Research Roundup – January 2024
This is a summary of the latest significant Canadian (
) and international suicide research we collected in the past month.
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() Laporte, N. et al. (2023). Striking a balance: Triage and crisis intervention models within the pediatric emergency room. Frontiers in Psychiatry. https://doi.org/10.3389/fpsyt.2023.1277095
This study examines the treatment youth receive when visiting emergency rooms for psychiatric crises. Specifically, the triage model and the crisis intervention model are compared.
Abstract – Upwards of 500,000 pediatric patients visit emergency rooms (ER) annually for psychiatric crises (1), with rates recently increasing (2, 3), necessitating an examination of ER treatment approaches, including triage and crisis interventions. Nurses and pediatricians without specialized psychiatric training often apply a triage approach to such youth’s care (4–8), rapidly admitting or discharging them depending on risks of auto- or hetero-aggression. Alternatively, a crisis intervention model emphasizes diagnosis, immediate treatment and orientation to either inpatient and/or outpatient resources on discharge (9–19). This approach is often multimodal (18), including nurses and social workers experienced in pediatric mental health, thus requiring additional resources compared to triage approaches. The triage (4–8) and crisis intervention (9–16) models have mostly been considered in isolation. When considered in tandem (17–20), there is little elaboration on treatment variables (e.g., alliance, the patient and physician’s emotional responses and time limitations). This article compares the two models and the interplay of these variables with respect to each. A composite case highlights the differences.
() Schmidt, K. et al. (2023). Influence of nonsuicidal self-injury functions on suicide risk in individuals with eating disorders. Suicide and Life-Threatening Behavior, 53(6). https://doi.org/10.1111/sltb.13006
This study aimed to gauge relationships between eating disorder diagnoses with non-suicidal self-injury and suicidal behaviours. 100 women seeking treatment in an emergency room setting were the study participants.
Abstract – Objective: Individuals with eating disorders (EDs) display elevated rates of suicidality (i.e., suicidal ideation and behaviors) as well as nonsuicidal self-injury (NSSI) (e.g., self-harm behaviors without intent to die). NSSI—and particularly the functions of NSSI—predict suicidal ideation in general samples; however, to our knowledge, the relation between NSSI functions and suicidal ideation in ED populations has been unexplored. Method: This study examined whether specific functions of NSSI are relevant to suicidal ideation in a treatment-seeking sample of women with EDs (n = 100). Participants completed self-report measures of suicidal ideation, NSSI, and related psychopathology upon intake to an ED treatment program. Results: Using the four-function model of NSSI, we found that intrapersonal and interpersonal-negative reinforcement, but not interpersonal-positive reinforcement functions, were related to suicidal ideation in women with EDs. Contrary to expectations, we did not find that endorsement of multiple NSSI functions was related to increased suicide risk. Discussion: Findings imply that some, but not all, functions of NSSI may be relevant to suicide risk in individuals with EDs.
() Skoblenick, K. et al. (2023). An emergency department survey on research participation in the patient with suicidal ideation or suicide attempt. Journal of Patient Experience, 10(1-3).
https://doi.org/10.1177/23743735231218866
The authors aimed to investigate levels of willingness of those with who have experienced suicidal crisis to participate in research. A survey was disseminated, asking individuals if they would participate in a (hypothetical) research study using ketamine to treat suicidal behaviours in the emergency room.
Abstract – The patient expressing suicidal ideation is a common mental health presentation in the emergency department (ED) but a notion exists that this psychiatric crisis precludes them from research participation. In order to better understand the potential research participation of suicidal patients, this study surveyed patients in the ED with suicide attempt or ideation. This was an anonymized survey study interviewing 50 patients in a tertiary care ED with a chief complaint of suicide attempt or suicidal ideation. A script was read by the research assistant regarding a hypothetical research study using ketamine to treat suicidality in the ED and asked to rate their interest in participation in the study as well as their interest in a 1-week follow-up call. Most patients (84%) reported that they would be interested in participating in this research project while 96% of all 50 patients would be interested in a follow-up phone call at 1 week. The data from this study should help other emergency medicine and psychiatry researchers advance projects in this underserved ED patient population.
Rahmani, M. et al. (2023). Youth suicidality in the context of disasters. Current Psychiatry Reports, 25, 587–602. https://doi.org/10.1007/s11920-023-01454-4
A review of studies that looked at the effects disasters (natural disasters, man-made disasters and “unique” disasters) have on youth and suicidal behaviours.
Abstract – Purpose of Review: The purpose of this review is to summarize the current literature regarding youth suicidality (suicidal ideation, suicidal behavior, and completed suicide) in the context of disasters. Recent Findings: There are fewer studies that examine the effect of disasters on suicidality specifically in children and youth than studies that focus on adults or general population. Summary: Numerous studies have reported on the effect of disasters on youth mental health in general without zeroing in on suicide risk. Some variables that have shown to increase suicide risk in children and youth after disasters include female gender, age at the time of disaster exposure, dependence on adults, attachments to places and caregivers, family functioning, and vulnerability to mistreatment. Several studies have demonstrated that youth suicidality fluctuates in response to disasters, at times increasing immediately post-disaster and at other times decreasing immediately post-disaster followed by an increase later. Exposure to natural disasters (e.g., earthquakes, typhoons, hurricanes, wildfires, and extremes of temperature and humidity), man-made disasters (e.g., armed conflict, global warming, and pollution), and unique disasters (e.g., the COVID-19 pandemic) have had significant impact on suicidality in children and adolescents. Although there are several promising interventions to mitigate the post-disaster suicide risk among youth, there is no consensus on a single intervention that is superior to others. More research is needed to study youth suicide risk in the context of disasters and develop culturally appropriate and evidence-based interventions.
