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AIMS: Suicide prevention strategies have shifted in many countries, from a national approach to one that is regionally tailored and responsive to local community needs. Previous Australian studies support this approach. However, most studies have focused on suicide deaths which may not fully capture a complete understanding of prevention needs, and few have focused on the priority population of youth. This was the first nationwide study to examine regional variability of self-harm prevalence and related factors in Australian young people. METHODS: A random sample of Australian adolescents (12-17-year-olds) were recruited as part of the Young Minds Matter (YMM) survey. Participants completed self-report questions on self-harm (i.e., non-suicidal self-harm and suicide attempts) in the previous 12 months. Using mixed effects regressions, an area-level model was built with YMM and Census data to produce out-of-sample small area predictions for self-harm prevalence. Spatial unit of analysis was Statistical Area Level 1 (average population 400 people), and all prevalence estimates were updated to 2019. RESULTS: Across Australia, there was large variability in youth self-harm prevalence estimates. Northern Territory, Western Australia, and South Australia had the highest estimated state prevalence. Psychological distress and depression were factors which best predicted self-harm at an individual level. At an area-level, the strongest predictor was a high percentage of single unemployed parents, while being in an area where ≥30% of parents were born overseas was associated with reduced odds of self-harm. CONCLUSIONS: This study identified characteristics of regions with lower and higher youth self-harm risk. These findings should assist governments and communities with developing and implementing regionally appropriate youth suicide prevention interventions and initiatives.
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Factores Protectores , Conducta Autodestructiva , Prevención del Suicidio , Humanos , Adolescente , Conducta Autodestructiva/epidemiología , Conducta Autodestructiva/psicología , Prevalencia , Femenino , Masculino , Australia/epidemiología , Factores de Riesgo , Niño , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , Análisis Espacial , Depresión/epidemiología , Depresión/psicologíaRESUMEN
There has been an overall increase in the number of suspected suicide attempts by self-poisoning among the adolescent population. Incidences of self-poisoning have increased since the coronavirus 2019 pandemic, particularly among patients age 10 to 19 years. Common agents used in self-poisoning include over-the-counter and prescription medications. It is crucial to identify adolescent patients with risk factors and provide appropriate resources to reduce the likelihood of intentional toxic ingestion. This article aims to summarize the current state of intentional toxic ingestions by adolescents, provide an overview of the most common agents implicated in self-poisoning, and discuss the best practices in screening patients. [Pediatr Ann. 2024;53(9):e330-e336.].
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Intento de Suicidio , Humanos , Adolescente , Intento de Suicidio/estadística & datos numéricos , Intoxicación/epidemiología , Intoxicación/diagnóstico , Factores de Riesgo , Niño , Sobredosis de Droga/epidemiología , COVID-19/epidemiología , Medicamentos sin Prescripción/envenenamientoRESUMEN
BACKGROUND: People with lived experience have had limited opportunities to meaningfully contribute to the design of caring contacts interventions. The objective of this study was to co-design text messages with peer support specialist staff to determine optimal language and delivery, within a cultural context. METHODS: In this qualitative study, participants were professional peer support specialist staff with lived experience employed by specialist mental health services. They were asked to evaluate the initial series of text messages by taking part in a focus group using a semi-structured interview. This was audiotaped, transcribed and analysed using reflexive thematic analysis with specific coding of cultural themes. RESULTS: Three main themes were identified: upholding a person's autonomy; establishing connection as a bridge to safety; and, words as healing rongoa (remedy). The last theme contained a cultural subtheme: Maori language providing entry to the Maori world. CONCLUSION: People with lived experience breathe empowerment and hope into caring contacts interventions and should be considered vital partners in developing any suicide prevention initiative. Feeling genuinely cared for promotes connection and may enable an internal sense of safety. Tailoring of texts can be enhanced by culturally nuanced language.
