Effect of Housing First on Suicidal Behaviour

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.

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Incidence of suicide ideation and attempts in adults: the 13-year follow-up of a community sample in Baltimore, Maryland

Psychological Medicine ◽

10.1017/s0033291701004482 ◽

2001 ◽

Vol 31 (7) ◽

pp. 1181-1191 ◽

Cited By ~ 140

Author(s):

WEN-HUNG KUO ◽

J. J. GALLO ◽

A. Y. TIEN

Keyword(s):

Mental Health ◽

Suicidal Ideation ◽

Mental Health Services ◽

Health Services ◽

Psychiatric Disorders ◽

Suicidal Behaviour ◽

Suicide Attempts ◽

Community Sample ◽

Suicide Behaviour

Background. Utilizing a prospectively designed community sample, we set out to estimate the rate of newly-incident suicidal ideation and attempts (non-fatal suicide behaviour) in a community sample, to evaluate antecedent sociodemographic characteristics and psychiatric disorders, and to assess use of mental health services in relation to non-fatal suicide behaviour.Method. Prospectively-gathered data was utilized from 3481 continuing participants in the 13-year follow-up of the Baltimore sample of the NIMH Epidemiologic Catchment Area survey interviewed in 1981, 1982 and 1993/6.Results. The incidence of suicide attempts was estimated at 148·8 per 100000 person-years and ideation at 419·9 per 100000 person-years. Persons in the youngest age group, in the lowest socio-economic status, and previously married persons were at increased risk for non-fatal suicide behaviour during the follow-up interval. Persons who reported suicidal ideation at baseline were more likely to report having attempted suicide at follow-up (RR = 6·09, 95% CI 2·58–14·36). Psychiatric disorders, especially depression and substance abuse, were associated with new-onset of non-fatal suicidal behaviour. While persons who reported newly-incident suicidal behaviour were more likely to report use of mental health services, few said that suicidal ideation or attempts were the reason for the visits.Conclusions. Suicidal ideation is a common and important antecedent to suicide attempts and deserves more attention in community and general medical settings.

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Effectiveness of a Continuity-of-Care Model to Reduce Youth Suicidality

Crisis ◽

10.1027/0227-5910/a000818 ◽

2021 ◽

Author(s):

Elizabeth Sale ◽

Amanpreet Singh Sandhu ◽

Shannon VonDras

Keyword(s):

Suicidal Ideation ◽

Continuity Of Care ◽

Repeated Measures ◽

Suicide Attempts ◽

Care Model ◽

Treatment As Usual ◽

Care Approach ◽

Ed Visits

Abstract. Background: Suicidal ideation and recent suicide attempts greatly increase the risk of suicide among youth. Many youth experiencing suicidality are not adequately connected to in-person treatment. Aims: This study aimed to determine the efficacy of a continuity-of-care approach in reducing suicide attempts, ideation, and related hospital and emergency department (ED) visits among youth at high risk for suicide. Method: Data on suicidal ideation, attempts, and related hospital and ED visits were collected over a 6-month period for youth under age 25 ( n = 376). One-way repeated measures ANOVA and Cochran's Q tests assessed change from intake at the 3- and 6-month follow-up. Results: Youth had significantly fewer suicide attempts and related hospital and ED visits at both 3- and 6-month timepoints. Suicidal ideation decreased to 52% from intake to 6-month follow-up. Limitations: This study lacked a comparison population to examine continuity-of-care versus treatment-as-usual. Furthermore, the study did not extend beyond 6 months, limiting the ability to assess the intervention's long-term effectiveness. Conclusion: This youth-focused continuity-of-care model reduced suicidal ideation and related behaviors. Further studies should utilize control groups to confirm the validity of these results.

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Mediating role of borderline personality disorder traits in the effects of childhood maltreatment on suicidal behaviour among mood disorder patients

European Psychiatry ◽

10.1016/j.eurpsy.2017.03.011 ◽

2017 ◽

Vol 44 ◽

pp. 53-60 ◽

Cited By ~ 8

Author(s):

K.I. Aaltonen ◽

T. Rosenström ◽

I. Baryshnikov ◽

B. Karpov ◽

T. Melartin ◽

...

