A Population-Based Analysis of Interpersonal Trauma, Psychosis, and Suicide: Evidence, Pathways, and Implications.

Subthreshold psychotic experiences (PEs) are known to confer a risk for suicidality. Yet, despite evidence of a strong etiological trauma-psychosis pathway, the coalesced effect of such concurrences on suicide risk is largely discounted. Our aims were to examine the impact of different manifestations of life span trauma and PEs on the risk of suicidal thoughts and attempts, using an exploratory person-centered approach. Data from the Adult Psychiatric Morbidity Survey (N = 7,403) were analyzed. PEs were assessed using the Psychosis Screening Questionnaire (PSQ) alongside items probing childhood and adult trauma, in addition to 12-month suicide thoughts and attempt. A manual three-step latent class analysis elicited four distinct profiles, namely, a socially disconnected/high PE, a sexual victimization/moderate PE, a life span trauma/low PE, and a baseline class. The socially disconnected class, characterized by a moderate likelihood of social disconnection, a high probability of various PE endorsements, yet a low likelihood of other significant trauma, showed the greatest risk of 12-month suicide ideation (odds ratio [OR] = 13.0, 95% confidence interval [CI] = [8.539, 19.021) and attempt (OR = 24.2, 95% CI = [10.349, 56.860). Neither multiple nor recurrent traumatic experiences invariably result in the emergence of PEs. Instead, a sense of social disconnection may be either resultant of PEs or alone sufficient to cultivate such symptom presentations, even in the absence of prior traumas. Moreover, just as traumatic encounters increase the risk of suicidality, so too might seemingly more innocuous adversities, such as poor-quality social relationships, further elevate the risk, particularly when proximal and coupled with the simultaneity of PEs.

An analysis of the impact of suicide prevention messages and memorials on motorway bridges.

Recently, there has been activity at public locations where people have died by suicide, including the erection of suicide prevention messages and memorials (decorations). This research looks at the impact of these decorations and associated media coverage of the decorations on suicidal behaviour at bridges. Incidents (n = 160) of suicidal behaviour on 26 bridges across motorways in England were analysed. Overall, there was no significant difference in the proportion of incidents pre-decoration versus post-decoration (p-value = .55). The incident rates were not significantly different pre- and post-decoration (p = .46). Only one bridge had statistically significantly more incidents post-decoration and media reporting (p = .03). However, following correction for multiple testing there was no significant difference in pre- and post-incident rates at any of the bridges. In total, 58% of bridges had a greater frequency of incidents when decorations were absent; however, this proportion was not statistically significant (p = .41). Further research is required to establish how suicide prevention messages are perceived. There does not appear to be any benefit, but it often generates media coverage which has been shown to increase risk.

Patterns of occupational stress in police contact and dispatch personnel: implications for physical and psychological health.

PURPOSE: Occupational stress in police call handlers is researched less frequently than in operational or frontline police, despite the role's unique challenges. Occupational stress is potentially manageable, thus improved understanding of its contributors and consequences is important for effective intervention. We aimed to compare levels and sources of organisational stress in police contact and dispatch personnel with UK benchmarks. Second, to test whether different typologies of stress were associated with physical health, mental health and substance use. Finally, to examine whether non-organisational factors (socio-demographic factors and family interference with work (FIW)) predicted organisational stress typologies. METHODS: A sample (n = 720) of police and civilian staff in a UK police call and dispatch centre were surveyed. RESULTS: The strongest sources of stress were competing and high demands, low control, insufficient managerial support and ambiguity surrounding workplace change-all of which indicated need for 'urgent action' according to UK benchmarks. Substance use and particularly mental health difficulties were higher than published norms. A latent profile analysis grouped respondents into a low-stress group and two high-stress profiles. As stress increased across profiles, this corresponded with worse physical and mental health and higher substance use. FIW predicted membership of both high-stress profiles. CONCLUSION: Despite non-operational roles, police contact and despatch personnel can experience high occupational stress which is associated with physical and mental health difficulties and substance use. Organisational-level interventions which address lack of control, conflicting role demands as well as enhance management support and communication around change might be most effective in this group.

The mental health of doctors during the COVID-19 pandemic.

Doctors experience high levels of work stress even under normal circumstances, but many would be reluctant to disclose mental health difficulties or seek help for them, with stigma an often-cited reason. The coronavirus disease 2019 (COVID-19) crisis places additional pressure on doctors and on the healthcare system in general and research shows that such pressure brings a greater risk of psychological distress for doctors. For this reason, we argue that the authorities and healthcare executives must show strong leadership and support for doctors and their families during the COVID-19 outbreak and call for efforts to reduce mental health stigma in clinical workplaces. This can be facilitated by deliberately adding 'healthcare staff mental health support process' as an ongoing agenda item to high-level management planning meetings.

Gender Differences in the Relationship Between Sleep Problems and Suicide Attempt in Adolescents.

