Problem gambling and suicidality in England: secondary analysis of a representative cross-sectional survey

Objectives: Problem gamblers in treatment are known to be at high risk for suicidality, but few studies have examined if this is evident in community samples. Evidence is mixed on the extent to which an association between problem gambling and suicidality may be explained by psychiatric comorbidity. We tested whether they are associated after adjustment for co-occurring mental disorders and other factors. Study design: Secondary analysis of the Adult Psychiatric Morbidity Survey 2007, a cross-sectional na- tional probability sample survey of 7403 adults living in households in England. Methods: Rates of suicidality in problem gamblers and the rest of the population were compared. A series of logistic regression models assessed the impact of adjustment on the relationship between problem gambling and suicidality. Results: Past year suicidality was reported in 19.2% of problem gamblers, compared with 4.4% in the rest of the population. Their unadjusted odds ratios (OR) of suicidality were 5.3 times higher. Odds attenuated but remained significant when depression and anxiety disorders, substance dependences, attention- deficit/hyperactivity disorder, and other factors were accounted for (adjusted OR 1⁄4 2.9, 95% confi- dence interval 1⁄4 1. 1, 8.1 P 1⁄4 0.023). Conclusions: Problem gamblers are a high-risk group for suicidality. This should be recognised in indi- vidual suicide prevention plans and local and national suicide prevention strategies. While some of this relationship is explained by other factors, a significant and substantial association between problem gambling and suicidality remains

Suicide Screening in Primary Care: Use of an Electronic Screener to Assess Suicidality and Improve Provider Follow-Up for Adolescents

Purpose The purpose of this study was to assess the feasibility of using an existing computer decision support system to screen adolescent patients for suicidality and provide follow-up guidance to clinicians in a primary care setting. Predictors of patient endorsement of suicidality and provider documentation of follow-up were examined. Methods A prospective cohort study was conducted to examine the implementation of a CDSS that screened adolescent patients for suicidality and provided follow-up recommendations to providers. The intervention was implemented for patients aged 12–20 years in two primary care clinics in Indianapolis, Indiana. Results The sample included 2,134 adolescent patients (51% female; 60% black; mean age = 14.6 years [standard deviation = 2.1]). Just over 6% of patients screened positive for suicidality. A positive endorsement of suicidality was more common among patients who were female, depressed, and seen by an adolescent−medicine board-certified provider as opposed to general pediatric provider. Providers documented follow-up action for 83% of patients who screened positive for suicidality. Documentation of follow-up action was correlated with clinic site and Hispanic race. The majority of patients who endorsed suicidality (71%) were deemed not actively suicidal after assessment by their provider. Conclusions Incorporating adolescent suicide screening and provider follow-up guidance into an existing computer decision support system in primary care is feasible and well utilized by providers. Female gender and depressive symptoms are consistently associated with suicidality among adolescents, although not all suicidal adolescents are depressed. Universal use of a multi-item suicide screener that assesses recency might more effectively identify suicidal adolescents

Needs Assessment of Suicide Prevention in Vermont Middle and High Schools

Introduction. Adolescent suicide is epidemic. 17% of high school students con- sidered suicide and 8% attempting to take their lives in 2015 nationwide. Vermont has seen a 2% increase within the last two years according to the VT Youth Risk Behavior Survey. School is one of several settings where effective suicide interventions could take place. Previous studies have identified means prevention as an effective way to combat adolescent suicide. This study aims to identify training levels and comfort of school staff in dealing with suicidality. Methods. A survey was emailed to all schools in Vermont covering grades 6-12. The survey addressed employee demographics, training, perception of suicide in their school, and concern regarding lethal means. Questions were multiple choice, scaled and free responses. Data was analyzed using SPSS and free responses were organized using thematic content analysis. Results. 126 responses represented 46% of Vermont middle and high schools. 77% agreed or strongly agreed that they felt confident in recognizing a student with suicidality. Respondents were not comfortable implementing lethal means prevention. Respondents identified early intervention and trusting communicative relationships as key to prevention, and identified lack of time, protocols, and resources as obstacles. Discussion. Respondents identified suicidality in 2.2% of their students, com- pared to the YRBS that recognized 12% of adolescents. Survey technique may con- tribute to this discrepancy, but it is also likely that schools are failing to identify students at risk. A lack of comfort recognizing suicidality and implementing prevention techniques warrants standardized training, screening and response protocols.https://scholarworks.uvm.edu/comphp_gallery/1265/thumbnail.jp

Forming ideal types by understanding. Application to the psychoanalytic treatment of suicidal men

This paper discusses the application of a qualitative methodology—forming ideal types by understanding—to the psychoanalytic psychotherapy of suicidal men. The paper focuses on a particular phase of the methodology: the validation through external expert replication. Data of cases from psychoanalytic treatment, analysed by the originating group in Germany, is analysed by a group in London, UK, which formed to undertake the task of blind comparison. We describe the contribution of this method in the field of psychoanalytic research, the method developed for generating data and the processes through which data are analysed. We demonstrate the comparative findings from the first (German) and second (UK) analyses and explore the meanings of the similarities and differences. The paper concludes with an appraisal of the strengths and limitations (in terms) of moderate levels of generalisation of results from this method for research in the field of qualitative psychotherapy researc

Practice Issues for Evaluation and Management of the Suicidal Left Ventricular Assist Device Patient

There is a high prevalence of depression among left ventricular assist device patients, who present with an increased risk of suicidality given access to means via the device either with nonadherence or disconnection. Suicidality via device nonadherence/disconnection is an underresearched clinical issue, as paradoxically this life-saving procedure can also provide a method of lethal means to patients with significant mental health concerns. A case study is used to highlight the course of an attempted suicide by ventricular assistive device nonadherence. Clinical implications and recommendations for practice include a thorough psychological evaluation presurgery, monitoring quality of life and coping styles before and after placement, psychological testing, outlining specific suicide protocols, psychiatric care considerations for patients with highly specialized medical devices, and related ethical concerns

The relationship between entrapment and suicidal behavior through the lens of the integrated motivational-volitional model of suicidal behavior

Suicide and suicidal behavior are major public health concerns. As a result, a number of psychological models have been developed to better understand the emergence of suicidal ideation and suicide attempts. One such model is the integrated motivational–volitional model, a tri-partite model of suicidal behavior, which posits that entrapment is central to the final common pathway to suicide. In this review, we summarize the extant research evidence for the relationship between entrapment and suicidal ideation and behavior. Although there is robust evidence for the relationship between entrapment and suicidal ideation and behavior, there are gaps in our knowledge. We discuss the clinical implications and suggest key directions for future research