Attitudes of acceptability and lack of condemnation toward suicide may be predictive of post-discharge suicide attempts

Abstract

BackgroundSuicide attempts (SA) after psychiatric hospitalization continue to be a major cause of morbidity. Implicit measures may enhance our ability to assess suicide risk. In this context, we describe the first use of the Suicide Opinion Questionnaire (SOQ) to identify post-discharge suicide attempters.MethodsAdult psychiatric inpatients admitted for suicidality (N = 91) were administered a battery of measures including the SOQ, and forty were reached and reassessed for SA at two months post-discharge. Exploratory factor analysis (EFA) on items associated with suicidality was performed to identify latent constructs. Linear discriminant analysis (LDA) was used to optimize factor combination for suicide identification. Results were compared with explicit measures of suicidality, and logistic regression was used to control for other risk factors. Finally, a simplified 9-item scale was derived from the results and its performance compared to that of the linear discriminant function.ResultsTwenty items differed between patients with and without SA at intake or follow-up. EFA on these identified two factors: suicide attempters indicated greater acceptability and less moral condemnation of suicide. The LDA-derived discriminant function and 9-item scale was significantly sensitive and specific for post-discharge SA.ConclusionsAttitudes of acceptability and lack of condemnation toward suicide may constitute an implicit measure of suicidality that could contribute to risk assessment in a high-risk population.

Suicide Acceptability and Suicide Attempt

“…Suicide acceptability which can be seen as one kind of cognition about suicide should also be associated with suicide attempt. This possible association was also discussed in a previous study (Galynker et al, 2015).…”

Suicide Risk Assessment and Prevention: A Systematic Review Focusing on Veterans

“…Nineteen studies evaluated the accuracy of methods to identify suicide risk (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46) [see table in online supplement]. No studies described the adverse effects of risk assessment methods.…”

“…No studies described the adverse effects of risk assessment methods. Five studies evaluated methods that could be offered to general populations (universal or primary prevention) (32,36,37,39,42); nine studies evaluated methods that target subpopulations likely to be at increased risk of suicide, such as patients presenting to emergency departments (selective or secondary prevention) (28)(29)(30)33,34,38,40,41,46); and five studies evaluated methods for individuals who have already been identified as having increased risk, such as patients admitted to a hospital for suicidal ideation (tertiary prevention) (31,35,(43)(44)(45). Studies enrolled participants from the community, online, emergency departments, and psychiatry services or used data from existing patient medical records or administrative databases.…”

“…Six studies included veterans or military personnel specifically (28)(29)(30)(31)36,37). Most studies included high-risk populations, such as adults presenting to emergency departments with suicide attempts (33,38,40,(43)(44)(45) or who had psychiatric hospitalizations or psychiatric risk factors that indicated higher risk of suicide (28)(29)(30)(31)(34)(35)(36)39,41,46), most commonly depression or previous suicide attempts.…”

Understanding Changes in Attitudes Toward Suicide Between 1980s and 2010s in the United States*

“…The negative consequences of suicide cannot be understated in terms of potential years of life lost, substantial medical and work loss costs, and devastating emotional and financial costs to family and friends (Brent, ; Centers for Disease Control and Prevention, ). Attitudes toward suicide, which appear to be a good indicator of suicidal behavior (Galynker et al., ; Phillips and Luth, ), may have shifted in recent decades, as reflected in the passage of legalized physician‐assisted suicide (PAS) in six states since 1999 (Brown, ). The legalization of a previously prohibited practice may reflect evolving attitudes toward suicide, at least in the case of an incurable disease.…”