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Background: The period after psychiatric hospital discharge is one of elevated risk for suicide-related behaviors (SRBs). Post-discharge clinical outreach, although potentially effective in preventing SRBs, would be more cost-effective if targeted at high-risk patients. To this end, a machine learning model was developed to predict post-discharge suicides among Veterans Health Administration (VHA) psychiatric inpatients and target a high-risk preventive intervention., Methods: The Veterans Coordinated Community Care (3C) Study is a multicenter randomized controlled trial using this model to identify high-risk VHA psychiatric inpatients (n = 850) randomized with equal allocation to either the Coping Long Term with Active Suicide Program (CLASP) post-discharge clinical outreach intervention or treatment-as-usual (TAU). The primary outcome is SRBs over a 6-month follow-up. We will estimate average treatment effects adjusted for loss to follow-up and investigate the possibility of heterogeneity of treatment effects., Results: Recruitment is underway and will end September 2024. Six-month follow-up will end and analysis will begin in Summer 2025., Conclusion: Results will provide information about the effectiveness of CLASP versus TAU in reducing post-discharge SRBs and provide guidance to VHA clinicians and policymakers about the implications of targeted use of CLASP among high-risk psychiatric inpatients in the months after hospital discharge., Clinical Trials Registration: ClinicalTrials.Gov identifier: NCT05272176 (https://www., Clinicaltrials: gov/ct2/show/NCT05272176)., (© 2024 The Author(s). International Journal of Methods in Psychiatric Research published by John Wiley & Sons Ltd.)

Mobile crisis teams (MCTs) deploy clinicians to assist individuals in acute crisis in the community. Little is known about the extent to which these teams provide evidence-based practices (EBPs) for suicide prevention nor the barriers they face. We surveyed 120 MCT clinicians across the United States about their: (1) use of suicide risk screening and assessment tools; (2) strategies used to address suicide risk (both EBPs and non-EBPs); and (3) perceived barriers to high-quality MCT services. Nearly all clinicians reported use of validated suicide screening tools and generic "safety planning." However, a sizeable minority also reported use of non-EBPs. Open-ended responses suggested many client/family-, clinician-, and systems-level barriers to MCT use of EBPs for suicide prevention. We identified several targets for future implementation efforts, including the need for de-implementation strategies to reduce use of ineffective and potentially harmful practices, and unique aspects of MCTs that require tailored implementation supports., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Most patients with suicide risk do not receive recommendations to reduce access to lethal means due to a variety of barriers (e.g., lack of provider time, training). Determine if highly efficient population-based EHR messaging to visit the Lock to Live (L2L) decision aid impacts patient-reported storage behaviors. Randomized trial. Integrated health care system serving Denver, CO. Served by primary care or mental health specialty clinic in the 75-99.5th risk percentile on a suicide attempt or death prediction model. Lock to Live (L2L) is a web-based decision aid that incorporates patients' values into recommendations for safe storage of lethal means, including firearms and medications. Anonymous survey that determined readiness to change: pre-contemplative (do not believe in safe storage), contemplative (believe in safe storage but not doing it), preparation (planning storage changes) or action (safely storing). There were 21,131 patients randomized over a 6-month period with a 27% survey response rate. Many (44%) had access to a firearm, but most of these (81%) did not use any safe firearm storage behaviors. Intervention patients were more likely to be categorized as preparation or action compared to controls for firearm storage (OR = 1.30 (1.07-1.58)). When examining action alone, there were no group differences. There were no statistically significant differences for any medication storage behaviors. Selection bias in those who responded to survey. Efficiently sending an EHR invitation message to visit L2L encouraged patients with suicide risk to consider safer firearm storage practices, but a stronger intervention is needed to change storage behaviors. Future studies should evaluate whether combining EHR messaging with provider nudges (e.g., brief clinician counseling) changes storage behavior.ClinicalTrials.gov: NCT05288517., (© 2024. Society for Prevention Research.)

Objective: Suicide prevention campaigns commonly employ brief informational materials aimed at emerging adults. Are such programs helpful, and do design characteristics yield differences in user outcomes? Literature is reviewed from the interpersonal theory of suicide, escape theory, and terror management theory, to inform our experimental design., Method: Participants (n = 977 MTurk emerging adults) reported demographics and suicide histories and were randomized to one of nine experimental cells with varying video and journaling conditions to approximate suicide prevention materials. Participants were surveyed on perceptions of the materials' risk reduction effectiveness, indicated their suicidality risk factors (e.g., hopelessness, depressiveness, purposelessness, and non-belongingness), and conducted an implicit association test of suicidality., Results: Suicide risk factors did not differ between experimental and control conditions, but certain conditions were rated as more effective (i.e., essay conditions prompting reflection, and the video condition featuring a personal/affective narrative). While there was no actual comparative reduction of risk, there was a perception that certain designs were more helpful., Conclusion: Real-world suicide prevention campaigns often feel justified despite lacking impact. Effective suicide risk reduction requires greater time investment and deeper personal connection than brief campaigns can offer, as well as systemic changes from a public health policy perspective., (© 2022 The American Association of Suicidology.)

Objective: This study examines the association between a patient's suicide and the therapist's suicide risk assessment (SRA) and suicide risk management (SRM) of patients, following the occurrence., Method: SRA values range from "absence of suicidality" to "immediate suicidal intent to die". SRM consists of therapists' written recommendations. Rates of the various SRA and SRM values in therapists' evaluations were assessed 6-months prior to the suicide and at the two three- and six-month time-points thereafter., Results: Of the 150 soldiers who died by suicides, 30 (20%) visited 50 military therapists in the 6 months preceding their deaths. Using Wilcoxon signed rank test, lower SRA rates of "threatens suicide" were found 2 months after a patient's suicide. Regarding SRM, the mean rates for "recommendations for psychotherapy treatment" were higher at the two (p = 0.022) and the 3 month time-points (p = 0.031) after a suicide., Conclusions: The SRA findings may indicate therapists' fear of treating suicidal patients, causing them to overlook patients' non-prominent suicide-risk indicators. In SRM, the higher rate of recommendations for additional therapy sessions rather than military release or referrals to other therapists may relate to over-caution and attempts to control the patient's therapy ensuring it's done properly., (© 2022 American Association of Suicidology.)

Introduction: This meta-analysis aimed to test the efficacy of the Collaborative Assessment and Management of Suicidality (CAMS) intervention against other commonly used interventions for the treatment of suicide ideation and other suicide-related variables., Method: Database, expert, and root and branch searches identified nine empirical studies that directly compared CAMS to other active interventions. A random effects model was used to calculate the effect size differences between the interventions; additionally, moderators of the effect sizes were tested for suicidal ideation., Results: In comparison to alternative interventions, CAMS resulted in significantly lower suicidal ideation (d = 0.25) and general distress (d = 0.29), significantly higher treatment acceptability (d = 0.42), and significantly higher hope/lower hopelessness (d = 0.88). No significant differences for suicide attempts, self-harm, other suicide-related correlates, or cost effectiveness were observed. The effect size differences for suicidal ideation were consistent across study types and quality, timing of outcome measurement, and the age and ethnicity of participants; however, the effect sizes favoring CAMS were significantly smaller with active duty military/veteran samples and with male participants., Conclusions: The existing research supports CAMS as a Well Supported intervention for suicidal ideation per Center of Disease Control and Prevention criteria. Limitations and future directions are discussed., (© 2021 The American Association of Suicidology.)

