Can profiles of behaviors occurring within 48 h of a suicide attempt predict future severity of suicidal thoughts and reattempt?: An examination of hospitalized patients 12 Months post-discharge.

Behavioral warning signs (WS) are near-term changes within individuals, which aid in determining imminent risk for suicide attempts. However, those who attempt suicide differ in their engagement of WS, and it is unclear if these differences relate to future risk of suicidal behavior. Using a sample of 132 adults presenting to a hospital following a suicide attempt, the current study sought to determine if differences in engagement in WS for the index attempt prospectively predicted suicide attempt, frequency of ideation, and intensity of suicide ideation 12 months post discharge. Latent class analyses (LCAs) conducted on 6 behaviors (i.e., alcohol use, nightmares, interpersonal negative life events, suicide communication, risky behavior, low sleep, and high sleep) found a 5-class solution optimally fit the data. One identified class, characterized by engagement in risky behaviors the hours before an attempt differed from other identified classes in terms of risk for future suicidal ideation and behaviors. More specifically, participants in "High Risky Behavior" class had higher rates of 12-month suicide reattempt, significantly more frequent suicide ideation, and significantly worse intensity of suicide ideation during the 12 months following their index attempt compared to participants endorsing typical patterns of WS. These results held when adjusting for various traditional baseline covariates (e.g., depressive symptoms). The current study demonstrates that patterns of behavioral WS may be utilized as their own prognostic indicator of future suicidal ideation and behaviors among high-risk individuals reporting a recent suicide attempt, which can inform post-discharge clinical intervention and prevention efforts.

Warning signs in a period of acute risk for suicide attempt: The utility of count- and combination-based classification.

OBJECTIVE: This study sought to establish if models involving the specific combinations of identifiable behavioral warning signs (WS; i.e., alcohol use, suicidal communications, preparation of personal affairs, experiencing negative interpersonal life events) for a suicide attempt outperformed a simpler count model of WS to distinguish an acute risk period (the six hours prior to a suicide attempt) from a control period (a matched six-hour period the day prior). METHOD: Generalized linear mixed models tested all logical combinations of four behavioral WS in addition to a count variable of the number of behavioral warning signs. For the count variable, receiver operating characteristic curve analysis was utilized to determine the optimal cut point for the number of endorsed WS. RESULTS: Area under the curve (AUC) compared classification across all models, with the count model demonstrating similar classification performance to the best multivariate model (AUCs of 0.72 and 0.73, respectively), with an optimal cut point of endorsing one or more WS. CONCLUSION: Although determinations of acute risk should be informed by multiple sources of information, this study suggests a relatively simple count-based approach that considers the presence of one (or more) behavioral WS may be used as a potential indication of increased acute risk for suicide attempt.

A dose-response meta-analysis on the relationship between average amount of alcohol consumed and death by suicide.

BACKGROUND: To determine whether sub-clinical levels of drinking may contribute to suicide risk, and whether the risk differs by sex, we aimed to evaluate the relationship between average amount of alcohol consumed per day and death by suicide. METHODS: A systematic literature search was performed in Embase, Medline, PsycINFO, PubMed, and Web of Science from database inception up to April 27, 2022. The search strategies incorporated a combination of medical subject headings and keywords for "alcohol use" and "suicide". One-stage dose-response meta-analyses using a restricted maximum likelihood random-effect estimator were conducted to explore the relationship between average alcohol volume consumed and suicide, by sex. Three different shapes of the dose-response relationship-linear (on the log-scale), quadratic, and restrictive cubic splines-were tested. RESULTS: A total of eight studies were included (three studies for females (n=781,205), and eight studies for males (n=1,215,772)). A linear dose-response relationship between average alcohol volume consumed and the log-risk of suicide was identified for both males and females. For males and females, a relative risk (RR) of 1.11 (95% CI: 1.05, 1.18) and 1.64 (95% CI: 1.07, 2.51) for suicide when consuming an average of 10 g of pure alcohol per day compared to lifetime abstention, 1.38 (95% CI: 1.14, 1.66) and 4.39 (95% CI: 1.21, 15.88) for 30g/day, and 1.71 (95% CI: 1.25, 2.33) and 11.75 (95% CI: 1.38, 100.33) for 50g/day, respectively. CONCLUSIONS: As consumption increases, the risk of suicide increases proportionally. The risk of suicide associated with average daily alcohol consumption may be elevated for females, compared with males. Albeit, more research is needed, particularly among females.

