Early attrition among suicidal clients

Purpose: The purpose of this study was to examine the association of multiple addiction risks with life satisfaction, depression, and suicidal ideation in Korean adults. Methods: This study was descriptive correlational. Data were collected in 800 adults (405 males, 395 females) aged 20 to 69 years recruited using the proportional allocation in a city on April 2017. The structured questionnaire consisted of the Alcohol Use Disorders Identification Test, the Internet Addiction Proneness Scale for adults, the Problem Gambling Severity Index, the Drug Screening Inventory, the Korean version of the Satisfaction with the Life Scale, the Patient Health Questionnaire-9, and the Scale for Suicidal Ideation. Results: Adults with multiple addiction risks had a low level of life satisfaction (p=.003) and high levels of depression and suicidal ideation (p<.001) compared to other participants. Multiple addiction risks were associated with low life satisfaction (β=.12), high depression (β=.21), and suicidal ideation (β=.20). Significant factors of life satisfaction were low suicidal ideation, a simple functioning job, high level of education, and unemployment status. Conclusion: Multiple addiction risks are associated with life satisfaction, depression, and suicidal ideation. The comprehensive mental health assessment for multiple addictions should precede the development of preventive multidimensional interventions.

Trajectories of suicidal ideation in depressed older adults undergoing antidepressant treatment

Psychological pain may be helpful in conceptualizing suicidal behavior, in that high motivation to avoid pain combined with painful feelings may contribute to an increased risk of suicide. However, no experimental study has tested this hypothesis. The aim of the present study is to provide empirical evidence for the relationship between anhedonia, pain avoidance motivation, and suicidal ideation. The sample comprised 40 depressed outpatients and 20 healthy control subjects. All participants completed the Beck Scale for Suicide Ideation (BSS), Beck Depression Inventory, Psychache Scale, Three-Dimensional Psychological Pain Scale, the monetary incentive delay (MID), and affective incentive delay (AID) tasks. Based on BSS scores, clinical participants were divided into high suicidal ideation (HSI) and low suicidal ideation (LSI) groups. In the AID task, the HSI group had longer response times (RTs) under the reward condition than those under the punishment condition (p = .002). The LSI and control groups had shorter RTs under the reward condition compared with those under the neural condition (p <.001 and p = .008, respectively). The LSI group also had shorter RTs under the reward condition than under the punishment condition (p = .003). Pain arousal (r = -.33, p <.01) and BSS scores were significantly negatively correlated with differences in RTs between neutral and reward conditions. Pain avoidance (r = .35, p <.01) and BSS scores were positively correlated with differences in RTs between neutral and punishment conditions. The AID task was more sensitive than the MID task for the detection of participants' motivation in approaching hedonic experiences and avoiding pain. A suicidal mindset is manifested as decreased motivation to experience hedonia and increased motivation to avoid pain, which could be strong predictors of suicidal behavior.

Objective: This study examined psychological resilience (PR) as a potential moderator and mediator of the association between borderline personality symptoms (BPS) and suicidal ideation (SI) among university students. Method: A cross-sectional design was used with (N = 257) university students. Moderation and mediation were tested in separate, theory-guided models using the PROCESS macro for SPSS, version 28. The moderation model (Model 1) and the mediation model (Model 4) were estimated with heteroskedasticity-consistent standard errors (HC3). In the adjusted analyses, sex, age, previous psychological consultation, previous psychotropic medication use, and family history of mental illness were entered as covariates. The indirect effect was evaluated using percentile bootstrap confidence intervals based on (5000) resamples. Results: BPS was positively correlated with SI, whereas PR was negatively correlated with both BPS and SI. In the adjusted moderation model, BPS was positively associated with SI (b = 0.118, p < 0.001) and PR was negatively associated with SI (b = -0.204, p = 0.048), but the interaction term was not significant (b = -0.001, p = 0.820) with negligible explained variance (ΔR2 = 0.0003). In the adjusted mediation model, BPS was significantly associated with lower PR (a: b = -0.135, p < 0.001), and PR was associated with lower SI while controlling for BPS and the covariates (b: b = -0.216, p = 0.028). The total effect of BPS on SI was significant (c: b = 0.146, p < 0.001), and the direct effect remained significant after including PR (c': b = 0.117, p < 0.001). The indirect effect was significant (ab = 0.029; 95% bootstrap CI [0.005, 0.061]). Conclusions: Psychological resilience did not moderate the association between BPS and suicidal ideation, but it showed a statistically significant indirect association consistent with the proposed mediation model. Higher BPS were associated with lower resilience, which in turn was associated with higher suicidal ideation. These findings suggest that resilience-related targets may complement interventions addressing core BPS-related risk processes, while the cross-sectional design precludes causal conclusions.

