Can HRM predict mental health crises? Using HR analytics to unpack the link between employment and suicidal thoughts and behaviors

PurposeThe aim of this research is to determine the extent to which the human resource (HR) function can screen and potentially predict suicidal employees and offer preventative mental health assistance.Design/methodology/approachDrawing from the 2019 National Survey of Drug Use and Health (N = 56,136), this paper employs multivariate binary logistic regression to model the work-related predictors of suicidal ideation, planning and attempts.FindingsThe results indicate that known periods of joblessness, the total number of sick days and absenteeism over the last 12 months are significantly associated with various suicidal outcomes while controlling for key psychosocial correlates. The results also indicate that employee assistance programs are associated with a significantly reduced likelihood of suicidal ideation. These findings are consistent with conservation of resources theory.Research limitations/implicationsThis research demonstrates preliminarily that the HR function can unobtrusively detect employee mental health crises by collecting data on key predictors.Originality/valueIn the era of COVID-19, employers have a duty of care to safeguard employee mental health. To this end, the authors offer an innovative way through which the HR function can employ predictive analytics to address mental health crises before they result in tragedy.

MDMA/ecstasy use and psilocybin use are associated with lowered odds of psychological distress and suicidal thoughts in a sample of US adults

Background: Suicide is one of the leading causes of death worldwide and rates within the United States have risen over the past two decades. Hence, there is a critical need for novel tools to treat suicidal ideation and related mental health conditions. 3,4-Methylenedioxymethamphetamine (MDMA)/ecstasy and classic psychedelics may be two such tools. Aims: The aim of this study was to assess non-causal associations between MDMA/ecstasy and classic psychedelic use and psychological distress and suicide risk. Methods: In this study, we examined the aforementioned associations among 484,732 adult participants in the National Survey on Drug Use and Health (2008–2019). Results: Lifetime MDMA/ecstasy use was associated with reduced odds of past year suicidal thinking (10% reduced odds; odds ratio (OR) = 0.90; 95% confidence interval, CI = (0.84–0.97); p < 0.01) and past year suicidal planning (OR = 0.88; 95% CI = (0.78–0.99); p < 0.05). Furthermore, lifetime psilocybin use was associated with reduced odds of past month psychological distress (OR = 0.78; 95% CI = (0.73–0.84); p < 0.001) and past year suicidal thinking (OR = 0.90; 95% CI = (0.83–0.96); p < 0.01). Finally, lysergic acid diethylamide (LSD) was associated with increased odds of past year suicidal thinking (OR = 1.07; 95% CI = (1.00–1.15); p < 0.05). Conclusion: MDMA/ecstasy and psilocybin use are associated with reduced odds of suicidal thinking and related outcomes—though experimental studies are needed to determine whether these associations are causal. These findings call for more research into the efficacy of MDMA/ecstasy and classic psychedelics for treating psychological distress and suicidal thoughts and behaviors, and for updated drug legislation that allows for further investigation into these substances.

A Cascade of Care Model for Suicide Prevention

The rising rates of suicide in the United States, particularly among young people of color, requires urgent attention. While the healthcare system is a critical service sector for suicide prevention given high levels of utilization by people at risk of suicide, it is not sufficient. Only approximately 50% of those identified as at-risk in an Emergency Department, agree to be connected to outpatient services, with even small proportions engaging in these services. This “care cascade” parallels health services challenges in other domains, such as HIV. Corresponding Cascade of Care (COC) models have been galvanizing public health frameworks, as they can be utilized to track both patient-level outcomes and leveraged to form aspirational goals to improve systems of care for those in need. We aim to delineate a COC model specific to suicide prevention efforts, to help frame existing challenges and unify efforts to address these gaps. Given the complexity of suicidal thoughts and behaviors, solutions are needed that address care at multiple levels of the socio-ecological framework and build multisectoral networks into an integrated system of care. Defining and delineating this COC model can help structure local and national efforts to comprehensively address the suicide epidemic in the United States.

Prevalence of Lifetime Self-Injurious Thoughts and Behaviors in a Global Sample of 599 Patients Reporting Prospectively Confirmed Diagnosis with Premenstrual Dysphoric Disorder

