Efficacy of the Zero Suicide framework in reducing recurrent suicide attempts: cross-sectional and time-to-recurrent-event analyses

Background The Zero Suicide framework is a system-wide approach to prevent suicides in health services. It has been implemented worldwide but has a poor evidence-base of effectiveness. Aims To evaluate the effectiveness of the Zero Suicide framework, implemented in a clinical suicide prevention pathway (SPP) by a large public mental health service in Australia, in reducing repeated suicide attempts after an index attempt. Method A total of 604 persons with 737 suicide attempt presentations were identified between 1 July and 31 December 2017. Relative risk for a subsequent suicide attempt within various time periods was calculated using cross-sectional analysis. Subsequently, a 10-year suicide attempt history (2009–2018) for the cohort was used in time-to-recurrent-event analyses. Results Placement on the SPP reduced risk for a repeated suicide attempt within 7 days (RR = 0.29; 95% CI 0.11–0.75), 14 days (RR = 0.38; 95% CI 0.18–0.78), 30 days (RR = 0.55; 95% CI 0.33–0.94) and 90 days (RR = 0.62; 95% CI 0.41–0.95). Time-to-recurrent event analysis showed that SPP placement extended time to re-presentation (HR = 0.65; 95% CI 0.57–0.67). A diagnosis of personality disorder (HR = 2.70; 95% CI 2.03–3.58), previous suicide attempt (HR = 1.78; 95% CI 1.46–2.17) and Indigenous status (HR = 1.46; 95% CI 0.98–2.25) increased the hazard for re-presentation, whereas older age decreased it (HR = 0.92; 95% CI 0.86–0.98). The effect of the SPP was similar across all groups, reducing the risk of re-presentation to about 65% of that seen in those not placed on the SPP. Conclusions This paper demonstrates a reduction in repeated suicide attempts after an index attempt and a longer time to a subsequent attempt for those receiving multilevel care based on the Zero Suicide framework.

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Psychological, Structural, Social and Economic Determinants of Suicide Attempt: Risk Assessment and Decision Making Strategies

OMEGA - Journal of Death and Dying ◽

10.1177/00302228211003462 ◽

2021 ◽

pp. 003022282110034

Author(s):

Azam Farmani ◽

Mojtaba Rahimianbougar ◽

Yousef Mohammadi ◽

Hossein Faramarzi ◽

Siamak Khodarahimi ◽

...

Keyword(s):

Risk Assessment ◽

Suicide Attempt ◽

Suicide Attempts ◽

Psychological Services ◽

Cross Sectional ◽

Economic Determinants ◽

History Of ◽

Cross Sectional Design ◽

High Level ◽

Risk Assessment And Management

The aim of this research was to conduct a risk assessment and management of psychological, structural, social and economic determinants (PSSED) in a suicide attempt. The sample consisted of 353 individuals who had a recorded history of suicidal attempt; and 20 professional individuals by purposive sampling method within a descriptive cross-sectional design. Worksheets for RAM and AHP were used for data collection in this study. The rate of suicide attempt was 7.21 per 100,000 population in this study. Analysis showed that depression and mental disorders; personality disorders; family problems; socio-cultural and economic problems; lack of awareness; and low level of education have a high level of risk for suicide attempts. Psychiatric and psychological services; awareness and knowledge of life skills; medical services to dysfunctional families; development of community-based planning for PSSED of suicide; and employment and entrepreneurship services may lower suicide attempt risk.

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Correlates of Suicidal Ideation and/or Behavior in Bariatric-Surgery-Seeking Individuals With Severe Obesity

Crisis ◽

10.1027/0227-5910/a000115 ◽

2012 ◽

Vol 33 (3) ◽

pp. 137-143 ◽

Cited By ~ 18

Author(s):

E. Y. Chen ◽

K. C. Fettich ◽

M. S. McCloskey

Keyword(s):

