Profile of people attending emergency departments with thoughts of self-harm and suicide: A descriptive study of a nurse-led programme in Ireland.

Increasing research has been conducted on individuals presenting with self-harm at emergency departments (EDs). However, less is known about individuals presenting to EDs with only self-harm ideation. We aimed to describe the characteristics of those attending Irish hospitals with self-harm ideation and investigate any differences in comparison to those presenting with suicide ideation. A prospective cohort study was conducted on Irish ED presentations due to suicidal and self-harm ideation. Data were obtained from the service improvement data set of a dedicated nurse-led National Clinical programme for the assessment of those presenting to Irish emergency departments due to Self-harm and Suicide-related Ideation (NCPSHI). A total of 10 602 anonymized presentation data were analysed from 1 January 2018 to 31 December 2019. Descriptive analysis was conducted to compare those with suicidal and self-harm ideation on sociodemographic and care interventions. Being female and aged <29 were more prevalent among the self-harm ideation presentations. Compared to the self-harm ideation group, a higher proportion of those with suicidal thoughts received an emergency care plan (63% vs 58%, p = 0.002) and General Practitioner letter sent within 24 h of presentation (75% vs 69%, p = 0.045). Little variation was found between hospitals for self-harm ideation in both years. Our study suggests that females and younger populations are more prevalent in hospital presentations due self-harm ideation, while presentations related to suicidal ideation are more often made by males and involving substance use. Attention should be given to the relationship between clinicians' attitudes towards care provision and the content of suicide-related ideation ED disclosure.

The Relationship Between Adult Attachment and Suicidal Thoughts and Behaviors: A Systematic Review.

We aimed to (1) determine the extent of the relationship between attachment and suicidal thoughts and behaviors (STB), (2) investigate whether any gender differences exist, and (3) conduct a theoretical synthesis of the included studies. A systematic search of the databases Web of Science; EBSCO Host Medical and Psychology-related resources, which includes CINAHL, Health Source: Nursing/Academic Edition, Psychology and Behavioral Sciences Collection, and PsycINFO; and EMBASE was conducted, with 52 studies meeting the inclusion criteria. While secure attachment acts as protective factor, insecure attachment orientations appear to be vulnerability factors compromising an individual's capacity to cope with relationship issues, increasing suicide risk. There is insufficient evidence about gender differences. The theoretical synthesis suggests that attachment, interacting with other psychological traits in response to negative life events, acts as a vulnerability or protective factor for STB. Implications for treatment are also discussed.

The Impact of Infectious Disease-Related Public Health Emergencies on Suicide, Suicidal Behavior, and Suicidal Thoughts.

Background: Infectious disease-related public health emergencies (epidemics) may increase suicide risk, and high-quality evidence is needed to guide an international response. Aims: We investigated the potential impacts of epidemics on suicide-related outcomes. Method: We searched MEDLINE, EMBASE, PsycInfo, CINAHL, Scopus, Web of Science, PsyArXiv, medRxiv, and bioRxiv from inception to May 13-16, 2020. Inclusion criteria: primary studies, reviews, and meta-analyses; reporting the impact of epidemics; with a primary outcome of suicide, suicidal behavior, suicidal ideation, and/or self-harm. Exclusion criteria: not concerned with suicide-related outcomes; not suitable for data extraction. PROSPERO registration: #CRD42020187013. Results: Eight primary papers were included, examining the effects of five epidemics on suicide-related outcomes. There was evidence of increased suicide rates among older adults during SARS and in the year following the epidemic (possibly motivated by social disconnectedness, fears of virus infection, and concern about burdening others) and associations between SARS/Ebola exposure and increased suicide attempts. A preprint study reported associations between COVID-19 distress and past-month suicidal ideation. Limitations: Few studies have investigated the topic; these are of relatively low methodological quality. Conclusion: Findings support an association between previous epidemics and increased risk of suicide-related outcomes. Research is needed to investigate the impact of COVID-19 on suicide outcomes.

Understanding and managing suicide risk.

