Studies of suicide
Today, I present summaries of three studies related to suicide. First, Pollak, Cheek, Rudolph, Hastings, Nock, & Prinstein (2023) published “Social Problem-Solving and Suicidal Behavior in Adolescent Girls: A prospective examination of proximal and distal social stress-related risk factors” in Journal of Psychopathology and Clinical Science. Here are the edited abstract and impact statements:
Adverse social experiences are often linked to suicidal behavior in adolescence, perhaps particularly for girls. Social problem-solving abilities may indicate more or less adaptive responses to adverse social experiences that contribute to adolescent girls’ risk for suicidal behavior. While social problem-solving is implicated in cognitive and behavioral theories of suicidal behavior, prior work is largely cross-sectional and examines bivariate associations between social problem-solving, assessed in neutral conditions, and suicidal behavior. Using a novel performance-based task, this study assessed social problem-solving in adolescent girls (N = 185, Mage = 14.66, SD = 1.41) before and after an experimentally simulated social stressor and examined associations between social problem-solving and past-year suicidal behavior. Prospective analyses tested whether greater changes in specific social problem-solving domains following the social stressor predicted greater likelihood of suicidal behavior over a 9-month follow-up in contexts of elevated, real-life interpersonal stress. Results revealed that adolescent girls who showed greater changes (i.e., reflecting declines) in problem-solving effectiveness following acute social stress were more likely to exhibit suicidal behavior over the following 9 months, but only if they also experienced elevated interpersonal stress in real life. State-dependent changes in social problem-solving may indicate a cognitive vulnerability following social stress that, in combination with cumulative interpersonal stress in real life, distinguishes adolescent girls at heightened risk for future suicidal behavior. Findings demonstrate the importance of examining suicide risk factors under conditions that may more closely mirror the interpersonal contexts in which adolescents’ risk for suicidal behavior may be elevated.
Suicide is the second leading cause of death among adolescents, and rates of suicide attempts are particularly high among adolescent girls. This study suggests that deficits in social problem-solving, particularly in problem-solving effectiveness, in contexts of elevated, real-life interpersonal stress may distinguish adolescent girls at greater risk for future suicidal behavior. Findings highlight the importance of studying state-dependent changes in suicide risk factors under conditions that may more closely mirror the interpersonal contexts in which adolescents’ risk for suicidal behavior may be heightened.
I like this study for several reasons: the sample is relatively large, the study longitudinal, and the measures make sense. I especially like the combination of measures of interpersonal stress, social problem-solving, and suicidality. In a world in which social media, bullying and rejection at school, and adolescent-parent conflict play important roles in teens’ lives, this study may be helpful. The next study takes on a similar theme. Dodge et al. (2024) published “A Qualitative Study of Supporters of Adults Following a Suicide-Related Psychiatric Emergency” in Families, Systems, & Health. The edited abstract and impact statements are as follows:
Family, friends, and romantic partners (i.e., supporters) play a key role in the implementation of safety and support measures for loved ones with elevated risk for suicide; yet despite the link between interpersonal factors and suicide risk, few supporter-focused interventions exist. This qualitative study to inform intervention development was conducted from September 2021 to March 2022 and explored (a) the feasibility and acceptability of a single-session phone call to a support person (n = 30, 67% female, 88% White non-Hispanic, Mage = 40.3 [SD = 17.1]) nominated during an emergency department (ED) visit for suicide risk and (b) the needs of supporters during and after a loved one’s suicide crisis. Of the 30 supporters nominated, 27 were eligible to participate and were contacted. Eighteen completed an interview (66%). Seven core themes with 26 subthemes were identified characterizing the supporter’s experience prior to, during, and following their loved one’s suicide crisis. We found moderate acceptability and feasibility of a single-session supportive phone call to a support person following an ED visit for suicide risk. Supporters reported a period of stress prior to and during the ED visit as well as adaptive coping with continued barriers and challenges. Brief interventions aimed at improving communication between the supporter, patient, and their care team; defining roles; and enhancing practical and emotional support are likely to be acceptable and feasible. Further study is needed to determine whether brief interventions to improve supporter self-efficacy can benefit both supporter and patient.
This is a small sample but continues the theme of interpersonal needs. In this instance, the recommendation that a brief intervention may make it easier for professionals to monitor and support patients with suicidality. The final study also focuses on collaboration. Hedman (2023) published “Interagency Collaboration in Suicide Prevention” in Traumatology. Here’s the edited abstract:
The purpose of this study was to examine interorganizational collaboration in suicide prevention activities coordinated by the fire service. Interviews and observations were conducted in ethnographic fieldwork in three Swedish fire stations. The analysis of data was guided by interagency collaboration theory. The findings demonstrated six central components of the practice: (a) a shared suicide incident plan for the emergency services, (b) a municipality action plan supported by the Swedish Law of protection against accidents viewing suicide as a psychological accident, (c) interagency groups working with suicide prevention, (d) education and training of firefighters and the public in Mental Health First Aid and suicide prevention, (e) suicide intervention operations carried out by the emergency services, and (f) crisis support of bereaved families and first responders exposed to suicide. Having a shared suicide intervention plan and practice created trust in interagency groups facilitating cooperation in suicide emergencies. The benefit of the fire service coordinating the suicide prevention activities was that the fire stations were many and geographically dispersed, unlike the police and ambulance. This meant that the fire service arrived at suicide attempt sites faster than ambulance and police, which saved lives. The results provide a starting point for the implementation of suicide prevention activities, training of firefighters, and the design of interorganizational collaboration in suicide intervention policy elsewhere in the world while adapting to regional and local circumstances and resource availability. These results might be considered in future strategy and the prioritization of suicide prevention activity.
Since this study was obviously done in Sweden, the first thing I searched for was the use of fire department personnel in dealing with suicidal behavior. The answer I found was that fire departments are increasingly responding to “jumpers” and other suicidal individuals and often respond with no clear protocol for intervention. I frequently see emphasis on the importance of multidisciplinary approaches to common psychological problems and think this series of articles offers some stimulating material for community leaders in schools, hospitals, and first responder settings.