Recent Suicidal Ideation Among Patients in an Inner City Emergency Department

The rates and associated features of suicidal ideation among 5,641 patients seeking routine, nonsuicide related care in an inner‐city emergency department were examined. Approximately 8% of patients seeking routine care in the emergency department reported some form of suicidal ideation within the past 2 weeks. Suicidal ideation was common in individuals who were single with poorer mental health, had higher depression, and had received some drug or alcohol treatment in the past 3 months or had used cocaine or marijuana in the past 30 days. Improved screening procedures could help to identify routine care patients who are at risk for suicide.     

Emergency Department Youth Patients With Suicidal Ideation or Attempts: Predicting Suicide Attempts Through 18 Months of Follow‐Up

This prospective study of suicidal emergency department (ED) patients (ages 10–18) examined the timing, cumulative probability, and predictors of suicide attempts through 18 months of follow‐up. The cumulative probability of attempts was as follows: .15 at 6 months, .22 at 1 year, and .24 by 18 months. One attempt was fatal, yielding a death rate of .006. Significant predictors of suicide attempt risk included a suicide attempt at ED presentation (vs. suicidal ideation only), nonsuicidal self‐injurious behavior, and low levels of delinquent symptoms. Results underscore the importance of both prior suicide attempts and nonsuicidal self‐harm as risk indicators for future and potentially lethal suicide attempts.     

Adolescent Decisional Autonomy Regarding Participation in an Emergency Department Youth Violence Interview

Much attention has been given to determining whether an adolescent patient has the capacity to consent to research. This study explores the factors that influence adolescents' decisions to participate in a research study about youth violence and to determine positive or negative feelings elicited by being a research subject. The majority of subjects perceived their decision to participate to be free of coercion, and few felt badly about having participated. However, adolescents who were alone in the room during the assent process were more likely to report that they chose freely to be a research subject. This study may influence the ways physicians communicate with adolescent patients around research assent within a clinical care environment.     

Predictors and Outcomes of Psychiatric Hospitalization in Youth Presenting to the Emergency Department with Suicidality

Youth suicide attempters presenting to the emergency department (ED) are frequently admitted to psychiatric inpatient hospitals, yet little is known about how clinicians decide which youths to admit versus discharge to outpatient care. We examine predictors of inpatient hospitalization and describe service use outcomes associated with hospitalization in 181 youths drawn from consecutive ED admissions for suicidality. Predictors of hospitalization include ED site, suicide plan, and parent report of problems. Hospitalization was associated with improved linkage to outpatient treatment and more intensive service use. Future research is needed to understand the best service delivery and treatments for these high‐risk youth.     

Screening for Suicidal Ideation and Attempts among Emergency Department Medical Patients: Instrument and Results from the Psychiatric Emergency Research Collaboration

Joint Commission National Patient Safety Goal 15 calls for organizations “to identify patients at risk for suicide.” Overt suicidal behavior accounts for 0.6% of emergency department (ED) visits, but incidental suicidal ideation is found in 3%–11.6%. This is the first multicenter study of suicide screening in EDs. Of 2,243 patients in six diverse emergency settings, 1,068 (47.7%) were screened with a brief instrument. Depression was endorsed by 369 (34.5%); passive suicidal ideation by 79 (7.3%); and active suicidal ideation by 24 (2.3%). One hundred thirty‐seven (12.8%) reported prior attempts, including 35 (3.3%) with current suicidal ideation. Almost half of those with current ideation had a prior attempt (43.8%) versus those without current ideation, 10.3%, χ² (1) = 75.59, p < .001. Twenty cases (25%) were admitted to medical services, but only 10 (12.5%) received mental health assessment; none were admitted directly to a psychiatry service. The prevalence of suicidal ideation here is similar to previous studies but the frequency of prior attempts has not been reported. The 35 cases with current ideation and prior attempt are at risk. As they did not present psychiatrically, they would likely have gone undetected. Despite reporting these cases to clinical staff, few received risk assessment.     

Behavioral Risk Assessment of the Guarded Suicidal Patient

Psychiatrists and other mental health professionals are trained to assess patients by direct observation and examination. Short inpatient length of stay, brief outpatient visits, emergency room evaluations, and other time‐limited clinical settings require rapid assessment of suicide risk. Recognition of behavioral suicide risk factors can assist in the early identification of the guarded suicidal patient, thus avoiding total reliance on the patient's reporting.     

The Impact of Religiosity on Suicidal Ideation Among Youth in Central Mexico

Although over 100 years of research has been dedicated to understanding the connection between religiosity and suicide, many questions still remain. This is especially true among adolescent populations in countries outside the US. In 2008, over 700 students attending eight alternative high school centers in central Mexico completed a health survey designed to provide a comprehensive overview of their physical, mental, spiritual, and emotional health. This article reports on the findings of a secondary analysis study of those data and focuses on the protective influence of religiosity on suicidal ideation. The findings of this study are discussed in light of the network theory’s assertion that there is a belonging aspect to religion, and also to the idea that in religiously homogeneous communities of Mexico, religion can have a protective effect on the suicidal ideation of its members.     

