Promoting Safe Sleep: The Role of Doulas in Black Communities.

BACKGROUND: Accidental suffocation and strangulation in bed continues to be a critical issue in Black communities, despite the widespread initiatives to promote safe sleep. Doulas are in an ideal position to promote safe sleep, particularly in hard-to-reach communities that are more distrusting of conventional medical providers. Little is known about their practices and perspectives for putting infants down to rest. This study informs this gap in the literature. PURPOSE: The purpose of this study was to explore doulas' perspectives and practices in the field of putting infants down to sleep. The researchers aimed to determine whether Black caregivers that work with doulas are likely to encounter safe sleep education. METHODS: The researchers used a descriptive approach to inquiry. They conducted three focus groups with a total of 17 Black doulas. The researchers independently and critically reviewed the transcriptions and observation notes from each group to identify codes. They then triangulated the results using Artificial Intelligence-driven tools. FINDINGS: The study found four themes: (1) Individualized Services, (2) Cultural Sensitivity, (3) Negotiating Safety, and (4) Safe Sleep Education. CONCLUSIONS: The study concluded doulas have a commitment to promoting safe sleep. The researchers found that doulas engage in practices that help caregivers to integrate safe sleep practices into their lifestyle and to adapt them to meet their needs. The researchers also documented a desire for more information and instruction on safe sleep among practicing doulas.

Risk Factors for Suffocation and Unexplained Causes of Infant Deaths.

BACKGROUND: Observational studies have improved our understanding of the risk factors for sudden infant death syndrome, but separate examination of risk for sleep-related suffocation and unexplained infant deaths has been limited. We examined the association between unsafe infant sleep practices and sudden infant deaths (sleep-related suffocation and unexplained causes including sudden infant death syndrome). METHODS: We conducted a population-based case-control study using 2016 to 2017 Centers for Disease Control and Prevention data. Controls were liveborn infants from the Pregnancy Risk Assessment Monitoring System; cases were from the Sudden Unexpected Infant Death Case Registry. We calculated risk factor prevalence among cases and controls and crude and adjusted odds ratios. RESULTS: We included 112 sleep-related suffocation cases with 448 age-matched controls and 300 unexplained infant death cases with 1200 age-matched controls. Adjusted odds for sleep-related suffocation ranged from 18.7 (95% confidence interval [CI]: 6.8-51.3) among infants not sharing a room with their mother or caregiver to 1.9 (95% CI: 0.9-4.1) among infants with nonsupine sleep positioning. Adjusted odds for unexplained death ranged from 7.6 (95% CI: 4.7-12.2) among infants not sharing a room with their mother or caregiver to 1.6 (95% CI: 1.1-2.4) among nonsupine positioned infants. COCLUSIONS: We confirmed previously identified risk factors for unexplained infant death and independently estimated risk factors for sleep-related suffocation. Significance of associations for suffocation followed similar patterns but was of larger magnitude. This information can be used to improve messaging about safe infant sleep.

Effectiveness and use of avalanche airbags in mortality reduction among winter-recreationists.

BACKGROUND/OBJECTIVE: The number of backcountry skiers and snowboarder surged in the last years, especially during the COVID-19 pandemic, as ski resorts shut down. Inevitably, this led to an increase in avalanche-related injuries and death. As avalanche rescue device, avalanche airbags are increasingly becoming part of the standard winter mountaineering equipment. This study provides a review of the available data and an updated perspective on avalanche airbags, discussing their function and efficacy to reduce mortality and their limitations. RESULTS: Causes of death in individuals caught by avalanches are multiple. Airbags seem to reduce mortality by decreasing the chances of critical burial, the most determining risk factor. However, there is a scarcity of reliable scientific research on the topic, and the way in which airbags reduce mortality and to what extent is still debated. Several elements seem to influence airbags efficacy, and their use still yields several limitations linked to manufacturing, proper use, users education and risk compensation. CONCLUSIONS: Avalanche airbags seem to be an important tool in reducing mortality in the backcountry expeditions. However, more research and standardized data collection are needed to fill the knowledge gap, and mountain communities should promote adequate education of winter-recreationists on how to prevent and react to an avalanche and on the correct use of airbags in combination with already available tools such as transceivers, probes and shovels; and manufacturing companies should ensure higher efficacy of the survival avalanche equipment for better prevention of burial, asphyxia and trauma.

Preventing the human factor: organizational aspects linked to fetal asphyxia.

