Characteristics of Telephone Crisis Hotline Callers with Suicidal Ideation in Japan

Hotline callers do not always have suicidal ideation and previous studies have noted that the rate of such callers is limited. Crisis hotline counselors must be able to identify high‐risk callers in order to provide appropriate support. This study investigated the characteristics of Japanese crisis hotline callers in 2012 (N = 541,694) and is the first to analyze crisis hotline data for all parts of Japan over 1 year. About 14% of the callers had suicidal ideation and 6% had a history of attempted suicide. The odds ratio for suicidal ideation among those with a history of attempted suicide was 15.5. The suicidal ideation rate was much smaller compared to previous studies in other countries. There is a psychological barrier that must be broken for high‐risk people to use support hotlines. In addition, attempted suicide is a strong exclusive predisposing factor for death due to suicide; therefore, counselors should pay careful attention to callers with a history of attempted suicide. The characteristics of Japanese crisis hotline callers and the features of suicidal ideation revealed in the present study are expected to be useful in developing telephone crisis hotline strategies.     

Follow‐up with Callers to the National Suicide Prevention Lifeline: Evaluation of Callers’ Perceptions of Care

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.     

The relation of new Samaritan clients and volunteers to high risk people in England and Wales (1965-1977)

The declining English and Welsh suicide rates are associated with increased Samaritan efforts and detoxification of household gas during the pre-1972 era. The resulting debate has been heuristic. The author reviewed annual rates of new callers, volunteers and suicidal deaths between 1965 and 1977 and computed ratios of new clients to high risk people. This reveals an asymptotic progression towards 27 percent since 1972. Similarly, the ratio of new clients to volunteers has been constant at 11 for the same period. These consistencies help to explain the constant suicide rate at eight per 100,000 live people after 1972 despite increasing Samaritan efforts. The author recommends an effort to increase the percentage of high risk served as a test for the hypothesis of Samaritan causality in explaining the reduced English suicide rates.     

National suicide prevention lifeline: enhancing mental health care for suicidal individuals and other people in crisis

Linking at-risk callers to ongoing mental health care is a key goal of crisis hotline interventions that has not often been addressed in evaluations of hotlines' effectiveness. We conducted telephone interviews with 376 suicidal and 278 nonsuicidal crisis callers to the National Suicide Prevention Lifeline (Lifeline) to assess rates of mental health care utilization following Lifeline calls and to assess attitudinal and structural barriers to service utilization. Postcall utilization rates were approximately 50% for suicidal and crisis callers who received mental health care referrals. Lack of health insurance and callers' perceptions about mental health problems emerged as significant barriers to accessing continued help.     

Influences on Call Outcomes among Veteran Callers to the National Veterans Crisis Line

The association of caller and call characteristics with proximal outcomes of Veterans Crisis Line calls were examined. From October 1–7, 2010, 665 veterans with recent suicidal ideation or a history of attempted suicide called the Veterans Crisis Line; 646 had complete data and were included in the analyses. A multivariable multinomial logistic regression was conducted to identify correlates of a favorable outcome (a resolution or a referral) when compared to an unfavorable outcome (no resolution or referral). A multivariable logistic regression was used to identify correlates of responder‐rated caller risk in a subset of calls. Approximately 84% of calls ended with a favorable outcome, 25% with a resolution, and 59% with a referral to a local health care provider. Calls from high‐risk callers had greater odds of ending with a referral than without a resolution or referral, as did weekday calls (6:00 am to 5:59 pm EST, Monday through Friday). Responders used caller intent to die and the absence of future plans to determine caller risk. Findings suggest that the Veterans Crisis Line is a useful mechanism for generating referrals for high‐risk veteran callers. Responders appeared to use known risk and protective factors to determine caller risk.     

Worker and caller variety in three crisis centers.

Worker and caller behaviors are studied and compared in an available sample of 100 suicidal calls to three crisis intervention centers. Caller-Worker Interaction Program results were compared among the three centers. Worker and caller differences across centers were significant in 32 of 41 categories (p less than .05); using four discriminant functions, 2 of 18 hit percentages exceeded p less than .01. The verbal behaviors of workers and callers at the three centers are substantially different, leading to the conclusion that crisis intervention is dissimilarly practiced between centers but similar within them.     

