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Objective: Suicide is a leading cause of death, yet the accurate prediction of suicidal behavior is an elusive target for clinicians and researchers. The current paper examines the predictive validity of the Mini Neuropsychiatric Interview (MINI) Suicidality subscale for suicide attempts (SAs) for a homeless population with mental illness.Methods: Two thousand two hundred and fifty-five homeless individuals with mental illness across five Canadian cities enrolled in the At Home/Chez Soi Housing First trial interviewed at baseline using the MINI Suicidality subscale with 2-year follow-up of self-reported SAs.Results: Two thousand two hundred and twenty-one participants were included in the analysis. High rates of mood and substance use disorders were present (56.5% and 67.4%, respectively). The mean MINI Suicidality subscale score was 7.71. Among 1,700 participants with follow-up data, 11.4% reported a SA over the 2-year study period. MINI Suicidality subscale scores were predictive of SAs (AUC ≥ 0.70) among those with and without a history of SAs, even among those with missing answers. A positive predictive value of 0.20 and a negative predictive value of 0.95 were demonstrated, with a relatively low number needed to assess of 4.5-5.Conclusion: The MINI Suicidal subscale shows promise as an easy to use and accurate suicide risk prediction tool among homeless individuals with mental illness. [ABSTRACT FROM AUTHOR]

This paper reports an instance of mass suicide committed by seven members of a local religious cult following the leader's death in Japan in November 1986. The case is discussed from the following viewpoints: (1) a Japanese feudal form of suicide called Junshi; (2) religion and current social changes in Japanese society; and (3) the destructive aspects of a cult. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the longitudinal relationships between unit cohesion, Army leader behaviors, and subordinate suicidal/death ideation. Recent cross-sectional research indicates that subordinates who perceive that their leaders instill a sense of purpose regarding military service demonstrate less frequent suicidal ideation.Method: Five hundred fifty-nine soldiers completed self-report measures of perceptions of leadership behaviors, unit cohesion, and suicidal/death ideation during deployment as well as one and three months following deployment. Latent change score modeling was conducted to evaluate the course and direction of study variables as well as the relationship between them.Results: Although lower levels of suicidal/death ideation were related to leader-provided purpose, leader-provided meaning, and unit cohesion at baseline, only leader-provided purpose and unit cohesion prospectively predicted changes in suicidal/death ideation.Conclusions: Consistent with the goal of military leadership to augment effective clinical interventions that reduce suicide risk, prevention programs that reach a broader population of personnel should be considered. Enhanced leadership training may be an important primary prevention tool to reduce suicide risk that warrants further research. [ABSTRACT FROM AUTHOR]

Objective: To test the effectiveness of a male-targeted upstream public health intervention in increasing help-seeking intentions for mental disorders and suicide in an adolescent population.Method: A two-arm controlled trial was conducted with 10 schools in the Australian Capital Territory. A total of 594 male adolescents aged between 16 and 18 years participated in the study. Participants in the intervention condition received the single session Silence is Deadly program, while participants in the control condition completed usual classes. All participants completed a pre-intervention, post-intervention, and a 6- to 12-week follow-up survey assessing help-seeking intentions, attitudes, and behaviors.Results: At follow-up, the Silence is Deadly program was found to significantly increase help-seeking intentions from friends, which was in line with the program's messaging to seek help from and provide support to friends in times of distress or suicide risk. The program did not have an effect on help-seeking intentions for other sources of help or on help-seeking attitudes and behavior.Conclusions: The present study provides preliminary support for male-targeted public health interventions for suicide that use male-focused norming and role modeling to improve help-seeking in this population. [ABSTRACT FROM AUTHOR]

Objective: Crisis hotlines are an important part of a public health approach to suicide prevention. The Veterans Crisis Line (VCL) provides hotline services to Veterans. There is a paucity of research concerning the effectiveness of the VCL. The current work describes efforts to establish groundwork for VCL effectiveness research.Methods: 155 VCL users who were referred to a Veterans Affairs Medical Center Suicide Prevention Team completed interviews including open-ended and closed-ended questions. Outcomes are reported for suicidal participants, non-suicidal participants, and those who had emergency intervention. Thematic analysis was used for open-ended questions.Results: Eighty-seven percent of interviewees expressed satisfaction with the VCL, 81.9% reported that the VCL was helpful, and 72.9% said that the VCL helped keep them safe. Of those with suicidal thoughts, 82.6% said the contact helped stop them from killing themselves. Themes are described concerning user identified reasons for VCL contact, most and least helpful aspects of the contact, and suggestions for improvement.Discussion: This project demonstrates that this group of people who used the VCL overwhelmingly finds the service to be helpful and a barrier to suicide. Further, implications of user feedback for application to VCL operations and future research are discussed. [ABSTRACT FROM AUTHOR]