BACKGROUND: Perinatal asphyxia can cause cerebral palsy and hypoxic-ischemic encephalopathy. They are public health problems because they cause permanent disability. METHODS: This is a retrospective, analytical, observational study. Overall, 162 cases of mothers whose children experienced fetal asphyxia were compared to 361 controls where this condition did not occur. The variables analyzed were classified as: prepartum, intrapartum and organizational. RESULTS: Assisted reproductive technology obtained pregnancies, smoking, maternal body mass index, lack of one-to-one assistance during labor, birth on a day of high-volume activity increased the risk of fetal asphyxia, as well as other traditionally linked factors like shoulder dystocia or age over 35 years. CONCLUSIONS: Cerebral palsy cannot always be prevented because it is a syndrome with a multitude of potential causes. But a small number of cases is likely to be linked to acute intrapartum events that could be limited by changing organizational policies such as staff training and implementing teamwork and discussion. Our paper proposes strategies to try and modify organizational risk factors and therefore limit the incidence of fetal asphyxia.

Trends in Rates of Sudden Unexpected Infant Death (SUID): Hopes for Prevention.

Infant deaths that occur unexpectedly during sleep have been attributed over generations to various explanations for this shocking and tragic loss of life. Historically, these deaths have been coded as caused by sudden infant death syndrome (SIDS), which defied prevention. This paper explores the evolution of understanding SIDS to the current use of the term sudden unexpected infant death (SUID) defined by the Centers for Disease Control as including three causes: SIDS, accidental strangulation and suffocation in bed (ASSB) and unknown. Data presented in this paper demonstrate that with enhanced death scene investigations there has been a shift over the past three decades in how SUIDs are coded. In 1990-4, nationally, 84 percent of post neonatal deaths were attributed to SIDS, 12 percent to unknown, and 3 percent to ASSB. Most current data (2014-18) show that 42 percent are now attributed to SIDS, 34 percent to unknown, and 25 percent to ASSB. While there has been stalled progress in the decrease of SUIDs, the diagnostic shift observed yields promise for the prevention of these deaths with public health measures that educate the public on the hazards of safe sleep for babies.

Should Airbag Backpacks Be Standard Avalanche Safety Equipment?

Avalanche airbag backpacks have been shown to be effective at reducing avalanche mortality. However, they are yet to be considered standard avalanche safety equipment, which has long consisted of a transceiver, a shovel, and a probe. This is despite data showing that airbags reduce mortality by decreasing the likelihood of burial. In addition, airbags probably lessen trauma and possibly delay asphyxia. Moreover, the literature suggests airbags reduce mortality at a rate similar to transceivers. For those who work, volunteer, and recreate in avalanche terrain, airbags should be considered standard safety equipment. However, multiple barriers exist for universal adoption, including cost, size, weight, training burden, availability, risk tolerance, and lack of community support and recommendations from professional societies and associations.

Out-of-hospital cardiac arrests in the young population; a 6-year review of the Irish out-of-hospital cardiac arrest register.

STUDY PURPOSE: Out-of-hospital cardiac arrests (OHCA) in the young population have only been examined in a limited number of regional studies. Hence, we sought to describe OHCA characteristics and predictors of survival to hospital discharge for the young Irish population. STUDY DESIGN: An observational analysis of the national Irish OHCA register for all OHCAs aged ≤35 years between January 2012 and December 2017 was performed. The young population was categorised into three age groups: ≤1 year, 1-15 years and 16-35 years. Multivariable logistic regression was used to determine the independent predictors of survival to hospital discharge. RESULTS: A total of 1295 OHCAs aged ≤35 years (26.9% female, median age 25 (IQR 17-31)) had resuscitation attempted. OHCAs in those aged ≥16 years (n=1005) were more likely to happen outside the home (38.5% vs 22.8%, p<0.001) and be of non-medical aetiology (59% vs 27.6%, p<0.001) compared with those aged <16 years (n=290). Asphyxiation, trauma and drug overdoses accounted for over 90% of the non-medical OHCAs for those 16-35 years. Overall survival to hospital discharge for the cohort was 5.1%; survival was non-significantly higher for those aged 16-35 years compared with those aged 1-15 years (6.0%, vs 2.8% p=0.93). Independent predictors of survival to hospital discharge included bystander witnessed OHCA, a shockable initial rhythm and a bystander defibrillation attempt. CONCLUSIONS: The high prevalence of non-medical OHCAs and the OHCA location need to be considered when developing OHCA care pathways and preventative strategies to reduce the burden of OHCAs in the young population.