Suicidal ideation (SI) is dynamic and closely tied to social context, yet most work treats these links as static or unidirectional. We tested a transactional account whereby SI and interpersonal appraisals co-evolve over hours and examined personality trait moderators. Young adults receiving behavioral treatment who endorsed SI and/or suicidal behavior in the past four months (N=140) completed 21 days of ecological momentary assessment (7 prompts/day). At each prompt, participants reported current SI and rated interpersonal strain (rejection/criticism/exclusion/stress) and enrichment (enjoyment/connection/meaning/support) from interpersonal interactions. Dynamic structural equation models estimated five features of SI: reactivity, generation, inertia, instability, and intensity. Negative Affectivity, Detachment, and Disinhibition trait domains were tested as moderators. Interpersonal strain was associated with higher subsequent SI (reactivity), and higher SI was associated with higher subsequent strain (generation). Likewise, interpersonal enrichment was associated with lower subsequent SI, and higher SI was associated with lower subsequent enrichment. Detachment uniquely moderated these dynamic processes: higher Detachment was associated with larger SI increases after strain and larger SI decreases after enrichment, as well as higher SI intensity and instability, higher strain, and lower enrichment. Facet models indicated that Anhedonia concentrated Detachment-related risk (higher mean SI, higher strain intensity and instability, lower enrichment, higher SI inertia and instability, and stronger reactivity to strain/enrichment). In contrast, Intimacy Avoidance was associated with lower strain instability and lower enrichment intensity. Negative Affectivity and Disinhibition did not moderate dynamic paths. SI was linked to interpersonal appraisals through short-cycle, bidirectional associations that were moderated by Detachment, especially its Anhedonia facet.

IntroductionIt is important to characterize patients’ mental health problems since the association between mental adjustment and life expectancy has stabilized in these patients. So, the present study was conducted to determine the prevalence of suicidal ideation and hopelessness in patients with ostomy. MethodA mixed method strategy (cross-sectional and content qualitative analysis) was done in Educational Hospitals in Tehran in 2019. Beck Suicide Ideation (19 item) and Beck Hopelessness (20 item) self-assessment questionnaires and unstructured interview were used for data collection. Data were expressed as frequency and percentage and independent t-test. Analysis was done in the Statistical Package for the Social Sciences (SPSS) 16.0 and conventional content analysis. ResultsThree months after surgery, 3% had low suicidal ideation and 97% had high risk suicidal ideation. This rate 6 months after surgery was 16% with low suicidal thoughts and 84% with high risk suicidal thoughts. In the case of hopelessness 3 months after the surgery, 20% had mild hopelessness, 79% had moderate hopelessness, and 1% had severe hopelessness. These figures 6 months after surgery were 11% hopeless, 31% mildly disappointed, 58% moderately disappointed. The results of the qualitative study resulted in the extraction of three main categories that included enduring the initial suffering, social isolation, and lag of ostomy admission. ConclusionThe relative improvement in suicidal ideation and hopelessness in the present study showed that the mental status of ostomy patients requires more careful attention.

Focuses on open science practices in suicide research. Specifically, the authors use examples from their own and others' work to demonstrate the opportunities for future-proofing research by implementing open science practices, and they discuss some of the challenges and their potential solutions. They cover implementing open science practices in new, ongoing, and concluded studies, and discuss practices in order of being 'low' to 'high' threshold to implement (based on Kathawalla et al., 2021). Space constraints preclude an extensive presentation of all open science practices although they briefly describe the strategies of providing preprints, sharing study materials and codes, preregistration of studies and registered reports, and sharing research data. To highlight the open science work of as many researchers as possible, examples are provided in Electronic Supplementary Material 1 (ESM 1) rather than in the text. The authors ask for readers' help in adding to these examples via their 'living' reading list (https://osf.io/v6y3t/).