Objective: There is growing interest in the development of composite precision treatment rules (PTRs) to guide the selection of the treatments most likely to be helpful for individual patients. We present here the results of an effort to develop a preliminary PTR for Collaborative Assessment and Management of Suicidality (CAMS) relative to enhanced-care as usual based on secondary analysis of the Operation Worth Living (OWL) randomized controlled trial. The outcome of interest is eliminating suicide ideation (SI) within 3 months of initiating treatment.Method: A state-of-the-art ensemble machine learning method was used to develop the PTR among the n = 148 U.S. Soldiers (predominately male and White, age range 18-48) OWL patients.Results: We estimated that CAMS was the better treatment for 77.8% of patients and that treatment assignment according to the PTR would result in a 13.6% (95% CI: 0.9%-26.3%) increase in 3-month SI remission compared to random treatment assignment.Conclusions: Although promising, results are limited by the small sample size, restrictive baseline assessment, and inability to evaluate effects on suicidal behaviors or disaggregate based on history of suicidal behaviors. Replication is needed in larger samples with comprehensive baseline assessments, longer-term follow-ups, and more extensive outcomes. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to examine the prevalence of suicidal ideation, suicide attempts, and help-seeking attitudes among D/HH and hearing college students.Method: A total of 500,860 students completed the ACHA-NCHA-IIb (Fall 2011-Spring 2015). Survey administration and sampling methods differed across institutions. We randomly selected hearing students to have a 1:1 ratio of D/HH and hearing students (analytic N = 12,056). The mean age was 20.3 years, and the sample was predominantly white (68%) and female (65%). Multinomial and binary logistic regressions determined the relation between hearing status, suicide ideation and attempt, and help-seeking.Results: D/HH college students were more likely than hearing college students to have seriously considered suicide or attempted suicide in their lifetime. [Correction added on November 26, 2019, after first online publication: The phrase "but not in the past year" was deleted in the previous sentence.] In adjusted analyses, D/HH college students were more likely than hearing college students to have attempted suicide in the past year (OR 2.42, 95% CI 1.85, 3.17). There were no differences between D/HH and hearing groups in help-seeking attitudes.Conclusions: Findings from this national data set indicate that D/HH college students are more likely to consider or attempt suicide. These results underscore the need for focused suicide risk prevention interventions with this population. [ABSTRACT FROM AUTHOR]

Objective: Suicide prediction, prevention, and intervention are urgent research areas. One barrier for research with high-risk populations is limited resources to manage risk in a research setting. We describe using the University of Washington Risk Assessment Protocol (UWRAP) to assess and manage suicide risk during phone-administered eligibility assessments in two clinical trials.Method: Study 1 (N = 151) recruited suicidal adults who were not engaged in mental health treatment and Study 2 (N = 135) recruited suicidal adults who used alcohol to regulate emotions. Pre- and postassessment ratings of stress, urge to harm self, urge to use drugs/alcohol, and intent to harm self were compared and strategies to manage increased suicide risk following screening interviews were implemented, as indicated.Results: In both studies, average postassessment ratings were significantly lower than pre-assessment. A minority of participants reported higher ratings on one or more domains; however, following more thorough suicide risk assessment, risk was appropriately managed by providing low-level interventions (e.g., validation).Conclusions: Suicide risk in research involving community participants can be managed by using appropriate risk protocols. [ABSTRACT FROM AUTHOR]