Objective: The connection of individuals at elevated suicide risk to mental healthcare services represents a critical component of suicide prevention efforts. This article provides recommendations for enhancing the assessment of help-seeking and mental health service use within the context of suicide prevention research., Method: We discuss evidence-based and theoretical rationale for improving current approaches to assessing help-seeking and mental health service use among at-risk individuals., Results: Recommendations are offered within three domains: (a) consideration of the spectrum of connection to care, (b) assessment of the degree to which mental healthcare services seek to and effectively target suicidal symptoms, and (c) evaluation of the sources and types of treatment and care sought and received by at-risk individuals., Conclusions: To further our understanding of how to bolster connection to care and improve experiences with mental healthcare services among individuals at elevated suicide risk, it is imperative that stakeholders precisely capture the degree, efficacy/effectiveness, and nature of care sought and received by individuals. In so doing, research gaps might be better identified and, ultimately, mental healthcare services might be better leveraged as tools to prevent suicide and support individuals in creating lives they perceive to be worth living., (© 2020 The American Association of Suicidology.)

Objective: The fluid vulnerability theory of suicide posits that each person has a baseline risk for suicide, which is comprised of both stable and dynamic factors. The current study investigated the unique involvement of suicide-specific cognitions and attentional fixation on recent suicidal ideation (SI) and SI at its worst., Method: Data were analyzed from a sample of N = 126 undergraduate students with a history of SI. Path analyses were used to analyze the relationship between suicide-specific cognitions, attentional fixation, and SI (current and worst point)., Results: Results revealed that suicide-specific cognitions were directly related to both recent SI and worst-point SI. Suicide-specific cognitions had a significant, indirect effect with worst-point SI through attentional fixation, but this effect was not significant when using recent SI., Conclusion: These data support the need for interventions to target cognitive contents and contexts (e.g., fixation) to reduce escalation of SI. Future work would benefit from replicating and extending results in studies that include prospective designs and the assessment of suicidal behaviors., (© 2020 The American Association of Suicidology.)

Objective: Psychache has been proposed to cause suicide when it becomes unbearable. However, existing measures of psychache do not directly target unbearable psychache. Thus, the purpose of the current study was to provide initial validation for a brief measure of unbearable psychache., Method: Three items were selected to create the Unbearable Psychache Scale (UP3). Psychometric properties were assessed in two populations: (1) an online sample composed of 1,006 adults (53% male) from various locations in the United States and (2) a sample of 190 psychiatric inpatient adults (47% male) from a hospital in Western Canada., Results: In both samples, the UP3 demonstrated excellent internal reliability, and strong convergent and predictive validity. Additionally, the UP3 predicted significant variance in suicidal ideation over and above documented correlates of suicidal ideation including general psychache, hopelessness, perceived burdensomeness, and low belongingness., Conclusions: The UP3 is a brief, psychometrically sound measure of unbearable psychache that may be well-suited for use in research protocols and clinical assessments., (© 2019 The American Association of Suicidology.)

Ethical concerns frequently arise in suicide prevention research regarding participant safety and confidentiality. Despite a substantial literature on managing and navigating ethical concerns in suicide research, little attention has been paid to the reporting of ethical procedures. Furthermore, standard procedures for reporting ethical risk management procedures have not been developed. A review of the current literature was performed to examine the current state of reporting of ethical procedures within suicide research. Articles published in 2020 (N = 263) from three suicide-focused publications were screened and then coded (n = 131) to identify reporting of procedures for the ethical conduct of research and suicide risk management steps taken by the research teams. The majority of articles reported ethical review or approval (84.7%) and reported the use of an informed consent process (77.9%). Only 28.2% included risk mitigation procedures. Of those 29.7% of those articles reported conducting risk evaluation, 66.7% reported resource dissemination, and 51.4% reported an intervention. As empirical support for brief interventions accrues, suicide prevention researchers should consider establishing standards for the reporting of procedures to ensure the safety of participants with suicidal risk. Reporting suicide safety protocols helps ensure high ethical standards in research. Fewer than 1/3 of articles reviewed reported risk mitigation procedures in 2020. Standard procedures for reporting safety protocols in suicide research are needed. [ABSTRACT FROM AUTHOR]

Suicide prevention is an emotive, complex goal for clinicians and health systems. Effective interventions for suicidality do exist; however, many patients do not receive them because implementation efforts tend to be time-limited and unsystematic. Implementation science is the study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice. This narrative review introduces implementation science to suicide researchers, with a special focus on healthcare settings. We outline prominent theories, methods, and measures, as well as examples of implementation research from suicidology. By embracing the principles of implementation science, suicidologists can help to close the gap between evidence-based practice and routine practice, thereby improving the delivery and uptake of suicide-related interventions and prevention programs. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Suicide prevention is an international healthcare priority.There is an urgent need to use approaches that are helpful and follow research evidence.Safety planning is now widely used in suicide prevention; however, it was developed for use with adults, and little is known about its effectiveness for children/young people. What the paper adds to existing knowledge?: This systematic scoping review brings together all research evidence since 2008 that reported how effective safety planning is for children/young people.Findings highlight that when healthcare professionals help children/young people who are suicidal, they need to ensure that the safety plan is completed collaboratively with healthcare professionals and children/young people and that it is appropriate for their age and development.There is also need for healthcare professionals to better recognize and respond to the needs of parents/carers who are caring for a child/young person with suicidal ideations/behaviours. What are the implications for practice?: There is some research indicating that safety planning is effective for use with children/young people, but such evidence has primarily been obtained from females and there is need for more evidence from male study populations. Further research on its use is needed for certain groups of children/young people including those who are care experienced, or identify as lesbian, gay, bisexual and transgender.This review highlighted that healthcare professionals need specific training before they deliver safety planning for children/young people.It was identified that parents/carers have additional needs and should be involved in safety planning. An additional resource specifically for parents/carers should be developed. Introduction: Suicide is a leading cause of death for children and young people and its prevention is a global priority. Many Mental Health Services employ safety planning as a brief intervention. There is some evidence of safety planning effectiveness for adults, but little is known about its effectiveness with young people. Aim: To synthesize research reporting safety planning effectiveness for children/young people with suicidal ideation and identify good practice recommendations. Inclusion criteria: The review relates to safety planning around suicide prevention for children/young people aged less than 18 years, even if it was within a wider intervention. The review was inclusive of all clinical areas (including mental health, primary care, etc), any geographical location or social economic status and inclusivity around the method of delivery. Methods: A systematic scoping review of literature reporting effectiveness data for the use of safety planning with children/young people with suicidal ideation. The systematic scoping review protocol (pre‐registered with Open Science Framework) followed Joanna Briggs Institute conduct guidance and PRISMA‐ScR checklist. Data analysis and presentation: Fifteen studies were reported during 2008–2021. Overall, there is promising, but limited, evidence of effectiveness for safety planning for children/young people but with complete evidence gaps for some demographic sub‐groups. Evidence determined that healthcare professionals should deliver a safety planning intervention that is completed collaboratively, developmentally appropriate, and recognizes parental/carer involvement. Discussion and implications for practice: Further research is needed but current evidence suggests safety planning should be a routine part of care packages for children/young people with suicidal ideation proportionate to their needs. Developing/implementing these plans needs bespoke health professional training and additional support and resources for parents/carers should be developed. [ABSTRACT FROM AUTHOR]

