
Cited by 59 | Viewed by 8248
Abstract
Suicide and non-fatal suicide behavior (NFSB) are significant problems faced by most countries. The objective of this research is to quantify the economic cost of suicide and NFSB in the Australian workforce and to examine the potential impact of introducing a workplace suicide [...] Read more.
Suicide and non-fatal suicide behavior (NFSB) are significant problems faced by most countries. The objective of this research is to quantify the economic cost of suicide and NFSB in the Australian workforce and to examine the potential impact of introducing a workplace suicide prevention intervention to reduce this burden. The analysis used the best available suicide data, a well-established costing methodology, and a proven workplace intervention. In 2014, 903 workers died by suicide, 2303 workers harmed themselves resulting in full incapacity, and 11,242 workers harmed themselves resulting in a short absence from work. The present value of the economic cost of suicide and NFSB is estimated at $6.73 billion. Our analysis suggests the economic benefit of implementing a universal workplace strategy would considerably outweigh the cost of the strategy. For every one dollar invested, the benefits would be in excess of $1.50 ($1.11–$3.07), representing a positive economic investment. All variations of the key parameter hold the positive benefit-cost ratio. Rates of suicide and NFSB are far too high in Australia and elsewhere. More needs to be done to reduce this burden. Although workplace strategies are appropriate for those employed, these interventions must be used within a multifaceted approach that reflects the complex nature of self-harming behavior. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)
319 KiB  
Article
Associations among Substance Use, Mental Health Disorders, and Self-Harm in a Prison Population: Examining Group Risk for Suicide Attempt
by Madison L. Gates, Asher Turney, Elizabeth Ferguson, Veronica Walker and Michelle Staples-Horne
Int. J. Environ. Res. Public Health 2017, 14(3), 317; https://doi.org/10.3390/ijerph14030317 - 20 Mar 2017
Cited by 34 | Viewed by 8107
Abstract
Substance use disorders (SUD) and mental health disorders are significant public health issues that co-occur and are associated with high risk for suicide attempts. SUD and mental health disorders are more prevalent among offenders (i.e., prisoners or inmates) than the non-imprisoned population, raising [...] Read more.
Substance use disorders (SUD) and mental health disorders are significant public health issues that co-occur and are associated with high risk for suicide attempts. SUD and mental health disorders are more prevalent among offenders (i.e., prisoners or inmates) than the non-imprisoned population, raising concerns about the risk of self-harm. This cross-sectional study examined the population of a state prison system (10,988 out of 13,079) to identify associations among SUD (alcohol, cannabis, intravenous drugs, narcotics, and tobacco smoking), mental health disorders (anxiety, bipolar, depression, and psychotic disorders), and suicide attempts. The primary aim was to determine which groups (SUD, mental health disorders, and co-occurrences) were strongly association with suicide attempts. Groups with a documented SUD or mental health disorders compared to peers without these issues had 2.0 and 9.2 greater odds, respectively, for attempting suicide, which was significant at p < 0.0001 for both conditions. There were also significant differences within SUD and mental health disorders groups in regard to suicide attempts. Groups with the greatest odds for suicide attempts were offenders with comorbid bipolar comorbid and anxiety, alcohol combined with depression, and cannabis co-occurring with depression. Documentation of suicide attempts during imprisonment indicates awareness, but also suggest a need to continue enhancing screening and evaluating environmental settings. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)
324 KiB  
Article
Risk of Suicide and Dysfunctional Patterns of Personality among Bereaved Substance Users
by Laura Masferrer and Beatriz Caparrós
Int. J. Environ. Res. Public Health 2017, 14(3), 316; https://doi.org/10.3390/ijerph14030316 - 20 Mar 2017
Cited by 9 | Viewed by 4338
Abstract
Background: Research has shown that suicide is a phenomenon highly present among the drug dependent population. Different studies have demonstrated an upraised level of comorbidity between personality disorders (PD) and substance use disorders (SUD). This study aimed to describe which PDs are [...] Read more.
