Understanding and responding to recurrent suicide attempts

People who have had recurrent suicide attempts (RSA) are known to be at higher risk of future attempts and eventual death by suicide. They are also identified as having unique psychosocial needs, however few treatment interventions have been developed for this particular population. The Skills for Safer Living: A Psychosocial-Psychoeducational Intervention for People with Recurrent Suicide Attempts (SfSL/PISA) is a psychotherapeutic group intervention created for and with people with RSA; seeking to engage with the possibility of living, enhance skills for living more safely and addressing their needs. This research project aimed to address these issues by examining whether participants who have engaged with this intervention transition away from RSA, and explores their experiences of this transition and of living with RSA. The project comprises four interlinked studies, two quantitative outcome studies and two qualitative studies, with different participant samples, all of whom had graduated from SfSL/PISA. These studies highlight that risk factors and deficit areas for RSA can be attenuated over time for those who completed the SfSL/PISA intervention; that the process of transitioning away from RSA comprises three phases wherein the person moves from a death orientation to a life orientation; and that living with RSA is marked by states that are ambiguous, fragile, and arduous. The findings suggest that psychotherapeutic intervention for RSA needs to address the specific needs of this group and to be sensitive to the particular stage of living with RSA to navigate through this experience

Exploring the Meaning of Recovery from Recurrent Suicide Attempts The views and opinions expressed herein do not necessarily reflect those of the Wellesley Institute. Recovery and Recurrent Suicide Attempts

Executive Summary A Psychosocial-Psychoeducational Intervention for Suicidal Young Adults: A Pilot Project, is a qualitative study undertaken to develop a grounded theory of successful transition from higher to lower risk of suicidal behaviour for young people with recurrent suicidal behaviour and the meaning that this transition held for clients. Participants had completed at least one cycle of the 20 week outpatient group program Psychosocial-Psychoeducational Intervention for People with Recurrent Suicide Attempts (PISA) and were between the ages of 18 yrs and 25 years at the time of their participation. . A qualitative Grounded Theory approach was used to investigate the transition away from recurrent suicide attempts. We used a criterion convenience sampling strategy (Patton, 1992). Qualitative interviews were face to face and transcribed word for word. Quantitative interviews provided an overview of symptom severity in the areas of identified deficits for people with recurrent suicide attempts. Ethics approval was obtained through St. Michael's Hospital Research Ethics Board. Sixteen young people participated in the qualitative interviews and 15 completed the quantitative measures. Participants showed improvements in all areas of previously identified deficits when compared to baseline measures completed while they were in the group. Significant changes were attained in the areas of alexithymia, depression, hopelessness, satisfaction with life, and impulsivity. A secondary analysis of the quantitative measures examining childhood maltreatment and the relationship to suicidal behaviour was completed by Hayley Eisenberg, a Master in Science candidate. Her study showed that increasing frequency of moderate to severe abuse identified by clients correlated with an earlier onset of suicidal behaviour and a greater frequency of suicidal behaviours. Transitioning from higher to lower risk of suicidal behaviour is a difficult task. Clients identified that the phenomenon of recurrent suicide attempts carries a core relationship with death that cannot be ignored. Transitioning from this relationship to developing a relationship with life/living often requires experiencing ambivalence and turning/tipping points. These seem to provide opportunities for awareness in a number of areas that the client must act on for the transition to lower of risk suicidal behaviour to occur. The transition to lower risk of suicidal behaviours is possible and it is not a linear path. Experiences of childhood maltreatment can significantly impact the pathway to safer behaviour. Our model of the transition process offers a way to understand where a client might be in the process and possible intervention points where clinicians can intervene. Each client's understanding of death is unique. It is necessary to understand what death means for the individual client. Limbo or existence is an ambivalent place for the client where they are unable to know or commit to either living or dying. Awareness comes through a variety of experience

Exploring the Meaning of Recovery from Recurrent Suicide Attempts Executive Summary