Impaired ability to turn in bed in parkinson's disease as a potential rare cause of positional asphyxia: a sensor-based analysis.

BACKGROUND: Nocturnal hypokinesia commonly affects Parkinson's disease (PD) patients, manifesting primarily as an impaired ability to turn in bed and sleeping in specific positions, such as prone that potentially poses the risk of positional asphyxia. OBJECTIVE: To objectively evaluate, using axial inertial sensors (the NIGHT-Recorder), the ability of PD patients and controls to turn in bed from prone to supine position and to correlate these parameters with disease severity scores. PATIENTS AND METHODS: Turning in bed from prone to supine position was assessed in 16 PD patients with a moderate disease stage and 16 age-matched controls using the NIGHT-Recorder. Successful turning was defined as a full 180 ° turn from prone to supine position as evidenced by the NIGHT-Recorder. Objective parameters included duration, velocity, and acceleration of turn. The ability to turn in bed was determined by torque per kilogram body weight (T/kg). RESULTS: Two out of 16 PD patients (12.5%) could not initiate their turns. PD patients turned with a significant longer duration (p = 0.04), slower velocity (p = 0.04), and acceleration (p = 0.04) compared to controls. Although PD patients had lower T/kg than controls, the difference was not significant. Several significant correlations were demonstrated between turning parameters and clinical rating scales (Duration vs. UPDRS axial: r=0.51, p = 0.04; T/kg vs. PDSS-2: r=0.53, p = 0.03; T/kg vs. NHQ: r=0.52, p = 0.03). CONCLUSION: Our study provides objective evidence of impaired turning in bed from prone to supine position in PD patients with nocturnal hypokinesia. Appropriate measures should be taken to improve nocturnal mobility in those at risk.

Effectiveness of using an educational video simulating the anatomical mechanism of shaking and smothering in a home-visit program to prevent self-reported infant abuse: A population-based quasi-experimental study in Japan.

BACKGROUND: A video that simulates the anatomical mechanism of shaking the infant head, which may have a stronger impact on the viewer, and a tool to prevent self-reported smothering in response to crying, has never been investigated. OBJECTIVE: To investigate whether watching an educational video at home visit at 2 months postpartum on infant crying and the dangers of shaking and smothering reduces self-reported shaking and smothering behaviors at 4 months postpartum. METHOD: In a quasi-experimental study in A city in Japan, the video intervention was implemented at home visits by a midwife, public health nurse or trained volunteers when babies were 2 months old. At the 4-month health checkup, participants received a questionnaire about the video, self-reported shaking and smothering behaviors and other covariates. The impacts of watching the video and self-reported shaking or smothering were analyzed using multiple logistic regression. RESULTS: In total, 5961 caregivers provided valid response for this study (valid response rate: 73.8 %). In the adjusted model, those who watched the video were 74 % less likely to shake their infants (odds ratio (OR): 0.36, 95 % confidence interval (CI): 0.21-0.64), 43 % were less likely to smother their infants (OR: 0.57, 95 % CI: 0.37-0.89), 52 % were less likely to shake or smother (OR: 0.48, 95 % CI: 0.33-0.69) their infants. CONCLUSION: The educational video on infant crying and the dangers of shaking and smothering, with anatomical mechanism of shaking, may halve the risk of self-reported shaking and smothering at 4 months of age.

Intensive Care Neonates and Evidence to Support the Elimination of Hats for Safe Sleep.

BACKGROUND: Although the incidence of sudden unexplained infant deaths has decreased over time with the use of safe sleep practices, one area that remains unclear is the safety of hats during infant sleep. PURPOSE: Decrease the risk of overheating or suffocation by removing NICU infants' hats during sleep without increasing the relative risk of hypothermia during transition to an open crib. METHODS: Removal of hats for routine thermoregulation, beyond the initial infant resuscitation and stabilization of NICU infant was implemented in 2015. Retrospective chart audits were conducted on all NICU infants between February 2015 and December 2016. Hypothermia (≤ 97.6°F) data during transition to an open crib was collected. Exclusion criteria included concurrent diagnosis of: sepsis, hyperbilirubinemia, congenital anomaly inhibiting infants thermoregulation and noncompliance with unit guideline for weaning infant to open crib. FINDINGS: Over 18 months, 2.7% of infants became hypothermic (≤ 97.6°F) during transition to open crib, requiring return to isolettes. IMPLICATIONS FOR PRACTICE: Hats were found to be unnecessary in maintaining thermoneutrality after weaning infants toan open crib in our NICU. By avoiding the use of hats in an open crib, it's possible infants will avoid overheating and a risk of suffocation, creating a safer sleep environment. IMPLICATIONS FOR RESEARCH: The removal of hats during sleep to promote infant health should be considered for all infants.