Background: Research has shown that suicide is a phenomenon highly present among the drug dependent population. Different studies have demonstrated an upraised level of comorbidity between personality disorders (PD) and substance use disorders (SUD). This study aimed to describe which PDs are more frequent among those patients with a risk of suicide. Methods: The study was based on a consecutive non-probabilistic convenience sample of 196 bereaved patients attended to in a Public Addiction Center in Girona (Spain). Sociodemographic data, as well as suicide and drug related characteristics were recorded. The risk of suicide was assessed with the Spanish version of “Risk of suicide”. Personality disorders were measured with the Spanish version of Millon Multiaxial Clinical Inventory. Results: The PDs more associated with the presence of risk of suicide were depressive, avoidant, schizotypal and borderline disorders. However, the histrionic, narcissistic and compulsive PDs are inversely associated with risk of suicide even though the narcissistic scale had no statistical correlation. Conclusions: The risk of suicide is a significant factor to take into account related to patients with SUD and especially with the presence of specific PDs. These findings underline the importance of diagnosing and treating rigorously patients with SUD. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)
384 KiB  
Article
Clinical Prediction of Suicide and Undetermined Death: A Pseudo-Prospective Clinical and Medico-Legal Study of Substance Abusers
by Louise Brådvik, Mats Berglund, Arne Frank and Peter Löwenhielm
Int. J. Environ. Res. Public Health 2017, 14(3), 310; https://doi.org/10.3390/ijerph14030310 - 17 Mar 2017
Cited by 3 | Viewed by 5323
Abstract
This study examines aspects of prediction of suicide and death of undetermined intent. We investigated all consecutive, autopsied patients between 1993 and 1997 who had been in contact with the Addiction Centre in Malmö from 1968 onwards. The staff was asked, shortly after [...] Read more.
This study examines aspects of prediction of suicide and death of undetermined intent. We investigated all consecutive, autopsied patients between 1993 and 1997 who had been in contact with the Addiction Centre in Malmö from 1968 onwards. The staff was asked, shortly after autopsy but before they knew of the manner of death, if they thought the patient had committed suicide. The case records were blindly evaluated, and toxicological autopsy findings for alcohol in blood samples investigated. The specificity of prediction was 83% and significantly more often correct than the sensitivity, which was only 45% for suicide and for suicide/death of undetermined intent (93% versus 39%). Suicidal communication was more often considered non-serious before death of undetermined intent than before suicide. The former could be predicted by ideation but not by suicide attempt reported in case records, unlike suicide, which was predicted by both. The undetermined group also showed higher levels of alcohol in the blood at autopsy. We concluded that more serious clinical investigation of suicidal feelings, which may be hidden and not taken seriously, and treatment of alcohol use disorders with active follow-up appear urgent in the efforts to prevent suicide. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)
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309 KiB  
Article
The Social Norms of Suicidal and Self-Harming Behaviours in Scottish Adolescents
by Jody Quigley, Susan Rasmussen and John McAlaney
Int. J. Environ. Res. Public Health 2017, 14(3), 307; https://doi.org/10.3390/ijerph14030307 - 15 Mar 2017
Cited by 9 | Viewed by 6043
Abstract
Although the suicidal and self-harming behaviour of individuals is often associated with similar behaviours in people they know, little is known about the impact of perceived social norms on those behaviours. In a range of other behavioural domains (e.g., alcohol consumption, smoking, eating [...] Read more.
Although the suicidal and self-harming behaviour of individuals is often associated with similar behaviours in people they know, little is known about the impact of perceived social norms on those behaviours. In a range of other behavioural domains (e.g., alcohol consumption, smoking, eating behaviours) perceived social norms have been found to strongly predict individuals’ engagement in those behaviours, although discrepancies often exist between perceived and reported norms. Interventions which align perceived norms more closely with reported norms have been effective in reducing damaging behaviours. The current study aimed to explore whether the Social Norms Approach is applicable to suicidal and self-harming behaviours in adolescents. Participants were 456 pupils from five Scottish high-schools (53% female, mean age = 14.98 years), who completed anonymous, cross-sectional surveys examining reported and perceived norms around suicidal and self-harming behaviour. Friedman’s ANOVA with post-hoc Wilcoxen signed-ranks tests indicated that proximal groups were perceived as less likely to engage in or be permissive of suicidal and self-harming behaviours than participants’ reported themselves, whilst distal groups tended towards being perceived as more likely to do so. Binary logistic regression analyses identified a number of perceived norms associated with reported norms, with close friends’ norms positively associated with all outcome variables. The Social Norms Approach may be applicable to suicidal and self-harming behaviour, but associations between perceived and reported norms and predictors of reported norms differ to those found in other behavioural domains. Theoretical and practical implications of the findings are considered. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)
306 KiB  
Article
Knowledge, Self-Confidence and Attitudes towards Suicidal Patients at Emergency and Psychiatric Departments: A Randomised Controlled Trial of the Effects of an Educational Poster Campaign
by Renate Van Landschoot, Gwendolyn Portzky and Kees Van Heeringen
Int. J. Environ. Res. Public Health 2017, 14(3), 304; https://doi.org/10.3390/ijerph14030304 - 14 Mar 2017
Cited by 13 | Viewed by 6105
Abstract
Educational posters are used to enhance knowledge, attitudes and self-confidence of patients. Little is known on their effectiveness for educating health care professionals. As these professionals may play an important role in suicide prevention, the effects of a poster and accompanying evaluation and [...] Read more.