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Intento de Suicidio , Envío de Mensajes de Texto , Humanos , Femenino , Masculino , Intento de Suicidio/psicología , Investigación Cualitativa , Adulto , Grupos Focales , Persona de Mediana EdadRESUMEN
Importance: Suicide is a leading cause of death among adolescents, who demonstrate high rates of sleep disturbance. Poor sleep appears to confer risk for suicide, but longitudinal investigation of suicidal behaviors remains rare, particularly in the transition from childhood to early adolescence. Objective: To evaluate sleep disturbances in preadolescent children (aged 9 and 10 years) in association with longitudinal risk for suicidal ideation and suicide attempts at the 2-year follow-up. Design, Setting, and Participants: This cohort study used data from the Adolescent Brain Cognitive Development Study between June 2016 and January 2021. This dataset included children aged 9 or 10 years at baseline and their parents or caregivers who were recruited at 21 sites across the US. Data were analyzed July 2023 to June 2024. Exposures: The Sleep Disturbance Scale for Children, a 26-item parent-reported inventory, was administered at baseline, generating a total score and 6 subscales. Central covariates included the Child Behavior Checklist Anxiety and Depression subscale and demographic variables. Main Outcomes and Measures: The computerized Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-COMP) assessed parent- and youth-reported suicidal behaviors and outcomes (none; passive, active nonspecific, and active specific suicidal ideation; and suicide attempt) at the 2-year follow-up. Sleep disturbance was further grouped by symptom severity (minimal, moderate, elevated, high, and severe). Results: Of the 10â¯136 youths who reported no baseline suicidal ideation or behavior, 8807 youths (mean [SD] age, 9.9 [0.6] years; 4507 males [51.2%]; 197 Asian individuals [2.2%], 1273 Black individuals [14.5%], and 5775 White individuals [65.6%]) completed the K-SADS-COMP assessment at the 2-year follow-up and were included in the analysis. At the follow-up, 8044 participants (91.3%) had no suicidal behavior, 317 (3.6%) had passive suicidal ideation, 258 (2.9%) had active nonspecific suicidal ideation, 130 (1.5%) had active specific suicidal ideation, and 58 (0.7%) had a first-time suicide attempt. Baseline sleep disturbance was associated with increased incidence risk for suicidal behavior at age 12 years (odds ratio, 2.68; 95% CI, 1.44-4.98; P = .002), adjusting for covariates. Individual subscales or items demonstrating associations with risk included disorders of excessive somnolence and frequency of nightmares. Conclusions and Relevance: Results of this longitudinal cohort study revealed that disturbed sleep at age 10 years was associated with risk for suicidal thoughts and behaviors in the next 2 years. The findings highlight the potential importance of sleep as a visible risk factor and intervention target in the prevention of youth suicide.
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Trastornos del Sueño-Vigilia , Ideación Suicida , Intento de Suicidio , Humanos , Niño , Masculino , Femenino , Trastornos del Sueño-Vigilia/epidemiología , Trastornos del Sueño-Vigilia/psicología , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , Factores de Riesgo , Estudios Longitudinales , Estados Unidos/epidemiología , Estudios de CohortesRESUMEN
Introduction: Warning signs serve as proximal indicators of suicide risk, making early recognition imperative for effective prevention strategies. This study aimed to explore self-identified suicide warning signs among Chinese patients with mood disorders based on safety planning framework. Methods: Researchers collaborated with patients to develop a safety plan and compiled warning signs based on it. Word frequency and network analysis were conducted to identify key warning signs. Directed content analysis categorized these signs into cognitive, emotional, behavioral, or physiological themes according to the suicide mode theory. Additionally, we examined potential variations in reported warning signs among participants with different demographic characteristics, including age, gender, and history of suicide attempts. Results: "Low mood" and "crying" emerged as prominent warning signs, with "social withdrawal" closely following. Patients commonly reported emotional themes during suicidal crises, often experiencing two to three themes simultaneously, primarily focusing on emotional, behavioral, and physiological themes. Males exhibited a higher proportion of concurrently reporting three sign themes compared to females (P < 0.05), while no difference was observed in warning signs among patients with other demographic traits. Discussion: This study offers a nuanced understanding of warning signs among mood disorder patients in China. The findings underscore the necessity for comprehensive suicide risk management strategies, emphasizing interventions targeting emotional regulation and social support. These insights provide valuable information for enhancing suicide prevention and intervention efforts.
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Trastornos del Humor , Investigación Cualitativa , Humanos , Masculino , Femenino , Trastornos del Humor/psicología , Adulto , China , Persona de Mediana Edad , Prevención del Suicidio , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , Ideación Suicida , Suicidio/psicología , Suicidio/estadística & datos numéricos , Adulto JovenRESUMEN
LGBTQIA+ youth are disproportionately affected by mental health issues including suicidal ideation and suicide attempts. Minoritized youth have numerous social and structural factors influencing their health, including a lack of access to care and resources. However, these youth and their caregivers also have many unique and individual cultural strengths. Awareness of special considerations and work toward dismantling structural drivers is essential in improving the health of these youth. Additionally, it is important to support minoritized youth and their caregivers through tailored evidence-based treatments in addressing social and structural drivers to influence individual, community, educational, institutional, and policy levels and prevent suicide in achieving mental health equity.
