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1.
Am J Geriatr Psychiatry ; 31(6): 415-424, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36682987

RESUMO

OBJECTIVE: Suicide is an outcome arising from a combination of risk and protective factors. Examining psychological resilience traits associated with successful aging may help to better understand late-life suicide and depression. We examined self-reported protective factors including mindfulness, life satisfaction and engagement, flourishing, and subjective and objective social support in a high suicide-risk sample of depressed older adults. METHODS: Participants were 297 individuals aged 55+ (mean age: 64.2): 92 depressed suicide attempters, 138 depressed individuals who never attempted suicide, and 67 non-psychiatric comparisons. Using linear and binomial logistic regression, we examined the effects of a combined Protective Factor value on presence and severity of depression and suicidal ideation, and history of suicide attempt. RESULTS: Relative to the non-psychiatric comparison group, all depressed participants had significantly lower Protective Factor values. Higher Protective Factor value was associated with lower likelihood of depression, depression severity, and likelihood of ideation, but was not associated with ideation severity or history of suicide attempt. Participants with one standard deviation higher Protective Factor had lower odds of ideation incidence by a factor of OR=0.68 (95%CI=0.48-0.96). CONCLUSION: Resiliency characteristics relevant to psychological wellbeing and successful aging may mitigate the emergence of depression and suicidal ideation, as well as the severity of depression in late-life. The Resilience Factor used in this study can help clinicians nuance their appraisal of depression and suicide risk.


Assuntos
Atenção Plena , Tentativa de Suicídio , Humanos , Idoso , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/psicologia , Ideação Suicida , Depressão/epidemiologia , Depressão/psicologia , Satisfação Pessoal , Fatores de Risco
2.
JAMA Psychiatry ; 79(11): 1118-1123, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36169979

RESUMO

Importance: Suicide is a leading cause of death in the United States, having increased more than 30% from 2000 to 2018. An inexpensive, safe, widely available treatment for preventing suicidal behavior could reverse this trend. Objective: To confirm a previous signal for decreased risk of suicide attempt following prescription fills for folic acid in a national pharmacoepidemiologic study of patients treated with folic acid. Design, Setting, and Participants: A within-person exposure-only cohort design was used to study the dynamic association between folic acid (vitamin B9) prescription fills over a 24-month period and suicide attempts and intentional self-harm. Data were collected from a pharmacoepidemiologic database of US medical claims (MarketScan) for patients with private health insurance who filled a folic acid prescription between 2012 and 2017. The same analysis was repeated with a control supplement (cyanocobalamin, vitamin B12). Data were analyzed from August 2021 to June 2022. Exposure: Folic acid prescription fills. Main Outcome and Measure: Suicide attempt or intentional self-harm resulting in an outpatient visit or inpatient admission as identified by codes from the International Statistical Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification. Results: Data on 866 586 patients were collected; 704 514 (81.30%) were female, and 90 296 (10.42%) were 60 years and older. Overall, there were 261 suicidal events during months covered by a folic acid prescription (5 521 597 person-months) for a rate of 4.73 per 100 000 person-months, compared with 895 suicidal events during months without folic acid (8 432 340) for a rate of 10.61 per 100 000 person-months. Adjusting for age and sex, diagnoses related to suicidal behavior, diagnoses related to folic acid deficiency, folate-reducing medications, history of folate-reducing medications, and history of suicidal events, the hazard ratio (HR) for folic acid for suicide events was 0.56 (95% CI, 0.48-0.65), with similar results for the modal dosage of 1 mg of folic acid per day (HR, 0.57; 95% CI, 0.48-0.69) and women of childbearing age (HR, 0.60; 95% CI, 0.50-0.73). A duration-response analysis (1-mg dosage) revealed a 5% decrease in suicidal events per month of additional treatment (HR, 0.95; 95% CI, 0.93-0.97). The same analysis for the negative control, cyanocobalamin, found no association with suicide attempt (HR, 1.01; 95% CI, 0.80-1.27). Conclusions and Relevance: This large-scale pharmacoepidemiologic study of folic acid found a beneficial association in terms of lower rates of suicide attempts. The results warrant the conduct of a randomized clinical trial with suicidal ideation and behavior as outcomes of interest. If confirmed, folic acid may be a safe, inexpensive, and widely available treatment for suicidal ideation and behavior.