Objectives: Internet- and mobile phone-based psychological interventions have the potential to overcome many of the barriers associated with accessing traditional face-to-face therapy. Self-injurious thoughts and behaviors (STB) are prevalent global health problems that may benefit from Internet- and mobile-based interventions. We provide a systematic review and meta-analysis of studies evaluating mobile- and Internet-based interventions for STB, including nonsuicidal self-injury (NSSI).Methods: Online databases (PsycINFO, Web of Science, Medline) were searched up to March 2019 for single-arm and controlled trials of Internet- or mobile-based interventions for STB. The potential for bias was assessed using the Cochrane risk of bias tool.Results: Twenty-two eligible trials were identified. The research was limited by a lack of controlled designs and small samples. Evidence supports the acceptability of interventions. There is preliminary evidence that these interventions are associated with a decline in STB. A meta-analysis suggested a positive treatment effect on suicidal ideation when compared to treatment as usual, but not when trials with active controls were also considered.Conclusions: Overall, Internet- and mobile-based interventions show promise and further controlled trials are warranted, focusing on behavioral outcomes (NSSI, suicidal behavior). This review was preregistered with PROSPERO (CRD42017074065). [ABSTRACT FROM AUTHOR]

Objective: The aim of the current study was to use a 23-item bank of self-reported symptoms of suicidal thoughts and behaviors to develop new brief measures of suicide risk using data-driven methods. Collectively referred to as the Rapid Measurement Toolkit for Suicidality (RMTS), the new brief static and adaptive measures would allow more efficient screening for suicide risk in clinical and research settings.Method: Data for the current study consist of 3,175 Australian adults who form the development sample and 3,755 Australian adults who form the validation sample. Both samples were independently recruited online using Facebook advertisements. Item response theory (IRT) was applied to the 23-item suicide item bank to develop a brief static dimensional measure and to simulate various computerized adaptive algorithms.Results: A 5-item brief static dimensional screener was developed, which performed as well as the commonly used Suicidal Behaviors Questionnaire-Revised (SBQ-R), with marginally greater sensitivity and more information across the continuum of suicidality. An adaptive screener required a mean of 6.2 items and correlated 0.98 with the full item bank.Conclusions: The RMTS provides reliable and valid brief static and adaptive screeners for the measurement of suicide risk in community, research, and clinical settings. [ABSTRACT FROM AUTHOR]

Objective: Firearms are a highly lethal and commonly used means of suicide. Firearm retailers may be an important group of community members to train as they guide sales and have conversations about firearm-related laws and safety issues with customers. This study presents findings from the largest survey to date of independently owned firearm retailers (n = 178) in Washington State with the goal of ascertaining the extent of willingness to engage in suicide prevention efforts and factors that may underlie willingness.Methods: Descriptive analyses and logistic regressions assess factors related to self-reported willingness to engage in suicide prevention activities guided by a well-tested theoretical model.Results: Respondents are unaware that suicide is the leading type of firearm fatality and have high levels of exposure to suicide in their personal and professional lives. The majority endorse a willingness to learn and engage in suicide prevention activities. Knowledge about warning signs of suicide and beliefs about the preventability of suicide are predictive of a willingness to engage in prevention efforts. Reluctance to discuss personal issues with customers is negatively associated with willingness to engage in prevention efforts.Conclusions: Suggestions for how to improve outreach to firearm retailers to enhance suicide prevention efforts are discussed. [ABSTRACT FROM AUTHOR]

Objective: Sexual and gender minority (SGM) adults often report a disproportionately high rate of suicidal ideation compared to their heterosexual and cisgender counterparts. The current study aimed to understand the relationship between discrimination for one's sexual orientation or gender identity and suicidal ideation. We hypothesized that discrimination would be associated with suicidal ideation at one's worst point through the indirect effects of hopelessness regarding thwarted belongingness and perceived burdensomeness.Method: A sample of 178 SGM adults (M age = 30.34, range 18-69; 76% white) completed an online questionnaire assessing minority-specific stressors and suicide-related thoughts and behaviors.Results: A mediation model with bootstrapping indicated that greater discrimination was associated with more frequent suicidal ideation at one's worst point through the indirect effect of hopelessness regarding thwarted belongingness.Conclusions: The current study provides evidence that the pathway between discrimination and worst point suicidal ideation may be partially explained by the perception that one will never belong. These findings support the utility of an understudied Interpersonal Theory of Suicide hypothesis for research among SGM adults. [ABSTRACT FROM AUTHOR]