Veterans are a group at increased risk for death by suicide. Veteran suicide is a complex multidetermined behavior, and preventing suicide among Veterans requires community collaboration and partnership to grow awareness, reduce stigma, and increase access to suicide prevention resources. This article discusses current theories of suicide including Joiner's (2005) Interpersonal Theory of Suicide and Klonsky & May's (2015) Three-Step Theory of Suicide as these theories relate to Veterans at risk for suicide. Discussion of the impacts of combat stress, traumatic brain injuries (TBI), military sexual trauma, and adverse childhood experiences (ACEs) are highlighted. Details of current clinical approaches that have been incorporated by the Veterans Health Administration (VHA) to reduce Veteran suicides are shared, including the Suicide Risk Identification Strategy (RISK ID), Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP), engagement with Suicide Prevention Coordinators, Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment (REACH VET), and the Veterans Crisis Line (VCL). Recommendations for Veteran suicide prevention strategies using a multipronged public health approach that combines both clinically-based and community-focused strategies are provided. [ABSTRACT FROM AUTHOR]

Introduction: Veteran suicide remains an ongoing public health concern in need of fresh, community‐based initiatives. The Department of Veterans Affairs (VA) has built an enterprise‐wide integrated behavioral health system that has pioneered numerous suicide prevention methods. However, most Veterans receive healthcare outside the VA, from organizations that may not be equipped to address Veteran suicide risk. One solution is implementing a VA/community suicide prevention learning collaborative to support organizations in implementing suicide prevention best practices for Veterans. Although learning collaboratives have a history of supporting improved patient safety in healthcare systems, to our knowledge, none have focused on Veteran suicide prevention. Method: The current quality improvement project sought to pilot a VA/community suicide prevention learning collaborative in the broader Denver and Colorado Springs areas with 13 organizations that served, interacted with, or employed Veterans. Results: The collaborative had a large footprint in the region, with organizations interacting with over 24,000 community members and over 5000 Veterans. Organizations implemented 92 Veteran suicide prevention program components within a 16‐month period. Overall, the learning collaborative made significant strides in Veteran suicide prevention. Conclusion: Findings suggest that this method facilitates rapid implementation of Veteran suicide prevention practices and may be promising for accelerating uptake within communities. [ABSTRACT FROM AUTHOR]

Implementation of evidence-based suicide prevention is critical to prevent death by suicide. Contrary to previously held beliefs, interventions including contracting for safety, no-harm contracts, and no-suicide contracts are not best practices and are considered contraindicated. Little is known about the current use of best practices and contraindicated interventions for suicide prevention in community settings. Data were collected from 771 individuals enrolled in a suicide prevention training. Both mental health clinicians (n = 613) and mental health allies (e.g., teachers, first responders) (n = 158) reported which best practices (i.e., safety plan, crisis response plan) and contraindicated interventions (i.e., contracting for safety, no-harm contract, no-suicide contract) they use with individuals who presents with risk for suicide. The majority of both mental health clinicians (89.7%) and mental health allies (67.1%) endorsed using at least one evidence-based practice. However, of those who endorsed using evidence-based interventions, ∼40% of both mental health clinicians and allies endorsed using contraindicated interventions as well. Contraindicated interventions are being used at high rates and suicide prevention trainings for evidence-based interventions should include a focus on de-implementation of contraindicated interventions. This study examined only a snapshot of what clinicians and allies endorsed using. Additional in depth information about each intervention and when it is used would provide helpful information and should be considered in future studies. Future research is needed to ensure only evidence-based interventions are being used to help prevent death by suicide. The majority of both mental health clinicians and mental health allies use evidence-based practices for suicide prevention. This indicates good implementation rates of evidence-based interventions for suicide prevention. Approximately 40% of both mental health clinicians and mental health allies who endorsed using evidence-based practices for suicide preventions also endorsed using contraindicated interventions. A focus on de-implementation of contraindicated suicide interventions is warranted and should be part of the focus on suicide prevention efforts. [ABSTRACT FROM AUTHOR]

People who self-harm frequently present to the emergency department (ED) and are treated by generalist healthcare staff with no specialist mental health training. We systematically reviewed (i) training interventions for generalist ED providers and (ii) psychosocial interventions delivered predominantly by generalist ED providers for people who self-harm. Five databases were searched for studies reporting on training interventions for generalist ED staff (at least 50% of the sample needed to be generalist ED staff) or psychosocial interventions for people who self-harm delivered predominantly by generalist ED staff. No limitations were placed regarding study design/country. Narrative synthesis was conducted. Fifteen studies from high-income countries were included. Nine studies of moderate methodological quality evaluated training for generalist ED providers (n = 1587). Six studies of good methodological quality evaluated psychosocial interventions for adults who self-harm (n = 3133). Only one randomized controlled trial was identified. Training was linked with pre-post improvements in staff knowledge, and less consistently with improvement in skills, attitudes, and confidence. Evidence on patient outcomes was lacking. Patient-level interventions involving common suicide prevention strategies—safety planning and follow-up contact—were consistently linked to pre-post reductions in suicide attempts. Effects on treatment engagement and psychiatric admissions were unclear. There is a clear need for further RCTs to improve the evidence base for ED generalist providers managing patients with self-harm. Evidence supports potential benefits of training for improving staff knowledge, attitudes, and skills, and of safety planning and follow-up contact for reducing repeat suicide attempts. More RCTs are needed to improve the evidence base for ED providers managing self-harm Safety planning and follow up contacts are linked to reductions in repeat suicide attempts Future research should investigate the impact of staff training on patient outcomes [ABSTRACT FROM AUTHOR]