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Minorías Sexuales y de Género , Humanos , Adolescente , Minorías Sexuales y de Género/psicología , Intento de Suicidio , Ideación Suicida , Prevención del Suicidio , Suicidio/psicologíaRESUMEN
BACKGROUND: The proliferation of electronic cigarettes (e-cigarettes) has presented new challenges in public health, particularly among adolescents and young adults. While marketed as safer than tobacco and as cessation aids, e-cigarettes have raised concerns about their long-term health and psychosocial impacts, including potential links to increased suicidal behaviors. This study aims to evaluate the relationship between e-cigarette use and suicidal behaviors by conducting a systematic review of the current literature. METHODS: We searched PubMed, Web of Science, and EMBASE for studies up to March 10, 2024, examining the relationship between e-cigarette use and suicidal behaviors. Eligible studies included cross-sectional, longitudinal, retrospective, prospective, and case-control designs. Meta-analysis was performed to calculate pooled odds ratios (ORs). Newcastle Ottawa scale was used to assess the quality of studies. R software (V 4.3) was used to perform the meta-analysis. RESULTS: Our analysis included fourteen studies, predominantly from the US and Korea, with participants ranging from 1,151 to 255,887. The meta-analysis identified a significant association between e-cigarette use and an increased risk of suicidal ideation (OR = 1.489, 95% CI: 1.357 to 1.621), suicide attempts (OR = 2.497, 95% CI: 1.999 to 3.996), and suicidal planning (OR = 2.310, 95% CI: 1.810 to 2.810). Heterogeneity was noted among the studies. CONCLUSION: E-cigarette use is significantly associated with the risk of suicidal behaviors, particularly among adolescents. The findings underscore the necessity for caution in endorsing e-cigarettes as a safer smoking alternative and call for more extensive research to understand the underlying mechanisms. Public health strategies should be developed to address and mitigate the risks of suicidal behaviors among e-cigarette users.
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Ideación Suicida , Intento de Suicidio , Vapeo , Humanos , Vapeo/psicología , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , Sistemas Electrónicos de Liberación de Nicotina/estadística & datos numéricos , Adolescente , Adulto JovenRESUMEN
The cognitive model of suicide proposes that biased cognitive processes contribute to suicidal thoughts and behaviors, and initial evidence suggests that attentional bias to suicide-congruent cues may predict suicidal behavior beyond established clinical risk factors. To date, much less work has explored the potential role of interpretation biases in the development and prediction of suicide risk. The present study assessed the psychometric properties, including reliability, concurrent validity, and predictive validity, of a novel adaptation of the Word Sentence Association Paradigm (WSAP) to assess suicide-suicide interpretation biases. In a sample of 239 psychiatric inpatients, including patients with no recent suicidal ideation or lifetime attempts (n = 35), those with recent suicide attempts (n = 29), and those with recent suicidal ideation (n = 174), participants completed the modified WSAP as well as self-reported suicidal ideation and attempts for the subsequent 6 months. Although the WSAP demonstrated good reliability, evidence of concurrent and prospective validity (in terms of self-reported suicidal ideation and attempts) was limited. Specifically, the clinical groups did not differ from one another on any measure of interpretation bias, nor did suicide-specific interpretation endorsements predict concurrent or future suicidal ideation when controlling for dysphoric interpretation bias. However, suicide-specific interpretation biases were uniquely associated with a history of a lifetime suicide attempt. Future work should further clarify the extent and specificity of the relationship between suicide-specific interpretation biases and clinical outcomes.