Bariatric Surgery ◽

Suicidal Ideation ◽

Suicide Attempt ◽

Severe Obesity ◽

Suicide Attempts ◽

Cross Sectional Study ◽

Cross Sectional ◽

Related Stigma ◽

Severely Obese ◽

And Control

Background: Approximately 10% of severely obese bariatric-surgery-seeking individuals report a lifetime history of suicide attempts, a higher rate than in the general community. Being overweight is associated with weight-related stigma, making an individual more vulnerable to social isolation, a potential risk factor for suicidal ideation and/or behavior. Aims: In this cross-sectional study of surgery-seeking adults with severe obesity, we examined whether weight-related stigma increases (1) the likelihood of suicidal ideation and/or behavior or (2) the degree of loneliness; and whether hypotheses (1) and (2) are supported (3) if loneliness mediates the effect of weight-related stigma on suicidal ideation and/or behavior. Methods: Online questionnaires were administered to 301 women and 95 men seeking bariatric surgery. Results: Approximately 30.3% reported having at least a passing thought of suicide, and 5.55% a suicide attempt during their lifetime. The suicide attempt rate appears lower than other bariatric surgery samples, but possibly higher than community and other surgery sample rates. For severely obese surgery-seeking women, weight-related stigma was associated with suicidal ideation and/or behavior, though this was not mediated by loneliness. Conclusions: Future studies are needed to model and compare suicidal ideation and/or behavior in bariatric-surgery-seeking individuals and control groups.

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Builiding Methods for a Proactive Prescription Drug Surveillance System

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v9i1.7591 ◽

2017 ◽

Vol 9 (1) ◽

Author(s):

Fan Xiong

Keyword(s):

Prescription Drug ◽

Surveillance System ◽

Recurrent Event ◽

Epidemiological Methods ◽

High Dose ◽

Prescription Opioids ◽

Event Analysis ◽

Cross Sectional ◽

Opioid Prescription ◽

Dependent Observations

ObjectiveThis study aims to show the application of longitudinal statisticaland epidemiological methods for building a proactive prescriptiondrug surveillance system for public health.IntroductionPrescription Drug Monitoring Programs (PDMPs) are operating in49 states and several U.S. territories. Current methods for surveillanceof prescription drug related behaviors, include the mean daily dosageof morphine milligram equivalent (MME) per patient, annualpercentage of days with overlapping prescriptions per patient, andannual multiple provider episodes for multiple controlled substanceprescription drugs per patient that are described elsewhere.1,2Thiswork builds on these efforts by extending longitudinal methodsto prescription drug behavior surveillance in order to predict risksassociated with prescription drug use.MethodsSchedule II prescription opioids from January 1, 2014 to February29, 2016 from the Kansas Tracking and Reporting of ControlledSubstances (KTRACS) was used for this analysis. Prescription opioidswere linked to the 2016 version of the morphine milligram equivalentconversion table from the National Center for Injury Preventionand Control.3Population estimates were based on the 2015 CountyVintage single-year of age bridged-race estimates from the NationalCenter for Health Statistics and used to calculate age-adjusted rates. Adaily high dose opioid prescription was defined as having greater thanor equal to 90 morphine milligram equivalent. Since this is a unit-daymeasure with patients experiencing multiple daily high dose opioiddays, the Prentice, William, and Peterson (PWP) recurrent eventmodel was used to estimate the number of high-dose opioid days forKansas patients by gender and age groups.4,5Start time was the firstprescription date with a high-dose opioid and stop time was the nexthigh-dose opioid date during a study period from January 1, 2014to Feb 29, 2016. The PWP model is a statistical model that allowsfor the estimation of covariates on an event history (i.e. total timewith prescription opioids, specifically high-dose opioids). Analysiswas completed with a stratified Cox-proportional hazard model,sandwich covariance for dependent observations, and statisticalsignificance was assessed with a Wald Chi-square. PROC PHREGin SAS/STAT(R) 14.1 was used since it has a new FAST option forfitting large proportional counting process hazard model.ResultsThe age-adjusted rate of daily high-dose opioid patients was3.2 patients per 100 Kansas population-year (95% CI: 3.1 – 3.2).Kansas patients aged 85 and older had the highest age-specific rateof 11.7 (95% CI: 11.5 –11.9). Preliminary recurrent event analysisshows on average nearly a quarter of approximately 50 millionSchedule II opioid patient days were high-dose opioid patient daysamong 785,514 Kansan patients with any prescribed opioid history.In an initial result stratified by the number of high-dose opioid daysand adjusting only for age, males on average had approximately 7%higher hazard of recurrent Schedule II high-dose opioid prescriptiondays than females (β: 0.07, S.E: 0.002, p<0.0001). Kansas patientsaged 45 to 54 compared to Kansas patients 85 and older on averagehad approximately 14% higher hazard of recurrent Schedule II high-dose opioid prescription days (β: 0.14, S.E: 0.007, p<0.0001).ConclusionsThis work demonstrates the application of survival analysistechniques to estimate the population at risk for high-dose opioids,which varies by the length of the total opioid prescription history. Earlyresults from the recurrent event analysis showed that Kansas maleand patients aged 45 to 54 years had the longest history of high-doseopioids. Annual cross-sectional population estimates may incorrectlyestimate the estimated risk of high-dose prescription opioids sinceit assumes all patients have the same prescription history. PDMPsare longitudinal databases. Survival analysis methods like recurrentevent models can leverage the longitudinal structure to more preciselyestimate risk statistics. Future work includes incorporation of healthoutcomes data and further prescription covariates to assess the timingand intensity of opioid potency escalation.