Suicide is a major public health issue in the United States and schools of social work have an important role to play in educating future social workers in suicide prevention. This article describes the results of a survey of BSW and MSW practice instructors (N = 259) exploring the strategies used to teach suicide content, including resources used to support their teaching and assignments to evaluate student competency with suicide prevention knowledge and skills. Most instructors (74.1%) use written resources such as practice textbooks and journal articles to support their teaching, although there are some differences between the practices of BSW versus MSW instructors. Fewer (34.0%) used an assessment of student competency working with clients with suicidal thoughts and behaviors. Implications for social work practice instructors are described, including the need to stay current on best practices in suicide assessment and intervention, expand the use of written resources for diverse groups, the use of culture in suicide assessment, maintaining up-to-date, current resources for students, and developing assignments which can effectively evaluate student competency and skill working with clients with suicidal thoughts and behaviors. [ABSTRACT FROM AUTHOR]

Background: Autistic adults experience more frequent suicidal thoughts and mental health difficulties than non‐autistic adults, but research has yet to explain how these experiences are connected. This study explored how anxiety and depression contribute to suicidal thoughts according to the Interpersonal Theory of Suicide for autistic and non‐autistic adults. Methods: Participants (autistic adults n = 463, 61% female; non‐autistic n = 342, 64% female) completed online measures of anxiety, depression, thwarted belonging, and perceived burdensomeness. Network analysis explored whether: (i) being autistic is a risk marker for suicide; and (ii) pathways to suicidal thoughts are consistent for autistic and non‐autistic adults. Results: Being autistic connected closely with feeling like an outsider, anxiety, and movement, which connected to suicidal thoughts through somatic experiences, low mood, and burdensomeness. Networks were largely consistent for autistic and non‐autistic people, but connections from mood symptoms to somatic and thwarted belonging experiences were absent for autistic adults. Conclusion: Autistic people experience more life stressors than non‐autistic people leading to reduced coping, low mood, and suicidal thoughts. Promoting belonging, reducing anxiety, and understanding the role of movement could inform suicide prevention for autistic people. Research should accurately capture autistic lived experience when modeling suicide to ensure suicide prevention meets autistic needs. [ABSTRACT FROM AUTHOR]

Introduction: There is little known about the clinicians' experience of collaboration using the Collaborative Assessment and Management of Suicide (CAMS) framework. This study aimed to give voice to the clinician experience. Method: A qualitative design utilised semi-structured interviews with ten psychologists who worked in a Suicide Assessment and Treatment Service (SATS) in Ireland which utilises the CAMS framework. Results: An Interpretative Phenomenological Analysis (IPA) approach revealed several important findings. The superordinate themes included 'Finding Safety', 'Regulation of the Self', 'Connecting', and 'Systemic Challenges'. Discussion: The CAMS framework plays an important role in providing a safe base for the clinician (in terms of understanding suicidality, in addition to the structures of the framework). It provides a mechanism in which to process difficult emotions, and a way of communicating a formulation of suicide to the treating team. Importantly, the CAMS emerged as facilitating a collaborative, therapeutic way of working. [ABSTRACT FROM AUTHOR]

This quality improvement activity examined Safety Planning Intervention (SPI) over two 3-monthly periods for presentations from 13–17-year-olds with suicidal risk to a regional hospital Emergency Department (ED). We collected patient demography, presentation characteristics, presentation rate, and clinician use of SPI, including those under Emergency Examination Authorities (EEAs). An education workshop was offered between the audits, aimed to increase clinician (social work, psychology, nursing, and psychiatry) knowledge of SPIs. The annual ED presentation rate for suicide risk for 15–17-year-olds was 1,520 per 100,000 persons. More presentations were female, non-Indigenous persons, and fewer than half presented voluntarily. Most presentations were for suicide attempt followed by suicide threat. In the first audit clinicians initiated SPIs in fewer than 50% of cases and completed SPIs in 15%. Whereas in the second audit where SPIs were initiated by clinicians in 69% of cases and fully completed in 49%, less than half the presentations with EEAs received a completed SPI. Indigenous persons, although a lower proportion of presentations, were overrepresented for the population. Following the education workshop, there was an improvement in SPI completion, reflecting the benefits of education and training to clinical staff. Lastly, this study highlights the benefit of conducting audits as quality improvement activities for patient care. IMPLICATIONS The international literature indicates an increase in child and youth suicide attempts. This increase requires preparedness from social workers and other clinicians (psychology, nursing, and psychiatry) who offer front-line healthcare for these presentations. Safety plans are best-practice and tailored strengths-based plans undertaken between a clinician and client so that the client feels confident knowing where to go and to whom to talk to avoid further suicide attempts. Social workers play an important role in undertaking safety plans with clients (especially those who are particularly vulnerable) in hospital and community settings to maximise client outcomes. [ABSTRACT FROM AUTHOR]

Schools in the United States increasingly incorporate social–emotional learning (SEL) as a part of comprehensive youth suicide prevention programs in schools. We reviewed the literature to investigate the inclusion of SEL in youth suicide prevention efforts. We identified several known risk factors to youth suicide, namely, hopelessness, anxiety, substance use, and child sexual abuse, then cross-walked that review to SEL competencies shown to mitigate each of those known risk factors. We found all SEL competencies, to some extent, across all the evidence-based, school-based youth suicide prevention programs we identified. Further, we found that all five SEL competencies are shown directly to address and mitigate the major, known risk factors for youth suicide. These findings suggest that SEL can play a productive role in upstream youth suicide prevention. State-level policy makers and school administrators should consider the inclusion of evidence-based SEL in efforts to address youth suicide prevention. [ABSTRACT FROM AUTHOR]

There are currently no national data regarding U.S. Primary Care Physicians' (PCPs') suicide screening practices. This study surveyed 302 U.S. PCPs about their current suicide screening practices to identify service gaps and intervention points for social workers. Although one-third of PCPs reported providing screening and safety planning, few were using evidence-based tools. Factors that increased the likelihood of routine screening were belief in the importance of screening (p <.01), time (p <.01), and access to co-located behavioral health (p <.01). Findings support the role of social workers in primary care and suggest areas for training and collaboration. [ABSTRACT FROM AUTHOR]

Suicide risk screening depends heavily on accurate patient self-report. However, past negative experiences with mental health care may contribute to intentional nondisclosure of suicide risk during screening. This study investigated among 282 men older than age 50 whether likelihood for current explicit risk nondisclosure was associated with previous highest level of mental health care received. This sample was selected post hoc out of a larger sample of participants from higher risk and lower help-seeking populations (i.e., military service members and veterans, men older than age 50, and lesbian gay bisexual, transgender, and queer young adults), however, the other groups were underpowered for analysis. Among these men, history of psychiatric hospitalization was significantly associated with likelihood for explicit nondisclosure of current suicide risk, while history of receiving only outpatient therapy for suicidal thoughts or behaviors was significantly associated with likelihood for full reporting of suicide risk. Severity of suicidal ideation and internalized stigma against mental illness were significant indirect contributors to the effect. Although causality could not be determined, results suggest that a potential cost to consider for psychiatric hospitalization may be future nondisclosure of suicide risk. Conversely, outpatient interventions that appropriately manage suicidal thoughts or behaviors may encourage future full reporting of suicide risk and improve screening detection. [ABSTRACT FROM AUTHOR]