Objective: This study examines the feasibility of a risk-management protocol for adolescent research participants at risk for suicide that relies on engagement with telephone crisis counselors. The study also examines whether engagement is moderated by adolescent demographics and clinical characteristics.Method: Participants were 234 adolescents (83% female; 63% White) ages 12-18 (M = 15.3 years) drawn from the national study, Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) Study One sample of adolescents randomized for 3-month telephone follow-up (n = 2,850). This study's sample was comprised of adolescents who completed the follow-up (69% retention), met study risk criteria, and were transferred to a crisis hotline for risk management. Engagement with a counselor was assessed by successful call connection, call duration, and information sharing.Results: Ninety-four percent of calls resulted in a successful call transfer, and the majority of youth (84%) shared information with counselor about one or more coping strategies. Average call length was 12.6 min (SD = 9.9). Engagement did not vary by gender, race, age, ethnicity, or clinical characteristics.Conclusions: Adolescents' engagement with telephone risk-management services was strong, suggesting that this strategy can address safety. Further, findings suggest telephone risk-management services effectively engage youth across demographic and clinical subgroups. [ABSTRACT FROM AUTHOR]

Objective: In recent years, rural areas have reported higher suicide rates than urban areas worldwide. Although agricultural activity is a key characteristic of many rural areas, rurality may also have heterogeneous qualities based on the type of agriculture pursued. However, to date, no study has examined potential linkages between suicide rate and types of agriculture.Method: In this study, we used 1983-2007 annual time-series data of the standardized mortality ratio (SMR) of suicide and product-specific agricultural outputs in Japanese municipalities to shed light on this phenomenon. We conducted a multilevel linear regression analysis, taking into account a hierarchical structure of the time-series data, limiting our analysis to municipalities where agricultural land use was high.Results: Our multilevel analysis showed that the animal husbandry output was positively associated with suicide SMR in both women and men, with a stronger relationship among women, whereas no association was observed in agricultural crop output. Temporal analysis showed that the association could be observed consistently throughout the period between 1983 and 2007.Conclusions: This study raises the possibility that the industrial and cultural characteristics of communities that rely on animal husbandry may be associated with an increased risk of suicide. [ABSTRACT FROM AUTHOR]

Background: The role of crisis hotlines traditionally was limited to de-escalation and service linkage. However, hotlines are increasingly recruited to provide outreach and follow-up to suicidal individuals. Hotlines have the opportunity to not just defuse current crises but also provide brief interventions to mitigate future risk. The Safety Planning Intervention (SPI) is a brief intervention designed to help manage suicidal crises, but its feasibility and effectiveness on hotlines are not established.Aims: This study examined feasibility and perceived effectiveness of SPI, as reported by 271 crisis counselors at five centers in the National Suicide Prevention Lifeline network.Method: Counselors were trained to use SPI. Self-report surveys were completed immediately after training (time 1) and at the end of the study, approximately 9 months later (time 2).Results: Counselors reported that SPI was feasible and helpful, and was used on both incoming and follow-up calls. Utilization and perceived effectiveness at time 2 were predicted by self-efficacy, feasibility, and helpfulness at time 1.Limitations: Results are preliminary and limited to counselors' perceptions. Future RCTs should establish efficacy of SPI for crisis callers.Conclusion: The Safety Planning Intervention is a promising approach to reduce crisis callers' future suicide risk that hotline counselors report is both feasible and helpful. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the efficacy of a problem-solving intervention for the prevention of suicidal risk in Brazilian adolescents with elevated suicidal potential and depressive symptoms.Methods: A randomized controlled trial was conducted involving 100 participants (mean age 17.2 years, 60% women, 46% mixed race), allocated to the problem-solving intervention (n = 50) or the usual care control group (n = 50). Blinded interviewers conducted assessments at pretreatment, posttreatment, 1, 3, and 6 months of follow-up. The main outcome was suicidal orientation; secondary outcomes were suicidal risk, suicidal plans and attempts, depressive symptoms, and problem-solving skills.Results: At posttreatment and up to 6-month follow-up, there was lower suicidal orientation and suicidal risk in the problem-solving group compared to the control group. There were lower suicidal plans and attempts (0.0% participants vs 2.2% with a suicide plan and 2.2% with both suicide plan and attempt); risk difference was 0.04 (95% CI: 0.01-0.09) and the number needed to treat was 25 (95% CI: 11-70). Significant effects of the intervention on depressive symptoms were found at posttreatment and maintained for 6 months. The change in global and functional problem-solving skills mediated the reduction in suicide orientation.Conclusions: Thus, suicidal risk can be successfully prevented in adolescents. [ABSTRACT FROM AUTHOR]