A Paradigm for the Telephonic Assessment of Suicidal Ideation

A three‐stage paradigm for telephonically assessing suicidal risk and triaging suicidal callers as practiced in an Employee Assistance Program Call Center was investigated. The first hypothesis was that the use of the procedure would increase the probability that callers would accept the clinician's recommendations, evidenced by fewer police interventions. The second hypothesis was that there would be an increase in confirmed appointments with providers. Samples involved three separate 6‐month periods. Results indicate the effectiveness of the paradigm with both hypotheses supported. Follow‐up data for the year after completion of this study yielded similar results.     

Predicting Suicidal Tendencies Among High Risk Youth With the General Theory of Crime

This study examines whether suicidal tendencies among a group of juveniles who have come to the attention of Child Protective Services can be predicted by self-control theory. Using data from the National Survey of Child and Adolescent Well-Being, we find that self-control predicts suicidal tendencies. In addition, the effect of self-control remains significant even when controlling for the juveniles’ depression and previously reported suicidal thoughts and behaviors. This study lends further support to the claim that self-control serves as a general explanation for a wide range of problematic outcomes. In addition, these findings provide caseworkers with another tool for assessing the risk of suicide among high risk youth.     

Interventions for Suicidal Youth: A Review of the Literature and Developmental Considerations

Suicidal behavior is developmentally mediated, but the degree to which interventions for suicidal behaviors have been developmentally tailored has varied widely. Published controlled studies of psychosocial treatment interventions for reducing adolescent suicidal behavior are reviewed, with a particular emphasis on the developmental nuances of these interventions. In addition, developmental considerations important in the treatment of suicidal adolescents are discussed. There are insufficient data available from controlled trials to recommend one intervention over another for the treatment of suicidal youth, but interventions that are sensitive to the multiple developmental contexts have potential for greater effectiveness in reducing adolescent suicidal behavior.     

Examining Youth Anxiety Symptoms and Suicidal Ideation in the Context of the Tripartite Model of Emotion

This study sought to clarify the relation of anxiety symptoms and suicidal ideation in children and adolescents by examining these variables in the context of depression and negative affect. As outlined in the tripartite model of anxiety and depression, negative affectivity is common to both emotional constructs; therefore negative affectivity may best explain the relation of each to suicidal ideation. Self report measures of generalized anxiety, depression, negative affectivity, and suicidal ideation were assessed in a primarily externalizing sample of children ages 7–18. Results suggested that the relation between anxiety and suicidal ideation was best accounted for by depression, not negative affectivity. Results also suggested that negative affectivity was associated with suicidal ideation but did not account for the relations among anxiety, depression, and suicidal ideation. Further, depression, negative affect, and anxiety all significantly contributed to the prediction of suicidal ideation scores (r ²  = .307, p < .01).     

Risk Assessment of the Suicidal Religious Person: Some Suggestions

For appropriate intervention, the counselor should gain an understanding of the individual's perspective of religious values and attitudes, which at the moment of suicidal crisis may or may not be consonant with his or her previously held religious tenets.     

Cross-Informant Agreement in the Assessment of Social Phobia in Youth

In the present study involving children and adolescents with a principal diagnosis of social phobia, we measured parent–child agreement regarding social anxiety symptoms. Additionally, we examined variables related to the severity of the children's social phobia symptoms as reported by children and as rated by clinicians. Examination of cross-informant agreement indicated little difference between mean parent and children ratings of the children's social fears. In contrast, there was a significant difference in parent and children ratings of the children's avoidance, with parents endorsing greater degrees of social avoidance. Children's report of social avoidance was negatively related to scores on a measure of self-presentational concerns (i.e., social desirability). Clinicians' determination of the severity of the children's social phobia was also influenced by the children's self-presentation as well as parent report of social avoidance and children's depression scores. Thus, this differential weighting by the clinician of parent versus child report may be related to the finding that children's self-reported social avoidance was negatively related to their concerns regarding positive self-presentation. Results suggest the need to consider the impact of social desirability when examining clinical characteristics of children and adolescents with social phobia.     

The Impact of Exposure to Peer Suicidal Self‐Directed Violence on Youth Suicidal Behavior: A Critical Review of the Literature

There is considerable evidence that being exposed to the suicide or suicidal behavior of another can increase the risk for suicide. Significant relationships between media coverage and youth suicide have been documented in the professional literature. Exposure to familial suicidal behavior has also been established as a risk factor for youth suicidal behavior; However, peer suicide exposure is not as clear cut as research results in this area have been mixed. In the current paper the empirical literature focused on the associations between exposure to peer suicides and suicide attempts and youth suicidal behavior is critically reviewed. Effect sizes were computed for each of the 23 studies included in the review to allow for cross‐study comparisons. The results demonstrate that having a friend or acquaintance attempt suicide is significantly related to risk for suicidal thoughts and behavior. However, the support for the relationship between the suicide of a peer and youth suicidal behavior was less consistent. Implications for clinical practice and suicide postvention as well as areas of future research are discussed.     

A Study of an Underserved Youth Sports Program Using the Youth Program Quality Assessment

Although positive youth development is an important line of inquiry, the evaluation of youth sport organizations that attempt to build character with underserved children remains understudied. To explore the efforts of a sport organization to build character, 66 observations of inner-city baseball and softball practices/games were conducted across three age groupings. Practice and game settings did not vary significantly. Two-way (Age × Gender) analyses of variance (ANOVAs) identified that Under-14 programs were rated lower than the U18 and U12 age groups in the safety, support, and engagement domains of the Youth Program Quality Assessment (YPQA). Boys’ programs were rated lower than girls’ in terms of support.