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Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Suicide Risk. Show all posts
Showing posts with label Suicide Risk. Show all posts

Monday, January 30, 2023

Abortion Access Tied to Suicide Rates Among Young Women

Michael DePeau-Wilson
MedPage Today
Originally posted 28 DEC 22

Restrictions on access to reproductive care were associated with suicide rates among women of reproductive age, researchers found.

In a longitudinal ecologic study using state-based data from 1974 to 2016, enforcement of Targeted Regulation of Abortion Providers (TRAP) laws was associated with higher suicide rates among reproductive-age women (β=0.17, 95% CI 0.03-0.32, P=0.02) but not among women of post-reproductive age, according to Ran Barzilay, MD, PhD, of the University of Pennsylvania in Philadelphia, and colleagues.

Nor was enforcement of TRAP laws associated with deaths due to motor vehicle crashes, they reported in JAMA Psychiatry in a new tab or window.

Additionally, enforcement of a TRAP law was associated with a 5.81% higher annual rate of suicide than in pre-enforcement years, the researchers found.

"Taken together, the results suggest that the association between restricting access to abortion and suicide rates is specific to the women who are most affected by this restriction, which are young women," Barzilay told MedPage Today.

Barzilay said their study "can inform, number one, clinicians working with young women to be aware that this is a macro-level suicide risk factor in this population. And number two, that it informs policymakers as they allocate resources for suicide prevention. And number three, that it informs the ethical, divisive debate regarding access to abortion."

In an accompanying editorial, Tyler VanderWeele, PhD, of Harvard T.H. Chan School of Public Health in Boston, wrote that while analyses of this type are always subject to the possibility of changes in trends being attributable to some third factor, Barzilay and colleagues did "control for a number of reasonable candidates and conducted sensitivity analyses indicating that these associations were observed for reproductive-aged women but not for a control group of older women of post-reproductive age."

VanderWeele wrote the findings do suggest that a "not inconsiderable" number of women might be dying by suicide in part because of a lack of access to abortion services, and that "the increase is cause for clinical concern."

But while more research "might contribute more to our understanding," VanderWeele wrote, its role in the legal debates around abortion "seems less clear. Regardless of whether one is looking at potential adverse effects of access restrictions or of abortion, the abortion and mental health research literature will not resolve the more fundamental and disputed moral questions."

"Debates over abortion access are likely to remain contentious in this country and others," he wrote. "However, further steps can nevertheless be taken in finding common ground to promote women's mental health and healthcare."

For their "difference-in-differences" analysis, Barzilay and co-authors relied on data from the TRAP laws index to measure abortion access, and assessed suicide data from CDC's WONDER database in a new tab or window database.

Sunday, December 4, 2022

Risk of Suicide After Dementia Diagnosis

Alothman D, Card T, et al.
JAMA Neurology
Published online October 03, 2022.

Abstract

Importance  Patients with dementia may be at an increased suicide risk. Identifying groups at greatest risk of suicide would support targeted risk reduction efforts by clinical dementia services.

Objectives  To examine the association between a dementia diagnosis and suicide risk in the general population and to identify high-risk subgroups.

Design, Setting, and Participants  This was a population-based case-control study in England conducted from January 1, 2001, through December 31, 2019. Data were obtained from multiple linked electronic records from primary care, secondary care, and the Office for National Statistics. Included participants were all patients 15 years or older and registered in the Office for National Statistics in England with a death coded as suicide or open verdict from 2001 to 2019. Up to 40 live control participants per suicide case were randomly matched on primary care practice and suicide date.

Exposures  Patients with codes referring to a dementia diagnosis were identified in primary care and secondary care databases.

Main Outcomes and Measures  Odds ratios (ORs) were estimated using conditional logistic regression and adjusted for sex and age at suicide/index date.

Conclusions and Relevance  Diagnostic and management services for dementia, in both primary and secondary care settings, should target suicide risk assessment to the identified high-risk groups.


Key Points

Question  Is there an association between dementia diagnosis and a higher risk of suicide?

