While the existence of mental illness has been documented for centuries, the understanding and treatment of such illnesses has evolved considerably over time. Ritual exorcisms and locking mentally ...ill patients in asylums have been fundamentally replaced by the use of psychotropic medications and evidence-based psychological practices. Yet the historic roots of mental health management and care has left a certain legacy. With regard to suicidal risk, the authors argue that suicidal patients are by definition seen as mentally ill and out of control, which demands hospitalization and the treatment of the mental disorder (often using a medication-only approach). Notably, however, the evidence for inpatient care and a medication-only approach for suicidal risk is either limited or totally lacking. Thus, the "one-size-fits-all" approach to treating suicidal risk needs to be re-considered in lieu of the evolving evidence base. To this end, the authors highlight a series of evidence-based considerations for suicide-focused clinical care, culminating in a stepped care public health model for optimal clinical of suicidal risk that is cost-effective, least-restrictive, and evidence-based.
This study (a) provides descriptive information about the personal technology use of a suicide sample of active‐duty military personnel and (b) uses a traditional and a technology‐based measure of ...social connectedness to examine their relation to suicide ideation and behaviors. Higher thwarted belongingness, and therefore lower perceived social connectedness, was associated with higher current and worst suicide ideation and a greater lifetime self‐directed violence regardless of intent to die. Higher social connectedness based on personal technology usage was associated with higher current suicide ideation and a higher number of lifetime self‐directed violence and suicide attempts.
This study compared the “next day appointment” (NDA) use of the Collaborative Assessment and Management of Suicidality (CAMS) to treatment as usual (TAU) for individuals discharged from the hospital ...following a suicide-related crisis. We hypothesized that CAMS would significantly reduce suicidal thoughts and behaviors as well as improve psychological distress, quality of life/overall functioning, treatment retention and patient satisfaction.
Participants were 150 individuals who had at least one lifetime actual, aborted, or interrupted attempt and were admitted following a suicide-related crisis. There were 75 participants in the experimental condition who received adherent CAMS and 75 participants who received TAU. Suicidal thoughts and behaviors, psychological distress, and quality of life/overall functioning were assessed at baseline and at 1, 3, 6, and 12 months post-baseline. Treatment retention and patient satisfaction were assessed at post-treatment.
Participants in both conditions improved from baseline to 12 months but CAMS was not superior to TAU for the primary outcomes. A small but significant improvement was found in probability of suicidal ideation at 3 months favoring TAU and amount of suicidal ideation at 12 months favoring CAMS. CAMS participants experienced less psychological distress at 12 months compared to baseline.
The study was limited by only one research clinic, lower than expected recruitment, and imbalance of suicidal ideation at baseline. Conclusions: All participants improved but CAMS was not more effective than TAU. The NDA clinic was feasible and acceptable to clients and staff in both conditions and future research should investigate its potential benefit.
•CAMS and TAU were deployed successfully as aftercare following inpatient admission.•CAMS was not superior to TAU in reducing suicide attempts or other primary aims.•CAMS was superior to TAU in therapist acceptability ratings for high-risk patients.
Although it is well established that individuals living with psychosis are at increased risk for suicidal ideation, attempts, and death by suicide, several gaps in the literature need to be addressed ...to advance research and improve clinical practice. This Call-to-Action highlights three major gaps in our understanding of the intersection of psychosis and suicide as determined by expert consensus. The three gaps include research methods, suicide risk screening and assessment tools used with persons with psychosis, and psychosocial interventions and therapies. Specific action steps to address these gaps are outlined to inform research and practice, and thus, improve care and prognoses among persons with psychosis at risk for suicide.
Safety planning is a suicide prevention intervention that relies partly on an individual's social relationships as distractions during or help in a suicidal crisis. The primary objectives of this ...study were to estimate rates of missingness on social aspects of safety plans to determine whether rates differ by demographic characteristics and diagnoses and to examine whether missing social contacts on safety plans may affect clinical outcomes.
Data were drawn from the U.S. Department of Veterans Affairs San Diego Healthcare System's electronic medical record (N=1,602 individuals) from 2018 to 2021. Safety plans were coded according to the absence of listed distraction or help contacts, and clinical records of suicide attempts, suicide deaths, and use of crisis services were recorded for 1 year after completion of the safety plan.