Avalanche airbag post-burial active deflation - The ability to create an air pocket to delay asphyxiation and prolong survival.

AIM: The primary purpose of an avalanche airbag is to prevent burial during an avalanche. Approximately twenty percent of avalanche victims deploying airbags become critically buried, however. One avalanche airbag actively deflates three minutes after deployment, potentially creating an air pocket. Our objective was to evaluate this air pocket and its potential to prevent asphyxiation. METHODS: Twelve participants were fitted with an airbag and placed prone on the snow. Participants deployed the airbag and were buried in 1.5 m of snow for 60 min with vital signs including oxygen saturation (SpO2) and end-tidal CO2 (ETCO2) measured every minute. Participants completed a post-burial survey to determine head movement within the air pocket. RESULTS: Eleven of the 12 participants (92%) completed 60 min of burial. Preburial baseline SpO2 measurements did not change significantly over burial time (P > 0.05). Preburial baseline ETCO2 measurements increased over the burial time (P < 0.02); only one ETCO2 value was outside of the normal ETCO2 range (35-45 mmHg). Participants reported they could move their head forward 11.2 cm (SD 4.8 cm) and backward 6.6 cm (SD 5.1 cm) with the majority of participants stated that they had enough head movement to separate the oral cavity from opposing snow if necessary. Visual examination during extrication revealed a well-defined air pocket in all burials. CONCLUSION: The avalanche airbag under study creates an air pocket that appears to delay asphyxia, which could allow extra time for rescue and improve overall survival of avalanche victims.

Trends in Breastfeeding Interventions, Skin-to-Skin Care, and Sudden Infant Death in the First 6 Days after Birth.

OBJECTIVE: To determine if implementation of skin-to-skin care and the Baby-Friendly Hospital Initiative (BFHI) contributes to sudden unexpected infant death (SUID) and asphyxia in the first 6 days after birth. STUDY DESIGN: Survey data were used to determine a correlation between BFHI and deaths from SUID and asphyxia among infants <7 days in the US and Massachusetts. Using data from the Centers for Disease Control and Prevention, implementation of BFHI was tracked from 2004-2016 and skin-to-skin care was tracked from 2007-2015. Using data from Centers for Disease Control and Prevention WONDER and the Massachusetts Department of Public Health, SUID and asphyxia were tracked from 2004-2016. RESULTS: Nationally, births in Baby-Friendly facilities rose from 1.8% to 18.3% and the percentage of facilities in which most dyads experienced skin-to-skin care rose from 40% to 83%. SUID prevalence among infants <7 days was rare (0.72% of neonatal deaths) and decreased significantly from 2004-2009 compared with 2010-2016, from 0.033 per 1000 live births to 0.028, OR 0.85 (95% CI 0.77, 0.94). In Massachusetts, births in Baby-Friendly facilities rose from 2.8% to 13.9% and skin-to-skin care rose from 50% to 97.8%. SUID prevalence decreased from 2010-2016 compared with 2004-2009: OR 0.32 (95% CI 0.13, 0.82), with 0 asphyxia deaths during the 13-year period. CONCLUSION: Increasing rates of breastfeeding initiatives and skin-to-skin care are temporally associated with decreasing SUID prevalence in the first 6 days after birth in the US and Massachusetts.

The wake project: Improving safe sleep practices in a neonatal intensive care unit.

