A Leader Suicide Risk Assessment Tool for Mitigating Risk Factors

Research Paper Title

Development of a Leader Tool for Assessing and Mitigating Suicide Risk Factors.

Background

Despite efforts in prevention, suicide rates in the US military remain unchanged. This article describes the development of a tool for leaders to identify and mitigate suicide risk factors.

Methods

A seven-item measure, the Leader Suicide Risk Assessment Tool (LSRAT), was constructed to allow leaders to assess and mitigate suicide drivers. During a 6-month pilot, unit leaders completed the LSRAT for 161 at-risk soldiers. The LSRAT data were compared to clinical data from a subset of these soldiers.

Results

The LSRAT showed good test-retest reliability. The LSRAT scores showed significant correlations with both clinical and screening measures of suicidality. Command actions mitigated or partially mitigated 89% of risk factors identified on the LSRAT.

Conclusions

This study provides initial psychometric data on a tool that prescribes concrete responses to mitigate risk. The LSRAT may be a valid and feasible tool to assist front-line commanders in identifying potential area’s risk mitigation. Synchronisation efforts between commanders, clinicians, and support services are crucial to ensure effective intervention to prevent suicide behaviour.

Reference

Hoyt, T., Repke, D., Barry, D., Baisley, M., Jervis, S., Black, R., McCreight, S., Prendergast, D., Brinton, C. & Amin, R. (2020) Development of a Leader Tool for Assessing and Mitigating Suicide Risk Factors. Military Medicine. 185(Suppl 1), pp.334-341. doi: 10.1093/milmed/usz194.

Dosed (2019)

Introduction

An award-winning documentary film about treating anxiety, depression and addiction with psychedelic medicine.

Outline

After years of prescription medications failed her a suicidal woman, Adrianne, turns to underground healers to try and overcome her depression, anxiety, and opioid addiction with illegal psychedelic medicine like magic mushrooms and iboga.

Production & Filming Details

  • Director(s): Tyler Chandler.
  • Producer(s): Robert J. Barnhart, Tyler Chandler, Jason Hodges, Kelley Hodges, Chris Mayerson, Nicholas Meyers, and Nick Soares.
  • Writer(s): Tyler Chandler, Nicholas Meyers, and Jessie Deeter (Story consultant).
  • Music: Jayme McDonald.
  • Cinematography: Nicholas Meyers.
  • Editor(s): Tyler Chandler and Nicholas Meyers.
  • Production: Golden Teacher Films.
  • Release Date: 20 March 2019 (US).
  • Running Time: 82 minutes.

What Haunts Us (2018)

Introduction

The 1979 class of Porter Gaud School in Charleston, South Carolina graduated 49 boys. Within the last 35 years, six of them have died by suicide.

Outline

When Paige Goldberg Tolmach gets word that another former student from her beloved high school has killed himself, she decides to take a deep dive into her past in order to uncover the surprising truth and finally release the ghosts that haunt her hometown to this day.

Production & Filming Details

  • Director(s): Paige Tolmach.
  • Producer(s): Sarah Gibson, James Huntsman, Andreas Olavarria, and Told Slater.
  • Music: Nathan Halpern.
  • Cinematography: Adam Dubrowa.
  • Editor(s): Derek Doneen and Allan Duso.
  • Production: Diamond Docs, Matt Tolmach Productions, and The Kennedy/Marshall Company.
  • Distributor(s): Blue Fox Entertainment.
  • Release Date: 24 February 2018 (Boulder International Film Festival) and 11 May 2018 (US, general release).
  • Running Time: 72 minutes.

Is there an Association between Firearm Ownership & Capability for Suicide in Post-Deployment National Guard Service Members?

Research Paper Title

Firearm Ownership and Capability for Suicide in Post-Deployment National Guard Service Members.

Background

National Guard service members demonstrate increased suicide risk relative to the civilian population.

One potential mechanism for this increased risk may be familiarity with and access to firearms following deployment.

This study examined the association between firearm ownership, reasons for ownership, and firearm familiarity with a widely studied suicide risk factor-capability for suicide-among National Guard service members.

Methods

Data were drawn from a cross-sectional survey of National Guard service members conducted immediately post-deployment in 2010. Service members (n = 2,292) completed measures of firearm ownership, firearm familiarity, and capability for suicide.

Results

Firearm ownership and increased firearm familiarity were associated with capability for suicide (d = 0.47 and r = .25, for firearm ownership and familiarity, respectively).

When examined separately based on reason for ownership, owning a firearm for self-protection (d = 0.33) or owning a military weapon (d = 0.27) remained significantly associated with capability for suicide.