Assuntos
Comportamento Autodestrutivo , Tentativa de Suicídio , Adulto , Feminino , Humanos , Estados Unidos/epidemiologia , Masculino , Tentativa de Suicídio/prevenção & controle , Ácido Fólico/uso terapêutico , Comportamento Autodestrutivo/epidemiologia , Comportamento Autodestrutivo/diagnóstico , Ideação Suicida , Prescrições , Seguro Saúde , Vitamina B 12
3.
Am J Clin Hypn ; 65(1): 30-44, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35595153

RESUMO

Suicide is a very distressing but preventable phenomenon; it is also the most profound and serious outcome for patients and healthcare professionals. Suicidal ideations and hopelessness are a high-risk predictor for suicide attempts and death by suicide. The proper therapeutic management of suicidal patients continues to be an important challenge to all practicing clinicians. This article provides a review of age progression and specific information on the value and use of hypnotically mediated age progression as a therapeutic tool in the effective clinical management of patients with suicidal thoughts and behaviors. Case examples are provided to illustrate the use of age progression in clinical practice. The literature that explores a future-oriented strategy in the treatment of suicidal patients is reviewed. Moreover, information on a method of enhancing a future oriented strategy with hypnotically mediated age progression interventions is provided. The goal is to improve therapeutic results and reducing the risk of suicide attempts and death by suicide.


Assuntos
Hipnose , Ideação Suicida , Humanos , Fatores de Risco , Autoimagem , Tentativa de Suicídio/prevenção & controle
4.
Neuropsychopharmacol Hung ; 24(4): 170-179, 2022 Dec 01.
Artigo em Húngaro | MEDLINE | ID: mdl-36776030

RESUMO

There are several approached to suicide prevention based on various psychotherapeutic interventions, which are effective, especially when these are matched to the given psychiatric patient population, environment and context. In this paper the possibilities of psychotherapeutic methods of suicide prevention and intervention are described along with their indications. The following interventions are discussed: Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP), Cognitive Therapy for Suicide Prevention (CT-SP), Brief Cognitive-Behavioral Therapy for Suicide Prevention (BCBT), Problem Solving Therapy (PST), Problem Adaptation Therapy (PATH), Dialectial Behavior Therapy (DBT), SchemaFocused Therapy (SFT), Mindfulness-Based Cognitive Therapy (MBCT), Mindfulness-Based Stress Reduction (MBSR), Acceptance and Commitment Therapy (ACT), Mentalization-Based Treatment (MBT), Interpersonal Psychotherapy (IPT), Transference-Focused Psychotherapy (TFP), Collaborative Assessment and Management of Suicidality (CAMS), Teachable Moment Brief Intervention (TMBI), Motivational Interviewing (MI), Attempted Suicide Short Intervention Program (ASSIP) and other Interned-Based Interventions (IBI). The effectiveness of the above methods may vary, however, they focus on the psychological processes playing a role in the emergence of suicidal behaviours including cognitive processes, as well as difficulties of problem solving and emotion regulation. As the efficacy of these interventions are supported by clinical trials, their use is recommended in case of this vulnerable patient population. The importance of using such methods in the clinical work with suicidal patients should be prioritized in our effort to provide a complex treatment for suicidal behaviour based on the most optimal and appropriate intervention considering the given patient.


Assuntos
Terapia de Aceitação e Compromisso , Terapia Cognitivo-Comportamental , Humanos , Ideação Suicida , Psicoterapia/métodos , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/psicologia , Terapia Cognitivo-Comportamental/métodos
5.
J Clin Psychiatry ; 82(5)2021 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-34464524