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Psicometría , Ideación Suicida , Intento de Suicidio , Humanos , Femenino , Masculino , Adulto , Intento de Suicidio/psicología , Reproducibilidad de los Resultados , Persona de Mediana Edad , Adulto Joven , Sesgo Atencional , Suicidio/psicología , Pruebas de Asociación de PalabrasRESUMEN
BACKGROUND: To estimate the prevalence of lifetime e-cigarette use and explore the association between lifetime conventional and electronic cigarette use with suicidality among Chinese adolescents, focusing on sex and school-type differences. METHODS: A total of 22,509 students from 432 classes in 80 schools were recruited in Guangdong Province using a multistage, stratified cluster, random sampling method in 2021. Self-report questionnaires were used to collect information. Multivariable logistic regression models were performed and stratification analysis was conducted. All analyses were weighted and adjusted for the complex survey design. RESULTS: The weighted prevalence of lifetime e-cigarette use among adolescents in Guangdong Province was 8.7 % (4.3 % were dual users and 4.4 % were e-cigarette-only users) and 2.6 % were conventional-cigarette-only users. Lifetime e-cigarette-only users (AOR [Adjusted OR] =1.46, 95 % CI = 1.21-1.76), conventional-cigarette-only users (AOR = 1.97, 95 % CI = 1.58-2.46) and dual users (AOR = 1.67, 95 % CI = 1.38-2.02) were at a higher risk of suicidal ideation than non-users. Lifetime e-cigarette-only users (AOR = 2.03, 95 % CI = 1.53-2.70), conventional-cigarette-only users (AOR = 1.97, 95 % CI = 1.42-2.73), and dual users (AOR = 2.76, 95 % CI = 2.10-3.61) had a significantly higher risk of suicide attempts than non-users. After further analysis stratified by sex and school type, the associations of lifetime cigarette use patterns with suicidality slightly varied. LIMITATION: The cross-sectional study design and self-report information. CONCLUSION: The prevalence of e-cigarettes among Chinese adolescents is concerning. Lifetime conventional and e-cigarette use were associated with suicidality among Chinese adolescents, with sex and school type moderating these associations. Targeted measures to restrict cigarette use, including new tobacco product (e-cigarette) use, among adolescents are warranted.
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Sistemas Electrónicos de Liberación de Nicotina , Instituciones Académicas , Estudiantes , Ideación Suicida , Vapeo , Humanos , Adolescente , Femenino , Masculino , China/epidemiología , Prevalencia , Estudiantes/estadística & datos numéricos , Estudiantes/psicología , Vapeo/epidemiología , Vapeo/psicología , Factores Sexuales , Sistemas Electrónicos de Liberación de Nicotina/estadística & datos numéricos , Estudios Transversales , Encuestas y Cuestionarios , Fumar Cigarrillos/epidemiología , Factores de Riesgo , Conducta del Adolescente/psicología , Intento de Suicidio/estadística & datos numéricos , Pueblos del Este de AsiaRESUMEN
BACKGROUND: Rates of suicide in United States Marines are among the highest in the military, and sleep disorder symptoms are a known risk factor for suicide in the military. Intensive ecological momentary assessments (EMA) might improve the ability to detect periods that are characterized by increased suicidal ideation. Marines who were at high risk for suicide were intensively assessed for one month on sleep, suicidal urges, posttraumatic stress disorder (PTSD) and depression symptoms. METHODS: U.S. Marines (N = 40) who had a past month suicide attempt or suicidal urges with intent were sent EMA for 28 days. Mixed effects models explored associations among daily sleep, suicidal urges, PTSD, and depression symptoms. RESULTS: Worsened sleep indicators on a given night significantly predicted higher maximum values of suicide urges the following day. Worse sleep quality the prior night was moderately associated with more severe PTSD symptoms and depression symptoms. Greater severity of PTSD symptoms and depression symptoms were strongly associated with both the maximum value and the range of suicide urges. PTSD and depression symptoms mediated the relationship between sleep quality and suicidal urges. Participants reported that 0000-0300 had the greatest elevation in endorsement of highest suicide urges. LIMITATIONS: This study had a small sample size may not generalize beyond active duty Marines. CONCLUSIONS: Poor sleep quality and other sleep markers were an important risk factor for suicidal urges among U.S. Marines. This relationship was mediated by exacerbations in PTSD and depression symptoms. Interventions are needed to interrupt suicide risk during and following nights with poor sleep.