Psychosocial response to COVID‐19 pandemic in India: Helpline counsellors’ experiences and perspectives

The COVID‐19 pandemic presents a threat to physical and psychosocial health of individuals. In lieu of the subsequent lockdown and containment measures, helpline counselling becomes a viable method of accessing psychosocial services during the pandemic. The present paper describes experiences of counsellors working with a special COVID‐19 counselling helpline initiated by iCALL, a national‐level technology‐assisted counselling service of the Tata Institute of Social Sciences, India, which aims to address the psychosocial impact of the pandemic and the lockdown. The paper is based on two focus group interviews held with 11 counsellors during the initial two months of the helpline's functioning. Findings of the study highlight the diverse profile of the callers, with individuals belonging to different strata of society and to marginalised communities. The nature of concerns presented by the callers were often a mix of psychological, relational and practical issues. The resultant distress emanated from an interplay of these factors with the relational contexts, their social locations and social structures the individuals were embedded in. This highlighted the need for conceptualising and responding from a psychosocial lens, whereby interventions involved traditional counselling approaches and strategies for addressing determinants of distress by connecting callers to required ground‐level resources. Counsellors’ engagement with this process impacted their professional and personal selves, necessitating the need for structured and continuous training, supervision and support. At a larger level, the counsellors’ narratives asserted the need for adopting a psychosocial paradigm for conceptualising and addressing mental health concerns in India.     

Social identification effects in social dilemmas: a transformation of motives

Three experimental studies were conducted to examine two alternative explanations for the widely established positive effect of social identification in promoting cooperation in social dilemmas. We hypothesised that social identification effects could be either ascribed to (1) an increase in the value assigned to the collective good (i.e. goal‐transformation hypothesis) or (2) an enhancement of trust in the cooperation of other group members (i.e. goal‐amplification hypothesis). To disentangle these two explanations, we examined the effects of social identification on the contributions to a public good of people with a different social value orientation (i.e. pre‐existing differences in preferred outcome distribution between self and others). Following the goal transformation hypothesis, we predicted that an increased group identification would raise contributions, in particular for people essentially concerned with their personal welfare (i.e. pro‐self value orientation). Alternatively, following the goal amplification hypothesis it was expected that increased group identification would primarily affect decisions of people concerned with the collective welfare (i.e. prosocial value orientation). The results of all three studies provided support for the goal‐transformation rather than goal‐amplification hypothesis, suggesting that ‘selfish’ individuals can be encouraged to cooperate by increasing the salience of their group membership. Copyright © 1999 John Wiley & Sons, Ltd.     

Suicidality in African American men: the roles of southern residence, religiosity, and social support

The rise in suicide by African Americans in the United States is directly attributable to the dramatic, nearly three-fold increase in suicide rates of African American males. Gibbs (1997) hypothesized high social support, religiosity, and southern residence are protective factors against suicidality for Black people. This hypothesis was tested among 5,125 participants from the National Comorbidity Survey; 299 were African American males. In this study we hypothesized that there would be significantly lower suicidality in the South, and social support and religiosity would mediate this relationship. Our results indicate that Southern region is indeed a significant predictor of suicidal symptoms in African American men, such that suicidal symptoms were lower in the South, but religiosity and social support did not account for this effect. Other potential mediators were also examined.     

An evaluation of crisis hotline outcomes. Part 1: Nonsuicidal crisis callers

The effectiveness of telephone crisis services/hotlines, examining proximal outcomes as measured by changes in callers' crisis state from the beginning to the end of their calls to eight centers in the U.S. and intermediate outcomes within 3 weeks of their calls, was evaluated. Between March 2003 and July 2004, 1,617 crisis callers were assessed during their calls and 801 (49.5%) participated in the followup assessment. Significant decreases in callers' crisis states and hopelessness were found during the course of the telephone session, with continuing decreases in crisis states and hopelessness in the following weeks. A majority of callers were provided with referrals and/or plans of actions for their concerns and approximately one third of those provided with mental health referrals had followed up with the referral by the time of the follow-up assessment. While crisis service staff coded these callers as nonsuicidal, at follow-up nearly 12% of them reported having suicidal thoughts either during or since their call to the center. The need to conduct suicide risk assessments with crisis callers and to identify strategies to improve referral follow-up is highlighted.     