RESUMO

Objective: This study evaluated whether Mindfulness-Based Cognitive Therapy for Preventing Suicide Behavior (MBCT-S) effectively augmented treatment-as-usual enhanced for suicide prevention (eTAU).Methods: From December 2013 through March 2018, veterans (N = 140) at high risk for suicide were recruited mostly (88.6%) during a suicide-related inpatient admission and randomly assigned to either (1) eTAU augmented with MBCT-S or (2) eTAU only. MBCT-S began during inpatient treatment (2 individual sessions emphasizing safety planning) and continued post-discharge (8 group sessions emphasizing mindfulness skills and elaborated safety planning). Four follow-up evaluations occurred over 12 months, and primary outcomes were (1) time to suicide event and (2) number of suicide events. Secondary outcomes were time to and number of suicide attempts, proportion with acute psychiatric hospitalization, and change in suicide-related factors (eg, depression, hopelessness, suicidal ideation).Results: Relative to eTAU, MBCT-S did not significantly delay time to suicide event (hazard ratio = 0.86; 95% CI, 0.52-1.41; P = .54), but did reduce total number of suicide events (MBCT-S: 56 events; eTAU: 92 events; incident rate ratio = 0.59; 95% CI, 0.36-0.99; P < .05). There were no significant differences in time to or number of suicide attempts. In a post hoc analysis, however, MBCT-S significantly reduced the proportion of participants attempting suicide (P < .05). MBCT-S also reduced the proportion with a psychiatric hospitalization. No significant between-group differences emerged on any suicide-related factors.Conclusions: Adding MBCT-S to system-wide suicide prevention efforts produced mixed findings on the primary outcome (suicide events) and promising findings on other important outcomes (suicide attempts, psychiatric hospitalizations). MBCT-S should continue to be examined in future research.Trial Registration: ClinicalTrials.gov identifier: NCT01872338.


Assuntos
Atenção Plena/métodos , Prevenção do Suicídio , Veteranos/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ideação Suicida , Tentativa de Suicídio/prevenção & controle , Resultado do Tratamento , Estados Unidos
6.
Home Healthc Now ; 38(3): 124-130, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32358439

RESUMO

Suicide among most age groups has been on the rise in the United States for the past 20 years. Suicide is currently the 10th leading cause of death in the United States, but suicide completion and suicide attempts may be underreported. Suicide is a very personal act often predicated on a sense of hopelessness and despair, but often prompted by very addressable factors such as pain and social isolation. This article will use a case narrative to illustrate life circumstances that may influence suicidal thinking. In addition, risk factors are addressed. Lastly, the article addresses some useful assessment tools to gauge suicide risk among older adult clients and provides resources for home care clinicians.


Assuntos
Isolamento Social/psicologia , Espiritualidade , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/psicologia , Suicídio/psicologia , Idoso , Depressão/psicologia , Feminino , Humanos , Masculino , Personalidade , Fatores de Risco , Ideação Suicida , Estados Unidos
7.
Gen Hosp Psychiatry ; 60: 98-110, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31377631

RESUMO

OBJECTIVE: This study aimed to summarize interventions for suicide prevention in patients with cancer and highlight any methodological issues. METHODS: We searched PubMed, PsycINFO, CINAHL, and the Cochrane database from their inception until July 2018. Additionally, we manually searched the references of included studies and recent systematic reviews of psychotherapy, antidepressants, and collaborative care for cancer patients with depression. RESULTS: Of the 1365 retrieved articles, 11 randomized controlled trials and 11 intervention studies met the inclusion criteria. These were categorized by type of intervention: psychotherapy, pharmacotherapy, integrated collaborative care, muscle relaxation and therapeutic walking, and cancer treatment. The trials showed little evidence to confirm the effects of suicide prevention strategies. Seven trials were designed to assess the efficacy of interventions treating depression. In all studies, suicidal behavior or ideation was reported as one of the secondary outcomes. Three trials did not report information about suicidal ideation, despite assessing depressive symptoms using scales that contained suicidal ideation items. Most trials demonstrated inadequate study quality. CONCLUSIONS: Our review summarized interventions for suicide prevention in patients with cancer and revealed methodological issues. The findings highlighted a need to explore new treatment strategies that focus on unique suicide risk factors among patients with cancer.