Sex-Specific Association of Alcohol Use Disorder With Suicide Mortality: A Systematic Review and Meta-Analysis.

Importance: Despite individual studies suggesting that sex differences exist in the association between alcohol use disorder (AUD) and suicide, most existing systematic reviews and meta-analyses have reported associations across the sexes. Objective: To estimate the sex-specific association between AUD and suicide mortality. Data Sources: Embase, MEDLINE (including MEDLINE In-Process), PsycINFO, PubMed, and Web of Science were searched from database inception to April 27, 2022. Study Selection: Inclusion criteria consisted of the following: (1) original, quantitative study, (2) inclusion of a measure of association and its corresponding measure of variability (or sufficient data to calculate these [eg, 95% CI]), and (3) results stratified by sex. Data Extraction and Synthesis: Data extraction was completed by one reviewer and then cross-checked by a second reviewer. Risk of bias was assessed by study design. Categorical random-effects meta-analyses were conducted to obtain sex-specific pooled estimates of the association between AUD and suicide mortality risk. Methodological moderators (ie, study design and comparator group) were assessed using sex-stratified meta-regressions. Main Outcomes and Measures: The association between AUD and suicide mortality. Results: A total of 16 347 unique records were identified in the systematic search; 24 studies were ultimately included for 37 870 699 participants (59.7% male and 40.3% female) (23 risk estimates for male and 17 for female participants). Participants ranged in age from 15 years to 65 years or older. Sex-specific meta-regression models indicated that study design (ie, longitudinal vs cross-sectional study design) affected the observed association between AUD and suicide mortality for both male participants (log odds ratio, 0.68 [95% CI, 0.08-1.28]; P = .03) and female participants (log odds ratio, 1.41 [95% CI, 0.57-2.24]; P < .001). For males and females, among longitudinal studies, the pooled odds ratios were 2.68 (95% CI, 1.86-3.87; I2 = 99% [n = 14]) and 2.39 (95% CI, 1.50-3.81; I2 = 90% [n = 11]), respectively. Conclusions and Relevance: This systematic review and meta-analysis yielded substantive evidence that AUD was associated with suicide mortality and that the association was similar across the sexes. The findings underscore the importance of identifying and treating AUD as part of a comprehensive suicide prevention strategy.

The Virtual Hope Box mobile application: A systematic review of the literature.

INTRODUCTION: The Virtual Hope Box (VHB) mobile application is an adapted version of the conventional hope box intervention that is used in several evidence-based treatments for suicide behaviors. The VHB is an award-winning app developed by a collaboration between the Departments of Defense and Veterans Affairs. Multiple studies have assessed the utility and effectiveness of the VHB for use in suicide prevention, but no reviews of the literature have been conducted. METHODS: Authors performed a review of the literature using PsycINFO, EBSCOhost, and PubMed. 15 articles were ultimately included. RESULTS: Results were categorized into three areas: (1) efficacy and effectiveness, (2) feasibility, awareness, and usage in high-risk populations, and (3) implementation approaches to increase use among patients and providers. Existing evidence for the VHB supports its feasibility and acceptability, especially among military and veteran populations. Only one study investigated effectiveness in a randomized control trial. Although the VHB developers have disseminated the app nationally, low adoption rates among veteran patients and VA providers remain. Studies found that educational implementation strategies can improve utilization rates. CONCLUSIONS: Future research should examine suicide behaviors as outcomes, approaches to incorporating the VHB into treatment, and a range of populations.

24-Hour warning signs for adolescent suicide attempts.

