Experiences of Inpatient Psychiatric Nursing Care among People Who Have Survived a Suicide Attempt.

Nurses are front line providers for people who have been hospitalized following a suicide attempt, yet few studies have explored this population's experiences specifically with nursing care in inpatient psychiatric units. The purpose of this study was to hear directly from people who have survived a suicide attempt about their experiences with inpatient psychiatric nursing care following a suicide attempt in order to identify strengths and weaknesses of current practices and elicit suggested improvements. Qualitative in-depth interviews were conducted with people who were previously psychiatrically hospitalized following a suicide attempt (N = 9; Mage=42). Applied thematic analysis was used to identify themes related to positive and negative experiences with nursing care during hospitalization and advice for nurses. Findings demonstrated that positive experiences with nurses related to empathy, friendliness, feeling supported, flexibility, and active listening, while negative experiences centered around feeling stigmatized, invalidated, degraded, and coerced. Advice for nurses included being self-aware of preconceived or stigmatized notions, practicing empathy, listening, and humanity. The results of this study indicate the need for compassionate care, training to reduce nurse stigma, and adequate resources for nurses to mitigate emotional strain and burnout.

Changes in social work students' attitudes and knowledge following opioid overdose prevention training.

Background: Opioid use disorders are widespread, commonly occurring, and have serious impacts on individuals, families, and communities. When adequately trained, social workers play a pivotal role in treating populations impacted by opioid use through the provision of high-quality services and the shifting of negative attitudes related to opioid use. However, workforce projections indicate a growing shortage of behavioral health professionals qualified to work with such populations and, presently, social work programs are not equipped to meet these workforce needs. Emerging evidence suggests opioid overdose education is associated with improved attitudes and knowledge among health professions; however, less information exists on the outcomes of such training among social work students. Schools of social work must develop and evaluate curricular components related to opioid use prevention and management to adequately prepare students for clinical work as social work practitioners. Methods: Thirty-three advanced-year MSW students received opioid overdose training as part of a day-long seminar on substance use. Content included acute effects of opioids, withdrawal symptoms, risk factors, signs of overdose, naloxone training, and harm reduction principles. Using a single-group pretest-posttest design, students completed the Opioid Overdose Attitudes Scale (OOAS) and the Opioid Overdose Knowledge Scale (OOKS). To evaluate students' attitudes and knowledge, investigators compared overall and subscale means before and after the training via paired samples t-tests. Results: Findings indicated statistically significant improvements in the "concerns" and "competence" domains of the OOAS. Likewise, findings indicated statistically significant improvements in the "risk," "signs," "action," and "naloxone use" domains of the OOKS. Conclusion: Students reported improved opioid overdose-related knowledge and attitudes when assessed after the training as compared to before the training. Due to the nature of the study design, causality cannot be inferred from the training outcomes. Findings may help other social work programs develop curricular components related to opioid use.

Examining Racial/Ethnic Differences in the Association of Victimization and Suicidal Thoughts and Behaviors with Alcohol Use Among Sexual Minority Youth.

Purpose: Integrating Minority Stress Theory and Bagge and Sher's Theoretical Framework of the Alcohol-Suicide Attempt Relation, this study aimed to test whether experiencing both minority stress and suicidal thoughts and behaviors (STBs) had a greater strength of association with Latinx and Black sexual minority youth (SMY)'s alcohol use compared with that of White SMY. Methods: Using data on 2341 non-Latinx Black, Latinx, and non-Latinx White SMY from the 2015 and 2017 Youth Risk Behavior Surveys, we tested the prevalence of STBs, victimization, and alcohol use for Black and Latinx participants compared with White participants. Multivariate logistic regression analyses tested the main effects of STBs, victimization, and race/ethnicity on alcohol use. Finally, interaction terms assessed the interaction among STBs, victimization, and race/ethnicity on alcohol use. Results: The results supported our hypothesis, based on Minority Stress Theory, that experiencing victimization would be associated with greater alcohol use. Results also supported Bagge and Sher's theoretical framework showing that suicide plan and attempts were associated with greater alcohol use. When taking all of these stressors into account, results showed that Latinx SMY who experienced victimization had greater current prevalence of alcohol use than their White counterparts. However, Latinx SMY who were victimized and experienced suicidal ideation reported lower alcohol use than White SMY. Conclusion: These findings support the double jeopardy and resiliency hypotheses, which suggest that minority stressors have differing associations for each racial/ethnic SMY group's alcohol use. More research is needed that helps to disentangle the protective and risk factors for alcohol use among Black and Latinx SMY.