Findings  In this nationally representative case-control study including 594, 674 persons in England from 2001 through 2019, dementia was found to be associated with increased risk of suicide in specific patient subgroups: those diagnosed before age 65 years (particularly in the 3-month postdiagnostic period), those in the first 3 months after diagnosis, and those with known psychiatric comorbidities.

Meaning  Given the current efforts to improve rates of dementia diagnosis, these findings emphasize the importance of concurrent implementation of suicide risk assessment for the identified high-risk groups.

Wednesday, November 16, 2022

‘What if Yale finds out?’

William Wan
The Washington Post
Originally posted November 11, 2022

Suicidal students are pressured to withdraw from Yale, then have to apply to get back into the university

Here are two excerpt:

‘Getting rid of me’

Five years before the pandemic derailed so many college students’ lives, a 20-year-old math major named Luchang Wang posted this message on Facebook:

“Dear Yale, I loved being here. I only wish I could’ve had some time. I needed time to work things out and to wait for new medication to kick in, but I couldn’t do it in school, and I couldn’t bear the thought of having to leave for a full year, or of leaving and never being readmitted. Love, Luchang.”

Wang had withdrawn from Yale once before and feared that under Yale’s policies, a second readmission could be denied.
Instead, she flew to San Francisco, and, according to authorities, climbed over the railing at the Golden Gate Bridge and jumped to her death.

Her 2015 suicide sparked demands for change at Yale. Administrators convened a committee to evaluate readmission policies, but critics said the reforms they adopted were minor.

They renamed the process “reinstatement” instead of “readmission,” eliminated a $50 reapplication fee and gave students a few more days at the beginning of each semester to take a leave of absence without having to reapply.

Students who withdrew still needed to write an essay, secure letters of recommendation, interview with Yale officials and prove their academic worth by taking two courses at another four-year university. Those who left for mental health reasons also had to demonstrate to Yale that they’d addressed their problems.

In April — nearly 10 months after S. had been pressured to withdraw — Yale officials announced another round of changes to the reinstatement process. 

They eliminated the requirement that students pass two courses at another university and got rid of a mandatory interview with the reinstatement committee.

The reforms have not satisfied student activists at Yale, where the mental health problems playing out on many American campuses has been especially prominent.

(cut)

In recent years, Yale has also faced an “explosion” in demand for mental health counseling, university officials said. Last year, roughly 5,000 Yale students sought treatment — a 90 percent increase compared with 2015.

“It’s like nothing we’ve ever seen before,” said Hoffman, the director of Yale Mental Health and Counseling. Roughly 34 percent of the 14,500 students at 

Yale seek mental health help from college counselors, compared with a national average of 11 percent at other universities.

Meeting that need has been challenging, even at a school with a $41.4 billion endowment.

Bluebelle Carroll, 20, a Yale sophomore who sought help in September 2021, said she waited six months to be assigned a therapist. She secured her first appointment only after emailing the counseling staff repeatedly.

“The appointment was 20 minutes long,” she said, “and we spent the last five minutes figuring out when he could see me again.”

Because of staffing constraints, students are often asked to choose between weekly therapy that lasts 30 minutes or 45-minute sessions every two weeks.

Friday, May 6, 2022

Interventions to reduce suicidal thoughts and behaviours among people in contact with the criminal justice system

A. Carter, A. Butler, et al. (2022)
The Lancet, Vol 44, 101266

Summary

Background

People who experience incarceration die by suicide at a higher rate than those who have no prior criminal justice system contact, but little is known about the effectiveness of interventions in other criminal justice settings. We aimed to synthesise evidence regarding the effectiveness of interventions to reduce suicide and suicide-related behaviours among people in contact with the criminal justice system.

Findings

Thirty-eight studies (36 primary research articles, two grey literature reports) met our inclusion criteria, 23 of which were conducted in adult custodial settings in high-income, Western countries. Four studies were randomised controlled trials. Two-thirds of studies (n=26, 68%) were assessed as medium quality, 11 (29%) were assessed as high quality, and one (3%) was assessed as low quality. Most had considerable methodological limitations and very few interventions had been rigorously evaluated; as such, drawing robust conclusions about the efficacy of interventions was difficult.

