Hopelessness and suicide ideation in ostomy patients: a mixed method study

Objective: Depression and hopelessness leading to suicide is a serious problem worldwide. It has been reported that hopelessness, which is stated to be important in the prevention of suicidal behavior, can be reduced with specific methods. The aim of this study is to determine the effect of motivational interviewing on hopelessness in patients with depression who are at risk of suicide. Methods: The research has the characteristics of experimental research. The research sample consisted of 89 depressive patients, 43 of whom were in the experimental group and 46 were in the control group. Patients with a score of 6 and above by applying the Beck Suicidal Ideation Scale to the patients were included in the study sample. Then, “Personal Information Form” and “Beck Hopelessness Scale” were applied to the patients. Motivational interview was applied to the patients in the experimental group. Results: The vast majority (47.2%) of the patients in the study reported that they attempted suicide. A positive correlation was found between the Beck Scale for Suicidal Ideation and the Beck Hopelessness Scale mean scores. It was observed that the mean Beck Hopelessness Scale scores of the experimental group, who applied motivational interviewing, decreased significantly in the post-test (8.53 ± 2.14) compared to the pre-test (11.58 ± 3.23) (P < .001). Conclusion: The findings of the study showed that motivational interviewing can be used in coping with hopelessness in patients with depression at the risk of suicide. It is recommended for psychiatric nurses to utilize motivational interviewing in order to reduce hopelessness. Cite this article as: Bahar A. The effect of motivational interviewing on hopelessness severity of the depression patients at the risk of suicide. Neuropsychiatr Invest. 2023;61(1):12-18.

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

BackgroundRecent investigations have demonstrated a significant prevalence of mental health disorders, including post-traumatic stress disorder (PTSD), and suicidal ideation, plans and attempts among Canadian public safety personnel, including police officers. What remains unknown is the relationship between mental disorders and suicide among sworn police officers, and the prevalence of both among civilian police workers.AimsTo examine the relationship between suicidal ideation, plans and attempts and positive mental health screens for depression, anxiety, panic disorder, alcohol abuse and PTSD among Canadian sworn and civilian police employees.MethodsParticipants completed an online survey that included self-report screening tools for depression, anxiety, panic disorder, alcohol abuse and PTSD. Respondents were also asked if they ever contemplated, planned or attempted suicide. Between-group (Royal Canadian Mounted Police [RCMP], provincial/municipal police and civilians) differences on mental health screening tools were calculated using Kruskal–Wallis analyses. The relationship between mental disorders and suicidal ideation, plans and attempts was evaluated with a series of logistic regressions.ResultsThere were 4236 civilian and sworn officer participants in the study. RCMP officers reported more suicidal ideation than other police and scored highest on measures of PTSD, depression, anxiety, stress and panic disorder, which were significantly associated with suicidal ideation and plans but not attempts. Relative to provincial and municipal police, civilians reported more suicide attempts and scored higher on measures of anxiety.ConclusionsThe results identify a strong relationship between mental health disorders and increased risk for suicidal ideation, plans and attempts among sworn and civilian Canadian police employees.

There are limited studies regarding suicidal ideation among Iranian medical students. We aimed to evaluate the prevalence of suicidal ideation and its association with hopelessness among Tehran University of Medical Sciences (TUMS) medical students. We designed a cross-sectional study conducted in TUMS in 2018. We developed a questionnaire consisting of three parts; the Beck Hopelessness Scale (BHS), four questions regarding suicidal ideation, and questions regarding demographic characteristics. We used the available sampling technique and sent the questionnaire to 517 medical students of TUMS. In total, 224 medical students completed and sent back the questionnaire (response rate=43.32%). Participants' mean age was 22.68 (SD=3.38) years, and 140 participants (62.5%) were female. One hundred seven students (47.76%) had mild, 58 (25.89%) had moderate, and 13 (5.8%) had severe hopelessness. Males, senior students, and dissatisfied students with their academic performance experienced more severe hopelessness (P<0.05). Thirty-six participants (16.07%) had suicidal ideation. After adjusting for age, gender, marital status, and student's satisfaction with their academic performance, BHS total score was independently associated with suicidal ideation (OR=1.29, 95% CI=1.14-1.46, P<0.0001). The prevalence of suicidal ideation and hopelessness is relatively high among Iranian medical students. Students with more severe hopelessness are at higher risk of suicidal ideation, and evaluating hopelessness among medical students can be used to screen medical students at risk of suicidal ideation.