Keyword(s):

Borderline Personality Disorder ◽

Suicidal Ideation ◽

Personality Disorder ◽

Childhood Maltreatment ◽

Suicidal Behaviour ◽

Suicide Attempts ◽

Borderline Personality ◽

Mediation Effect ◽

Mediation Analyses ◽

Borderline Personality Disorder Traits

AbstractBackground:Substantial evidence supports an association between childhood maltreatment and suicidal behaviour. However, few studies have examined factors mediating this relationship among patients with unipolar or bipolar mood disorders.Methods:Depressive disorder and bipolar disorder (ICD-10-DCR) patients (n = 287) from the Helsinki University Psychiatric Consortium (HUPC) Study were surveyed on self-reported childhood experiences, current depressive symptoms, borderline personality disorder traits, and lifetime suicidal behaviour. Psychiatric records served to complement the information on suicide attempts. We examined by formal mediation analyses whether (1) the effect of childhood maltreatment on suicidal behaviour is mediated through borderline personality disorder traits and (2) the mediation effect differs between lifetime suicidal ideation and lifetime suicide attempts.Results:The impact of childhood maltreatment in multivariate models on either lifetime suicidal ideation or lifetime suicide attempts showed comparable total effects. In formal mediation analyses, borderline personality disorder traits mediated all of the total effect of childhood maltreatment on lifetime suicide attempts, but only one fifth of the total effect on lifetime suicidal ideation. The mediation effect was stronger for lifetime suicide attempts than for lifetime suicidal ideation (P = 0.002) and independent of current depressive symptoms.Conclusions:The mechanisms of the effect of childhood maltreatment on suicidal ideation versus suicide attempts may diverge among psychiatric patients with mood disorders. Borderline personality disorder traits may contribute to these mechanisms, although the influence appears considerably stronger for suicide attempts than for suicidal ideation.

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Cognitive Behavioural Therapy for Nightmares for Patients with Persecutory Delusions (Nites): An Assessor-Blind, Pilot Randomized Controlled Trial

The Canadian Journal of Psychiatry ◽

10.1177/0706743719847422 ◽

2019 ◽

pp. 070674371984742 ◽

Cited By ~ 7

Author(s):

Bryony Sheaves ◽

Emily A. Holmes ◽

Stephanie Rek ◽

Kathryn M. Taylor ◽

Alecia Nickless ◽

...

Keyword(s):

Suicidal Ideation ◽

Cognitive Behavioural Therapy ◽

Controlled Trial ◽

Pilot Trial ◽

Behavioural Therapy ◽

Serious Adverse Events ◽

Persecutory Delusions ◽

Treatment As Usual ◽

Cognitive Behavioural

Objective:Nightmares are relatively common in patients experiencing psychosis but rarely assessed or treated. Nightmares may maintain persecutory delusions by portraying fears in sensory-rich detail. We tested the potential benefits of imagery-focused cognitive behavioural therapy (CBT) for nightmares on nightmare severity and persecutory delusions.Method:This assessor-blind parallel-group pilot trial randomized 24 participants with nightmares and persecutory delusions to receive CBT for nightmares delivered over 4 weeks in addition to treatment as usual (TAU) or TAU alone. Assessments were at 0, 4 (end of treatment), and 8 weeks (follow-up). Feasibility outcomes assessed therapy uptake, techniques used, satisfaction, and attrition. The primary efficacy outcome assessed nightmare severity at week 4. Analyses were intention to treat, estimating treatment effect with 95% confidence intervals (CIs).Results:All participants offered CBT completed therapy (mean [SD], 4.8 [0.6] sessions) with high satisfaction, and 20 (83%) participants completed all assessments. Compared with TAU, CBT led to large improvements in nightmares (adjusted mean difference = −7.0; 95% CI, –12.6 to –1.3; d = –1.1) and insomnia (6.3; 95% CI, 2.6 to 10.0; d = 1.4) at week 4. Gains were maintained at follow-up. Suicidal ideation was not exacerbated by CBT but remained stable to follow-up, compared with TAU, which reduced at follow-up (6.8; 95% CI, 0.3 to 3.3; d = 0.7). CBT led to reductions in paranoia (–20.8; 95% CI, –43.2 to 1.7; d = –0.6), although CIs were wide. Three serious adverse events were deemed unrelated to participation (CBT = 2, TAU = 1).Conclusions:CBT for nightmares is feasible and may be efficacious for treating nightmares and comorbid insomnia for patients with persecutory delusions. It shows promise on paranoia but potentially not on suicidal ideation.