Educational posters are used to enhance knowledge, attitudes and self-confidence of patients. Little is known on their effectiveness for educating health care professionals. As these professionals may play an important role in suicide prevention, the effects of a poster and accompanying evaluation and triage guide on knowledge, self-confidence and attitudes regarding suicidal thoughts and behaviours, were studied in a multicentre cluster randomised controlled trial, involving staff from 39 emergency and 38 psychiatric departments throughout Flanders (n = 1171). Structured self-report questionnaires assessed the knowledge, confidence and beliefs regarding suicidal behaviour management, and attitudes. Data were analysed through a Solomon four-group design, with random assignment to the different conditions. Baseline scores for knowledge and provider confidence were high. The poster and accompanying evaluation and triage guide did not have an effect on knowledge about suicide and self-confidence in suicidal behaviour management. However, the poster campaign appeared to be beneficial for attitudes towards suicidal patients, but only among staff from mental health departments that were assigned to the un-pretested condition. Given the limited effects of the poster campaign in the studied population with a relatively high baseline knowledge, the evaluation of this poster as part of a multimodal educational programme in a more heterogeneous sample of health care professionals is recommended. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)
288 KiB  
Article
Perceived Stigma of Sudden Bereavement as a Risk Factor for Suicidal Thoughts and Suicide Attempt: Analysis of British Cross-Sectional Survey Data on 3387 Young Bereaved Adults
by Alexandra Pitman, Khadija Rantell, Louise Marston, Michael King and David Osborn
Int. J. Environ. Res. Public Health 2017, 14(3), 286; https://doi.org/10.3390/ijerph14030286 - 09 Mar 2017
Cited by 48 | Viewed by 7407
Abstract
The sudden death of a friend or relative, particularly by suicide, is a risk factor for suicide. People who experience sudden bereavement report feeling highly stigmatised by the loss, potentially influencing access to support. We assessed whether perceived stigma following sudden bereavement is [...] Read more.
The sudden death of a friend or relative, particularly by suicide, is a risk factor for suicide. People who experience sudden bereavement report feeling highly stigmatised by the loss, potentially influencing access to support. We assessed whether perceived stigma following sudden bereavement is associated with suicidal thoughts and suicide attempt. We analysed cross-sectional survey data on 3387 young adults bereaved by the sudden death of a close contact. We tested the association of high versus low perceived stigma (on the stigma sub-scale of the Grief Experience Questionnaire) with post-bereavement suicidal ideation and suicide attempt, using random effects logistic regression, adjusting for socio-demographic factors, pre-bereavement psychopathology, and mode of sudden bereavement (natural causes/unnatural causes/suicide). Subjects with high perceived stigma scores were significantly more likely to report post-bereavement suicidal thoughts (adjusted odds ratio (AOR) = 2.74; 95% confidence interval (CI) = 1.93–3.89) and suicide attempt (AOR = 2.73; 95% CI = 2.33–3.18) than those with low stigma scores. People who feel highly stigmatised by a sudden bereavement are at increased risk of suicidal thoughts and suicide attempt, even taking into account prior suicidal behaviour. General practitioners, bereavement counsellors, and others who support people bereaved suddenly, should consider inquiring about perceived stigma, mental wellbeing, and suicidal thoughts, and directing them to appropriate sources of support. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)
1202 KiB  
Article
Suicide Behaviors in Adult Inpatients with Mental Disorders in Beijing, China
by Qi Gao, Hua Fan, Fei Di, Xue Xia, Haiying Long and Huiping Zhu
Int. J. Environ. Res. Public Health 2017, 14(3), 259; https://doi.org/10.3390/ijerph14030259 - 03 Mar 2017
Cited by 6 | Viewed by 5722
Abstract
Background: This study examined the tendency and suicidal behavior rates of Chinese adult inpatients with different types of mental disorders from 2010 to 2015. The aim was to provide some interesting clues for further studies. Methods: Adult patients with mental disorders [...] Read more.
