Predictors of Suicide Risk in Adolescents with Drug Experience: Focusing on Smoking, Drinking Behavior and Mental Health Characteristics

Introduction: Risk assessment tools are routinely used to identify patients at high risk. There is increasing evidence that these tools may not be sufficiently accurate to determine the risk of suicide of people, particularly those being treated in community mental health settings. Methods: An outcome analysis for case serials of people who died by suicide between January 2014 and December 2016 and had contact with a public mental health service within 31 days prior to their death. Results: Of the 68 people who had contact, 70.5% had a formal risk assessment. Seventy-five per cent were classified as low risk of suicide. None were identified as being at high risk. While individual risk factors were identified, these did not allow to differentiate between patients classified as low or medium. Discussion: Risk categorisation contributes little to patient safety. Given the dynamic nature of suicide risk, a risk assessment should focus on modifiable risk factors and safety planning rather than risk prediction. Conclusion: The prediction value of suicide risk assessment tools is limited. The risk classifications of high, medium or low could become the basis of denying necessary treatment to many and delivering unnecessary treatment to some and should not be used for care allocation.

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Prevalence of mental health and suicide risk in prisons in low- and middle-income countries: a rapid review

Journal of Forensic Psychiatry and Psychology ◽

10.1080/14789949.2021.2016891 ◽

2022 ◽

pp. 1-16

Author(s):

Kathryn Hill ◽

Verity Wainwright ◽

Caroline Stevenson ◽

Jane Senior ◽

Catherine Robinson ◽

...

Keyword(s):

Mental Health ◽

Suicide Risk ◽

Rapid Review ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Association between acute psychiatric bed availability in the Veterans Health Administration and veteran suicide risk: a retrospective cohort study

BMJ Quality & Safety ◽

10.1136/bmjqs-2020-012975 ◽

2021 ◽

pp. bmjqs-2020-012975

Author(s):

Peter J Kaboli ◽

Matthew R Augustine ◽

Bjarni Haraldsson ◽

Nicholas M Mohr ◽

M Bryant Howren ◽

...

Keyword(s):

Mental Health ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Suicide Risk ◽

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

Bed Occupancy ◽

Increased Risk

BackgroundVeteran suicides have increased despite mental health investments by the Veterans Health Administration (VHA).ObjectiveTo examine relationships between suicide and acute inpatient psychiatric bed occupancy and other community, hospital and patient factors.MethodsRetrospective cohort study using administrative and publicly available data for contextual community factors. The study sample included all veterans enrolled in VHA primary care in 2011–2016 associated with 111 VHA hospitals with acute inpatient psychiatric units. Acute psychiatric bed occupancy, as a measure of access to care, was the main exposure of interest and was categorised by quarter as per cent occupied using thresholds of ≤85%, 85.1%–90%, 90.1%–95% and >95%. Hospital-level analyses were conducted using generalised linear mixed models with random intercepts for hospital, modelling number of suicides by quarter with a negative binomial distribution.ResultsFrom 2011 to 2016, the national incidence of suicide among enrolled veterans increased from 39.7 to 41.6 per 100 000 person-years. VHA psychiatric bed occupancy decreased from a mean of 68.2% (IQR 56.5%–82.2%) to 65.4% (IQR 53.9%–79.9%). VHA hospitals with the highest occupancy (>95%) in a quarter compared with ≤85% had an adjusted incident rate ratio (IRR) for suicide of 1.10 (95% CI 1.01 to 1.19); no increased risk was observed for 85.1%–90% (IRR 0.96; 95% CI 0.89 to 1.03) or 90.1%–95% (IRR 0.96; 95% CI 0.89 to 1.04) compared with ≤85% occupancy. Of hospital and community variables, suicide risk was not associated with number of VHA or non-VHA psychiatric beds or amount spent on community mental health. Suicide risk increased by age categories, seasons, geographic regions and over time.ConclusionsHigh VHA hospital occupancy (>95%) was associated with a 10% increased suicide risk for veterans whereas absolute number of beds was not, suggesting occupancy is an important access measure. Future work should clarify optimal bed occupancy to meet acute psychiatric needs and ensure adequate bed distribution.