Sussell, A. et al. (2023). Suicide rates by industry and occupation—National Vital Statistics System, United States, 2021. MMWR Morbidity and Mortality Weekly Report. http://dx.doi.org/10.15585/mmwr.mm7250a2
A Centers for Disease Control and Prevention (CDC) report detailing American suicide rates by both industry and occupation. Data from the 2021 National Vital Statistics System were used.
Abstract – The suicide rate among the U.S. working-age population has increased approximately 33% during the last 2 decades. To guide suicide prevention strategies, CDC analyzed suicide deaths by industry and occupation in 49 states, using data from the 2021 National Vital Statistics System. Industry (the business activity of a person’s employer or, if self-employed, their own business) and occupation (a person’s job or the type of work they do) are distinct ways to categorize employment. The overall suicide rates by sex in the civilian noninstitutionalized working population were 32.0 per 100,000 among males and 8.0 per 100,000 among females. Major industry groups with the highest suicide rates included Mining (males = 72.0); Construction (males = 56.0; females = 10.4); Other Services (e.g., automotive repair; males = 50.6; females = 10.4); Arts, Entertainment, and Recreation (males = 47.9; females = 15.0); and Agriculture, Forestry, Fishing, and Hunting (males = 47.9). Major occupation groups with the highest suicide rates included Construction and Extraction (males = 65.6; females = 25.3); Farming, Fishing, and Forestry (e.g., agricultural workers; males = 49.9); Personal Care and Service (males = 47.1; females = 15.9); Installation, Maintenance, and Repair (males = 46.0; females = 26.6); and Arts, Design, Entertainment, Sports, and Media (males = 44.5; females = 14.1). By integrating recommended programs, practices, and training into existing policies, workplaces can be important settings for suicide prevention. CDC provides evidence-based suicide prevention strategies in its Suicide Prevention Resource for Action and Critical Steps Your Workplace Can Take Today to Prevent Suicide, NIOSH Science Blog.
Yin et al. (2023). Untangling the temporal association between daily urges to die by suicide and to use substances. Psychiatry Research. https://doi.org/10.1016/j.psychres.2023.115178
40 individuals who had experiences of suicidal behaviours, binge-drinking behaviours, and emotion regulation difficulties were recruited for a clinical trial of internet-delivered dialectical behaviour therapy (DBT) skills training. The recruits “completed daily diaries on suicide and substance use urges and emotions over twenty-one days”. These qualitative data were used by the authors in the present study to analyze associations between substance use and suicidal behaviours.
Abstract – The current study examined the potential bi-directional associations between urges to die by suicide and to use alcohol or drugs as well as sadness and anger in relation to these urges. Forty individuals with suicidal thoughts, binge drinking behaviors, and emotion regulation difficulties, who were recruited for a clinical trial of internet-delivered Dialectical Behavior Therapy skills training, completed daily diaries on suicide and substance use urges and emotions over twenty-one days. Results indicated that higher daily peak substance use urges were associated with a greater likelihood of reporting suicide urges on the next day. Participants with higher and an increase in peak substance use urges (relative to their daily average) were both more likely to report suicide urges on the same day. Furthermore, both daily peak sadness and anger ratings predicted next-day suicide urges while accounting for substance use urges, though sadness may be a stronger predictor. These findings suggested a possible unidirectional pathway from urges to use substances to subsequent urges to die by suicide and a unique role of sadness.
() Ganson, K.T. et al. (2023). Muscle dysmorphia symptomatology is prospectively associated with suicidal thoughts, suicidal behaviors, and non-suicidal self-injury among a sample of Canadian adolescents and young adults. Suicide and Life-Threatening Behavior, 53(6), 1076-1085. https://doi.org/10.1111/sltb.13008
Data from the Canadian Study of Adolescent Health Behaviours (waves one and two) were used to gauge the association of suicidal thoughts, suicidal behaviours and non-suicidal self-injury with muscle dysmorphia, a subset of body dysmorphic disorder.
Abstract – Introduction: Limited, primarily cross-sectional research has identified associations between muscle dysmorphia and suicidal thoughts suicidal behaviors, and non-suicidal self-injury (NSSI). This study aimed to investigate the associations between muscle dysmorphia and suicidal thoughts, suicidal behaviors, and NSSI prospectively over a 1-year period among a large, diverse sample of Canadian adolescents and young adults. Methods: Data from wave one (2021) and wave two (2022) of the Canadian Study of Adolescent Health Behaviors were analyzed (N = 912). Multiple modified Poisson regression analyses were used to determine the associations between muscle dysmorphia symptomatology at wave one and three items of suicidal thoughts and behaviors and one item of NSSI at wave two. Unadjusted models and adjusted models were estimated. Results: Total muscle dysmorphia symptomatology and symptoms of Appearance Intolerance were prospectively associated with suicidal ideation and suicide planning at 12-month follow-up. These findings were significant across unadjusted and adjusted models. Conclusions: Findings from this study expand prior research and underscore the clinical complexity of muscle dysmorphia. Future research should investigate mechanisms explaining the association between muscle dysmorphia and suicide and develop interventions to prevent suicide among people with muscle dysmorphia.