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Changes in the pattern of suicide attempters visiting the emergency room after COVID-19 pandemic: an observational cross sectional study

BMC Psychiatry ◽

10.1186/s12888-021-03570-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ji-Hun Kang ◽

Si-Won Lee ◽

Jae-Gu Ji ◽

Jae-Kwang Yu ◽

Yun-Deok Jang ◽

...

Keyword(s):

Blood Pressure ◽

Suicide Attempt ◽

Systolic Blood Pressure ◽

Emergency Room ◽

Suicide Attempts ◽

Educational Background ◽

Management Program ◽

Cross Sectional ◽

History Of ◽

At Home

Abstract Background This study aimed to find out the change in the rate and pattern of suicide attempts during severe acute respiratory syndrome COVID-19 pandemic period. Methods This study was a retrospective analysis of data collected as a part of an emergency room-based post-suicide management program. The data were collected through interviews and from medical records of suicide attempts, maintained in the emergency room, from January 19 to October 31, 2020, during the “COVID-19 period,” and those who attempted suicide from January 19 to October 31, 2019 “pre-COVID-19 period.” We extracted educational background, marital status, occupation, presence of domestic partner, history of mental illness, alcohol consumption, history of previous suicide attempts; suicide attempt method and location (i.e., at home or a place other than home) at the time of attempt, and whether the attempt was a mass suicide. In addition, we compared patient severity between “COVID-19 period” and “pre-COVID-19 period” using the initial KTAS (South Korean triage and acuity scale) level, consciousness level, and systolic blood pressure. In 2012, KTAS was developed through the Ministry of Health and Welfare’s research project to establish triage system in South Korea. Results The analysis of the number of suicide attempts during “pre-COVID-19 period” and “ COVID-19 period” showed that the number of suicide attempts during “COVID-19 period” (n = 440) increased compared to the “pre-COVID-19 period” (n = 400). Moreover, the method of suicide attempts during “COVID-19 period” included overdose of drugs such as hypnotics, antipsychotics, and pesticides that were already possessed by the patient increased compared to the “pre-COVID-19 period” (P < 0.05). At the time of the visit to the emergency room, high KTAS level, low level of consciousness, and low systolic blood pressure, were observed, which were significantly different between “COVID-19 period” and “pre-COVID-19 period” (P < 0.05). Conclusion With the worldwide COVID-19 virus spread, suicide rate and suicide attempts at home have significantly increased. In addition, patient severity was higher in the “COVID-19 period” than that in the “pre-COVID-19 period.” The increasing suicide attempt rate should be controlled by cooperation between the emergency room and regional organizations.