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OPUS study: Suicidal behaviour, suicidal ideation and hopelessness among patients with first-episode psychosis

The British Journal of Psychiatry ◽

10.1192/bjp.181.43.s98 ◽

2002 ◽

Vol 181 (S43) ◽

pp. s98-s106 ◽

Cited By ~ 193

Author(s):

M. Nordentoft ◽

P. Jeppesen ◽

M. Abel ◽

P. Kassow ◽

L. Petersen ◽

...

Keyword(s):

Suicide Attempt ◽

Suicidal Behaviour ◽

Female Gender ◽

First Episode Psychosis ◽

Integrated Treatment ◽

High Risk Group ◽

First Episode ◽

Treatment As Usual ◽

Episode Psychosis

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.

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Suicidal Behaviour among Female and Male Commercial Sex Workers; Interpersonal Therapy as A Mode of Intervention

International Journal of Indian Psychology ◽

10.25215/0301.082 ◽

2015 ◽

Vol 3 (1) ◽

Author(s):

Vaniprabha G. V ◽

S. G. Jadhav

Keyword(s):

Sex Workers ◽

Suicidal Behaviour ◽

Suicide Attempts ◽

Commercial Sex ◽

Interpersonal Therapy ◽

Commercial Sex Workers ◽

Suicidal Attempts ◽

The Difference

Suicidal behaviour and Depression among the 100 Female and 100 Male Commercial Sex Workers (CSW’S) and their mode of suicide was studied. Interpersonal therapy was initiated to lower their Depression and Suicidal behaviour. Despite the difference in the suicidal attempts among these population A 8 weeks’ therapy and 6 month follow up lowered their Depression and no further suicide attempts. This study explored these factors among this population in Bengaluru, India

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Work related sexual harassment and risk of suicide and suicide attempts: prospective cohort study

BMJ ◽

10.1136/bmj.m2984 ◽

2020 ◽

pp. m2984 ◽

Cited By ~ 1

Author(s):

Linda L Magnusson Hanson ◽

Anna Nyberg ◽

Ellenor Mittendorfer-Rutz ◽

Fredrik Bondestam ◽

Ida E H Madsen

Keyword(s):

Cohort Study ◽

Sexual Harassment ◽

Suicide Attempt ◽

Prospective Cohort Study ◽

Suicidal Behaviour ◽

Prospective Cohort ◽

Suicide Attempts ◽

Men And Women ◽

Work Related

Abstract Objective To analyse the relation between exposure to workplace sexual harassment and suicide, as well as suicide attempts. Design Prospective cohort study. Setting Sweden. Participants 86 451 men and women of working age in paid work across different occupations responded to a self-report questionnaire including exposure to work related sexual harassment between 1995 and 2013. The analytical sample included 85 205 people with valid data on sexual harassment, follow-up time, and age. Main outcome measures Suicide and suicide attempts ascertained from administrative registers (mean follow-up time 13 years). Results Among the people included in the respective analyses of suicide and suicide attempts, 125 (0.1%) died from suicide and 816 (1%) had a suicide attempt during follow-up (rate 0.1 and 0.8 cases per 1000 person years). Overall, 11 of 4095 participants exposed to workplace sexual harassment and 114 of 81 110 unexposed participants committed suicide, and 61/4043 exposed and 755/80 513 unexposed participants had a record of suicide attempt. In Cox regression analyses adjusted for a range of sociodemographic characteristics, workplace sexual harassment was associated with an excess risk of both suicide (hazard ratio 2.82, 95% confidence interval 1.49 to 5.34) and suicide attempts (1.59, 1.21 to 2.08), and risk estimates remained significantly increased after adjustment for baseline health and certain work characteristics. No obvious differences between men and women were found. Conclusions The results support the hypothesis that workplace sexual harassment is prospectively associated with suicidal behaviour. This suggests that suicide prevention considering the social work environment may be useful. More research is, however, needed to determine causality, risk factors for workplace sexual harassment, and explanations for an association between work related sexual harassment and suicidal behaviour.

