Protocol: A two-wave cross-sectional study in England investigating suicidal behaviour and self-harm amongst healthcare workers during the Covid-19 pandemic

AbstractIntroductionThere have been longstanding concerns regarding an increased risk of suicide amongst healthcare workers. The Covid-19 pandemic has placed an additional burden on staff, yet few studies have investigated the impact of the pandemic on their risk of suicide and self-harm. We aimed to investigate the cumulative incidence, prevalence and correlates of suicidal ideation, suicide attempts and non-suicidal self-injury amongst healthcare workers during the Covid-19 pandemic.Methods and AnalysisNHS Check is an online survey that was distributed to all staff (clinical and non-clinical), students, and volunteers in 18 NHS Trusts across England during the Covid-19 pandemic. Data collected in wave 1 (collected between April 2020 and January 2021) and wave 2 (collected 6-month after wave 1) will be analysed. The full cohort of wave 1 participants will be weighted to represent the age, sex, ethnicity, and roles profile of the workforce at each Trust, and the weighted prevalence and cumulative incidence of suicidal ideation, suicide attempts and non-suicidal self-injury will be described. Two-level random effects logistic regression models will be used to investigate the relationship between suicidal behaviour and self-harm, and demographic characteristics (age, sex, ethnicity) and workplace factors (concerns regarding access to personal protective equipment, re-deployment status, moral injury, confidence around raising and the management of safety concerns, support by supervisors or managers, satisfaction with standard of care provided). Results will be stratified by role (clinical/non-clinical).

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756 The Moderating Influence of Depression on Insomnia and Suicidal Ideation in a Military Sample

SLEEP ◽

10.1093/sleep/zsab072.753 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A294-A295

Author(s):

Emma Palermo ◽

Jennifer Goldschmied ◽

Elaine Boland ◽

Elizabeth A Klingaman ◽

Philip Gehrman ◽

...

Keyword(s):

Depressive Symptoms ◽

Suicidal Ideation ◽

Research University ◽

Negative Binomial ◽

Suicide Attempts ◽

Risk And Resilience ◽

Depression Severity ◽

Significant Interaction Effect ◽

Increased Risk ◽

The Impact

Abstract Introduction Military personnel are at an increased risk for suicide compared to the general population, making it important to develop a deeper understanding of which factors contribute to this elevated risk. Given that suicidal ideation (SI) is one of the strongest predictors of suicide attempts, understanding factors that underlie SI may improve prevention efforts. Insomnia and depression both serve as independent risk factors for SI, and therefore the aim of this study was to examine the extent to which depressive symptoms moderate the association between insomnia and SI. Methods Data were obtained from the All Army Study of the Army Study to Assess Risk and Resilience in Servicemembers (STARRS). Soldiers (n=21,450) completed questions related to suicidal ideation (5 items), depressive symptoms (9 items), and insomnia (5 items) based on symptom presence in the past 30 days. Items in each domain were summed to create a total severity score. GEE models using a negative binomial linking function were conducted to examine the impact of depression, insomnia, and their interaction on SI. Results Both depression (χ2 =117.56, p<0.001) and insomnia (χ2=11.79, p=0.0006) were found to have significant main effects on SI, and there was a significant interaction effect (χ2=4.52, p=0.0335). Follow up simple effects revealed that insomnia was no longer significantly associated with SI when depression severity was low, but was associated with SI in the presence of greater depression severity (χ2=2.91, p=0.0882). Conclusion In a large sample of Army soldiers, depression significantly moderated the association between SI and insomnia, such that insomnia seems to amplify the effects of depression on SI. These findings highlight the importance of addressing insomnia severity as a mean of reducing SI in those with depression, potentially allowing for intervention prior to a suicide attempt. Support (if any) Perlis: K24AG055602 & R01AG041783. This publication is based on public use data from Army STARRS (Inter-university Consortium for Political and Social Research, University of Michigan- http://doi.org/10.3886/ICPSR35197-v1), funded by U.S. NIMH-U01MH087981.