BACKGROUND: Little is known about when youth may be at greatest risk for attempting suicide, which is critically important information for the parents, caregivers, and professionals who care for youth at risk. This study used adolescent and parent reports, and a case-crossover, within-subject design to identify 24-hour warning signs (WS) for suicide attempts. METHODS: Adolescents (N = 1094, ages 13 to 18) with one or more suicide risk factors were enrolled and invited to complete bi-weekly, 8-10 item text message surveys for 18 months. Adolescents who reported a suicide attempt (survey item) were invited to participate in an interview regarding their thoughts, feelings/emotions, and behaviors/events during the 24-hours prior to their attempt (case period) and a prior 24-hour period (control period). Their parents participated in an interview regarding the adolescents' behaviors/events during these same periods. Adolescent or adolescent and parent interviews were completed for 105 adolescents (81.9% female; 66.7% White, 19.0% Black, 14.3% other). RESULTS: Both parent and adolescent reports of suicidal communications and withdrawal from social and other activities differentiated case and control periods. Adolescent reports also identified feelings (self-hate, emotional pain, rush of feelings, lower levels of rage toward others), cognitions (suicidal rumination, perceived burdensomeness, anger/hostility), and serious conflict with parents as WS in multi-variable models. CONCLUSIONS: This study identified 24-hour WS in the domains of cognitions, feelings, and behaviors/events, providing an evidence base for the dissemination of information about signs of proximal risk for adolescent suicide attempts.

Multidimensional Evaluation of Screening Brief Intervention and Referral to Treatment Training for Medical Students.

OBJECTIVE: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based approach to identifying and addressing alcohol use in non-specialty settings. Many medical schools teach SBIRT, but most published evaluations of these efforts exclude rigorous skill assessments and teaching methods. METHODS: During the 2017-2018 academic year, 146 third-year medical students received classroom-based learning on SBIRT and motivational interviewing (MI) and at least two SBIRT practices with feedback as part of a 4-week psychiatry clerkship. The objective of this curriculum was to improve SBIRT knowledge, attitudes, and confidence and enable learners to skillfully deliver SBIRT. Outcomes evaluated included satisfaction, knowledge, attitudes and confidence, and clinical skill in delivering SBIRT to a standardized patient (rated by the actor, as well as an expert). RESULTS: Results indicated acceptable satisfaction at post-curriculum and significant improvements in attitudes and knowledge from pre- to post-curriculum. On the clinical skills exam, all students were rated as having mastered at least 80% of SBIRT elements by standardized patients and 91.8% were rated at this level by a faculty expert. Student attitudes and knowledge were unrelated to expert ratings, and standardized patient ratings had limited associations with expert ratings. CONCLUSIONS: These results suggest curriculum objectives were achieved and provide unique contributions to the SBIRT curricular outcome research for healthcare trainees. Other findings included that trainee knowledge and confidence may not relate to skill, and standardized patient feedback provides different information on SBIRT and MI skill than expert ratings.

A controlled examination of acute warning signs for suicide attempts among hospitalized patients.

BACKGROUND: Near-term risk factors for suicidal behavior, referred to as 'warning signs' (WS), distinguish periods of acute heightened risk from periods of lower risk within an individual. No prior published study has examined, using a controlled study design, a broad set of hypothesized WS for suicide attempt. This study addressed this gap through examination of hypothesized behavioral/experiential, cognitive, and affective WS among patients recently hospitalized following a suicide attempt. METHODS: Participants were recruited during hospitalization from five medical centers across the USA including two civilian hospitals and three Veterans Health Administration facilities (n = 349). A within-person case-crossover study design was used, where each patient served as her/his own control. WS were measured by the Timeline Follow-back for Suicide Attempts Interview and were operationalized as factors that were present (v. absent) or that increased in frequency/intensity within an individual during the 6 h preceding the suicide attempt (case period) compared to the corresponding 6 h on the day before (control period). RESULTS: Select WS were associated with near-term risk for suicide attempt including suicide-related communications, preparing personal affairs, drinking alcohol, experiencing a negative interpersonal event, and increases in key affective (e.g. emptiness) and cognitive (e.g. burdensomeness) responses. CONCLUSIONS: The identification of WS for suicidal behavior can enhance risk recognition efforts by medical providers, patients, their families, and other stakeholders that can serve to inform acute risk management decisions.