Research in context

Evidence before this study

One previous review had synthesised the literature regarding the effectiveness of interventions during incarceration, but no studies had investigated the effectiveness of interventions to prevent suicidal thoughts and/or behaviours among people in contact with the multiple other settings in the criminal justice system. We searched Embase, PsycINFO, and MEDLINE on 1 June 2021 using variants and combinations of search terms relating to suicide, self-harm, prevention, and criminal justice system involvement (suicide, self-injury, ideation, intervention, trial, prison, probation, criminal justice).
 Added value of this study

Our review identified gaps in the evidence base, including a dearth of robust evidence regarding the effectiveness of interventions across non-custodial criminal justice settings and from low- and middle-income countries. We identified the need for studies examining suicide prevention initiatives for people who were detained in police custody, on bail, or on parole/license, those serving non-custodial sentences, and those after release from incarceration. Furthermore, our findings suggested an absence of interventions which considered specific population groups with diverse needs, such as women, First Nations people, and young people.

Monday, February 7, 2022

On loving thyself: Exploring the association between self-compassion, self-reported suicidal behaviors, and implicit suicidality among college students

Zeifman, R. J., Ip, J., Antony, M. M., & Kuo, J. R. 
(2021). Journal of American college health
J of ACH, 69(4), 396–403.

Abstract

Suicide is a major public health concern. It is unknown whether self-compassion is associated with suicide risk above and beyond suicide risk factors such as self-criticism, hopelessness, and depression severity. 

Participants: Participants were 130 ethnically diverse undergraduate college students. 

Methods: Participants completed self-report measures of self-compassion, self-criticism, hopelessness, depression severity, and suicidal behaviors, as well as an implicit measure of suicidality. 

Results: Self-compassion was significantly associated with self-reported suicidal behaviors, even when controlling for self-criticism, hopelessness, and depression severity. Self-compassion was not significantly associated with implicit suicidality. 

Conclusions: The findings suggest that self-compassion is uniquely associated with self-reported suicidal behaviors, but not implicit suicidality, and that self-compassion is a potentially important target in suicide risk interventions. Limitations and future research directions are discussed.

Discussion

Clinical implications

Our findings suggest that self-criticism and self-compassion are uniquely predictive of self-reported suicidal behaviors.  Therefore, in addition to the importance of targeting self-criticism, self-compassion may also be an important, and independent, target within suicide risk interventions. Indeed, qualitative analysis of interviews conducted with individuals with borderline personality disorder (a psychiatric disorder characterized by high levels of suicide risk) and their service providers, identified self-compassion as an important theme in the process of recovery.  Interventions that specifically focus on fostering self-compassion, by generating feelings of self-reassurance, warmth, and self-soothing, include compassion-focused therapy and mindful self-compassion. Compassion based interventions have shown promise for a wide range of populations, including eating disorders, psychotic disorders, personality disorders, and healthy individuals.

Wednesday, July 22, 2020

FCC Approves 988 as Suicide Hotline Number

Jennifer Weaver
KUTV.com
Originally posted 16 July 20

A three-digit number to connect to suicide prevention and mental health crisis counselors has been approved.

The Federal Communications Commission voted unanimously Thursday to make 988 the number people can call to be connected directly to the National Suicide Prevention Hotline.

Phone service providers have until July 2022 to implement the new number. The 10-digit number is currently 1-800-273-8255 (TALK).

Tuesday, October 15, 2019

Want To Reduce Suicides? Follow The Data — To Medical Offices, Motels And Even Animal Shelters

Maureen O’Hagan
Kaiser Health News
Originally published September 23, 2019

Here is an excerpt:

Experts have long believed that suicide is preventable, and there are evidence-based programs to train people how to identify and respond to folks in crisis and direct them to help. That’s where Debra Darmata, Washington County’s suicide prevention coordinator, comes in. Part of Darmata’s job involves running these training programs, which she described as like CPR but for mental health.