Background: This study examined the tendency and suicidal behavior rates of Chinese adult inpatients with different types of mental disorders from 2010 to 2015. The aim was to provide some interesting clues for further studies. Methods: Adult patients with mental disorders who were hospitalized in Beijing Anding hospital from 1 January 2010 to 31 December 2015 were included. Chi-square tests were used to compare the difference among inpatients with mental disorders by gender and year. Frequency, trend and suicidal behavior rates of inpatients with mental disorders were graphed. Results: A total of 17,244 psychiatric adult inpatients were included in our study. About 53.2% of the inpatients had mood disorders, followed by schizophrenia, which accounted for 34.6%. The proportion of female inpatients with mental disorders was larger than that of males (52.6% to 47.4%). Of the total, 3296 psychiatric inpatients were recognized as having suicidal behaviors. The rate of suicidal behavior among all inpatients was 19.1%, and it varied over the years. The suicidal behavior rate of female inpatients with mood disorders was much higher than that of the corresponding male inpatients. Conclusions: The presence of suicidal behavior varied among people with different types of mental disorders. For each type of mental illness, identifying the risk of specific suicide behavior would help tailor-make preventive efforts accordingly. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)
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647 KiB  
Article
The Basic Act for Suicide Prevention: Effects on Longitudinal Trend in Deliberate Self-Harm with Reference to National Suicide Data for 1996–2014
by Miharu Nakanishi, Kaori Endo and Shuntaro Ando
Int. J. Environ. Res. Public Health 2017, 14(1), 104; https://doi.org/10.3390/ijerph14010104 - 21 Jan 2017
Cited by 10 | Viewed by 6607
Abstract
A suicide prevention strategy was launched in Japan in 2006 to address the high suicide rate, which had increased considerably since 1998. The national strategy from 2007 involved the enhancement of psychiatric treatment services at emergency medical facilities and supportive observation by individuals [...] Read more.
A suicide prevention strategy was launched in Japan in 2006 to address the high suicide rate, which had increased considerably since 1998. The national strategy from 2007 involved the enhancement of psychiatric treatment services at emergency medical facilities and supportive observation by individuals close to patients. The national suicide rate has decreased gradually since 2008; however, national information regarding the number of patients who had engaged in deliberate self-harm was absent. Therefore, the present study examined the longitudinal trend in hospital admissions due to deliberate self-harm in Japan. Data from the National Patient Survey between 1996 and 2014—a nationally representative cross-sectional survey of inpatient care every 3 years—were used. Data for 13,014 patients were included in the estimation of the number of hospital admissions due to deliberate self-harm. The results show that the estimated number of admissions due to deliberate self-harm increased from 2078 in September 1996 to 3189 in September 2008, when the national number of suicide cases peaked, and decreased to 1783 in 2014. Approximately half of the patients were admitted to hospital because of self-harm via means other than drug poisoning, which had a high mortality rate (5.6%). The proportion of patients receiving public assistance was higher in those who had engaged in deliberate self-harm (8.5%) relative to that observed in the general population. Overall, the trend in deliberate self-harm was synchronous with the number of suicide cases over time. As economic poverty has been associated with suicidal ideation and behavior and some recipients of public assistance tend to abuse psychotropic medication, the public assistance program should provide mental health support for recipients of social benefit schemes. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)
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281 KiB  
Article
Factors that Affect Suicide Attempts of Adolescents in Multicultural Families in Korea
by Subin Park and Yeeun Lee
Int. J. Environ. Res. Public Health 2016, 13(12), 1184; https://doi.org/10.3390/ijerph13121184 - 28 Nov 2016
Cited by 18 | Viewed by 4493
Abstract
We examined the factors that affect suicide attempts adolescents multicultural families in South Korea. The participants were 727 adolescents whose mothers and/or fathers were born outside of South Korea (376 males and 351 females). Among them, 41 (weighted prevalence 6.2%) had attempted suicide [...] Read more.
