Psicothema

Editorial for Special Issue on Understanding and Prevention of Suicidal Behavior: Humanizing Care and Integrating Social Determinants

Susana Al-Halabí, Eduardo Fonseca-Pedrero — Tue, 05 Nov 2024 00:00:00 +0000

Background: Suicide is a preventable public health and social problem. Suicidal behavior is a complex and multifactorial phenomenon whose characterization, assessment, prevention, intervention, and postvention require a comprehensive approach focused on the meaning in a person’s life and ttheir suffering in their biographical, social and cultural context. It is an extraordinarily variable phenomenon over time and highly dependent on contextual elements. Method: This editorial includes the social determinants of this phenomenon, key aspects linked to the dehumanization of healthcare settings, the problems of iatrogenic harm in universal prevention programs for schoolchildren and adolescents, and good clinical practices collected in the scientific literature. Results: The editorial highlights the importance of research for the prevention of suicidal behavior from any intervention level, whether educational, community, social, or health, as all are involved in prevention. Conclusions: The goal is to help improve the biographical circumstances of people with suicidal behaviors and the meaningfulness of their lives. This must be done through a collective scaffolding in which the most vulnerable can ask for help when they need it, as well as guide themselves towards life circumstances worth living.

Reasons to Live During a Suicidal Crisis: A Case Series With Suicidal Inpatients

Tue, 05 Nov 2024 00:00:00 +0000

Background: Following experts’ recommendations for a phenomenological approach to suicidal behavior, this study opted to focus on the life-protecting beliefs and values expressed by people in acute suicidal crisis. Method: 61 adults hospitalized in psychiatric emergency for suicidal crises were assessed in terms of reasons for living (RFL) and suicidality. Multiple correspondence analysis was used to discern groups of patients based on their RFL profiles. Group differences on suicidality were further examined. Results: 4 groups of patients were observed, emerging from RFL differences in “Survival and Coping Beliefs”, “Fear of Social Disapproval”, “Responsibility to Family” and “Child- Related Concerns”. Profiles varied by gender but not age. We further observed that “Survival and Coping Beliefs” and “Moral Objections” are weakened during an acute suicidal crisis. Conclusions: These findings underline the clinical utility of evaluating RFL during a suicidal crisis, and that RFL may be useful to personalize case formulation during an emergency intervention. They could further increase therapeutic communication by connecting the individual to key psychological resources. Longitudinal studies are necessary to evaluate how the different groups identified in this study may yield specific post-emergency trajectories connected to specific clinical needs.

Mortality and Suicide Among Persons Experiencing Homelessness: A Seven-Year Follow-up Study

Tue, 05 Nov 2024 00:00:00 +0000

Background: There is a significant gap in scientific understanding about suicide among people experiencing homelessness (PEHs). Method: This seven-year longitudinal study examined a cohort of 154 PEHs. In 2015, clinical assessments were conducted, including an evaluation of suicide risk, with data on causes of death collected from public health service records in 2022. Results: Over the course of seven years, 14.3% of the sample passed away at an average age of 52.6 years. The leading causes of death were cancer, suicide, and accidental overdose. Participants who experienced violence had a higher number of suicide attempts and scored higher on the suicidal ideation scale. The most significant factors associated with mortality were prior suicide attempts and suicidal ideation. Conclusions: This study underscores the importance of suicide risk scale scores as the primary predictor of mortality. It emphasizes the need for further longitudinal research on suicide among PEHs and the development of specific programs to prevent suicide within this population. An approach combining structural and individual perspectives is suggested, considering appropriate housing policies and mental health care.

Suicidal Ideation, Social Participation, Loneliness, and Mobility Limitations: Longitudinal Evidence in Older European Adults

Tue, 05 Nov 2024 00:00:00 +0000

Background: Suicide behavior represents a major public health problem for the older population. Within the continuum of suicidal behavior, suicidal ideation may lead to a suicide attempts/death. Risk factors for developing suicidal ideation include mobility limitations, lack of social participation and loneliness. However, there is a need for longitudinal studies to examine these relationships over time. Method: 50423 older people from three waves of the SHARE project formed the sample (60 years in the first wave; M ± SD = 71.49 ± 8.15; 55% female). Results: A series of nested Cross-Lagged Panel Models (CLPM) of suicidal ideation, mobility limitations, social participation and loneliness were tested. The best fitting model was that with equal autoregressive and cross-lagged effects across waves (χ2 = 1220.56, CFI = .982, RMSEA = .028, SRMR = .024). The autoregressive effects showed high stability across waves. The cross-lagged effects between suicidal ideation and mobility limitations were strong, while the cross- lagged effects between suicidal ideation and social participation were comparatively smaller. In the case of loneliness, statistical significance was not achieved. Conclusions: These findings highlight the importance of promoting mobility programs and social activities to prevent suicidal ideation among older adults.

