Journal articles on the topic 'Suicidal behaviour – Treatment'
To see the other types of publications on this topic, follow the link: Suicidal behaviour – Treatment.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 journal articles for your research on the topic 'Suicidal behaviour – Treatment.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Wisłowska-Stanek, Aleksandra, Karolina Kołosowska, and Piotr Maciejak. "Neurobiological Basis of Increased Risk for Suicidal Behaviour." Cells 10, no. 10 (September 23, 2021): 2519. http://dx.doi.org/10.3390/cells10102519.
Full textAbstract:
According to the World Health Organization (WHO), more than 700,000 people die per year due to suicide. Suicide risk factors include a previous suicide attempt and psychiatric disorders. The highest mortality rate in suicide worldwide is due to depression. Current evidence suggests that suicide etiopathogenesis is associated with neuroinflammation that activates the kynurenine pathway and causes subsequent serotonin depletion and stimulation of glutamate neurotransmission. These changes are accompanied by decreased BDNF (brain-derived neurotrophic factor) levels in the brain, which is often linked to impaired neuroplasticity and cognitive deficits. Most suicidal patients have a hyperactive hypothalamus–pituitary–adrenal (HPA) axis. Epigenetic mechanisms control the above-mentioned neurobiological changes associated with suicidal behaviour. Suicide risk could be attenuated by appropriate psychological treatment, electroconvulsive treatment, and drugs: lithium, ketamine, esketamine, clozapine. In this review, we present the etiopathogenesis of suicide behaviour and explore the mechanisms of action of anti-suicidal treatments, pinpointing similarities among them.
2
Aquin, Joshua P., Leslie E. Roos, Jino Distasio, Laurence Y. Katz, Jimmy Bourque, James M. Bolton, Shay-Lee Bolton, et al. "Effect of Housing First on Suicidal Behaviour." Canadian Journal of Psychiatry 62, no. 7 (February 27, 2017): 473–81. http://dx.doi.org/10.1177/0706743717694836.
Full textAbstract:
Objective: This study attempted to determine if Housing First (HF) decreased suicidal ideation and attempts compared to treatment as usual (TAU) amongst homeless persons with mental disorders, a population with a demonstrably high risk of suicidal behaviour. Method: The At Home/Chez Soi project is an unblinded, randomised control trial conducted across 5 Canadian cities (Vancouver, Winnipeg, Toronto, Montreal, Moncton) from 2009 to 2013. Homeless adults with a diagnosed major mental health disorder were recruited through community agencies and randomised to HF ( n = 1265) and TAU ( n = 990). HF participants were provided with private housing units and received case management support services. TAU participants retained access to existing community supports. Past-month suicidal ideation was measured at baseline and 6, 12, 18, and 21/24 months. A history of suicide attempts was measured at baseline and the 21/24-month follow-up. Results: Compared to baseline, there was an overall trend of decreased past-month suicidal ideation (estimate = –.57, SE = .05, P < 0.001), with no effect of treatment group (i.e., HF vs. TAU; estimate = –.04, SE = .06, P = 0.51). Furthermore, there was no effect of treatment status (estimate = –.10, SE = .16, P = 0.52) on prevalence of suicide attempts (HF = 11.9%, TAU = 10.5%) during the 2-year follow-up period. Conclusion: This study failed to find evidence that HF is superior to TAU in reducing suicidal ideation and attempts. We suggest that HF interventions consider supplemental psychological treatments that have proven efficacy in reducing suicidal behaviour. It remains to be determined what kind of suicide prevention interventions (if any) are specifically effective in further reducing suicidal risk in a housing-first intervention.
3
Suherman, Suherman. "INITIAL STUDY OF LINGUISTIC; VERBAL AND NONVERBAL SIGN OF ATTEMPTED SUICIDE AMONG ADOLESCENTS." Elevate The International Journal of Nursing Education, Practice and Research 1, no. 1 (July 24, 2018): 29–32. http://dx.doi.org/10.25077/elevate.1.1.29-32.2018.
Full textAbstract:
Increasing number of suicide cases, especially in adolescents, becomes problems that require serious treatment. Adolescence is a period of transition and hormonal development that can affect the emotions or mood. It is known that before attempting suicide, there are signs of language or linguistic such as verbal and nonverbal as an indication of the suicidal behavior action. This systematic review aims to identify these signs based on the results of several studies. There were 12 articles that have reviewed, the results showed there are three aspect that can be identified: used language from the suicider; perception of suicider toward the behaviour; and observerd behaviours. Most of the suicider express the feeling of Hopeless, Self-balming, feeling depressed and lonely, and also withdraw from society. It is expectedthat the result can be used as basic data toindentify signs and symptoms of suicide in adolescents.
Keywords: observed behaviors, suicide language; emotional expression
4
Bertelsen, Mette, Pia Jeppesen, Lone Petersen, Anne Thorup, Johan ⊘hlenschlæger, Phuong Le Quach, Torben Østergaard Christensen, Gertrud Krarup, Per J⊘rgensen, and Merete Nordentoft. "Suicidal behaviour and mortality in first-episode psychosis: the OPUS trial." British Journal of Psychiatry 191, S51 (December 2007): s140—s146. http://dx.doi.org/10.1192/bjp.191.51.s140.
Full textAbstract:
BackgroundThose with first-episode psychosis are at high-risk of suicideAimsTo identify predictive factors for suicidal thoughts, plans and attempts, and to investigate the rate of suicides and other deaths during the 5 years after first diagnosis and initiation of treatmentMethodA longitudinal, prospective, 5-year follow-up study of 547 individuals with first-episode schizophrenia spectrum psychosis. Individuals presenting for their first treatment in mental health services in two circumscribed urban areas in Denmark were included in a randomised controlled trial of integrated v. standard treatment. All participants were followed in the Danish Cause of Death Register for 5 years. Suicidal behaviour and clinical and social status were assessed using validated interviews and rating scales at entry, and at 1- and 2-year follow-upsResultsSixteen participants died during the follow-up. We found a strong association between suicidal thoughts, plans and previous attempts, depressive and psychotic symptoms and young age, and with suicidal plans and attempts at 1- and 2-year follow-upConclusionsIn this first-episode cohort depressive and psychotic symptoms, especially hallucinations, predicted suicidal plans and attempts, and persistent suicidal behaviour and ideation were associated with high risk of attempted suicide
5
VUORILEHTO, M. S., T. K. MELARTIN, and E. T. ISOMETSÄ. "Suicidal behaviour among primary-care patients with depressive disorders." Psychological Medicine 36, no. 2 (November 23, 2005): 203–10. http://dx.doi.org/10.1017/s0033291705006550.
Full textAbstract:
Background. Most national suicide prevention strategies set improved detection and management of depression in primary health care into a central position. However, suicidal behaviour among primary-care patients with depressive disorders has been seldom investigated.Method. In the Vantaa Primary Care Depression Study, a total of 1119 primary-care patients in the City of Vantaa, Finland, aged 20 to 69 years, were screened for depression with the Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire. Depressive disorders were diagnosed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), and the 137 patients with depressive disorder were included in the study. Suicidal behaviour was investigated cross-sectionally and retrospectively in three time-frames: current, current depressive episode, and lifetime. Current suicidal ideation was measured with the Scale for Suicidal Ideation (SSI), and previous ideation and suicide attempts were evaluated based on interviews plus medical and psychiatric records.Results. Within their lifetimes, 37% (51/137) of the patients had seriously considered suicide and 17% (23/137) attempted it. Lifetime suicidal behaviour was independently and strongly predicted by psychiatric treatment history and co-morbid personality disorder, and suicidal behaviour within the current episode was predicted most effectively by severity of depression.Conclusions. Based on these findings and their convergence with studies of completed suicides, prevention of suicidal behaviour in primary care should probably focus more on high-risk subgroups of depressed patients, including those with moderate to severe major depressive disorder, personality disorder or a history of psychiatric care. Recognition of suicidal behaviour should be improved. The complex psychopathology of these patients in primary care needs to be considered in targeting preventive efforts.
6
Walsh, Elizabeth, Kate Harvey, Ian White, Anna Higgitt, Janelle Fraser, and Robin Murray. "Suicidal behaviour in psychosis: Prevalence and predictors from a randomised controlled trial of case management." British Journal of Psychiatry 178, no. 3 (March 2001): 255–60. http://dx.doi.org/10.1192/bjp.178.3.255.
Full textAbstract:
BackgroundIt is unclear whether intensive case management influences the prevalence of suicidal behaviour in patients with psychosis.AimsTo compare the effect of intensive case management and standard care on prevalence of suicidal behaviour in patients with chronic psychosis.MethodPatients with established psychosis (n=708) were randomised either to intensive case management or to standard care. The prevalence of suicidal behaviour was estimated at 2-year follow-up and compared between treatment groups. Suicide attempters and non-attempters were compared on multiple socio-demographic and clinical variables to identify predictors of suicidal behaviour.ResultsThere was no significant difference in prevalence of suicidal behaviour between treatment groups. Recent attempts at suicide and multiple recent hospital admissions best predicted future attempts.ConclusionsIntensive case management does not appear to influence the prevalence of suicidal behaviour in chronic psychosis. Predictors identified in this study confirm some previous findings.