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Suicidal behaviour and nonsuicidal self-injury among patients with eating disorders

Oxford Textbook of Suicidology and Suicide Prevention ◽

10.1093/med/9780198834441.003.0036 ◽

2021 ◽

pp. 301-306

Author(s):

Judit Balazs ◽

Lili Olga Horvath

Keyword(s):

Risk Factors ◽

Eating Disorders ◽

Suicidal Behaviour ◽

Emotion Dysregulation ◽

Suicide Attempts ◽

The Self ◽

Self Injury ◽

Duration Of Illness ◽

Increased Risk ◽

Comorbid Psychopathology

Eating disorders (EDs), especially anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) often co-occur with suicidal behaviour and non-suicidal self-injury (NSSI). The shared epidemiological and risk factors of EDs, suicidal behaviour, and NSSI include the self-destructive and body-focused characteristics of these behaviours; body dissatisfaction, interoceptive deficits, emotion dysregulation, impulsivity, and several environmental risk factors. Compared to the general population, lifetime rates of suicidal ideation, suicide attempts, and NSSI are increased among patients with AN, BN, or BED. Risk factors play a role in the development of suicidal behaviour in patients with EDs, including comorbid psychopathology that is associated with an increased risk of suicide itself, increased impulsive behaviours including NSSI, the duration of illness, and the number of previous treatments. Being aware of the increased risk and the ED-specific risk factors of suicidal behaviour are essential for preventing suicide and treating clinical risk factors in patients with EDs.

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Impact of the 2009-2014 economic crisis on suicide attempts and self-harm in Portugal

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.911 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

V Pinheiro ◽

B Nunes ◽

S Pereira da Silva ◽

C Caetano

Keyword(s):

Hospital Admission ◽

Economic Crisis ◽

Suicide Attempts ◽

Admission Rate ◽

Sudden Increase ◽

Hospital Admission Rate ◽

Crisis Period ◽

Increased Risk ◽

Self Harm ◽

The Impact

Abstract Background Following the worldwide economic crisis of 2008, studies have found an increased risk for self-harm and suicide attempts, many of which need hospital care. There is no research in Portugal on the matter. Therefore, our goal was to estimate the impact of the Portuguese economic crisis of 2009-2014 on the hospital admission rates by attempted suicide and self-harm in Portugal. Methods A retrospective ecological study, with an interrupted time series analysis of hospital admissions by suicide attempts (data from the national Hospital Mobility Database) in mainland Portugal, between 2003 and 2014, was performed. Resident population data over 15 years old was retrieved from the National Statistics Institute. Poisson regression models were used to compare rates and trends before (2003-2008) and during (2009-2014) the Portuguese economic crisis. All rates were adjusted for seasonality. Results A total of 35,077 hospital admission episodes by suicide attempt were retrieved. The mean admission rate was 2.947 per 100 000 inhabitants per month before the crisis, falling to 2.798 during the crisis period. Before the crisis, the total admission rate was decreasing 1% per year. After the crisis erupted, there was a level change, with a sudden increase of 7.9%. The suicide and self-harm admission rate, after 2008, was constant and approximately 38.8% higher than expected if the earlier trend had continued. Conclusions There was an increase in the total hospital admission rate by suicide attempts and self-harm during the economic crisis period in Portugal, when compared to the previous period. Key messages Economic crisis can pose considerable suicide risks. Urgent action is needed to prevent economic crisis leading to additional suicides.

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The Impact of Infectious Disease-Related Public Health Emergencies on Suicide, Suicidal Behavior, and Suicidal Thoughts

Crisis ◽

10.1027/0227-5910/a000753 ◽

2020 ◽

pp. 1-14 ◽

Cited By ~ 4

Author(s):

Tiago C. Zortea ◽

Connor T. A. Brenna ◽

Mary Joyce ◽

Heather McClelland ◽

Marisa Tippett ◽

...

Keyword(s):