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Repetitive negative thinking about suicide: Associations with lifetime suicide attempts

Clinical Psychology in Europe ◽

10.32872/cpe.5579 ◽

2021 ◽

Vol 3 (3) ◽

Author(s):

Tobias Teismann ◽

Thomas Forkmann ◽

Johannes Michalak ◽

Julia Brailovskaia

Keyword(s):

Suicide Attempt ◽

Suicidal Behavior ◽

Suicide Ideation ◽

Suicide Attempts ◽

Clinical Sample ◽

Cross Sectional Study ◽

Repetitive Negative Thinking ◽

Cross Sectional ◽

Suicide Attempters ◽

Negative Thinking

Background Repetitive negative thinking has been identified as an important predictor of suicide ideation and suicidal behavior. Yet, only few studies have investigated the effect of suicide-specific rumination, i.e., repetitive thinking about death and/or suicide on suicide attempt history. On this background, the present study investigated, whether suicide-specific rumination differentiates between suicide attempters and suicide ideators, is predictive of suicide attempt history and mediates the association between suicide ideation and suicide attempts. Method A total of 257 participants with a history of suicide ideation (55.6% female; Age M = 30.56, Age SD = 11.23, range: 18–73 years) completed online measures on suicidality, general and suicide-specific rumination. Results Suicide-specific rumination differentiated suicide attempters from suicide ideators, predicted suicide attempt status (above age, gender, suicide ideation, general rumination) and fully mediated the association between suicide ideation and lifetime suicide attempts. Conclusion Overall, though limited by the use of a non-clinical sample and a cross-sectional study design, the present results suggest that suicide-specific rumination might be a factor of central relevance in understanding transitions to suicidal behavior.

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Gender and other potential biases in peer review: cross-sectional analysis of 38 250 external peer review reports

BMJ Open ◽

10.1136/bmjopen-2019-035058 ◽

2020 ◽

Vol 10 (8) ◽

pp. e035058 ◽

Cited By ~ 1

Author(s):

Anna Severin ◽

Joao Martins ◽

Rachel Heyard ◽

François Delavy ◽

Anne Jorstad ◽

...

Keyword(s):

Peer Review ◽

Multivariable Analysis ◽

Evidence Base ◽

Funding Agency ◽

Cross Sectional ◽

Cross Sectional Analysis ◽

Grant Applications ◽

Peer Reviewers ◽

Review Reports ◽

Sectional Analysis

ObjectivesTo examine whether the gender of applicants and peer reviewers and other factors influence peer review of grant proposals submitted to a national funding agency.SettingSwiss National Science Foundation (SNSF).DesignCross-sectional analysis of peer review reports submitted from 2009 to 2016 using linear mixed effects regression models adjusted for research topic, applicant’s age, nationality, affiliation and calendar period.ParticipantsExternal peer reviewers.Primary outcome measureOverall score on a scale from 1 (worst) to 6 (best).ResultsAnalyses included 38 250 reports on 12 294 grant applications from medicine, architecture, biology, chemistry, economics, engineering, geology, history, linguistics, mathematics, physics, psychology and sociology submitted by 26 829 unique peer reviewers. In univariable analysis, male applicants received more favourable evaluation scores than female applicants (+0.18 points; 95% CI 0.14 to 0.23), and male reviewers awarded higher scores than female reviewers (+0.11; 95% CI 0.08 to 0.15). Applicant-nominated reviewers awarded higher scores than reviewers nominated by the SNSF (+0.53; 95% CI 0.50 to 0.56), and reviewers from outside of Switzerland more favourable scores than reviewers affiliated with Swiss institutions (+0.53; 95% CI 0.49 to 0.56). In multivariable analysis, differences between male and female applicants were attenuated (+0.08; 95% CI 0.04 to 0.13) whereas results changed little for source of nomination and affiliation of reviewers. The gender difference increased after September 2011, when new evaluation forms were introduced (p=0.033 from test of interaction).ConclusionsPeer review of grant applications at SNSF might be prone to biases stemming from different applicant and reviewer characteristics. The SNSF abandoned the nomination of peer reviewers by applicants. The new form introduced in 2011 may inadvertently have given more emphasis to the applicant’s track record. We encourage other funders to conduct similar studies, in order to improve the evidence base for rational and fair research funding.