7
Özlü-Erkilic, Zeliha, Thomas Wenzel, Oswald D. Kothgassner, and Türkan Akkaya-Kalayci. "Transcultural Differences in Risk Factors and in Triggering Reasons of Suicidal and Self-Harming Behaviour in Young People with and without a Migration Background." International Journal of Environmental Research and Public Health 17, no. 18 (September 7, 2020): 6498. http://dx.doi.org/10.3390/ijerph17186498.
Full textAbstract:
Minors with and without migration background can have different risk factors and triggering reasons for self-harming and suicidal behaviour. We retrospectively analysed the data of 192 children and adolescents to investigate the transcultural differences in self-harming, as well as suicidal behaviour in Austrian, Turkish, and Bosnian/Croatian/Serbian (BCS)-speaking patients, who were treated in an emergency out-patient clinic in Vienna. Our results showed transcultural differences in both behaviours. In all groups, females had higher rates of suicide attempts and self-harming behaviour than males. While Turkish-speaking patients received treatment more often, after attempted suicide, Austrians and BCS-speaking patients needed treatment more often for acute stress disorder. Suicide attempts and self-harming behaviours were triggered most frequently by intrafamilial problems, but more frequently in migrant patients. Turkish-speaking patients were at a more than 2 times (OR = 2.21, 95%CI: 1.408–3.477) higher risk for suicide attempts, and were triggered almost 3 times (OR = 2.94, 95%CI: 1.632–5.304) more often by interfamilial conflicts. The suicide attempts of BCS-speaking minors were more often caused by relationship and separation crises (OR = 2.56, 95%CI: 1.148–5.705). These transcultural differences in suicidal and self-harming behaviour of minors, demand an increase of transcultural competence to provide optimal treatment of migrant children.
8
Beautrais, Annette L. "Risk Factors for Suicide and Attempted Suicide among Young People." Australian & New Zealand Journal of Psychiatry 34, no. 3 (June 2000): 420–36. http://dx.doi.org/10.1080/j.1440-1614.2000.00691.x.
Full textAbstract:
Objective: Suicide rates in young people have increased during the past three decades, particularly among young males, and there is increasing public and policy concern about the issue of youth suicide in Australia and New Zealand. This paper summarises current knowledge about risk factors for suicide and suicide attempts in young people. Method: Evidence about risk factors for suicidal behaviour in young people was gathered by review of relevant English language articles and other papers, published since the mid-1980s. Results: The international literature yields a generally consistent account of the risk factors and life processes that lead to youth suicide and suicide attempts. Risk factor domains which may contribute to suicidal behaviour include: social and educational disadvantage; childhood and family adversity; psychopathology; individual and personal vulnerabilities; exposure to stressful life events and circumstances; and social, cultural and contextual factors. Frequently, suicidal behaviours in young people appear to be a consequence of adverse life sequences in which multiple risk factors from these domains combine to increase risk of suicidal behaviour. Conclusions: Current research evidence suggests that the strongest risk factors for youth suicide are mental disorders (in particular, affective disorders, substance use disorders and antisocial behaviours) and a history of psychopathology, indicating that priorities for intervening to reduce youth suicidal behaviours lie with interventions focused upon the improved recognition, treatment and management of young people with mental disorders.
9
Nordentoft, M., P. Jeppesen, M. Abel, P. Kassow, L. Petersen, A. Thorup, G. Krarup, R. Hemmingsen, and P. Jørgensen. "OPUS study: Suicidal behaviour, suicidal ideation and hopelessness among patients with first-episode psychosis." British Journal of Psychiatry 181, S43 (September 2002): s98—s106. http://dx.doi.org/10.1192/bjp.181.43.s98.
Full textAbstract:
BackgroundPatients with first-episode psychosis comprise a high-risk group in terms of suicide.AimsTo identify predictive factors for suicidal behaviour and to examine the effect of integrated treatment on suicidal behaviour and hopelessness.MethodA total of 341 patients with a first-episode schizophrenia-spectrum disorder were randomised to integrated treatment or treatment as usual.ResultsDuring the 1-year follow-up period, 11% attempted suicide. This was associated with female gender, hopelessness, hallucinations and suicide attempt reported at baseline, with the two latter variables being the only significant ones in the final multivariate model. The integrated treatment reduced hopelessness.ConclusionsHallucinations and suicide attempt before inclusion in the study were the most significant predictors of suicide attempt in the follow-up period.
10
Mehlum, Lars. "Clinical challenges in the assessment and management of suicidal behaviour in patients with bordeline personality disorder." Epidemiologia e Psichiatria Sociale 18, no. 3 (September 2009): 184–90. http://dx.doi.org/10.1017/s1121189x00000440.
Full textAbstract:
AbstractSelf-injurious and suicidal behaviours are highly prevalent in patients with borderline personality disorder (BPD) and the risk of completed suicide is high. Borderline patients often present with heterogeneous clinical pictures and widespread comor-bidity complicating clinical assessments and management. This calls for increased efforts in systematic evaluation and monitoring of self-harming and suicidal behaviours; these behaviours should be addressed actively as high priority treatment targets. Early drop-out is common for BPD patients in treatment but is possible to counteract by fostering a strong therapeutic relationship through adopting a realistic, but consistent and supportive approach carefully avoiding reinforcement of suicidal behaviours. Suicidal crises should primarily be managed in an outpatient setting giving priority to keeping the patient safe adopting a safety plan procedure, while helping the patient as quickly as possible to return emotionally to a more acceptable level of arousal and mental functioning. Pharmacological treatments should primarily be used for management of comorbid conditions, but may possibly also be helpful when used to reduce specific symptoms such as anger, hostility and impulsivity. There is currently a range of different integrated short-term and long-term psychological treatments in different stages of development and some of them have been shown to be efficacious in reducing suicidal behaviours; notably dialectical behaviour therapy and mentalization-based therapy.Declaration of Interest: None.
11
Rhodes, Anne E., and Paul S. Links. "Suicide and Suicidal Behaviours: Implications for Mental Health Services." Canadian Journal of Psychiatry 43, no. 8 (October 1998): 785–91. http://dx.doi.org/10.1177/070674379804300802.
Full textAbstract:
Objective: To examine what is known about engaging and maintaining suicidal individuals in treatment and what can be learned from the randomized, controlled trials of psychosocial interventions concerning the reduction of suicidal behaviours. Method: Review of the relevant literature. Results: Treatment follow-through is low among those who attempt suicide. The evidence to date is inconclusive as to whether psychosocial interventions can reduce the repetition of suicidal behaviour. Conclusions: Certain groups may benefit from psychosocial interventions. Future research must overcome several methodological issues. As treatment relies on adequate follow-through, changes in the delivery of care may enhance treatment effectiveness.
12
Bota, Robert G. "Prevention and Treatment of Suicidal Behaviour." Primary Care Companion to The Journal of Clinical Psychiatry 10, no. 06 (December 15, 2008): 489–90. http://dx.doi.org/10.4088/pcc.v10n0613c.
Full text
13
Jordans, M., S. Rathod, A. Fekadu, G. Medhin, F. Kigozi, B. Kohrt, N. Luitel, et al. "Suicidal ideation and behaviour among community and health care seeking populations in five low- and middle-income countries: a cross-sectional study." Epidemiology and Psychiatric Sciences 27, no. 4 (February 16, 2017): 393–402. http://dx.doi.org/10.1017/s2045796017000038.
Full textAbstract:
AimsSuicidal behaviour is an under-reported and hidden cause of death in most low- and middle-income countries (LMIC) due to lack of national systematic reporting for cause-specific mortality, high levels of stigma and religious or cultural sanctions. The lack of information on non-fatal suicidal behaviour (ideation, plans and attempts) in LMIC is a major barrier to design and implementation of prevention strategies. This study aims to determine the prevalence of non-fatal suicidal behaviour within community- and health facility-based populations in LMIC.MethodsTwelve-month prevalence of suicidal ideation, plans and attempts were established through community samples (n = 6689) and primary care attendees (n = 6470) from districts in Ethiopia, Uganda, South Africa, India and Nepal using the Composite International Diagnostic Interview suicidality module. Participants were also screened for depression and alcohol use disorder.ResultsWe found that one out of ten persons (10.3%) presenting at primary care facilities reported suicidal ideation within the past year, and 1 out of 45 (2.2%) reported attempting suicide in the same period. The range of suicidal ideation was 3.5–11.1% in community samples and 5.0–14.8% in health facility samples. A higher proportion of facility attendees reported suicidal ideation than community residents (10.3 and 8.1%, respectively). Adults in the South African facilities were most likely to endorse suicidal ideation (14.8%), planning (9.5%) and attempts (7.4%). Risk profiles associated with suicidal behaviour (i.e. being female, younger age, current mental disorders and lower educational and economic status) were highly consistent across countries.ConclusionThe high prevalence of suicidal ideation in primary care points towards important opportunities to implement suicide risk reduction initiatives. Evidence-supported strategies including screening and treatment of depression in primary care can be implemented through the World Health Organization's mental health Global Action Programme suicide prevention and depression treatment guidelines. Suicidal ideation and behaviours in the community sample will require detection strategies to identify at risks persons not presenting to health facilities.
14
de Beurs, Derek P., Claudia D. van Borkulo, and Rory C. O'Connor. "Association between suicidal symptoms and repeat suicidal behaviour within a sample of hospital-treated suicide attempters." BJPsych Open 3, no. 3 (May 2017): 120–26. http://dx.doi.org/10.1192/bjpo.bp.116.004275.