In contrast, owning a firearm for hobby purposes did not (d = -0.07).

Conclusions

Our findings support theories emphasising practical aspects of suicide (e.g., three-step theory) and suggest that owning firearms, in particular for self-protection, along with familiarity using firearms may be associated with greater capability for suicide.

Reference

Goldberg, S.B., Tucker, R.P., Abbas, M., Schultz, M.E., Hiserodt, M., Thomas, K.A., Anestis, M.D. & Wyman, M.F. (2019) Firearm Ownership and Capability for Suicide in Post-Deployment National Guard Service Members. Suicide & Life-Threatening Behavior. 49(6), pp.1668-1679. doi: 10.1111/sltb.12551. Epub 2019 Apr 19.

What is the Prevalence & Associated Factors of Depression among Patients with Schizophrenia?

Research Paper Title

The prevalence and associated factors of depression among patients with schizophrenia in Addis Ababa, Ethiopia, cross-sectional study.

Background

Depression is common among people with schizophrenia and associated with severe positive and negative symptoms, higher rates of disability, treatment resistance and mortality related to suicide, physical and drug-related causes.

However, to the researchers knowledge, no study has been conducted to report the magnitude of depression among people with schizophrenia in Ethiopia.

Therefore, this study aimed to determine the prevalence and associated factors of depression among people with schizophrenia.

Methods

A hospital-based cross-sectional study was conducted among 418 patients with schizophrenia selected by systematic sampling technique.

Patient Health Questionnaire 9 (PHQ-9) was used to measure depression among the study participants.

To identify the potential contributing factors, we performed binary and multi-variable logistic regression analysis adjusting the model for the potential confounding factors.

Odds ratios (OR) with the corresponding 95% confidence interval (95%CI)) was determined to evaluate the strength of association.

Results

The prevalence estimate of depression among people with schizophrenia was found to be 18.0% [95% confidence interval: 14.50-22.30].

The multi-variable analysis revealed that current substance use (AOR 2.28, 95%CI (1.27, 4.09), suicide attempt (AOR 5.24, 95%CI (2.56, 10.72), duration of illness between 6 and 10 years (AOR 2.09, 95%CI (1.08, 4.04) and poor quality of life (AOR 3.13, 95%CI (1.79, 5.76) were found to be the factors associated with depression among people with schizophrenia.

Conclusions

The current study revealed that co-morbid depression was high among people with schizophrenia and associated with current substance use, suicide attempt, and long duration of the illness as well as poor quality of life.

Attention needs to be given to address co-morbid depression among people with schizophrenia.

Reference

Fanta, T., Bekel, D. & Ayano, G. (2020) The prevalence and associated factors of depression among patients with schizophrenia in Addis Ababa, Ethiopia, cross-sectional study. BMC Pyschiatry. 20(1):3. doi: 10.1186/s12888-019-2419-6.

Course: Applied Suicide Intervention Skills Training (ASIST)

Just completed the 2-day Applied Suicide Intervention Skills Training (ASIST) course.

ASIST is intended as ‘suicide first-aid’ training.

It aims to enable helpers (anyone in a position of trust) to become more willing, ready, and able to recognise and intervene effectively to help persons at risk of suicide.

You can find out more about the ASIST course here.

Linking Risk of Suicidal Behaviour with Mental Disorders & Work Disability

Research Paper Title

Mental disorders and suicidal behavior in refugees and Swedish-born individuals: is the association affected by work disability?

Background

Among potential pathways to suicidal behavior in individuals with mental disorders (MD), work disability (WD) may play an important role.

The Researchers examined the role of WD in the relationship between MD and suicidal behaviour in Swedish-born individuals and refugees.

Methods

The study cohort consisted of 4,195,058 individuals aged 16-64, residing in Sweden in 2004-2005, whereof 163,160 refugees were followed during 2006-2013 with respect to suicidal behaviour.

Risk estimates were calculated as hazard ratios (HR) with 95% confidence intervals (CI).

The reference groups comprised individuals with neither MD nor WD.

WD factors (sickness absence (SA) and disability pension (DP)) were explored as potential modifiers and mediators.

Results

In both Swedish-born and refugees, SA and DP were associated with an elevated risk of suicide attempt regardless of MD. In refugees, HRs for suicide attempt in long-term SA ranged from 2.96 (95% CI: 2.14-4.09) (no MD) to 6.23 (95% CI: 3.21-12.08) (MD).

Similar associations were observed in Swedish-born. Elevated suicide attempt risks were also observed in DP.

In Swedish-born individuals, there was a synergy effect between MD, and SA and DP regarding suicidal behaviour.