Background: Suicide is the second leading cause of death among Americans ages 10 to 34. Recent increases in suicide rates among those assigned female at birth are particularly alarming. A large body of evidence points to menstrual cycle influences on self-injurious thoughts and behaviors (STBs), suggesting that neurobiological hormone sensitivities such as those observed in premenstrual dysphoric disorder (PMDD) may drive risk for suicide in females. However, existing studies of the prevalence of STBs in PMDD have used cross-sectional self-report measures of PMDD with poor validity. As a first step to establishing more accurate prevalence rates of STBs in PMDD, we examined the lifetime prevalence of STBs in a large global survey of patients reporting a diagnosis of PMDD based on daily ratings. Method: Individuals with self-reported PMDD symptoms were invited to an online survey through online support groups for PMDD and social media posts from accounts focused on PMDD awareness and information. Participants reported on demographics, whether they had been diagnosed with PMDD by a healthcare provider using daily ratings, STBs using the Columbia Suicide Severity Rating Scale, and history of various lifetime comorbid psychiatric diagnoses. Results: 2,689 unique participants completed the survey. Of those, 599 (23%) reported a provider diagnosis with PMDD based on two months of daily ratings and were included in analyses. We observed high rates of lifetime active suicidal ideation (72%), planning (49%), intent (42%), preparing for an attempt (40%), and attempt (34%), as well as non-suicidal self-injury (51%). The majority (70%) of the sample reported at least one lifetime comorbid psychiatric diagnosis by a medical provider. STB rates were only slightly attenuated among those reporting no history of diagnosed psychiatric comorbidities (i.e., PMDD only). Predictors of lifetime suicidal ideation included nulliparity, low-to-moderate (vs. high) income, and history of diagnosis with major depression or post-traumatic stress disorder. Predictors of lifetime attempts among those reporting lifetime ideation included older age, nulliparity, lower income, and history of diagnosis with post-traumatic stress disorder or borderline personality disorder.Conclusions: These data indicate high rates of STBs among those reporting prospective medical diagnosis of PMDD and highlight the need for more prospective research on mechanisms and prevention of STBs in PMDD. Clinical practice guidelines for PMDD should accommodate comorbidities and recommend frequent screenings for STB risk. Suicidal thoughts and behaviors should be considered for inclusion in future iterations of the DSM PMDD diagnostic criteria.

Current Research on Suicide in Older Adults

Rates of suicide are elevated in middle- and late-life, yet studies focusing on suicidal ideation and behavior in older adults are limited compared to research in younger adults. The studies included in the present symposium offer valuable findings on suicide in older adults across the span of late-life. Owsiany et al. focus on age differences between older and younger adults in the association between anxiety symptoms and suicide risk. In Heisel et al., an online intervention is assessed for improving the outcomes of psychological well-being and suicide risk in older adult men who are transitioning into retirement during the COVID-19 pandemic. Crnek-Georgeson and Wilson reviewed the link between retirement patterns and psychological effects, including suicidal behaviors, among older adults. Additionally, this review includes recommendations for policy makers and employers in an effort to assist older adults with the transition into retirement. Utilizing baseline data from the Helping Older Adults Engage study, Fenstermacher et al. research the association between volunteering and suicidal ideation in a predominantly lonely older adult sample across the span of late-life. Together, these studies provide foundation for future research on suicide in late-life to build upon. Future studies should continue to focus on risk and protective factors for suicide in older adults and aim to improve screening and intervention for suicidal thoughts and behaviors in this population. Yeates Conwell, M.D., Director of Geriatric Psychiatry and Co-Director of the Center for the Study and Prevention of Suicide at the University of Rochester Medical Center, will serve as discussant.

Sleep problems predict next-day suicidal thinking among adolescents: A multimodal real-time monitoring study following discharge from acute psychiatric care

Suicidal thoughts and behaviors (STBs) are major public health concerns among adolescents, and research is needed to identify how risk is conferred over the short term (hours and days). Sleep problems may be associated with elevated risk for STBs, but less is known about this link in youth over short time periods. The current study utilized a multimodal real-time monitoring approach to examine the association between sleep problems (via daily sleep diary and actigraphy) and next-day suicidal thinking in 48 adolescents with a history of STBs during the month following discharge from acute psychiatric care. Results indicated that specific indices of sleep problems assessed via sleep diary (i.e., greater sleep onset latency, nightmares, ruminative thoughts before sleep) predicted next-day suicidal thinking. These effects were significant even when daily sadness and baseline depression were included in the models. Moreover, several associations between daily-level sleep problems and next-day suicidal thinking were moderated by person-level measures of the construct. In contrast, sleep indices assessed objectively (via actigraphy) were either not related to suicidal thinking or were related in the opposite direction from hypothesized. Together, these findings provide some support for sleep problems as a short-term risk factor for suicidal thinking in high-risk adolescents.

Early Identification of Suicide Risk Factors Among Justice-Involved Youth

Suicidal thoughts and behaviors among juvenile justice populations are elevated. However, the characteristics of justice-involved youth who consider and attempt suicide are not well understood. This study examined suicidal ideation and attempt with first-time, preadjudicated diverted youth, and the relationship with commonly associated risk factors. The sample included 135 youth (50% male, Mage = 14.48) that provided complete responses to self-reported lifetime suicidal ideation and attempt items. Analyses examined relationships between suicidal ideation/attempt and mental health, child welfare involvement, delinquency, self-cutting, and substance use. First time, preadjudicated diverted youth reported high rates of lifetime suicidal ideation (27%) and attempt (17%). Suicidal ideation and attempt were associated with sexually minoritized status and self-cutting, while child welfare involvement was only associated with suicidal ideation. This high-risk population would benefit from refined suicide screening and prevention services not always available to justice-involved youth living in the community.