National Suicide Rates a Century after Durkheim: Do We Know Enough to Estimate Error?

Durkheim's nineteenth‐century analysis of national suicide rates dismissed prior concerns about mortality data fidelity. Over the intervening century, however, evidence documenting various types of error in suicide data has only mounted, and surprising levels of such error continue to be routinely uncovered. Yet the annual suicide rate remains the most widely used population‐level suicide metric today. After reviewing the unique sources of bias incurred during stages of suicide data collection and concatenation, we propose a model designed to uniformly estimate error in future studies. A standardized method of error estimation uniformly applied to mortality data could produce data capable of promoting high quality analyses of cross‐national research questions.     

The Self‐Directed Violence Classification System and the Columbia Classification Algorithm for Suicide Assessment: A Crosswalk

The lack of a standardized nomenclature for suicide‐related thoughts and behaviors prompted the Centers for Disease Control and Prevention, with the Veterans Integrated Service Network 19 Mental Illness Research Education and Clinical Center, to create the Self‐Directed Violence Classification System (SDVCS). SDVCS has been adopted by the Department of Veterans Affairs and the Department of Defense. Another classification system, the Columbia Classification Algorithm for Suicide Assessment, has been recommended by the Food and Drug Administration. To facilitate the use of both systems, this article provides a “crosswalk” between the two classification systems.     

Thoughts of Self‐Harm and Help‐Seeking Behavior among Youth in the Community

The association between thoughts of self‐harm and help‐seeking among youth with symptoms of depression was examined. Data were drawn from the Health Behavior of School‐aged Children Study (n = 15, 686), a nationally representative sample of youth in the United States. Analyses focused on comparing help‐seeking behaviors among youth with and without thoughts of deliberate self‐harm (DSH) when depressed. Depressed youth with thoughts of DSH exhibited different patterns of help‐seeking than those without. Both groups most frequently sought help from friends and parents. However, adolescents with thoughts of DSH were statistically more likely than youth without to seek help from friends (DSH: 69.9%; no DSH: 57.8%; AOR = 1.46), but less likely to seek help from parents (DSH: 53.7%; no DSH: 73.1%; AOR = 0.47). Youth with DSH were more likely to seek help from school officials (AOR = 1.05), health professionals (AOR: 1.83), or a counselor (AOR = 1.93) compared with those without thoughts of DSH who were more likely to seek help from a sibling (AOR: 0.77) or other relatives (AOR: 0.78). Results may help inform programs to improve identification of youth at risk of self‐harm in community and school settings.     

Predicting Suicide Attempts among Treatment‐Seeking Male Alcoholics: An Exploratory Study

Documented risk factors for suicide among alcohol‐dependent patients are sensitive but insufficiently specific to effectively identify individuals who are prone to future suicide attempt. As a first step to assess factors not previously considered, this pilot study involved a group of male alcohol‐dependent patients (N = 175) coming to detoxification to examine the potential utility of adverse childhood experiences (ACE) along with other documented events to discriminate individuals with a history of attempted suicide from their detoxifying peers. Family health history questionnaires were used to evaluate their ACEs. Receiver operating characteristic (ROC) analysis was applied to examine the predictive power of ACEs, alone or in combination with documented risk factors, to lifetime history of attempted suicide. Among our participants, 48 (27.4%) had a history of a suicide attempt and 156 (89.1%) reported at least one out of the nine categories of ACEs. Modeling by ROC analysis, we found that a cutoff of four or more ACEs plus a history of personal violence achieved the best predictive power to a history of any suicide attempt, producing a sensitivity of 0.7, specificity of 0.81, and area under curve of 0.75. A prospective study to replicate and extend our findings is necessary.     

Development of a Scale to Assess Knowledge about Suicide Postvention using Item Response Theory

Knowledge about suicide postvention (KSPV) is an important distal outcome in the evaluation of suicide prevention programs that focus on the bereaved. However, most scales are specifically tailored to the evaluation study in question and psychometric properties are often unsatisfactory. Therefore, we developed the KSPV scale. Scale properties were investigated with Rasch trees, a newly developed method in the framework of item response theory. Additionally, we provide cues for convergent validity. In summary, the scale shows satisfactory properties for assessing KSPV and could be used to evaluate suicide postvention programs more effectively.     

A Systematic Review of Suicide Prevention Programs for Military or Veterans

Military personnel and veterans have important suicide risk factors. After a systematic review of the literature on suicide prevention, seven (five in the U.S.) studies of military personnel were identified containing interventions that may reduce the risk of suicide. The effectiveness of the individual components was not assessed, and problems in methodology or reporting of data were common. Overall, multifaceted interventions for active duty military personnel are supported by consistent evidence, although of very mixed quality, and in some cases during intervals of declines in suicide rates in the general population. There were insufficient studies of U.S. Veterans to reach conclusions.     

Adolescents Exposed to Suicidal Behavior of Others: Prevalence of Self‐Harm and Associated Psychological,Lifestyle, and Life Event Factors

Exposure to suicidal behavior of others was examined among 3,881 Irish adolescents in the Child and Adolescent Self‐harm in Europe (CASE) study. One third of the sample had been exposed to suicidal behavior, and exposed adolescents were eight times more likely to also report own self‐harm. Exposed adolescents shared many risk factors with those reporting own self‐harm. Those reporting both exposure and own self‐harm presented the most maladaptive profile on psychological, life event, and lifestyle domains, but neither anxiety nor depression distinguished this group. Exposed adolescents are burdened by a wide range of risk factors and in need of support.     

Suicide Ideations,Suicide Attempts,and Completed Suicide in Persons with Pathological Gambling and Their First‐Degree Relatives

We examined the relationship between suicidal ideations and attempts in 95 probands with pathological gambling (PG), 91 controls, and 1075 first‐degree relatives. The results were analyzed using logistic regression with generalized estimating equations. Thirty‐four PG probands (35.8%) and 4 controls (4.4%) had attempted suicide (OR = 12.12, p < .001); in 13 probands, the attempt occurred before PG onset. Lifetime suicidal ideations occurred in 60 PG probands (63.2%) and 12 controls (13.2%) (OR = 11.29, p < .001). Suicidality in PG probands is a marker of PG severity and is associated with greater psychiatric comorbidity. Offspring of PG probands had significantly higher rates of suicide attempts than control offspring.     

Suicide in Psychiatric Patients: Age Distribution

ABSTRACT: In eight years, 21183 San Diego County residents killed themselves. Of these, 52 had been at some time patients of one private psychiatric group. The suicide rate increased with age for the county population but not for the psychiatric patients. This difference was highly significant. Although older people generally are at greater risk for suicide, older psychiatric patients may be more responsive to treatment.