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Self-guided cognitive behavioral therapy apps: Can they help? Systematic assessment of features, functionality, and congruence with evidence (Preprint)

10.2196/preprints.27619 ◽

2021 ◽

Author(s):

Laura Martinengo ◽

Anne-Claire Stona ◽

Konstadina Griva ◽

Paola Dazzan ◽

Carmine Maria Pariante ◽

...

Keyword(s):

Mental Health ◽

Risk Management ◽

Data Security ◽

Suicide Risk ◽

Behavioral Therapy ◽

Cognitive Restructuring ◽

Evidence Based ◽

Inclusion Criteria ◽

Systematic Assessment ◽

Health Apps

BACKGROUND Mental health disorders affect one in ten people globally, of which around 300 million are affected by depression. At least half of affected people remain untreated. Cognitive behavioral therapy (CBT) is an effective treatment but access to specialized providers, habitually challenging, has worsened with COVID-19. Internet-based CBT (iCBT) is effective and a feasible strategy to increase access to treatment for people with depression. Mental health apps may further assist in facilitating self-management for people affected by depression but accessing the right app might be cumbersome given the large number and wide variety of apps offered by public app marketplaces. OBJECTIVE To systematically assess features, functionality, data security and congruence with evidence of self-guided CBT-based apps available in major app stores, suitable for users suffering from depression. METHODS A systematic assessment of self-guided CBT-based apps available in Google Play and Apple’s App Store was conducted. Apps launched or updated since August 2018 were identified through a systematic search in 42matters using CBT-related terms. Apps meeting inclusion criteria were downloaded and assessed using a Samsung Galaxy J7 Pro (Android 9) and iPhone 7 (iOS 13.3.1). Apps were appraised using a 182-question checklist developed by the research team, comprising apps’ general characteristics, CBT-related features, including six evidence-based CBT techniques as informed by a CBT manual, CBT competences framework and a literature review of iCBT clinical trial protocols (psychoeducation, behavioral activation, cognitive restructuring, problem solving, relaxation, and exposure for comorbid anxiety), and technical aspects and quality assurance. Results were reported as a narrative review, using descriptive statistics. RESULTS The initial search yielded 3006 apps, of which 98 apps met inclusion criteria and were systematically assessed. There were 20 wellbeing apps, 65 mental health apps and 13 depression apps. Twenty-eight apps offered at least four evidence-based CBT techniques, particularly depression apps. Cognitive restructuring was the most common technique, offered by 77/98 apps. Only a third of apps offered suicide- risk management resources while less than 20% of apps offered COVID-19-related information. Most apps included a privacy policy, but only a third of apps presented it before account creation. Eighty percent of privacy policies stated sharing data with third party service providers. Half of app development teams included academic institutions or healthcare providers. CONCLUSIONS Only few self-guided CBT-based apps offer comprehensive CBT programs or suicide risk management resources. Sharing of users’ data is widespread, highlighting shortcomings in the health app market governance. To fulfill their potential, self-guided CBT-based apps should follow evidence-based clinical guidelines, be patient-centered and enhance users’ data security. CLINICALTRIAL NA

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Structured Professional Judgment to Assist the Evaluation and Safety Planning of Suicide Risk: The Risk of Suicide Protocol (RoSP)

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.607120 ◽

2021 ◽

Vol 12 ◽

Author(s):

Nicola S. Gray ◽

Ann John ◽

Aimee McKinnon ◽

Stephanie Raybould ◽

James Knowles ◽

...

