National trends in non-fatal suicidal behaviors among adults in the USA from 2009 to 2017.

BACKGROUND: The age-adjusted rate of suicide death in the USA has increased significantly since 2000 and little is known about national trends in non-fatal suicidal behaviors (ideation, plan, and attempt) among adults and their associated sociodemographic and clinical characteristics. This study examined trends in non-fatal suicidal behaviors among adults in the USA. METHODS: Data were obtained from adults 18-65 years of age who participated in the National Survey on Drug Use and Health (NSDUH), including mental health assessment, from 2009 to 2017 (n = 335 359). Examinations of data involved trend analysis methods with the use of logistic regressions and interaction terms. RESULTS: Suicidal ideation showed fluctuation from 2009 to 2017, whereas suicide plan and attempt showed significantly positive linear trends with the odds increasing by an average of 3% and 4%, respectively. Suicide plan increased the most for females and adults ages 18-34, and attempt increased the most for adults with drug dependence. Both plan and attempt increased the most among adults who either had mental illness but were not in treatment or had no mental illness. CONCLUSIONS: Given attempted suicide is the strongest known risk factor for suicide death, reducing non-fatal suicidal behaviors including attempt are important public health and clinical goals. The interactional findings of age, sex, mental health status, and drug dependence point toward the importance of tailoring prevention efforts to various sociodemographic and clinical factors.

The Relationships Between Risk-Taking, Depression, and Alcohol Use in the Experience of Suicidal Ideation Among Adults in the General Population.

Risk-taking is associated with suicide among depressed adolescents. In the United States, alcohol is among the most used substances resulting in need for treatment. While alcohol use relates to greater depression and suicidality, less is known about these relationships with risk-taking tendencies, particularly among adult populations. The current study examined suicidal ideation, alcohol use, depression, and risk-taking tendencies among adults 18-65 years old who participated in the 2017 National Survey on Drug Use and Health. Structural equation modeling was used to examine the specific aims in Mplus8. A total of 1,740 (21.4%) participants endorsed suicidal ideation. The model demonstrated good fit and findings indicate increases in alcohol abuse or dependence (b = 0.094, SE = 0.01, p < .001), depression (b = 0.036, SE = 0.01, p < .001), and risk-taking (b = 0.044, SE = 0.01, p < .001) all independently related to increased odds of ideation. Increases in alcohol abuse or dependence (b = 0.210, SE = 0.02, p < .001) and depression (b = 0.026, SE = 0.01, p < .05) also related to elevated risk-taking. Based on the joint significance test, risk-taking tendencies served as a partial mediator, functioning as a mechanism in the relationships between alcohol use, depression, and ideation. Risk-taking thus serves as an important treatment target in the prevention of suicide. Implications for practice and future research are discussed.

Suicidal ideation in first-episode psychosis: Considerations for depression, positive symptoms, clinical insight, and cognition.

BACKGROUND: Suicide is a leading cause of death for individuals with psychosis. Although factors influencing suicide risk have been studied in schizophrenia, far less is known about factors that protect against or trigger increased risk during early-stage and first episode of psychosis. This study examined whether depression, psychotic symptoms, clinical insight, and cognition were associated with suicide ideation among individuals with first-episode psychosis. METHODS: Data were obtained from the Recovery After an Initial Schizophrenia Episode (RAISE) project. Participants (n = 404) included adults between ages 15 and 40 in a first episode of psychosis. Measurement included the Positive and Negative Syndrome Scale, Brief Assessment of Cognition in Schizophrenia, and Calgary Depression Scale for Schizophrenia. A logistic regression model evaluated clinical and cognitive variables as predictors of suicidal ideation. RESULTS: Greater positive symptoms (OR = 1.085, p < .01) and depression (OR = 1.258, p < .001) were associated with increased likelihood of experiencing suicidal ideation during the RAISE project. Meanwhile, stronger working memory (OR = 0.922, p < .05) and impaired clinical insight (OR = 0.734, p < .05) were associated with a decreased likelihood of experiencing suicidal ideation. CONCLUSION: The likelihood of experiencing suicidal ideation was significantly increased when positive and depressive symptoms were present, and significantly decreased when clinical insight was poorer and working memory stronger. These findings have important implications for the role of cognition and insight in risk for suicide ideation in early-stage psychosis, which may aid in improving the prediction of suicide behaviors and inform clinical decision-making over the course of the illness.

Computerized Clinical Training Simulations with Virtual Clients Abusing Alcohol: Initial Feasibility, Acceptability, and Effectiveness.

Although masters-level social work students typically build clinical skills via role-playing with their peers or instructors, several innovative training simulations are emerging in the literature that may enhance existing skill-building methodologies. We evaluated the initial feasibility, acceptability, usability, and effectiveness of three computerized simulations (two cognitive behavioral therapy, one motivational interviewing) during an interpersonal practice course among 22 students in a Master of Social Work program accredited by the Council on Social Work Education. Trainees repetitively practiced their clinical skills with virtual clients while receiving feedback via real-time nonverbal cues, transcript review, and performance assessment across pre-specified theoretical learning objectives. Across the three simulations, at least 86.4% of students completed the required protocol and completed M = 468.95 (SD = 178.27) minutes of simulated sessions. Students improved their scores (range 0 to 100) across all the simulations from M = 63.41 (SD = 11.13) to M = 93.64 (SD = 3.24). Students found the simulations to be acceptable with strong usability. Paired sample t-tests revealed students reported greater self-efficacy in general clinical skills, exploration skills, insight skills, and action skills between pre-test and post-test after completing the simulations (all p < 0.001). Students reported that the clinical skills learned from the simulations translated into successful interactions with real-world clients during their field placements. We discuss the results of this initial feasibility study within the context of simulation-based learning and the potential for broader implementation within MSW programs.