Assuntos
Prestação Integrada de Cuidados de Saúde , Tratamento Farmacológico , Terapia por Exercício , Transtornos Mentais/terapia , Neoplasias/psicologia , Psicoterapia , Ideação Suicida , Tentativa de Suicídio/prevenção & controle , Humanos , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/etiologia , Transtornos Mentais/prevenção & controle , Neoplasias/complicações
8.
Crisis ; 39(6): 451-460, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29848083

RESUMO

BACKGROUND: Few investigations of patient perceptions of suicide prevention interventions exist, limiting our understanding of the processes and components of treatment that may be engaging and effective for high suicide-risk patients. AIMS: Building on promising quantitative data that showed that adjunct mindfulness-based cognitive therapy to prevent suicidal behavior (MBCT-S) reduced suicidal thinking and depression among high suicide-risk patients, we subjected MBCT-S to qualitative inspection by patient participants. METHOD: Data were provided by 15 patients who completed MBCT-S during a focus group and/or via a survey. Qualitative data were coded using thematic analysis. Themes were summarized using descriptive analysis. RESULTS: Most patients viewed the intervention as acceptable and feasible. Patients attributed MBCT-S treatment engagement and clinical improvement to improved emotion regulation. A minority of patients indicated that factors related to the group treatment modality were helpful. A small percentage of patients found that aspects of the treatment increased emotional distress and triggered suicidal thinking. These experiences, however, were described as fleeting and were not linked to suicidal behavior. LIMITATIONS: The sample size was small. CONCLUSION: Information gathered from this study may assist in refining MBCT-S and treatments to prevent suicidal behavior among high suicide-risk patients generally.


Assuntos
Assistência Ambulatorial/métodos , Terapia Cognitivo-Comportamental/métodos , Atenção Plena/métodos , Aceitação pelo Paciente de Cuidados de Saúde , Ideação Suicida , Prevenção do Suicídio , Adulto , Atitude Frente a Saúde , Depressão/psicologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Participação do Paciente , Pesquisa Qualitativa , Suicídio/psicologia , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/psicologia
9.
Contemp Clin Trials ; 50: 245-52, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27592123

RESUMO

BACKGROUND: Although suicide ranks 10th as a cause of death in the United States, and 1st among active military personnel, there are surprisingly few evidence-based therapies addressing suicidality, and development of new treatments is limited. This paper describes a clinical trial testing a novel therapy for reducing suicide risk in military veterans. The intervention, Mindfulness-Based Cognitive Therapy for Preventing Suicide Behavior (MBCT-S), is a 10-week group intervention adapted from an existing treatment for depression (Mindfulness-Based Cognitive Therapy - MBCT). MBCT-S incorporates the Safety Planning Intervention, which is currently implemented throughout the Veterans Health Administration (VHA) for veterans at high suicide risk. METHODS: MBCT-S is being tested in a VHA setting using an intention-to-treat, two-group randomized trial design in which 164 high suicide risk veterans are randomized to either VHA Treatment As Usual (TAU; n=82) or TAU+MBCT-S (n=82). Our primary outcome measure, suicide-related event, defined to include suicide preparatory behaviors, self-harm behavior with suicidal or indeterminate intent, suicide-related hospitalizations and Emergency Department (ED) visits, will be measured through five assessments administered by blinded assessors between baseline and 12months post-baseline. We will measure suicide attempts and suicide deaths as a secondary outcome, because of their anticipated low incidence during the study period. Secondary outcomes also include severity of suicidal ideation, hopelessness and depression. SIGNIFICANCE: This study has the potential to significantly enhance the quality and efficiency of VHA care for veterans at suicide risk and to substantially improve the quality of life for veterans and their families.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Atenção Plena/métodos , Projetos de Pesquisa , Prevenção do Suicídio , Veteranos , Humanos , Qualidade de Vida , Fatores de Risco , Comportamento Autodestrutivo/prevenção & controle , Método Simples-Cego , Ideação Suicida , Tentativa de Suicídio/prevenção & controle
10.
Crit Care Nurse ; 36(4): 64-9, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27481803