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Over-the-Counter Drugs and Other Substances Used in Attempted Suicide Presented to Emergency Departments in Montreal, Canada

Crisis ◽

10.1027/0227-5910/a000545 ◽

2019 ◽

Vol 40 (3) ◽

pp. 166-175 ◽

Cited By ~ 1

Author(s):

Alexandre Mikhail ◽

Omaid Tanoli ◽

Gilles Légaré ◽

Pierre-André Dubé ◽

Youssef Habel ◽

...

Keyword(s):

Substance Use ◽

Suicide Attempt ◽

Substance Use Disorders ◽

Prescription Drugs ◽

Suicide Attempts ◽

Patient Characteristics ◽

Cross Sectional ◽

Over The Counter ◽

Otc Drugs ◽

Do So

Abstract. Background: Over-the-counter (OTC) analgesics are frequently used in suicide attempts. Accessibility, toxicity, and unsupervised acquisition of large amounts may be facilitators. Aims: To identify patient characteristics associated with OTC drug use as a suicide attempt method among adults. Method: A cross-sectional study was conducted using chart review of all individuals who presented to the emergency department (ED) of two adult general hospitals following a suicide attempt during 2009–2010 in Montreal, Canada. Results: Among the 369 suicide attempters identified, 181 used overdosing, 47% of whom used OTC drugs. In logistic regression, women and those with medical comorbidity were more likely to use overdosing, while those with substance use disorders were less likely to do so. Among those who overdosed, women were more likely to use OTC drugs, while those who were Caucasian, had children, comorbidities, diagnoses with substance use disorders, and made attempts in the Fall were less likely to do so. Substances most frequently used were: acetaminophen among OTC drugs (30%); antidepressants (37%), anxiolytics (30%), opioids (10%), and anticonvulsants (9%) among prescription drugs; and cocaine (10%) among recreational drugs. Limitations: Reasons for the suicide method choice were not available. Conclusion: OTC drugs, in particular acetaminophen, are frequently used in suicide attempts. Accessibility to these drugs may be an important contributor.

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Moral injury and peri- and post-military suicide attempts among post-9/11 veterans

Psychological Medicine ◽

10.1017/s0033291721005274 ◽

2022 ◽

pp. 1-10

Author(s):

Shira Maguen ◽

Brandon J. Griffin ◽

Dawne Vogt ◽

Claire A. Hoffmire ◽

John R. Blosnich ◽

...

Keyword(s):

Mental Health ◽

Suicide Attempt ◽

Military Service ◽

Suicide Attempts ◽

Moral Injury ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Nationally Representative ◽

Military Suicide ◽

The Impact

Abstract Background Our goal was to examine the association between moral injury, mental health, and suicide attempts during military service and after separation by gender in post-9/11 veterans. Methods A nationally representative sample of 14057 veterans completed a cross-sectional survey. To examine associations of exposure to potentially morally injurious events (PMIEs; witnessing, perpetrating, and betrayal) and suicidal self-directed violence, we estimated two series of multivariable logistic regressions stratified by gender, with peri- and post-military suicide attempt as the dependent variables. Results PMIE exposure accounted for additional risk of suicide attempt during and after military service after controlling for demographic and military characteristics, current mental health status, and pre-military history of suicidal ideation and attempt. Men who endorsed PMIE exposure by perpetration were 50% more likely to attempt suicide during service and twice as likely to attempt suicide after separating from service. Men who endorsed betrayal were nearly twice as likely to attempt suicide during service; however, this association attenuated to non-significance after separation in the fully adjusted models. In contrast, women who endorsed betrayal were over 50% more likely to attempt suicide during service and after separation; PMIE exposure by perpetration did not significantly predict suicide attempts before or after service among women in the fully adjusted models. Conclusions Our findings indicate that suicide assessment and prevention programs should consider the impact of moral injury and attend to gender differences in this risk factor in order to provide the most comprehensive care.