Public Health ◽

Infectious Disease ◽

Suicidal Ideation ◽

Suicidal Behavior ◽

Suicide Attempts ◽

Data Extraction ◽

Public Health Emergencies ◽

Increased Risk ◽

Meta Analyses ◽

The Impact

Abstract. Background: Infectious disease-related public health emergencies (epidemics) may increase suicide risk, and high-quality evidence is needed to guide an international response. Aims: We investigated the potential impacts of epidemics on suicide-related outcomes. Method: We searched MEDLINE, EMBASE, PsycInfo, CINAHL, Scopus, Web of Science, PsyArXiv, medRxiv, and bioRxiv from inception to May 13–16, 2020. Inclusion criteria: primary studies, reviews, and meta-analyses; reporting the impact of epidemics; with a primary outcome of suicide, suicidal behavior, suicidal ideation, and/or self-harm. Exclusion criteria: not concerned with suicide-related outcomes; not suitable for data extraction. PROSPERO registration: #CRD42020187013. Results: Eight primary papers were included, examining the effects of five epidemics on suicide-related outcomes. There was evidence of increased suicide rates among older adults during SARS and in the year following the epidemic (possibly motivated by social disconnectedness, fears of virus infection, and concern about burdening others) and associations between SARS/Ebola exposure and increased suicide attempts. A preprint study reported associations between COVID-19 distress and past-month suicidal ideation. Limitations: Few studies have investigated the topic; these are of relatively low methodological quality. Conclusion: Findings support an association between previous epidemics and increased risk of suicide-related outcomes. Research is needed to investigate the impact of COVID-19 on suicide outcomes.

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Self-harm

New Oxford Textbook of Psychiatry ◽

10.1093/med/9780198713005.003.0126 ◽

2020 ◽

pp. 1289-1295

Author(s):

Nav Kapur ◽

Sarah Steeg ◽

Adam Moreton

Keyword(s):

Risk Factors ◽

Young People ◽

Health Services ◽

Predictive Value ◽

Suicidal Behaviour ◽

Genetic Factors ◽

Lifetime Prevalence ◽

Self Injury ◽

Increased Risk ◽

Self Harm

Self-harm—mainly self-poisoning and self-injury—is an important cause of presentation to health services internationally. The annual incidence worldwide is likely to be in the region of 4 per 1000 adults, with a lifetime prevalence of between 3% and 5% in Western countries. Self-harm is more common in young people and more common in girls than boys. Self-harm has a complex aetiology, with sociodemographic, clinical, environmental, and genetic factors all contributing. It is associated with a greatly increased risk of suicide and death by other causes—1 in 50 people die by suicide in the year after hospital presentation for self-harm. Models of suicidal behaviour may help us to understand how different risk factors link together, but risk scales are unlikely to be useful in practice because of their limited predictive value.

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A Comparison between Severe Suicidality and Nonsuicidal Self-Injury Behaviors in Bipolar Adolescents Referred to a Psychiatric Emergency Unit

Brain Sciences ◽

10.3390/brainsci11060790 ◽

2021 ◽

Vol 11 (6) ◽

pp. 790

Author(s):

Gabriele Masi ◽

Ilaria Lupetti ◽

Giulia D’Acunto ◽

Annarita Milone ◽

Deborah Fabiani ◽

...

Keyword(s):

Suicidal Ideation ◽

Suicide Ideation ◽

Suicide Attempts ◽

Self Injury ◽

Depressive Feelings ◽

Thought Disorders ◽

Self Harm ◽

Preventative Interventions ◽

Anxiety Depression ◽

Shared Risk

Background: Severe suicide ideation or attempts and non-suicidal self-injury (NSSI) present both differences and relevant overlaps, including frequent co-occurrence and shared risk factors. Specific categorical diagnoses, namely bipolar disorder (BD), may affect clinical features and natural histories of suicidal or not suicidal self-harm behaviour. Our study aimed to compare suicidality (severe suicidal ideation or suicidal attempts) and NSSI in referred bipolar adolescents. Methods: The sample included 95 bipolar adolescents (32 males, 63 females) aged 11 to 18 years. Thirty adolescents with suicide attempts/suicidal ideation and BD (SASIB) were compared with structured measures to 35 adolescents with NSSI and BD, without suicidal ideation or attempts (NSSIB), and to 30 adolescents with BD, without suicidal ideation or attempts or NSSI (CB). Results: Compared to CB, suicidality and NSSI were both associated with female sex, borderline personality disorder and self-reported internalizing disorders, anxiety/depression and thought disorders. The NSSI were specifically associated with somatic problems. Severe suicidal ideation and suicide attempts were associated with adverse life events, immigration, bullying, eating disorders, social problems, depressive feelings, performance and social anxiety, and feelings of rejection. Conclusions: Both shared and differential features between suicidal and not suicidal adolescents may represent possible targets for diagnostic and preventative interventions.

