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.

Maladaptive Personality Traits and Psychopathological Symptoms in Individuals with the First Suicidal Attempt and with Chronic Suicidal Behavior

The paper compares the severity of maladaptive personality traits and psychopathological symptoms in patients with primary and repeated suicide attempts. The study involved patients of the somatopsychiatric department of the Sklifosovsky Research Institute of Emergency Care (N=61), who committed the first suicide attempt (n=31) or a repeated attempt (n=30). The results of the study did not reveal differences between the two groups in the severity of symptoms of social anxiety, depression and trait anxiety. However, indicators of such maladaptive personality traits as perfectionism and hypersensitive narcissism were significantly higher in the group of patients with a repeated suicide attempt. This group also manifested higher rates of the severity of borderline personality disorder traits and significant correlations between measures of psychopathology and maladaptive personality traits listed above. Conclusion: timely diagnostics of maladaptive traits and psychotherapy targeting socially prescribed perfectionism, hypersensitive narcissism, and borderline personality features after the first suicide attempt is necessary to prevent repeated ones.

Psychological assessment of persons following suicide attempt by self-poisoning

Background/Aim. Urgent psychiatric help and effective psychotherapeutic treatments are required soon after revival of a person after suicide attempt by self-poisoning. The aim of this article was to define an assessment of actual psychological characteristics of a person after suicide attempt by self-poisoning in order to apply psychotherapeutic crisis intervention after suicide attempt, as well as to show an approach to the treatment guided by the assessment that uses a psychodynamic model of suicidal crisis intervention based on our clinical experience. Methods. Hamilton Depression Rating Scale (HAMD), Center for Epidemiological Studies- Depression Scale (CES-D), Defensive Questionnaire Scale (DSQ-40), Scaling of Life Events (Paykel), and Pierce Suicide Intent Scale (SIS) were applied in 30 hospitalized persons following suicide attempt by self-poisoning and in 30 patients who had asked for psychiatric examination at the outpatient clinic due to various life crises not resulting in suicide attempt. The examinees of both groups were matched by sex, age, and education, professional and marital status. Comparison of the patient groups was done by the ttest. Logistic regression analysis was used for suicidal risk assessment. Results. The suicide attempters were depressed (HAMD = 22.60 ? 5.93, CES-D = 29.67 ? 7.99), with medium suicide risk factor (SIS = 4.5 ? 4.17), using immature (projection, dissociation, devaluation, acting-out) and neurotic (altruism) defense mechanisms. The most important motives for suicide attempt were separation problems, problems with parents and a problem of loneliness. The commonest feelings and thoughts of a subject preceding suicide attempt were a wish to escape an unbearable situation, loss of control, desire to show love for a partner and wish to be helped. After a suicide attempt, 90% of the persons felt relief because the attempt failed, although almost half of them intend to repeat it. The risk of repeated suicide attempt was 1.8 (90% CI = 0.09-37.70, p < 0.001) times higher if values on the SIS Total Score were increased and 1.62 (90% CI = 0.03-81.39, p < 0.001) times higher if values on the SIS 1 (Circumstances Score) subscale were increased, too. Conclusion. Before starting with psychotherapy for persons after suicide attempt by self-poisoning it is very important to define psychological assessment of a person, choose the treatment (out-patient clinic or inpatient/ hospital), assess indications for pharmacotherapy and psychotherapy that also must include a selection of patients for application of this therapeutic method. Assessment of conscientious and unconscientious conflicts leading to a suicide attempt represents initial basis for a therapist's work with a patient after suicide attempt and for application of psychotherapeutic crisis intervention.