Suicidal behavior in older adults (65 years old and over) is a major public health issue in many countries. Suicide rates increase during the life course and are as high as 48.7/100,000 among older ...white men in the USA. Specific health conditions and stress factors increase the complexity of the explanatory model for suicide in older adults. A PubMed literature search was performed to identify most recent and representative studies on suicide risk factors in older adults. The aim of our narrative review was to provide a critical evaluation of recent findings concerning specific risk factors for suicidal thoughts and behaviors among older people: psychiatric and neurocognitive disorders, social exclusion, bereavement, cognitive impairment, decision making and cognitive inhibition, physical illnesses, and physical and psychological pain. We also aimed to approach the problem of euthanasia or physician-assisted suicide in older adults. Our main findings emphasize the need to integrate specific stress factors, such as feelings of social disconnectedness, neurocognitive impairment or decision making, as well as chronic physical illnesses and disability in suicide models and in suicide prevention programs in older adults. Furthermore, the chronic care model should be adapted for the treatment of older people with long-term conditions in order to improve the treatment of depressive disorders and the prevention of suicidal thoughts and acts.
This open access book focuses on the public health crisis of youth suicide and provides a review of current research and prevention practices. It addresses important topics, including suicide ...epidemiology, suicide risk detection in school and medical settings, critical cultural considerations, and approaches to lethal means safety. This book offers cutting-edge research on emerging discoveries in the neurobiology of suicide, psychopharmacology, and machine learning. It focuses on upstream suicide prevention research methods and details how cost-effective approaches can mitigate youth suicide risk when implemented at a universal level. Chapters discuss critical areas for future research, including how to evaluate the effectiveness of suicide prevention and intervention efforts, increase access to mental health care, and overcome systemic barriers that undermine generalizability of prevention strategies. Finally, this book highlights what is currently working well in youth suicide prevention and, just as important, which areas require more attention and support. Key topics include: The neurobiology of suicide in at-risk children and adolescents. The role of machine learning in youth suicide prevention. Suicide prevention, intervention, and postvention in schools. Suicide risk screening and assessment in medical settings. Culturally informed risk assessment and suicide prevention efforts with minority youth. School mental health partnerships and telehealth models of care in rural communities. Suicide and self-harm prevention and interventions for LGBTQ+ youth. Risk factors associated with suicidal behavior in Black youth. Preventing suicide in youth with autism spectrum disorder (ASD) and intellectual disability (ID). Youth Suicide Prevention and Intervention is a must-have resource for policy makers and related professionals, graduate students, and researchers in child and school psychology, family studies, public health, social work, law/criminal justice, sociology, and all related disciplines.
Full Circle Abu-Libdeh, Reem A
JAMA : the journal of the American Medical Association,
05/2020, Letnik:
323, Številka:
17
Journal Article
Recenzirano
In this narrative medicine essay, a psychiatrist used her residency to avoid grieving the loss of her brother to suicide but through participation in a grief support group during training she began ...to thaw enough to remember her brother, watch videos of ephemeral moments like celebrating his fourth birthday, an act that allowed her to see him and her family again.
A history of self-injurious thoughts and behaviors (SITBs) is consistently cited as one of the strongest predictors of future suicidal behavior. However, stark discrepancies in the literature raise ...questions about the true magnitude of these associations. The objective of this study is to examine the magnitude and clinical utility of the associations between SITBs and subsequent suicide ideation, attempts, and death.
We searched PubMed, PsycInfo, and Google Scholar for papers published through December 2014. Inclusion required that studies include at least one longitudinal analysis predicting suicide ideation, attempts, or death using any SITB variable. We identified 2179 longitudinal studies; 172 met inclusion criteria.
The most common outcome was suicide attempt (47.80%), followed by death (40.50%) and ideation (11.60%). Median follow-up was 52 months (mean = 82.52, s.d. = 102.29). Overall prediction was weak, with weighted mean odds ratios (ORs) of 2.07 95% confidence interval (CI) 1.76-2.43 for ideation, 2.14 (95% CI 2.00-2.30) for attempts, and 1.54 (95% CI 1.39-1.71) for death. Adjusting for publication bias further reduced estimates. Diagnostic accuracy analyses indicated acceptable specificity (86-87%) and poor sensitivity (10-26%), with areas under the curve marginally above chance (0.60-0.62). Most risk factors generated OR estimates of <2.0 and no risk factor exceeded 4.5. Effects were consistent regardless of sample severity, sample age groups, or follow-up length.