Suicidal Behavior, Mental Health, and Stressful Life Events Among Adolescents

Tue, 05 Nov 2024 00:00:00 +0000

Background: Adolescence is an important period for development, when psychological problems may appear, including suicidal behavior. Experiencing Stressful Life Events (SLEs) is associated with increased risk of such problems, although the impact of distinct types of SLEs has seldom been examined. This study aims to analyze associations between different SLEs, psychological problems, subjective well-being, and suicidal behavior in adolescents. A new instrument was developed—the Stressful Life Events Checklist for Adolescents (SLECA)—where SLEs were classified as: minor/major, dependent/independent, interpersonal/non-interpersonal, and chronic/episodic. Method: Two waves of data collection were included. Wave 1 involved 5,610 adolescents whereas wave 2 involved 2,312 adolescents. Results: Major dependent interpersonal episodic SLEs were strongly associated with externalizing problems. Major dependent non-interpersonal episodic SLEs showed the highest association with attention-deficit/hyperactivity problems. Major independent chronic SLEs were associated with low subjective well-being, and internalizing problems. Peer problems and academic SLEs were associated with psychological problems and low subjective-well-being. Controlling for mental health variables, suicidal behavior was related to major independent chronic SLEs and to those linked to victimization and sexuality- related problems. Conclusions: The SLECA is a useful instrument for assessing SLEs in adolescents, unravelling the interrelations between SLEs, mental health, and suicidal behavior.

The Questionnaire for Suicidal Ideation (QSI): Psychometric Properties of a Brief Tool Measuring Suicidal Ideation in Adult and Adolescent Clinical Populations

Tue, 05 Nov 2024 00:00:00 +0000

Background: Identifying accurate methods of assessing suicidal ideation has important implications. The lack of a universal definition of suicidal ideation has complicated measurement efforts. This study details the development of a brief self-report measure of suicidal ideation which specifically focuses on thoughts of suicide. Method: The Questionnaire for Suicidal Ideation (QSI) was developed by collating items from three existing measures of suicidal ideation. Items explicitly describing acts or behaviours were removed and Posner et al.’s (2007) definition of suicidal ideation was applied to the remaining items. The final questionnaire consisted of 6 items. Participants were adults (n = 192) and adolescents (n = 152) attending community mental health services in the Irish public health service. Results: The QSI demonstrated excellent reliability in adult (α = .91) and adolescent (α = .90) samples. Exploratory factor analysis produced a one-factor solution explaining 70% and 66% of the variance in adult and adolescent samples respectively. Evidence of relation with other variables was demonstrated with strong correlations between the QSI and measures of depression, hopelessness and borderline symptoms (r = .48 - .68). Conclusions: The results suggest that the QSI may be a reliable and valid method of assessing suicidal ideation in clinical populations.

The Moderating Role of Family Communication in Suicidal Ideation and Victimization in Adolescents

Tue, 05 Nov 2024 00:00:00 +0000

Background: Traditional peer victimization and cyber-victimization are predictive risk factors for suicidal behavior in adolescents. Family communication is a protective factor that has seldom been studied in the specific problem of suicidal ideation in adolescent victims of traditional victimization and cyber-victimization. The objective of the present study was to use two different moderated mediation models to analyze the direct and indirect—mediating—effects of traditional victimization and cyber-victimization on suicidal ideation in adolescents, as well as the moderating role of family communication in the relationships between traditional victimization, cyber-victimization, and suicidal ideation. Method: 1007 adolescents (51.9% boys) aged 12-18 years participated. Results: Significant direct and indirect effects of traditional victimization and cyber-victimization on suicidal ideation were confirmed. Family communication moderated the direct effects of cyber-victimization on suicidal ideation, but not the direct effects of traditional victimization on suicidal ideation. In addition, it moderated the relationship between traditional victimization and cyber-victimization. Conclusions: Family communication is a protective factor associated with decreased cyber-victimization in adolescents who suffer traditional victimization and reduced suicidal ideation in victims of cyber-victimization.