Tech-Mediated and Traditional Communication Modes in Adult Adoptees' Contact With Birth Parents.

OBJECTIVE: To understand how adult adoptees use traditional and tech-mediated modes of communication in contact with birth parents. To examine associations between desire for increased use of both modes and quality of relationship. BACKGROUND: As tech-mediated modes of communication become more commonplace, it is important to understand their implications for family relationship quality. Limited research has examined the use of tech-mediated modes of communication between adult adoptees and birth parents. METHOD: Participants (M age = 31 years) were adopted as infants (N = 90). Participants reported their current and desired future use of traditional and tech-mediated communication modes and their satisfaction with contact, current closeness, desired future closeness, and psychological presence of birth parents. RESULTS: Those with current contact reported using both traditional and tech-mediated modes of communication. Desired increase of traditional modes was associated with greater psychological presence and desired future closeness with birth mothers, while both traditional and tech-mediated were associated with these outcomes for birth fathers. CONCLUSION: Adult adoptees use both traditional and tech-mediated modes of communication with their birth parents. However, these modes may play distinct roles in maintaining close relationships with birth parents. IMPLICATIONS: Family professionals should consider the unique roles traditional and tech-mediated modes of communication may play when supporting adult adoptees in contact with birth relatives.

The relationship between alcohol and cannabis use with nonsuicidal self-injury among adolescent inpatients: Examining the 90 days prior to psychiatric hospitalization.

BACKGROUND: This study examined the trajectories of alcohol use, cannabis use, suicide planning (SP), and nonsuicidal self-injury (NSSI) prior to hospitalization and examined the role of alcohol and cannabis use, independently and jointly, in predicting NSSI on a daily level and over time. METHODS: Participants included 71 adolescents hospitalized for suicide risk (75% female; 25% male; Mage = 15.79). All participants drank alcohol at least once in the prior 90-days. We conducted mixed effect models to assess the trajectories of alcohol use, cannabis use, and NSSI over the 90-days prior hospitalization. To test the effect of SP, alcohol use, and cannabis use on NSSI, we conducted logistic random effect models, while controlling for demographics. RESULTS: SP (OR = 4.47, p < 0.001) and suicide ideation (SI) (OR = 10.09, p < 0.001) significantly increased the odds of engaging in NSSI. Neither cannabis nor alcohol use independently predicted the odds of engaging in NSSI, however, the co-occurrence of alcohol and cannabis use increased the odds of engaging in NSSI on a given day (OR = 30.5, p < 0.05). CONCLUSIONS: Study findings extend current knowledge about the longitudinal and day-to-day relationships between alcohol and cannabis use and NSSI. Results underscore the importance of developing interventions that address polysubstance use among suicidal adolescents engaging in NSSI.

Associations of Discrimination, Suicide Ideation Severity and Attempts, and Depressive Symptoms Among Sexual and Gender Minority Youth.

We examined the unique associations among discrimination, suicidal thoughts, suicide attempts, and depressive symptoms in a sample of sexual and gender minority (SGM) youth as well as interpersonal mediators of these associations. Participants included 94 SGM youth (Mage = 18; SD = 2.88) recruited from SGM-specific drop-in centers. We used mediation analyses to test the mediating effects of perceived burdensomeness and thwarted belongingness on the associations between discrimination and suicidal ideation, suicide attempts, and depressive symptoms, accounting for childhood trauma and sociodemographic variables (age, gender identity, race, and sexual orientation). Within our nonclinical community sample of SGM youth, 49% reported a lifetime suicide attempt, 84% reported current suicide ideation, and 82% reported current depressive symptoms. Experiencing discrimination was associated with greater likelihood of suicide attempts and depressive symptoms, and greater perceived burdensomeness and thwarted belongingness, over and above the effects of childhood trauma and sociodemographic variables. Discrimination was indirectly associated with greater depressive symptoms through perceived burdensomeness and thwarted belongingness, and with greater severity of suicidal ideation through perceived burdensomeness. Findings suggest clinicians should assess for discrimination and include a focus on perceived burdensomeness and thwarted belongingness as targets of intervention for suicide and depression.

