Oral Communication Index


(3) OC-3. Suicide Assessment Kit (SAK)

Day: 10 | Time: 08:00 | Room: Sala 1

Speaker:
Joanne Ross . University of New South Wales, Sydney - Australia

 Abstract:
This presentation introduces the Suicide Assessment Kit (SAK), a comprehensive assessment and
policy development package, designed to assist alcohol and other drug workers in the assessment
and management of suicide risk. The need for the SAK was identified as a result of interviewing staff
in drug and alcohol residential rehabilitation services across Australia. The SAK contains three key
resources: 1) the Suicide Risk Screener which measures the client?s level of suicidal risk to determine
what intervention and management strategies are necessary 2) the Suicide Risk Formulation
Template: A resource to collate (in the client record) the various risk factors and client strengths
from different sources; identify how the known risk factors are being addressed by the current
treatment plan; identify gaps in what is currently known about the client?s suicide risk profile; and
assist staff in communicating the client?s suicide risk to support services; and 3) the Suicide Policies
and Procedures Pro-forma: The Pro-forma provides an overview of the issues that must be
considered in the development of written policies and procedures, forms a template for agencies to
structure their own policies and procedures from, and provides supporting documentation for
management of suicide risk. Three videos have also been developed by the team to support services
using the SAK. These include i) An introduction to the SAK ii) Role-plays demonstrating use of the
Suicide Risk Screener, and iii) Service providers discussing integration of the SAK at their service.
Feedback from treatment services on their impression of the SAK has been very positive. The SAK is
an excellent example of translational research that is having a positive impact upon the practice of
drug and alcohol agencies.


(7) OC-7. The importance of family functioning in suicidal depressed patients

Day: 10 | Time: 08:00 | Room: Sala 4

Speaker:
Gabor Keitner . Rhode Island Hospital/Brown University, Providence, USA

 Abstract:
A number of risk factors have been identified as predictors of suicidal behavior in depressed patients including: age of onset, previous suicide attempts, family history of suicidality, and chronicity. None of these variables are amenable to clinical intervention. Suicidal behavior often occurs in the context of difficult interpersonal relationships. Problematic family functioning, for example, has been found to be associated with suicidal behavior. Little attention has been paid to such findings in spite of the fact that family and interpersonal conflicts are amenable to modification by a number of different therapeutic approaches. This presentation will review the evidence for the association between dysfunctional family relationships and suicidal behavior from a study of 121 depressed inpatients and their families. We found that: 1.Suicide attempting depressed inpatients perceived their family?s functioning to be worse than did their families and worse than non-suicidal depressed inpatients, 2. Perception of poor family functioning was associated with recurrent suicidal behavior 2 years later, 3. Adjunctive family therapy was associated with decreased suicidal ideation. The presentation will suggest ways of involving families in the assessment and treatment of patients with depression and suicidal intent.


(25) OC-25. Interest group framing of suicide and its reporting in the New Zealand news media

Day: 09 | Time: 08:00 | Room: Sala 3

Speaker:
Gabrielle Jenkin . Univeristy of Otago, New Zealand

 Abstract:
In August 2010, the Chief Coroner of New Zealand released to the media for the first time data on the methods used by those who died by suicide. This was accompanied by his call to open up discussions around suicide. These actions were controversial as they went against the recommendations of existing media guidelines not to report methods due to the evidence that it can result in copycat suicides. What followed was a ?debate? in the media about suicide and the role of media in suicide prevention. This research examined the framing of this debate, its origins, and drawing on faming theory, examined the perspectives of the key interest groups cited in the news media.
Seven key interest groups commenting on the issue of suicide and its reporting in the media were identified and their perspectives documented. These were: 1) Coroners; 2) representatives of health service providers; 3) health professionals (not representing a health organisation); 4) government and government agencies; 5) media individuals and groups; 6) health and related citizen non-government groups; and 7) family (people bereaved by suicide).
The research found that the two interest groups dominated the media debate about suicide and its reporting in the media, these were the coroners and health agency representatives. Although the framing of the issues varied between the interest groups, our analysis suggests that there were more areas of consensus between the various stakeholders than contention.


(31) OC-31. Self-reported symptoms and interviewer-rated assessments in older and younger patients with non-fatal suicidal behavior

Day: 10 | Time: 08:00 | Room: Sala 1

Speaker:
Dimitra Bachlava . Institute of Neuroscience, University of Gothenburg, Gothenburg, Sweden

 Abstract:
Background: The aim was to examine age-related differences in self-reported symptoms of psychopathology and interviewer-rated assessments in patients with non-fatal suicidal behavior.
Methods: Interviews were carried out with 399 persons who were in contact with acute psychiatric services at three large Swedish hospitals in connection with non-fatal suicidal behavior. Only cases reporting at least some degree of suicidal intention in accordance with the Columbia Suicide Severity Rating Scale were included in the current study. Thirty-four (8.5%) of the participants were aged 65 and above (21 women and 13 men).
Results: Lower scores were observed in the older group when depression symptoms were self-rated with the MADRS-S (18.2 vs 28.0 in the younger group, p<0.001). The older adults also scored lower on the self-rated anxiety (12.9 vs 22.3, p<0.001) and compulsion (10.7 vs 21.2, p<0.001) subscales of the Comprehensive Psychopathological Rating Scale. Impulsivity, as rated by the Suicide Intent Scale item 15, was reported in 32% of the older adults and 50% of the younger group (p=0.05). Reports of hopelessness, as assessed with a single question (Did you experience severe hopelessness during the past week?) did not differ in older and younger persons (85% vs 91% p= 0.27). While older adults scored lower than the younger group on the interviewer-rated symptom-based Suicide Assessment Scale (32.0 vs 45.5, p=<0.001), scores on the Suicide Intent Scale did not differ in the two age groups (16.4 vs 15.2, p= 0.38).
Conclusion: Findings suggest that older persons at risk of suicidal behavior may be missed if clinicians rely on older adults? responses to questions about symptoms of depression and anxiety.


(32) OC-32. Depressive and anxiety symptomatology in older female suicide attempters and a comparison group from the general population

Day: 09 | Time: 08:00 | Room: Sala 3

Speaker:
Stefan Wiktorsson . Institute of Neuroscience, University of Gothenburg, Gothenburg, Sweden

 Abstract:
Background:
The number of suicide deaths is projected to increase over the next decades due to population aging. While suicide rates among older adult women are not as high as those observed among their male counterparts, women live longer than men. There are relatively few gender-specific studies in older adult suicide research. The aim of this study was to compare depressive and anxiety symptomatology in female suicide attempters and a general population comparison group.

Methods:
Fifty-six female suicide attempters aged 71 and above (mean age 80.5) participated in the study. A comparison group (n=78, mean age 79.2) frequency matched for MADRS score was selected from the Gothenburg-based geriatric population studies. Symptoms of depression were rated with the Montgomery-Asberg Depression Rating Scale (MADRS); anxiety symptoms were evaluated with the Brief Scale of Anxiety (BSA).

Results:
Cases were more likely to have a history of psychiatric treatment (61% vs.18%) and alcohol use disorder (11% vs.0%) compared to comparison subjects. Furthermore, cases were more likely to have been prescribed antidepressants (64% vs 30%, p = <0.001) and they scored lower on MMSE (mean=24.8 vs. 27.0, p=0.001). Despite matching procedure attempters had somewhat higher mean MADRS score (mean 26.1 vs 20.4, p = <0.001). BSA scores were significantly lower (10.2 vs. 15.3, p=<0.001). Inability to feel was almost twice as common in suicide attempters compared to the comparison group. Proportions with both reported and observed autonomic disturbances, hypochondriasis, reduced sleep and aches and pain were higher among comparison subjects.

Conclusion:
A number of specific anxiety symptoms were more common in comparison subjects than in attempters. This finding was somewhat unexpected and might be explained in part by the greater use of psychotropic drugs in the attempter group.


(46) OC-46. The Effectiveness of the Collaborative Assessment and Management of Suicidality (CAMS) Based on Clinical Trial Research

Day: 10 | Time: 14:30 | Room: Sala 4

Speaker:
David Jobes . The Catholic University of America, Washington, DC USA

 Abstract:
The Effectiveness of the Collaborative Assessment and Management of Suicidality (CAMS) Based on Clinical Trial Research
CAMS is an evidence-based therapeutic framework that provides suicide-specific clinical care for suicidal patients (Jobes, 2006; 2016). Based on 25 years of clinical research, CAMS is guided by the use of the "Suicide Status Form" which is a multipurpose assessment, stabilization, treatment-planning, tracking, and clinical outcome tool. All CAMS assessments are done collaboratively and with empathically; patient-defined "suicidal drivers" are identified, targeted, and treated over the duration of CAMS-guided care. CAMS has a robust evidence-base with seven published correlational clinical trials across a range of settings and suicidal patients (Jobes, 2012). Two randomized controlled trials have also been published (Andreasson et al., 2016; Comtois et al., 2011). Three additional randomized controlled trials are underway in the United State and abroad. This presentation will present new data from the most recent randomized controlled trials to provide the recent results about the effectiveness and utility of CAMS with suicidal US Army Soldiers and suicidal college students. The various findings across all studies to date will be integrated to better understand the effectiveness of CAMS in different settings with different types of suicidal patients. Next steps in this line of research will also be reviewed.


(73) OC-73. Single dose ketamine trials for sucidal ideation in major depression: a systematic review and meta-analysis

Day: 09 | Time: 08:00 | Room: Sala de Cámara

Speaker:
Greg Carter . University of Newcastle, Australia

 Abstract:
Background: Several recent trials indicate low-dose ketamine produces rapid antidepressant effects. However, uncertainty remains in possible effects on suicidality (suicidal ideation).
Methods: A systematic search was conducted for relevant randomized trials in Medline, Embase, and PsycINFO databases up to August 2014. The primary endpoints were change in suicidal ideation scores at days 1, 3 and 7, Data were independently abstracted by 2 reviewers. Unpublished data were obtained for suicidal ideation and for treatment effects in the first period of crossover trials.
Results: Nine trials were identified, including 201 patients (52% female, mean age 46 years). Six trials assessed low-dose ketamine (0.5 mg/kg i.v.) and 3 tested very low-dose ketamine (one trial assessed 50 mg intra-nasal spray, another assessed 0.1?0.4 mg/kg i.v., and another assessed 0.1?0.5 mg/kg i.v., intramuscular, or s.c.). Seven trials provided unpublished data on suicidality item scores, which showed signifcant reductions compared to placebo on days 1 and 3 but not day 7.
Conclusion: Single dose ketamine has immediate but unsustained beneficial effects on suicidal ideation in major depression. Future trials should use parallel trial designs, multiple dosing regimens and include suicidal ideation as a primary endpoint.