In total, 30% of plans lacked a contact for distraction or help. Male veterans were less likely to have a distraction contact listed, and veterans identifying as Hispanic or Latino were more likely to have a help contact listed. The lack of a help contact (odds ratio OR=2.11) and having neither distraction nor help contacts (OR=2.45) were associated with a markedly higher risk for next-year suicide attempt or death. The lack of a help contact was associated with increased odds of a next-year psychiatric inpatient hospitalization (OR=1.90) and an emergency department visit (OR=1.88).
A lack of social contacts on safety plans may be a potential indicator for increased suicide risk among veterans.
Childhood trauma (CT) is associated with suicidal ideation and behaviors (SI/SB) in people with psychosis. The interpersonal psychological theory of suicide (IPTS) suggests that there are four ...factors that increase suicide risk: thwarted belongingness, perceived burdensomeness, acquired capacity for suicide, and hopelessness. The IPTS constructs and social cognitive biases are associated with SI/SB in psychotic disorders. However, the role of CT in IPTS constructs and social cognitive biases has not been examined in psychosis. In an outpatient community sample of persons with psychotic disorders (N = 96) assessed with the Childhood Trauma Questionnaire, the aims of this study were to a) evaluate rates of CT in this sample, b) determine the relationship between CT types and lifetime SI/SB, and c) explore the relationship between CT types, IPTS constructs, and social cognitive biases. All participants reported experiencing CT. Emotional abuse was associated with greater SI severity and higher rates of lifetime suicide attempts, as well as with greater perceived burdensomeness and more severe negative social cognitive biases. Other CT types were minimally associated with SI/SB or IPST constructs; hopelessness was not associated. Overall, negative interpersonal beliefs and social cognitive biases may explain how CT increases suicide risk in psychosis.
Given the vast public health problem of suicide, the need for more effective assessment of suicidal risk is clear. The major approaches applied to this challenge include various direct approaches ...(e.g., suicide-focused interviews) and indirect approaches (e.g., implicit methodologies or “occult” assessments) that tend to assess an attentional bias for suicidal risk, the latter of which the present investigation sought to study. Using the Suicide Status Form (SSF)—the central multi-purpose tool that is used within a collaborative assessment process with suicidal patients who are engaged in the “Collaborative Assessment and Management of Suicidality” (CAMS; Jobes, 2016)—we aimed to investigate the influence of perseverative, hand-written content responses pertaining to potential suicidal risk. Specifically, we explored whether repeating certain topic content might reflect a perseverative response style; we thus compared written content results of first session SSFs taken from a sample of suicidal U.S. Army Soldiers (Study 1) and a sample of suicidal college students (Study 2). Across the two studies, patients who repeated the same content (“1-Topic Repeaters”) had significantly higher ratings related to suicidal ideation in comparison to those with more heterogeneous response styles. This replicated finding perhaps reveals a form of behavioral perseveration that is potentially related to increased suicidal risk with possible implications for successful treatment.
•Across two studies, patients' written responses to qualitative assessment prompts revealed a potential suicidal attributional bias.•Patients with written assessment responses focusing on only one topic demonstrated an increased level of suicidal ideation and frequency of suicidal thoughts.•Findings reveal a potential ruminative thought process that may prove useful to successful assessment and treatment of suicidal risk.
Childhood trauma is associated with a variety of negative outcomes in psychosis, but it is unclear clear if childhood trauma affects day-to-day social experiences. We aimed to examine the association ...between childhood trauma and functional and structural characteristics of real-world social relationships in psychosis.
Participants with psychotic disorders or affective disorders with psychosis completed ecological momentary assessments (EMAs) over ten days (N = 209). Childhood trauma was assessed retrospectively using the Childhood Trauma Questionnaire. Associations between childhood trauma and EMA-assessed social behavior and perceptions were examined using linear mixed models. Analyses were adjusted for sociodemographic characteristics and psychotic and depressive symptom severity.