Alcohol use and the gender-specific risk of suicidal behavior: a systematic review and meta-analysis protocol.

BACKGROUND: Alcohol use is an important risk factor for suicidal behavior, with a heightened risk found among women. The objective of this study is to determine the gender-specific risk of suicidal behaviors (suicide attempt and death by suicide) for different levels and dimensions of alcohol use-i.e., for (1) average alcohol volume consumed, (2) binge drinking, and (3) individuals with an alcohol use disorder. METHODS: We will systematically search the available literature for primary studies on the risk relationships specified above. Using a predetermined set of keywords, a comprehensive systematic literature search will be conducted in the following electronic databases: Embase, PsycINFO, PubMed, and Web of Science. The basic inclusion criteria will be (1) an original, quantitative (cohort, case-control or cross-sectional) study; with (2) a measure of risk of at least one dimension of our alcohol exposures in relation to at least one of our outcomes of interest (suicide attempt or death by suicide), and its corresponding measure of variability is reported (or sufficient data to calculate these); and (3) estimates of risk stratified by gender. Studies (1) that use only qualitative labels of alcohol use, and (2) where suicide attempt and non-suicidal self-harm cannot be disaggregated will be excluded. There will be no restrictions on language, geographical region, or year of publication. Two reviewers will independently perform the search and systematic assessment of each identified study and subsequent extraction of data. Categorical random-effects meta-analyses will be conducted to obtain gender-specific pooled risk estimates. Risk of bias will be assessed using the Risk of Bias In Non-randomised Studies-of Interventions tool and the Grading of Recommendations Assessment, Development and Evaluation approach will be used to rate the quality of evidence. DISCUSSION: This study will synthesize all available data on the gender-specific relationship between various dimensions of alcohol use and suicidal behavior simultaneously in a coherent framework. We will provide risk estimates with the detail needed to better understand the respective risk relationships and appreciate the burden of alcohol-attributable suicide. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022320918.

Comparing gender-specific suicide mortality rate trends in the United States and Lithuania, 1990-2019: putting one of the "deaths of despair" into perspective.

INTRODUCTION: The increase in the suicide mortality rate among middle-aged adults in the United States (US) has been well documented. Aside from a few studies from the United Kingdom, it is unclear whether the suicide mortality rate trend in the US is also occurring in other developed countries. Accordingly, we aimed to compare the suicide mortality rate trends over the past 30 years in the US to a country in the European Union-Lithuania. METHODS: Joinpoint regression analyses were performed to identify secular trends in the gender-specific age-standardized suicide mortality rate among individuals 15 + years of age, as well as middle-aged adults (45-54 years of age), and suicide mortality rate ratio for men-to-women. RESULTS: Age-standardized suicide mortality rates among middle-aged adults in the US increased annually, on average, by 0.89% (95% CI: 0.66%, 1.12%) among men and 1.21% (95% CI: 0.75%, 1.66%) among women between 1990 and 2019. In contrast to the US, there was an overall downward trend in the suicide mortality rates among middle-aged adults in Lithuania across the study period. The average annual percent change in the suicide mortality rate ratio for men-to-women were not statistically significant for either country. CONCLUSION: The suicide mortality rate trend in the US does not appear to be an indicator of an upcoming global trend, but rather should be regarded as a cautionary example of what other countries should strive to avoid.

Gender-specific risk relationship between heavy alcohol use/alcohol use disorders and suicidal thoughts and behavior among adults in the United States over time.

PURPOSE: Suicidal thoughts and behaviors have been on the rise in the recent years in the US. There is a well-known link between heavy alcohol use/alcohol use disorders (AUDs) and suicidal thoughts and behaviors. An increase in the respective risk relationships is one way in which heavy alcohol use/AUDs may be driving the increase in the rate of suicidal thoughts and behaviors. The objective of the current study was to investigate whether the gender-specific risk relationships between heavy alcohol use/AUDs and past-year (1) suicidal thoughts and (2) attempted suicide have increased over time. METHODS: Individual-level annual data from the National Survey on Drug Use and Health for the past 12 years (2008-2019) were utilized. Year- and gender-specific multivariate binary logistic regression analyses were first conducted. Gender-stratified random-effects meta-regressions across study years were then conducted. RESULTS: Heavy alcohol use/AUDs were associated with elevated odds of past-year suicidal thoughts and attempted suicide for both men and women; however, a linear increase in the risk relationships over time was not found. CONCLUSION: Although a temporal increase in the risk relationships of interest was not found, until additional research in this area is conducted, heavy alcohol use/AUDs cannot be ruled out as being a driving force behind the increasing rate of suicidal thoughts and behaviors in the US.