A gap between psychotherapy research and practice exists, and many social workers may not be informed about evidence-based techniques used in cognitive behavioral therapy (CBT) for suicide prevention. Therefore, the purpose of this brief article is to introduce social workers to CBT targeting suicide risk in both outpatient and inpatient settings. Three clinical techniques incorporated into CBT for suicide are introduced: hope building, social support, and lethal means counseling. Practical tips, resources, and recommendations are offered to empower social workers to integrate these clinical tools into their current practice when working with clients at risk for suicide. [ABSTRACT FROM AUTHOR]

This PRISMA scoping review explored worldwide research on the delivery of suicide-specific interventions through an exclusive telehealth modality. Research over telehealth modalities with suicidal individuals highlights the importance of facilitating participants' access to treatments despite location and circumstances (e.g., rural, expenses related to appointments, etc.). The review sought evidence of outcomes of trials or projects in which both the patient and therapist attended sessions conjointly and openly discussed suicide over a telehealth modality (e.g., phone, zoom). To explore this topic the authors searched for research trials and quality improvement projects using Ovid Medline, Ovid Embase, Ovid PsycINFO, EBSCO Social Services Abstracts, and Web of Science on 3/3/2021. Nine different articles were included that each spanned distinct treatments, with eight being research studies and one being a quality improvement project. Publications featuring ongoing or upcoming research in which complete study results were not available did not meet inclusion criteria for this review. Several important research gaps were identified. While this approach has been largely understudied, exclusive telehealth delivery of suicide-specific interventions has great potential for the prevention of suicidality, especially in the era of COVID-19 and beyond. [ABSTRACT FROM AUTHOR]

Suicide and self-harm are widespread yet underreported. Risk assessment is key to effective self-harm and suicide prevention and management. There is contradicting evidence regarding the effectiveness of risk assessment tools in predicting self-harm and suicide risk. This systematic review examines the effect of risk assessment strategies on predicting suicide and self-harm outcomes among adult healthcare service users. Electronic and gray literature databases were searched for prospective research. Studies were screened and selected by independent reviewers. Quality and level of evidence assessments were conducted. Due to study heterogeneity, we present a narrative synthesis under three categories: (1) suicide- and self-harm-related outcomes; (2) clinician assessment of suicide and self-harm risk; and (3) healthcare utilization due to self-harm or suicide. Twenty-one studies were included in this review. The SAD PERSONS Scale was the most used tool. It outperformed the Beck Scale for Suicide Ideation in predicting hospital admissions and stay following suicide and self-harm, yet it failed to predict repeat suicide and self-harm and was not recommended for routine use. There were mixed findings relating to clinician risk assessment, with some studies recommending clinician assessment over structured tools, whilst others found that clinician assessment failed to predict future attempts and deaths. There is insufficient evidence to support the use of any one tool, inclusive of clinician assessment of risk, for self-harm and suicidality. The discourse around risk assessment needs to move toward a broader discussion on the safety of patients who are at risk for self-harm and/or suicide. There is insufficient evidence to support using standalone risk assessment tools. There are mixed findings relating to clinician assessment of risk. Structured professional judgment is widely accepted for risk assessment. [ABSTRACT FROM AUTHOR]

The safety planning intervention (SPI) is gaining momentum in suicide prevention practice and research. This systematic review sought to determine the effectiveness of the SPI for adults experiencing suicide-related distress. Systematic searches of international, peer-reviewed literature were conducted in six databases (Cochrane Trials, Embase, Emcare, Medline, PsycINFO and Web of Science), including terms for safety planning, suicide, and suicide-related outcomes. A total of 565 results were included for screening. Result screening (title/abstract and full-text), data extraction and critical appraisal were conducted in duplicate. Twenty-six studies met the inclusion criteria. Studies were primarily quantitative (n = 20), largely with general adult or veteran samples; a small number of studies explored the perspectives of staff and significant others. Half of the studies included the SPI as a standalone intervention, while the other half examined the SPI in combination with other interventions. Most interventions were delivered in-person, with a hard-copy safety plan created, while a smaller number explored internet-based interventions. Primary measures included: suicidality (ideation, behavior, deaths; 10 studies), suicide-related outcomes (depression, hopelessness; 5 studies) and treatment outcomes (hospitalizations, treatment engagement; 7 studies). The evidence supports improvements in each of these domains, with complementary findings from the remaining quantitative and qualitative studies suggesting that the SPI is a feasible and acceptable intervention. While positive, these findings are limited by the heterogeneity of interventions and study designs, making the specific impact of the SPI difficult to both determine and generalize. Conversely, this also points to the flexibility of the SPI. The Safety Planning Intervention (SPI) is a valuable indicated intervention for general adult and veteran populations experiencing suicide-related distress, primarily in face-to-face, clinical settings. Quantitative findings indicate associations between the SPI and improvements in suicidal ideation and behavior, decreases in depression and hopelessness, along with reductions in hospitalizations and improvements in treatment attendance. Qualitative studies suggest the SPI is acceptable and feasible, with areas for development. SPIs have been shown to be adaptable to the clinical area in its modality (digital or paper-based), delivery (face-to-face or online), facilitation (clinician or self-administered) and multiplicity (as stand-alone or combined intervention). [ABSTRACT FROM AUTHOR]

Suicide rates continue to rise, and clinicians and mental health staff play a critical role in keeping suicidal clients safe. Safety planning, including means safety, may help to decrease suicide risk. Unfortunately, availability and evaluation of safety planning training for these providers are scarce. The goal of the present study was to evaluate a safety planning training, LINC to LIFE Safety Planning (L2L SP). L2L SP is a 150-minute, face-to-face training program that teaches providers to engage clients in collaborative safety planning and means safety efforts, facilitate diverse client coping strategies, problem-solve, and involve close others, among other skills. These objectives are achieved through interactive content delivery, role-play, and corrective feedback. L2L SP was administered to 95 participants. Key determinants of behavioral change (e.g., knowledge, attitudes, perceived behavioral control [PBC]) were measured at pre, post, and six-month follow-up. Additionally, participants' behaviors and emotions in working with suicidal clients were measured at pretest and six-month follow-up. Paired sample t-tests, repeated measures MANOVA, and univariate ANOVAs with post-hoc testing using Bonferroni correction were conducted. Results supported significant improvements in knowledge, PBC, and intentions at post-test, and attitudes, PBC, and effective emotional responses at follow-up. Exploratory analyses suggested significant improvements in behaviors among clinicians and mental health staff who saw clients reporting suicidal ideation. The present study provides promising results regarding brief safety planning training. Declines in knowledge and PBC following the training highlight the potential need for booster sessions or more intensive initial training in these areas. The present study evaluated a comprehensive, interactive safety planning training. Knowledge, PBC, and intentions were significantly improved at post-test. Attitudes, PBC, and emotions were significantly improved at follow-up. [ABSTRACT FROM AUTHOR]