Full textAbstract:
BackgroundSuicidal behaviour is the end result of the complex relation between many factors which are biological, psychological and environmental in nature. Network analysis is a novel method that may help us better understand the complex association between different factors.AimsTo examine the relationship between suicidal symptoms as assessed by the Beck Scale for Suicide Ideation and future suicidal behaviour in patients admitted to hospital following a suicide attempt, using network analysis.MethodSecondary analysis was conducted on previously collected data from a sample of 366 patients who were admitted to a Scottish hospital following a suicide attempt. Network models were estimated to visualise and test the association between baseline symptom network structure and suicidal behaviour at 15-month follow-up.ResultsNetwork analysis showed that the desire for an active attempt was found to be the most central, strongly related suicide symptom. Of the 19 suicide symptoms that were assessed at baseline, 10 symptoms were directly related to repeat suicidal behaviour. When comparing baseline network structure of repeaters (n=94) with the network of non-repeaters (n=272), no significant differences were found.ConclusionsNetwork analysis can help us better understand suicidal behaviour by visualising the complex relation between relevant symptoms and by indicating which symptoms are most central within the network. These insights have theoretical implications as well as informing the assessment and treatment of suicidal behaviour.
15
Werner, N., and J. P. Kahn. "Suicidology and Substance abuse in Adolescence." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70524-3.
Full textAbstract:
Adolescence is a critical period for suicidal risk. Suicide currently ranks as the second or third leading cause of mortality among adolescents in developped countries. It has been shown that a history of suicidal act, of depressive disorder and of a substance use disorder (SUD), alcohol and drugs, are the most prominent risk factors for suicidal behaviour among adolescents.Data on alcohol and drug use disorders and suicide consisted primarily of reports on alcohol use disorders and, to a lesser extent, opioid use disorder. The magnitude of the association with other drugs is still unclear.The relationships between substance use disorder and suicidal behaviour are multiple: In the long term, SUD may be associated with increases in stress and co-occuring psychopathology (poor self esteem, feeling of worthlessness, isolation).These elements may reach a level where a suicide attempt is viewed as a means to cope with perceived unsolvable difficulties. During life crises, SUD can also be responsible for inhibiting adaptative coping and desinhibiting suicidal behaviour. Finally, SUD and suicidal behaviour share common vulnerability factors: history of childhood abuse, genetically determined dimensions such as impulsivity or psychiatric disorders, particularly unipolar depressive and bipolar disorder.Given the comorbidity between SUD and suicide, it is essential for treatment and prevention that all suicidal adolescents be screened for SUD and vice versa. Ideally, adolescents who receive diagnosis of SUD and co-occuring suicidality should follow an integrated treatment protocol that addresses both conditions.
16
Wasserman, D., Z. Rihmer, D. Rujescu, M. Sarchiapone, M. Sokolowski, D. Titelman, G. Zalsman, Z. Zemishlany, and V. Carli. "The European Psychiatric Association (EPA) guidance on suicide treatment and prevention." European Psychiatry 27, no. 2 (February 2012): 129–41. http://dx.doi.org/10.1016/j.eurpsy.2011.06.003.
Full textAbstract:
AbstractSuicide is a major public health problem in the WHO European Region accounting for over 150,000 deaths per year.Suicidal crisis:Acute intervention should start immediately in order to keep the patient alive.Diagnosis:An underlying psychiatric disorder is present in up to 90% of people who completed suicide. Comorbidity with depression, anxiety, substance abuse and personality disorders is high. In order to achieve successful prevention of suicidality, adequate diagnostic procedures and appropriate treatment for the underlying disorder are essential.Treatment:Existing evidence supports the efficacy of pharmacological treatment and cognitive behavioural therapy (CBT) in preventing suicidal behaviour. Some other psychological treatments are promising, but the supporting evidence is currently insufficient. Studies show that antidepressant treatment decreases the risk for suicidality among depressed patients. However, the risk of suicidal behaviour in depressed patients treated with antidepressants exists during the first 10–14 days of treatment, which requires careful monitoring. Short-term supplementary medication with anxiolytics and hypnotics in the case of anxiety and insomnia is recommended. Treatment with antidepressants of children and adolescents should only be given under supervision of a specialist. Long-term treatment with lithium has been shown to be effective in preventing both suicide and attempted suicide in patients with unipolar and bipolar depression. Treatment with clozapine is effective in reducing suicidal behaviour in patients with schizophrenia. Other atypical antipsychotics are promising but more evidence is required.Treatment team:Multidisciplinary treatment teams including psychiatrist and other professionals such as psychologist, social worker, and occupational therapist are always preferable, as integration of pharmacological, psychological and social rehabilitation is recommended especially for patients with chronic suicidality.Family:The suicidal person independently of age should always be motivated to involve family in the treatment.Social support:Psychosocial treatment and support is recommended, as the majority of suicidal patients have problems with relationships, work, school and lack functioning social networks.Safety:A secure home, public and hospital environment, without access to suicidal means is a necessary strategy in suicide prevention. Each treatment option, prescription of medication and discharge of the patient from hospital should be carefully evaluated against the involved risks.Training of personnel:Training of general practitioners (GPs) is effective in the prevention of suicide. It improves treatment of depression and anxiety, quality of the provided care and attitudes towards suicide. Continuous training including discussions about ethical and legal issues is necessary for psychiatrists and other mental health professionals.
17
Walton, Carla J., Nick Bendit, Amanda L. Baker, Gregory L. Carter, and Terry J. Lewin. "A randomised trial of dialectical behaviour therapy and the conversational model for the treatment of borderline personality disorder with recent suicidal and/or non-suicidal self-injury: An effectiveness study in an Australian public mental health service." Australian & New Zealand Journal of Psychiatry 54, no. 10 (June 17, 2020): 1020–34. http://dx.doi.org/10.1177/0004867420931164.
Full textAbstract:
Objectives: Borderline personality disorder is a complex mental disorder that is associated with a high degree of suffering for the individual. Dialectical behaviour therapy has been studied in the largest number of controlled trials for treatment of individuals with borderline personality disorder. The conversational model is a psychodynamic treatment also developed specifically for treatment of borderline personality disorder. We report on the outcomes of a randomised trial comparing dialectical behaviour therapy and conversational model for treatment of borderline personality disorder in a routine clinical setting. Method: Participants had a diagnosis of borderline personality disorder and a minimum of three suicidal and/or non-suicidal self-injurious episodes in the previous 12 months. Consenting individuals were randomised to either dialectical behaviour therapy or conversational model and contracted for 14 months of treatment ( n = 162 commenced therapy). Dialectical behaviour therapy involved participants attending weekly individual therapy, weekly group skills training and having access to after-hours phone coaching. Conversational model involved twice weekly individual therapy. Assessments occurred at baseline, mid-treatment (7 months) and post-treatment (14 months). Assessments were conducted by a research assistant blind to treatment condition. Primary outcomes were change in suicidal and non-suicidal self-injurious episodes and severity of depression. We hypothesised that dialectical behaviour therapy would be more effective in reducing suicidal and non-suicidal self-injurious behaviour and that conversational model would be more effective in reducing depression. Results: Both treatments showed significant improvement over time across the 14 months duration of therapy in suicidal and non-suicidal self-injury and depression scores. There were no significant differences between treatment models in reduction of suicidal and non-suicidal self-injury. However, dialectical behaviour therapy was associated with significantly greater reductions in depression scores compared to conversational model. Conclusion: This research adds to the accumulating body of knowledge of psychotherapeutic treatment of borderline personality disorder and supports the use of both dialectical behaviour therapy and conversational model as effective treatments in routine clinical settings, with some additional benefits for dialectical behaviour therapy for persons with co-morbid depression.
18
Voros, V., P. Osvath, and S. Fekete. "A Model for the Management of Suicidal Behaviour in Primary Care." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70618-2.
Full textAbstract:
Introduction:Although suicide rates are decreasing in most European countries, suicide is still a major health concern. Despite of the fact, that the vast majority of suicidal patients contacted with health care services before the suicidal act, the doctor-patient meeting is a necessary, but sometimes not sufficient way enough to prevent suicide. Most patients, who commit or attempt suicide, are not regarded as being at high immediate risk at their final contact with health care services.Aims and methods:Based on reviewing the relevant literature and on our previous studies we developed a brief, practical, clinical guideline, which may aid general practitioners and primary care professionals to assess suicide risk and also to manage these patients.Results:We introduce a model for an integrated, regional suicide prevention strategy, which includes recognition, risk assessment and also intervention. The main steps of our model are to recognize warning signs, explore crisis situation and/or psychopathologic symptoms, assess protective and risk factors, estimate suicide risk, plan intervention strategies, and finally manage suicidal patients through the different levels of intervention.Conclusion:In the management of suicidal behaviour the complex stress-diathesis model has to be adjusted by considering biological markers (mental disorders, personality traits) and psycho-social factors (crisis, negative life events, interpersonal conflicts). Only after the assessment of these factors primary care professionals, as ‘gatekeepers’ can manage suicidal patients effectively by using adequate psychopharmacotherapeutic and psychotherapeutic facilities in the recognition, treatment and prevention of suicidal behaviour.