Prior SITBs confer risk for later suicidal thoughts and behaviors. However, they only provide a marginal improvement in diagnostic accuracy above chance. Addressing gaps in study design, assessment, and underlying mechanisms may prove useful in improving prediction and prevention of suicidal thoughts and behaviors.
The subclassification of homicide‐suicide into psychopathology and intrafamilial homicide‐suicides having been presented in the foregoing Parts I and II, this Part III concerns extrafamilial ...homicide‐suicides. Extrafamilial homicide‐suicides are divided into adversarial, autogenic mass, cult, and terrorist homicide‐suicides. Adversarial homicide‐suicides involve a “formal” relationship between actor and homicide victims, further divided according to the role of the actor in their relationship as employee, current or former pupil/student as in school shootings, patient, and litigant. For comparison, school shootings were divided into those resulting in 10 or more homicide victims and those with fewer. The autogenic mass homicide‐suicide, wherein victims are strangers to the actor, was heuristically bifurcated here depending on the number of homicide victims, 10 or more or fewer. As expected, the homicide‐suicides with larger numbers of victims were more homogenous.
Suicide is a troubling, preventable phenomenon. Prior to attempts, individuals often seek help, prompting practitioners to perform risk assessments that ideally use evidence‐based risk management ...strategies. A literature review was performed using Harvard Countway Library of Medicine, Google Scholar, PubMed. Key words used were “Forensic Science,” “Suicide Risk Management,” “Pediatric Suicide Risk Factors,” “Adult Suicide Risk Factors,” “Geriatric Suicide Risk Factors,” “Suicide Risk Assessment.” Parameters limited articles to studies/reviews completed in the past twenty years in the United States. Results indicated predictors of suicide in juveniles were insomnia, burdensomeness, and recent conflicts with family or a romantic partner. Adults had greater risk if male, substance abusing, with marital/job loss. Elderly individuals with multiple medical comorbidities, hopelessness, and isolation were at higher risk. Everyone evaluated should be screened for access to firearms. Management of suicide risk involves providing the least restrictive form of treatment which maintains an individual's safety.
Over the past decade, the interpersonal theory of suicide has contributed to substantial advances in the scientific and clinical understanding of suicide and related conditions. The interpersonal ...theory of suicide posits that suicidal desire emerges when individuals experience intractable feelings of perceived burdensomeness and thwarted belongingness and near-lethal or lethal suicidal behavior occurs in the presence of suicidal desire and capability for suicide. A growing number of studies have tested these posited pathways in various samples; however, these findings have yet to be evaluated meta-analytically. This paper aimed to (a) conduct a systematic review of the unpublished and published, peer-reviewed literature examining the relationship between interpersonal theory constructs and suicidal thoughts and behaviors, (b) conduct meta-analyses testing the interpersonal theory hypotheses, and (c) evaluate the influence of various moderators on these relationships. Four electronic bibliographic databases were searched through the end of March, 2016: PubMed, Medline, PsycINFO, and Web of Science. Hypothesis-driven meta-analyses using random effects models were conducted using 122 distinct unpublished and published samples. Findings supported the interpersonal theory: the interaction between thwarted belongingness and perceived burdensomeness was significantly associated with suicidal ideation; and the interaction between thwarted belongingness, perceived burdensomeness, and capability for suicide was significantly related to a greater number of prior suicide attempts. However, effect sizes for these interactions were modest. Alternative configurations of theory variables were similarly useful for predicting suicide risk as theory-consistent pathways. We conclude with limitations and recommendations for the interpersonal theory as a framework for understanding the suicidal spectrum.
Public Significance Statement
This meta-analysis generally found support for the interpersonal theory of suicide-thwarted belongingness and perceived burdensomeness were significant correlates of suicidal ideation severity, and thwarted belongingness, perceived burdensomeness, and capability for suicide were significantly associated with suicide attempt history. Effect sizes for these relationships were weak-to-moderate, suggesting potentially modest clinical significance. However, there was insufficient research on the theory's specific hypotheses, including its capacity for predicting death by suicide and the role of viewing thwarted belongingness and perceived burdensomeness as intractable in suicidal desire.
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