Few models consider if and how positive psychological resources mitigate suicide risk in rural sexual minorities (SM). The purpose of the current study was to determine whether positive emotions can offset the relationships between thwarted interpersonal need and suicidal behaviors. Data were collected from rural SM (N = 211). Positive emotions moderated the association between thwarted interpersonal needs and suicidal behaviors; the relationship was nullified at higher levels of positive emotions. Our findings offers preliminary evidence for positive emotions as a protective factor to suicide and provides some insights for using positive psychological interventions in suicide prevention efforts. [ABSTRACT FROM AUTHOR]

Human trafficking survivors experience elevated suicide risk in comparison to the general population. Anti-trafficking service providers in the Philippines have identified capacity building in suicide prevention as a critical priority given the insufficient number of trained mental health professionals and lack of culturally adapted evidence-based interventions in the Philippines. We conducted a focused ethnography exploring the experiences of non-mental health professionals working in the anti-human trafficking sector in the Philippines in responding to suicidality among survivors of human trafficking (n = 20). Themes included: emotional burden on service providers, manifestations of stigma regarding suicide, lack of clarity regarding risk assessment, lack of mental health services and support systems, transferring responsibility to other providers, and the need for training, supervision, and organizational systems. We discuss implications for training service providers in the anti-human trafficking sector, as well as cultural adaptation of suicide prevention interventions with human trafficking survivors in the Philippines. [ABSTRACT FROM AUTHOR]

Lethal means safety is an effective suicide prevention strategy with demonstrated results at the population level, yet individual-level uptake is less well understood. Using automated data extraction methods, we conducted an investigation of electronic health records from psychiatric emergency service (PES) patients from January 1, 2012 to December 31, 2017 at a busy urban medical center in the Pacific Northwest. At each PES mental health evaluation, every patient received a Suicide Risk Assessment during which providers used an electronic template with standardized fields to record lethal means access and other suicide risk factors. We assessed 32,658 records belonging to 15,652 patients. Among all visits, 69.9% (n = 22,824) had some documentation of lethal means assessment. However, 54.1% (n = 17,674) of all visits lacked some or all potential documentation detail. Additionally, among 59.6% of visits in which a patient had documented access to lethal means, the specific means available were not indicated. Across the twenty risk and demographic factors we assessed, the prevalence of documentation did not vary by any given risk factor and only varied minimally by age and race. For example, when comparing visits which indicated family history of suicide to those which indicated no family history of suicide, the prevalence ratio was 0.99 (95% CI: 0.95, 1.03). Despite the high-risk patient population, mental health focus of the facility, and the presence of a standardized tool, lethal means documentation was suboptimal. In alignment with recent recommendations, our findings indicate that additional focus on implementation is needed to improve documentation of lethal means assessment. Fifteen times larger than prior comparable studies Findings demonstrate persistent under-documentation patterns in new setting and region Standardized methods likely needed to improve documentation detail and frequency [ABSTRACT FROM AUTHOR]

This article aims to investigate helpful relationship characteristics in suicide attempt health care. Semistructured interviews with seven participants (five women and two men; meanage = 26) were conducted after a suicide attempt. All participants took part in the Attempted Suicide Short Intervention Program (ASSIP). Findings revealed the necessity of an egalitarian, attentive, benevolent, and competent relationship with health-care specialists. Coercive clinical management was considered disrespectful, while the needs for physical safety and freedom were expressed. A suicide-specific treatment program in addition to standard care was considered helpful, in particular the development of warning signs and safety strategies. [ABSTRACT FROM AUTHOR]

Aim: Brief screening and predictive modeling have garnered attention for utility at identifying individuals at risk of suicide. Although previous research has investigated these methods, little is known about how these methods compare against each other or work in combination in the pediatric population. Methods: Patients were aged 8–18 years old who presented from January 1, 2017, to June 30, 2019, to a Pediatric Emergency Department (PED). All patients were screened with the Ask Suicide Questionnaire (ASQ) as part of a universal screening approach. For all models, we used 5‐fold cross‐validation. We compared four models: Model 1 only included the ASQ; Model 2 included the ASQ and EHR data gathered at the time of ED visit (EHR data); Model 3 only included EHR data; and Model 4 included EHR data and a single item from the ASQ that asked about a lifetime history of suicide attempt. The main outcome was subsequent PED visit with suicide‐related presenting problem within a 3‐month follow‐up period. Results: Of the N = 13,420 individuals, n = 141 had a subsequent suicide‐related PED visit. Approximately 63% identified as Black. Results showed that a model based only on EHR data (Model 3) had an area under the curve (AUC) of 0.775 compared to the ASQ alone (Model 1), which had an AUC of 0.754. Combining screening and EHR data (Model 4) resulted in a 17.4% (absolute difference = 3.6%) improvement in sensitivity and 13.4% increase in AUC (absolute difference = 6.6%) compared to screening alone (Model 1). Conclusion: Our findings show that predictive modeling based on EHR data is helpful either in the absence or as an addition to brief suicide screening. This is the first study to compare brief suicide screening to EHR‐based predictive modeling and adds to our understanding of how best to identify youth at risk of suicidal thoughts and behaviors in clinical care settings. [ABSTRACT FROM AUTHOR]

Objective: Suicide rates have been of increasing concern across the United States, particularly among military veterans. The Veterans Health Administration has initiated multiple suicide prevention initiatives, but little research has examined the impact of these programs. The purpose of this study was to test the hypothesis that more frequent contact with suicide prevention clinicians would predict lower odds of suicidal behavior.Method: Retrospective medical record review was performed for 1364 veterans identified as high risk for suicide during 2012-2018. Logistic regression was used to test whether the number of suicide prevention contacts predicted the odds of suicide attempt, any self-directed violence, or reactivation of high-risk status in the next year, accounting for age, sex, length of high-risk episode, and other mental health contacts.Results: Each additional suicide prevention coordinator contact was associated with 4%-5% lower odds of suicide attempt, suicidal behavior, and reactivation of high-risk status in the next year (ps < 0.05). For suicide attempt and self-directed violence, associations were stronger when considering only initial high-risk episodes (8%-10% lower odds, ps < 0.05).Conclusions: Findings suggest ongoing support from suicide prevention clinicians can have a significant protective effect. Additional research is needed to identify mechanisms by which this support reduces risk. [ABSTRACT FROM AUTHOR]