19
Voros, V., P. Osvath, and S. Fekete. "A Model for the Management of Suicidal Behaviour in Primary Care." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71227-1.
Full textAbstract:
Introduction:Although suicide rates are decreasing in most European countries, suicide is still a major health concern. Despite of the fact, that the vast majority of suicidal patients contacted with health care services before the suicidal act, the doctor-patient meeting is a necessary, but sometimes not sufficient way enough to prevent suicide. Most patients, who commit or attempt suicide, are not regarded as being at high immediate risk at their final contact with health care services.Aims and methods:Based on reviewing the relevant literature and on our previous studies we developed a brief, practical, clinical guideline, which may aid general practitioners and primary care professionals to assess suicide risk and also to manage these patients.Results:We introduce a model for an integrated, regional suicide prevention strategy, which includes recognition, risk assessment and also intervention. The main steps of our model are to recognize warning signs, explore crisis situation and/or psychopathologic symptoms, assess protective and risk factors, estimate suicide risk, plan intervention strategies, and finally manage suicidal patients through the different levels of intervention.Conclusion:In the management of suicidal behaviour the complex stress-diathesis model has to be adjusted by considering biological markers (mental disorders, personality traits) and psycho-social factors (crisis, negative life events, interpersonal conflicts). Only after the assessment of these factors primary care professionals, as ‘gatekeepers’ can manage suicidal patients effectively by using adequate psychopharmacotherapeutic and psychotherapeutic facilities in the recognition, treatment and prevention of suicidal behaviour.
20
Power, A. C., and P. J. Cowen. "Fluoxetine and Suicidal Behaviour." British Journal of Psychiatry 161, no. 6 (December 1992): 735–41. http://dx.doi.org/10.1192/bjp.161.6.735.
Full textAbstract:
“In the practical decisions of life it will scarcely ever be possible to go through all the arguments in favour of or against one possible decision, and one will therefore always have to act on insufficient evidence” Werner Heisenberg (1962).The development of selective serotonin (5-hydroxytryptamine, 5-HT) reuptake inhibitors (SSRIs) has added a new dimension to the pharmacotherapy of depression. Their lack of sedative and anticholinergic effects together with relative safety in overdose, has led some authors to suggest that the older tricyclic antidepressants (TCAs) should not now be considered a first-line treatment (Montgomery, 1988). However, since a report by Teicher et al (1990) of suicidal preoccupation associated with fluoxetine treatment, there has been both intense media interest and animated correspondence in clinical and scientific journals (O'Donnell, 1991).
21
Tosic-Golubovic, Suzana, Olivera Zikic, Violeta Slavkovic, Gordana Nikolic, and Maja Simonovic. "Relationship of depersonalization and suicidality in depressed patients." Vojnosanitetski pregled 75, no. 11 (2018): 1065–69. http://dx.doi.org/10.2298/vsp161201023t.
Full textAbstract:
Background/Aim. Depersonalization is considered to be the third leading symptom in psychiatric morbidity. The aim of this study was to investigate the correlation of depersonalization and different patterns of suicidal behaviour in patients suffering from depresssive disorder. Methods. The study included 119 depressed patients divided into two groups: the first group consisted of depressed patients with clinically manifested depersonalization according to the Cambridge Depresonalisation Scale presented score ? 70, and the second group consisted of the patients whithout clinically manifested depersonalization symptomatology, or, it was on the subsyndromal level. Subsequently, these two groups were compared regarding the suicidality indicators. Results. According to the Scale for Suicide Ideation of Beck, the depressed patients with depersonalization had statistically significantly higher scores regarding suicidal ideation, both active and passive, more often manifested suicidal desire, suicidal planning and overall suicidality (p < 0.000). Positive ideation, as a protective factor, was reduced in this group (p < 0.000). These patients had more previous suicide attempts (p < 0.001) and family history of suicides (p = 0.004). The depressed patients with depersonalization had 8 times more often active suicidal desire, 11 times more often passive suicidal desire and 5 times more often suicidal planning compared to patients without depersonalization. Conclusion. Suicidal potential, manifested in various patterns of suicidal behaviour among the patients suffering from depressive disorder with clinically manifested depersonalization is prominent. It is necessary to pay particular attention to depersonalization level during diagnostic and treatment procedure of the depressed patients having in mind that it may be associated with high suicidal potential.
22
Gonlag, A., M. van Baest, C. Rijnders, and R. Teijeiro. "Who gains from suicide risk assessment: Health inspectorate and health insurances, or also psychiatrist and patient?" European Psychiatry 33, S1 (March 2016): S601. http://dx.doi.org/10.1016/j.eurpsy.2016.01.2245.
Full textAbstract:
IntroductionThe number of suicides rises in the Netherlands. In 2008, 1435 suicides were recorded; in 2012: 1753 (CBS). Adequate risk assessment with suicidal behaviour (SRA) is essential for prevention. The Health Inspectorate and Insurances seek to have a stronger grip on the way suicide risk is assessed and insist on using questionnaires. This runs counter to the multidisciplinary guidelines in the Netherlands for diagnosis and treatment of suicidal behaviour, which state that “questionnaires or observation instruments cannot replace clinical diagnostic examination.”ObjectiveDo questionnaires rather than ‘care as usual’ (CAU) in SRA lead to different treatment policies?AimTo determine whether the use of questionnaires rather than CAU in SRA leads to different treatment policies.MethodsPatients who were seen by staff at the department of Psychiatry at the ETS Hospital, either for in-house consultation or at the MPU, in connection with attempted suicide, auto-intoxication, or psychological distress with suicidal statements. Patients were examined by conducting a questionnaire, resulting in treatment policy (admission, discharge with an appointment with patient's own practitioner, discharge with referral to a practitioner, discharge without aftercare). Then, the same patient was again examined by another colleague in a free interview (CAU). The colleague was not informed about the outcome of the first assessment. Again, treatment policy was determined as a result. The two outcomes were then compared.ResultsData collection still continues.ConclusionsThere are signs that there are no differences in the determined treatment policies following SRA based on the use of questionnaires or CAU.Disclosure of interestThe authors have not supplied their declaration of competing interest.
23
Hirvikoski, T., M. Boman, Q. Chen, B. M. D'Onofrio, E. Mittendorfer-Rutz, P. Lichtenstein, S. Bölte, and H. Larsson. "Individual risk and familial liability for suicide attempt and suicide in autism: a population-based study." Psychological Medicine 50, no. 9 (June 26, 2019): 1463–74. http://dx.doi.org/10.1017/s0033291719001405.
Full textAbstract:
AbstractBackgroundStudies on the individual gender-specific risk and familial co-aggregation of suicidal behaviour in autism spectrum disorder (ASD) are lacking.MethodsWe conducted a matched case-cohort study applying conditional logistic regression models on 54 168 individuals recorded in 1987–2013 with ASD in Swedish national registers: ASD without ID n = 43 570 (out of which n = 19035, 43.69% with ADHD); ASD + ID n = 10 598 (out of which n = 2894 individuals, 27.31% with ADHD), and 270 840 controls, as well as 347 155 relatives of individuals with ASD and 1 735 775 control relatives.ResultsThe risk for suicidal behaviours [reported as odds ratio OR (95% confidence interval CI)] was most increased in the ASD without ID group with comorbid ADHD [suicide attempt 7.25 (6.79–7.73); most severe attempts i.e. requiring inpatient stay 12.37 (11.33–13.52); suicide 13.09 (8.54–20.08)]. The risk was also increased in ASD + ID group [all suicide attempts 2.60 (2.31–2.92); inpatient only 3.45 (2.96–4.02); suicide 2.31 (1.16–4.57)]. Females with ASD without ID had generally higher risk for suicidal behaviours than males, while both genders had highest risk in the case of comorbid ADHD [females, suicide attempts 10.27 (9.27–11.37); inpatient only 13.42 (11.87–15.18); suicide 14.26 (6.03–33.72); males, suicide attempts 5.55 (5.10–6.05); inpatient only 11.33 (9.98–12.86); suicide 12.72 (7.77–20.82)]. Adjustment for psychiatric comorbidity attenuated the risk estimates. In comparison to controls, relatives of individuals with ASD also had an increased risk of suicidal behaviour.ConclusionsClinicians treating patients with ASD should be vigilant for suicidal behaviour and consider treatment of psychiatric comorbidity.
24
Schosser, A., R. Calati, A. Serretti, I. Massat, S. Linotte, J. Mendlewicz, D. Souery, S. Montgomery, and S. Kasper. "FC04-06 - Candidate gene association study of suicidality in treatment resistant MDD." European Psychiatry 26, S2 (March 2011): 1833. http://dx.doi.org/10.1016/s0924-9338(11)73537-4.