(77) OC-77. Association of Menstruation with Completed Suicide ?A Hospital based Case Control Study

Day: 10 | Time: 16:00 | Room: Sala 1

Speaker:
Chittaranjan Behera . Assistant Professor, Deptt. of Forensic Medicine, All India Institute of Medical Sciences, New Delhi, India

 Abstract:
Abstract
In the past few years, there has been an interest in the biological aspects of the suicide which includes impact of menstrual cycle on it. To identify the association between suicide and menstrual cycle, many studies have been conducted mostly in attempted suicide suicidal threats and a few in suicidal deaths with mixed outcomes. The present study reports the stage of menstrual cycle in reproductive age group female who died by suicide compared to a control group of female who died from other manner of death. The study included 86 cases in suicidal group and 80 cases in non-suicidal group. The menstrual phase was decided by histological examination of uterus and ovary at autopsy. Psychological and social aspect of the victim was accessed through interview of relatives. Mean age range in suicidal group was 23.7 years and in non-suicidal group was 32.1 years with statistically significant difference. Domestic issue was the most common reason for suicide, followed by academic failure, physical illness and psychological illness, love affairs, economic and financial reasons. Most of the suicidal deaths were due to hanging, others were due to poisoning and jumping from height. The study found that suicidal deaths were more during secretory phase and during menstrual phase. There is more chance of suicide with presence of corpus luteum in right ovary compared to left ovary corpus luteum.
Key words: Suicide, Menstruation, Corpus luteum, Histopathology, Psycho-social


(81) OC-81. Post Admission Cognitive Therapy (PACT): An Inpatient Cognitive Behavioral Program for Suicide Prevention

Day: 09 | Time: 08:00 | Room: Sala 1

Speaker:
Marjan Ghahramanlou-Holloway . Uniformed Services University of the Health Sciences, Bethesda - Maryland - United States

 Abstract:
Post-Admission Cognitive Therapy (PACT) is an inpatient treatment program (Ghahramanlou-Holloway, Cox, & Greene, 2012; Ghahramanlou-Holloway, Neely, & Tucker, 2014 and in press; Neely et al., 2013) for individuals who are psychiatrically hospitalized following a suicide-related event. While psychiatric inpatient units in the United States currently offer a variety of services including group therapy, medication management, art therapy, and individual therapy, none of these services directly target suicide ideation and/or suicide attempts. To address this clinical gap, PACT has been adapted from an efficacious outpatient cognitive behavioral treatment program for the prevention of suicide, as described by Gregory Brown and colleagues (2005). The adapted PACT intervention consists of approximately 6-8 individual therapy inpatient sessions (averaging 60-90 minutes per session, totaling approximately 7 to 12 hours). In addition, the PACT intervention program offers a maximum of 4 telephone booster sessions, each lasting up to 60 minutes, within the first 3 months following psychiatric discharge in order to maximize the likelihood of linkage to aftercare. There are three distinct phases of delivery for PACT during the inpatient stay. Phase I focuses on building a relationship with the patient, understanding his or her suicide ideation/attempt story, and building a cognitive behavioral case conceptualization to best understand the activation of suicidal thoughts and behaviors. Phase II focuses on teaching skills that are either underdeveloped or overdeveloped that are associated with the patient?s suicide mode activation. Phase III focuses on relapse prevention, safety planning, and linkage to care following discharge. During this presentation, a brief introduction to the PACT protocol will be provided. In addition, the presenter will outline a multi-site randomized controlled trial that is currently underway to examine the efficacy of PACT.


(87) OC-87. Exploring the Relationship between Social Support and Suicidality in Bipolar Disorder

Day: 10 | Time: 16:00 | Room: Sala 3

Speaker:
Rebecca Owen . University of Manchester, Manchester, UK

 Abstract:
Background: The prevalence rate of death by suicide in bipolar disorder is estimated to be as high as 19%. Perceived social isolation can contribute to the development of suicidal ideation in both clinical and non-clinical populations. Yet, there is a lack of studies examining suicidality from a psychosocial perspective in people who experience bipolar disorder.

Method: 80 participants with a diagnosis of bipolar disorder completed standardised measures of perceived social support, including the Personal Resources Questionnaire (PRQ-85) and the General Help-Seeking Questionnaire (GHSQ); proxy-indicators of suicidality including the Beck Hopelessness Scale (BHS) and measures of defeat and entrapment; and the Beck Scale for Suicide Ideation (BSS).

Results: Hierarchical multiple regression was performed on the data. Low perceived social support significantly predicted greater suicidality (p<.001). A mediational model demonstrated that the relationship between perceived social support and suicidal ideation was mediated by feelings of defeat, entrapment, and hopelessness (p<.001).

Conclusion: These results highlight the importance of considering the social context in which suicidality is experienced and incorporating strategies to buffer against the effects of negative social experiences in psychological interventions which target suicide risk in bipolar disorder. Results are discussed in relation to contemporary theoretical models of suicidal behaviour.


(89) OC-89. SUPRANET CARE: The Dutch Suicide Prevention Action Network of collaborating Mental Health Care Institutions

Day: 10 | Time: 08:00 | Room: Sala de Cámara

Speaker:
Renske Gilissen . 113Online Foundation, Amsterdam

 Abstract:
SUPRANET Care is currently being established as a SUicide PRevention Action NETwork of 14 mental health care institutions across the Netherlands. Purpose of SUPRANET Care is a national network of mental health care providers focusing on an improved organization of suicide prevention and care by a) implementing key recommendations, quality of care indicators derived from the Dutch multidisciplinary suicide prevention guideline; b) registration of suicide data and suicide attempts in a national database for standardization and analyzing trends; and c) regular feedback, suggestions for improvement and meetings for exchange of best-practices. The organization and first results of this bottom-up program for learning among mental health care institutions will be presented.


(93) OC-93. The global burden of fatal self-poisoning with pesticides 2006-15: systematic review and update on recent trends

Day: 10 | Time: 16:00 | Room: Sala 4

Speaker:
Prianka Padmanathan . University of Bristol, Bristol, United Kingdom

 Abstract:
Objective: Self-poisoning with agricultural pesticides is a major contributor to the global burden of suicide. Over the last decade there has been a marked decrease in overall suicide rates in a number of regions. This review provides an update of the contribution of pesticide poisoning to the global incidence of suicide.

Methods: WHO method-specific suicide mortality data were supplemented by an extensive systematic review of the literature. The review process included searches using thirteen electronic databases (2006-2015) and the Internet (Google), citation searching and a review of reference lists and personal collections.

Findings: Preliminary estimates are based on data from 110 countries. A conservative estimation suggests approximately 116,360 deaths occur from pesticide self-poisoning each year, contributing to 14.6% of suicides globally. An additional sensitivity analysis, in which national data from India has been adjusted to account for previous under-reporting and the inclusion of insecticides only, indicates 157,086 deaths may occur from pesticide self-poisoning each year, accounting for 19.7% of suicides worldwide. The proportion of suicides due to pesticides continues to vary considerably between regions, from 1.4% in high-income countries to 45.6% in countries of the Western Pacific region.

Conclusion: There has been a decline in pesticide self-poisoning in recent years. Nonetheless pesticide self-poisoning remains a major public health challenge, which requires further consideration of existing evidence-based interventions.


(95) OC-95. Differences in NSSI, Suicidal Behaviors, and Reasons for Living in Heterosexual and Sexual Minority Young Adults

Day: 09 | Time: 08:00 | Room: Sala 5

Speaker:
Amy Brausch . Western Kentucky University, Bowling Green, KY

 Abstract:
Research Aims: Evidence suggests individuals identifying as sexual minorities have increased rates of non-suicidal self-injury (NSSI) and suicidal behaviors compared to the heterosexual population (Goldbach & Gibbs, 2015). A possible contributing factor to this occurrence is fewer reasons for living (Westefeld et al., 2001). The current study compared NSSI and suicidal behavior prevalence as well as reasons for living in heterosexual and sexual minority young adults. Reasons for living were also examined as a mediator between sexual orientation and self-harm behaviors. Methods: The sample included 781 undergraduates; participants who identified as lesbian, gay, bisexual, pansexual, or questioning made up the sexual minority group (n = 66, 8.5%). For both the full sample and subsample, the mean age was around 19 and the majority were female and Caucasian. Participants completed questionnaires assessing reasons for living (RFL), suicidal behaviors, and NSSI. Results: Chi-square analyses found the sexual minority group to be significantly more likely to report lifetime history of NSSI, suicide attempts, suicide threats, and suicide ideation than the heterosexual group. Rates of NSSI and suicide ideation among sexual minorities was especially high (50% and 44%, respectively). The sexual minority group also scored significantly lower on RFL than the majority group. Bootstrap mediation analysis found RFL scores to mediate the relationship between sexual orientation status and total suicidality [CI: -13.48, -3.45]. Conclusion: Results support the alarming rate of self-injury and suicidal behaviors among young people who identify as non-heterosexual, as well as highlighting decreased RFL as a possible reason for increased risk.
NOTE: If there are related papers, we would like to be included in a SIG Suicide and Culture Symposium. My co-author is Emily M. Cox, B.S., also from Western Kentucky University.


(97) OC-97. A collaborative, inclusive approach to suicide prevention and mental health promotion in Irish secondary schools

Day: 10 | Time: 08:00 | Room: Sala de Cámara

Speaker:
Catherine Hughes . Pieta House, Centre for the Prevention of Suicide and Self-harm, Dublin, Ireland

 Abstract:
Suicide is the second highest cause of death for 15 to 29 year olds. In an effort to combat this, suicide prevention programmes are becoming an increasingly common feature in schools. However, the sheer volume of programmes and the conflicting findings that they have produced result in an unclear picture of the most appropriate and worthwhile approach to designing such a programme. This research aimed to simplify existing recommendations and enable the development of an informed and integrative school programme based on international evidence and best practice. This involved two processes. The first was a scoping review of all suicide awareness and intervention programmes conducted in secondary level schools in the last ten years. The second was a series of interviews and focus groups with school principals, teachers, and students as well as with key service providers. Analyses identified a number of recurring themes that were used to inform ten recommendations for an effective suicide intervention programme. These are discussed in terms of practical application and implications for future schools-based programmes.


(103) OC-103. Infections and Risk of Suicide - a Nationwide Cohort Study

Day: 10 | Time: 16:00 | Room: Sala 3

Speaker:
Helene Lund-Sørensen . Mental Health Centre, Copenhagen , Denmark

 Abstract:
Introduction:
A growing field of research suggests that infections play a critical role in mental disorders as well as in suicidal behavior. Recent findings have linked infections to suicide but the neurobiology of suicidal behavior is still poorly understood. In order to examine the role of infections on suicide we utilize the unique Danish nationwide registers to longitudinally investigate the associations between infections and the risk of dying by suicide.

Methods:
Based on individual-level data drawn from Danish registers we followed all individuals aged 15 years or older living in Denmark from Jan 1st 1980 and until death by suicide, death by any other cause, emigration from Denmark or Dec 31st 2011 (n=7,221,578). Survival analyses were performed to examine the risk of suicide among persons diagnosed with infection. Multivariate analyses were adjusted for gender, calendar period, age, socio-economic status, and physical comorbidity.

Results:
During follow-up a total of 32.683 died by suicide with 7.892 individuals (24%) having had a prior hospital contact with infection. A prior hospital contact with infection increased the risk of suicide with an IRR of 1.42 (95%CI=1.38-1.46), compared to individuals without infections. A dose-response association with the number of infections was observed, with seven or more infections increasing the risk of suicide with an IRR of 2.90 (95%CI=2.14-3.93). The risk of suicide was elevated the most with the temporal proximity of the last infection (p<0.001); however, the risk was still significantly elevated after three years since the last infection (IRR: 1.37; 95% CI: 1.32-1.41). Length of hospital admittance with infection was associated with the suicide rate in a dose-response relationship with an IRR of 2.38 (95%CI=2.05-2.76) after three months of hospitalization due to infections.

Conclusion:
Infections increased the risk of suicide with temporal and dose-response associations also after adjusting for a range of possible confounders.