A Psychosocial-Psychoeducational Intervention for Suicidal Young Adults: A Pilot Project, is a qualitative study undertaken to develop a grounded theory of successful transition from higher to lower risk of suicidal behaviour for young people with recurrent suicidal behaviour and the meaning that this transition held for clients. Participants had completed at least one cycle of the 20 week outpatient group program Psychosocial-Psychoeducational Intervention for People with Recurrent Suicide Attempts (PISA) and were between the ages of 18 yrs and 25 years at the time of their participation. . A qualitative Grounded Theory approach was used to investigate the transition away from recurrent suicide attempts. We used a criterion convenience sampling strategy (Patton, 1992). Qualitative interviews were face to face and transcribed word for word. Quantitative interviews provided an overview of symptom severity in the areas of identified deficits for people with recurrent suicide attempts. Ethics approval was obtained through St. Michael's Hospital Research Ethics Board. Sixteen young people participated in the qualitative interviews and 15 completed the quantitative measures. Participants showed improvements in all areas of previously identified deficits when compared to baseline measures completed while they were in the group. Significant changes were attained in the areas of alexithymia, depression, hopelessness, satisfaction with life, and impulsivity. A secondary analysis of the quantitative measures examining childhood maltreatment and the relationship to suicidal behaviour was completed by Hayley Eisenberg, a Master in Science candidate. Her study showed that increasing frequency of moderate to severe abuse identified by clients correlated with an earlier onset of suicidal behaviour and a greater frequency of suicidal behaviours. Transitioning from higher to lower risk of suicidal behaviour is a difficult task. Clients identified that the phenomenon of recurrent suicide attempts carries a core relationship with death that cannot be ignored. Transitioning from this relationship to developing a relationship with life/living often requires experiencing ambivalence and turning/tipping points. These seem to provide opportunities for awareness in a number of areas that the client must act on for the transition to lower of risk suicidal behaviour to occur. The transition to lower risk of suicidal behaviours is possible and it is not a linear path. Experiences of childhood maltreatment can significantly impact the pathway to safer behaviour. Our model of the transition process offers a way to understand where a client might be in the process and possible intervention points where clinicians can intervene. Each client's understanding of death is unique. It is necessary to understand what death means for the individual client. Limbo or existence is an ambivalent place for the client where they are unable to know or commit to either living or dying. Awareness comes through a variety of experience

Understanding the Risks of Recent Discharge: The Phenomenological Lived Experiences – “Existential Angst at the Prospect of Discharge”

Background: Evidence indicates that people whose mental health problems lead them to require psychiatric hospitalization are at a significantly increased risk of suicide, and that the time immediately following discharge after such hospitalizations is a particularly high-risk time. Aims: This paper reports on phenomenological findings from a federally funded, mixed-methods study that sought to better understand the observed increased risk for suicide following discharge from an inpatient psychiatric service. Methods: A purposive sample of 20 recently discharged former suicidal inpatients was obtained. Data were collected in hermeneutic interviews lasting between 1 h and 2 h and analyzed according to van Manen’s (1997) interpretation of hermeneutic phenomenology. Results: Two key themes, “existential angst at the prospect of discharge” and “trying to survive while living under the proverbial ‘sword of Damocles’” were induced. Each of these was comprised of five themes with the first key theme (which is the focus of this paper) encompassing the following: “Feeling scared, anxious, fearful and/or stressed,” “Preparedness,” “Leaving the place of safety,” “Duality and ambivalence,” and “Feel like a burden.” Conclusions: Early exploration of and reconciling of patients’ expectations regarding inpatient care for their suicidality would be empirically based interventions that could diminish the postdischarge risk for further suicide attempts

Understanding the Risks of Recent Discharge: The Phenomenological Lived Experiences – “Existential Angst at the Prospect of Discharge”

Background: Evidence indicates that people whose mental health problems lead them to require psychiatric hospitalization are at a significantly increased risk of suicide, and that the time immediately following discharge after such hospitalizations is a particularly high-risk time. Aims: This paper reports on phenomenological findings from a federally funded, mixed-methods study that sought to better understand the observed increased risk for suicide following discharge from an inpatient psychiatric service. Methods: A purposive sample of 20 recently discharged former suicidal inpatients was obtained. Data were collected in hermeneutic interviews lasting between 1 h and 2 h and analyzed according to van Manen’s (1997) interpretation of hermeneutic phenomenology. Results: Two key themes, “existential angst at the prospect of discharge” and “trying to survive while living under the proverbial ‘sword of Damocles’” were induced. Each of these was comprised of five themes with the first key theme (which is the focus of this paper) encompassing the following: “Feeling scared, anxious, fearful and/or stressed,” “Preparedness,” “Leaving the place of safety,” “Duality and ambivalence,” and “Feel like a burden.” Conclusions: Early exploration of and reconciling of patients’ expectations regarding inpatient care for their suicidality would be empirically based interventions that could diminish the postdischarge risk for further suicide attempts

Prospective Study of Risk Factors for Increased Suicide Ideation and Behavior following Recent Discharge

Objective The purpose of this study is to prospectively examine the association between predictors from the three thematic areas — suicidality, personal risk factors and patient care factors — and the occurrence of postdischarge suicide ideation and behavior in recently discharged patients. Methods The design is a prospective cohort study of all patients admitted to an inner city inpatient psychiatric service with a lifetime history of suicidal behavior and current suicidal ideation. Predictors of suicide ideation at 1, 3 and 6 months following discharge and suicide behavior over the 6 months of follow-up were examined. Results The incidence of death by suicide during the study period was 3.3% [95% confidence interval (CI)=0.9%–8.3%], and 39.4% (95% CI=30.0%–49.5%) of the surviving participants reported self-injury or suicide attempts within 6 months of hospital discharge. Risk factors such as recent suicide attempts, levels of depression, hopelessness and impulsivity were predictive of increased suicide ideation or behavior after discharge from the inpatient service. Conclusions The high risk of suicide ideation, suicide attempts and suicide demonstrated in these recently discharged patients supports the need to develop selective prevention strategies