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Depresión , Personal Militar , Trastornos del Sueño-Vigilia , Trastornos por Estrés Postraumático , Ideación Suicida , Intento de Suicidio , Humanos , Masculino , Adulto , Trastornos por Estrés Postraumático/epidemiología , Femenino , Estados Unidos/epidemiología , Personal Militar/estadística & datos numéricos , Trastornos del Sueño-Vigilia/epidemiología , Adulto Joven , Intento de Suicidio/estadística & datos numéricos , Depresión/epidemiología , Evaluación Ecológica Momentánea , Suicidio/estadística & datos numéricosRESUMEN
INTRODUCTION: Researchers predict long-term increases in suicide deaths following the COVID-19 pandemic. Little is known about risk factors for suicidal ideation (SI) and suicidal attempts (SA) or treatment barriers and promoters during the pandemic. We examine these factors in a young adult sample. METHODS: Analyses used a 2022 cross-sectional survey dataset (N = 1,956). Logistic regression identified factors associated with pandemic suicidality (i.e., SI, SA). Non-treatment seekers reported barriers to seeking treatment. Logistic regression identified promotive factors associated with treatment-seeking. RESULTS: 28.6 % of our sample developed suicidality during the pandemic, of whom 49.6 % did not seek treatment. Asian race and sexual minority status were strongly associated with increased odds of pandemic suicidality. Among SI non-treatment-seekers, barriers were primarily attitudinal (e.g., "symptoms are not serious enough for treatment"); among non-treatment-seekers with SA, barriers were mostly structural (e.g., insufficient funds). Previous depression treatment was strongly associated with increased odds of treatment-seeking. CONCLUSION: Asian American individuals were at increased risk for pandemic suicidality, which may reflect interpersonal risks related to COVID-19-related anti-Asian racism. Our findings point to a "foot-in-the-door" effect: past treatment-seeking was positively associated with future treatment-seeking. To promote this effect and decrease barriers, we suggest integrated mental health screening and referrals in primary care.
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COVID-19 , Aceptación de la Atención de Salud , Ideación Suicida , Intento de Suicidio , Humanos , COVID-19/psicología , COVID-19/epidemiología , Masculino , Femenino , Adulto Joven , Aceptación de la Atención de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Factores de Riesgo , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , Estudios Transversales , Adulto , Adolescente , Asiático/psicología , Asiático/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Minorías Sexuales y de Género/psicología , Minorías Sexuales y de Género/estadística & datos numéricosRESUMEN
Dementia is a global health concern with increasing numbers of people living long enough to develop dementia. People with dementia (PwD) may be particularly vulnerable to suicidality. However, suicide in PwD has not been thoroughly explored. The objective of this review was to determine the prevalence and risk factors of suicide in PwD. Five databases were searched from inception to July 2023. Peer-reviewed publications reporting prevalence, risk factors or quantitative summary data for suicide outcomes in PwD were included. Random effects models were used to calculate the pooled prevalence and effect sizes. 54 studies met inclusion criteria. In PwD, the point prevalence of suicidal ideation was 10â¯% (95â¯%CI=6â¯%;16â¯%), 2-year period prevalence of suicide attempts was 0.8â¯% (95â¯%CI=0.3â¯%;2â¯%), 10-year period prevalence of suicide attempts was 8.7â¯% (95â¯%CI=6.0â¯%%;12.7â¯%) and the incidence of death by suicide 0.1â¯% (95â¯%CI=0.1â¯%;0.2â¯%). Compared to not having dementia, a diagnosis of dementia increased risk of suicidal ideation (OR=1.62[95â¯%CI=1.17;2.24]) but not risk of suicide attempt (OR=1.77 [95â¯%CI=0.85;3.69]) or death by suicide (OR=1.30 [95â¯%CI=0.81;2.10]). People with moderate dementia had significantly increased risk of suicidal ideation than those with mild dementia (OR=1.59[95â¯%CI=1.11;2.28]), younger PwD were at increased risk of dying by suicide (OR=2.82[95â¯%CI=2.16;3.68]) and men with dementia were more likely to attempt (OR=1.28[95â¯%CI=1.25;1.31]) and die by suicide (OR=2.88[95â¯%CI=1.54;5.39]) than women with dementia. This review emphasises the need for mental health support and suicide prevention in dementia care, emphasising tailored approaches based on age, symptoms, and being male.