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Clinical Evaluation ◽

Suicide Risk ◽

Professional Judgment ◽

Health Board ◽

Safety Planning ◽

Nice Guidelines ◽

Structured Professional Judgment

Background: The Risk of Suicide Protocol (RoSP) is a structured professional judgment (SPJ) scheme designed in line with NICE guidelines to improve clinicians' ability to evaluate and manage suicide risk.Aims: This study aimed to evaluate the efficacy of RoSP in two settings: (1) unexpected deaths of people in the community who were known to mental health services; and (2) an inpatient hospital specializing in the assessment and treatment of patients with personality disorder.Method: In Study 1, information from a database of unexpected deaths (N = 68) within an NHS health board was used to complete a RoSP assessment (blind to cause of death) and information from the Coroner's Court was used to assign people to suicide vs. natural causes/accidental death. In Study 2, patients (N = 62) were assessed on the RoSP upon admission to hospital and their self-injurious behaviors were recorded over the first 3 months of admission.Results: (1) Evaluations using RoSP were highly reliable in both samples (ICCs 0.93–0.98); (2) professional judgment based on the RoSP was predictive of completed suicide in the community sample (AUC = 0.83) and; (3) was predictive of both suicide attempts (AUC = 0.81) and all self-injurious behaviors (AUC = 0.80) for the inpatient sample.Conclusion: RoSP is a reliable and valid instrument for the structured clinical evaluation of suicide risk for use in inpatient psychiatric services and in community mental health services. RoSP's efficacy is comparable to well-established structured professional judgment instruments designed to predict other risk behavior (e.g., HCR-20 and the prediction of violence). The use of RoSP for the clinical evaluation of suicide risk and safety-planning provides a structure for meeting NICE guidelines for suicide prevention and is now evidence-based.

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Suicide rates among patients subject to community treatment orders in England during 2009–2018

BJPsych Open ◽

10.1192/bjo.2021.1021 ◽

2021 ◽

Vol 7 (6) ◽

Author(s):

Isabelle M. Hunt ◽

Roger T. Webb ◽

Pauline Turnbull ◽

Jane Graney ◽

Saied Ibrahim ◽

...

Keyword(s):

Mental Health ◽

Suicide Risk ◽

Psychiatric Patients ◽

Case Series ◽

Population Based ◽

Time Dependent ◽

Community Treatment ◽

Community Treatment Orders ◽

Suicide Rates ◽

Discharged Patients

Background Community treatment orders (CTOs) enable patients to be treated in the community rather than under detention in hospital. Population-based studies of suicide among patients subject to a CTO are scarce. Aims To compare suicide rates among patients subject to a CTO with all discharged psychiatric patients and those detained for treatment but not subject to a CTO at discharge (‘CTO-eligible’ patients). Method From a national case series of patients who died by suicide within 12 months of contact with mental health services in England during 2009–2018, we estimated average annual suicide rates for all discharged patients, those on a CTO at the time of suicide, those ever treated under a CTO and CTO-eligible patients. Results Suicide rates for patients on a CTO at the time of suicide (191.3 per 100 000 patients) were lower than all discharged patients (482.3 per 100 000 discharges). Suicide rates were similar in those ever treated under a CTO (350.1 per 100 000 CTOs issued) and in CTO-eligible patients (382.9 per 100 000 discharges). Suicide rates within 12 months of discharge were higher in persons ever under a CTO (205.1 per 100 000 CTOs issued) than CTO-eligible patients (161.5 per 100 000 discharges), but this difference was reversed for rates after 12 months of discharge (153.2 per 100 000 CTOs issued v. 223.4 per 100 000 discharges). Conclusions CTOs may be effective in reducing suicide risk. The relative benefits of CTOs and intensive aftercare may be time-dependent, with the benefit of a CTO being less before 12 months after discharge but greater thereafter. CTO utilisation requires a careful balancing of patient safety versus autonomy.