ABSTRACTBackground and AimsPsychological disorders like anxiety and depression are prevalent among dental professionals, being responsible for negatively affecting their mental health. Such factors are detrimental and may lead to suicidal thoughts and ideation. This study aimed to evaluate the impact of anxiety and depression on suicidal thoughts and ideation among dental professionals in Pakistan.MethodsThis descriptive, cross‐sectional study formulated a self‐reporting online questionnaire of dental professionals of Karachi, Pakistan between September and December 2023. The online questionnaire consisted of demographics and validated tools to measure anxiety using GAD‐7, depression using PHQ‐9, and Suicide thoughts and ideation using SIDAS.ResultsA total of 636 dental professionals were recruited in the study. Overall, 76.1% of the participants reported moderate to severe anxiety, 64.1% experienced moderate to severe depression, and 11.9% of participants reported high levels of suicidal thoughts and ideation. Anxiety and depression had a statistically significant association with suicide among dental professionals (p‐value < 0.001).ConclusionThis study highlights the positive association of anxiety and depression with suicidal ideation and thoughts among dental professionals. Hence, it is important to monitor the mental health of dental professionals and provide essential health and support to overcome such psychological distress.

Suicidal thoughts and behaviours among construction workers: Identifying risks and protective factors.

This study aims to analyze the major factors influencing suicidal ideation among elderly individuals residing in rural areas of Chungcheongnam-do, and to propose practical intervention strategies for suicide prevention. For this purpose, raw data from the 『2023 Chungcheongnam-do Social Survey』 were utilized, and elderly respondents living in rural areas were extracted for analysis. Logistic regression analysis was conducted to identify significant factors affecting suicidal ideation. The key findings of the study are as follows. First, elderly individuals with religious affiliations reported higher levels of suicidal ideation. Second, happiness and depression were found to be significant predictors of suicidal ideation. Specifically, an increase in happiness was associated with a decrease in suicidal ideation, whereas severe depressive symptoms were linked to a higher likelihood of experiencing suicidal thoughts. Third, economic difficulties, particularly challenges in maintaining a stable livelihood, were closely correlated with suicidal ideation. Lastly, social characteristics also played a crucial role in suicidal ideation, with anxiety about social safety and difficulties in transportation being identified as major contributing factors. Based on these findings, comprehensive suicide prevention and intervention strategies were discussed to reduce suicide rates among the elderly population.

Sleep problems are a modifiable risk factor for suicidal thoughts and behaviors. Yet, sparse research has examined temporal relationships between sleep disturbance, suicidal ideation, and psychological factors implicated in suicide, such as entrapment. This is the first in-the-moment investigation of relationships between suicidal ideation, objective and subjective sleep parameters, and perceptions of entrapment. Fifty-one participants with current suicidal ideation completed week-long ecological momentary assessments. An actigraph watch was worn for the duration of the study, which monitored total sleep time, sleep efficiency, and sleep latency. Daily sleep diaries captured subjective ratings of the same sleep parameters, with the addition of sleep quality. Suicidal ideation and entrapment were measured at six quasi-random time points each day. Multi-level random intercept models and moderation analyses were conducted to examine the links between sleep, entrapment, and suicidal ideation, adjusting for anxiety and depression severity. Analyses revealed a unidirectional relationship whereby short sleep duration (both objective and subjective measures), and poor sleep quality, predicted the higher severity of next-day suicidal ideation. However, there was no significant association between daytime suicidal ideation and sleep the following night. Sleep quality moderated the relationship between pre-sleep entrapment and awakening levels of suicidal ideation. This is the first study to report night-to-day relationships between sleep disturbance, suicidal ideation, and entrapment. Findings suggest that sleep quality may alter the strength of the relationship between pre-sleep entrapment and awakening suicidal ideation. Clinically, results underscore the importance of assessing and treating sleep disturbance when working with those experiencing suicidal ideation.