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History of suicide attempts and COVID-19 infection in Veterans with schizophrenia or schizoaffective disorder: moderating effects of age and body mass index

Complex Psychiatry ◽

10.1159/000521230 ◽

2021 ◽

Author(s):

Olaoluwa O. Okusaga ◽

Rachel L. Kember ◽

Gina M. Peloso ◽

Roseann E. Peterson ◽

Marijana Vujkovic ◽

...

Keyword(s):

Body Mass Index ◽

Suicide Attempt ◽

Body Mass ◽

Schizoaffective Disorder ◽

Suicide Attempts ◽

Medical Center ◽

Cross Sectional ◽

Suicide Attempters ◽

History Of ◽

The Relationship

Introduction: Relative to the general population, patients with schizophrenia or schizoaffective disorder have higher rates of suicide attempts and mortality from COVID-19 infection. Therefore, determining whether a history of suicide attempt is associated with COVID-19 in patients with schizophrenia or schizoaffective disorder has implications for COVID-19 vulnerability stratification in this patient population. Methods: We carried out cross-sectional analyses of electronic health records (EHR) of veterans with a diagnosis of schizophrenia or schizoaffective disorder that received treatment at any United States Veterans Affairs Medical Center between January 1, 2020 to January 31, 2021. We used logistic regression to estimate unadjusted and adjusted (including age, sex, race, marital status, body mass index (BMI), and a medical comorbidity score) odds ratios (ORs) for COVID-19 positivity in suicide attempters relative to non-attempters. Results: A total of 101,032 Veterans [mean age 56.67 ± 13.13 years; males 91,715 (90.8%)] were included in the analyses. There were 2,703 (2.7%) suicide attempters and 719 (0.7%) patients were positive for COVID-19. The association between history of suicide attempt and COVID-19 positivity was modified by age and BMI, such that the relationship was only significant in patients younger than 59 years, and in obese (BMI ≥ 30) patients (adjusted OR 3.42, 95% CI 2.02 - 5.79 and OR 2.85, 95% CI 1.65 - 4.94, respectively). Conclusions: Higher rates of COVID-19 in young or obese suicide attempters with a diagnosis of schizophrenia or schizoaffective disorder might be due to elevated risk for the infection in this sub-group of patients.

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Single and multiple suicide attempts: Prevalence and correlates in school-going adolescents in Liberia in 2017

10.21203/rs.3.rs-27558/v1 ◽

2020 ◽

Author(s):

Supa Pengpid ◽

Karl Peltzer

Keyword(s):

Suicide Attempt ◽

Tobacco Use ◽

Fast Food ◽

Suicide Attempts ◽

Multinomial Logistic Regression ◽

Cross Sectional ◽

Multinomial Logistic Regression Analysis ◽

The Past ◽

Nationally Representative ◽

Social Environmental

Abstract Background: This investigation aimed to estimate the prevalence and its correlates of single and multiple suicide attempts among adolescents in Liberia.Method: Cross-sectional nationally representative data were analysed from 2,744 adolescents (18 years median age) that participated in the “2017 Liberia Global School-Based Student Health Survey (GSHS).”Results: Results indicate that 33.7% of students had made a suicide attempt in the past 12 months (16.5% single and 17.2% multiple suicide attempts). In adjusted multinomial logistic regression analysis, having no close friends, loneliness, having been frequently physically attacked, ever used amphetamine and fast food intake were associated with multiple suicide attempts in the past 12 months. In addition, having been frequently in a physical fight and current tobacco use were associated with single suicide attempt. In sex stratified analyses, in addition, among boys frequent bullying victimization and among girls, parental tobacco use and parents never or rarely check on home work were associated with multiple suicide attempts. Multiple psychosocial distressors, multiple social-environmental factors and multiple health risk behaviours were associated with single and multiple suicide attempts.Conclusion: One in three students had made suicide attempt in the past 12 months (one in six students multiple suicide attempts) and several associated variables were detected which can aid in designing intervention strategies.

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