There are few studies examining which types of sleep problems are independently associated with suicide attempt (SA) and gender difference in adolescents. The aim of the present study was to examine whether specific sleep problems were uniquely associated with suicide attempt in adolescents and explore gender differences in the association. A school-based health survey was conducted in four provinces within China from November 2014 to January 2015. A total of 15,132 students aged 10-21 years completed standard questionnaires assessing past 12 month suicide attempt in addition to measures of sleep quality, quantity and sleep beliefs. 5.4% of participants reported a suicide attempt within the last 12 months. After adjustment for sociodemographic variables and psychological symptoms, almost all sleep problems remained significantly associated with a greater endorsement of suicide attempt. Further adjustment for co-occurring sleep problems revealed that weekday sleep duration (<6, 8-10, and ≥10 h), insomnia (often), and nightmares (sometimes and often) remained independently associated with suicide attempt in boys (p < 0.05). However in girls, weekday sleep duration (<6 and ≥10 h), weekend sleep duration (<6 h), midday nap (0 or 1-2 d/week), insomnia (sometimes and often), nightmare (often) and sleep beliefs (high) were independently associated with suicide attempt (p < 0.05). Multiple sleep problems are associated with suicide attempt in adolescents, however the relationship varies by gender.

Impacts of Overweight and Obesity in Older Age on the Risk of Dementia: A Systematic Literature Review and a Meta-Analysis.

BACKGROUND: It is unclear whether overweight and obesity in older age reduces or increases the risk of incident dementia. OBJECTIVE: To assess the impacts of overweight and obesity in older age on incident dementia. METHODS: We searched cohort studies reporting body weight measured in older age and dementia through PubMed, Embase, Medline, PyschInfo, and Cochrane library until July 2016. Sixteen articles were identified for the review. We pooled data from them and a new unpublished study from China, to calculate relative risk (RR) of incident dementia in relation to body mass index (BMI) and waist circumference (WC). RESULTS: All 16 cohort studies were undertaken in high income countries, with follow-up periods ranging between 3 to 18 years. Thirteen studies showed an inverse association between BMI and dementia, and three studies demonstrated a positive association. Pooled RR of dementia in relation to continuous BMI from 14 studied populations, including the new Chinese data, was 0.97 (95% CI 0.95-1.00); in those followed up <9 years it was 0.95 (0.93-0.96) while in ≥9 years follow-up it was 1.03 (0.96-1.11). In five studied populations examining categorical BMI, RR of dementia in older people classified as overweight and obese was 0.98 (0.54-1.77) and 1.17 (0.65-2.10) respectively, in comparison with other weights. The pooled WC data showed no association between increased WC and reduced risk of dementia. CONCLUSION: The current evidence did not support a paradox on beneficial impacts of overweight and obesity in older age on incident dementia. More studies with long term follow up are needed to clarify the association of body weight in older age with dementia risk.

Associations of adverse childhood experiences and social support with self-injurious behaviour and suicidality in adolescents.

BACKGROUND: There is little investigation on the interaction effects of adverse childhood experiences (ACEs) and social support on non-suicidal self-injury (NSSI), suicidal ideation and suicide attempt in community adolescent populations, or gender differences in these effects.AimsTo examine the individual and interaction effects of ACEs and social support on NSSI, suicidal ideation and suicide attempt in adolescents, and explore gender differences. METHOD: A school-based health survey was conducted in three provinces in China between 2013-2014. A total of 14 820 students aged 10-20 years completed standard questionnaires, to record details of ACEs, social support, NSSI, suicidal ideation and suicide attempt. RESULTS: Of included participants, 89.4% reported one or more category of ACEs. The 12-month prevalence of NSSI, suicidal ideation and suicide attempt was 26.1%, 17.5% and 4.4%, respectively; all were significantly associated with increased ACEs and lower social support. The multiple adjusted odds ratio of NSSI in low versus high social support was 2.27 (95% CI 1.85-2.67) for girls and 1.81 (95% CI 1.53-2.14) for boys, and their ratio (Ratio of two odds ratios, ROR) was 1.25 (P = 0.037). Girls with high ACEs scores (5-6) and moderate or low social support also had a higher risk of suicide attempt than boys (RORs: 2.34, 1.84 and 2.02, respectively; all P < 0.05). CONCLUSIONS: ACEs and low social support are associated with increased risk of NSSI and suicidality in Chinese adolescents. Strategies to improve social support, particularly among female adolescents with a high number of ACEs, should be an integral component of targeted mental health interventions.Declaration of interestNone.

Childhood maltreatment and psychotic experiences: Exploring the specificity of early maladaptive schemas.

OBJECTIVE: One potential mechanism that has received limited attention in psychosis research is early maladaptive schemas (EMS). Our aim was to examine whether EMS acts as a potential mediating pathway between early trauma and psychotic symptomology. METHODS: A quantitative survey was conducted online. N = 302 participants took part. The analysis used a multiple mediation framework. RESULTS: Analysis demonstrated significant specificity effects. Different forms of child maltreatment were significantly associated with psychosis experiences through specific dimensions of maladaptive schemas. CONCLUSIONS: Results indicated specificity effects in that specific types of maltreatment are associated with specific maladaptive schemas. From a practitioner's perspective, these findings offer credence to cognitive theories of psychopathology, and support the validity of EMS identification and modification among clients with psychotic symptomology both as a fundamental component of traditional CBT and within specialized schema-focused therapy.