(108) OC-108. Understanding the role of sleep in suicide risk: A qualitative study

Day: 10 | Time: 08:00 | Room: Sala 1

Speaker:
Donna Littlewood . University of Manchester, Manchester, UK

 Abstract:
Introduction
Sleep problems are associated with increased risk of suicide, independent of depression. Given that sleep disturbance is highly prevalent in mental illness, it is important to examine the putative mechanisms which underlie the sleep-suicide relationship. To date, work in this area is confined to a small number of cross-sectional studies based on questionnaire data, which are unlikely to capture the complexity of suicide pathways. Therefore, the main aim of this study was to conduct the first in-depth qualitative study of service-user?s perspectives of the role of sleep within suicidal pathways, in individuals with experience of depression.
Methods
In-depth, semi-structured interviews were conducted with 18 participants focusing on their experiences of sleep in relation to depressed mood, and suicidal thoughts and behaviours. Data were analysed with an inductive, latent thematic analysis.
Results
Participants identified three interrelated pathways in which beliefs about sleep contributed to risk of suicidal thoughts and behaviours. First, being awake during the night was perceived to be a particularly risky time for suicide attempts. This was attributed to reductions in access to support and the likelihood of friends or family not intervening to prevent a suicide attempt. Second, failure to achieve ?good? kinds of sleep was perceived to make life harder by perpetuating core features of depression, such as, negative thought processes. Third, sleep was seen as a way of escaping problems and, in this sense, was identified as a more adaptive form of coping, acting as an alternative to suicide. However, the downside of this, was that sleeping during the daytime to escape problems could compromise the subsequent ability to sleep well.
Discussion and conclusion
Clinically, these findings underscore the importance of addressing sleep problems and establishing access to support during night-time hours, when working with suicidal clients.


(109) OC-109. Early exposure to interpersonal violence as risk factor of suicidal behaviours in adolescence and young adulthood: A systematic review and meta-analysis of longitudinal studies

Day: 10 | Time: 16:00 | Room: Sala 1

Speaker:
Pere Castellvi . IMIM (Hospital del Mar Medical Research Institute), Barcelona, Barcelona - Spain

 Abstract:
Background: To assess the association and magnitude of the effect of early exposure to different types of interpersonal violence (IPV) with suicide attempt and suicide in adolescence and young adulthood.
Method: We searched Cochrane Library, Medline, PsycINFO, EMBASE, and Web of Science databases until June 2015. Inclusion criteria were: 1. Assessment of any type of IPV as risk factor of suicide attempt or completed suicide: a) child maltreatment [childhood sexual, physical, or emotional abuse, and neglect]; b) bullying; c) dating violence; and d) community violence; 2. Case-control or cohort studies; 3. Subjects aged 12 - 26 years old. Random models were used for meta-analyses. Population attributable risks were estimated. (Reg: CRD42013005775)
Results: From 23,682 potentially eligible articles, we included for meta-analyses 29 articles with 143,730 subjects. For victims of any early IPV, OR of suicide attempt was 1.99 (95% CI 1.73-2.28); for victims of child maltreatment was 2.24, for bullying was 2.39 (95% CI 1.89-3.01), for dating violence was 1.65 (95% CI 1.40-1.94), and for community violence was 1.48 (95% CI 1.16-1.87). The major contributors of suicide attempts were bullying (22%) and childhood sexual abuse (14%). For any IPV, the OR of completed suicide was 10.49 (95% CI 3.91-28.13).
Conclusions: All types of early IPV exposures are at risk of suicide attempts, and particularly, suicide death in adolescence and adulthood. Effective prevention strategies of reducing all types of IPV exposure in early life should be developed and implemented to substantially reduce the number of youth suicide behaviors.
 Bibliography:
FUNDING: ISCIII- FEDER (PI13/00343), CIBER (CB06/02/0046); MSSSI-PNSD (Exp. 2015I015); AGAUR (2014 SGR 748).


(112) OC-112. Career prevalence and correlates of suicidal thoughts and behaviors among firefighters

Day: 09 | Time: 08:00 | Room: Sala 5

Speaker:
Ian Stanley . Florida State University, Tallahassee, FL USA

 Abstract:
Background: Firefighters experience high-risk occupational hazards that may confer increased risk for suicide; however, prevalence rates of suicidal thoughts and behaviors among firefighters are unknown.
 Goals:
The purpose of this study is to describe the career prevalence of suicide ideation, plans, attempts, and non-suicidal self-injury among firefighters, in addition to sociodemographic, physical health, and occupational correlates.
 Methodology:
Data were obtained from a cross-sectional convenience sample of 1027 current and retired firefighters who completed a nationwide web-based survey on mental health (mean age=38.49, SD=11.70; 91.2% male; 87.3% White). Sociodemographic, physical health, and occupational correlates were assessed via a structured questionnaire. Suicidal thoughts and behaviors were assessed using a modified version of the Self-Injurious Thoughts and Behaviors Interview-Short Form (SITBI-SF).
 Results:
The career prevalence estimates of suicide ideation, plans, attempts, and non-suicidal self-injury were found to be 46.8%, 19.2%, 15.5%, and 16.4%, respectively. Key factors associated with increased risk for reporting suicidal thoughts and behaviors included lower firefighter rank, fewer years of firefighter service, membership in an all-volunteer department, a history of professionally responding to a suicide attempt or death, and active duty military status.
 Conclusiones:
Firefighters report an alarmingly high career prevalence of suicidal thoughts and behaviors. Our preliminary data are compelling, indicating the need for additional research as well as increased prevention and treatment efforts among firefighters to decrease suicide risk. The current study utilized a cross-sectional convenience sample of firefighters.


(120) OC-120. Mental health services, suicide, and seven day working: An opportunity for prevention?

Day: 09 | Time: 08:00 | Room: Sala 4

Speaker:
Nav Kapur . Centre for Suicide Prevention, University of Manchester, Manchester

 Abstract:
Background:
International data suggest that patients admitted to hospital at the weekend appear to be at increased risk of death compared to patients admitted at other times. One explanation relates to reduced levels of staffing. However, a ?weekend effect? has not been explored previously in mental health. There may also be other times of year when patients are vulnerable ? for example during the rotation of medical staff.
 Goals:
To investigate the timing of suicide in high risk mental health patients
 Methodology:
We examined the incidence of suicide between 2001-2013 in England for 1,621 inpatients, 2,819 patients who were recently (<3 months) discharged from inpatient care, and 1,765 patients under the care of crisis resolution home treatment teams (CRHT). We compared the incidence of suicide at the weekend vs during the week, and also in August (the month of junior doctor changeover) vs other months.
 Results:
The incidence of suicide was lower at the weekends for each group (IRR(95%CI): 0.88(0.79-0.99) for inpatients, 0.87(0.78-0.97) for post discharge patients, 0.85(0.78-0.92) for CRHT patients). Patients who died by suicide were also less likely to have been admitted at weekends than during the week (IRR(95% CI):0.52(0.45-0.69)). The incidence of suicide in August was not significantly different from other months.
 Conclusiones:
We found evidence of a weekend effect for suicide risk among high risk mental health patients, but with a 12%-15% lower incidence at weekends. This could be related to social contact and other protective factors or may reflect temporal patterns in suicide risk more generally. Although seven day working across health services may have advantages related to improved access and outcomes, we found no evidence to suggest that its introduction in mental health services would reduce the number of suicide deaths.


(122) OC-122. Care differences by a consultation-liaison service between patients who attempted suicide and those primarily suffering from medical conditions

Day: 10 | Time: 08:00 | Room: Sala 3

Speaker:
Juan Valdes-Stauber . University of Ulm, Department of psychiatry and Psychotherapy I, Raven sburg- Germany

 Abstract:
Background:
The assessment of patients post- suicide attempt is perhaps one of the most important tasks of the CLS because of the acute risk, the need for immediate treatment and the importance of implementing additional preventive measures.
Objectives:
Are there significant differences according to selected care variables between patients having attempted suicide and other patients suffering from both medical and psychiatric conditions attended by a CLS?
Method:
Full survey of all patients (N = 4,072) assessed by a CLS in a middle-sized general hospital in southern Germany (520 beds) during a 4 year period (2012-2015) using structured records. Group differences were assessed using chi-square and ANOVA tests (including Scheffé tests) and associations by multivariate (without robust regression coefficients) and logistic regression models.
Results:
Patients who had attempted suicide (N = 136) comprised of 3.3 % of sample, were younger (44.4 years old), were less likely to be women, more likely to have foreign roots (15.4 %) and exhibited a lower functionality (GAF = 56.6) than patients with primarily physical conditions. They received fewer interventions but same cumulative treatment time (74 min.). They received more often advice regarding post-discharge treatment (98 % vs. 63.1 %), but there were no differences in psychopharmacological or psychotherapeutic interventions. Relevant differences were found in the distribution of psychiatric diagnoses: Personality and mood disorders as well as addictions were more frequent in patients who attempted suicide. No significant gender and nationality differences were found. Older people received significant less intensive care.
Discussion: In general, whilst patients who had attempted suicide received on average less intensive care than patients suffering from somatic conditions, advice regarding post-discharge treatment was higher in this group. We conclude that CLS interventions for patients who attempted suicide are focused on acute management, risk assessment and advice towards further care.


(128) OC-128. Preventing suicide by restricting the sale of high-toxicity pesticides: a review of the international evidence.

Day: 09 | Time: 08:00 | Room: Sala 4

Speaker:
David Gunnell . University of Bristol, Bristol

 
 Goals:
Pesticide self-poisoning accounts for up to a fifth of all suicides worldwide. Current evidence indicates that the most effective approach to preventing these deaths is via targeted bans on the most toxic products. We reviewed the literature on the impact of such bans in countries where pesticides make a major contribution to the burden of suicide.
 Methodology:
Literature review using Web of Science, Medline and other databases, citation searching and a review of reference lists and personal collections.
 Results:
We identified studies reporting on the impact of targeted sales restrictions on both pesticide poisoning and overall suicide rates in a number of countries including Finland (parathion); Sri Lanka (Class-I pesticides, paraquat and other products); Taiwan (a range of products), Japan (paraquat), Iran (aluminium phosphide) and South Korea (paraquat) and of reduced availability in Western Samoa (paraquat). In many of these countries sales bans resulted in significant falls in suicides by pesticide poisoning and in several countries these bans were accompanied by fall in overall suicide rates. There is no evidence that bans have impacted on agricultural yields, but this requires further study.
 Conclusiones:
Sales restrictions and / or sales bans on pesticides that are highly toxic to humans have resulted in declines in suicide in several countries. This approach to prevention is the only measure for preventing suicide by pesticide poisoning for which there is evidence of an impact on overall suicide rates. Such bans have the potential for having a major impact on suicide mortality worldwide.


(130) OC-130. Suicide Prevention Austria (SUPRA) : the implementation of a national suicide prevention program

Day: 10 | Time: 16:00 | Room: Sala 1

Speaker:
Christian Haring . State Hospital Hall in Tyrol/tirol-kliniken, Hall, Austria

 Abstract:
Suicide Prevention Austria (SUPRA) is a package of measures which should help the Austrian ministry of health to realize an evidence based suicide prevention program. That such a program is indispensible can be seen on the fact that suicide is on the second position as cause of death in male Austrians up to the age of forty. The concept itself summarizes successful national programs which fit to the Austrian situation. In the meantime the Austrian ministry of health established an office for coordination of the SUPRA program and a commission of experts which is responsible for the first activities of the national Austrian suicide prevention program. These activities are the design of national gatekeeper program, the development of acadamic courses in Vienne and Innsbruck, the implementation of the Youth Aware of Mantel Health (YAM) program in Austria.