In this article, we describe the Stanford Crisis Clinic protocol, a brief, evidence-informed clinical service that we developed to address the barriers to care for youth with SITBs in our local community. The Crisis Clinic is housed within the larger general outpatient child and adolescent psychiatry clinic run by the Division of Child and Adolescent Psychiatry and Child Development, in the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine. The general child and adolescent outpatient clinic provides mental health services primarily to residents of Santa Clara and San Mateo Counties in the state of California. Both are large, ethnically and economically diverse counties that are home to Silicon Valley and part of the larger San Francisco Bay Area. The clinic conducts approximately 20,542 patient visits, receives approximately 3500 new referrals, and sees over 2000 new patients each year across several sub-specialty clinics within the larger general clinic. The clinic is one of the few that accept private insurance in the local area; hence, the demand often exceeds the supply of providers and wait times are typically several months long. The clinic does not currently serve clients with public insurance (i.e., MediCal). For the Crisis Clinic, our goal was to create a time-limited program, consisting of evidence-based safety interventions and best-practice recommendations, in order to treat as many youth with SITBs seeking treatment at Stanford as possible. [ABSTRACT FROM AUTHOR]

Suicide-related coping refers to strategies for adaptively managing suicidal urges and can be important an important factor for assessing risk and targeting intervention. The current study evaluated whether suicide-related coping predicted a suicidal event within 90-days, independently of other known risk factors. Veterans (N = 64) were evaluated shortly after a suicidal crisis and completed several assessments, including a measure of suicide-related coping. Multivariate analyses showed that suicide-related coping remained protective of a suicidal event (OR = 0.93; p = .047) after adjusting for suicidal ideation, previous suicide attempts, mood disorder, distress tolerance, and gender. Suicide-related coping may augment commonly assessed clinical factors in prediction of a suicidal event and is a suitable target for suicide prevention efforts. [ABSTRACT FROM AUTHOR]

Objective: As suicide risk screening becomes more common in healthcare settings, geospatial coding of behavioral health data may offer a means for identifying areas of elevated suicide risk for use in public health prevention efforts. The present study demonstrates an analytic approach for using universal suicide risk screening data to identify areas of elevated suicide risk.Method: Data were drawn from standard suicide risk screens recorded in electronic health records of a large pediatric emergency department. A total of 12,400 suicide risk screening responses were recorded, among youth aged 11-19 years (mean = 14.60, SD = 2.16; 57.2% girls, 47.8% Hispanic/Latinx, 72.1% White). A total of 86 unique ZIP codes had at least 50 completed screens, representing 9139 respondents.Results: Rates of positive screens ranged from 6.17% to 31.03% (mean = 18.33, SD = 5.14) for any suicide-related behavior and from 0.0% to 19.61% (mean = 9.14, SD = 3.43) for suicide attempt. Rates of positive screens approximated a normal distribution.Conclusions: Results demonstrated several areas with elevated rates of positive suicide risk screens, within the hospital catchment area. The proposed method capitalizes on large-scale screening data, provides an estimate of areas of relative increased risk, and may be used to inform public health responses to suicide prevention. [ABSTRACT FROM AUTHOR]

Suicide-related behaviors are over-represented among youth with autism spectrum disorder (ASD). A more thorough understanding of the connections between ASD and suicide-related behaviors may help to identify potential avenues for prevention efforts and can inform clinical care for youth with ASD. This manuscript presents a conceptualization of suicide risk among youth with ASD based on the Interpersonal Theory of Suicide, in order to spur discussion and future research. This manuscript also provides preliminary clinical recommendations for improving suicide prevention efforts among youth with ASD based on hypothesized risk and protective factors. [ABSTRACT FROM AUTHOR]

Suicide is the second leading cause of death among adolescents worldwide, yet adequate mental health services for children and adolescents are lacking across the globe. Likewise, youth who engage in non-suicidal self-injury (NSSI) are at heightened risk for suicide, but few pediatric settings have established protocols for screening and responding to youth who engage in NSSI and/or endorse thoughts of suicide. In this article, we highlight similarities and differences of managing suicide and NSSI across cultures, including persisting stigma associated with youth at risk for self-harm. We summarize current guidelines for screening youth at risk for suicide and NSSI across services, consider the use of online and telehealth services, and offer recommendations for a multidisciplinary approach to treating youth who engage in self-harming behaviors as well as how healthcare professionals can communicate with each other using common, non-stigmatizing language. We conclude with a discussion of future policy recommendations and areas for research. [ABSTRACT FROM AUTHOR]

The collaborative assessment and management of suicidality (CAMS) serves as a framework for maintaining a collaborative relationship between the therapist and patient. This study used an original coding manual to examine responses to open-ended questions to better understand the ways in which therapists use CAMS collaboratively as well as their reasons for adhering (or not adhering) to certain aspects of the framework. Results suggest differences in treatment application based on therapist characteristics including amount of experience, intensity of training received, and experience of a patient suicide attempt. Implications of this research include informing therapists interested in using the CAMS framework about the specific ways in which implementation can be made collaborative. Further, this research helps to shed light on how experiencing a client's death by suicide can impact therapists' future work with suicidal clients. [ABSTRACT FROM AUTHOR]

The completed suicide of a patient represents a critical event for any nurse who was in charge of or had some contact with the individual or their family. Nurses may blame themselves and experience feelings of worthlessness associated with their inability to prevent the patient's death. One way to prevent an attempted or completed suicide on the inpatient unit is to educate psychiatric nursing personnel in suicide prevention. The focus of the current article is to present and discuss the unique issues faced by nursing educators in Egypt and whether the education and training of nurses employed at a rural hospital in Egypt would be a useful step toward mitigating these high-risk behaviors and lethal actions. [The completed suicide of a patient represents a critical event for any nurse who was in charge of or had some contact with the individual or their family. Nurses may blame themselves and experience feelings of worthlessness associated with their inability to prevent the patient's death. One way to prevent an attempted or completed suicide on the inpatient unit is to educate psychiatric nursing personnel in suicide prevention. The focus of the current article is to present and discuss the unique issues faced by nursing educators in Egypt and whether the education and training of nurses employed at a rural hospital in Egypt would be a useful step toward mitigating these high-risk behaviors and lethal actions. [Journal of Psychosocial Nursing and Mental Health Services, 58(5), 32–38.] [ABSTRACT FROM AUTHOR]

OBJECTIVE: To understand the extent to which implementation of evidence-based practices affects emergency department (ED) nurse managers' perceptions of quality of care provided to deliberate self-harm patients. METHODS: ED nursing leadership from a nationally representative sample of 513 hospitals completed a survey on the ED management of deliberate self-harm patients, including the quality of care for deliberate self-harm patients on a 1 to 5 point Likert-type scale. Unadjusted and adjusted analyses, controlling for relevant hospital characteristics, examined associations between the provision of evidence-based practices and quality of care. RESULTS: The overall mean quality rating was 3.09. Adjusted quality ratings were higher for EDs that routinely engaged in discharge planning (β = 0.488) and safety planning (β = 0.736) processes. Ratings were also higher for hospitals with higher levels of mental health staff (β = 0.368) and for teaching hospitals (β = 0.319). CONCLUSION: Preliminary findings suggest a national institutional readiness for further implementation of evidence-based practices for deliberate self-harm patients. [ABSTRACT FROM AUTHOR]