Perceived Utility and Characterization of Personal Google Search Histories to Detect Data Patterns Proximal to a Suicide Attempt in Individuals Who Previously Attempted Suicide: Pilot Cohort Study.

BACKGROUND: Despite decades of research to better understand suicide risk and to develop detection and prevention methods, suicide is still one of the leading causes of death globally. While large-scale studies using real-world evidence from electronic health records can identify who is at risk, they have not been successful at pinpointing when someone is at risk. Personalized social media and online search history data, by contrast, could provide an ongoing real-world datastream revealing internal thoughts and personal states of mind. OBJECTIVE: We conducted this study to determine the feasibility and acceptability of using personalized online information-seeking behavior in the identification of risk for suicide attempts. METHODS: This was a cohort survey study to assess attitudes of participants with a prior suicide attempt about using web search data for suicide prevention purposes, dates of lifetime suicide attempts, and an optional one-time download of their past web searches on Google. The study was conducted at the University of Washington School of Medicine Psychiatry Research Offices. The main outcomes were participants' opinions on internet search data for suicide prediction and intervention and any potential change in online information-seeking behavior proximal to a suicide attempt. Individualized nonparametric association analysis was used to assess the magnitude of difference in web search data features derived from time periods proximal (7, 15, 30, and 60 days) to the suicide attempts versus the typical (baseline) search behavior of participants. RESULTS: A total of 62 participants who had attempted suicide in the past agreed to participate in the study. Internet search activity varied from person to person (median 2-24 searches per day). Changes in online search behavior proximal to suicide attempts were evident up to 60 days before attempt. For a subset of attempts (7/30, 23%) search features showed associations from 2 months to a week before the attempt. The top 3 search constructs associated with attempts were online searching patterns (9/30 attempts, 30%), semantic relatedness of search queries to suicide methods (7/30 attempts, 23%), and anger (7/30 attempts, 23%). Participants (40/59, 68%) indicated that use of this personalized web search data for prevention purposes was acceptable with noninvasive potential interventions such as connection to a real person (eg, friend, family member, or counselor); however, concerns were raised about detection accuracy, privacy, and the potential for overly invasive intervention. CONCLUSIONS: Changes in online search behavior may be a useful and acceptable means of detecting suicide risk. Personalized analysis of online information-seeking behavior showed notable changes in search behavior and search terms that are tied to early warning signs of suicide and are evident 2 months to 7 days before a suicide attempt.

Proportion of Individuals With Past-Year Suicidal Ideation Who Attempted Suicide Over the Past 10 Years in the United States, and the Influence of Age and Sex.

Background: In recent years, the rate of death by suicide has been increasing disproportionately among females and young adults in the United States. Presumably this trend has been mirrored by the proportion of individuals with suicidal ideation who attempted suicide. Aim: We aimed to investigate whether the proportion of individuals in the United States with suicidal ideation who attempted suicide differed by age and/or sex, and whether this proportion has increased over time. Method: Individual-level data from the National Survey on Drug Use and Health (NSDUH), 2008-2017, were used to estimate the year-, age category-, and sex-specific proportion of individuals with past-year suicidal ideation who attempted suicide. We then determined whether this proportion differed by age category, sex, and across years using random-effects meta-regression. Overall, age category- and sex-specific proportions across survey years were estimated using random-effects meta-analyses. Results: Although the proportion was found to be significantly higher among females and those aged 18-25 years, it had not significantly increased over the past 10 years. Limitations: Data were self-reported and restricted to past-year suicidal ideation and suicide attempts. Conclusion: The increase in the death by suicide rate in the United States over the past 10 years was not mirrored by the proportion of individuals with past-year suicidal ideation who attempted suicide during this period.