Suicidal Behaviour and Stressful Life Events: The Mediating Role of the Impulsivity-Aggression-Hostility Triad Through Psychological Autopsy

Tue, 05 Nov 2024 00:00:00 +0000

Background: Stressful life events (SLEs), impulsivity, aggression, and hostility are known risk factors for suicide. The existence of an “I-A-H Triad” (composed of impulsiveness, aggressiveness and hostility) is proposed as a mediating factor between SLEs and suicide. Method: Data on 399 deceased people (274 from suicide, 125 from other causes) were collected through psychological autopsy. The Paul Ramsey Life Experience Scale (to collect SLE history), the Barrat Impulsivity Scale (BIS-11) and the Buss-Durkee Hostility Inventory (BDHI) were applied, using versions adapted for psychological autopsy. Results: Comparative analysis of the two groups showed significant differences in the variables of interest (SLE: t = 7.280; BDHI: t = 4.201; BIS-11: t = 3.812; I-A-H Triad: t = 4.84). Mediation analysis confirmed the role of the I-A-H Triad in mediation of the presence of SLEs and the type of death. Conclusions: High levels of impulsivity, aggression, and hostility increase the risk of suicide when a person is faced with SLEs

Suicidal Behavior in Adolescents: An Ecological-Relational Study

Teresa I. Jiménez, Francisco Estévez-García2, Estefanía Estévez — Tue, 05 Nov 2024 00:00:00 +0000

Background: The present study analyzes factors of adolescents’ ecological-relational contexts in relation to suicidal behavior. In particular, it examined the role of peer bullying and cyberbullying, classroom climate, violence and partner victimization, parental socialization styles, and child-to-parent violence. Method: The participants are 2,977 Spanish adolescents attending seven secondary schools. They were aged 11-17 (M = 14.0, SD = 1.40; 51.5% girls). Multivariate logistic regression analyses and a two-step cluster analysis were applied to analyze the data. Results: Findings showed a prevalence of suicidal thoughts in 43.3% of the sample, with 7.7% reporting suicide attempts. Adolescents experiencing high/low victimization (ORa = 3.10, p < .001) and high cybervictimization (ORa = 1.67, p < .001) were at risk. However, high cyberbullying involvement (ORa = 0.55, p < .001) and not having a partner (ORa = 0.61, p < .001) emerged as protective factors. Sex-specific analyses underscored distinct interaction effects, with suicidal behavior in girls being significantly related to maternal negative socialization (ORa = 1.57, p = .05). Conclusions: An ecological- relational and sex approach is needed to understand and prevent suicidal behavior in adolescents.

Suicidal Behavior and Social Cognition: The Role of Hypomentalizing and Fearlessness About Death

Tue, 05 Nov 2024 00:00:00 +0000

Background: Suicide attempt (SA) lethality is associated with heightened suicidal desires and social cognition deficits. Fearlessness about death (FAD) and hypomentalizing may play a role in SA and self-harm. Although studies have identified relationships between these constructs, this line of research is still limited. We aimed to explore the mediating role of FAD and mentalizing between suicidal ideation and both SA lethality and self-harm. Method: 1,371 suicide attempters (70.1% women; M = 40 years) from seven Spanish hospitals participated. We used the Fearlessness About Death (ACSS-FAD) subscale, the Reflective Functioning Questionnaire-8 (RFQ-8), and the Columbia Suicide Severity Rating Scale (CSSRS). We conducted serial multiple mediation analyses with suicidal ideation as exposure; FAD and mentalizing as mediators; SA lethality and self-harm as outcomes. Results: Indirect effects were found of suicidal ideation on self-harm (B = 0.08, CI = 0.03-0.15) and SA lethality mediated by FAD (B = 0.02, CI = 0.001-0.04); indirect effects of suicidal ideation on self-harm through mentalizing (B = 0.10, CI = 0.04-0.167), and total indirect effects between suicidal ideation and self-harm through FAD and mentalizing (B = 0.18, CI = 0.11-0.27). Conclusions: Interventions addressing mentalizing and FAD may help reduce SA lethality and self-harm risk.