Full textAbstract:
Suicidal behaviour runs in families and the existence of genetic vulnerability to suicidality is well-established. Mental disorders, especially depression, are present in more of 90% of suicides. The incidence of treatment emergent suicidal ideation in major depression (MDD) varies from 4% to 20%, depending on the definition of suicidal ideation and sample characteristics.In the present study, we further elucidated the impact of depression candidate genes in treatment emergent suicidal ideation in MDD. One hundred-seventy MDD patients were collected in the context of a resistant depression study and treated with antidepressants at adequate doses for at least 4 weeks. MDD subjects were genotyped for SNPs within the COMT gene, BDNF, DTNBP1, 5HT1A, 5HT2A, GNB3, GRIK4, PTGS1, PTGS2, CREB, and cytochrome P450 CYP1A2, CYP2C9, CYP2C19 and CYP2D6 gene. Response, remission and treatment resistance, as well as suicidality information derived from Mini International Neuropsychiatric Interview (MINI) and Hamilton Rating Scale for Depression (HAM-D) were recorded.A quantitative and measure of suicidal behaviour was defined using the Hamilton rating scale (score 0 to 4) and the MINI-item (yes/no) on suicidality in a large cohort of depression cases. In addition, we tested for association with ‘serious suicidal attempts’ corresponding to a HAMD score of 4 (discrete trait analyses). Results of this candidate gene approach in treatment emergent suicidal ideation in MDD will be presented and discussed.
25
Serafini, G., G. Canepa, G. Adavastro, M. Pompili, P. Girardi, and M. Amore. "Exploring the Complex Association Between Affective Temperaments and Suicidal Behaviour." European Psychiatry 41, S1 (April 2017): S210. http://dx.doi.org/10.1016/j.eurpsy.2017.01.2175.
Full textAbstract:
IntroductionSuicidal behaviour is one of the most relevant public health problems and it is associated with a significant disability and psychosocial impairment. Affective temperaments, hopelessness, suicidal ideation, and suicide intent may be significantly involved in suicidal behaviour.ObjectivesThe present study explored the complex relation between these clinical variables and suicide.AimsWe aimed to evaluate the specific role of affective temperaments and other risk factors as potential predictors of suicide risk.MethodsThe sample included 276 patients (19.9% men, 81.1% women; mean age: 48.1 years, SD:16.9), of which most with major affective disorders, who were admitted at the Psychiatric Unit of the University of Genoa (Italy). All participants have been evaluated using the Temperament Evaluation of Memphis, Pisa and San Diego Auto-questionnaire (TEMPS-a), Beck Hopelessness scale (BHS), Scale for Suicide Ideation (SSI), and Intent Score Scale (ISS).ResultsPatients with anxious temperament significantly differ in terms of residual interepisodic symptoms, substances abuse, adherence to treatment, and current episode duration when compared with those having other affective temperaments. Only suicidal ideation and irritable temperament resulted significant predictors of suicide preparation. In addition, suicidal ideation and prior suicide attempts represent significant predictors of suicide intent.ConclusionsThe present findings suggest the importance of systematic evaluation for suicidal behaviour that may allow clinicians to identify patients at higher suicide risk. As these data may be influenced by the severity of the psychopathological conditions and psychiatric medications, which were used during admission by our patients, further additional studies are needed to test these preliminary findings.Disclosure of interestThe authors have not supplied their declaration of competing interest.
26
Carli, V. "The Patient is Suicidal: What Should I Do as a Clinician?" European Psychiatry 41, S1 (April 2017): S41. http://dx.doi.org/10.1016/j.eurpsy.2017.01.185.
Full textAbstract:
Suicidal behaviour is the most common psychiatric emergency. A large proportion of suicidal behaviour can be prevented, particularly in cases associated with mental disorders. Early recognition of suicidality and reliable evaluation of suicide risk are crucial for the clinical prevention of suicide. Evaluation of suicidal risk involves assessment of suicidal intent, previous suicide attempts, underlying psychiatric disorders, the patients’ personality, the social network, and suicide in the family or among acquaintances as well as other well-known risk factors. Suicide risk assessment should take place on several levels and relate to the patient, the family and social network but also to the availability of treatment, rehabilitation and prevention resources in the community. As suicide risk fluctuates within a short period of time, it is important to repeat the suicide risk assessment over time in an emphatic and not mechanistic way. The suicidal person may mislead both family members and hospital staff, giving a false sense of independence and of being able to manage without the help of others. Although extreme ambivalence to living or dying is often strongly expressed by the suicidal individual, it is not seldom missed by others. If observed in the diagnostic and treatment process, dialogue and reflection on such ambivalence can be used to motivate the patient for treatment and to prevent suicide. If ambivalence and suicidal communications go undiscovered, the treatment process and the life of the patient can be endangered. Today, several measurement tools of suicide risk exist, including psychometric and biological measurements. Some of these tools have been extensively studied and measures of their sensitivity and specificity have been estimated. This allows for the formulation of an approximate probability that a suicidal event might happen in the future. However, the low precision of the predictions make these tools insufficient from the clinical perspective and they contribute very little information that is not already gained in a standard clinical interview. Psychiatrists and other mental health professionals have always longed for reliable and precise tools to predict suicidal behavior, which could support their clinical practice, allow them to concentrate resources on patients that really need them, and backup their clinical judgement, in case of eventual legal problems. In order to be useful, however, the approximate probability that a suicidal event might happen in the future is not sufficient to significantly change clinical routines and practices. These should rely on the available evidence base and always consider the safety of the patient as paramount.Disclosure of interestThe author declares that he has no competing interest.
27
Pratt, D., N. Tarrier, G. Dunn, Y. Awenat, J. Shaw, F. Ulph, and P. Gooding. "Cognitive–behavioural suicide prevention for male prisoners: a pilot randomized controlled trial." Psychological Medicine 45, no. 16 (July 13, 2015): 3441–51. http://dx.doi.org/10.1017/s0033291715001348.
Full textAbstract:
Background.Prisoners have an exceptional risk of suicide. Cognitive–behavioural therapy for suicidal behaviour has been shown to offer considerable potential, but has yet to be formally evaluated within prisons. This study investigated the feasibility of delivering and evaluating a novel, manualized cognitive–behavioural suicide prevention (CBSP) therapy for suicidal male prisoners.Method.A pilot randomized controlled trial of CBSP in addition to treatment as usual (CBSP; n = 31) compared with treatment as usual (TAU; n = 31) alone was conducted in a male prison in England. The primary outcome was self-injurious behaviour occurring within the past 6 months. Secondary outcomes were dimensions of suicidal ideation, psychiatric symptomatology, personality dysfunction and psychological determinants of suicide, including depression and hopelessness. The trial was prospectively registered (number ISRCTN59909209).Results.Relative to TAU, participants receiving CBSP therapy achieved a significantly greater reduction in suicidal behaviours with a moderate treatment effect [Cohen's d = −0.72, 95% confidence interval −1.71 to 0.09; baseline mean TAU: 1.39 (s.d. = 3.28) v. CBSP: 1.06 (s.d. = 2.10), 6 months mean TAU: 1.48 (s.d. = 3.23) v. CBSP: 0.58 (s.d. = 1.52)]. Significant improvements were achieved on measures of psychiatric symptomatology and personality dysfunction. Improvements on psychological determinants of suicide were non-significant. More than half of the participants in the CBSP group achieved a clinically significant recovery by the end of therapy, compared with a quarter of the TAU group.Conclusions.The delivery and evaluation of CBSP therapy within a prison is feasible. CBSP therapy offers significant promise in the prevention of prison suicide and an adequately powered randomized controlled trial is warranted.
28
Wasserman, D. "Debate: Can suicide be prevented?" European Psychiatry 33, S1 (March 2016): S2. http://dx.doi.org/10.1016/j.eurpsy.2016.01.113.
Full textAbstract:
Suicidal behaviour is the most common life-threatening psychiatric emergency. Reliable and precise tools to predict suicidal behaviours and to get support in the clinical practice are frequently requested.Several measurement tools for suicide risk assessment, both psychometric and biological have been studied. However, the low precision of the predictions make these tools insufficient from the clinical perspective. To date, the same applies to the search of genetic predictors. The best information is gained in a standard clinical evaluation, which puts focus on the need of acquiring the best possible knowledge and skills by practicing clinicians.The European Psychiatric Association (EPA) issued a guidance paper on suicide treatment and prevention, which was published in the European Psychiatry in 2012 [1]. This guidance paper elucidates the process of systematic evaluation of suicidal risks in the clinical interview, an overview of the best treatment possibilities and strategies for follow-up. As psychiatric patients constitute the majority of people who commit suicide, the adequate treatment of depression, substance use disorders, schizophrenia and other psychiatric diseases is a must.We will probably never be able to have perfect measurements to predict if an individual will or will not commit suicide, due to the complexities of human behaviour. However, with a good clinical praxis, suicide is an unnecessary death [2].Disclosure of interestThe author has not supplied his declaration of competing interest.
29
Martins, A. P., A. Silva, M. Pinho, and G. Samico. "Drug addiction and suicide - retrospective study." European Psychiatry 26, S2 (March 2011): 1629. http://dx.doi.org/10.1016/s0924-9338(11)73333-8.
Full textAbstract:
Impulsiveness has an important role in suicide behaviour and substance abuse.In this context, it's important to assess suicide risk among drug users and to determine which factors play a protective role and which factors increase the risk.In this study the authors propose to determine the prevalence of actual or past suicidal ideation in a sample of substance users; to determine the prevalence of previous suicidal behaviours in the same sample; and to study the relation with clinical and sociodemographic variables.The sample included 119 patients with drug addiction behaviours receiving treatment in an inpatient detoxication unit (Unidade de Desabituação do Norte do IDT - Instituto da Droga e das Toxicodependências), admitted between May 2010 and July 2010.Data was obtained from the patient clinical chart, including the admission protocol form.SPSS was used for statistical analysis.The results founded were:18,5% (n = 22) had previous suicidal ideation at least once in their lifetime.2,5% (n = 3) had suicidal ideation at admission.10,9% (n = 13) had previous suicidal attempts.According to literature, in general population, lifetime prevalence of suicidal ideation is 10–18% and history of suicidal attempt is 3–5%.In the studied sample, suicidal ideation during lifetime is slightly raised (18,5%) and history of suicidal behaviours is strongly higher (10.9%).These data suggest a raised suicidal risk in drug abuse population, probably reflecting a higher impulsiveness in this population.