(135) OC-135. The involvement of alcohol in hospital-treated self-harm and associated factors: findings from two national registries

Day: 10 | Time: 16:00 | Room: Sala 1

Speaker:
Eve Griffin . National Suicide Research Foundation, Cork, Ireland

 Abstract:
Self-harm is an important public health issue. Alcohol is often involved in self-harm acts presenting to hospital emergency departments, and therefore it is important to establish the role of alcohol in self-harm as well as to identify associated factors, in order to best inform service provision.
Data on self-harm presentations to hospital emergency departments from national registries in Ireland and Northern Ireland from April 2012 to December 2013 were analysed. We calculated the prevalence of alcohol consumption in self-harm. Using Poisson regression models, we identified the factors associated with having consumed alcohol at the time of a self-harm act.
Of 34,429 self-harm presentations recorded, alcohol was present in 43% of acts, and more common in Northern Ireland (50% vs. 37%). The factors associated with alcohol being involved were being male, aged between 25-64 years, and having engaged in a drug overdose or attempted drowning. Time of presentation to the emergency department was also associated with having consumed alcohol, in particular for women, with those presenting out-of-hours and at the weekend more likely to have done so. Patients with alcohol on board were also more likely to leave without having been seen.
This study has highlighted the prevalence of alcohol in self-harm presentations, and has identified factors distinguishing presentation with alcohol present from those without. The findings underline the need for increased awareness among medical staff about the link between alcohol and self-harm as well as for increased availability of mental health teams out-of-hours.


(137) OC-137. The role of physical and mental health multimorbidity in suicidal ideation and suicide attempts

Day: 10 | Time: 16:00 | Room: Sala 3

Speaker:
Aikaterini (katerina) Kavalidou . PhD student, Suicidal Behaviour Research Laboratory, University of Glasgow, Glasgow, United Kingdom

 Abstract:
Background: Previous research has focused on the separate role of mental and physical illness in suicide risk, with a number of suicide-related studies investigating the additional effect of mental disorders upon an index physical health condition. The present study aimed to investigate the extent to which suicide risk varies as a function of physical and mental multimorbidity.
Methods: The Adult Psychiatric Morbidity Survey 2007 of England was investigated. Participants were grouped into three distinct categories [Common mental disorders (CMD) only (n=177), physical issues only (n=4254), and CMD/physical multimorbidity (n=1098)] and compared to those who had neither health issues (n=1860) in terms of their suicidal history (thoughts and attempts). Multinomial logistic regression models were performed and odds ratios (OR) and 95% CIs are presented.
Results: In the fully adjusted model, multimorbidity had an increased effect on suicidal ideation and suicide attempts, compared to the control group (OR = 15.63, 95% CI: 9.27-26.34; OR = 23.16, 95% CI:3.06-175.00). There was also an increased risk for both suicidality assessments within the CMD-only group (OR = 16.64, 95% CI: 8.88-31.19; OR = 15.59, 95% CI:1.68-144.27), but not for the physical illness-only group (OR = 1.49, 95% CI: 0.86-2.59; OR = 2.48, 95% CI: 0.29 -20.69).
Limitations: Secondary analyses of cross-sectional data. Reporting of physical and/or mental health conditions may have been over- or under-reported by participants.
Conclusions: Multimorbidity may be associated with suicidal ideation and suicide attempts, beyond the independent effects of physical illness and CMD. Suicide and multimorbidity are both major public health issues. Clinicians in primary and secondary care should be aware that multimorbidity may increase risk of suicide in vulnerable groups.


(142) OC-142. A Feasibility Study of the PH-SIM - an integrative psychotherapy model for suicide prevention

Day: 10 | Time: 14:30 | Room: Sala 4

Speaker:
Evelyn Gordon . Dublin City University & University College Cork, Dublin Ireland
Ella Arensman . ,

 Abstract:
There is a growing body of literature indicating best practice responses for suicidal persons (e.g. Jobes, 2006) and how recovery processes occur and are facilitated (e.g. Gordon et al., 2014), however, there is little distinction between those designed as crisis and long-term interventions.
 Goals:
This paper will present preliminary findings of a Feasibility Study on the Pieta House-Suicide Intervention Model (PH-SIM), which is an integrative psychotherapy model for responding to those in suicidal crisis. Using a mixed methods design the study aims to establish: the perceived value of this intervention to the target group; the best methods for evaluating the model; and whether a large-scale controlled study of its effectiveness is warranted.
 Methodology:
Data are being gathered from different sources: one-to-one and group interviews; pre, post and follow-up psychometric tests; and process records.
 Results:
Preliminary findings will be reported regarding client?s experiences of the PH-SIM, client engagement with the model, and client outcomes.
 Bibliography:
Gordon, E. Cutcliffe, J. & Stevenson, C. (2014) Transcending Suicidality: Facilitating re-vitalizing worthiness. Chapter 4 IN J.R. Cutliffe et al. (eds) Routledge International Handbook of Clinical Suicide Research.
Jobes, D. A. (2006) Managing Suicidal Risk: A collaborative approach. NY: Guilford Press.


(143) OC-143. The association between symptom network structure and suicidal behaviour

Day: 10 | Time: 16:00 | Room: Sala 1

Speaker:
Derek De Beurs . Netherlands Institute for Health Services Research (NIVEL), Amsterdam Netherlands

 Abstract:
We applied a network analysis to better understand why an individual moves from suicidal thoughts (the motivational phase) to suicidal behavior (the volitional phase).
 Goals:
1) To examine which suicidal symptoms activate other suicidal symptoms in patients treated in hospital following a suicide attempt 2) To analyze if baseline structure of suicidal symptoms is associated with repeat suicidal behavior at 15 months follow-up.
 Methodology:
A sample of patients (n = 366) seen by the liaison psychiatry service of a single hospital following a suicide attempt completed the Beck Scale for Suicide ideation (SSI). Next, using a national linkage database, re-admission to any Scottish hospital with self-harm within 15 months of the index episode was determined. At follow-up, 94 patients (repeaters) were treated in hospital following a repeat suicide attempt and 272 patients (non-repeaters) who completed baseline assessment were not hospitalized again for another suicide attempt.
Main Outcomes and Measures: The baseline network structure of the SSI was estimated for all patients treated in the hospital following a suicide attempt. Next, baseline network structure of the SSI for patients who attempted suicide during the 15-month follow-up (repeaters) was compared with the baseline network structure of patients who did not attempt suicide during follow-up (non-repeaters).
 Results:
Three symptoms were most central: two motivational (a desire to kill oneself, and attitude towards suicide) and one volitional (expectancy to commit suicide). When comparing the network of repeaters with the network of non-repeaters we found no significant differences.
 Conclusiones:
Three suicidal symptoms were most central within patients treated for a suicide attempt: desire to kill oneself, attitude and expectancy to commit suicide. Targeting these symptoms might be a good start for interventions as they may influence other suicidal symptoms. The symptom network structure of repeaters and non-repeaters appeared to be similar.


(148) OC-148. Predictive accuracy of risk scales following self-harm: Multicentre, prospective cohort study

Day: 10 | Time: 16:00 | Room: Sala 1

Speaker:
Quinlivan Leah . University of Manchester, England

 Abstract:
BACKGROUND: Risk scales to assess risk of repeat self-harm are often a core component of psychosocial assessments following self-harm. There is little evidence of their effectiveness.

Objective: We sought to evaluate the performance of risk scales (Manchester Self-Harm Rule, ReACT Self-Harm Rule, SAD PERSONS Scale, Modified SAD PERSONS Scale, Barratt Impulsivity Scale; and Patient and Clinician estimations of risk) in identifying patients who repeat self-harm within six months of hospital presentation.

Method: A prospective cohort study was conducted of adults aged 18 years and over referred to liaison psychiatry services following self-harm in five hospitals in England. Diagnostic accuracy statistics were used to evaluate a priori cut-offs and area under the receiver operating characteristic curve (AUC) to determine optimal cut-offs and compare global accuracy.

Results: 483 episodes of self-harm by 464 individuals were included in the study. In 30% of episodes (N=145), there was a repeat episode of self-harm within six months. Sensitivity of the scales ranged from 1% (95% CI: 0%, 5%) for the SAD PERSONS scale, to 97% (95% CI: 93%, 99%) for the Manchester Self-Harm Rule. Positive predictive values ranged from 13% (95% CI: 2%, 47%) for the Modified SAD PERSONS Scale to 47% (95% CI: 41%, 53%) for the clinician assessment of risk. AUC ranged from 0.55 for the SAD PERSONS Scale to 0.74 for the clinician scale. The SAD PERSONS Scale, the Modified SAD PERSONS scale, and the Barratt Impulsivity Scale performed significantly worse than global clinician and patient estimates of risk (p<.001).

Conclusion: Risk scales following self-harm have limited clinical utility. Most scales performed no better than clinician or patient ratings of risk and some performed considerably worse. Positive predictive values were modest. In line with recommendations from clinical guidelines, risk scales should not be used to determine patient management or predict repeat self-harm.


(149) OC-149. Suicide and unemployment: 2003-2014 period in Barakaldo, Spain

Day: 10 | Time: 16:00 | Room: Sala 4

Speaker:
Jon García Ormaza. Servicio Vasco de Salud, Barakaldo (Vizcaya)

 Abstract:
Introduction: The World Health Organization has recently warned of the potential effects that economic crises can have on mental health. This study analyzes the evolution of suicides in Barakaldo (Spanish city of 100,000 inhabitants), changes in the trend of suicide rates and the socio-demographic and clinical variables associated with an increased suicide risk.

Goals: The main goal of this work is to calculate the annual incidence rates of suicide for each year of the 2003-2014 period, and analyze the trend before and after the increase in unemployment. Secondary objectives include analyzing the different methodologies used and defining the effect of the area of residence on the risk of suicide.

Methodology: The study includes a total of 95 cases of suicide recognized by the Basque Institute of Legal Medicine during the period from 1 January 2003 to 31 December 2014.

Results: Incidence rates of suicide of people with a psychiatric history show a statistically significant upward trend since 2008 (annual increase of 21.4% over the period 2008-2014). Female suicide rates show a significant increase during the period 2008-2012. The incidence of young women suicide continues to increase significantly since the onset of the economic crisis. All cases of female suicide were recorded in economically disadvantaged Districts. One out of three suicidal people had no previous psychiatric history. Substance-related disorders, anxiety disorders and depressive disorders are, in this order, the most common diagnoses. Most people choose jumping as method of suicide, regardless of age or psychiatric condition.

Conclusion: The increase in suicide rates in people with psychiatric history and young women registered since 2008, and the identification of jumping as the first method of suicide, require the implementation of specific preventive measures.


(151) OC-151. Functional coping dynamics and self-harm: Reappraisal and approach coping differentiate self-harm ideation from enactment, in recent self-harm

Day: 10 | Time: 08:00 | Room: Sala 5

Speaker:
Emma Nielsen . University of Nottingham, Nottingham, UK

 Abstract:
The Experiential Avoidance Model (Chapman, Gratz & Brown, 2006) considers
(non-suicidal) self-injury as a form of emotional avoidance, employed in response to a stimulus that elicits intense aversive affect. This conceptualisation is consistent with research that views self-harm as a means of coping with distress; functionally, self-harm representing a means of escaping or altering the nature or intensity of an otherwise intolerable emotion. Understanding the transitions between ideation (thoughts) and enactment (behaviours) has been identified as a key hurdle in suicide prevention efforts. Within this it is paramount to appreciate that transitions are a dynamics process and do not necessarily follow a uni-directional progression from ideation to enactment. Therefore, the present study aimed to explore whether functional coping dynamics can differentiate self-harm experiences in response to a specific stresssor (no self-harm; ideation; enactment), in those with recent self-harm.
 Methodology:
Methods:
One thousand, one hundred and fifty-seven participants (N = 1,157) with a recent history of self-harm (3 months) took part in the cross-sectional, community-based survey. Participants ranged in age from 16-49 years (Mean: 18.21, ±3.24). The majority of the sample was female (79.9%; male, 9.4%). Participants completed a battery of online, self-report measures assessing their cognitive and behavioural coping in response to their most significant recent stressor (3 months).
 Results:
In multivariate analysis, adjusting for depressive and anxious symptomology, emotion regulation was predictive of self-harm thoughts (ideation, n = 38). Approach, emotion regulation and reappraisal coping were significantly predictive of self-harm (enactment, n = 645).
 Conclusiones:
Taken together, results suggest that functional coping dynamics may be differentially associated with self-harm ideation and enactment. Coping which an individual believes will 1) allow them to deal directly with a stressor, or 2) allow them to reinterpret or construct the problem may be particularly important psychological variables in distinguishing thoughts and actions.


