Suicidal behaviour is common in acute psychiatric wards resulting in distress, and burden for patients, carers and society. Although psychological therapies for suicidal behaviour are effective in ...out-patient settings, there is little research on their effectiveness for in-patients who are suicidal.AimsOur primary objective was to determine whether cognitive-behavioural suicide prevention therapy (CBSP) was feasible and acceptable, compared with treatment as usual (TAU) for in-patients who are suicidal. Secondary aims were to assess the impact of CBSP on suicidal thinking, behaviours, functioning, quality of life, service use, cost-effectiveness and psychological factors associated with suicide.
A single-blind pilot randomised controlled trial comparing TAU to TAU plus CBSP in in-patients in acute psychiatric wards who are suicidal (the Inpatient Suicide Intervention and Therapy Evaluation (INSITE) trial, trial registration: ISRCTN17890126). The intervention consisted of TAU plus up to 20 CBSP sessions, over 6 months continuing in the community following discharge. Participants were assessed at baseline and at 6 weeks and 6 months post-baseline.
A total of 51 individuals were randomised (27 to TAU, 24 to TAU plus CBSP) of whom 37 were followed up at 6 months (19 in TAU, 18 in TAU plus CBSP). Engagement, attendance, safety and user feedback indicated that the addition of CBSP to TAU for in-patients who are acutely suicidal was feasible and acceptable while on in-patient wards and following discharge. Economic analysis suggests the intervention could be cost-effective.DiscussionPsychological therapy can be delivered safely to patients who are suicidal although modifications are required for this setting. Findings indicate a larger, definitive trial should be conducted.Declaration of interestThe trial was hosted by Greater Manchester Mental health NHS Trust (formerly, Manchester Mental Health and Social Care NHS Trust). The authors are affiliated to the University of Manchester, Greater Manchester Mental Health Foundation Trust, Lancashire Care NHS Foundation trust and the Manchester Academic Health Sciences Centre. Y.A. is a trustee for a North-West England branch of the charity Mind.
This study investigated paths to suicidal behavior in 94 civilian participants with chronic posttraumatic stress disorder (PTSD). Two statistical modeling programs, TETRAD II version 2.1 and Mplus ...5.21 were used to construct a working model of suicide in PTSD. Two paths to suicidal behavior were identified. In the first path, suicidal behavior was directly associated with greater life impairment, which in turn was associated with poorer occupational and social functioning. In the second path, suicidal behavior was directly associated with depressive symptoms, which in turn were associated with more severe PTSD symptoms. Psychotropic medication, employment status, and threat to life further contributed to the model. The findings suggest that negative perceptions of functional impairment and depression are strongly associated with suicidal behavior in PTSD.
Traditional and Simplified Chinese s by AsianSTSS
Theoretical perspectives into suicidality have suggested that heightened perceptions of defeat and entrapment lead to suicidality. However, all previous empirical work has been cross‐sectional. We ...provide the first longitudinal test of the theoretical predictions, in a sample of 79 students who reported suicidality. Participants completed self‐report measures of suicidal ideation, depression, defeat, and entrapment at two time points, approximately 12 months apart. People higher in defeat became more suicidal over time (β = .45), with baseline levels of suicidality and depressive symptoms controlled. The current results support the posited role of perceived defeat in driving suicidal ideation.
Problem gambling is of serious public, social and clinical concern, especially so because ease of access to different types of gambling is increasing. A systematic review and meta-analysis was ...carried out to determine whether Cognitive-Behavioural Therapies (CBT) were effective in reducing gambling behaviour. Twenty-five studies which met the inclusion criteria were identified. Overall, there was a highly significant effect of CBT in reducing gambling behaviours within the first three months of therapy cessation regardless of the type of gambling behaviour practiced. Effect sizes were also significant at six, twelve and twenty-four month follow-up periods. Sub-group analysis suggested that both individual and group therapies were equally as effective in the 3 month time window, however this equivalence was not clear at follow-up. All variants of CBT (cognitive therapy, motivational interviewing and imaginal desensitization) were significant, although there was tentative evidence that when different types of therapy were compared cognitive therapy had an added advantage. Meta-regression analyses showed that the quality of the studies influenced the effect sizes, with those of poorer quality having greater effect sizes. These results give an optimistic message that CBT, in various forms, is effective in reducing gambling behaviours. However, caution is warranted because of the heterogeneity of the studies. Evaluation of treatment for problem gambling lags behind other fields and this needs to be redressed in the future.