BACKGROUND: Every year, about 50 babies in New York City die from a sleep-related injury. The Bronx County ranked second highest rate of sleep-related infant deaths (SRID) at 0.5 per 1000 among the other boroughs. The highest rate was among blacks and the rate of SRID cases were highest in our population at 0.97 (zip code 10466) among all other Bronx neighborhoods which comprises 77% of non-Hispanic black population. Further, Bronx has the highest preterm birth rate at 9.5%. This quality improvement (QI) project aimed to develop and implement an educational initiative on infant safe sleep (SS) to improve "Safe Sleep Practices (SSP) in a level III neonatal intensive care unit (NICU) for one of the highest risk populations in the country. METHODS: Baseline data was collected prior to initiating the QI project. Multiple plan-do-study-act (PDSA) cycles were completed over a 12 month period. Run charts were utilized to identify improvement and guide interventions. These interventions included education for nurses, crib cards, posters, feedback forms, grand rounds and small group discussions. RESULTS: Approximately 600 crib checks (CC) were performed over the duration of this project. At baseline, 7% of infants were placed in a SS position in the NICU. Following the QI project, SS position increased to 96% of infants. CONCLUSION: Multifactorial interventions significantly improved SS compliance among NICU nurses. Cultivating personal motivation among nurses, consistent empowerment and dedication to culture change by the entire team was crucial for the sustainability of the project.

Extrication Times During Avalanche Companion Rescue: A Randomized Single-Blinded Manikin Study.

Aims: This study aimed to determine the time needed for one or two companion rescuers to access, extricate, and deliver cardiopulmonary resuscitation (CPR) to a fully buried manikin during a simulated avalanche burial scenario. Materials and Methods: In this randomized, single-blinded study, 18 medical students were required to extricate a manikin manually from a simulated avalanche burial of 1 m in depth, either alone or in teams of two. Each participant performed three consecutive tests with the manikin in three different positions in random order. Results: Median time to first manikin contact was 2.5 minutes, median time to airway access 7.2 minutes, and median time to standard position for CPR 10.1 minutes. Overall, the number of rescuers (one compared to two rescuers, 10.5 minutes vs. 9.3 minutes; p = 0.686) and the burial position of the manikin (10.8 minutes vs. 10.6 minutes vs. 8.8 minutes; p = 0.428) had no influence on extrication times. Preexisting training (6.1 minutes vs. 11.0 minutes p = 0.006) and a learning effect obtained during the experiments (12.4 minutes the first test vs. 9.3 in the third test; p = 0.017) improved all extrication times. Conclusion: It takes an average of 7 minutes after location of a simulated avalanche victim, buried at a depth of 1 m, to free the airway, plus a further 3 minutes to initiate CPR in standard supine position. This is more than two-thirds of the 15 minutes considered necessary for successful companion avalanche rescue. Even minimal training significantly reduced extrication times. These findings emphasize the importance of regular practice in specific extrication techniques that should be part of any training in avalanche companion rescue.

Reports of Injury Risks and Reasons for Choice of Sleep Environments for Infants and Toddlers.

OBJECTIVE: Compare mothers' reports of injuries for infants and toddlers sleeping with crib-bumpers/mesh-liners/no-barriers and reasons for these sleep environment choices. METHODS: A cross-sectional survey of mothers subscribing to a parenting magazine and using crib bumpers (n = 224), mesh liners (n = 262), and no barriers (n = 842). Analyses of four possible injuries (face-covered, climb-out/fall, slat-entrapment, hit-head) including multivariate logistic regression adjusted for missing data/demographics and Chi squared analyses of reasons for mothers' choices. RESULTS: Maternal reports of finding infants/toddlers with face covered had 3.5 times higher adjusted odds (aOR) for crib bumper versus mesh liner use. Breathing difficulties and wedgings were reported for infants/toddlers using crib bumpers but not mesh liners. Climb-outs/falls showed no significant difference in aORs for crib bumpers versus no-barriers and mesh liners versus no barriers. Reports of slat-entrapment were less likely for mothers using crib bumpers and mesh liners than using no barrier (aOR = .28 and .32). Reports of hit-heads were less likely for crib bumpers vs no barrier (aOR = .38) with no significant difference between mesh liners versus no barrier use. Mothers using crib bumpers and mesh liners felt their choice prevented slat-entrapment (89%, 91%); 93.5% of crib bumper users felt their choice prevented hit-heads. Significantly more mesh liner than crib bumper users chose them because "There is no suffocation risk" (64.1% vs. 40.6%), while 83.6% of no-barrier users chose them because "I was concerned about suffocation risk." CONCLUSIONS FOR PRACTICE: Mothers appeared to be more concerned about preventing minor risks than suffocation. Understanding reasons for mothers' use of barriers/no-barriers is important in tailoring counseling for mothers with infants/toddlers.

Sleep-Related Infant Suffocation Deaths Attributable to Soft Bedding, Overlay, and Wedging.