30
van Heeringen, Kees. "The Neurobiology of Suicide and Suicidality." Canadian Journal of Psychiatry 48, no. 5 (June 2003): 292–300. http://dx.doi.org/10.1177/070674370304800504.
Full textAbstract:
Objective: To investigate the current state of knowledge regarding the neurobiology of suicide and suicidality. Method: The literature on the neurobiology of suicidality and suicide was reviewed. Results: There is clear evidence that the activity of 3 neurobiological systems has a role in the pathophysiology of suicidal behaviour. This includes hyperactivity of the hypothalamo-pituitary-adrenal axis, dysfunction of the serotonergic (5-HTergic) system, and excessive activity of the noradrenergic system. While the first and the last system appear to be involved in the response to stressful events, dysfunction of the serotonergic system is thought to be trait-dependent and associated with disturbances in the regulation of anxiety, impulsivity, and aggression. It can be hypothesized that neurobiological dysfunctions mediate the occurrence of suicidal behaviour through the disturbed modulation of basic neuropsychological functions. Conclusion: Increasing insight into the neurobiological basis of suicidal behaviour suggests that serotonin (5-HT) agonists have an important role in the treatment and prevention of suicidal behaviour. Studies of the efficacy of such drugs have, however, been disappointing. Because suicidal behaviour continues to be a major public health problem, further study is clearly needed, including research on the effect of combined pharmacologic and psychotherapeutic approaches.
31
Decker, Suzanne E., Lynette Adams, Laura E. Watkins, Lauren M. Sippel, Jennifer Presnall-Shvorin, Mehmet Sofuoglu, and Steve Martino. "Feasibility and preliminary efficacy of dialectical behaviour therapy skills groups for Veterans with suicidal ideation: pilot." Behavioural and Cognitive Psychotherapy 47, no. 5 (March 21, 2019): 616–21. http://dx.doi.org/10.1017/s1352465819000122.
Full textAbstract:
AbstractBackground:Veterans are at high risk for suicide; emotion dysregulation may confer additional risk. Dialectical behaviour therapy (DBT) is a well-supported intervention for suicide attempt reduction in individuals with emotion dysregulation, but is complex and multi-component. The skills group component of DBT (DBT-SG) has been associated with reduced suicidal ideation and emotion dysregulation. DBT-SG for Veterans at risk for suicide has not been studied.Aims:This study sought to evaluate the feasibility and acceptability of DBT-SG in Veterans and to gather preliminary evidence for its efficacy in reducing suicidal ideation and emotion dysregulation and increasing coping skills.Method:Veterans with suicidal ideation and emotion dysregulation (N = 17) enrolled in an uncontrolled pilot study of a 26-week DBT-SG as an adjunct to mental health care-as-usual.Results:Veterans attended an average 66% of DBT-SG sessions. Both Veterans and their primary mental health providers believed DBT-SG promoted Veterans’ use of coping skills to reduce suicide risk, and they were satisfied with the treatment. Paired sample t-tests comparing baseline scores with later scores indicated suicidal ideation and emotion dysregulation decreased at post-treatment (d = 1.88, 2.75, respectively) and stayed reduced at 3-month follow-up (d = 2.08, 2.59, respectively). Likewise, skillful coping increased at post-treatment (d = 0.85) and was maintained at follow-up (d = 0.91).Conclusions:An uncontrolled pilot study indicated DBT-SG was feasible, acceptable, and demonstrated potential efficacy in reducing suicidal ideation and emotion dysregulation among Veterans. A randomized controlled study of DBT-SG with Veterans at risk for suicide is warranted.
32
Bruffaerts, R., K. Demyttenaere, I. Hwang, W. T. Chiu, N. Sampson, R. C. Kessler, J. Alonso, et al. "Treatment of suicidal people around the world." British Journal of Psychiatry 199, no. 1 (July 2011): 64–70. http://dx.doi.org/10.1192/bjp.bp.110.084129.
Full textAbstract:
BackgroundSuicide is a leading cause of death worldwide; however, little information is available about the treatment of suicidal people, or about barriers to treatment.AimsTo examine the receipt of mental health treatment and barriers to care among suicidal people around the world.MethodTwenty-one nationally representative samples worldwide (n=55 302; age 18 years and over) from the World Health Organization's World Mental Health Surveys were interviewed regarding past-year suicidal behaviour and past-year healthcare use. Suicidal respondents who had not used services in the past year were asked why they had not sought care.ResultsTwo-fifths of the suicidal respondents had received treatment (from 17% in low-income countries to 56% in high-income countries), mostly from a general medical practitioner (22%), psychiatrist (15%) or non-psychiatrist (15%). Those who had actually attempted suicide were more likely to receive care. Low perceived need was the most important reason for not seeking help (58%), followed by attitudinal barriers such as the wish to handle the problem alone (40%) and structural barriers such as financial concerns (15%). Only 7% of respondents endorsed stigma as a reason for not seeking treatment.ConclusionsMost people with suicide ideation, plans and attempts receive no treatment. This is a consistent and pervasive finding, especially in low-income countries. Improving the receipt of treatment worldwide will have to take into account culture-specific factors that may influence the process of help-seeking.
33
Driessen, Martin, Clemens Veltrup, Jutta Weber, Ulrich John, Tilman Wetterling, and Horst Dilling. "Psychiatric co-morbidity, suicidal behaviour and suicidal ideation in alcoholics seeking treatment." Addiction 93, no. 6 (June 1998): 889–94. http://dx.doi.org/10.1046/j.1360-0443.1998.93688910.x.
Full text
34
Beautrais, AL. "Understanding suicidal behaviour: the suicidal process approach to research, treatment and prevention." Australian and New Zealand Journal of Psychiatry 37, no. 1 (January 22, 2003): 128–29. http://dx.doi.org/10.1046/j.1440-1614.2003.t01-6-01119h.x.
Full text
35
Beautrais, Annette L., J. Elisabeth Wells, Magnus A. Mcgee, and Mark A. Oakley Browne. "Suicidal Behaviour in Te Rau Hinengaro: The New Zealand Mental Health Survey." Australian & New Zealand Journal of Psychiatry 40, no. 10 (October 2006): 896–904. http://dx.doi.org/10.1080/j.1440-1614.2006.01909.x.
Full textAbstract:
Objective: To describe prevalence and correlates of suicidal behaviour in the New Zealand population aged 16 years and over. Method: Data are from Te Rau Hinengaro: The New Zealand Mental Health Survey, a nationally representative household survey conducted from October 2003 to December 2004 in a sample of 12 992 participants aged 16 years and over to study prevalences and correlates of mental disorders assessed using the World Mental Health Composite International Diagnostic Interview. Lifetime and 12 month prevalences and onset distributions for suicidal ideation, plans and attempts, and sociodemographic and mental disorder correlates of these behaviours were examined. Results: Lifetime prevalences were 15.7% for suicidal ideation, 5.5% for suicide plan and 4.5% for suicide attempt, and were consistently significantly higher in females than in males. Twelve-month prevalences were 3.2% for ideation, 1.0% for plan and 0.4% for attempt. Risk of ideation in the past 12 months was higher in females, younger people, people with lower educational qualifications, and people with low household income. Risk of making a plan or attempt was higher in younger people and in people with low household income. After adjustment for sociodemographic factors, there were no ethnic differences in ideation, although Māori and Pacific people had elevated risks of plans and attempts compared with non-Māori non-Pacific people. Individuals with a mental disorder had elevated risks of ideation (11.8%), plan (4.1%) and attempt (1.6%) compared with those without mental disorder. Risks of suicidal ideation, plan and attempt were associated with mood disorder, substance use disorder and anxiety disorder. Major depression was the specific disorder most strongly associated with suicidal ideation, plan and attempt. Less than half of those who reported suicidal behaviours within the past 12 months had made visits to health professionals within that period. Less than one-third of those who had made attempts had received treatment from a psychiatrist. Conclusions: Risks of making a suicide plan or attempt were associated with mental disorder and sociodemographic disadvantage. Most people with suicidal behaviours had not seen a health professional for mental health problems during the time that they were suicidal.
36
MacLeod, Andrew K., J. Mark G. Williams, and Marsha M. Linehan. "New Developments in the Understanding and Treatment of Suicidal Behaviour." Behavioural and Cognitive Psychotherapy 20, no. 3 (July 1992): 193–218. http://dx.doi.org/10.1017/s0141347300017201.