Inflammatory bowel disease (IBD) is associated with an increased prevalence of depression when compared to the general population. Studies have suggested that depression may be more pronounced in the early period of diagnosis, with the strongest association occurring within one year of diagnosis. It has also been documented that depression can amplify symptoms, decrease medication compliance, alter self-perception and worsen individuals' adaptation to their disease. It is recommended that all IBD patients be screened for depression. We present 2 cases of patients with IBD who were hospitalized with suicidal ideation at the time or shortly following their IBD diagnosis. These cases emphasize the need to screen for depression with assessment for severity. Case 1: A 45 year old man was hospitalized with depression and suicidal ideation with a plan. His psychiatric interview revealed that he was profoundly depressed as a result of ‘years' of chronic, frequent (50-60 times daily) diarrhea with blood, urgency, nocturnal awakening and fecal incontinence which had worsened in recent months. He had no history of depression or psychiatric disorders and a previous history of cocaine dependency was not thought to contribute to his depression. Gastroenterology consult was obtained and following an evaluation he was diagnosed with ulcerative colitis. Treatment with 6-mercaptopurine, mesalamine, and tapering steroids (with discontinuation) resulted in clinical improvement of his gastrointestinal symptoms and resolution of his depression. Case 2: A 37 year old woman without significant past medical history transferred her care to our institution and presented to Gastroenterology clinic for a second opinion of rectal pain and bleeding following a hemorrrhoidectomy. Medical records revealed that she presented to an outside surgeon with complaints of hemorrhoids. Rectal fissures and a large hemorrhoid complex were noted and she underwent a fissurectomies and a hemorrhoidectomy which resulted in chronic fecal drainage and incontinence. A rectal exam under anesthesia revealed rectal ulcerations and a large nonhealing wound in the posterior midline which extended through her internal and part of her external sphincter. A colonoscopy revealed pancolitis with biopsies demonstrating chronic active colitis and noncaseating granulomas. She was diagnosed with Crohn's disease. Two weeks following the diagnosis she was hospitalized with depression and suicidal ideation. Psychiatric interview revealed that her depression was related to her gastrointestinal symptoms and new Crohn's diagnosis. Improvement of her symptoms with oral and topical mesalamine, 6-mercaptopurine and tapering steroids has resulted in improvement of her depression. The psychiatrists did not believe that her steroid therapy precipitated or exacerbated her depression. She is not maintained on antidepressants. While there is a higher prevalence of depression in IBD patients, there are limited reports addressing suicide or suicidal ideation. It is critical that physicians are aware of the association of depression with IBD and recognize that increased occurrence occurs early after diagnosis and with severe symptoms. It is important that physicians caring for IBD remain vigilant in assessing for depression. Recognizing suicidal ideation, while rarely occurs, is critical to ensure effective intervention and enhance clinical outcome.