Objective: Opioid use disorders are associated with heightened suicidal ideation, suicide attempts, and suicide death. This study aimed to examine the extent to which opioid differentiates between those with suicide attempts from those with lifetime suicidal ideation but no history of attempt.Methods: Participants were drawn from the US National Guard and a residential substance use treatment facility. Multinomial logistic regression was utilized to determine the extent to which a lifetime history of nonmedical opioid use differentiated between (1) individuals with no lifetime history of suicidal ideation or attempt, (2) individuals with a history of suicidal ideation but no attempt, and (3) individuals with a history of at least one suicide attempt.Results: History of opioid use among National Guard personnel and opioid use disorders among substance-dependent patients were associated with an increased likelihood of having at least one suicide attempt relative to both a history of suicidal ideation but no attempts and no history of ideation or attempts. Findings held when accounting for lifetime nonmedical use of other substances and the presence of other lifetime substance use disorders.Conclusions: Results highlight the importance of assessing for suicide risk among opioid users. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and effectiveness of Kognito At Risk for College Students, an online, interactive suicide prevention gatekeeper training.Methods: In Study 1, a randomized controlled trial was conducted to test the efficacy of Kognito. Retention of participants at follow-up was strong. In Study 2, administrative records were used to follow the help-seeking behavior of Kognito trainees for one academic year, contrasted with untrained students.Results: In Study 1, between-group changes in gatekeeper attitudes were large at time-two, but attenuated modestly by 2-month follow-up. Kognito trainees referred more peers at 2-month follow-up (Cohen's d = .56, p < .05) - training 4 students in Kognito produces 1 more peer referred. In Study 2, the help-seeking rate of Kognito trainees (14.4%) was two-times the rate (6.8%) of untrained students (p < .001). Training 14 students in Kognito leads to 1 more self-referral to the Counseling Center.Conclusions: This first randomized controlled trial of the college student version of Kognito validates the findings of less rigorous studies. Few brief suicide prevention trainings have shown changes in trainee behaviors such as referrals of at-risk peers and trainees actual help-seeking behavior. These results are promising that Kognito may outperform other similar suicide prevention trainings. [ABSTRACT FROM AUTHOR]

Evidence for proximal risk factors for suicide is based on case-control psychological autopsy studies, with these reports showing that mood and substance use disorders are the most prevalent mental disorders among suicide decedents worldwide and are associated with marked risk. However, moderators of risk and the degree of risk associated with (nonalcohol) drug use disorder are unknown. A comprehensive search was used to identify 35 case-control psychological autopsy studies published worldwide over a 30-year period that were metaanalyzed using random effects models. Major depression, odds ratio (95% confidence interval) = 9.14 (5.53, 15.09), and drug use disorder, OR (95% CI) = 7.18 (3.22, 16.01), had large effect sizes, among other results. Risk estimates associated with major depression were greater in studies with a larger proportion of women and those conducted in Asia compared with other regions. There was no evidence of publication bias or that any one study had a disproportionate impact on findings. Risk for suicide associated with major depression appears to be moderated by sex and/or world region. Drug use disorder is a potent risk factor, illustrating the importance of assessing drug use in clinical risk assessment. [ABSTRACT FROM AUTHOR]

We report on associations of retrospectively reported temporally prior mental disorders and Army career characteristics with subsequent first onset of suicidal behaviors in a large, representative sample of US Army soldiers who participated in the Consolidated All-Army Survey of the Army Study to Assess Risk and Resilience in Servicemembers (N = 29,982). Results reveal that among men and women, all self-reported lifetime disorders measured (some assessed with screening scales) are associated with subsequent onset of suicide ideation. Among men, three disorders characterized by agitation and impulsiveness (intermittent explosive disorder, panic disorder, and substance disorders) predict the transition from suicide ideation to attempt. For both men and women, being in the Regular Army (vs. National Guard or Army Reserve) predicts suicide attempts in the total sample. For men, a history of deployment and junior rank are predictors of suicide attempts after adjusting for preenlistment disorders but not accounting for pre- and postenlistment disorders, suggesting that postenlistment disorders account for some of the increased suicide risk among these career characteristics. Overall, these results highlight associations between mental disorders and suicidal behaviors, but underscore limitations predicting which people with ideation attempt suicide. [ABSTRACT FROM AUTHOR]