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Demencia , Ideación Suicida , Suicidio , Humanos , Demencia/epidemiología , Demencia/psicología , Factores de Riesgo , Prevalencia , Suicidio/psicología , Suicidio/estadística & datos numéricos , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , MasculinoRESUMEN
INTRODUCTION: Understanding the mechanisms of suicidal behavior is a prerequisite for suicide prevention and intervention. The current study aims to propose and verify the utility of pre-suicidal attempt as an intermediate type in the transition from suicidal ideation to suicidal attempt within the ideation-to-action framework. METHODS: A sample of 1084 college students completed a measurement package consisting of suicide history, suicide risk factors, and demographic information. Stratified stepwise multiple regression models and mediated moderation models were used to examine the relationship among the variables. RESULTS: Pre-suicidal attempts rather than suicidal ideation are predictive of suicide attempts. Age, depression, thwarted belongingness, fearlessness about death, perceived burdensomeness and suicidal ideation were predictors of pre-suicidal attempts. Supporting the interpersonal theory of suicide, pre-suicidal attempts mediated the relationship between suicidal ideation and suicidal attempts and were positively moderated by pain tolerance and fearlessness about death. The pre-suicidal attempters scored higher on fearlessness about death and suicide risk than the ideators, while pre-suicidal attempters scored significantly lower on suicide risk than suicide attempters. CONCLUSION: As an independent intermediate type within the ideation-to-action framework, pre-suicidal attempts contribute to deepen the understanding of the intermediate transition from suicidal ideation to suicidal attempts.
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Ideación Suicida , Intento de Suicidio , Humanos , Femenino , Masculino , Intento de Suicidio/psicología , Adulto Joven , Adulto , Adolescente , Estudiantes/psicología , Factores de Riesgo , UniversidadesRESUMEN
BACKGROUND: Suicidal ideation (SI) and suicide attempts (SA) are risk factors for suicide which peak during adolescence; however, evidence focused on differences in SI and SA risk among racial/ethnic minority youth is limited despite increasing suicide rates among several racial/ethnic minority groups. METHODS: We analyzed a representative sample of adolescents aged 12-17 with prior depressive symptoms (n = 32,617) from the cross-sectional National Surveys on Drug Use and Health (2008-2019). Survey-weighted adjusted logistic regressions estimated the association of race/ethnicity with self-reported lifetime SI and SA, controlling for sociodemographics, lifetime substance use, lifetime major depressive episode, and self-rated health. RESULTS: Compared to white adolescents, Black and Hispanic adolescents had a 2.5 % (p = 0.04) and 4.2 % (p < 0.001) lower likelihood of reporting SI. However, among participants reporting SI, Black and Hispanic adolescents had a 3.2 % (p = 0.03) and 3.1 % (p = 0.03) higher likelihood of reporting SA than white adolescents. Multiracial adolescents were 5.9 % (p = 0.03) more likely to report SA than white adolescents. LIMITATIONS: Although racial/ethnic minority groups are less likely to self-report mental health symptoms, we could only assess SI/SA among adolescents self-reporting prior depressive symptoms, and we could only assess SA among adolescents self-reporting SI due to survey methods. CONCLUSIONS: Variation in the racial/ethnic distribution of suicidality supports theories conceptualizing separate pathways for SI and SA. This underscores the need for greater attention to racial/ethnic differences in suicide-related research, surveillance, and prevention efforts, including ensuring that mental health risk assessments directly evaluate SA in addition to SI in order to better identify high-risk racial/ethnic minority youth.
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Ideación Suicida , Intento de Suicidio , Adolescente , Niño , Femenino , Humanos , Masculino , Negro o Afroamericano/estadística & datos numéricos , Negro o Afroamericano/psicología , Estudios Transversales , Etnicidad/estadística & datos numéricos , Etnicidad/psicología , Hispánicos o Latinos/estadística & datos numéricos , Hispánicos o Latinos/psicología , Factores de Riesgo , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/etnología , Intento de Suicidio/psicología , Estados Unidos/epidemiología , Blanco/psicología , Blanco/estadística & datos numéricosRESUMEN
Little is known about the individual course of suicidal ideations and attempts (i.e., suicidality) after treatment initiation. We examined the trajectories of suicidality and associated risk factors over a 2-year early intervention program for first-episode psychosis in 450 patients (age range 18-35 years at admission) consecutively admitted from 2003 to 2017. Suicidality was assessed via systematic file review, while sociodemographic and clinical variables were assessed at admission. Latent class growth modelling identified three trajectories: low (69.6 %), initially high (22.9 %), and persistently high (7.6 %) suicidality. Patients who were younger, lived alone and were diagnosed with affective psychosis were significantly more likely to follow the initially high trajectory. Patients who attempted suicide up to 3 months before admission, lived alone and presented lower levels of the PANSS excited factor were significantly more likely to follow the persistently high trajectory. Attempting suicide up to 3 months before admission distinguished persistently high and initially high suicidality trajectories. Suicide risk during early intervention program for first-episode psychosis is heterogenous, with acute and enduring suicidal risk, suggesting the need to adapt suicide prevention strategies to these different risk profiles.