Hope as a Predictor of Interpersonal Suicide Risk

The current study hypothesized that (1) hope would negatively predict burdensomeness, thwarted belongingness, and acquired capability to enact lethal injury; (2) hope would negatively predict suicidal ideation; and (3) the interpersonal suicide risk factors would predict suicidal ideation. Results indicated that hope negatively predicted burdensomeness and thwarted belongingness, but positively predicted acquired capability to enact suicide. Contrary to our second hypothesis, hope did not predict suicidal ideation, but interpersonal risk factors for suicide predicted suicidal ideation. Results are discussed in terms of implications for hope theory and Joiner's (2005) interpersonal risk factors for suicide, and for clinical practice.     

Defeat and Entrapment in Bipolar Disorder: Exploring the Relationship with Suicidal Ideation from a Psychological Theoretical Perspective

Contemporary psychological theoretical models of suicide hypothesize that defeat and entrapment underlie the development of suicidal ideation. This hypothesis has never been tested in people who experience bipolar disorder. Regression analysis revealed that defeat and entrapment significantly predicted suicidal ideation at 4‐month follow‐up. The relationship between defeat and suicidal ideation was mediated by total entrapment and internal entrapment, but not external entrapment. Results suggest that perceived defeat and entrapment underlie the development of prospective suicidal ideation in bipolar disorder. Findings could potentially improve the assessment of suicide risk in people who experience bipolar disorder.     

Suicidal ideation and attitudes toward suicide

Although hopelessness and depression are known risk factors for suicide, most individuals who are hopeless or depressed never make a suicide attempt. In this study, we tested the hypothesis that college students' (n = 230) attitudes toward suicide (the degree to which they see it as an acceptable option under some circumstances) would moderate the link between both hopelessness and depressive symptoms and their levels of suicidal ideation. This moderation hypothesis was supported, but only among men. Specifically, among men, levels of hopelessness and depressive symptoms were significantly related to suicidal ideation among only those with relatively positive attitudes toward suicide.     

Suicide and suicide attempts in the European Economic Community: an analysis of trends, with special emphasis upon trends among the young

An attempt is made to explain the increase in adolescent suicidal behavior reported for most countries in the European Economic Community over the last two decades, within the framework of a social learning theory. A typology of suicidal acts based on an outcome-expectancy model is proposed that would make intelligible the observed positive correlation between the incidence of lethal and nonlethal suicidal acts, the latter having grown to epidemic proportions among the young. This epidemic can be attributed to the interplay of three groups of factors, namely, the socialization of a specific problem-solving behavior repertoire, socioeconomic conditions, and attitudes toward suicide. The implications for suicide prevention are briefly discussed.     

The Sexual Harassment–Suicide Connection in the U.S. Military: Contextual Effects of Hostile Work Environment and Trusted Unit Leaders

Sexual harassment has been associated with suicidal behaviors, and with the rise in suicides in the U.S. military, sexual harassment's role in suicide has been of growing interest. Lacking are studies that examine group‐ or unit‐level variables in the relationship of sexual harassment to suicidal behaviors (thoughts, plans, and attempts). In this study, survey data from soldiers (12,567 soldiers in 180 company‐sized units) who completed the Unit Risk Inventory administered during calendar year 2010 were analyzed using hierarchical linear modeling. At the individual level, sexual harassment was associated with a fivefold increase for risk of suicide. Reporting that leaders could be trusted was associated with a decreased suicide risk by about one‐third. There was no statistically significant interaction between sexual harassment and trusted leaders in predicting the suicidal behaviors. At the group level, units or companies having higher levels of sexual harassment also had soldiers three times more at risk for suicide. A cross‐leveling effect was also observed: Among units having higher levels of sexual harassment, the negative correlation (buffering effect of unit leaders on suicidal behaviors) was diminished. Implications of findings for preventing sexual harassment and suicide risk are discussed.     

