Nurses die by suicide at a higher rate than the general population. Previous studies have observed mental health problems, including substance use, as a prominent antecedent before death. The purpose of this study was to explore the characteristics of nurses who died by suicide documented in the death investigation narratives from the National Violent Death Reporting System from 2003 to 2017 using thematic analysis and natural language processing. One thousand three hundred and fifty-eight subjects met these inclusion criteria. Narratives from 601 subjects were thematically analyzed and 2544 individual narratives were analyzed using natural language processing. The analyses revealed five themes: "mental health treatment," "poor general health and chronic pain," "substance use," "worsening mental health after bereavement," and "repeating a family member's suicide." Mental health/substance use, chronic illness, and chronic pain were seen to coexist in a complex, interdependent manner that appeared to be entangled in the nurses' narratives before death. These findings echo the need for reducing the stigmatization of mental health problems in nursing and removing barriers to help-seeking behaviors as early preventative interventions. Future research is needed to determine if a comprehensive healthcare integration approach to address these entangled problems would reduce suicide vulnerability in nurses and improve their quality of life.

Entangled: A mixed method analysis of nurses with mental health problems who die by suicide.

Adults with behavioral health disorders in criminal-legal systems are at heightened risk of suicide relative to the general population. Despite documented racial disparities in criminal processing and behavioral health treatment, few studies have examined racial differences in suicide risk in this already high-risk population. This study examined 1) the correlates of suicide risk in this population overall and by race and 2) the moderating role of race in these associations.We investigated correlates of clinician-rated suicide risk at baseline in a statewide sample of 2,827 Black and 14,022 White adults with criminal-legal involvement who engaged in community-based behavioral health treatment. Regression-based approaches were used to model suicide risk and test for evidence of interaction effects.Findings showed the strongest correlates of suicide risk were greater behavioral health needs, evidence of self-harm, and a primary mental health diagnosis or co-occurring diagnosis. In race-specific analyses, correlates of suicide risk were mostly similar for both Black and White clients, with a couple exceptions. Interaction terms testing between-group effects on correlates of suicide risk were non-significant.Adults with behavioral health disorders in criminal-legal systems experience similar risk factors for suicide as the general population. Similar to prior research, we found that Black adults, in particular, are at lower risk for suicide overall. Contrary to expectations, we found similarities in correlates of suicide risk across race in our sample of felony-level adults with behavioral health disorders in the criminal-legal system. Prior research shows that behavioral health professionals should be cognizant of cultural factors when developing a comprehensive approach to suicide care and treatment. Our findings show correlates of suicide risk are largely stable in Black and White adults involved in criminal-legal systems, suggesting culturally responsive treatment for suicide risk should target shared risk factors. 

/pdf/correlates-of-suicide-risk-among-black-and-white-adults-with-3r6slv3n.pdf

Correlates of suicide risk among Black and White adults with behavioral health disorders in criminal-legal systems

Despite the psychotherapeutic and pharmacotherapeutic advances in the treatment of depressive, anxiety, and psychotic disorders over the past several decades, the suicide rate in the United States has increased over the past 18 years. Medications are safer and more difficult to use in overdosing, but not necessarily more efficacious in bringing about complete remission of symptoms. The current article focuses on the theories and psychosocial and neurobiological correlates of suicide with the intent of formulating intervention strategies to prevent suicide. Particular attention is on medications that may contribute to suicidal ideation and behaviors and those that show evidence of reducing the risk of suicide. [Journal of Psychosocial Nursing and Mental Health Services, 57(12), 9-14.].

Psychopharmacology of Suicide.

Objectives The association between childhood trauma and suicidal ideation has been well documented in several populations, including individuals with a substance use disorder (SUD). However, a gap still exists in the literature regarding the mechanisms by which childhood trauma later impacts suicide risk. This cross-sectional study tested the effect of childhood trauma on suicidal ideation, as well as the mediating effect of tolerance for psychological pain (managing the pain and enduring the pain) in that relationship, controlling for the effect of depressive symptoms, in individuals with a SUD. Methods A sample of 102 adults with a SUD participated in the study. Path analysis by structural equation modelling tested a mediation model. Results Depressive symptoms and lower levels of managing the pain were found to fully mediate the association between childhood trauma and suicidal ideation. Conclusions Our results suggest that depressive symptoms and a lack of ability to manage psychological pain contribute towards explaining why traumatic childhood experiences may result in suicidal cognitions in individuals with SUDs. Moreover, they have relevant implications for prevention and clinical interventions regarding suicidal ideation in this population. Practitioner points Childhood trauma relates to suicidal ideation in individuals with a substance use disorder. Depressive symptoms contribute towards explaining why traumatic childhood experiences may result in suicidal cognitions. A lack of ability to manage psychological pain also contributes towards explaining this relationship. The obtained results have relevant implications for the prevention of and clinical intervention for suicidal ideation in SUD individuals.

The mediating role of tolerance for psychological pain in the relationship of childhood trauma to suicidal ideation in individuals with a substance use disorder

Suicide rates are markedly high among children with foster care involvement. Transition-age youth (TAY) who age-out of the foster care system are at particularly high risk. 

Characteristics of Transition-Age Youth Engaging in Suicidal Behavior

Objectives: The main objectives of this study were to compare the risk of suicide, sociodemographic and clinical characteristics in 3 designated groups: dual diagnosis (DD), substance-related disorder without other comorbid mental disorder, and any mental disorder without the presence of co-occurring substance-related disorders. Materials and Methods: This was a cross-sectional study with secondary information source from a population study. Adults of both sexes between 19 and 65 years of age were included and were screened for 23 mental disorders, the data collection tool used was the Compositum International Diagnosis Interview (CIDI 3.0), which uses DSM IV diagnostic criteria. Suicide risk in individuals with DD and other mental disorders was compared. Results: In total, 303 adults between 19 and 65 years of age were included. In all, 63% were women. The median age was 41 and the interquartile range 21. The prevalence of DD was 2.0% in the last 12 months and the prevalence of suicidal behavior was 7.6%, any substance abuse disorder 4.8%, any mental disorder without substance abuse 17.4%. An association of suicidal behavior with DD was found [odds ratio (OR), 13.85; 95% confidence interval (CI), 2.62-73.09) with grouped substance-related disorder (OR, 9.61; 95% CI, 2.49-37.00) and grouped mental disorders (OR, 4.97; 95% CI, 2.07-11.92). Conclusions: A higher risk of suicide was found in DD compared with noncomorbid mental disorders or substance-related disorder.

Suicide Risk Associated With Dual Diagnosis in General Population

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Suicide Risk Associated With Dual Diagnosis in General Population