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Trastornos Psicóticos , Ideación Suicida , Intento de Suicidio , Humanos , Trastornos Psicóticos/terapia , Trastornos Psicóticos/psicología , Masculino , Femenino , Adulto , Adulto Joven , Adolescente , Estudios Longitudinales , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , Intervención Médica Temprana , Factores de RiesgoRESUMEN
Suicide in young people is a public health problem. Typically, protective factors for suicide are not studied; research tends to focus on measuring risk factors. However, knowing the risk factors does not mean that we also know the opposing factors that influence a group's health problems. For this reason, we examined the relationship between developmental assets in Mexican youth aged 18 to 25 years who are not at risk for suicide, exhibit self-injurious behavior, and whose last suicide attempt had low or high lethality. A cross-sectional study of 478 young people (73% female and 27% male) from Mexico City was conducted using an online survey and correlations were tested with dummy variables (groups) and multinomial logistic regression. The no-risk group showed associations with all developmental assets, the self-injurious group had an association with the house rules variable, the low lethality group was correlated with twelve assets and the high lethality group with four assets. Four internal developmental strengths were significant in the regression model: avoidance of risk behaviors, school expectations, resistance to pressure, and expression of anger. These results suggest that PYD is a useful framework for examining suicide risk and promotes skill development in young college students.
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Intento de Suicidio , Humanos , Femenino , Masculino , México/epidemiología , Adulto Joven , Adolescente , Estudios Transversales , Adulto , Factores de Riesgo , Intento de Suicidio/estadística & datos numéricos , Suicidio/estadística & datos numéricos , Encuestas y Cuestionarios , Conducta Autodestructiva/epidemiología , Asunción de RiesgosRESUMEN
More than half of suicide deaths in the United States result from self-inflicted firearm injuries. Extreme risk protection order (ERPO) laws in 21 states and the District of Columbia temporarily limit access to firearms for individuals found in a civil court process to pose an imminent risk of harm to themselves or others. Research with large multistate study populations has been lacking to determine effectiveness of these laws. This study assembled records pertaining to 4,583 ERPO respondents in California, Connecticut, Maryland, and Washington. Matched records identified suicide decedents and self-injury method. Researchers applied case fatality rates for each suicide method to estimate nonfatal suicide attempts corresponding to observed deaths. Comparison of counterfactual to observed data patterns yielded estimates of the number of lives saved and number of ERPOs needed to avert one suicide. Estimates varied depending on the assumed probability that a gun owner who attempts suicide will use a gun. Two evidence-based approaches yielded estimates of 17 and 23 ERPOs needed to prevent one suicide. For the subset of 2,850 ERPO respondents with documented suicide concern, comparable estimates were 13 and 18, respectively. This study's findings add to growing evidence that ERPOs can be an effective and important suicide prevention tool.
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Armas de Fuego , Prevención del Suicidio , Humanos , Armas de Fuego/legislación & jurisprudencia , Masculino , Femenino , Estados Unidos , Adulto , Intento de Suicidio/legislación & jurisprudencia , Intento de Suicidio/estadística & datos numéricos , Suicidio/estadística & datos numéricos , Suicidio/legislación & jurisprudencia , Persona de Mediana Edad , California , ConnecticutRESUMEN
INTRODUCTION: Different parameters of suicide attempts treated since the implementation of the Attention to Suicide Risk Program (ARSUIC) in 2012 at the Hospital Ramón y Cajal in Madrid Region are described in this paper. METHOD: The sample was composed of 107 patients and the information was collected through a questionnaire created ad hoc with the following variables: type of suicidal ideation; drug use immediately prior to the attempt; method (in case of drug overdosing: drug/s used); location; accessibility to rescue; planning; intentionality; criticism; and brakes. RESULTS: Descriptive statistics were obtained and a comparison by gender was made through the χ2 and contingency coefficients tests. The data from the retrospective longitudinal study showed that the most common profile was of patients with unstructured ideas of death and no previous drug use who took an unplanned drug overdose in the family home, with the intention of self-harm or avoidance of discomfort, especially with benzodiazepines. Patients tend to ask for help afterwards and criticise the attempt, but potential restraints are often not recorded in the clinical report. Regarding the dissimilarities based on gender, statistically significant differences were found in prior alcohol consumption, in favour of men and in the overdose method, specifically with benzodiazepines, in favour of women. CONCLUSIONS: Knowing the types of attempts at self-harm is essential for improving prevention, understanding and patient management.