Full textAbstract:
Recent developments in the understanding, assessment and treatment of suicidal behaviour are reviewed. The accumulated social and demographic knowledge of suicidal populations has proved to be clinically useful in shaping the general level of concern, but at the individual level an understanding of the psychological processes involved in suicidal behaviour is required. Studies examining psychological processes involved in suicidal behaviour is required. Studies examining psychological processes in parasuicidal groups have revealed a number of deficits, including poor interpersonal problem solving, hopelessness about the future, and reduced ability to regulate affect. Research has also begun to look at some of the processes underlying these deficits, such as over-general retrieval of autobiographical memories and reduced anticipation of specific positive experiences. The clinical picture is now more optimistic, with therapies, such as Dialectical Behaviour Therapy, which focus on using problem solving strategies with those clients who are most vulnerable to repeat parasuicide episodes, producing demonstrable delays in parasuicide and reduced risk of repetition. The importance of the relationship between research and clinical practice is emphasized.
37
McGuffin, P., N. Perroud, R. Uher, A. Butlera, K. J. Aitchison, I. Craig, C. Lewis, and A. Farmer. "The genetics of affective disorder and suicide." European Psychiatry 25, no. 5 (June 2010): 275–77. http://dx.doi.org/10.1016/j.eurpsy.2009.12.012.
Full textAbstract:
AbstractSuicidal behaviour shows evidence of familial clustering and the twin data on completed suicide suggest moderate heritability. The extent to which the genetics of suicidal behaviour overlaps with the genetics of affective disorders is unclear but there is overwhelming evidence that both bipolar and unipolar disorder are substantially influenced by genes. So far, candidate gene studies of suicidality have provoked much interest, but recently, attention has also turned to candidate gene approaches to suicidal ideation emerging during antidepressant treatment. The advent of genome-wide association studies (GWAS) has had a major impact on studies of affective disorder with some provocative new findings. The GWAS approach is also beginning to be applied in the search for genes that underlie suicidal ideation and behaviour.
38
Serafini, G., and M. Pompili. "Affective temperaments, white matter hyperintensities and suicidal risk in patients with mood disorders." European Psychiatry 26, S2 (March 2011): 1644. http://dx.doi.org/10.1016/s0924-9338(11)73348-x.
Full textAbstract:
IntroductionPatients with white matter hyperintensities (WMHs) may be at higher risk for affective disorders and suicidal behaviour and affective temperaments may play a significant role in mood disorders.Objectives, aims, methodsRecently, we conducted a study in a sample of 247 patients with major affective disorders consecutively admitted as psychiatric inpatients.ResultsWe found that those with higher dysthymia and lower hyperthymia were more likely to have higher BHS scores, more WMHs, higher MINI suicidal risk, and more recent suicide attempts than patients with higher hyperthymia and lower dysthymia. Previously, we have reported that depressive, cyclothymic, irritable and anxious temperaments are risk factors whereas the hyperthymic temperament is a protective factor for suicidal behaviour, at least for suicide attempters. This is in line with recent genetic studies showing that the short allele of serotonin transporter gene promoter (5-HTTLPR) was significantly related to depressive, cyclothymic, irritable and anxious temperaments (but not to the hyperthymic temperament) and individuals with the short allele of the 5-HTTLPR and major affective disorders have more microstructural white matter abnormalities in specific brain regions.ConclusionsIn subjects with mood disorders, some temperament profiles in addition to WMHs presumably play a critical role in the emergence of hopelessness and suicidal behaviour. Differences among temperament profiles associated with WMHs may be used as biological markers for clinically grouping subjects at higher risk both for the emergence of mood disorders and suicidal behaviour (highly lethal suicide attempts) and this may have relevant implications for treatment.
39
Govender, R. D., and L. Schlebusch. "A suicide risk screening scale for HIV-infected persons in the immediate post-diagnosis period." Southern African Journal of HIV Medicine 14, no. 2 (June 4, 2013): 58–63. http://dx.doi.org/10.4102/sajhivmed.v14i2.79.
Full textAbstract:
Background. The risk of suicidal tendencies in HIV-infected persons appears high and may parallel the increasing prevalence of suicidal behaviour in South Africa.Objective. To construct a brief suicide risk screening scale (SRSS) as a self-administered instrument to screen for suicidal ideation in recently diagnosed HIV-infected persons.Methods. An SRSS was developed, drawing 14 items from two established screening tests, and assessed using a sample of 150 HIV-infected consenting adults identified at a voluntary counselling and testing (VCT) clinic at an academic district level hospital in Durban, South Africa. Participants returned three weeks after their initial assessment for a re-assessment.Results. The internal consistency of the SRSS was good (Cronbach’s alpha, 0.87), and its sensitivity (81%) was higher than its specificity (47%). The findings suggest that, despite certain limitations, the SRSS may be a valuable screening tool for suicidal ideation at VCT clinics.Conclusion. Screening for suicide risk and possible suicidal behaviour in HIV-positive persons may form a routine aspect of comprehensive patient care at VCT clinics to assist with effective prevention and treatment.
40
Saunders, Kate E. A., and Keith Hawton. "The role of psychopharmacology in suicide prevention." Epidemiologia e Psichiatria Sociale 18, no. 3 (September 2009): 172–78. http://dx.doi.org/10.1017/s1121189x00000427.
Full textAbstract:
AbstractThe potential role of psychopharmacology in suicide prevention is often minimised. This may to some extent reflect that few medication trials have specifically focussed on prevention of suicidal behaviour – indeed this outcome is often not reported in trials. However, there is reasonably strong evidence that lithium may reduce risk of suicide, the postulated mechanism being a specific effect on aggression. Evidence is lacking with regard to any protective effect of other mood stabilizers. Clozapine may reduce suicidal behaviour in patients with schizophrenia, with reduction of affective symptoms being a possible explanation. The role of antidepressants in relation to suicide risk is highly controversial, especially in children and adolescents. It is unclear whether minor tranquillizers or hypnotics can assist in suicide prevention, although they can reduce the anxiety symptoms that may occur during initial treatment with SSRI antidepressants. Itis also uncertain whether psychopharmacology has a role in preventing suicidal behaviour in people with personality disorders. Despite the limitations of the evidence we contend that suicide risk should be an important factor in deciding when and what to prescribe.Declaration of Interest: We have no interests to declare.
41
Öhlund, Louise, Michael Ott, Robert Lundqvist, Mikael Sandlund, Ellinor Salander Renberg, and Ursula Werneke. "Suicidal and non-suicidal self-injurious behaviour in patients with bipolar disorder and comorbid attention deficit hyperactivity disorder after initiation of central stimulant treatment: a mirror-image study based on the LiSIE retrospective cohort." Therapeutic Advances in Psychopharmacology 10 (January 2020): 204512532094750. http://dx.doi.org/10.1177/2045125320947502.
Full textAbstract:
Background: Currently, our understanding regarding treatment of adult attention deficit hyperactivity disorder (ADHD) co-occurring with bipolar disorder (BD) remains limited. The aim of this study was to evaluate the impact of central stimulant (CS) treatment on suicidal and non-suicidal self-injurious behaviour in patients with a pre-existing diagnosis of BD or schizoaffective disorder (SZD). Specifically, we tested the hypothesis that CS treatment significantly decreased the number of suicide attempts and non-suicidal self-injury events. Methods: A mirror-image study in patients with a dual diagnosis of BD or SZD and ADHD, comparing suicide attempts and non-suicidal self-injury events within 6 months and 2 years before and after CS initiation. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of BD as compared with other mood stabilisers. Results: Of 1564 eligible patients, 206 patients met the inclusion criteria. Within the 6 months after CS initiation, suicide attempts and non-suicidal self-injury events decreased significantly, both in terms of numbers of patients having such events ( p = 0.013) and numbers of events experienced ( p = 0.004). These effects were preserved 2 years after CS initiation. Conclusions: CS treatment may reduce the risk of suicide attempts and non-suicidal self-injury events in patients with a dual diagnosis of BD or SZD and ADHD. Based on our findings, clinicians should not withhold CS treatment from patients with concomitant ADHD for fear of deterioration of the underlying BD. However, to minimise the risk of manic episodes concomitant mood stabiliser treatment and close monitoring remains warranted.
42
Vismara, M. E. M., B. Dell’Osso, C. Dobrea, L. Cremaschi, G. Benedetta, C. Arici, B. Benatti, L. Oldani, and A. C. Altamura. "Clinical Characteristics Associated with Suicide Attempt in Patients with Bipolar Disorder." European Psychiatry 41, S1 (April 2017): S94. http://dx.doi.org/10.1016/j.eurpsy.2017.01.293.
Full textAbstract:
IntroductionBipolar disorder (BD) is a chronic, highly disabling condition, associated with a high burden of morbidity and mortality, often secondary to suicidal behaviors. In previous reports, different variables have been associated with a higher risk of suicidal acts, with variable effect.ObjectivesTo evaluate which socio-demographic and clinical variables correlate with suicide attempts in bipolar patients.AimsTo enrich literature data about suicidal behaviour in BD.MethodsA sample of 362 BD patients (DSM IV-TR) was retrospectively collected and divided in two subgroups, in relation to the presence of a previous suicide attempt. Socio-demographic and clinical variables were compared between attempters and non-attempters using Corrected multivariate analysis of covariance (MANCOVA).ResultsA total of 26,2% of analyzed patients attempted suicide in their lifespan, and approximately one third of them had multiple suicide attempts (i.e. ≥ 2; 31%). Depressive polarity at index mood episode, higher number of psychiatric hospitalizations, comorbidity with alcohol abuse, eating disorders and psychiatric poly-comorbidity were significantly associated with suicide attempt. Additionally, treatment with lithium, poly-pharmacotherapy (≥ 4 current drugs) and higher recurrence of psychosocial rehabilitation were significantly more frequent in patients who attempted suicide.ConclusionsThe present paper reported a correlation with some specific clinical variables and the lifetime presence of suicide attempt in patients with BD. Although these retrospective findings did not address the causality issue, they may be of clinical relevance in order to better understand suicidal behavior in BD and to adopt proper strategies to prevent suicide in higher risk patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.
