Julie Cerel

Sexual Orientation and Risk Factors for Suicidal Ideation and Suicide Attempts Among Adolescents and Young Adults

Same-gender sexual orientation has been repeatedly shown to exert an independent influence on suicidal ideation and suicide attempts, suggesting that risk factors and markers may differ in relative importance between lesbian, gay, and bisexual individuals and others. Analyses of recent data from the National Longitudinal Study of Adolescent Health revealed that lesbian, gay, and bisexual respondents reported higher rates of suicidal ideation and suicide attempts than did heterosexual respondents and that drug use and depression were associated with adverse outcomes among heterosexual respondents but not among lesbian, gay, and bisexual respondents.

The Impact of Suicide on the Family

Little research has examined the consequences of a suicide for social or family networks. Because suicide occurs within families, the focus on the aftermath of suicide within families is an important next step to determine exactly how to help survivors. In this article, we review and summarize the research on the impact of suicide on individuals within families and on family and social networks. We begin with a discussion of family changes following suicide. Next, we discuss the effects of suicide on social networks overall and responses of children and the elderly to a suicide in the family. Finally, we identify key issues that remain to be resolved in family survivor research and make recommendations for future studies.

A Call for Research: The Need to Better Understand the Impact of Support Groups for Suicide Survivors

Support groups for suicide survivors (those individuals bereaved following a suicide) are widely used, but little research evidence is available to determine their efficacy. This paper outlines the pressing public health need to conduct research and determine effective ways to identify and meet the needs of suicide survivors, particularly through survivor support groups. After describing the various approaches to survivor support groups, we explain the need for further research, despite the inherent challenges. Finally, we pose several questions for researchers to consider as they work with survivors to develop a research agenda that sheds more light on the experiences of survivors and the help provided by survivor support groups.

Exposure to Suicide in the Community: Prevalence and Correlates in One U.S. State.

Objective. Suicide has been identified as a major public health issue. Exposure to suicide (i.e., knowing someone who died by suicide) is far more pervasive than previously considered and might be associated with significant adverse outcomes. As suicide becomes more commonly discussed in the public arena, a compelling need exists to determine who is exposed to suicide and how this exposure affects those left behind. This study estimated the proportion of the population exposed to suicide and delineated factors that predict significant psychiatric and psychosocial morbidity following that exposure. Methods. A dual-frame random-digit-dial survey was conducted on a sample of 1,736 U.S. adults in the Commonwealth of Kentucky. Depression and anxiety were compared in suicide-exposed and suicide-unexposed individuals. Relationships were examined between psychiatric outcomes and perceptions of closeness to the decedent. Results. Forty-eight percent of weighted participants (n=816/1,687) reported lifetime exposure to suicide. Current depression and anxiety symptoms were higher in suicide-exposed than in suicide-unexposed individuals. Suicide-exposed individuals were twice as likely as suicide-unexposed individuals to have diagnosable depression and almost twice as likely to have diagnosable anxiety. Suicide-exposed individuals were more likely than suicide-unexposed individuals to report suicide ideation (9% vs. 5%). Closeness to the decedent increased the odds of depression and anxiety and almost quadrupled the odds of posttraumatic stress disorder. Conclusion. Exposure to suicide is pervasive and occurs beyond family; as such, it is imperative to identify those with perceived closeness to the decedent. This hidden cohort of suicide-exposed people is at elevated risk for psychopathology and suicidal ideation.

Suicide Survivors Seeking Mental Health Services: A Preliminary Examination of the Role of an Active Postvention Model

Archival data from suicide survivors presenting for treatment from 1999-2005 at the Baton Rouge Crisis Intervention Center (BRCIC) were used to examine differences in those who received an active model of postvention (APM; n=150) compared to those who received a traditional passive postvention (PP, n=206). APM presented sooner for treatment (48 days) than PP (97 days). APM survivors were more likely to have been the survivor of a violent suicide. APM were more likely than PP to attend survivor support group meetings and APM attended more groups. To better understand the efficacy of APM in helping survivors, a prospective evaluation is needed.