Back to table of contents Previous article Next article Professional NewsFull AccessMHA Ranks States on Prevalence of MH Disorders, Access to CareLinda M. RichmondLinda M. RichmondSearch for more papers by this authorPublished Online:18 Dec 2018https://doi.org/10.1176/appi.pn.2018.12a16AbstractThe report concluded that far too many people are not receiving the services they need to live healthy and productive lives. The states that ranked highest overall on access to mental health care—with the lowest prevalence of mental illness—were Minnesota, Maine, Massachusetts, New Jersey, and Vermont, according to the “State of Mental Health in America 2019” report by Mental Health America (MHA).States were assigned an overall mental health ranking based on 15 measures involving prevalence of mental illness, including serious thoughts of suicide and substance use disorder, and access to care, including health insurance status, mental health coverage, and mental health workforce availability.The state that ranked lowest was Nevada, followed by Idaho, Oregon, Mississippi, and Alaska.Now in its fifth year, the annual report provides a snapshot of mental health status and access to care among youth and adults and monitors trends. The report analyzes national survey results from all 50 states and the District of Columbia from the Substance Abuse and Mental Health Services Administration, Centers for Disease Control and Prevention, as well as other state and federal sources.The report also ranked states based on their availability of “mental health providers,” defined as psychiatrists, psychologists, social workers, counselors, marriage/family therapists, and advanced practice nurses specializing in mental health care. In the top-ranked states, the ratio of state residents to mental health providers was close to 200 to 1 (Massachusetts, District of Columbia, Maine, Oregon, and Vermont), but in the lowest-ranked states there were at least four to six times as many residents for every provider (Alabama, Texas, West Virginia, Georgia, and Arizona).Key PointsOther findings in the Mental Health America report “State of Mental Health in America 2019” include the following:Adults with any mental health illness: 18 percentAdults with any mental illness who are uninsured: 12 percentAdults with a severe mental illness: 4 percentAdults with serious thoughts of suicide: 4 percentAdults who reported a past-year substance use disorder: 8 percentYouth who reported a past-year substance use disorder: 5 percentThe shortage of mental health providers has resulted in many individuals not accessing care or relying on emergency room services for psychiatric care. More than half of psychiatrists will reach retirement age within seven years, which could exacerbate the shortage if many of them decide to retire.“Integrating primary care and behavioral health services is key for early identification and intervention but is only part of the solution. Primary care providers cannot fill the void created by a lack of psychiatrists,” the MHA report noted.Twenty percent of adults with any mental illness were not able to receive the treatment they needed, and this number has not declined since 2011, MHA reported. Some barriers included cost of care, lack of insurance or limited coverage of mental health services, and a shortage of mental health providers.The report showed alarming increases in serious suicidal ideation among adults and major depression among youth. The number of adults reporting serious thoughts of suicide was more than 9.8 million (4 percent nationwide) this year, an increase of 200,000 people since 2017. Among young people, nearly 13 percent of youth had at least one past-year major depressive episode, up from 9 percent in 2017.“Despite mental health being something that more and more people are talking about, far too many people are still suffering,” said Paul Gionfriddo, MHA president and CEO. “People are simply not receiving the treatment they need to live healthy and productive lives—and too many don’t see a way out.”When it comes to unmet mental health needs, there was a wide disparity between the highest ranked states (Hawaii, Alabama, Texas, Nebraska, and Maine), where nearly 16 percent to 17 percent of adults reported unmet mental health care needs, and the lowest ranked states (Nevada, New Hampshire, Oregon, and Idaho) and the District of Columbia, where 25 percent to 26 percent did not receive needed services.The report also uncovered some good news: Under the Affordable Care Act, the U.S. continues to see a decline in the number of Americans who are uninsured, with a nearly 3 percent reduction from last year. In fact, 46 states reported a reduction in the number of adults with any mental illness who lack insurance. The largest reductions were seen in South Carolina, Missouri, Arkansas, and Arizona, all of which had a 6 percent to 7 percent decline in adults with mental illness who had no insurance coverage.Youth with mental illness seemed to fare far worse than adults when it came to access to care: Close to two-thirds of youth with major depression (62 percent) did not receive any mental health treatment, MHA reported. Only one-quarter of youth with severe depression receive consistent treatment, defined as seven to 21 visits in a year. Late recognition of mental illness in primary care settings and limited coverage of mental health services often prevent youth from receiving timely and effective treatment.Nationwide, less than 1 percent of students (0.8) were identified as having an Individual Education Program (IEP) for emotional disturbance (ED). “If states were doing a better job of identifying whether youth had emotional difficulties that could be better supported through an IEP, the average rate would be closer to 8 percent instead of 0.8 percent,” MHA wrote. “Early identification for IEPs is critical. IEPs provide the services and support students with ED need to receive a high-quality education.” The top five states (Vermont, Minnesota, Massachusetts, Wisconsin, and Pennsylvania) identified 15 students to 27 students per 1,000 as having an IEP for ED, and the lowest-performing five states (Alabama, Arkansas, Louisiana, Utah, South Carolina) identified 2 students to 4 students per 1,000.■The report, “The State of Mental Health in America 2019,” can be accessed here. ISSUES NewArchived

A meta-analysis of well-controlled studies of alprazolam in depression was performed to assess the possible association of alprazolam and suicidal ideation. Pooled data from 3,217 patients (alprazolam, placebo, and various active-comparative agents) who were enrolled in 22 placebo- and/or active drug-controlled depression studies were retrospectively analyzed to evaluate the emergence, worsening, and improvement of suicidal ideation during treatment with alprazolam, placebo, or other active drugs. Item 3 of the Hamilton Rating Scale for Depression was used to evaluate these events. Neither the risk of emergence nor the risk of worsening of suicidal ideation was significantly different for alprazolam than for placebo; however, alprazolam was significantly superior to placebo in producing improvement of suicidal ideation. There was no significant difference between alprazolam and the active-comparator group in the risk of emergence of suicidal ideation. The risk of worsening of suicidal ideation was significantly less for the active-comparator group (the majority of patients in this group received amitriptyline or imipramine) than for alprazolam, and improvement of suicidal ideation occurred significantly more frequently in that group than in the alprazolam group. Use of alprazolam in depressed patients is not associated with any particular increased risk of suicidality.