The training is typically offered to people like counselors, educators or pastors. But with the new data, the county realized they were missing people who may have been the last to see the decedents alive. They began offering the training to motel clerks and housekeepers, animal shelter workers, pain clinic staffers and more.

It is a relatively straightforward process: Participants are taught to recognize signs of distress. Then they learn how to ask a person if he or she is in crisis. If so, the participants’ role is not to make the person feel better or to provide counseling or anything of the sort. It is to call a crisis line, and the experts will take over from there.

Since 2014, Darmata said, more than 4,000 county residents have received training in suicide prevention.

“I’ve worked in suicide prevention for 11 years,” Darmata said, “and I’ve never seen anything like it.”

The sheriff’s office has begun sending a deputy from its mental health crisis team when doing evictions. On the eviction paperwork, they added the crisis line number and information on a county walk-in mental health clinic. Local health care organizations have new procedures to review cases involving patient suicides, too.

The info is here.

Wednesday, September 18, 2019

California Requires Suicide Prevention Phone Number On Student IDs

Mark Kreider
Kaiser Health News
Originally posted August 30, 2019

Here is an excerpt:

A California law that has greeted students returning to school statewide over the past few weeks bears a striking resemblance to that Palo Alto policy from four years ago. Beginning with the 2019-20 school year, all IDs for California students in grades seven through 12, and in college, must bear the telephone number of the National Suicide Prevention Lifeline. That number is 800-273-TALK (8255).

“I am extremely proud that this strategy has gone statewide,” said Herrmann, who is now superintendent of the Roseville Joint Union High School District near Sacramento.

The new student ID law marks a statewide response to what educators, administrators and students themselves know is a growing need.

The numbers support that idea — and they are as jarring as they are clarifying.

Suicide was the second-leading cause of death in the United States among people ages 10 to 24 in 2017, according to the U.S. Centers for Disease Control and Prevention.  The suicide rate among teenagers has risen dramatically over the past two decades, according to data from the CDC.

The info is here.

Friday, September 13, 2019

The dynamics of social support among suicide attempters: A smartphone-based daily diary study

Coppersmith, D.D.L.; Kleiman, E.M.; Glenn, C.R.; Millner, A.J.; Nock, M.K.
Behaviour Research and Therapy (2018)

Abstract

Decades of research suggest that social support is an important factor in predicting suicide risk and resilience. However, no studies have examined dynamic fluctuations in day-by-day levels of perceived social support. We examined such fluctuations over 28 days among a sample of 53 adults who attempted suicide in the past year (992 total observations). Variability in social support was analyzed with between-person intraclass correlations and root mean square of successive differences. Multi-level models were conducted to determine the association between social support and suicidal ideation. Results revealed that social support varies considerably from day to day with 45% of social support ratings differing by at least one standard deviation from the prior assessment. Social support is inversely associated with same-day and next-day suicidal ideation, but not with next-day suicidal ideation after adjusting for same-day suicidal ideation (i.e., not with daily changes in suicidal ideation). These results suggest that social support is a time-varying protective factor for suicidal ideation.

The research is here.

Tuesday, February 13, 2018

How Should Physicians Make Decisions about Mandatory Reporting When a Patient Might Become Violent?

Amy Barnhorst, Garen Wintemute, and Marian Betz
AMA Journal of Ethics. January 2018, Volume 20, Number 1: 29-35.

Abstract

Mandatory reporting of persons believed to be at imminent risk for committing violence or attempting suicide can pose an ethical dilemma for physicians, who might find themselves struggling to balance various conflicting interests. Legal statutes dictate general scenarios that require mandatory reporting to supersede confidentiality requirements, but physicians must use clinical judgment to determine whether and when a particular case meets the requirement. In situations in which it is not clear whether reporting is legally required, the situation should be analyzed for its benefit to the patient and to public safety. Access to firearms can complicate these situations, as firearms are a well-established risk factor for violence and suicide yet also a sensitive topic about which physicians and patients might have strong personal beliefs.

The commentary is here.

