How to improve testing when trying to predict inmate suicidal behavior.

OBJECTIVE: To measure the predictive power of the Suicide Probability Scale (SPS) in a male inmate population (federal penitentiary) with the added contribution of actuarial data. METHOD: SPS scores and data from the files of 518 inmates were analyzed in relation to their suicidal behaviors over the following 10 years. RESULTS: During this period, 12 inmates committed suicide (2.32%), 43 engaged in non-lethal self-harm (8.3%) and 15 expressed serious suicidal intention (2.9%), for a total of 70 (13.51%) who manifested at least one form of suicidal behavior. The records of the 518 inmates allowed identifying seven actuarial variables (out of 24 documented) that distinguished the group that acted out. These variables were tested in combination with the SPS score to determine the best predictive models of suicidal behavior. Depending on type of suicidal behavior and on observation period, the following seven variables could prove useful in improving the predictive capacity of the SPS: age, prior suicidal behavior, borderline personality disorder, length of sentence, number of sentences, prior incarceration in a provincial prison, and juvenile priors. However, analyses did not allow developing a better predictive model for the specific subgroup of suicide completers. CONCLUSIONS: SPS is improved when adding actuarial data.

Pilot evaluation of a group therapy program for children bereaved by suicide.

BACKGROUND: Thousands of children are bereaved each year by suicide, yet there exists very little literature specifically on the psychological care, programs, and interventions available to help them. AIMS: (1) To build and validate theoretical models for the Group Therapy Program for Children Bereaved by Suicide (PCBS); (2) to test these models in a preliminary evaluation. METHODS: In the first part, we built theoretical models, which were then validated by scientists and clinicians. In the second part, the sessions of the PCBS were observed and rated. The participating children were tested pre- and postprogram. RESULTS: Positive changes were observed in the participating children in terms of basic safety, realistic understanding and useful knowledge, inappropriate behaviors, physical and psychological symptoms, child-parent and child-child communication, capacity for social and affective reinvestment, actualization of new models of self and the world, self-esteem, awareness and use of tools, cognitive, verbal, written and drawing abilities, cognitive dissonance, ambivalence, antagonism, and isolation. CONCLUSIONS: The changes reported in the bereaved children show that the PCBS has some efficacy.

Validation of the 'How I Think Questionnaire' in a population of French-speaking adolescents with externalizing behaviors.

'How I Think Questionnaire' (HIT) is used to measure self-serving cognitive distortions among delinquents. Previously validated on Americans, this instrument was translated, adapted and validated for French-speaking teens. To assess convergent and discriminant validity, 336 adolescents with externalizing behaviors in Québec (Canada) completed the HIT, the Self-Reported Delinquency Scale (SRD), and the Auto-aggression Questionnaire. There were 165 boys and 171 girls with M(age) = 16.4 years (SD = 0.5) who received services under the Youth Criminal Justice Act (n = 145) or the Youth Protection Act (n = 191). HIT and SRD total scores were correlated (0.51, p < 0.01). On the HIT, past suicidal attempting delinquents were not significantly different than non-suicide attempting delinquents; also delinquents living in closed detention facilities had more self-serving cognitive distortions than delinquents living in open facilities or under probation in the community. This French-language version of the HIT is a reliable and valid measure.

Suicide attempts: prevention of repetition.

OBJECTIVE: To present an overview of promising strategies to prevent repetition of suicidal behaviours. METHOD: This literature review on tertiary preventive interventions of suicide attempts was produced using the computerized databases PubMed and PsycINFO from January 1966 to September 2010, using French- and English-language limits and the key words: suicid* or deliberate self-harm and treatment* or therapy or intervention* or management. RESULTS: Thirteen of the 35 included studies showed statistically significant effects of fewer repeated attempts or suicides in the experimental condition. Overall, 22 studies focused on more traditional approaches, that is, pharmacological or psychological approaches. Only 2 of the 6 pharmacological treatments proved significantly superior to a placebo- a study of lithium with depression and flupenthixol with personality disorders. Eight out of 16 psychological treatments proved superior to treatment as usual or another approach: cognitive-behavioural therapy (CBT) (n = 4), (including dialectical behaviour therapy [n = 2]); psychodynamic therapy (n = 2); mixed (CBT plus psychodynamic therapy [n = 1]); and motivational approach and change in therapist (n = 1). Among the 8 studies using visit, postal, or telephone contact or green-token emergency card provision, 2 were significant: one involving telephone follow-up and the other telephone follow-up or visits. Hospitalization was not related to fewer attempts, and 1 of the 4 outreach approaches had significant results: a program involving individualized biweekly treatment. The rationale behind these single or multiple approaches still needs to be clarified. There were methodological flaws in many studies and some had very specific limited samples. CONCLUSIONS: There is a need for more research addressing the problem in definitions of outcomes and measurement of the dependent variables, gender-specific effects, and inclusion of high-risk groups. There is a need for the development and evaluation of new approaches that support collaboration with community resources and more careful assessment and comparisons of existing treatments with different populations.

Inter-regional variations in men's attitudes, suicide rates and sociodemographics in Quebec (Canada).