(155) OC-155. Sensitivity to physical and emotional pain in self-harm ideation and enactment: Does self-report predict behaviour?

Day: 10 | Time: 08:00 | Room: Sala 5

Speaker:
Olivia Kirtley . University of Glasgow, Glasgow, United Kingdom

 Abstract:
Background
Previous research has suggested that both self-reported and behavioural sensitivity to emotional and physical pain may be altered in individuals who think about (ideate) or engage in (enact) self-harm. The current laboratory study investigated, for the first time, the relationship between self-reported and behavioural sensitivity to emotional and physical pain in self-harm ideation and enactment.

Methods
88 healthy adults with different histories of self-harm completed a battery of online questionnaires in the laboratory, assessing self-harm thoughts and behaviours, as well as self-reported emotional and physical pain sensitivity. Participants completed an impossible card-sort task as a measure of behavioural emotional pain sensitivity and also self-administered a pressure algometer, in order to assess behavioural physical pain threshold and tolerance.

Results
Significant ordered effects were found for self-reported emotional pain sensitivity and physical pain distress such that, self-harm enactment group > ideation group > controls. No significant between-group differences were found in behavioural measures of emotional or physical pain sensitivity, and the self-report and behavioural measures of these constructs did not exhibit a significant association with one another.

Conclusions
Self-reported emotional and physical pain sensitivity are elevated in those who have engaged in self-harm behaviour and also those with self-harm ideation. Self-perceived sensitivity to both physical and emotional pain may be part of a wider pattern of cognitive distortions that occur before an individual ever engages in self-harm behaviour. The results do not, however, support elevated physical pain threshold and tolerance in self-harm, nor do they support heightened behavioural sensitivity to emotional pain in self-harming individuals. Furthermore, the non-significant relationship between self-report and behavioural measures of emotional and physical pain suggest a dissociation between these two types of measure.


(159) OC-159. The economic recession and patient suicides in England 2000-2011

Day: 10 | Time: 16:00 | Room: Sala 4

Speaker:
Saied Ibrahim . University of Manchester, United Kingdom

 Abstract:
Existing studies have largely examined economic downturn in relation to suicides in general populations, and there has been little specific investigation on those who are mentally ill. The aim of the study was to investigate the possible impact of the economic crisis in 2008, by examining suicide in people aged 16 or over with a history of mental illness in England between 2000 and 2011. A time-trend analysis was performed to compare the actual number of suicides in 2008-2011 (after the onset of recession) with those expected based on pre-recession trends between 2000 and 2007.
There was a decreasing trend in suicide numbers between 2000 and 2007 which began to rise from 2008 to 2011. We estimated 49 (95% confidence interval: -15 to 109) excess patient suicides in 2008, 20 (-54 to 90) in 2009, 119 (34 to 198) in 2010 and 199 (103 to 288) in 2011 based on pre-recession trends. This increase in suicides was largely due to males, where suicides increased by 12% (5% to 20%), with an excess of 363 (153 to 558) suicides estimated between 2008-2011. Evidence of an increase in suicides in females was not found, with a non-significant increase of 22 (-174 to 197) excess suicides. We will be comparing this to the results in the general population.
As well as the general population, increase in suicides after the onset of the recession was also found in the clinical population, mainly in men in England. This may be due to increase in patients presenting to mental health services generally or the fact that clinical populations are equally effected by economic downturn.


(160) OC-160. Trajectories of Suicidal Ideation in People Seeking Online Help for Suicidality: Secondary analysis of a Dutch randomized controlled trial

Day: 09 | Time: 08:00 | Room: Sala 1

Speaker:
Trine Madsen . Mental Health Center Copenhagen, Copenhagen - Denmark

 Abstract:
Background: Suicidal ideation (SI) is a common mental health problem. Variability in intensity of SI over time has been linked to suicidal behavior, yet little is known about the temporal course of SI. The primary aim was to identify prototypical trajectories of SI in the general population and secondly to examine predictors of membership of the identified SI trajectories.
Method: 236 people, from the general Dutch population, seeking online help for SI were enrolled in a randomized controlled trial comparing online self-help for SI to a control group. Participants were assessed at inclusion, at two, four and six weeks. The Beck Scale for Suicide Ideation was applied at all assessments and included in Latent Growth Mixture Modeling analysis to empirically identify trajectories.
Findings: Four SI trajectories were identified. A High Stable trajectory represented 52% of participants and was characterized by constant high level of SI. The High Decreasing trajectory (21%) consisted of people with high baseline SI score followed by a gradual decrease to a very low score. A third trajectory, High Increasing (5%), also had high initial SI score followed by an increase to the highest level of SI at six weeks. The final trajectory, Low Stable (22%) had a constant low level of SI. Previous attempted suicide and having received online self-help for SI predicted membership in the High Decreasing trajectory.
Interpretation: Many adults experience high persisting levels of SI, though results encouragingly indicate that receiving online self-help for SI increased membership of a decreasing trajectory of SI.


(164) OC-164. Adverse outcomes following routine hospital management of self-harm: propensity score analysis using record-based cohort data

Day: 10 | Time: 08:00 | Room: Sala 5

Speaker:
Sarah Steeg . University of Manchester, Manchester, UK

 Abstract:
Background

The routine hospital management received by people who present to hospital following self-harm varies but can include specialist psychosocial assessment, admission to a medical bed, referral to outpatient psychiatric services and admission to an inpatient psychiatric ward. When examining outcomes for people receiving different types of care, traditional multivariable regression techniques that account for selection bias have limitations.

Method

This study used population-level cohort data from the Manchester Self-Harm Project, UK, to examine adverse outcomes following presentation to the Emergency Department. Propensity score methods were used to address observed differences between individuals receiving different levels of care after a self-harm episode. Log-binomial regression models were used to estimate unadjusted and propensity score stratified risk ratios. Repeat self-harm outcomes were compared between treatment groups.

Results

Unadjusted comparisons showed that hospital care was associated with either no change in risk or an increased risk of repeat self-harm. There were large differences in observed patient characteristics by treatment group. The propensity scores resulted in improved balance in most of these characteristics between groups. After stratifying by propensity score stratum, psychosocial assessment was associated with decreased risk of adverse outcome. Associations varied by propensity stratum. Sensitivity analyses using a multicentre cohort consisting of more basic information resulted in no observed reduced risk.

Conclusions

The estimated propensity scores reduced many important observed differences in patient characteristics between treatment groups. However, this method does not address unobserved differences between groups. The treatment effect estimates suggest there are some types of hospital care that reduce the risk of repeat self-harm. It is possible that this effect is limited to specific centres. There may be particular characteristics that are necessary to include when adjusting for differences between patients, and these are not always available in record-based data.


(175) OC-175. On the relationship between attachment and suicidal behaviour: A systematic review

Day: 10 | Time: 08:00 | Room: Sala 4

Speaker:
Tiago Zortea . Suicidal Behaviour Research Laboratory, University of Glasgow, Glasgow - United Kingdom

 Abstract:
Many different theoretical approaches and perspectives have been applied to understanding suicidal behaviour. In this presentation, we focus on a developmental perspective, specifically on attachment which is key to understanding how early life influences affect vulnerability for suicide, Indeed, in recent decades there has been increased research attention on the relationship between attachment and suicidality. Although this is a welcome development, inconsistent findings have been reported and as a result the nature of this relationship remains unclear. As far as we know, this is the first systematic review to investigate the nature of this relationship. In this review we summarise the findings from 46 empirical studies (44 quantitative and 2 qualitative) examining the relationship between general (non-romantic) attachment patterns and suicidal thoughts and behaviours in adolescents and adults. The search included publication of studies up to 1st of July 2015. A synthesis of the findings yielded evidence for a relationship between attachment and suicidality. The literature shows a positive association between insecure attachment patterns (avoidant, anxious, unresolved, and dismissive), and a negative association between secure attachment and suicidal ideation and behaviours. 72% of all associations between anxious attachment and suicidality, and 75% of all associations between avoidant attachment and suicidality were found among clinical patients. A correspondence analysis revealed that avoidant attachment was strongly associated with suicide attempts, and anxious attachment was similarly associated with suicidal ideation and suicide attempts. The results indicate the necessity of better understanding the psychological differences between each attachment style and how these differences affect suicidal thoughts and behaviours. Clinical implications point to designing specific intervention strategies for patients suffering from suicidal thoughts and behaviours according to their attachment patterns. The implications for early intervention will also be discussed.


(177) OC-177. Secondary prevention of suicide by treating depressed and suicidal youth with affective psychotherapy based on reconsolidation

Day: 10 | Time: 14:30 | Room: Sala 4

Speaker:
Göran Högberg . BUP Child Psychiatry Stockholm, Sweden

 Abstract:
Secondary prevention of suicide by treating depressed and suicidal youth with affective psychotherapy based on reconsolidation
Suicide is one of the three most frequent causes of death in the 15-19 age group in Sweden. Despite increased availability of treatment the figures remain about the same over the years.
Goals
Adolescents in treatment with depression and suidality are a riskgroup of later suicidality and finding an efficient treatment is an approach to secondary prevention.
Methods
In adolescent depression there are often difficult life events involved, such as traumatic loss, assault, bullying and victimization. Posttraumatic reactions are common in suicidal subjects. Thus efficient means to deal with traumatic memories might be of value in the psychotherapeutic treatment of suicidal subjects. A new devopment in affective neuroscience is the study of memory reconsolidation, meaning that traumatic memories are amenable to a transformation during a short time-window of reconsolidation once the traumatic memory is activated. A new treatment approach, affective psychotherapy, has been developed based on this.
Affective psychotherapy is a short term manualized approach to treat depression focusing on mood-regulation and emotional problem solving.
This method has now been tested in randomized controlled study at the BUP Child Psychiatry, Stockholm, Sweden.
Suicidal events were estimated according to the Columbia Suicide Severity Rating Scale (CSSR-S). Depression was rated with the Mood and Feelings Questionnaire - Short version (MFQ-S)
Results
Results showed significant remission of depression and suicidality in subjects treated with affective psychotherapy in comparison to treatment as usual.
Conclusion
The significant remission of suicidal events with affective psychotheapy nourishes the hope of improving secondary prevention by development of efficient treatments of subjects with suicidality.
Bibliography
1. Göran Högberg, Davide Nardo, Tore Hällström, Marco Pagani. Affective psychotherapy in post-traumatic reactions guided by affective neuroscience: memory reconsolidation and play. Psychology Research and Behavior Management 2011;4:87-96


(194) OC-194. Stigma, attitudes and help-seeking intentions for psychological problems in relation to regional suicide rates

Day: 09 | Time: 08:00 | Room: Sala 5

Speaker:
Alexandre Reynders . KU Leuven - Odisee, Brussels - Belgium

 Abstract:
The aim of this oral communication is to stimulate the discussion concerning the potential role of intentions, attitudes and stigma related to psychological help-seeking in understanding differences between regional suicide rates. There is an indirect and direct way in which these attitudinal factors could be related to suicide rates. First, receiving psychological help is assumed to be an important protective factor of suicide. Negative attitudes, shame and stigma in relation to help-seeking impose major barriers to seek psychological help. Second, beside this indirect relation via help-seeking, there is also a more direct relation between stigma and suicide. According to the stress - diatheses model, most suicidal persons are characterized by a certain level of biological, psychological and social vulnerability. These persons must not only cope with their psychological problems but they also must undergo the negative consequences of stigma, such as discrimination, reduced self-esteem and reduced self-efficacy. These stressors are risk factors of suicide. These hypotheses will be discussed based on the results of published ecological studies in which we investigated the association between on the one hand help seeking related stigma, attitudes and intentions and on the other hand the suicide rates of 20 regions within the Netherlands and Belgium. Significant associations were found between regional suicide rates and the intention to seek informal help (Beta = -1.47, p = .001), self-stigma (Beta = 1.33, p = .038) and shame (Beta = 0.71, p = .030). The association between self-stigma and suicide rate was mediated by intentions to seek informal help. These results suggest that, in order to promote suicide prevention at the level of the regional population, stigma, shame and intentions to seek help should be targeted in the public domain.