Longitudinal predictors of stigma in first-episode psychosis: Mediating effects of depression.

AIM: Stigma is commonly experienced among individuals with schizophrenia spectrum disorders and has been shown to be a barrier to help-seeking and behavioural service utilization. Given the established relationships between stigma, barriers to treatment, and poorer psychiatric outcomes including depression and psychotic symptoms, we examined the relationships between symptoms of depression, positive and negative symptoms, and the emergence of stigma longitudinally among a sample of first-episode of psychosis (FEP) participants in the United States. METHODS: Data were obtained from the Recovery After an Initial Schizophrenia Episode project of National Institute of Mental Health's Early Treatment Program. Participants (n = 404) included adults between ages 15 and 40 with schizophrenia or other psychotic disorders based on the DSM-IV. Data were analysed using structural equation modelling (SEM). RESULTS: Findings indicated that increased positive and negative symptoms independently related to greater symptoms of depression at baseline. Furthermore, increased positive symptoms and symptoms of depression at baseline independently related to the emergence of greater stigma being experienced over time. CONCLUSIONS: Considering the role that symptoms of depression played as a factor explaining the relationships between positive and negative symptoms and emergence of stigma over time among individuals in FEP, and symptoms of depression is important predictor of stigma and may furthermore present as a viable and less stigmatizing initial treatment target in the early course of a psychotic disorder.

Effectiveness of Suicide-Focused Psychosocial Interventions in Psychosis: A Systematic Review and Meta-Analysis.

OBJECTIVE: Suicide ideation, plan, attempt, and death are significant and prevalent concerns among individuals with psychosis. Previous studies have focused on risk factors, but few have systematically evaluated the effect of psychosocial interventions on these experiences among individuals with psychosis. This study evaluated the effectiveness of psychosocial interventions in reducing suicide ideation, plan, attempt, and death among individuals with psychotic symptoms. METHODS: Eight electronic databases were systematically searched from inception until June 30, 2019. Identified studies included both randomized controlled trials and controlled trials without randomization that examined psychosocial interventions for suicide ideation, plan, attempt, and death among individuals with psychotic symptoms. A random-effects model was used to pool the effect sizes for synthesis. RESULTS: Eleven studies with 14 effect sizes (N=4,829 participants) were analyzed. The average age of participants ranged from 21 to 51, and most participants identified as male and non-Hispanic Caucasian or Chinese and were in an early or first-episode stage of illness. On average, participants who received psychosocial interventions were less likely than their counterparts in the control group to report suicide ideation, plan, and attempt and die by suicide (odds ratio [OR]=0.57, 95% confidence interval [CI]=0.41-0.78). Subgroup analyses further revealed significant reductions in suicide ideation (OR=0.73, 95% CI=0.55-0.97) and suicide death (OR=0.45, 95% CI=0.30-0.68) among intervention participants. CONCLUSIONS: Preliminary evidence indicated that psychosocial interventions are effective in reducing suicide ideation, plan, attempt, and death among individuals with psychotic symptoms. Intervention characteristics, however, varied across studies, which suggests a lack of consensus on best clinical practices.

Depression moderates the relationships between hallucinations, delusions, and suicidal ideation: The cumulative effect of experiencing both hallucinations and delusions.

Suicide is a leading cause of preventable death in the United States and worldwide, with symptoms of depression and psychosis relating to increases in risk for ideation, attempt, and completion. This study examined moderating effects of depression in the relationships between three categories of psychotic symptoms (experiencing only hallucinations, only delusions, and both hallucinations and delusions) and suicidal ideation. Data (n = 12,195) were obtained from the cross-sectional Collaborative Psychiatric Epidemiology Surveys data which include large general population-based samples of households in the United States. Data were examined using Structural Equation Modeling (SEM) in Mplus 8. Approximately 19% of the sample met criteria for major depression and 13% reported having the experience of suicidal ideation. Only 16% of the sample reported having a diagnosis of schizophrenia and/or a psychotic disorder. Depression functioned as a moderator and among those who experienced depression, increases in all psychotic symptom categories significantly related to increased likelihood of experiencing suicidal ideation. Among those who were not depressed, increases in two psychotic symptom categories (only hallucinations and both hallucinations and delusions) were significantly related to greater likelihood of experiencing suicidal ideation. Findings emphasize the high-risk for ideation among individuals who experience hallucinations or delusions, with the cumulative effect of experiencing both hallucinations and delusions being most harmful in relation to the likelihood of experiencing suicidal ideation; particularly so among those who were depressed. Assessment of risk factors for suicidal ideation is imperative given its relationship to the potential of suicide attempt and/or completion.