RESUMO

Amlodipine, a dihydropyridine calcium channel blocker, is commonly prescribed for the treatment of hypertension. Ingestion of an overdose leads to severe hypotension; if the hypotension is not treated, death may be imminent. Conventional and unconventional interventions were used to treat an adolescent who ingested a life-threatening dose of amlodipine. Severe hypotension resistant to conventional treatment with intralipids and hyperinsulinemia-euglycemia therapy led to the use of plasmapheresis and a pneumatic antishock garment as lifesaving measures. Plasmapheresis has been described in only one other case of severe amlodipine overdose, and the use of a pneumatic antishock garment has never been described in the management of a calcium channel blocker overdose. Because short-term use of a pneumatic antishock garment has associated risks, the critical care nurse's anticipation of side effects and promotion of safe use of the garment were instrumental in the patient's care and outcome. (Critical Care Nurse 2016; 36[4]:64-69).


Assuntos
Anlodipino/intoxicação , Antídotos/administração & dosagem , Overdose de Drogas/terapia , Tentativa de Suicídio/psicologia , Adolescente , Terapia Combinada , Cuidados Críticos/métodos , Overdose de Drogas/diagnóstico , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Escala de Coma de Glasgow , Humanos , Masculino , Plasmaferese/métodos , Medição de Risco , Tentativa de Suicídio/prevenção & controle
11.
Psychother Psychosom Med Psychol ; 66(7): 283-98, 2016 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-27388871

RESUMO

The emotionally instable personality disorder, mostly called borderline disorder, shows central abnormalities in impulse control as well as instability of mood and identity. It is composed of behaviour problems in creating relationships and in self-management, first of all by high psychophysiological tension. The prevalence of this disorder is 10 % in outpatients and 20 % in inpatients and has therefore high relevance for the medical-psychotherapeutic care system. The treatment is deemed to be complex and interminable. Regarding all evaluated techniques of treatment the best examined is the Dialectical Behavioral Therapy (DBT). This specific therapy, developed in the eighties by Marsha M. Linehan, can be used for inpatient and outpatient treatment and combines single and group sessions. It is essential in mental health care of this disorder, but not available everywhere. Essential part of DBT is the skill training, a specific technique for the acquirement and for exercising skills for mindfulness, modulation of tension, regulation of emotions, structuring of social competence and developing self value. The central goal of DBT is to ensure the survival of the patients, to reduce self- and external aggressive behaviour and to provide inpatient crisis interventions. For sustained crisis management skills for reality acceptance are best fitting. But before, fast available sensory and active body-related skills should be used. Radical acceptance is the most important, since most effective, skill. The skills training, although in use for only twenty years, is permanently expanding in practice and is meanwhile also used for other disorders such as, for example, PTSD or ADHD. Since 2010, there also exists an elaborated DBT-version for adolescents. For medical care politics and health-economic reasons a supply with skills training for in- and outpatients all over the country is desirable.


Assuntos
Adaptação Psicológica , Transtorno da Personalidade Borderline/terapia , Terapia Cognitivo-Comportamental/métodos , Adolescente , Transtorno da Personalidade Borderline/diagnóstico , Transtorno da Personalidade Borderline/psicologia , Inteligência Emocional , Feminino , Humanos , Relações Interpessoais , Atenção Plena , Autoimagem , Comportamento Autodestrutivo/psicologia , Comportamento Autodestrutivo/terapia , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/psicologia
12.
J Psychiatr Res ; 79: 8-20, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27128172

