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Objectives. Risks for suicide and nonfatal self-injury hospitalizations associated with previous injury hospitalizations were investigated in a nationwide retrospective cohort study conducted in New Zealand. Methods. Linked data from all New Zealand public hospitals were used to identify individuals with injury hospitalizations. Participants were followed for 12 months. Results. Significantly increased age- and sex-adjusted relative risks for suicide were associated with previous hospitalization for self-injury, injuries of undetermined causes, and assault. Also, elevated risks were associated with these causes of hospitalization in the case of subsequent self-injury hospitalizations. Conclusions. Results indicate that identifiable subgroups of individuals hospitalized for injuries are at marked risk for serious suicidal behavior and suggest the potential of targeted suicide prevention for these individuals.

Objective: Alcohol dependence is a potent risk factor for completed suicide and medically serious attempts, but data are limited on factors that distinguish risk within this high-risk population. The purpose of this study is to identify risk factors for serious suicidal behavior among individuals with alcohol dependence. Method: Data on completed suicides and medically serious suicide attempters and controls were gathered in the Canterbury region of New Zealand, using psychological autopsy methodology. A subsample of adult alcoholic subjects was selected for analyses yielding 38 completed suicides, 62 medically serious suicide attempters and 46 community controls, all with alcohol dependence (past month). Multinomial logistic analyses were used to compare the two case groups to controls on demographic and diagnostic variables. Results: Mood disorders and financial difficulties were more frequent among medically serious attempters than controls. Completed suicides were older and were more likely to be male, to have mood disorders, partner-relationship difficulties and other interpersonal life events than were controls. Completed suicides were older and more likely to be male than were medically serious attempters. Conclusions: Risk factors in alcoholics are generally consistent with reports based on general samples of suicide and medically serious suicide attempts. Suicide prevention efforts in alcoholics, if they are to be successful, must include a focus on depression as well as interpersonal factors, including partner-relationship difficulties., ALTHOUGH IT HAS BEEN ESTABLISHED that alcoholism confers risk for completed suicide (Harris and Barraclough, 1997), data are limited on risk factors for serious suicidal behavior among alcoholics (Murphy et [...]

Objective: The associations of suicidal ideation with both the intensity (drinks per drinking day) and frequency of alcohol consumption were examined in a longitudinal study of treated alcoholics. Method: The data are from alcohol dependent subjects (1,187 men and 374 women) enrolled in Project MATCH, a multisite clinical trial of psychosocial treatments of alcoholism. Multivariate analyses for correlated data using generalized estimating equation approaches were performed to examine correlates of suicidal ideation at study entry and at 3-, 9-and 15-month follow-up. Analyses were stratified by gender and controlled statistically for depression and alcoholism severity. Results: Suicidal ideation was common among women (15.5%) and men (9.9%) entering treatment, and at least 3.6% of women and 4.2% of men re ported suicidal ideation at each follow-up. There were gender patterns in suicidal ideation. In women, intensity was associated with suicidal ideation, but even nonintense drinking became associated with suicidal ideation with more frequent drinking (intensity-frequency interaction). In men, intensity was also associated with suicidal ideation, whereas frequency was unrelated. Antisocial personality disorder in men but not in women, and depression in both groups, were also linked to suicidal ideation. Conclusions: Suicidal ideation is prevalent among treated alcoholics. Drinking is strongly associated with suicidal ideation and in women even light drinking, if it occurs regularly, is associated with suicidal ideation, with implications for suicide risk-recognition and intervention. (J. Stud. Alcohol 64: 402-408, 2003), ALTHOUGH ALCOHOL DEPENDENCE is a potent risk factor for suicide (Harris and Barraclough, 1997), only about 7% of alcoholics commit suicide (Inskip et al., 1998). It is therefore important to [...]

The authors examined threatened and attempted suicide among partner-violent male respondents in a family court domestic violence intervention court based on the reports of 101 women petitioning the court for orders of protection. Suicidal behavior was prevalent; 45.5% of respondents had a history of threatened suicide and 12.9% had a history of suicide attempts. Most recent threats were clustered in the previous 6 months (70.5%) with one-fourth occurring within a week of the petition, potentially indicating a desperate response to a deteriorating relationship. Attempts were not clustered in recent months. Men with a history of threatened or attempted suicide were shown to have been more violent at the index offense and greater domestic violence severity overall, potentially indicating a subsample of more severely partner-violent men also at particularly heightened risk for suicide. The study of suicidal behavior in partner-violent men may inform the prevention of suicide and severe domestic violence.