Motivations for Suicide Attempts amongst Psychiatric Inpatients: Associations with Risk Factors and Recent Suicide Attempt Characteristics.

Suicide is a major and preventable public health issue and research has identified several distal risk factors for determining individuals at risk for a suicide attempt. However, understanding imminent processes could enhance individualized safety plan formulations and interventions. Motivation for suicide attempt (MfSA) reflects why an individual engages in a specific attempt. Research indicates such motives can be organized into major factors, but consensus on the number, and their correlates, has not been reached. The sample consisted of 190 patients who attempted suicide within 24 hours of hospitalization and completed the MfSA within the Suicide Attempt-Self Injury Interview. Exploratory factor and correlational analyses were conducted to identify the factors that underlie MfSA. Regression analyses were conducted to examine the relations of MfSA factors to distal suicide risk factors and suicide-related attempt characteristics. Two underlying MfSA factors were identified. Interpersonal MfSA was associated with lower age and higher problematic alcohol use. Intrapersonal MfSA was related to having previous suicide attempts, more past year negative life events, and higher depressive symptoms. The modified MfSA is easy to administer, and its factors show unique associations with important suicide-related constructs. The results could inform safety planning procedures to prevent future death by suicide.

Acute stressors and clinical characteristics differentiate death by suicide, accident, or natural causes among illicit and prescription opiate users.

BACKGROUND: Opiate misuse has reached epidemic levels. Prevention efforts depend on distinguishing opiate users from abusers. The current study compared opioid users who died by natural cases, accidents, and suicide using psychological autopsy methods. Groups were compared on substance use characteristics, treatment history, experiences of negative life events, and circumstances at the time of death. METHODS: Substance use and suicide risk were evaluated using psychological autopsy methods in 63 decedents with positive toxicology for opiates at death divided into three groups: adults dying by suicide (n = 19), accident (n = 19), and natural causes (n = 25). Groups were compared on several dependent measures, using chi-square analyses to examine categorical variables and one-way analyses of variance (ANOVA) to examine continuous variables. RESULTS: Individuals who died by suicide were similar in many ways to adults who died by an accidental overdose. However, suicide completers were more likely to have struggled with severe depression, and previously attempted suicide, whereas the accidental overdose sample was more likely to display a chronic pattern of severe drug abuse. CONCLUSIONS: The current study helps to distinguish between opiate users who are at risk for death by an accidental or intentional overdose. In the ongoing opiate crisis, clinicians must understand the risk of overdose and the nuances of accidental behaviors compared to purposeful ones. Signs of suicidal planning, relevant psychopathology, and ongoing life stress may be useful points of intervention for stopping the increasing number of deaths among opiate users.

A preliminary examination of the association between drinking as a typical coping strategy and level of acute alcohol consumption prior to a suicide attempt.

Drinking to cope is associated with suicide ideation and attempts. Event-based research shows drinking, particularly when alcohol is consumed in large quantities, increases the intensity of suicidal thoughts and immediate risk for attempt. Such findings suggest those who typically drink to cope may be especially likely to drink heavily in the hours preceding a suicide attempt. In the first examination of the association between regular use of alcohol as a coping strategy and acute alcohol consumption prior to a suicide attempt, participants included 130 patients hospitalized for a recent attempt. The number of drinks consumed in the acute period preceding the attempt, as well as past-year heavy drinking frequency, typical drinking motives, and depressive symptoms were assessed. The unique impacts of coping motives on odds of consuming any alcohol, and of using specific amounts of alcohol in the acute period, were determined through binary and multinomial logistic regressions. Results demonstrated that commonly drinking for coping motives increased the odds of heavy drinking - but not of using alcohol at low levels - during the acute period. Results held after adjusting for relevant covariates. Clinicians should assess drinking motives and prioritize prevention of drinking to cope to reduce risk of alcohol-related suicide attempts.

Suicidal Behavior: Links Between Alcohol Use Disorder and Acute Use of Alcohol.