Suicide safety planning is an intervention to assist individuals with suicide ideation in maintaining safety during a suicidal crisis. However, safety planning with adolescents is complicated by adolescents' limited access to coping strategies at school and lack of financial means and transportation for social activities. Adolescents also rely on parents for means safety and seeking healthcare services. To address these issues, the Safety Planning Assistant was developed to create personalized safety plans and provide psychoeducation to adolescents and parents. The program consists of two web-based, clinician-administered modules. The aims of this pilot feasibility and acceptability trial were (a) to evaluate whether use of the Safety Planning Assistant resulted in completed safety plans in a timely manner and (b) to evaluate participant satisfaction with the Safety Planning Assistant and completion of the intervention modules. Participants were 15 adolescents who screened positive for suicide risk, 12–17 years of age (M = 14.53 years, SD = 17.73 years) and their parents/guardians. Participants completed pre-treatment, post-treatment, and 1-month follow-up assessments. Results indicated an average time of 48.13 minutes for youth and 31.69 minutes for parents. Adolescents and parents reported a high degree of satisfaction with the intervention. At the follow-up assessment, 73.3% of adolescents reported using their safety plan and 73.3% of parents reported engaging in at least one means safety behavior. Data support the preliminary feasibility of administering safety planning using the web-based tool and the acceptability of the Safety Planning Assistant to both adolescents and their parents. [ABSTRACT FROM AUTHOR]

Suicide risk on college campuses remains a pervasive problem. Structural deficits in current clinical care models often result in sub-optimal treatment for suicidal students. This study reports on the feasibility, acceptability, and utility of the Safety Planning Intervention (SPI), a brief, empirically validated, clinician-administered suicide prevention intervention, in a university counseling center (UCC) setting. A group of 12 university counseling center direct service staff completed a 2-hour training in SPI. Participants reported on suicide intervention practices, training needs, and confidence at baseline and 10 weeks post-training. Acceptability, utility, and frequency of SPI use were assessed at follow-up. All clinical staff attended the training and found it useful, reporting that confidence in managing suicide risk increased as a result. Two-thirds of staff implemented SPI least once. Results suggest that SPI is a feasible, acceptable, and useful suicide intervention tool for UCCs. [ABSTRACT FROM AUTHOR]

Adults age 65 and older have high rates of suicide, despite recent efforts to reduce the suicide rate in this population. One suicide prevention strategy with burgeoning empirical support is safety planning; however, there is a lack of information and resources on safety planning for older adults to support uptake of this evidence-based practice in clinical settings where older adults are commonly seen. Safety plans can address risk factors for suicide in older adults, including social isolation, physical illness, functional limitations, and use of highly lethal means. Safety plans also promote relevant protective factors, including increasing use of coping strategies, social support, and help-seeking. Clinicians may encounter challenges and barriers to safety planning with older adults. This paper describes a collaborative, creative approach to safety planning that is relevant and useful for this vulnerable population. Using two case examples, we illustrate how to engage older adults in safety planning, including ways to minimize barriers associated with the aging process. [ABSTRACT FROM AUTHOR]

Objective: A critical need exists to identify objective markers of suicide ideation. One potential suicide risk marker is the Suicide Implicit Association Task (S-IAT), a behavioral task that uses differential reaction times to compare the implicit association between the self and death to the implicit association between the self and life. Individuals with a stronger association between the self and death on the S-IAT are more likely to attempt suicide in the future. To better understand the neural underpinnings of the implicit association between self and either life or death, a functional magnetic resonance imaging (fMRI) version of the S-IAT was adapted and piloted in healthy volunteers.Method: An fMRI version of the S-IAT was administered to 28 healthy volunteers (ages 18-65, 14F/14M).Results: Behavioral results were comparable to those seen in non-scanner versions of the task. The task was associated with patterns of neural activation in areas relevant to emotional processing, specifically the insula and right ventrolateral prefrontal cortex.Conclusions: Performance on the S-IAT fMRI task may reflect scores obtained outside of the scanner. In future evaluations, this task could help assess whether individuals at increased risk of suicide display a different pattern of neural activation in response to self/death and self/life stimuli. [ABSTRACT FROM AUTHOR]

Both bereavement and thwarted belongingness serve as risk markers for youth suicide-related behaviors. This study examined candidate predictors of thwarted belongingness among bereaved youth, including caregiver cause of death and surviving caregiver coping style. A group of 43 caregiver-bereaved families (58 children aged 7-13-years-old) participated in a longitudinal study investigating associations between hypothesized bereavement-related contextual factors and youth thwarted belongingness. Cause of caregiver deaths included anticipated deaths preceded by illness (37%; n = 16), sudden natural deaths (25.6%; n = 11), accidental deaths (20.9%; n = 9), death by suicide (9.3%; n = 4), and death from drug overdose (7.0%; n = 3). Children's thwarted belongingness was significantly higher among youth bereaved by suicide compared to youth bereaved by sudden natural death, accident, and anticipated death by illness. Surviving caregivers' use of behavioral disengagement and positive reinterpretation and growth as coping strategies at Time 1 predicted lower thwarted belongingness in children at Time 2. Implications for risk screening and assessment of suicide risk among bereaved youth are discussed. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to examine the feasibility and effectiveness of a suicide prevention smartphone application.Method: Thirty-six non-Aboriginal Australians aged between 16 and 42 years (67% female) were recruited from a tertiary mental health service where they were receiving treatment for suicide risk. Participants were asked to use the BeyondNow safety planning smartphone application to manage their suicide safety plan during a 2-month trial, as an adjunct to treatment as usual. A survey battery designed to measure feasibility and effectiveness of the smartphone app plus treatment as usual intervention was completed at baseline and follow-up.Results: A vast majority of participants used the app to view and edit their safety plans and reported that the app was easy to use. A reduction was observed in participant severity and intensity of suicide ideation, and suicide-related coping increased significantly. No significant changes were observed in suicide resilience.Conclusions: The BeyondNow safety planning smartphone application was shown to be feasible and effective as an adjunct to mental health treatment among patients at risk of suicide. [ABSTRACT FROM AUTHOR]

Accumulating evidence supports the efficacy of cognitive behavioral therapy for suicide prevention (CBT-SP) as an empirically supported treatment approach for suicidal patients. In light of these findings, several procedures pulled from CBT-SP have been recommended for standard care with suicidal patients. The present article provides an overview of the procedures used in CBT-SP and discusses how these procedures meet, or even exceed, standard of care expectations for outpatient mental healthcare clinicians. Finally, the relevance of clinician fidelity to the CBT-SP model when evaluating standard of care expectations is discussed. [ABSTRACT FROM AUTHOR]