To investigate the correlation between suicidal ideation, sense of meaning in life, and perceived social support among adolescent patients with mental disorders, and to provide a scientific basis for suicide prevention and intervention in this population. To explore the relationship between suicidal ideation, sense of meaning in life, and perceived social support among adolescent patients with mental disorders. A cross-sectional study design and convenience sampling were employed. A total of 245 adolescent patients with mental disorders hospitalized at Hunan Provincial Brain Hospital from January to May 2024 were included. Data were collected using a general information questionnaire, the Adolescent Suicidal Ideation Scale, the Sense of Meaning in Life Scale (MLS), and the Perceived Social Support Scale (PSSS). Pearson correlation analysis examined relationships among suicidal ideation, sense of meaning in life, and perceived social support. Structural equation modeling was performed using AMOS 24.0 to validate the mediation model. A total of 265 questionnaires were distributed, and 245 valid questionnaires were collected, yielding a valid response rate of 92.5%. The mean score for perceived social support among the participants was 43.61 ± 15.41, the mean total score for sense of meaning in life was 37.78 ± 12.38, and the mean total score for suicidal ideation was 43.39 ± 13.61. Perceived social support negatively correlated with suicidal ideation (r =-0.620, P <0.01). Sense of meaning in life negatively correlated with suicidal ideation (r =-0.628, P<0.01) and positively correlated with perceived social support (r =0.548, P <0.01). Structural equation modeling indicated that perceived social support partially mediated the relationship between sense of meaning in life and suicidal ideation (β = -0.691, P<0.001), accounting for 34.3% of the total effect. Perceived social support is a mediator between sense of meaning in life and suicidal ideation among adolescent patients with mental disorders. Medical staff should implement interventions that enhance perceived social support by improving patients' sense of meaning in life to reduce suicidal ideation.

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.

A relationship between seizure activity and hallucinations is well established. The psychopathologic significance of hallucinations in individuals with seizures, however, is unclear. In this study, we assessed the prevalence of auditory and visual hallucinations in individuals who reported a seizure history and investigated their relationship with a number of mental disorders, suicidal ideation, and suicide attempts. Data were from the "Adult Psychiatric Morbidity Survey," a population-based cross-sectional survey. Auditory and visual hallucinations were assessed using the Psychosis Screening Questionnaire. Mental health disorders were assessed using the Clinical Interview Schedule. Logistic regressions assessed relationships between hallucinatory experiences and mental disorders, suicidal ideation, and suicide attempts. A total of 14812 adults (58% female; mean [standard error of the mean; SEM] age 51.8 [0.15]) completed the study; 1.39% reported having ever had seizures (54% female), and 8% of individuals with a seizure history reported hallucinatory experiences (odds ratio [OR] 2.05, 95% confidence interval [CI] 1.24-3.38). Individuals with seizures had an increased odds of having any mental disorder (OR 2.34, 95% CI 1.73-3.16), suicidal ideation (OR 2.38, 95% CI 1.77-3.20), and suicide attempt (OR 4.15, 95% CI 2.91-5.92). Compared to individuals with seizures who did not report hallucinatory experiences, individuals with seizures who reported hallucinatory experiences had an increased odds of any mental disorder (OR 3.47, 95% CI 1.14-10.56), suicidal ideation (OR 2.58, 95% CI 0.87-7.63), and suicide attempt (OR 4.61, 95% CI 1.56-13.65). Overall, more than half of individuals with a seizure history who reported hallucinatory experiences had at least one suicide attempt. Adjusting for psychopathology severity did not account for the relationship between hallucinatory experiences and suicide attempts. Hallucinatory experiences in individuals with seizures are markers of high risk for mental health disorders and suicidal behavior. There is a particularly strong relationship between hallucinations and suicide attempts in individuals with seizures. Clinicians working with individuals with seizures should routinely ask about hallucinatory experiences.

Purpose: This study was conducted to investigate factors influencing suicidal ideation in people with mental\ndisorder. Methods: The subjects were 176 people with mental disorder from community mental health centers,\nsocial rehabilitation facilities, and university hospital psychiatric outpatient departments. The instruments used\nincluded a suicidal ideation questionnaire, a self-esteem scale, a spiritual well-being scale, a family support scale,\nand a professional support scale. Data were analyzed with t-test, one-way ANOVA, Pearson's correlation coefficient,\nand hierarchical regression analysis. Results: Suicidal ideation was influenced by age, history of suicidal\nattempts, and existential spiritual well-being. This study shows that suicidal ideation has negative correlation with\nexistential spiritual well-being, self-esteem, family support, and age. Existential spiritual well-being, history of suicidal\nattempts, and age accounted for 30% regarding suicidal ideation in people with mental disorder. Conclusion:\nThe lower existential spiritual well-being and age, the higher suicidal ideation. And also suicidal ideation was higher\nin people who had attempted suicide than in those who had not. Based on the outcomes of this study, it is necessary\nto design an intervention program that emphasizes existential spiritual well-being in order to decrease suicidal\nideation in young people with mental disorder.

German S3-Guideline on the treatment of Psoriasis vulgaris, adapted from EuroGuiDerm - Part 2: Treatment monitoring and specific clinical or comorbid situations.

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.