Effects of Different Telephone Intervention Styles with Suicidal Callers at Two Suicide Prevention Centers: An Empirical Investigation

To determine the relative effectiveness of telephone intervention styles with suicidal callers, researchers listened unobtrusively to 617 calls by suicidal persons at two suicide prevention centers and categorized all 66,953 responses by the 110 volunteer helpers according to a reliable 20-category checklist. Outcome measures showed observer evaluations of decreased depressive mood from the beginning to the end in 14% of calls, decreased suicidal urgency ratings from the beginning to the end in 27% of calls, and reaching a contract in 68% of calls, of which 54% of contracts were upheld according to follow-up data. Within the context of relatively directive interventions, a greater proportion of Rogerian nondirective responses was related to significantly more decreases in depression. Reduction in urgency and reaching a contract were related to greater use of Rogerian response categories only with nonchronic callers.     

Typicality effects in picture‐word interference paradigm: An evaluation of the response exclusion hypothesis

The response exclusion hypothesis suggests that the polarity of semantic effects in the picture‐word interference paradigm is determined by the response‐relevant criteria. Semantic interference effects would be observed when semantically related distractor words satisfy the response‐relevant criteria; otherwise, semantic facilitation effects should be found. The purpose of this study was to further evaluate the response exclusion hypothesis by exploring the typicality effects in pictures naming. In two experiments, pictures of objects were named either in the context of verb distractor words with different typicality of passive functions or in the context of adjective distractor words with different typicality of characteristics. Facilitation effects were observed in context of typical verbs and adjectives, while interference effects were observed in the context of atypical verbs and adjectives. Given that neither typical nor atypical distractor words satisfy the response‐relevant criteria to produce noun, these findings are problematic for the response exclusion hypothesis. Role of syntagmatic relationships in lexical retrieval was invoked to explain present findings.     

Stress in telephone helpline nurses is associated with failures of concentration,attention and memory,and with more conservative referral decisions

Nurses working for telephone‐based medical helplines must maintain attentional focus while quickly and accurately processing information given by callers to make safe and appropriate treatment decisions. In this study, both higher levels of general occupational stress and elevated stress levels on particular shifts were associated with more frequent failures of attention, memory, and concentration in telephone nurses. Exposure to a stressful shift was also associated with a measurable increase in objectively assessed information‐processing errors. Nurses who experienced more frequent cognitive failures at work made more conservative decisions, tending to refer patients on to other health professionals more often than other nurses. As stress is associated with cognitive performance decrements in telephone nursing, stress‐reduction interventions could improve the quality and safety of care that callers to medical helplines receive.     

Stress, self-esteem, and suicidal ideation in late adolescents

The relationships among stress, self-esteem, and suicidal ideation in late adolescents were examined in a group of college students. Multiple regression analysis indicated that both stress and self-esteem were significantly related to suicidal ideation; low self-esteem and stressful life events significantly predicted suicidal ideation. The hypothesis that self-esteem would moderate the effects of life stressors on suicidal ideation was supported at the .06 level. A significant minority of the sample indicated having thoughts severe enough to be classified as clinical suicidal ideation. In general, participants who had experienced negative life events in the 6 to 12 months prior to participating in the study had lower self-esteem than those who had similar stresses within the prior six months. However, the opposite was true for clinical suicidal ideators; those who experienced negative life stressors recently had lower self-esteem than those who experienced negative life events six months to a year in the past.     

Overhabituation and dishabituation: Effects of extraversion and amount of training

The Eysenck (1967) hypothesis that introverts have higher levels of cortical activation than extraverts has received support in a number of psychophysiological studies, though there is not complete consistency. The present study extended the habituation paradigm used in some previous work to include an examination of differences between extraverts and introverts during and following long-term overhabituation. Electrodermal activity was recorded while 72 extraverts and 72 introverts were subjected to criterion auditory habituation to a 1000-Hz, 90-db tone, followed by 60, 100, or 140 trials of overhabituation. The overhabituation run was followed by a test stimulus of 7000 Hz and a final repetition of the standard stimulus. Results showed that introverts increased in response frequency with increasing overhabituation exposure, while extraverts showed an increase only from 100 to 140 trials. In addition, the hypothesis that differences in test response amplitude favoring introverts would be eliminated by extended overhabituation training was supported. Specifically, extraverts showed increased responses at 100 and 140 trials, while introverts remained approximately constant across the three conditions. Finally, results supported the Sokolov hypothesis that overhabituation training produces test responses of larger amplitude.