Asunto(s)
Sobredosis de Droga , Hospitales Públicos , Intento de Suicidio , Humanos , Intento de Suicidio/estadística & datos numéricos , Masculino , España , Femenino , Adulto , Estudios Retrospectivos , Sobredosis de Droga/epidemiología , Persona de Mediana Edad , Adulto Joven , Estudios Longitudinales , Encuestas y Cuestionarios , Factores Sexuales , Ideación Suicida , Adolescente , AncianoRESUMEN
Importance: Deliberate self-poisoning using pesticides as a means of suicide is an important public health problem in low- and middle-income countries. Three highly toxic pesticides-dimethoate, fenthion, and paraquat-were removed from the market in Sri Lanka between 2008 and 2011. In 2015, less toxic pesticides (chlorpyrifos, glyphosate, carbofuran, and carbaryl) were restricted. Subsequent outcomes have not been well described. Objective: To explore the association of pesticide bans with pesticide self-poisonings and in-hospital deaths. Design, Setting, and Participants: In this cross-sectional study with an interrupted time series design, data were prospectively collected on all patients with deliberate self-poisonings presenting to 10 Sri Lankan hospitals between March 31, 2002, and December 31, 2019, and analyzed by aggregated types of poisoning. The correlates of pesticide bans were estimated within the pesticide group and on self-poisonings within other substance groups. The data analysis was performed between April 1, 2002, and December 31, 2019. Exposures: Implementation of 2 sets of pesticide bans. Main Outcomes and Measures: The main outcomes were changes in hospital presentations and in-hospital deaths related to pesticide self-poisoning as measured using segmented Poisson regression. Results: A total of 79â¯780 patients (median [IQR] age, 24 [18-34] years; 50.1% male) with self-poisoning from all causes were admitted to the study hospitals, with 29â¯389 poisonings (36.8%) due to pesticides. A total of 2859 patients died, 2084 (72.9%) of whom had ingested a pesticide. The first restrictions that targeted acutely toxic, highly hazardous pesticides were associated with an abrupt and sustained decline of the proportion of poisonings with pesticides (rate ratio [RR], 0.85; 95% CI, 0.78-0.92) over the study period and increases in poisonings with medications (RR, 1.11; 95% CI, 1.02-1.21) and household and industrial chemicals (RR, 1.20; 95% CI, 1.05-1.36). The overall case fatality of pesticides significantly decreased (RR, 0.33; 95% CI, 0.26-0.42) following the implementation of the 2008 to 2011 restrictions of highly hazardous pesticides. Following the 2015 restrictions of low-toxicity pesticides, hospitalizations were unchanged, and the number of deaths increased (RR, 1.98; 95% CI, 1.39-2.83). Conclusions and Relevance: These findings support the restriction of acutely toxic pesticides in resource-poor countries to help reduce hospitalization for and deaths from deliberate self-poisonings and caution against arbitrary bans of less toxic pesticides while more toxic pesticides remain available.
Asunto(s)
Plaguicidas , Humanos , Sri Lanka/epidemiología , Plaguicidas/envenenamiento , Masculino , Femenino , Estudios Transversales , Adulto , Persona de Mediana Edad , Intoxicación/epidemiología , Intoxicación/mortalidad , Suicidio/estadística & datos numéricos , Mortalidad Hospitalaria , Adulto Joven , Análisis de Series de Tiempo Interrumpido , Intento de Suicidio/estadística & datos numéricos , Adolescente , Estudios ProspectivosRESUMEN
Ethical questions surrounding withdrawal of life support can be complex. When life support therapies are the result of a suicide attempt, the potential ethical issues take on another dimension. Duties and principles that normally guide clinicians' actions as caregivers may not apply as easily. We present a case of attempted suicide in which decisions surrounding withdrawal of life support provoked conflict between a patient's family and the medical team caring for him. We highlight the major unresolved philosophical questions and contradictory normative values about suicide that underlie this conflict. Finally, we show how these considerations were practically applied to this particular case.