To examine whether suicidal intent and medical lethality of past suicide attempts are predictive of future attempts, the association between intent and lethality, and the consistency of these characteristics across repeated attempts among youth.Suicide attempts in a 15-year prospective study of 180 formerly psychiatrically hospitalized adolescents (M(age at hospitalization) = 14.83; 51% female; 80% Caucasian) were characterized with the Subjective Intent Rating Scale and Lethality of Attempt Rating Scale. Anderson-Gill recurrent events survival models and generalized estimating equations were used to assess predictive validity. Generalized linear models were used to examine stability of characteristics across attempts.Neither intent nor lethality from the most recent attempt predicted future attempts. The highest level of intent and most severe lethality of attempts during the follow-up predicted subsequent attempts, but the degree to which highest intent and most severe lethality contributed to prediction after considering methods of suicide attempts, past number of attempts, or psychiatric diagnoses was mixed. Across successive attempts, there was little consistency in reported characteristics. Intent and lethality were related to each other only for attempts occurring in early adulthood.Highest intent and lethality were better predictors of future attempts than intent and lethality of the most recent attempt. However, these characteristics should be considered as predictors only within the context of other factors. For youth, clinicians should not infer true intent from the lethality of attempts, nor assume that characteristics of future suicide attempts will be similar to those of previous attempts.
Eighty-seven school-age children with insulin-dependent diabetes mellitus (IDDM) were assessed repeatedly over the first 6 years of their IDDM to determine the effects of the medical disorder on intellectual development and academic performance. At the initial diagnosis, verbal and nonverbal intellectual performance and school grades were in the average ranges. Over time, verbal performance and school grades declined, whereas nonverbal intellectual performance improved slightly. Duration of IDDM was found to be related to the outcome variables, but the degree of metabolic control was not. Analysis of longitudinal data for a 6-year interval on a demographically closely matched post hoc comparison group revealed parallel but less pronounced trends in verbal and nonverbal intellectual performance but not in school grades
Suicide, suicidal behaviors, and self-harm are major public health problems among youth and can often co-occur with traumatic stress experiences and related symptoms. Given this interrelation, it is important that suicide prevention and intervention practices take a trauma-informed approach to reflect the complex, intertwined relation of traumatic stress symptoms and suicidal thoughts/behaviors. To that end, we summarize key steps in a proposed trauma-informed approach to suicide prevention and illustrate this approach with examples of how to clinically apply suggested components for youth who are suicidal and have been exposed to traumatic events.
Objective To better understand Black mothers' and White mothers' qualitative reactions to their adolescents' hospitalizations due to suicide attempts. Background Caregivers of youth with suicidal behaviors play a vital role in youth's subsequent treatment and recovery. Yet little attention has been paid to how they are affected by youth's psychiatric hospitalizations or how their reactions may be influenced by race. Method Twenty Black mothers ( M age = 42.50; SD = 8.48) and 20 White mothers ( M age = 44.85; SD = 6.86) were randomly selected from data originally collected for a larger longitudinal, mixed method, multisite study. Data analysis was informed by grounded theory methodology. Results Four themes emerged from the data: mothers' emotional distress; mothers' coping, needs, and supports; mothers' perceived need for increased monitoring; and improved mother–child relationships. Conclusions Black mothers and White mothers largely had similar reactions to youth's hospitalizations; however, nuanced differences also were noted regarding how they described their experiences and what they emphasized. Implications During discharge planning, mothers need additional support (beyond referrals) in their roles as caregivers and for their own coping. Additional clinical and research implications are discussed.
Objective Suicidal ideation is strikingly common among people living with HIV (PLWH) worldwide, leading to higher burden of disease, poor HIV care engagement, and loss of life. In low- and middle-income countries such as Tanzania, mental health resources are scarce, requiring innovative strategies for treatment. We describe the protocol for a clinical trial of a three-session telehealth counseling intervention to reduce suicidality and improve HIV care engagement in Tanzania. Methods In a pilot randomized controlled trial, we will assess the feasibility, acceptability, and potential efficacy of a new telehealth intervention, termed “IDEAS for Hope”. A total of 60 PLWH will be enrolled from two HIV clinics in the Kilimanjaro region and connected to telehealth counsellors based at a large regional hospital. Participants will be ≥18 years old and speak either Kiswahili or English. Patient screening will occur during routine HIV clinical care to identify PLWH experiencing suicidal ideation. Baseline surveys will be administered upon enrollment and participants will be randomized 1:1 to receive either IDEAS for Hope or the comparison condition, a brief safety planning session. All participants will receive an additional referral for psychiatric treatment. Follow-up assessment will occur at three months. IDEAS for Hope is informed by a Motivational Interviewing-enhanced safety planning intervention (MI-SafeCope) and our formative work in Tanzania. The model consists of Four Pillars: living healthy with HIV, managing HIV stigma, seeking social support, and meeting basic needs. Together, these mechanisms serve as a foundation for developing a sense of safety and hope for the future. Outcome measures will include intervention feasibility, acceptability, participant suicidality, and HIV care engagement. Significance Innovative, telehealth-based counseling represents a promising treatment for suicidality among PLWH in low-resource settings. Results from this pilot trial will inform intervention refinement and parameter estimates for a future clinical trial powered to evaluate effectiveness.