(199) OC-199. Gender differences in suicidal behaviour in adolescents and young adults: Systematic review and meta-analysis

Day: 09 | Time: 08:00 | Room: Sala 3

Speaker:
Andrea Miranda-Mendizábal . Health Services Research Group, IMIM-Institut Hospital del Mar d´Investigacions Mèdiques, Barcelona, Spain

 Abstract:
Rate differences in suicidal behaviour among males and females have been called the Gender Paradox: suicide attempt rates are higher for females; nevertheless young males commit suicide at higher rates. There is no previous systematic review assessing gender in suicidal behaviour.
 Goals:
Assess the association between gender and suicidal behaviour in adolescents/youths; and identify gender specific risk factors.
 Methodology:
Systematic review of 6 databases was performed until June 2015. Population-based longitudinal studies of individuals aged between 12 and 26 years estimating the association between gender and suicidal behaviour, or evaluating gender risk factors for suicidal behaviour, were included. Random effect models were used for meta-analysis.
 Results:
Suicide attempts: female adolescents/youths have higher risk than males (OR=1.98, 95% CI 1.54-2.55). Significant risk factors for both genders include: history of any mental disorder, past suicidal behaviour, being victim of interpersonal violence, and the presence of familiar suicidality. Additional significant risk factors were: for female, previous abortion (OR=1.3), depressive symptoms (OR=1.15), and relationship conflicts (OR=1.10); and for male, conduct problems (OR=8.78), hopelessness (OR=1.74), exposition to peers suicidal behaviour (OR=1.65), access to means (OR=1.6), and parental death (OR=1.56). Suicide: no meta-analysis could be performed assessing the association between gender and suicide. Increased risk for both genders included: childhood maltreatment, exposure to negative life events, and history of any mental disorder. For females, exposition to familiar suicidality (OR=5.68), and for males, antisocial behaviours (OR=4.19) and access to means (OR=4.00), were gender specific risk factors.
 Conclusiones:
Female adolescents/youths have almost twice the risk of suicide attempts than males, while further research is needed on gender and suicide. Prevention strategies to reduce the incidence of suicidal behaviour among adolescents/youths are needed; these strategies should consider that not only the type of suicidal behaviour, but some risk factors differ by gender.


(200) OC-200. Epidemiology of acute substance use among deliberate self-harm patients seeking treatment in a South African hospital

Day: 10 | Time: 16:00 | Room: Sala 3

Speaker:
Elsie Breet . Department of Psychology, Stellenbosch University, Cape Town, South Africa

 Abstract:
Background: Little is known about the epidemiology of acute substance use among deliberate self-harm (DSH) patients in developing countries, like South Africa (SA). This relationship is potentially important given high rates of substance use in SA and the fact that substance use is a potentially modifiable risk factor. Aim: This epidemiological study aimed to compare the socio-demographic characteristics, clinical features and nature of DSH between individuals who used substances at the time of the self-harm and those who had not. Methods: We analysed data for 238 consecutive patients. Chi-square analyses and logistical regression analyses were used to examine the association between gender, socio-economic status, having dependents, history of substance use, method of DSH, medical intervention, impulsivity, previous suicide attempt and ASU. Results: Approximately 20% of DSH patients had used substances at the time of self-injury, most commonly alcohol. There were no statistically significant differences between ASU patients and other patients with respect to socio-demographic characteristics, method and severity of injury. Not having dependents (p=.039, OR = .416, 95% CI =.181-.959) and a history of substance abuse (p=0.000, OR=4.74, 95% CI=2.290-9.819) significantly predicted ASU. Limitations: It is likely that there would have been more statistically significant differences with a larger sample. Conclusion: More sophisticated quantitative or qualitative research is needed to further explore the risk factors for DSH among ASU as well as the context in which these behaviours occur. Implications: This gap in the research has implications for public health interventions aiming to reduce morbidity and mortality associated with DSH.


(201) OC-201. Disability pension due to common mental disorders and subsequent suicidal behaviour; a population-based prospective cohort study

Day: 10 | Time: 16:00 | Room: Sala 4

Speaker:
Syed Rahman . Karolinska Institutet, Stockholm, Sweden

 Abstract:
Objective: Adverse health outcomes, including suicide, among individuals on disability pension (DP) due to mental diagnoses have been reported previously. Nevertheless, the scientific knowledge on possible risk factors for suicidal behaviour (suicide attempt and suicide) in this group, such as gender, age, underlying DP diagnoses, co-morbidity, DP duration and grade, is surprisingly sparse. This study aimed to investigate the associations of different measures (main and secondary diagnoses, duration, and grade) of DP due to common mental disorders (CMD) with subsequent suicidal behaviour, considering gender and age differences. Design: Population-based prospective cohort study based on Swedish nationwide registers. Methods: A cohort of the 46 515 individuals aged 19-64 years and on DP due to CMD throughout 2005 was followed up for five years. In relation to different measures of DP, univariate and multivariate hazard ratios (HR) and 95% confidence intervals (CI) for suicidal behaviour were estimated by Cox regression. All analyses were stratified by gender and age. Results: During 2006-2010, 1036 (2.2%) individuals attempted and 207 (0.5%) completed suicide. Multivariate analyses showed that a main DP diagnosis of ‘stress-related mental disorders’ was associated with a lower risk of subsequent suicidal behaviour than ‘depressive disorders’ (HR range 0.4-0.7). Substance abuse or personality disorders as secondary DP diagnosis predicted suicide attempt in all sub groups (HR range 1.8-4.6) and suicide in women and younger individuals (HR range 2.2-7.7). Full-time DP was associated with a higher risk of suicide attempt and suicide compared to part-time DP in women (HR range 1.8-2.3). Conclusions: Depressive disorders as main and substance use or personality disorders as secondary DP diagnosis were risk markers for subsequent suicidal behaviour in individuals on DP due to CMD. Particular attention should be given to younger individuals on DP due to anxiety disorders due to the higher suicide risk.


(204) OC-204. Charity, Identification & Well-being: Participation Benefits of a Suicide Prevention Fundraiser for those with Exposure to Suicide

Day: 09 | Time: 08:00 | Room: Sala de Cámara

Speaker:
Michelle Kearns . University of Limerick, Limerick, Ireland

 Abstract:
Objectives: Darkness into Light, an Irish suicide prevention fundraiser / 5km walk, has become increasingly popular in recent years. This study investigated whether the effects of Darkness into Light go beyond those of a simple fundraiser and if there are participation benefits in terms of personal well-being. We hypothesised that 1) there would be an increase in a measure of well-being amongst participants, 2) that this would differ based on exposure to suicide and 3) that the increase in well-being would be partially explained by the participants identification with other members of the crowd at Darkness into Light. Design: Individuals who took part in Darkness into Light 2015 were invited to participate in an online survey comprised of questionnaires measuring exposure to suicide, identification with the crowd and positive affect. Participation was possible at two time points; prior to the walk (Time 1) and immediately afterward (Time 2). Study 1 consisted of participants who completed the survey either before (N=1780) or after (N=2050) the event whilst Study 2 consisted of a longitudinal sample of participants who completed the survey at both time points (N =121). Results: Study 1 revealed a significant increase in positive affect from Time 1 to Time 2 for those who had lost somebody to suicide. Study 2 replicated and extended the findings of Study 1, with a significant increase in positive affect demonstrated for participants who had lost an immediate family member to suicide. Mediation analysis revealed that the increase in Positive Affect could be partially explained by identification with the crowd. Conclusions: Darkness into Light can be viewed as more than just a fundraiser, but as an intervention in terms of personal well-being for those who have lost somebody to suicide. This finding can be explained through mechanisms including social identity and social connectedness.


(206) OC-206. Changes in Parenting Strategies after a Young Person's Self-harm

Day: 10 | Time: 08:00 | Room: Sala 4

Speaker:
Anne E Ferrey . University of Oxford Centre for Suicide Research, Oxford - UK

 Abstract:
Self-harm in young people is a large and growing problem. A young person’s self-harm can affect their parents and family relationships. Self-harm can be particularly distressing for parents when they are not immediately aware of the self-harm, or when their perception of the family’s functioning differs from that of their child. After discovering their child’s self-harm, parents may re-evaluate their parenting strategies with regard to the child who is self-harming as well as their other children. This could include increased or decreased support, control and monitoring of their children. We conducted a qualitative study with 37 parents of young people who had self-harmed in which we explored how and why their parenting changed after the discovery of self-harm using thematic analysis. Results indicated that parents were careful not to upset their child early on, but later felt they were able to take more control in their parenting. Parents’ reactions to the self-harm often depended on how they conceptualised it: as part of adolescence, as a mental health issue or as “naughty behaviour”. When co-parents disagreed about how best to respond to their child (e.g., in a more controlling or more supportive manner), it could lead to relationship strain. Parenting of other children in the family could also be affected, with parents worrying about less of their time being available for siblings. Many parents developed specific strategies they felt helped them to be more effective parents, such as learning to avoid blaming themselves or their child for the self-harm and developing new ways to communicate with their child. Parents were generally eager to pass their knowledge on to other people in the same situation. Clinicians can help by providing information about parenting strategies after self-harm and forums for parents to share their experiences.