Research on associations of suicidal behavior, including suicide and suicide attempt, with alcohol use disorder (AUD) and acute use of alcohol (AUA) are discussed, with an emphasis on data from meta-analyses. Based on psychological autopsy investigations, results indicate that AUD is prevalent among individuals who die by suicide. Results also indicate that AUD is a potent risk factor for suicidal behavior. Risk estimates are higher for individuals with AUD in treatment settings, when compared to individuals in the community who have AUD. Also, although rates of suicide and prevalence of AUD remain higher in men, they have increased more among women in recent decades. Based on postmortem blood alcohol concentrations, AUA was commonly present among those who died by suicide. AUA is a potent proximal risk factor for suicidal behavior, and the risk increases with the amount of alcohol consumed, consistent with a dose-response relationship. Research indicates that AUA increases risk for suicidal behavior by lowering inhibition and promoting suicidal thoughts. There is support for policies that serve to reduce alcohol availability in populations with high rates of AUD and suicide, that promote AUD treatment, and that defer suicide risk assessments in intoxicated patients to allow the blood alcohol concentration to decrease.

Commentary: Opioid use disorder and suicide: An important opportunity to address two significant public health epidemics.

Nationwide, the opioid epidemic continues to have a significant and widespread adverse impact on morbidity and mortality. The number of individuals dying by suicide and unintentional overdose has continued to increase over the past decade, with opioids being involved in a significant proportion of each category of mortality in 2017. Currently, most strategies for decreasing opioid-overdose deaths do not include systematic screening for suicide risk, nor do they address the necessity to customize interventions for those who misuse opioids to decrease near-term suicide risk (defined here as less than 72 h) factors. Improved screening of near-term and chronic suicide risk along with rapid access to treatment is of critical importance to prevent opioid-related deaths by suicide.

Impulsivity facets and perceived likelihood of future suicide attempt among patients who recently attempted suicide.

BACKGROUND: Given the substantial heterogeneity of both impulsivity and suicidality, increased specificity in studying relations between these variables is needed. One aspect of suicidality that may be especially important for predicting future risk among those with a recent suicide attempt is self-perceived likelihood of making a future attempt (suicide likelihood). Presently, little is known about the extent to which impulsivity is related to this important aspect of suicidality. We examined whether three distinct impulsivity facets (i.e., deficits in conscientiousness, negative urgency, and sensation seeking) would differentially predict suicide likelihood. METHODS: Participants included 155 psychiatric inpatients who presented to a Level-1 trauma hospital after a recent suicide attempt. Structural Equation Modeling (SEM), in which demographic and clinical covariates were controlled, was conducted to examine whether each impulsivity facet would uniquely predict suicide likelihood. RESULTS: Deficits in conscientiousness was the only robust predictor of suicide likelihood, with an association that persisted after accounting for demographic and clinical covariates. LIMITATIONS: The cross-sectional design and unknown predictive validity of suicide likelihood are study limitations. CONCLUSION: This was a preliminary investigation of impulsivity facets with suicide likelihood. Clinical implications of this study suggest that deficits in conscientiousness and suicide likelihood may be important factors to consider when identifying and intervening with patients at high-risk for suicide.

Age Differences in Suicide Risk Screening and Management Prior to Suicide Attempts.

OBJECTIVE: This study examined differences by age in suicide risk screening and clinical actions to reduce suicide risk among patients with visits to Veterans Health Administration (VHA) medical facilities in the year prior to an attempt. METHODS: Ninety-three VHA patient records were reviewed specific to the last visit before an attempt. Information was extracted regarding documentation of individual suicide risk factors and provider actions to reduce risk. RESULTS: The authors examined differences by patient age (≥50 versus 18-49). Older patients' medical records were less likely to have evidence of 1) screening for impulsivity and firearms access and 2) engagement in safety planning, referrals for mental health services, and consideration of psychiatric hospitalization. General medical providers were less likely to document these risk factors and action steps in comparison with mental health clinicians. CONCLUSION: Lethal means education and collaborative care are universal strategies that may improve identification of and lower suicide risk in older veterans.