Retrospective research shows that close to 90 percent of suicides have a diagnosable psychiatric disorder; however, only a small proportion of individuals with psychopathology take their own lives. This article reviews the empirical literature on psychological vulnerability to completed suicide. A search of the MEDLINE and PsycINFO databases yielded 46 cohort or case-control studies that used standardized or structured assessments of psychological dimensions. Five constructs have been consistently associated with completed suicide: impulsivity/aggression, depression, anxiety, hopelessness, and self-consciousness/social disengagement. Current knowledge of psychological vulnerability to completed suicide could inform social and neurobiological research, and thereby deepen understanding of suicide while potentially bridging these areas of study.

Rates of harmful alcohol use are high among justice-involved individuals and may contribute to violent recidivism. Robust treatments for alcohol-related violence in criminal justice systems are thus a public health priority. In this analysis of existing randomized controlled trial data (N = 105), we examined the impact of a brief motivational intervention (BMI) for harmful substance use on violent recidivism among individuals in a pretrial jail diversion program. Results indicated that, after controlling for violence history, the intervention's impact on violent recidivism was moderated by baseline harmful alcohol use. Specifically, among people with severe alcohol problems at baseline, the BMI + standard care group had less violent recidivism at a 1-year follow-up than participants randomized to standard care alone. This finding was unchanged when we accounted for psychopathic traits. Our study provides preliminary evidence that a BMI may be useful for decreasing violent recidivism among heavy drinkers in criminal justice systems. [ABSTRACT FROM AUTHOR]

During a trial, standardization can lock in a treatment that researchers learn is flawed and may be ineffective. In such cases, researchers typically decide between two options, continue the trial and monitor for iatrogenic effects or stop the trial. When faced with this dilemma while testing an adaptation of motivational interviewing to address suicidal ideation, our research team considered a third option, to correct the flaws in the intervention and study the effect on outcome. We explored the rationale for and against changing an intervention mid-trial and progressed through a series of steps to determine whether we should change the intervention, ultimately deciding to make changes and examine their impact. We developed a procedure that researchers can use to determine whether they should change an intervention during a trial, how to implement the changes, and how to redesign their study. When faced with evidence that a treatment is ineffective, researchers should consider changing the intervention and examining the effects of the changes on outcome. Such decisions may be particularly relevant in trials examining life-threatening outcomes. Making and studying these changes may increase the potential for the study to identify a treatment that produces a desired outcome. [ABSTRACT FROM AUTHOR]

Objective: Although the months following discharge from psychiatric hospitalization are a period of acute risk for veterans, there is a dearth of empirically supported treatments tailored to veterans in acute psychiatric hospitalization.Method: We conducted a randomized controlled trial to test the efficacy of Motivational Interviewing to Address Suicidal Ideation (MI-SI) that explored and resolved ambivalence, and a revised MI-SI (MI-SI-R) that resolved ambivalence, on suicidal ideation (SI) in hospitalized veterans who scored > 2 on the Scale for Suicidal Ideation. Participants were randomized to receive MI-SI plus treatment as usual (TAU), MI-SI-R+TAU, or TAU alone. MI-SI+TAU and MI-SI-R+TAU included two in-hospital therapy sessions and one telephone booster session. Participants completed follow-up assessments over 6 months.Results: Participants in all groups experienced reductions in the presence and severity of SI, but there were no significant differences among the groups. For the presence of SI, results were in the hypothesized direction for both MI-SI+TAU conditions.Conclusions: Results are nondefinitive, but the effect size of both versions of MI-SI+TAU on the presence of SI was consistent with prior MI findings. Exploratory analyses suggest MI-SI-R may be preferable to MI-SI. More intensive MI-SI-R with a greater number of follow-ups may increase its effectiveness. [ABSTRACT FROM AUTHOR]

Person-centered approaches are underutilized to identify people with shared risk profiles. In this study, an at-risk sample of 773 past/current military personnel (Mage = 31.3 years, SD = 6.8) with current ideation (90.6%) and/or a prior suicide attempt (43.9%) were assessed using latent profile analysis. Variables included prior suicide attempts, suicidal ideation, alcohol/drug use, insomnia, depression, belongingness, burdensomeness, and post-traumatic stress disorder symptoms. Three classes emerged: Low Symptoms (N = 502), Elevated Suicidality (N = 176), and Elevated Substance Use (N = 95). At 1-month follow-up, the Elevated Suicidality and Elevated Substance Use classes had the highest odds of suicidal behavior. The finding concerning the Elevated Substance Use class suggests it may represent a distinct short-term risk group in military personnel. [ABSTRACT FROM AUTHOR]