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Examining the Relationships between Cumulative Childhood Adversity and the Risk of Criminal Justice Involvement and Victimization among Homeless Adults with Mental Illnesses after Receiving Housing First Intervention

The Canadian Journal of Psychiatry ◽

10.1177/0706743720902616 ◽

2020 ◽

Vol 65 (6) ◽

pp. 409-417

Author(s):

Hanie Edalati ◽

Tonia L. Nicholls ◽

Christian G. Schütz ◽

Julian M. Somers ◽

Jino Distasio ◽

...

Keyword(s):

Mental Illness ◽

Criminal Justice ◽

Mental Illnesses ◽

Housing First ◽

Criminal Justice Involvement ◽

Homeless Adults ◽

Treatment As Usual ◽

Increased Risk ◽

The Relationship

Objectives: Exposure to adverse childhood experiences (ACEs) is associated with increased risk of criminal justice involvement and repeated victimization among homeless individuals. This study aimed to (1) examine whether the relationship between cumulative ACE score and odds of experiencing criminal justice involvement and victimization remains significant over time after receiving the Housing First (HF) intervention and (2) investigate the moderating effect of cumulative ACE score on the effectiveness of the HF intervention on the likelihood of experiencing these outcomes among homeless individuals with mental illnesses. Methods: We used longitudinal data over the 2-year follow-up period from the At Home/ Chez Soi demonstration project that provided HF versus treatment as usual (TAU) to homeless adults with mental illness in five Canadian cities (N = 1,888). Results: In all 4 follow-up time points, the relationship between cumulative ACE score and both outcomes remained significant, regardless of study arm (HF vs. TAU) and other confounding factors. However, cumulative ACE score did not moderate intervention effects on odds of experiencing either outcome, suggesting that the effectiveness of HF versus TAU, with regard to the odds of being victimized or criminal justice involvement, did not differ by cumulative ACE scores over the course of study. Conclusions: Findings suggest that providing services for homeless individuals with mental illness should be trauma informed and include specialized treatment strategies targeting the experience of ACEs and trauma to improve their treatment outcomes. An intensive approach is required to directly address the problem of criminal justice involvement and victimization in these individuals.

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Cognitive-Behavioural Problem Solving in the Treatment of Patients who Repeatedly Attempt Suicide a Controlled Trial

The British Journal of Psychiatry ◽

10.1192/bjp.157.6.871 ◽

1990 ◽

Vol 157 (6) ◽

pp. 871-876 ◽

Cited By ~ 205

Author(s):

Paul M. Salkovskis ◽

Chris Atha ◽

David Storer

Keyword(s):

Problem Solving ◽

High Risk ◽

Suicide Attempts ◽

Controlled Trial ◽

Behavioural Problem ◽

Treatment As Usual ◽

Cognitive Behavioural ◽

End Of Treatment ◽

One Year

In a controlled trial, 20 patients at high risk of repeated suicide attempts were randomly allocated to either cognitive-behavioural problem solving or a ‘treatment-as-usual’ control condition. The group practising problem solving improved significantly more than controls on ratings of depression, hopelessness, suicidal ideation and target problems at the end of treatment and at follow-up of up to one year, and there was evidence of an effect on the rates of repetition over the six months after treatment.

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