BACKGROUND: Unintentional suffocation is the leading cause of injury death among infants <1 year old in the United States, with 82% being attributable to accidental suffocation and strangulation in bed. Understanding the circumstances surrounding these deaths may inform prevention strategies. METHODS: We analyzed data from the population-based Sudden Unexpected Infant Death Case Registry from 2011 to 2014. Cases categorized as explained suffocation with unsafe sleep factors (suffocation), per the Centers for Disease Control and Prevention's Sudden Unexpected Infant Death Case Registry classification system, were included and assigned a mechanism of obstruction, including soft bedding, overlay, or wedging. We calculated frequencies and percentages of suffocation deaths by mechanism and selected demographic and sleep-environment characteristics. RESULTS: Fourteen percent of sudden unexpected infant death cases were classified as suffocation; these cases were most frequently attributed to soft bedding (69%), followed by overlay (19%) and wedging (12%). Median age at death in months varied by mechanism: 3 for soft bedding, 2 for overlay, and 6 for wedging. Soft-bedding deaths occurred most often in an adult bed (49%), in a prone position (82%), and with a blanket (or blankets) obstructing the airway (34%). Overlay deaths occurred most often in an adult bed (71%), and infants were overlaid by the mother (47%). Wedging deaths occurred most often when the infant became entrapped between a mattress and a wall (48%). CONCLUSIONS: Safe sleep environments can reduce infant suffocation deaths. Increased knowledge about the characteristics of suffocation deaths can help inform prevention strategies by targeting highest-risk groups.

Effects of maternal dietary nitrate supplementation on farrowing and placental characteristics, level of asphyxiation at birth and piglet vitality.

We investigated whether maternal dietary nitrate supplementation, leading to nitric oxide (NO) formation, would affect duration of farrowing, levels of asphyxiation, vitality of piglets at birth and/or loss of potential viable piglets in the form of stillbirth and pre-weaning mortality. Data were collected from 190 crossbred (Yorkshire x Dutch Landrace) sows, which were allocated, balanced for parity, to six dietary nitrate levels (0, 0.03, 0.06, 0.09, 0.12 or 0.15% of nitrate). Sow received the lactational diet containing nitrate from approximately 7 days before farrowing until 5 days after farrowing. Blood acid-base parameters (pH, pO2, pCO2, BEecf, HCO3, sO2 and lactate) and nitrate concentration were determined in umbilical cord blood. The farrowing process was video recorded and later analysed for total duration of farrowing, piglet birth interval, piglet vitality was scored and piglet latency to stand right after birth. Placentas were collected after expulsion during and after farrowing. Placenta length and width were measured and placental color scores were assessed based on redness of the placenta. The probability of a higher vitality score of piglets (being more vital) linearly increased with increasing levels of maternal dietary nitrate. This higher vitality score however, was not reflected by changes in the blood acid-base parameters in umbilical cord blood, except for a tendency for a higher pO2 with increasing levels of nitrate, which could have been caused by a quicker onset of respiration or an increased blood flow to the piglets during birth. Placenta width increased with increasing levels of maternal dietary nitrate, but no effect on placenta length and redness was found. Neither duration of farrowing nor birth interval were affected by maternal dietary nitrate level. In conclusion, maternal nitrate supplementation may affect piglet vitality via vasodilatation (placental characteristics) rather than an increase in exercise efficiency (duration of farrowing).

Brief measures of physical and psychological distance to suicide methods as correlates and predictors of suicide risk: A multi-study prospective investigation.

A core component of suicide risk assessment and management is determining one's physical proximity to specific suicide means and counseling individuals to minimize their physical access to these means. However, this approach ignores other potentially relevant parameters, such as perceptions of how psychologically close/distant one feels to a particular suicide method. The present study examined the degree to which novel, brief measures of physical and psychological distance to suicide methods were associated with and prospectively predicted suicide-related outcomes at (1) two-month follow-up among 121 students with current/recent suicidality; and (2) one-week follow-up among 91 community-dwelling adults at high suicide risk. Results indicated that both physical and psychological distance to means were related to suicidal intent at baseline. Additionally, in Study 2, lower psychological distance, but not physical distance, predicted suicidal intent and increased likelihood of having made suicide plans and suicide preparations at one-week follow-up. Overall, these findings highlight the importance of considering not only physical proximity to suicide means, but also psychological distance, pointing to the potential import of assessing and intervening upon psychological distance during lethal means counseling. Our findings also highlight the potential clinical utility of two brief measures of physical and psychological closeness to suicide means.