Financial Sector Workers' Experiences of Managing Suicidal Clients.

BACKGROUND: Financial sector workers interface with indebted clients, who may be distressed and have heightened vulnerability to suicidality. AIM(S): This study examined the experiences of 10 Irish financial sector workers who had experiences of encountering distressed clients who discuss suicide. METHOD: Semistructured interviews (open-ended questions) were used. RESULTS: Interpretative phenomenological analysis (IPA) identified four themes, namely: (1) avoidance versus confrontation of reality (management of the debt); (2) role conflict (recovering the debt vs. supporting the client); (3) emotional impact and distancing from clients (coping with concerns for client welfare); (4) desire for support (practical and emotional training and support needs). LIMITATIONS: The frequency with which such clients were encountered was not assessed. CONCLUSION: These themes demonstrate the need to provide support to this group, and also the difficulties in providing training to manage suicidal clients in a context where the staff member's goal is to recover debt.

Suicide in Northern Ireland: An Analysis of Gender Differences in Demographic, Psychological, and Contextual Factors.

BACKGROUND: The circumstances surrounding death by suicide can give us insight into the factors affecting suicide risk in particular regions. AIMS: This study examined gender and circumstances surrounding death by suicide in Northern Ireland from 2005 to 2011. METHOD: The study analyzed 1,671 suicides (77% male and 23% female cases) using information contained from the coroner's files on suicides and undetermined deaths. RESULTS: Hanging was the most common method and more than one third of the deceased had prior suicide attempts. There was evidence of alcohol use in 41% of the cases. Only, 61% of cases had recorded adverse events; most had multiple and complex combinations of experiences. Relationship and interpersonal difficulties were the most common category of adverse event (40.3%). However, illness and bereavement, employment /financial crisis, and health problems were also common. One third of those who died by suicide were employed, compared with 50.3% who were not in employment. Just over half (50.1%) were known to have a mental health disorder. CONCLUSION: The results provide the first profile of deaths by suicide in Northern Ireland. They highlight the need to target people who have difficult life experiences in suicide prevention work, notably men, people with employment, financial and relationship crises, and those with mental disorders.

Patterns of stressful life events: distinguishing suicide ideators from suicide attempters.

BACKGROUND: Suicidal ideation is an important indicator for subsequent suicidal behaviour, yet only a proportion of ideators transit from thought to action. This has led to interest surrounding the factors that distinguish ideators who attempt from non-attempters. The study aimed to identify distinct classes of life event categories amongst a sample of ideators and assess the ability of the classes to predict the risk of a suicide attempt. METHODS: A subsample of ideators was extracted based on responses to the suicidality section of the Adult Psychiatric Morbidity Survey (N=7403). Fifteen stressful life events (SLEs) were grouped into six broad categories. RESULTS: Using Latent Class Analysis (LCA), three distinct classes emerged; class 1 had a high probability of encountering interpersonal conflict, class 2 reported a low probability of experiencing any of the SLE categories with the exception of minor life stressors, whereas class 3 had a high probability of endorsing multiple SLE categories. The Odds Ratio for attempted suicide were highest among members of Class 3. LIMITATIONS: The use of broad event categories as opposed to discrete life events may have led to an underestimation of the true exposure to SLEs. CONCLUSIONS: The findings suggest the experience of multiple types of SLEs may predict the risk of transitioning towards suicidal behaviour for those individuals who have contemplated suicide. In application, this re-emphasises the need for a routine appraisal of risk amongst this vulnerable group and an assessment of the variety of events which may signal the individuals who may be at immediate risk.

Childhood maltreatment and social functioning in adults with sub-clinical psychosis.

Studies now acknowledge a robust association between childhood maltreatment and psychosis development in adulthood. Research shows that maltreatment not only influences the child's psychological wellbeing but also inhibits domains of social development. These social impairments have been found to predate the onset of psychosis and may crucially represent an intervening factor which triggers the decline towards psychosis. To examine social functioning as a potential mediating pathway between early maltreatment and sub-clinical psychosis. The study utilised data from the Adult Psychiatric Morbidity Survey (N=7403). Psychotic-like experiences were assessed using the Psychosis Screening Questionnaire (PSQ) along with measures designed to capture childhood maltreatment and social impairment. Results revealed that maltreatment was associated with both social functioning deficits as well as psychotic symptomology. Furthermore, social functioning was found to mediate the relationship between maltreatment and psychosis. The results align with literature linking maltreatment to both social functioning deficits and psychosis. Crucially, the study bridges these research areas by presenting functional decline as possible risk indicator and intervening factor between maltreatment and psychosis. Intervention strategies should therefore seek to capitalise on treatments which boost social aptitude as a means of averting further decline towards psychopathology.