43
Agarwal, Meena, and Keith Gaskell. "Clinical features of alcoholic suicide attempters/ non-attempters." Psychiatric Bulletin 20, no. 11 (November 1996): 656–59. http://dx.doi.org/10.1192/pb.20.11.656.
Full textAbstract:
A cross-sectional study of 74 consecutive alcoholic patients admitted to a subregional alcohol treatment unit examines the socio-demographic and clinical differences between those who had/had not attempted suicide, and investigates their relationships to current suicidal ideation. The suicide attempters were significantly younger, separated and unemployed. They began regular drinking earlier, were more severely dependent and had a higher proportion of major depression, antisocial personality disorder and another drug abuse. The results suggest a high incidence of suicidal behaviour in alcoholics and high psychiatric comorbidity in alcoholics who attempt suicide.
44
Cedereke, M., K. Monti, and A. Öjehagen. "Telephone contact with patients in the year after a suicide attempt: does it affect treatment attendance and outcome? A randomised controlled study." European Psychiatry 17, no. 2 (April 2002): 82–91. http://dx.doi.org/10.1016/s0924-9338(02)00632-6.
Full textAbstract:
SummaryAmbivalence to treatment and repeated suicidal behaviour are well-known problems in suicide attempters. A randomised controlled study was performed to investigate the influence of repeated telephone contacts on treatment attendance, repetition of suicidal behaviour and mental health the year after a suicide attempt.Subjects and methodsOne month after their suicide attempt 216 patients were randomised to either two telephone interventions in addition to treatment as usual, or no such intervention during the subsequent year. The interventions included motivational support to attend and/or to stay in treatment. At 1 month and again after 12 months the following measurements were used: GSI (SCL-90), GAF and SSI.ResultsAt follow-up treatment attendance was high and did not differ between the randomised groups. Among those with an initial treatment contact other than psychiatric, more patients in the intervention group had such contact at follow-up. The randomised groups did not differ in repetition of suicide attempts during follow-up or in improvement in GSI (SCL-90), GAF and SSI. In individuals with no initial treatment the intervention group improved more in certain psychological symptom dimensions (SCL-90).ConclusionsTelephone interventions seem to have an effect on patients who at their suicide attempt had other treatment than psychiatric and in those with no treatment.
45
Bellairs-Walsh, India, Yael Perry, Karolina Krysinska, Sadhbh J. Byrne, Alexandra Boland, Maria Michail, Michelle Lamblin, et al. "Best practice when working with suicidal behaviour and self-harm in primary care: a qualitative exploration of young people’s perspectives." BMJ Open 10, no. 10 (October 2020): e038855. http://dx.doi.org/10.1136/bmjopen-2020-038855.
Full textAbstract:
ObjectivesGeneral practitioners (GPs) have a key role in supporting young people who present with suicidal behaviour/self-harm. However, little is known about young people’s opinions and experiences related to GPs’ practices for such presentations, and their decisions to disclose suicidal behaviour/self-harm to GPs. Additionally, existing guidelines for the management of suicide risk and/or self-harm have not incorporated young people’s perspectives. This study aimed to explore young people’s views and experiences related to the identification, assessment and care of suicidal behaviour and self-harm in primary care settings with GPs.Design, setting and participantsTwo qualitative focus groups were conducted in Perth, Western Australia, with 10 young people in total (Mage = 20.67 years; range: 16–24). Data were collected using a semistructured, open-ended interview schedule and analysed using thematic analysis.ResultsFive major themes were identified from the focus groups. (1) Young people wanted a collaborative dialogue with GPs, which included being asked about suicidal behaviour/self-harm, informed of treatment processes and having autonomy in decision making; (2) young people were concerned with a loss of privacy when disclosing suicidal behaviour/self-harm; (3) young people viewed labels and assessments as problematic and reductionist—disliking the terms ‘risk’ and ‘risk assessment’, and assessment approaches that are binary and non-holistic; (4) young people highlighted the importance of GPs’ attitudes, with a genuine connection, attentiveness and a non-judgemental demeanour seen as paramount; and (5) young people wanted to be provided with practical support and resources, followed-up, and for GPs to be competent when working with suicidal behaviour/self-harm presentations.ConclusionsOur study identified several concerns and recommendations young people have regarding the identification, assessment and care of suicidal behaviour/self-harm in primary care settings. Taken together, these findings may inform the development of resources for GPs, and support progress in youth-oriented best practice.
46
Petersen, Christina Bjørk, Morten N. Grønbæk, Marie Bussey Rask, Bent Nielsen, and Anette Søgaard Nielsen. "Suicidal behaviour among alcohol-dependent Danes attending outpatient treatment." Nordic Journal of Psychiatry 63, no. 3 (January 2009): 209–16. http://dx.doi.org/10.1080/08039480802559965.
Full text
47
Maharajh, Hari D., and Monique Konings. "Cannabis and Suicidal Behaviour Among Adolescents: A Pilot Study from Trinidad." Scientific World JOURNAL 5 (2005): 576–85. http://dx.doi.org/10.1100/tsw.2005.79.
Full textAbstract:
Cannabis use and suicidal behaviour are causes of adolescent morbidity and mortality worldwide. Changing trends in these behaviours in younger age groups, higher incidence, gender differences and sociocultural variations present an enormous challenge. There is no consensus whether these complex relationships are either a direct or an indirect effect due to other mental disorders, or a social response of disclosure of drug taking habits to family members and school authorities. This paper reviews the epidemiology of suicidal behaviour and cannabis use among adolescents and looks at the relationship of these behaviours regionally and internationally. The Caribbean islands have an established use of cannabis with higher suicidal rates, which provides an ideal setting to investigate the interrelationship of these disorders. Preliminary research findings in Trinidad indicate high rates of cannabis use among school students with higher rates in vocational schools compared to grammar schools. Utilising the CAPE questionnaire, depressive and psychotic experiences were common findings in adolescent cannabis users with a significant preponderance of depressive experiences (p<0.01). Our findings suggest that there is a convincing relationship between suicidal behaviour and cannabis use, the latter awakening depressive experiences. Suicidal behaviour and cannabis use are major public health problems and require a multidimensional approach with culturally competent preventive interactions. School based prevention programmes are necessary at the levels of parent-teacher partnership and classroom intervention. The treatment of adolescent disorders remains a major challenge of the future. Double disorders such as cannabis use and suicidal behaviour are uncharted areas and need novel approaches.
48
Isometsa, E. "Large-scale suicide prevention by pharmacological treatment of mood disorders." European Psychiatry 33, S1 (March 2016): S53. http://dx.doi.org/10.1016/j.eurpsy.2016.01.927.
Full textAbstract:
IntroductionIn psychological autopsy studies, at least half of suicides have suffered from depressive or bipolar disorders at time of death. Improving access to care and provision of evidence-based pharmacotherapies can be important preventive measures.ObjectivesTo examine suicide risk and pharmacoepidemiology in mood disorders; evidence for efficacy of pharmacotherapies in mood disorders and in preventing suicidal behaviour in them, and limitations to effectiveness of treatment due to problems of adherence.AimsTo evaluate potentials for suicide prevention in mood disorders by improved access to treatment, improved quality of treatment provision, improved adherence, or by specific pharmacotherapies.MethodsSelective review of literature.ResultsRisk of suicide death and attempts in mood disorders clusters into major depressive and mixed illness episodes, and time spent in them is a major determinant of risk, but direct evidence for preventive effects of effective pharmacotherapies remains limited. Observational and randomized studies indicate lithium treatment to reduce risk of suicide deaths and attempts. Ecological evidence from Europe shows increasing sales of antidepressants to consistently associate with declining regional suicide rates. Forensic chemical studies still find majority suicides negative for antidepressants. Poor adherence is a central problem in treatment provision.ConclusionsPositive impact of increase in pharmacotherapy provision in the last few decades on suicide mortality remains uncertain. Lithium is the pharmacological agent with best evidence for preventive utility, but underused. Providing treatments for those at risk, improving quality and continuity of treatment, and integrating them with psychosocial approaches is likely to be beneficial for suicide prevention.Disclosure of interestThe author has not supplied his declaration of competing interest.
49
Kapur, Navneet. "Review of “Understanding Suicidal Behaviour: The Suicidal Process Approach to Research, Treatment and Prevention”." Journal of Psychosomatic Research 54, no. 6 (June 2003): 607. http://dx.doi.org/10.1016/s0022-3999(02)00513-5.
Full text
50
Beautrais, AL. "Book Review: Understanding Suicidal Behaviour: The Suicidal Process Approach to Research, Treatment and Prevention." Australian & New Zealand Journal of Psychiatry 37, no. 1 (February 2003): 128–29. http://dx.doi.org/10.1046/j.1440-1614.2003.t01-7-01119.x.
Full text