BACKGROUND: Suicide rates can vary quite considerably and attitudes regarding suicide may explain part of the variation. METHOD: The present study investigated, across the 17 regions of Quebec (Canada), men's attitudes towards suicide, expressing pain and help seeking, as they are related to suicide rates and sociodemographic variables (unemployment, divorce/separation, income and education). RESULTS: Most correlations were non-significant. However, in regions with an above-average educational level and with higher divorce/separation rates, men had better attitudes towards expressing pain. Furthermore, in regions where men were more inclined to express pain, suicide rates were lower. Also, significant positive correlations were found between suicide rates and low educational level, but also between an increase in suicide rates and an increase in income level. CONCLUSIONS: Where the aetiology of suicide is concerned, researchers must examine both sociodemographic factors and the psychological factors associated with them.

Preventing suicide in prisons, part I. Recommendations from the International Association for Suicide Prevention Task Force on Suicide in Prisons.

In 2000 the Department of Mental Health of the World Health Organization (WHO) published a guide named Preventing Suicide. A Resource for Prison Officers as part of the WHO worldwide initiative for the prevention of suicide. In 2007 there are new epidemiological data on prison suicide, a more detailed discussion of risk factors accounting for the generally higher rate of suicide in correctional settings in comparison to the general population, and several strategies for developing screening instruments. As a first step, this paper presents an update of the WHO guide by the Task Force on Suicide in Prisons, created by the International Association for Suicide Prevention. A second paper, by the same Task Force, will present some international comparisons of suicide prevention services in correctional facilities.

Preventing suicide in prisons, part II. International comparisons of suicide prevention services in correctional facilities.

The International Association for Suicide Prevention created a Task Force on Suicide in Prisons to better disseminate the information in this domain. One of its objectives was to summarize suicide-prevention activities in the prison systems. This study of the Task Force uncovered many differences between countries, although mental health professionals remain central in all suicide prevention activities. Inmate peer-support and correctional officers also play critical roles in suicide prevention but there is great variation in the involvement of outside community workers. These differences could be explained by the availability of resources, by the structure of the correctional and community services, but mainly by the different paradigms about suicide prevention. While there is a common and traditional paradigm that suicide prevention services are mainly offered to individuals by mental health services, correctional systems differ in the way they include (or not) other partners of suicide prevention: correctional officers, other employees, peer inmates, chaplains/priests, and community workers. Circumstances, history, and national cultures may explain such diversity but they might also depend on the basic way we think about suicide prevention at both individual and environmental levels.

Further evidence of the validity of the Suicide Risk Assessment Scale for prisoners.

The Suicide Risk Assessment Scale (SRAS; nine items) is useful in correctional settings but needed further validation. First, 44 inmates originally screened as suicidal with the SRAS were evaluated by institutional psychologists according to five criteria: suicidal urgency, risk, appropriateness of referral, need for short- or long-term watch. On the whole, the SRAS was judged to be as effective as a more elaborate test. Second, 242 suicidal and non-suicidal inmates were tested with the SRAS. Their results correlated better with suicidal risk (.71) than with urgency (.50). Receiver operating characteristic (ROC) analysis even showed that the SRAS performed better than a more elaborate test in predicting risk.

Nonfatal suicide-related behavior among inmates: testing for gender and type differences.

Suicide-related behavior (SRB) is significantly more prevalent among female (40.8%) than among male (28%) inmates, although suicide risk is higher among the latter. When instrumental behavior (IB) is excluded and only suicidal acts (SA) considered, rates for the two groups are more comparable (11.9% and 16%, respectively). Compared with other female inmates, the SRB group is more suicidal, hostile, and impulsive and more likely to have been previously victimized and to be diagnosed with Axis I and II disorders. Women with IB are not significantly different from those with SA, except that their behavior provides significantly greater tension release.

Suicide prevention through means restriction: assessing the risk of substitution. A critical review and synthesis.

The effectiveness of restricting access to certain means of committing suicide has been demonstrated, at least as regards toxic domestic gas, firearms, drugs and bridges. At the individual level, studies tend to indicate that many persons have a preference for a given means, which would limit the possibility of substitution or displacement towards another method. Similarly, the fact that suicidal crisis are very often short-lived (and, what is more, influenced by ambivalence or impulsiveness) suggests that an individual with restricted access to a given means would not put off his plans to later or turn to alternative methods. This has been more difficult to demonstrate scientifically in population studies. Nevertheless, it appears that, should such a shift occur towards other means, it would be put into effect only in part and over a longer term.

Cultural traits and immigration: hostility and suicidality in Chinese Canadian students.

Suicidality has been related to inwardly directed aggression. We compared convenience samples of 89 Canadian students of Chinese origin (CC) and 81 Canadian students from other backgrounds on measures of suicidality, hostility and aggression. The Chinese Canadian group reported higher levels of suicidality and hostility than the group of other Canadians. However, aggressive behaviors directed toward self or others were less frequent among Chinese Canadians. No differences were found between men and women. The results are interpreted by invoking the influence of Chinese culture on emotional restraint, particularly as regards aggressiveness.