Both SA and DP were found to mediate the studied associations in Swedish-born, but not in refugees.

Conclusions

There is an effect modification and a mediating effect between mental disorders and WD for subsequent suicidal behaviour in Swedish-born individuals.

Also for refugees without MD, WD is a risk factor for subsequent suicidal behaviour.

Particularly for Swedish-born individuals with MD, information on WD is vital in a clinical suicide risk assessment.

Reference

Björkenstam, E., Helgesson, M., Amin, R., Lange, T. & Mittendorfer-Rutz, E. (2020) Mental disorders and suicidal behavior in refugees and Swedish-born individuals: is the association affected by work disability? Social Psychiatry and Psychiatric Epidemiology. doi: 10.1007/s00127-019-01824-5. [Epub ahead of print].

Do Individuals who are Suicidal have Unusual Patterns of Brain Activity?

Individuals who are suicidal seem to have unusual patterns of brain activity.

The differences are not big enough to identify those who may try to kill themselves, however, the researchers hope it will provide them with more information about what may be happening in terms of brain mechanisms (Schmaal et al., 2019).

The finding comes from a review of 131 brain-scan studies, comprising more than 12,000 people. The study looked to see whether there are distinctive patterns of brain activity in those who had made suicide attempts or had been thinking about suicide.

Most of these studies compared individuals with a certain mental health condition, such as depression, who had a history of suicidal behaviour, with a similar group with that condition who had not become suicidal, or with individuals without mental health problems.

The researchers found that two brain networks appear to function differently:

  • The first of these involves areas at the front of the head known as the medial and lateral ventral prefrontal cortex and their connections to regions involved in emotion. This may lead to difficulties regulating emotions.
  • A second involves regions known as the dorsal prefrontal cortex and inferior frontal gyrus system, which play a role in decision making.

However, the differences in these networks may just reflect that individuals who are suicidal are in more distress, rather than indicating specific thoughts of suicide.

Reference

Wilson, C. (2019) Suicidal Behaviour Linked to Two Brain Networks. New Scientist. 07 December 2019, pp.16.

Schmaal, L>, van Harmelen, A-L., Chatzi, V., Lippard, E.T.C., Toenders, Y.J., Averill, L.A., Mazure, C.M. & Plumberg, H.P. (2019) Imaging suicidal thoughts and behaviors: a comprehensive review of 2 decades of neuroimaging studies. Molecular Psychiatry. 25, pp.408-427. https://www.nature.com/articles/s41380-019-0587-x

Suicide in Older Adults: A Critical Problem

Research Paper Title

Suicide in Older Adults.

Abstract

Suicide in older adults is a critical problem that nurses and other health professionals need to address. Evidence-based interventions for prevention of late-life suicide are urgently needed, as well as increased availability of health care professionals with knowledge and skills to recognise suicide risks and intervene to provide effective care for this vulnerable population.

Reference

Sorrell, J.M. (2020) Suicide in Older Adults. Journal of Psychosocial Nursing and Mental Health Services. 58(1), pp.17-20. doi: 10.3928/02793695-20191218-04.

Veterans: We’re Afraid to Say Suicide

Research Paper Title

“We’re Afraid to Say Suicide”: Stigma as a Barrier to Implementing a Community-Based Suicide Prevention Program for Rural Veterans.

Background

Suicide is a significant public health concern for veterans residing in rural communities.

Although various initiatives have been implemented to prevent suicide among veterans, efforts specific to rural veterans remain limited.

Methods

To aid such efforts, the researchers examined stigma as a potential barrier to community readiness in the implementation of a community-based suicide prevention program for rural veterans.

In this qualitative study, community readiness interviews were conducted with 13 participants in a rural community.

Themes included lack of awareness regarding veteran suicide, rare discussions of veteran suicide, and suicide-related stigma within the community.

Results

Results suggest that prioritising destigmatisation may be particularly important to implementing community-based suicide prevention programming in rural communities.

Conclusions

In particular, addressing community misconceptions regarding veteran suicide, while increasing knowledge of the extent to which veteran suicide occurs locally may facilitate increased awareness and thus community readiness to prevent suicide among rural veterans.

Reference

Monteith, L.L., Smith, N.B., Holliday, R., Dorsey Holliman, B.A., LoFaro, C.T. & Mohatt, N.V. (2019) “We’re Afraid to Say Suicide”: Stigma as a Barrier to Implementing a Community-Based Suicide Prevention Program for Rural Veterans. The Journal of Nervous and Mental Disease. doi: 10.1097/NMD.0000000000001139. [Epub ahead of print].