We examined the factors that affect suicide attempts adolescents multicultural families in South Korea. The participants were 727 adolescents whose mothers and/or fathers were born outside of South Korea (376 males and 351 females). Among them, 41 (weighted prevalence 6.2%) had attempted suicide during the last 12 months. Female gender, residence in large cities (compared with in rural areas), living with relatives/alone/with friends/in a dormitory or living in a facility (compared with living with family), high and low socio-economic status (compared with a middle level), high and low academic performance (compared with a middle level), severe perceived stress (compared with non-severe stress), conflicts with a teacher (compared with conflicts with parent), and foreign-father/-parent families (compared with foreign-mother family) were associated with increased odds of suicide attempt. The results indicate that greater awareness of the possibility of suicidal behavior is prudent for adolescents in multicultural families with certain risk factors, such as being from a foreign-parents family, living separately from the family, and having conflicts with a teacher. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)
676 KiB  
Article
Analysis of Japanese Articles about Suicides Involving Charcoal Burning or Hydrogen Sulfide Gas
by Yoshihiro Nabeshima, Daisuke Onozuka, Takanari Kitazono and Akihito Hagihara
Int. J. Environ. Res. Public Health 2016, 13(10), 1013; https://doi.org/10.3390/ijerph13101013 - 15 Oct 2016
Cited by 6 | Viewed by 6130 | Correction
Abstract
It is well known that certain types of media reports about suicide can result in imitative suicides. In the last two decades, Japan has experienced two suicide epidemics and the subsequent excessive media coverage of these events. However, the quality of the media [...] Read more.
It is well known that certain types of media reports about suicide can result in imitative suicides. In the last two decades, Japan has experienced two suicide epidemics and the subsequent excessive media coverage of these events. However, the quality of the media suicide reports has yet to be evaluated in terms of the guidelines for media suicide coverage. Thus, the present study analyzed Japanese newspaper articles (n = 4007) on suicides by charcoal burning or hydrogen sulfide gas between 11 February 2003 and 13 March 2010. The suicide reports were evaluated in terms of the extent to which they conformed to the suicide reporting guidelines. The mean violation scores were 3.06 (±0.7) for all articles, 3.2 (±0.8) for articles about suicide by charcoal burning, and 2.9 (±0.7) for articles about suicide by hydrogen sulfide (p < 0.001). With the exception of not following several recommendations, newspaper articles about suicide have improved in quality, as defined by the recommendations for media suicide coverage. To prevent imitative suicides based on media suicide reports, individuals in the media should try not to report suicide methods and to make attempts to report the poor condition of suicide survivors. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)
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Review

Jump to: Research, Other

313 KiB  
Review
Risk Estimates and Risk Factors Related to Psychiatric Inpatient Suicide—An Overview
by Trine Madsen, Annette Erlangsen and Merete Nordentoft
Int. J. Environ. Res. Public Health 2017, 14(3), 253; https://doi.org/10.3390/ijerph14030253 - 02 Mar 2017
Cited by 38 | Viewed by 6715
Abstract
People with mental illness have an increased risk of suicide. The aim of this paper is to provide an overview of suicide risk estimates among psychiatric inpatients based on the body of evidence found in scientific peer-reviewed literature; primarily focusing on the relative [...] Read more.
People with mental illness have an increased risk of suicide. The aim of this paper is to provide an overview of suicide risk estimates among psychiatric inpatients based on the body of evidence found in scientific peer-reviewed literature; primarily focusing on the relative risks, rates, time trends, and socio-demographic and clinical risk factors of suicide in psychiatric inpatients. Psychiatric inpatients have a very high risk of suicide relative to the background population, but it remains challenging for clinicians to identify those patients that are most likely to die from suicide during admission. Most studies are based on low power, thus compromising quality and generalisability. The few studies with sufficient statistical power mainly identified non-modifiable risk predictors such as male gender, diagnosis, or recent deliberate self-harm. Also, the predictive value of these predictors is low. It would be of great benefit if future studies would be based on large samples while focusing on modifiable predictors over the course of an admission, such as hopelessness, depressive symptoms, and family/social situations. This would improve our chances of developing better risk assessment tools. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)

Other

Jump to: Research, Review

297 KiB  
Concept Paper
Treatment of Intrusive Suicidal Imagery Using Eye Movements
by Jaël S. van Bentum, Marit Sijbrandij, Marcus J. H. Huibers, Annemiek Huisman, Arnoud Arntz, Emily A. Holmes and Ad J. F. M. Kerkhof
Int. J. Environ. Res. Public Health 2017, 14(7), 714; https://doi.org/10.3390/ijerph14070714 - 30 Jun 2017
Cited by 14 | Viewed by 7927
Abstract
Suicide and suicidal behavior are major public health concerns, and affect 3–9% of the population worldwide. Despite increased efforts for national suicide prevention strategies, there are still few effective interventions available for reducing suicide risk. In this article, we describe various theoretical approaches [...] Read more.