Can J Psychiatry. 2009;54(2):72-74. The rate of suicidal adverse events is elevated around 2-fold in drugs, relative to placeboes, in clinical trials of antidepressants in children, adolescents, and young adults.1,2 Since the FDA's black box warning in 2003-2004, there has been a decline in the prescription rate of antidepressants, with no compensatory increase in referrals for psychotherapy in the United States.3 Families, patients, and clinicians are uncertain about how to balance the benefits and risks of antidepressants. In this brief review, the clinical significance of suicidal events is discussed along with the factors that may increase or attenuate the risk, possible explanations for this phenomenom, the benefits and risks of antidepressants, the public health implications of a decline in the use of SSRIs, and recommendations for clinicians. Suicidal adverse events are treatment-emergent increases in suicidal ideation or an actual suicide attempt. In more than 4300 participants in pediatric antidepressant clinical trials, there have been no deaths by suicide, and most of these events were increases in suicidal ideation, rather than actual suicide attempts. The actual risk difference for the occurrence of an event is not large. While the FDA initially reported a risk difference of 2%, a more recent re-analysis included more recently conducted trials found a risk difference of only 0.9%, which translates to a NNH of 121.1,2 Moreover, during the period of time when the rate of SSRI prescriptions was increasing, youth suicide rates were declining.4 One cannot necessarily infer a causal relation between the increase in the use of SSRIs in adolescents and a decline in the adolescent suicide rate. However, if antidepressants were associated with an increased risk for suicide, one would have expected an increase in adolescent suicide, which clearly was not the case. The nature of assessment for suicidal events has also been questioned. In most clinical trials, suicidal events are not surveyed systematically, but are reported spontaneously. In fact, in the subset of clinical trials that had systematic assessment, there was no difference between medication and placebo regarding systematically assessed suicidal ideation.2 However, other reports have shown similar rates of events, whether using usual adverse event reporting methods or by deriving the occurrence of events from systematically assessed measures of self-reported suicidal ideation. 5'6 Predictors of suicidal adverse events include previous suicidal behaviour and higher baseline levels of suicidal ideation, anger, and irritability.5 In the Treatment of Adolescent Depression Study,6 the rate of suicidal events was lower in the combination of antidepressant and CBT than in medication alone; however, in other clinical trials of more severely or chronically depressed youth, no protective effect was found for combination treatment.6,7 No relation has been established among dosage, adherence pattern, medication type, and risk for events, and while some promising pharmacogenetic findings have been reported, there is currently no clinical applicability of these findings. Several hypotheses, all unproven, have been advanced to explain the increased rate of suicidal events in antidepressant-treated patients, compared with those on placebo. These have included induction of akathisia, disinhibition, increasing energy of the patient to the point where he or she can actually make an attempt, induction of mania or a mixed state, or withdrawal from medication as a result of nonadherence, with induction of dysphoria and suicidality. The adage of suicidal behaviour coming as a consequence of improvement in mood is not consistent with data showing a high correlation between severity of suicidal ideation and severity of depression; further, most reported suicidal events were not attempts, but were increases in suicidal ideation. The induction of a mixed state can certainly lead to suicidal ideation and behaviour; however, while the risk of a suicidal event is higher in adolescents than in children, the risk of mania after treatment with an antidepressant is higher in younger children. …

While research supports a strong association between risk of school dropout and suicidality, this youth population remains understudied. This qualitative study addresses this gap by examining self-reported risk and protective factors among 44 alternative high school students who endorsed varying levels of suicidal ideation. Criterion sampling of Suicidal Ideation Questionnaire-JR scores informed student selection for semi-structured interviews. Students were grouped by low, moderate, or high suicidal ideation scores. Transcribed interviews were analyzed using thematic analysis. The findings demonstrate subgroup differences of suicide risk and resiliency among students at risk of dropout and offer points for prevention and intervention. School practitioners can advocate for school-based suicide preventive interventions that are tailored for students who are both at risk of suicide and academic failure.

Psychotic-like experiences and their relationship to suicidal ideation in adolescents

Background: Suicide is a global public health concern. To explore the relationship between childhood maltreatment and college students’ suicidal ideation and the mediating role of social support and basic psychological needs. Methods: A questionnaire survey of 625 college students was conducted using the childhood Maltreatment Scale, the Suicidal Ideation Scale, the Social Support Scale, and the Basic Needs Satisfaction Scale. Results: The study revealed that (1) childhood maltreatment positively predicted college students’ suicidal ideation, (2) social support and basic psychological needs played independent mediating roles before childhood maltreatment and suicidal ideation, and (3) social support and basic psychological needs played chain mediating roles before childhood maltreatment and suicidal ideation. Conclusions: Childhood maltreatment positively predicts suicidal ideation among college students, and social support and basic psychological needs play a chain mediating role. This study contributes to the understanding of the effects of childhood maltreatment on suicidal ideation and its mechanism of action, which is of practical significance for the prevention and intervention of college students’ suicidal behaviours.