Nonsuicidal Self-injury, Suicide Planning, and Suicide Attempts Among High-risk Adolescents Prior to Psychiatric Hospitalization.

The purpose of this study was to understand the trajectories of nonsuicidal self-injury (NSSI) and suicide plans (SP) in the 90 days prior to inpatient hospitalization, understand the role of NSSI and SP in predicting suicide attempts (SA) on a given day, and to test the interaction between NSSI and SP in predicting same-day SA. Participants included 69 adolescents (77% female, 65% white, 77% Non-Hispanic/Latinx, Mage = 15.77 SDage = 1.00) from an inpatient psychiatric unit. Past 90 day NSSI, SP, and SA were measured using the Columbia Suicide Severity Rating Scale and Timeline Follow Back. First, mixed effect models were conducted to assess trajectories of NSSI and SP leading up to inpatient hospitalization. The odds of NSSI remained relatively stable prior to hospitalization (OR = 1.01, 95% CI [1.00,1.02]). The odds of SP increased in the 90 days prior to hospitalization (OR = 1.04, 95% CI [1.02,1.05]) with each day associated with a 4% increase in the odds of making a SP. Second, random effect models were conducted to predict the odds of same-day SA from NSSI and SP. When adolescents endorsed either NSSI (OR = 2.99, p < .001) or a SP (OR = 77.13, p < .001) there was elevated odds of same-day SA. However, the presence of both NSSI and SP on a given day did not increase risk of SA on that same day. For this high-risk clinical sample of suicidal adolescents who drink alcohol, odds of SP increased in the days leading up to psychiatric hospitalization, but NSSI remained stable. On days when adolescents reported NSSI or SP, they had an increased odds of same-day SA. These results underscore the importance of frequent monitoring of NSSI and SP among high-risk adolescents who drink alcohol to prevent suicide attempts.

Substance use and suicidal ideation among child welfare involved adolescents: A longitudinal examination.

BACKGROUND: The purpose of this study was to investigate the longitudinal predictors of alcohol use, marijuana use, and suicidal ideation among maltreated adolescents. METHODS: Longitudinal data from this study come from three waves of the National Survey of Child and Adolescent Wellbeing II (NSCAW II). Participants included 1050 adolescents (Mage = 14.13) who were subjects of child abuse or neglect investigations. Items from the Health Risk Behavior Questionnaire were used to measure alcohol and marijuana use. Suicidal ideation was measured using an item from the Childhood Depression Inventory. Data on deviant peer affiliation, caregiver health, maltreatment type, age, race, and gender were also collected. RESULTS: Marijuana use, suicidal ideation, caregiver drug abuse, deviant peer affiliation, age, and race were predictive of alcohol use. Alcohol use, deviant peer affiliation, age, and time were predictive of marijuana use. Alcohol use, deviant peer affiliation, age, and gender predicted suicidal ideation. CONCLUSIONS: Longitudinal evidence indicated that individual, family, and peer factors played an important role in predicting alcohol use, marijuana use, and suicidal ideation among child welfare involved adolescents. In addition, this study provides evidence of a potentially reciprocal relationship between alcohol use and suicidal ideation among this population. Intervention efforts for reducing the public health problems of substance use and suicide among child welfare involved adolescents should focus on the importance of peers in influencing thoughts and behaviors, as well as the functional relationship between alcohol use and suicidal ideation.

Alcohol and marijuana use as daily predictors of suicide ideation and attempts among adolescents prior to psychiatric hospitalization.

OBJECTIVE: Little research has been conducted on alcohol use, marijuana use, and suicide ideation and attempts on a daily level, and specifically among adolescents prior to inpatient hospitalization. The purpose of this study was to examine the within (over time) and between (between adolescents) effects of alcohol use and marijuana use on suicide ideation and attempts. METHODS: Participants included 50 adolescents (80% female; Mage = 15.8). All participants reported drinking alcohol in the prior three months and were receiving treatment in an inpatient psychiatric hospital. Random and mixed-effect models were used to test study hypotheses. RESULTS: Results from the random effect model indicated that alcohol use, marijuana use, hospitalization and sexual orientation were significant predictors of suicide attempts. Results from the mixed-effect model indicated that marijuana use, hospitalization, and sexual orientation were significant predictors of suicide ideation. CONCLUSIONS: Study findings extend current knowledge about the longitudinal and day-to-day relationship between alcohol and marijuana use and suicide ideation and attempts. Results underscore the importance of addressing alcohol and marijuana use in interventions with suicidal adolescents, recognizing that sexual minority youth may be at elevated risk for suicide ideation.