Higher levels of childhood trauma were associated with more perceived threat (B = −0.19, 95 % CI −0.33, −0.04) and negative self-perception (B = −0.18, 95 % CI −0.34, −0.01) during recent social interactions, as well as reduced social motivation (B = −0.29, 95 % CI −0.47, −0.10), higher desire for social avoidance (B = 0.34, 95 % CI 0.14, 0.55), and lower sense of belongingness (B = −0.24, 95 % CI −0.42, −0.06). These negative social perceptions were mainly linked with emotional abuse and emotional neglect. In addition, paranoia was more strongly associated with negative social perceptions in individuals with high versus low levels of trauma. Childhood trauma was not associated with frequency (i.e., time spent alone) or type of social interactions.
Childhood trauma – particularly emotional abuse and neglect – is associated with negative social perceptions but not frequency of real-world social interactions. Our findings suggest that childhood trauma may affect day-to-day social experiences beyond its association with psychosis.
A novel avatar system (Virtual Collaborative Assessment and Management of Suicidality System; V-CAMS) for suicidal patients and medical personnel in emergency departments (EDs) was developed and ...evaluated. V-CAMS facilitates the delivery of CAMS and other evidence-based interventions to reduce unnecessary hospitalization, readmissions, and suicide following an ED visit.
Using iterative user-centered design with 24 suicidal patients, an avatar prototype, “Dr. Dave” (based on Dr. Jobes) was created, along with other patient-facing tools; provider-facing tools, including a clinical decision support tool were also designed and tested to aid discharge disposition.
Feasibility tests supported proof of concept. Suicidal patients affirmed the system's overall merit, positive Perception of Care, and acceptability; medical providers (n = 21) viewed the system as an efficient, effective, and safe method of improving care for suicidal ED patients and reducing unnecessary hospitalization.
Technology tools including a patient-facing avatar and e-caring contacts, along with provider-facing tools may offer a powerful method of facilitating best-practice suicide prevention interventions and point-of-care tools for suicidal patients seeking ED services and their medical providers. Future directions include full development of V-CAMS and integration into a health electronic medical record and a rigorous randomized controlled trial to study its effectiveness.
Objective: People with serious mental illnesses (SMIs) are at high risk for suicidal ideation and behavior, and yet few suicide prevention interventions have been customized for this group. We ...describe the outcomes of a pilot trial of Mobile SafeTy And Recovery Therapy (mSTART), a four-session suicide-focused cognitive behavioral intervention for SMI, designed for the transition from acute to outpatient care and augmented with ecological momentary intervention to reinforce intervention content. Methods: The primary objective of this pilot trial was to evaluate the feasibility, acceptability, and preliminary effectiveness of START. Seventy-eight people with SMI and elevated suicidal ideation were randomized to either: (a) mSTART or (b) START alone (i.e., without mobile augmentation). Participants were evaluated at baseline, 4 weeks (end of in-person sessions), 12 weeks (end of mobile intervention), and 24 weeks. The primary outcome of the study was change in suicidal ideation severity. Secondary outcomes included psychiatric symptoms, coping self-efficacy, and hopelessness. Results: A total of 27% of randomized persons were lost to follow-up after baseline, and engagement with mobile augmentation was variable. There was clinically significant improvement (d = 0.86) in suicidal ideation severity scores sustained over 24 weeks, with similar effects seen for secondary outcomes. Preliminary comparison indicated a medium effect size (d = 0.48) advantage at 24 weeks of mobile augmentation in suicidal ideation severity scores. Treatment credibility and satisfaction scores were high. Conclusions and Implications for Practice: START, regardless of mobile augmentation, was associated with sustained improvement in suicidal ideation severity and secondary outcomes in people with SMI at-risk for suicide in this pilot trial.
Impact and Implications
This pilot study tested a new brief intervention designed to target suicide ideation in at-risk people with SMIs, focusing on the gap period between urgent and ongoing care. We found that the intervention, which included both in-person and mobile technology components, was feasible, acceptable, and linked with sustained improvement in suicide ideation. Although a pilot study, this research suggests that brief suicide-specific interventions adapted for people with SMIs could be helpful in bridging acute to outpatient care.
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