Through a one-year follow-up design, this study examined whether distress tolerance would increase the risk for nonsuicidal self-injury (NSSI), mediated through depression in a representative sample of adolescents. Participants (N = 2,170) were recruited from senior high schools throughout Taiwan using both stratified and cluster sampling in time 1 (T1), and 1,832 students were followed-up one year later (T2). Structure equation modeling results revealed that after controlling NSSI measured at T1, NSSI (T2) was significantly predicted by distress tolerance (T1) and fully mediated through depression (T2). The mediating role of depression in the relationship between distress tolerance and NSSI are discussed. [ABSTRACT FROM AUTHOR]

Previous studies have failed to detect an iatrogenic effect of assessing suicidality. However, the perception that asking about suicide may induce suicidality persists. This meta-analysis quantitatively synthesized research concerning the iatrogenic risks of assessing suicidality. This review included studies that explicitly evaluated the iatrogenic effects of assessing suicidality via prospective research methods. Thirteen articles were identified that met inclusion criteria. Evaluation of the pooled effect of assessing suicidality with regard to negative outcomes did not demonstrate significant iatrogenic effects. Our findings support the appropriateness of universal screening for suicidality, and should allay fears that assessing suicidality is harmful. [ABSTRACT FROM AUTHOR]

Continuity of care for suicidal individuals engaged with a variety of health and mental health care systems has become a national priority, and crisis hotlines are increasingly playing a part in the risk management and continuum of care for these individuals. The current study evaluated a national initiative to have crisis centers in the National Suicide Prevention Lifeline network provide follow-up care to suicidal callers. Data were obtained from 550 callers followed by 41 crisis counselors from 6 centers. Two main data sources provided the information for the current study: a self-report counselor questionnaire on the follow-up activities completed on each clinical follow-up call and a telephone interview with follow-up clients, providing data on their perceptions of the follow-up intervention's effectiveness. The majority of interviewed follow-up clients reported that the intervention stopped them from killing themselves (79.6%) and kept them safe (90.6%). Counselor activities, such as discussing distractors, social contacts to call for help, and reasons for dying, and individual factors, such as baseline suicide risk, were associated with callers' perceptions of the impact of the intervention on their suicide risk. Our findings provide evidence that follow-up calls to suicidal individuals can reduce the perceived risk of future suicidal behavior. [ABSTRACT FROM AUTHOR]

Detecting suicide risk among nonclinical populations is challenging due to low base rates and the help-negation tendency of at-risk individuals. The current longitudinal study investigated the predictive validity of the modified emotional Stroop task (EST) by conducting a follow-up study of 197 students who participated in a study by Chung and Jeglic (2016). The EST latencies for suicide-related cues and past suicidal behaviors were the only significant predictors of suicide risk. The findings of this study provide preliminary support for the use of the EST as part of a suicide risk screening battery that could add to the detection of suicide risk. [ABSTRACT FROM AUTHOR]

Research since the 1960s has consistently found that lay volunteers are better at helping suicidal callers than professionals. Yet, professional degrees are increasingly becoming requirements for helpline workers. In our first study, we conducted post hoc comparisons of U.S. helplines with all professional paid staff, all lay volunteers, and a mix of both, using silent monitoring and standardized assessments of 1,431 calls. The volunteer centers more often conducted risk assessments, had more empathy, were more respectful of callers, and had significantly better call outcome ratings. A second study of five Quebec suicide prevention centers used silent monitoring to compare telephone help in 1,206 calls answered by 90 volunteers and 39 paid staff. Results indicate no significant differences between the volunteers and paid employees on outcome variables. However, volunteers and paid staff with over 140 hours of call experience had significantly better outcomes. Unlike the United States, Quebec paid employees were not required to have advanced professional degrees. We conclude from these results and previous research that there is no justification for requiring that suicide prevention helpline workers be mental health professionals. In fact, the evidence to date indicates that professionals may be less effective in providing telephone help to suicidal individuals when compared to trained lay volunteers. [ABSTRACT FROM AUTHOR]