(208) OC-208. Parental suicide attempt and offspring educational attainment during adolescence in the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort

Day: 10 | Time: 08:00 | Room: Sala 4

Speaker:
Galit Geulayov Geulayov . University of Bristol, Bristol

 Abstract:
Parental suicide attempt and offspring educational attainment during adolescence in the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort Background: Few studies have investigated the impact of parental suicide attempt (SA) on offspring outcomes other than mental health. We investigated the association of parental SA with offspring educational attainment in the Avon Longitudinal Study of Parents and Children (ALSPAC). Method: Parental SA was prospectively recorded from pregnancy until the study children were 11 years old. National school test results (ages 11-16 years) were obtained by record linkage. Multilevel regression models quantified the association between parental SA and offspring outcomes. Results: Data were available for 6,667 mother-child and 3,054 father-child pairs. Adolescents whose mothers had attempted suicide were less likely than their peers to achieve the expected educational level by age 14 years [adjusted odds ratio (aOR) 0.63, 95% confidence interval (CI) 0.41-0.95] in models controlling for relevant confounders, including parental education and depression. At age 16, adolescents whose mothers had attempted suicide were less likely to obtain the expected educational level (>=5 qualifications at grade A*-C) (aOR 0.66, 95% CI 0.43-1.00) in models controlling for relevant confounders and parental education; but after additionally controlling for maternal depression the results were consistent with chance (aOR 0.74, 95% CI 0.48-1.13). Findings in relation to paternal suicide attempt were consistent with those of maternal suicide attempt but power was limited due to lower response rate amongst fathers. Conclusions: Maternal SA was associated with diminished educational performance at age 14 years. Educational attainment during adolescence can have substantial effect on future opportunities and well-being and these offspring may benefit from interventions.


(211) OC-211. Community Capacity Building: Engaging Young Men to Prevent and Respond to Suicidal Behaviour

Day: 09 | Time: 08:00 | Room: Sala 4

Speaker:
Shane O Donnell . National Centre for Mens Health, Institute of Technology Carlow, Carlow Ireland

 Abstract:
Background Ireland has one of the highest rates of young male (YM; 15-24yrs) suicide in the EU. Paradoxically, YMs are amongst the least likely to seek-help during times of distress and are rarely considered a ‘target-group’. There can also be confusion among service providers (SP) on how to effectively engage YM using ‘male-friendly’ approaches. Community capacity building recognises the importance of social capital in shaping the health outcomes of communities and has emerged as an important concept within health promotion practice. Aim To support and strengthen the capacity of a disadvantaged rural community to provide more effective and gender-specific mental health promotion and suicide prevention programmes to young men. Methodology Qualitative methodologies (semi-structured interviews) were used at baseline with SPs (n=10) and ‘at risk’ YM (n=12; data collection ongoing) to ascertain what information, knowledge, support, skills or resources are needed to meet YM’s needs and to enable service providers to engage more effectively with YMs on mental health and well-being issues. The findings will inform a tailored training programme delivered to SPs and a 10 week health and well-being programme delivered to YMs. Qualitative methodologies will also be used post-intervention to gain deeper insights into participants’ experiences/perspectives of what constitutes sustainable community capacity building. Findings Preliminary findings in relation to SP’s perspectives on engaging young men and barriers to building community capacity will be presented along with YM’s experiences of their socio-economic environment and their expressed needs in relation to mental health and well-being. Conclusion This project will help to inform how community capacity-building can support YM’s mental health and well-being, by supporting local services with the provision of more innovative and gender-specific programmes to prevent and respond to suicide and suicidal behaviour.


(212) OC-212. Suicidal patient interview: the relevance of a qualitative approach focusing on the narratives, sociometry, and transactional analysis in contrast to the DSM-5 criteria priority

Day: 09 | Time: 08:00 | Room: Sala 1

Speaker:
Carlos Saraiva . Universidade de Coimbra (Portugal), Coimbra (Portugal)

 Abstract:
Introduction The current importance given to neurobiological models related to the suicidal behavior and the pressing to impose DSM-5 criteria has relegated to a second plan the classical approach. Therefore, there is a growing need to use more qualitative models in suicidal behavior studies as well as improving communication skills (1). Goals Over twenty years of experience in the Suicide Research and Prevention Unit (Coimbra, Portugal) concerning tertiary prevention, we feel the relevance of raising awareness to that issue. Methodology This presentation is essentially based on a literature review concerning the latest studies in suicidal behavior and reflects our own clinical experience eliciting qualitative aspects. Results Our main evaluation tool, EACOS (2), has important quantitative data related to sociodemography, childhood development, medical personal and familial history, characterizing the suicidal behavior, clinical and psychological aspects, and also qualitative data related to internal dialogue, expectations and sociometric topics. Conclusion For a better understanding of the suicidal mind the qualitative approach must be prioritized over the more neurobiological view as the urgency of a DSM-5 nomenclature. For instance, to determine a psychotherapeutic starting point, the knowledge about aspects of a patient satisfaction towards survival and his future expectations can assume a vital importance. Bibliography (1) Saraiva, C. B. (2014) – Depressão e Suicídio, p. 45-63, Lidel, Lisboa. (2) Saraiva, C. B. (1998) – Entrevista de Avaliação dos Comportamentos Suicidários, EACOS, Psiquiatria Clínica, 19(4), 251-274.


(215) OC-215. Alexithymia and Suicide Risk Among Emergency Responders: Comparison to a Normative College Student Sample

Day: 10 | Time: 16:00 | Room: Sala 3

Speaker:
L. James A. Schut . Trevecca Nazarene University, Nashville, TN, USA

 Abstract:
Dr. Schut received his doctorate in applied social psychology in 2000 from Vanderbilt University (Nashville, Tennessee, U.S.A.). His academic emphasis was child and adolescent mental health services and the development of indicators and measures for research and program evaluation. He conducted research on dropout from mental health services, quality of care, therapeutic alliance, outcome measurement systems, and adolescent domestic violence programs. Since 2000, Dr. Schut has assumed various roles managing projects and overseeing evaluations of programs for children, youth, and families. He has worked for state government, a university research center, a large behavioral healthcare organization, and independently as a consultant for research, evaluation, and statistics. Currently, Dr. Schut serves as associate professor and research director for a graduate counseling program in middle Tennessee, where he teaches quantitative and qualitative research methods, oversees doctoral dissertations, and conducts independent research. His professional interests include evaluation, research, and program development for services that promote wellness in children and families. Dr. Schut played a key role in the development and evaluation of gatekeeper training for statewide suicide prevention in Tennessee from 2006 to 2011. He has verbally presented suicide prevention research and evaluation results more than 20 times at multiple annual meetings of the American Association of Suicidology, grantee meetings for state-sponsored youth suicide and early intervention grants funded by the Center for Mental Health Services, at the Centers for Disease Control and Prevention, and at the 13th ESSSB conference held in Rome. Most recently, Dr. Schut collaborated with two recently graduated students who conducted doctoral research on alexithymia and suicide risk in two separate populations (emergency responders and college students).


(217) OC-217. Designing and implementing a systems approach to suicide prevention in Australia

Day: 10 | Time: 08:00 | Room: Sala de Cámara

Speaker:
Fiona Shand . Black Dog Institute, University of New South Wales, Sydney, Australia

 Abstract:
Aims: There is growing evidence that implementing multiple suicide prevention strategies simultaneously in a region can substantially reduce suicidal acts. In Australia, suicides have increased in the past two years, highlighting a need for a different approach. This study (1) demonstrates the methods used to identify suicide clusters in Australia; (2) provides an overview of the nine-strategy systems approach to suicide prevention and their likely impact; and (3) describes the evaluation framework for the implementation of the systems approach in Australia. Methods: High-risk regions were identified by mapping suicides and hospital-treated self-harm. Best-practice suicide prevention strategies were identified via an extensive literature review and population preventable fractions were calculated. The systems approach will be rolled out in four regions using a stepped-wedge design where each community is randomised to a different implementation time. Results: 25 regions were identified as high-risk. At the time of writing, regions were yet to be selected. Nine strategies were identified for inclusions in the systems-approach, ranging from population-level through to indicated strategies for high risk individuals. When implemented together, it is estimated these strategies could reduce suicides by 21% and avert 30% of suicide attempts. Individual strategies estimated to have the biggest reduction on suicides were: GP training (6.3%), psychosocial treatment (5.8%), gatekeeper training (4.9%) and means restriction (4.1%). For suicide attempts, it was estimated that 19.8% could be averted by coordinated crisis- and after-care, and 8.0% by psychosocial treatment. Discussion: This work demonstrates that when multiple strategies are combined, they are likely to achieve substantial reductions in suicide. Current suicide prevention activities in Australia place too much emphasis on strategies that have little evidence of efficacy; the focus needs to shift to prioritising strategies with proven effectiveness. The implementation and evaluation framework will be discussed.


(220) OC-220. The effectiveness of Mindfulness-Based Cognitive Therapy and Future Oriented Group Therapy to prevent suicidal behaviour in at-risk outpatients: study protocol for a multicenter cluster randomized controlled trial

Day: 10 | Time: 14:30 | Room: Sala 4

Speaker:
Renate Van Landschoot . Flemish Suicide Prevention Centre (VLESP), Ghent University, Ghent - Belgium

 Abstract:
Background In clinical settings, suicidal behaviour is often seen as a symptom of a disorder that will resolve if the underlying psychiatric disorder is treated. However, a growing body of research has shown the relevance of addressing suicidal behaviour as a distinct psychiatric problem. Evidence on the effectiveness of psychotherapy focusing primarily on the reduction of suicidal ideation is rather limited. Therefore, there is an urgent need to develop and investigate well described treatment methods targeting individuals at risk for suicidal behaviour. As Mindfulness-Based Cognitive Therapy (MBCT) and Future Oriented Group Therapy (FOGT) focus on key factors within the suicidal process (e.g., hopelessness, emotion/avoidance-focused coping and impaired positive future thinking), they are potentially promising therapies to mitigate suicide risk. MBCT teaches skills based on mindfulness training and cognitive therapy and consists of 8 weekly group sessions. FOGT combines cognitive and problem-solving principles and consists of 10 weekly group sessions. The main aim of this study is to develop and test the effectiveness of MBCT and FOGT for reducing suicidality. It is expected that both therapies will reduce suicidal thoughts and suicidal behaviour and, in addition, symptoms of depression, hopelessness and worry. Method A multicenter cluster randomized controlled trial with three parallel group arms will be employed, enabling a comparison of the intervention groups with a Treatment As Usual group. Suicidal outpatients in Flanders (Belgium) will be recruited between September 2016 and May 2017. Participants will be assessed online at baseline, 10 weeks later (post-test) and 12-week follow up by using self-completion questionnaires. A safety procedure will be followed when participants exceed the cut-off score of 26 on the Beck Scale for Suicide Ideation.


(223) OC-223. A qualitative exploration of the relationship between interpersonal factors and suicide in bipolar disorder

Day: 09 | Time: 8:00 | Room: Sala de Cámara

Speaker:
Rebecca Owen . University of Manchester, UK

 Abstract:
Background: Evidence suggests that up to 50% of people with bipolar disorder will attempt suicide at least once in their lifetime. Negative social factors, such as, the breakdown of a relationship can contribute to the development of suicidal ideation in clinical and non-clinical populations. Yet, there is a lack of studies examining suicidality from a psychosocial perspective in people who experience bipolar disorder. Method: Semi-structured interviews were used to collect qualitative data from 20 participants with bipolar disorder. The interview focused on the link between social factors and participants' experience of suicidality (suicidal thoughts, feelings or behaviours). A thematic analysis was used to understand the data. Results: Social or interpersonal factors which participants identified as protective against suicidality included, ‘the perceived impact of suicide upon others’ and, ‘reflecting on positive social experiences’. Social factors which triggered suicidal thoughts included, ‘negative social experiences’ and, ‘not being understood or acknowledged’. Social factors which worsened suicidal thoughts or facilitated suicidal behaviour were, ‘feeling burdensome,’ and ‘reinforcing negative self-appraisals’. Conclusions: These results highlight the importance of considering the psychosocial context in which suicidality is experienced. Psychological interventions which aim to reduce suicide risk in bipolar disorder should incorporate coping strategies to buffer against the effects of negative interpersonal factors.