An mHealth approach to extend a brief intervention for adolescent alcohol use and suicidal behavior: Qualitative analyses of adolescent and parent feedback.

Mobile health (mHealth) tools that supplement inpatient psychiatric care can maintain and enhance intervention effects following hospitalization. Adolescents hospitalized following a suicidal event represent a vulnerable population who could greatly benefit from such an mHealth intervention. In specific, suicidal adolescents who drink alcohol are in need of robust interventions that address the bidirectional relationship between alcohol use and suicidal thoughts and behaviors, because it puts them at especially high risk for suicide upon discharge. The purpose of this study was to conduct qualitative interviews to gather feedback to improve a brief alcohol intervention provided to suicidal adolescents during psychiatric hospitalization, and to develop a mHealth tool to extend care after discharge. Participants, eight adolescents and their parents, identified the need for a smartphone application to deliver intervention content to adolescents and parents during the post-hospitalization period. Adolescents sought support in meeting alcohol- and mood-related goals, while parents desired general resources as well as tips for conversations with their adolescent about mood and alcohol use.

Adolescent Alcohol Use: The Effects of Parental Knowledge, Peer Substance Use, and Peer Tolerance of Use.

OBJECTIVE: Parents and peers exert significant influence on a young person's decision to consume alcohol. This study examines the relationship between parental monitoring and adolescent alcohol consumption and tests whether peer substance use and tolerance of use mediates the relationship between monitoring and drinking. METHOD: Participants included 116 adolescents (53.5% female; Mage = 15.6). All participants reported drinking alcohol in the past 6 months, and 96 participants had been previously admitted to a hospital emergency department for an alcohol-related event. Mediation analyses were used to test the study hypotheses. RESULTS: The total effect of baseline parental monitoring on 6-month alcohol use was -1.15 (p < .01), with higher monitoring related to less use. Controlling for peer use and tolerance of use, the effect of parental monitoring was reduced to .46, leaving an indirect effect of .69 (p < .01). Peer use and tolerance of use had no effect on participant alcohol use when controlling for parental monitoring. CONCLUSIONS: Study findings extend current knowledge about the interactive effects of parental supervision and peer influence on the drinking patterns of adolescents. Results underscore the importance of addressing both parental monitoring and peer influence in interventions that target adolescent alcohol use, recognizing peer factors as a potential mechanism of the effect that parental monitoring has on adolescent drinking.

Feasibility, acceptability, and preliminary effects of a brief alcohol intervention for suicidal adolescents in inpatient psychiatric treatment.

Alcohol use, both short-term intoxication and longer-term use, is a notable risk factor for suicide. Despite the strong relationship between alcohol use and suicidal thoughts and behaviors, providers typically treat these two problems independently. In particular, acute psychiatric care hospitalizations for adolescents are typically brief, and many only cursorily address alcohol use. Integrating a brief motivational enhancement intervention for alcohol use into an inpatient psychiatric hospitalization treatment protocol has the potential to enhance motivation to stop or reduce drinking if adolescents can more fully understand how it increases risk for suicidal behavior. This study tested the feasibility, acceptability, and preliminary effects of the Alcohol and Suicide Intervention for Suicidal Teens (ASIST), a brief motivational enhancement intervention targeting alcohol use and suicidal thoughts and behaviors for suicidal adolescents receiving inpatient psychiatric treatment. Results from a randomized pilot trial of ASIST (N = 50) revealed that the intervention was both feasible and acceptable, with 92% of those in the ASIST condition reporting that the intervention helped them to understand how their alcohol use is related to their suicidal thoughts and behaviors. Study findings suggest a larger randomized controlled trial may be warranted to test the effectiveness of ASIST with psychiatrically hospitalized adolescents.