Objective
Obsessive–compulsive disorder (OCD) is a disabling mental health problem that affects a significant proportion of the general population. Experiential avoidance appears to account for the ...development of anxiety and depressive symptoms. However, its relationship with OCD has yielded contradictory results. Furthermore, although OCD‐specific thoughts and behaviors, including obsessing, checking, washing, and ordering, have been suggested to significantly predict suicidal ideation and behaviors, this line of research has received scant empirical attention. The overarching aim of this study was to explore the relationship between OCD, OCD‐specific behaviors, experiential avoidance, and suicidal experiences.
Methods
Overall, 1,046 adults from the community who completed self‐report scales participated.
Results
Strong links between overall OCD severity, obsessing, experiential avoidance, and suicidal experiences were established. Results from mediational analyses showed that overall OCD severity and individual obsessive–compulsive thoughts and behaviors were both directly and indirectly linked with suicidal experiences, via experiential avoidance. Obsessing was among the critical obsessive–compulsive symptoms leading to suicidal experiences.
Conclusions
These findings are important because they identify experiential avoidance as a potential key explanatory construct in accounting for the development of OCD and suicidal experiences. However, future research using longitudinal and/or experimental designs is needed to infer causality.
•A novel scale measuring histories of social punishment (HoSP) in childhood was assessed.•The scale showed very good to excellent construct, convergent, and divergent validity.•Social punishment was ...strongly linked with depression, OCDs, and suicidal acts.•Suicide prevention priorities should target such adverse social relationships.
There is robust evidence for relationships between adverse events experienced in childhood and mental health problems experienced as an adult. However, the measurement of perceptions of different types of adverse relationships in childhood, especially those that are in social contexts, is lacking. Given the absence of an appropriate tool to measure perceptions of adverse social relationships in childhood within English-speaking populations, we endeavored to examine the construct validity of the English version of the History of Social Punishment (HoSP) scale. In total, 557 adults from the extant community participated by completing self-report scales that measured perceptions of adverse childhood relationships, symptoms of depression, obsessive-compulsive disorder (OCD), hoarding disorder (HD), body dysmorphic disorder (BDD), and suicidal experiences. Results demonstrated that the HoSP is a sound psychometric tool to evaluate perceptions of adverse social relationships within English-speaking populations. A strong association between perceptions of adverse social relationships in childhood, common mental health problems, and suicidal behaviors was established. These results provide robust evidence for the importance of screening for experiences of social adversities and for developing clinical interventions that directly target these experiences.
Suicide is the leading cause of premature death among individuals experiencing psychosis. The risk of suicide is proposed to increase with a greater potential for activation of suicide related ...schemas. Empirical representations of suicide schemas were compared between individuals experiencing non-affective psychosis, with and without a history of suicidal behaviour. Employing a cross-sectional between-groups comparison design, 84 participants, previously diagnosed with a non-affective psychotic disorder, were recruited from community mental health services. Participants completed a demographic questionnaire and clinical measures of psychopathology. To assess participants’ suicide schemas, a series of direct and indirect cognitive tasks were designed and administered. Pathfinder analysis enabled the construction of empirically derived representations of the groups’ suicide schemas based on responses to the cognitive tasks. The suicide group achieved significantly greater scores on measures of anxiety, depression, hopelessness and suicidality than the non-suicide group, but not on measures indicative of the severity of psychosis. The suicide schema for the suicide group was more elaborate and extensive than for the non-suicide group, even when clinical measures were taken into account. Clinical and theoretical implications are discussed.
Partaking in studies about suicide can be a positive experience. There is also evidence of some negative impacts in the days immediately following participation. No research has examined both the ...short and longer term effects of repeated assessment of an individual's suicidal thoughts/behaviours. Clinical trials can involve multiple suicide assessments over several months. The current study investigated whether participants experienced any brief or lasting effects from this kind of intense suicide focused research. Participants had recent suicidal experiences, and were participating in a randomised controlled trial evaluating a psychological therapy targeting suicidal experiences for people with non-affective psychosis. Multiple measures of suicidal thoughts/acts were completed at baseline, 6 and 12-month follow-up time-periods. For the current study, participants (N = 100 at baseline and n = 32 at follow-up) undertook a semi-structured qualitative interview about their experiences of taking part in suicide research, and completed a checklist of adjectives to describe how it felt to talk about suicide during the assessments. They rated their current mood before and after completing the trial assessments using a visual analogue scale. A convergent mixed methods approach indicated that participation was positive in both the short and longer term. Mood improved or did not change over the course of assessments. More positive than negative adjectives were selected, regardless of the severity of suicidal thoughts experienced by participants. Thematic analysis of the qualitative data revealed many benefits of participating, including catharsis, being able to help others and being part of a wider endeavour to understand suicidal experiences. Both short and longer term feelings of distress arising from participation were offset by the expectation and acceptance of this occurring, together with the application of participant-initiated coping strategies. These findings lend reassurance that inviting people with severe mental health problems to participate in suicide research is not detrimental in either the short or long-term.
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