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Suicide risk after suicide bereavement: The role of loss-related characteristics, mental health, and hopelessness

Journal of Psychiatric Research ◽

10.1016/j.jpsychires.2021.09.056 ◽

2021 ◽

Author(s):

Raphaela Grafiadeli ◽

Heide Glaesmer ◽

Laura Hofmann ◽

Thomas Schäfer ◽

Birgit Wagner

Keyword(s):

Mental Health ◽

Suicide Risk ◽

Suicide Bereavement

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Dermatologists’ perceptions of suicidality in dermatological practice: a survey of prevalence estimates and attitudes in Austria

BMC Dermatology ◽

10.1186/s12895-020-00107-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Ekaterina Pronizius ◽

Martin Voracek

Keyword(s):

Mental Health ◽

Atopic Dermatitis ◽

Suicidal Ideation ◽

Mental Health Professionals ◽

Health Professionals ◽

Suicide Risk ◽

Female Gender ◽

Treatment Quality ◽

Person Perspective ◽

Low Rate

Abstract Background Chronic illnesses belong to suicide risk factors. The goal of the current study was to estimate the rate of suicide-related behaviors in patients with atopic dermatitis, psoriasis, or acne from a third-person perspective (namely, Austrian dermatologists). Methods A link to a questionnaire specially developed for this study was emailed to 450 self-employed dermatologists in Austria, from which a total of 45 participated. Results Three dermatologists reported more than five patients with atopic dermatitis, psoriasis, or acne who committed suicide in 2017. Seven doctors treated between 1 and 10 such patients suffering from suicidal ideation. These results are suggestive for a low rate of suicidal ideations in Austrian dermatology ordinations. The majority of dermatologists in the sample (82%) knew that these patients are at higher suicide risk. 60% of participants also believed that it rather would not be a problem for them to recognize suicidal ideation. When facing patients in a suicide crisis, reported intervention steps were: referring them to a specialist in psychiatry, or having a conversation about it. In the sample, most challenging about suicide was lack of time and lack of knowledge. Dermatologists were also interested in cooperating with mental health professionals and in the implementation of new prevention strategies (e.g., suicide-related training programs). Analysis revealed that private specialists, as compared with contract physicians, had fewer patients, but spent more time with them. Yet, these differences did not appear to influence the quality of treatment they provided. Treatment quality was defined as the extent to which doctors tell their patients that additional psychological treatments could be helpful and asking them about their emotional state. Female gender and a professional background in psychology impacted positively on treatment quality. Conclusions Possible explanations for the low rate of suicidal ideations reported include the advanced Austrian health care system and dermatologists’ underestimation of the problem. Implications of the study are to promote cooperation between dermatologists and mental health professionals and to address patient suicidality from a first-person perspective (i.e., the patients).

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How to increase the role of social workers in suicide preventive interventions

Acta Neuropsychiatrica ◽

10.1017/neu.2020.11 ◽

2020 ◽

Vol 32 (4) ◽

pp. 186-195

Author(s):

Joshua Levine ◽

Leo Sher

Keyword(s):

Mental Health ◽

Risk Factors ◽

Social Work ◽

Social Workers ◽

Suicide Prevention ◽

Suicide Risk ◽

Preventive Interventions ◽

Suicide Risk Factors ◽

Suicidal Patients

AbstractObjective:Suicide is a serious public health issue that affects individuals, families and societies all over the world. International studies provide consistent evidence that the presence of psychiatrists in a region is associated with lesser suicide rates. However, many psychiatric patients including suicidal patients do not have access to psychiatrists. This indicates that mental health and non-mental health social workers need to be involved in suicide prevention efforts. This paper is the first comprehensive work that discusses how to increase the role of social workers in the area of suicide prevention.Methods:A review of the relevant literature.Results:Increasing the role of social workers in suicide prevention efforts may reduce suicide risk in groups and people at elevated risk for suicide, as well as the general population.Conclusion:Recommendations are provided for how the social work profession can improve upon suicide prevention while incorporating universal, selective and indicated suicide preventive interventions. Social work research efforts should focus on how to increase the role of social workers in suicide prevention and the management of suicidal patients. Social work education programmes should modify their curricula and increase their attention on suicide prevention. Mental health social workers need to educate the patient and their family on suicide risk factors. Furthermore, mental health and non-mental health social workers need to educate the general public on suicide risk factors.

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