RESUMO

OBJECTIVE: To determine the efficacy of psychotherapy interventions for reducing suicidal attempts (SA) and non-suicidal self-injury (NSSI). METHODS: Meta-analysis of randomized controlled trials (RCTs) comparing psychotherapy interventions and treatment as usual (TAU; including also enhanced usual care, psychotropic treatment alone, cognitive remediation, short-term problem-oriented approach, supportive relationship treatment, community treatment by non-behavioral psychotherapy experts, emergency care enhanced by provider education, no treatment) for SA/NSSI. RCTs were extracted from MEDLINE, EMBASE, PsycINFO and Cochrane Library and analyzed using the Cochrane Collaboration Review Manager Software and Comprehensive Meta-analysis. RESULTS: In the 32 included RCTs, 4114 patients were randomly assigned to receive psychotherapy (n = 2106) or TAU (n = 2008). Patients who received psychotherapy were less likely to attempt suicide during the follow-up. The pooled risk difference for SA was -0.08 (95% confidence intervals = -0.04 to -0.11). The absolute risk reduction was 6.59% (psychotherapy: 9.12%; TAU: 15.71%), yielding an estimated number needed to treat of 15. Sensitivity analyses showed that psychotherapy was effective for SA mainly in adults, outpatients, patients with borderline personality disorder, previously and non-previously suicidal patients (heterogeneous variable that included past history of SA, NSSI, deliberate self-harm, imminent suicidal risk or suicidal ideation), long- and short-term therapies, TAU only as a control condition, and mentalization-based treatment (MBT). No evidence of efficacy was found for NSSI, with the exception of MBT. Between-study heterogeneity and publication bias were detected. In the presence of publication bias, the Duval and Tweedie's "trim and fill" method was applied. CONCLUSION: Psychotherapy seems to be effective for SA treatment. However, trials with lower risk of bias, more homogeneous outcome measures and longer follow-up are needed.


Assuntos
Psicoterapia , Comportamento Autodestrutivo/prevenção & controle , Tentativa de Suicídio/prevenção & controle , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
Arch Suicide Res ; 20(4): 635-49, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26984524

RESUMO

Mindfulness is often part of treatment for non-suicidal self-injury (NSSI); however, there has been limited research examining the role of mindfulness in NSSI. Thus, the current study sought to investigate the relationship among mindfulness, depressive symptoms, and NSSI (past year) in adolescents (N = 764; 56.8% female, M age = 14.42, SD = 0.64) with consideration of gender. Adolescents with recent NSSI (n = 74; 83.8% female, M age = 14.36, SD = 0.56) and a matched for age and gender no-NSSI group completed measures of mindfulness and depression. Findings revealed that mindfulness and depressive symptoms were negatively correlated, although significantly less so for the NSSI group. Second, the NSSI group reported greater depressive symptoms and less mindfulness. Finally, mindfulness was found to partially mediate the effect of depressive symptoms on NSSI. The present study is the first to provide empirical support for the protective role of mindfulness in NSSI.


Assuntos
Depressão , Atenção Plena/métodos , Comportamento Autodestrutivo , Ideação Suicida , Tentativa de Suicídio , Adolescente , Comportamento do Adolescente/psicologia , Depressão/diagnóstico , Depressão/psicologia , Depressão/terapia , Feminino , Humanos , Masculino , Avaliação de Resultados da Assistência ao Paciente , Fatores de Risco , Comportamento Autodestrutivo/diagnóstico , Comportamento Autodestrutivo/fisiopatologia , Comportamento Autodestrutivo/prevenção & controle , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/psicologia
14.
J Nerv Ment Dis ; 204(11): 861-867, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26963748

RESUMO

Spirituality and religiousness are associated with a lower risk of suicide. A detailed assessment of spirituality among 88 suicide attempters hospitalized after a suicide attempt was performed. Factors associated with the recurrence of suicide attempts over 18 months were looked into. Spirituality was low among most suicide attempters in comparison with the general population. Two groups were identified: those with a high score of depression who featured "low" in spirituality and those with a more heterogeneous profile, for example, involving personality disorders, characterized by a "high" spirituality. At the follow-up, the "meaning in life" score appeared to correlate with recurrence of suicide. Clinical implications are discussed herein.


Assuntos
Entrevista Psicológica , Transtornos Mentais/psicologia , Religião e Psicologia , Espiritualidade , Tentativa de Suicídio/psicologia , Adulto , Feminino , Seguimentos , Humanos , Entrevista Psicológica/métodos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Tentativa de Suicídio/prevenção & controle , Adulto Jovem
15.
J Consult Clin Psychol ; 83(6): 1013-20, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26302249