Wednesday, July 12, 2017

Suicide and self-harm in prisons hit worst ever levels

Rajeev Syal
The Guardian
Originally posted June 28, 2017

Prisons have “struggled to cope” with record rates of suicide and self-harm among inmates following cuts to funding and staff numbers, the public spending watchdog has said. The National Audit Office said it remains unclear how the authorities will meet aims for improving prisoners’ mental health or get value for money because of a lack of relevant data.

Auditors said that self-harm incidents increased by 73% between 2012 and 2016 to 40,161, while the 120 self-inflicted deaths in prison in 2016 was the highest figure on record and almost double that for 2012. Since 2010, when David Cameron became prime minister, funding of offender management has been reduced by 13%, while staff numbers have been cut by 30%, the report said.

The article is here.

Tuesday, October 25, 2016

Dear Donald Trump: I treat combat veterans with PTSD, and they are not weak

Joan Cook
The Conversation
Originally published October 5, 2016

Here is an excerpt:

Combat trauma is a powerful predictor for a number of mental health problems. PTSD is, of course, the most notable consequence, but veterans who have served in war zones also suffer alarming rates of depression, anxiety and substance abuse. And in recent years, the high suicide rates among U.S. service members have soared to an estimated 22 dying by their own hand each day.

If knowing that isn’t enough to make most Americans – including you – hang their heads, pause in appreciation and potentially cry, I’m not sure what would.

Sadly, veterans with PTSD also have what health care professionals call a “reduced quality of life.” They go to work less and use more health care services.

Unless treated, PTSD typically runs a chronic course and haunts a person for many years or decades. Thus, the substantial burden of PTSD is not just on a veteran’s back, but on their families, their communities and society as well.

The article is here.

Wednesday, August 24, 2016

The Controversial Issue of Euthanasia in Patients With Psychiatric Illness

Emilie Olie & Philippe Courtet
JAMA. 2016;316(6):656-657

A main objective of legalization of euthanasia or physician-assisted suicide (EAS) is to ease suffering (ie, physical pain and loss of autonomy elicited by an irreversible serious disease), when a terminally ill patient's pain is overwhelming despite palliative care. It implies that there is no reasonable alternative in the patient's situation, with no prospect of improvement of a painful condition or global functioning. Because mental disorders are among the most disabling illnesses, requests for EAS based on unbearable mental suffering caused by severe psychiatric disease may possibly increase. EAS may be differentiated from suicide because EAS results in death without self-inflicted behavior, yet both are driven by a desire to end life. This raises the question: Should the management of patients with psychiatric disorders requesting EAS be considered for suicide prevention?

Mental illness increases suicidal risk and requires treatment. Nevertheless, evidence-based medical and psychosocial treatments currently are not provided to the majority of patients with psychiatric diseases who would benefit. Even if these therapies were prescribed, about 30% of depressed patients are treatment resistant. Patients may have undergone treatments destined to fail or they may have refused potential effective therapeutics. Nevertheless, the probability of disease remission increases with number of different treatments attempted. Given these uncertainties and that there are no valid indicators to predict the response to treatment, there is no reliable mechanism to define incurable disease and determine medical futility for psychiatric care. Considering euthanasia for psychiatric patients may reinforce poor expectations of the medical community for mental illness treatment and contribute to a relative lack of progress in developing more effective therapeutic strategies.

The article is here.

Monday, January 27, 2014

When Doctors ‘Google’ Their Patients

By Haider Javed Warraich
The New York Times - Well Blog
Originally published January 6, 2013

Here is an excerpt:

I am tempted to prescribe that physicians should never look online for information about their patients, though I think the practice will become only more common, given doctors’ — and all of our — growing dependence on technology. The more important question health care providers need to ask themselves is why we would like to.

To me, the only legitimate reason to search for a patient’s online footprint is if there is a safety issue. If, for example, a patient appears to be manic or psychotic, it might be useful to investigate whether certain claims the patient makes are true. Or, if a doctor suspects a pediatric patient is being abused, it might make sense to look for evidence online. Physicians have also investigated patients on the web if they were concerned about suicide risk, or needed to contact the family of an unresponsive patient.

The entire article is here.