The objective of this study was to identify factors associated with complete mental health among Canadians who had ever seriously considered suicide. Data for this study were obtained from Statistics Canada's 2012 Canadian Community Health Survey-Mental Health (N = 2,844). The outcome variable examined in this study was complete mental health and was analyzed using binary logistic regression. Of the 2,844 respondents with lifetime suicidal ideation, 1,088 (38.2%) had complete mental health (i.e., had flourishing mental health, no mental illness, and no suicidal ideation in the past 12 months). Those who had a confidant were seven times more likely to have complete mental health. Other factors associated with achieving complete mental health among formerly suicidal respondents include being older, being a woman, having higher income, use of religious coping, and never previously having a mental illness. Considering the importance of these protective factors in formulating public health policies will allow for a more wide-reaching approach to suicide prevention. [ABSTRACT FROM AUTHOR]

A total of 295 veterans who died by suicide in 2009 across 11 states and received Veterans Affairs (VA) health care in the 6 months prior to death were identified. The suicide risk factors documented and the care received at these veterans' last VA contacts are described, and the study explores whether veterans present differently to VA care (i.e., different risk factors documented or different care settings accessed) based on the proximity of their last contact to suicide. Many veterans were seen in primary care (n = 136; 46%) for routine follow-up (n = 168; 57%). Fifty-three (18%) were assessed for suicidal thoughts; 20 (38%) of whom endorsed such thoughts. Although higher frequencies of some risk factors at last contacts more proximal to suicide compared to those more distal were observed, findings overall highlight the challenges clinicians face detecting enhanced risk prior to suicide. [ABSTRACT FROM AUTHOR]

The national cost of suicides and suicide attempts in the United States in 2013 was $58.4 billion based on reported numbers alone. Lost productivity (termed indirect costs) represents most (97.1%) of this cost. Adjustment for under-reporting increased the total cost to $93.5 billion or $298 per capita, 2.1-2.8 times that of previous studies. Previous research suggests that improved continuity of care would likely reduce the number of subsequent suicidal attempts following a previous nonfatal attempt. We estimate a highly favorable benefit-cost ratio of 6 to 1 for investments in additional medical, counseling, and linkage services for such patients. [ABSTRACT FROM AUTHOR]

Chaplains play an important role in supporting the mental health of current and former military personnel; in this study, the engagement of Department of Veterans Affairs (VA), Army, Navy, and Air Force chaplains with suicidality among their service users were examined. An online survey was used to collect data from 440 VA and 1,723 Department of Defense (DoD) chaplains as part of the VA/DoD Integrated Mental Health Strategy. Differences were noted for demographics, work setting characteristics, encountering suicidality, and self-perceived preparation for dealing with suicidality. Compared to DoD chaplains, VA chaplains encounter more at-risk service users, yet feel less prepared for dealing with suicidality. [ABSTRACT FROM AUTHOR]

This randomized controlled trial was designed to evaluate the effectiveness of using crisis coping cards (n = 32) in the case management of suicide prevention compared with case management without the use of coping cards (n = 32) over a 3-month intervention period. The generalized estimating equation was used to examine the interaction effect between treatments and time on suicide risk, depression, anxiety, and hopelessness. Results indicated that subsequent suicidal behaviors, severity of suicide risk, depression, anxiety, and hopelessness were reduced more in the coping card intervention group compared to the case management only group. Moreover, for the survival curves of time to suicide reattempt, the coping card group showed a significantly longer time to reattempt than the case management only group at 2-month and 3-month intervention periods. [ABSTRACT FROM AUTHOR]

This study explored suicidal behavior in 291 adolescents who were using runaway shelters in St. Louis. Thirty percent of the runaways reported having attempted suicide in the past. The suicide attempters had significantly more behavioral and mental health problems, and reported having more family members and more friends with problems, than nonattempters. A logistic regression showed that youths' substance use, behavior problems, family instability, and sex all helped to explain their suicide attempts. Most of the attempters made their first attempt by their midteens. One-quarter made their latest attempt shortly before entering the shelter, and one-fifth stated that they would still consider suicide. The great majority of attempts were not preplanned, but one-third followed troubles or arguments at home and feelings of confusion and depression. Remarkably, half of the teenage suicide attempters never received any professional help following their attempt. [ABSTRACT FROM AUTHOR]