BACKGROUND: Suicidal behaviours and non-suicidal self-harm (NSSH) are global public health concerns that affect millions of lives. SOURCES OF DATA: This review is a narrative synthesis of systematic reviews, meta-analyses of randomized control trials (RCTs) and landmark studies published in scientific journals. AREAS OF AGREEMENT: Restricting access to lethal means reduces the likelihood of future suicide deaths. AREAS OF CONTROVERSY: Our ability to predict future suicidal behaviour is no better than chance. No individual risk prediction instrument offers sufficient sensitivity and specificity to inform clinically useful decision-making. GROWING POINTS: Different types of psychosocial interventions may be effective in preventing future suicide attempts; such interventions include clinical assessment, tailored crisis response and safety plans and follow-up contact. AREAS TIMELY FOR DEVELOPING RESEARCH: Whilst some psychosocial interventions can be effective in reducing suicide risk, little is known about the mechanisms of recovery from suicidal thoughts and behaviours.

Perceptions of Past Parenting and Adult Attachment as Vulnerability Factors for Suicidal Ideation in the Context of the Integrated Motivational-Volitional Model of Suicidal Behavior.

OBJECTIVE: We aimed to investigate whether perceptions of past parenting and current attachment orientations are associated with key components of the Integrated Motivational-Volitional (IMV) Model of Suicidal Behavior. We investigated the relationship between perceptions of past parenting, attachment, suicide ideation, defeat, entrapment, coping, and resilience. METHOD: A total of 730 adult participants responded to an online questionnaire comprised of psychological measures. An initial regression analysis indicated that memories of past parenting and attachment were associated with suicide ideation. Four mediation models were tested based on the IMV model, all controlling for depressive symptoms. RESULTS: In the first model, attachment orientations mediated the relationships between perceptions of past parenting dimensions and defeat. In the second, defeat mediated the relationships between attachment orientations and entrapment. In the third, entrapment mediated the relationship between defeat and suicidal ideation, but coping did not moderate the defeat-entrapment relationship. In the final model, entrapment mediated the relationship between defeat and suicide ideation, with resilience moderating this relationship. CONCLUSIONS: The findings are novel and congruent with the core principles of the IMV model. Clinical implications suggest the protective effect of resilience and strengthening of self-compassion attitudes to reduce the effect of insecure attachment strategies.

Adult attachment: Investigating the factor structure of the Relationship Scales Questionnaire.

OBJECTIVE: In this study, we aimed to conduct an in-depth psychometric investigation of the Relationships Scales Questionnaire (RSQ). METHOD: About 717 UK-based participants responded to an online questionnaire (F = 540, M = 177; age range 18-66 years, M = 25, SD = 8.46). We conducted (a) a series of confirmatory factor analyses (CFA) to test previously published factor models of the RSQ, (b) traditional (exploratory factor analysis and confirmatory factor analysis) and contemporary (exploratory graph analysis) exploratory techniques, followed by (c) validity and reliability analyses. RESULTS: Although the RSQ was developed to assess four categories of adult attachment (typological approach - i.e., secure, preoccupied, dismissing, and fearful), our findings do not support the hypothesis that the RSQ delivers a psychometrically consistent measure of adult attachment styles. CONCLUSION: The results of the present study suggest that a two-dimensional approach (i.e., anxiety and avoidance) to assessing adult attachment is optimal.

Associations between experiences of disrupted attachments and suicidal thoughts and behaviours: An interpretative phenomenological analysis.

RATIONALE: Suicide is a major public health concern and its aetiology is complex. Evidence suggests that experiences of early disrupted attachment relationships with parents and family members are associated with later experiences of suicidal thoughts and behaviours (STB). However, no study has investigated this relationship from an inductive, interpretative and idiographic perspective. OBJECTIVE: This paper explores the role of interpersonal relationships in STB among nine individuals who have attempted suicide. METHOD: Semi-structured face-to-face interviews were analysed using an interpretative phenomenological analysis approach. RESULTS AND CONCLUSION: Two inter-related master themes were identified: 1) 'challenging relationships as catalysts for STB'; and 2) 'positive relationships as buffers against STB'. Findings indicate that experiences of early disrupted parent-child attachments may contribute to vulnerability for STB by shaping participants' perceptions of intimate others and themselves (internal working models). These working models, along with other environmental factors and life events, may increase the risk of STB through perceptions of defeat, entrapment, perceived burdensomeness and thwarted belongingness. Results also suggest that being exposed to respectful, caring, unconditionally accepting, reciprocal, trusting, and non-judgemental intimate adult relationships increase resilience and is associated with recovery from past STB and a reduction of current suicide risk. The theoretical and clinical implications are discussed.