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The relevance of suicidal behaviour in jail and prison suicides

European Psychiatry ◽

10.1016/s0924-9338(03)00064-6 ◽

2003 ◽

Vol 18 (4) ◽

pp. 161-165 ◽

Cited By ~ 31

Author(s):

Stefan Fruehwald ◽

Patrick Frottier ◽

Teresa Matschnig ◽

Reinhard Eher

Keyword(s):

Suicidal Ideation ◽

Suicidal Behaviour ◽

Attempted Suicide ◽

Psychiatric Care ◽

Suicide Attempts ◽

Personal Characteristics ◽

Correctional Institutions ◽

Preventive Action ◽

Suicide Threats ◽

Self Harm

AbstractPurposeSuicide rates in correctional institutions have been increasing during the last decades. There has been little interest in whether suicidal ideation and intent has been documented by non-medical prison staff (reports of attempted suicide, suicide threats, self-harm), and whether these signs of suicidality had the consequence of adequate intervention efforts.MethodsThe personal files of inmates who committed suicide in the 29 Austrian jails and prisons during the last 25 years (1975–1999) were included. We analysed personal characteristics, criminological data, circumstances of custody and information about psychiatric disorders and treatment.ResultsOf a total of 250 suicides, 220 personal files were available and included. Suicide attempts were known in 50% of all suicides and 37% had expressed suicidality. In >20%, non-medical staff had documented signs of suicidality, but no further preventive action (e.g. referral to psychiatric care) had taken place.ConclusionsSigns of suicidality play an important role in vulnerability profiles for jail and prison suicides and should have the minimal consequence of further psychiatric care.

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Suicidal Behaviour and Self-harm in Adults with Autism and Asperger Syndrome

10.53902/jpssr.2021.01.000503 ◽

2021 ◽

Vol 1 (1) ◽

Author(s):

Eruslu E

Keyword(s):

Social Support ◽

Early Childhood ◽

Suicidal Ideation ◽

Asperger Syndrome ◽

Suicidal Behaviour ◽

Suicidal Risk ◽

Adults With Autism ◽

Increased Risk ◽

Self Harm ◽

High Level

Some adults with Asperger syndrome are at increased risk of suicidal ideation/behaviour and require a high level social support. Psychological and physical abuse in early childhood might increase suicidal risk at later age. Intact executive functioning might facilitate suicidal behaviour.

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Psychotic experiences and psychological distress predict contemporaneous and future non-suicidal self-injury and suicide attempts in a sample of Australian school-based adolescents

Psychological Medicine ◽

10.1017/s0033291714001615 ◽

2014 ◽

Vol 45 (2) ◽

pp. 429-437 ◽

Cited By ~ 44

Author(s):

G. Martin ◽

H. Thomas ◽

T. Andrews ◽

P. Hasking ◽

J. G. Scott

Keyword(s):

Psychological Distress ◽

Suicide Attempts ◽

General Health Questionnaire ◽

Diagnostic Interview ◽

Psychotic Experiences ◽

Cross Sectional ◽

School Based ◽

Self Injury ◽

Increased Risk ◽

Self Harm

BackgroundRecent cross-sectional studies have shown psychotic experiences (PEs) are associated with suicidal ideation and behaviours. We aimed to examine associations between psychotic experiences (including persistent PE), and contemporaneous and incident non-suicidal self-injury (NSSI) and suicide attempts.MethodParticipants were from an Australian longitudinal cohort of 1896 adolescents (12–17 years). NSSI and suicide attempts were measured using the Self-Harm Behaviour Questionnaire. Items from the Diagnostic Interview Schedule for Children were used to assess psychotic experiences, and the General Health Questionnaire-12 measured psychological distress.ResultsAdolescents both psychologically distressed and endorsing psychotic experiences had increased odds of contemporaneous and incident NSSI and attempted suicide. Psychotic experiences alone did not predict future risk. Persistent psychotic experiences were associated with increased risk of NSSI and suicide attempts.ConclusionsPsychological distress with accompanying psychotic experiences and persistent psychotic experiences are important predictors of NSSI and suicide attempts. Screening these phenotypes in adolescents will assist in discerning those adolescents most at risk, providing opportunities for targeted suicide prevention strategies.

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