RESUMO

OBJECTIVE: In patients with a history of suicidal depression, recurrence of depressive symptoms can easily reactivate suicidal thinking. In this study, we investigated whether training in mindfulness, which is aimed at helping patients "decenter" from negative thinking, could help weaken the link between depressive symptoms and suicidal cognitions. METHOD: Analyses were based on data from a recent randomized controlled trial, in which previously suicidal patients were allocated to mindfulness-based cognitive therapy (MBCT), an active control treatment, cognitive psychoeducation (CPE), which did not include any meditation practice, or treatment as usual (TAU). After the end of the treatment phase, we compared the associations between depressive symptoms, as assessed through self-reports on the Beck Depression Inventory-II (Beck, Steer, & Brown, 1996), and suicidal thinking, as assessed through the Suicidal Cognitions Scale (Rudd et al., 2001). RESULTS: In patients with minimal to moderate symptoms at the time of assessment, comparisons of the correlations between depressive symptoms and suicidal cognitions showed significant differences between the groups. Although suicidal cognitions were significantly related to levels of symptoms in the 2 control groups, there was no such relation in the MBCT group. CONCLUSION: The findings suggest that, in patients with a history of suicidal depression, training in mindfulness can help to weaken the association between depressive symptoms and suicidal thinking, and thus reduce an important vulnerability for relapse to suicidal depression.


Assuntos
Depressão/terapia , Atenção Plena/métodos , Ideação Suicida , Tentativa de Suicídio/prevenção & controle , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Resultado do Tratamento
16.
J Affect Disord ; 186: 156-61, 2015 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-26241664

RESUMO

BACKGROUND: Several risk factors have been associated with suicidal behavior (SB) in bipolar disorder (BD), but little is known regarding possible protective factors. Religiosity has been related to favorable outcomes in mental health and to a reduction in the risk of SB, although the relation between BD, religiosity and SB remains under-investigated. The objective of this study was to evaluate the association between religiosity and SB in euthymic bipolar I outpatients. METHOD: In this study, 164 outpatients with BD type I with and without a history of suicide attempts were assessed and compared using a questionnaire to collect clinical and sociodemographic characteristics, the Structured Clinical Interview for DSM-IV, the Hamilton Depression Rating Scale, the Young Mania Rating Scale, the Duke Religious Index, and the Barratt Impulsivity Scale. RESULTS: The suicide attempters (SA) group had more psychiatric comorbidity (p=0.007), more rapid cycling (p=0.004), higher levels of impulsivity in all domains (p=0.000), and less religious affiliation (p=0.006) compared with the non-SA group. In the multivariate analysis, after controlling for covariates, non-organizational religious activities (OR, 0.66; 95% CI, 0.50-0.86) and intrinsic religiosity (OR, 0.70; 95% CI, 0.60-0.81) were associated with less SB. LIMITATIONS: A small sample size, the cross-sectional design that precluded the possibility of assessing cause and effect relationships, and the infeasibility of determining the time lapse between the last suicide attempt and the period when the patients were evaluated. CONCLUSION: Non-organizational religious activities and intrinsic religiosity dimensions exert a protective effect against SB in bipolar I outpatients, even when controlling for variables that may affect the outcome in question.


Assuntos
Transtorno Bipolar/psicologia , Pacientes Ambulatoriais/psicologia , Religião e Psicologia , Espiritualidade , Tentativa de Suicídio/psicologia , Adulto , Brasil , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Proteção , Tentativa de Suicídio/prevenção & controle , Inquéritos e Questionários
17.
J Am Acad Child Adolesc Psychiatry ; 54(2): 97-107.e2, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25617250