Consumer and family experiences in the emergency department following a suicide attempt

Objective. To understand the separate experiences of consumers (patients) and family members in the Emergency Department (ED) following a suicide attempt. Methods. Separate anonymous surveys were created for two groups: 1) consumers (n = 465) who had made a suicide attempt and been to the ED, and 2) others (referred to here as family members; n = 254) who had a close friend or relative treated in an ED due to suicidal behavior. Surveys were available on the National Alliance on Mental Illness (NAMI) website (www.nami.org) for 2 months. Results. Almost half of consumers were accompanied by a family member to the ED following their suicide attempt. Over half of consumers and family members felt that staff treated them with respect and addressed ethnic and cultural issues appropriately. However, fewer than 40% of consumers felt that staff listened to them, described the nature of treatments to them, or took their injury seriously. Family members were more likely than consumers to feel heard or to receive information about treatment. More than half of consumers and almost a third of family members felt directly punished or stigmatized by staff. Consumers and family members also reported negative experiences involving a perception of unprofessional staff behavior, feeling the suicide attempt was not taken seriously, and long wait times. Conclusions. Individuals who visited the NAMI website reported a range of negative experiences in EDs following visits for suicide attempts. The effects of these experiences on retention in care and subsequent self-injurious behavior are largely unexplored. A greater understanding of these effects may inform development of interventions to increase the satisfaction of consumers and their families and friends and improve outcomes that result from emergency care of suicidal patients and their families.

The Development of Effective Message Content for Suicide Intervention

BACKGROUND Each year there are over 31,000 suicides in the United States, constituting a significant problem in every respect. It is important for research efforts to focus on the communication elements involved in suicide prevention because the messages produced by individuals close to those who have suicidal thoughts have the potential to save a life. AIMS The current manuscript presents the theory of planned behavior (TPB) as a foundation to increase understanding of what message content would be most effective to convince an individual to intervene when someone is suicidal. METHODS Suicide and suicidal behaviors are briefly reviewed, as is the TPB. Then it is argued how and why TPB can help construct persuasive messages. RESULTS The authors suggest that TPB guide the content of persuasive messages. Messages created in combination of persuasive theories with TPB are likely to encourage an individual to intervene when someone is suicidal. CONCLUSIONS A key element to suicide prevention is intervention by close others. Use of TPB provides an increased understanding of how to persuade close individuals to intervene when an individual is suicidal.

Veteran exposure to suicide: Prevalence and correlates.

BACKGROUND The aim of this study was to determine rates and consequences of suicide exposure in a veteran population and variables related to psychiatric morbidity. METHODS 931 veterans from a random digit dial survey conducted July 2012-June 2013 in the Commonwealth of Kentucky was utilized to examine associations between suicide exposure and depression and anxiety. For those with lifetime suicide exposure, perceptions of closeness to the decedent and additional traumatic death exposure were also examined. RESULTS Almost half of veterans (47.1%, n=434) reported lifetime exposure to suicide. Suicide-exposed individuals were almost twice as likely to have diagnosable depression (OR=1.92, CI=1.31-2.8) and more than twice as likely to have diagnosable anxiety (OR=2.37, CI=1.55-3.61). Suicide-exposed were also more likely than non-exposed to report suicide ideation (9.9% vs. 4.3%). Perceived closeness to decedent increased the odds of depression (OR=1.38, CI=1.12-1.69), anxiety (OR=1.51, CI=1.21-1.89) and PTSD (OR=1.65, CI=1.27-2.16) and more than doubled the odds of Prolonged Grief (OR=2.47, CI=1.60-3.83). A model examined time sequence of suicide and traumatic death exposure. Experiencing a suicide exposure first and subsequent traumatic death exposure in their military career almost quadrupled the odds of suicide ideation (OR=3.56, p=.01, CI=1.34-9.46). LIMITATIONS Major study limitations include use of only one US state and random digit dial response rate. CONCLUSIONS Suicide exposure confers psychiatric risks in veterans. Perceptions of closeness to decedents, which may extend beyond familial lines, may heighten these risks in the suicide exposed. Multiple exposures to suicide and traumatic death may lead to significant suicide risk.

Risk for Suicide and the Role of Family A Narrative Review

Limited research exists that examines the contribution of family factors to the development and treatment of suicide. Although suicidal behavior occurs within an individual, the context in which it occurs can add necessary insights for understanding and preventing suicide. In this article, the existing literature on the family’s psychosocial role in the development of suicidal behavior is reviewed. Additionally, a review of the limited research on the family’s role in treatment following a suicidal action is provided. Finally, several directions for future research and clinical work are discussed to enhance our understanding of the family’s role in preventing suicide.

Support groups for suicide survivors: results of a survey of group leaders

To update and expand Rubey and McIntoshs (1996) survivors of suicide support groups report, SPAN USA completed a survey of U.S. support group leaders (n = 100; 24% completion). There are now more survivor groups (from 280 to 417), and the majority of groups now have a survivor leader (78% vs. 25%). Groups continue to be small (88% < 10 members per session) and meet on a monthly basis (55%). Sharing continues to be a universal experience in groups, which tend to be open-ended (85%). Current groups are newer, and more operate without a sponsor. Further research is needed to examine group member perspectives and effectiveness of groups.