Suicide and suicidal behavior are major public health concerns, and affect 3–9% of the population worldwide. Despite increased efforts for national suicide prevention strategies, there are still few effective interventions available for reducing suicide risk. In this article, we describe various theoretical approaches for suicide ideation and behavior, and propose to examine the possible effectiveness of a new and innovative preventive strategy. A model of suicidal intrusion (mental imagery related to suicide, also referred to as suicidal flash-forwards) is presented describing one of the assumed mechanisms in the etiology of suicide and the mechanism of therapeutic change. We provide a brief rationale for an Eye Movement Dual Task (EMDT) treatment for suicidal intrusions, describing techniques that can be used to target these suicidal mental images and thoughts to reduce overall behavior. Based on the available empirical evidence for the mechanisms of suicidal intrusions, this approach appears to be a promising new treatment to prevent suicidal behavior as it potentially targets one of the linking pins between suicidal ideation and suicidal actions. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)
672 KiB  
Concept Paper
A Novel Therapy for People Who Attempt Suicide and Why We Need New Models of Suicide
by Konrad Michel, Ladislav Valach and Anja Gysin-Maillart
Int. J. Environ. Res. Public Health 2017, 14(3), 243; https://doi.org/10.3390/ijerph14030243 - 01 Mar 2017
Cited by 38 | Viewed by 8827
Abstract
This paper presents a model of suicidal behaviour based on suicide as a goal-directed action, and its implications. An action theoretical model has guided the authors in the development of a brief therapy for individuals who attempt suicide (ASSIP—Attempted Suicide Short Intervention Program). [...] Read more.
This paper presents a model of suicidal behaviour based on suicide as a goal-directed action, and its implications. An action theoretical model has guided the authors in the development of a brief therapy for individuals who attempt suicide (ASSIP—Attempted Suicide Short Intervention Program). Key elements are an early therapeutic alliance, narrative interviewing, psychoeducation, a joint case conceptualization, safety planning, and regular letters over 24 months. In a randomized controlled trial, ASSIP was highly effective in reducing the risk of suicide reattempts. The therapeutic elements in this treatment are described and possible implications for future directions in clinical suicide prevention discussed. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)
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1247 KiB  
Perspective
Network Analysis: A Novel Approach to Understand Suicidal Behaviour
by Derek De Beurs
Int. J. Environ. Res. Public Health 2017, 14(3), 219; https://doi.org/10.3390/ijerph14030219 - 23 Feb 2017
Cited by 33 | Viewed by 6967
Abstract
Although suicide is a major public health issue worldwide, we understand little of the onset and development of suicidal behaviour. Suicidal behaviour is argued to be the end result of the complex interaction between psychological, social and biological factors. Epidemiological studies resulted in [...] Read more.
Although suicide is a major public health issue worldwide, we understand little of the onset and development of suicidal behaviour. Suicidal behaviour is argued to be the end result of the complex interaction between psychological, social and biological factors. Epidemiological studies resulted in a range of risk factors for suicidal behaviour, but we do not yet understand how their interaction increases the risk for suicidal behaviour. A new approach called network analysis can help us better understand this process as it allows us to visualize and quantify the complex association between many different symptoms or risk factors. A network analysis of data containing information on suicidal patients can help us understand how risk factors interact and how their interaction is related to suicidal thoughts and behaviour. A network perspective has been successfully applied to the field of depression and psychosis, but not yet to the field of suicidology. In this theoretical article, I will introduce the concept of network analysis to the field of suicide prevention, and offer directions for future applications and studies. Full article
(This article belongs to the Special Issue From Understanding Suicide Risk to Preventing Suicide)
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