RESUMO

OBJECTIVE: Suicidal behavior and self-harm are common in adolescents and are associated with elevated psychopathology, risk of suicide, and demand for clinical services. Despite recent advances in the understanding and treatment of self-harm and links between self-harm and suicide and risk of suicide attempt, progress in reducing suicide death rates has been elusive, with no substantive reduction in suicide death rates over the past 60 years. Extending prior reviews of the literature on treatments for suicidal behavior and repetitive self-harm in youth, this article provides a meta-analysis of randomized controlled trials (RCTs) reporting efficacy of specific pharmacological, social, or psychological therapeutic interventions (TIs) in reducing both suicidal and nonsuicidal self-harm in adolescents. METHOD: Data sources were identified by searching the Cochrane, Medline, PsychINFO, EMBASE, and PubMed databases as of May 2014. RCTs comparing specific therapeutic interventions versus treatment as usual (TAU) or placebo in adolescents (through age 18 years) with self-harm were included. RESULTS: Nineteen RCTs including 2,176 youth were analyzed. TIs included psychological and social interventions and no pharmacological interventions. The proportion of the adolescents who self-harmed over the follow-up period was lower in the intervention groups (28%) than in controls (33%) (test for overall effect z = 2.31; p = .02). TIs with the largest effect sizes were dialectical behavior therapy (DBT), cognitive-behavioral therapy (CBT), and mentalization-based therapy (MBT). There were no independent replications of efficacy of any TI. The pooled risk difference between TIs and TAU for suicide attempts and nonsuicidal self-harm considered separately was not statistically significant. CONCLUSION: TIs to prevent self-harm appear to be effective. Independent replication of the results achieved by DBT, MBT, and CBT is a research priority.


Assuntos
Transtornos Mentais/prevenção & controle , Transtornos Mentais/terapia , Comportamento Autodestrutivo/prevenção & controle , Tentativa de Suicídio/prevenção & controle , Adolescente , Terapia Comportamental/métodos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
18.
Arch Psychiatr Nurs ; 28(1): 55-61, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24506988

RESUMO

The purpose of this study was to explore the context and the intervening conditions that impacted on individuals' healing from a suicide attempt. Patients who had survived a suicide attempt (n=14) and their caregivers (n=6) were interviewed in this study. Findings revealed that the suicidal individuals who lived in a sheltered, friendly environment, and had support systems helped their suicidal healing process. Conversely, suicidal individuals who experienced negative aspects of self, family predicaments, environmental difficulties, and the re-emergence of stressors impeded their suicidal healing process. Consequently, health professionals need to promote healthy internal and external environments for suicidal individuals.


Assuntos
Comparação Transcultural , Transtorno Depressivo/enfermagem , Cura Mental/psicologia , Tentativa de Suicídio/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Transtorno Depressivo/etnologia , Transtorno Depressivo/psicologia , Feminino , Teoria Fundamentada , Humanos , Masculino , Pessoa de Meia-Idade , Teoria de Enfermagem , Resiliência Psicológica , Fatores de Risco , Meio Social , Valores Sociais , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/estatística & dados numéricos , Taiwan
19.
Asia Pac Psychiatry ; 6(1): 23-7, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24019245

RESUMO

INTRODUCTION: The purpose of the present study is to compare the role of spiritual and religious beliefs in the prevention of suicidal risk among depressive women with suicidal ideation or attempts, treated in the psychiatric unit of a general hospital in Santiago de Chile (Servicio de Psiquiatría del Hospital del Salvador) between 2010 and 2011. METHOD: The relationship among severity of depression, suicidal risk, and religiosity is explored in women treated in Servicio de Psiquiatría del Hospital del Salvador. The sociodemographic and clinical characteristics of believers (n = 121) and nonbelievers (n = 22) were compared, and their global mental health was assessed, as well as their rating in scales for depression, anxiety, aggressivity, and impulsivity. RESULTS: Most of the patients self-reported to belong to Catholic or other Christian churches. There were few statistically significant differences between them and nonbelievers, who were younger, had more years of education, were more frequently employed, and lived alone or with their parents. When comparing the least religious and the most religious quartiles, there were no differences in the type of affective disorder, attendance to temples, or self-appraisal of religiosity. Nonbelievers had more history of previous suicidal attempts and had more relatives committing suicide. DISCUSSION: In a country where most of the population is believer, self-reported religiosity seems to have a nonsignificant association with suicidality and severity of depression. Our results could be biased given the small number of nonbelievers in the sample.


Assuntos
Transtorno Depressivo/psicologia , Religião , Ideação Suicida , Tentativa de Suicídio/prevenção & controle , Adulto , Assistência Ambulatorial , Chile , Feminino , Hospitalização , Hospitais Gerais , Humanos , Escalas de Graduação Psiquiátrica , Fatores de Risco , Espiritualidade
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