(225) OC-225. Cortisol reactivity and suicidal behaviour

Day: 10 | Time: 14:30 | Room: Sala 4

Speaker:
Rory Oconnor . University of Glasgow, Glasgow, Scotland

 Abstract:
Cortisol reactivity and suicidal behaviour: investigating the role of hypothalamic-pituitary-adrenal (HPA) axis responses to stress in suicide attempters and ideators Rory C O’Connor, Jessica A. Green, Eamonn Ferguson, Ronan E. O’Carroll, & Daryl B. O’Connor Background. Suicide is a major cause of death worldwide. The causes of suicidal behaviour are not fully understood. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, is one potential risk factor. The current study aimed to investigate whether cortisol reactivity to a laboratory stress task differentiated individuals who had previously made a suicide attempt from those who had thought about suicide (suicide ideators) and control participants. Methods: One hundred and sixty participants were recruited to a previous attempt, a suicidal ideation or a control group. Participants completed background questionnaires before completing the Maastricht Acute Stress Test. Cortisol levels were assessed throughout the stress task. Measures of suicide behaviour were measured at baseline, 1 month and 6 month follow-up. Results: Participants who had made a previous suicide attempt exhibited significantly lower cortisol response to the MAST compared to participants in the ideator and control groups. Moreover, participants who made an attempt within the past year exhibited a blunted cortisol response compared to participants with a more distant history of attempt. Participants who had made a suicide attempt and had a family history of suicide also exhibited a blunted cortisol response to stress. Finally, lower levels of cortisol in response to the MAST were associated with higher levels of suicidal ideation at 1-month follow-up in the suicide attempters group. Conclusions: These findings confirm that HPA axis activity is associated with suicidal behaviour. Moreover, cortisol reactivity may represent an important biomarker of a trait-diathesis following serious stressful and traumatic events.


(228) OC-228. Suicide rates in Nordic prisons 1999-2012; a multicenter study

Day: 10 | Time: 16:00 | Room: Sala 4

Speaker:
Britt Morthorst . Health Science University of Copenhagen, Research Unit Mental Health Center Copenhagen, Denmark

 Abstract:
By Morthorst, Mehlum, Pàlsson, Mühlmann, Hammerlin, Madsen, Nordentoft, and Erlangsen. Prison suicide rates vary considerably between countries, but are generally found to be elevated when compared with the general population. Since the age distribution among persons in prison is skewed and age-standardized suicide rates among prisoners have rarely been reported we lack precise estimates of the excess mortality by suicide in prisoners. Objective: to examine the suicide rates among persons in prison in relation to the general population of the Nordic countries using longitudinal cohort data. Method: We used cohort data on deaths by suicide and person-years for persons in prison and the general populations in Nordic countries. Age-standardization was applied to assess the difference in suicide mortality between persons in prison and the general population for males in Denmark, Iceland, and Norway. Results: The overall suicide rate was 113.0 (95 % CI 99.5 to 126.5) per 100.000 person-years for people in prison. The suicide rates of prison populations did not differ significantly between the Nordic countries and was fluctuating over time. The suicide rate of persons in prison ranged between 50 (95 % CI 17.3 to 82.7) and 158 (95 % CI 94.8 to 221.2) measured in 2009 and 2001, respectively. Over the entire period, significantly higher suicide rates were found among male prisoners when compared to males in the general populations; their gender- and age-standardised mortality ratio (SMR) was 942.1 (95 % CI 749.4 to 1060.7). That, males in prison in these Nordic countries have a 9.4-fold higher risk of dying by suicide when compared to peers in the general population calls for strengthened preventive efforts such as routinely screening for depression and suicidal behavior.


(230) OC-230. Suicide prevention team of the mental health centres across Flanders and Brussels

Day: 10 | Time: 08:00 | Room: Sala de Cámara

Speaker:
Ine Vermeersch . Mental Health Centre Eclips (Suicide Prevention Team), Ghent, Belgium

 Abstract:
With a suicide rate of 17,67 per 100 000 inhabitants, Flanders is at the bottom of the European ranking. In 2012, the Flemish Government launched the second Flemish Action Plan for Suicide Prevention. The aim of this plan is to reduce the incidence of suicide by 20% by 2020, compared to 2000. One of the organisations that help carry out this plan is the Suicide Prevention Team of the Mental Health Centres. Last year, their education and awareness programmes reached 5525 professionals who are (or may be) in contact with potentially vulnerable populations. These programmes include education and training in the recognition and evaluation of suicide risk, interview and clinical communication skills, crisis management, etc. Educational methods used in these training sessions include lectures, group discussions, rehearsal of skills, role-play and video-testimonials. The team has also coached 93 organisations in developing a comprehensive suicide prevention policy, which includes a range of prevention strategies that act on different levels within the organisational context. In addition, the team supports and enhances health care services such as adequate care for suicide attempters, care for persons who have lost a significant other to suicide, and continuity of care for suicidal patients.


(232) OC-232. Understanding self-harm in looked-after young people: A sequence analysis approach

Day: 10 | Time: 08:00 | Room: Sala 5

Speaker:
Ellen Townsend . University of Nottingham, Nottingham, UK

 Abstract:
Background: Self-harm is a significant problem in looked-after young people (looked-after in care homes or by foster parents). Despite this few studies which have investigated self-harm in this population. Self-harm is the strongest predictor of completed suicide with suicide being the second commonest cause of death in young people globally. Thus, it is crucial to understand the thoughts, feelings, behaviours and events that lead a young person to self-harm. We developed the Card Sort Task for Self-Harm (CaTS) to investigate this. Method: We recruited 45 (24 looked-after) participants aged 13-21 years who had self-harmed in the past 6 months from Child and Adolescent Mental Health Services, Social Care and from the community. Participants completed the CaTS to describe their first ever and most recent self-harm episode. Lag sequential analysis was used to determine significant transitions in factors leading to self-harm for looked-after young people and a contrast group of young people who had never been looked-after. Results: A significant sequential structure to the card sequences produced was observed demonstrating similarities and important differences in antecedents to first, and most recent self-harm, and between groups (looked-after vs contrast). For the looked-after young people self-harm led to them ‘feeling better’ after their first ever episode, but this effect disappeared for their most recent episode and feeling unafraid of death (acquired capability) emerged along with impulsivity as factors most proximal to self-harm. For both groups strong negative emotions precede self-harm at first and most recent episode. Discussion: The CaTS offers a systematic approach to understanding the interplay of factors that lead to self-harm in young people. It offers a method to target key points for intervention in the self-harm pathway. Crucially we demonstrate that the factors most proximal to self-harm are modifiable with existing interventions (negative emotions, impulsivity and access to means).


(245) OC-245. Trajectories of people with intellectual disabilities and / or autism spectrum disorder who have attempted suicide

Day: 09 | Time: 08:00 | Room: Sala de Cámara

Speaker:
Xenia Halmov . CRISE - UQAM, Canada

 Abstract:
As part of a research project to develop a suicide risk assessment protocol for people with intellectual disabilities or autism spectrum disorder, 100 case histories were analyzed, of which 60 people had communicated suicidal thoughts and 40 had never communicated any suicidal thoughts. This presentation focuses on the 13 participants who had made at least one suicide attempt. A qualitative analysis of their clinical case files describes their trajectories in the months before their last documented attempt. This presentation describes the different risk factors involved in these trajectories, warning signs and manifestations associated with suicide, and the implications for intervention and for the development of a suicide risk assessment protocol. Three types of trajectories were identified: one in which there were symptoms of major depression, which is very similar to high risk groups for suicide in the general population; the second trajectory had unstable mood and a history of suicidal behaviours, and the third had severe behaviour disorders and frequent periods of disorganization. Two important factors that contribute to the development of a suicidal crisis were identified: the accumulation of seemingly minor events and expressions of concerns about death, in general.


(251) OC-251. Predicting the occurrence (and intensity) of suicidal ideation by momentary ratings of burdensomeness and belongingness: An experience sampling study in psychiatric inpatients with major depression

Day: 10 | Time: 16:00 | Room: Sala 3

Speaker:
Heide Glaesmer . University of Leipzig, Leipzig, Germany

 Abstract:
Purpose: To date, empirical evidence on proximal factors predicting suicidality is scarce. One theory that sheds light on this issue is the Interpersonal Theory of Suicide (IPTS, Joiner, 2005). The IPTS hypothesizes two interpersonal cognitive-affective states that are dynamic: perceived burdensomeness (PB) and thwarted belongingness (TB). The simultaneous presence of these constructs is assumed to cause active suicidal desire. This experience sampling study investigates whether PB and TB is positively associated with suicidal ideation (SI) at the same time and whether this association holds even when controlling for well-known risk factors for SI as depression and hopelessness. Methods: Preliminary, 18 inpatients with depressive disorders reported on their momentary PB, TB, depressiveness, hopelessness, and SI ten times per day for six days via experience sampling method. Hierarchical linear modelling (HLM) was used to analyze associations between suicidal ideation and PB, TB, depressiveness, and hopelessness on Level 1 (controlling for PB and TB on Level 2). (Preliminary) Results: Multilevel analyses revealed that PB (B = 0.167, SE B = 0.059, p > .05), TB (B = 0.118, SE B = 0.039, p > .01) and hopelessness (B = 0.635, SE B = 0.102, p > .001) but not depressiveness (B = 0.087, SE B = 0.057, ns) at Level 1 are significantly and positively associated with SI (controlled for PB and TB at Level 2). Discussion: This is the first study with a longitudinal real-time assessment of PB and TB to predict SI. It is still in process but preliminary results exhibit evidence for the predictive power of PB and TB for SI beyond well-known risk factors such as depressiveness and hopelessness.


(254) OC-254. The role of self esteem as a moderator in the pathways from defeat, entrapment, and hopelessness to suicide probability in participants on acute psychiatric inpatient wards.

Day: 10 | Time: 16:00 | Room: Sala 1

Speaker:
Patricia Gooding . University of Manchester, UK

 Abstract:
Co-Authors:Awenat,Y., Davies,L., Emsley,R., Peters,S., Pratt,D., Haddock,G. Introduction: People who are psychiatric in-patients experience a range of severe mental illnesses. Consequently, they are at an increased risk of experiencing suicidal thoughts and behaviours. Contemporary psychological models of suicidality posit that defeat, entrapment, and hopelessness are key in the pathways to suicidality. The Schematic Appraisals Model of Suicide has detailed an interactive role of self appraisals in contributing to this pathway. The goal of the current study was to examine the ways in which self-appraisals of self esteem impacted pathways to suicide probability via defeat, entrapment, and hopelessness. Method: This was a cross-sectional questionnaire design. Participants were recruited from acute psychiatric wards from NHS trusts in the North West of England, UK, as part of a single blind randomised controlled trial with two arms, treatment as usual (TAU) or cognitive therapy for suicide plus TAU. Inclusion criteria comprised being between the ages of 18-65 years of age, able to provide informed consent, experience of suicidal thoughts or behaviours within the 3 months prior to admission, and having sufficient English language capacity to complete measures. A questionnaire battery included measures of suicide probability, hopelessness, defeat, entrapment, self esteem, and depression. Mediation, and moderated mediation, analyses were applied to the data. Results: There was an interaction/moderation effect in the first step of the model in which defeat predicted entrapment. Self esteem acted as a buffer, with low levels of self esteem together with low levels of defeat having a protective effect against entrapment, particularly internal entrapment. Defeat predicted levels of hopelessness, and self esteem was inversely related to suicide probability. Discussion and conclusions: It is important to bolster self esteem in people experiencing suicidality because this protects against perceptions of internal entrapment. Entrapment is an important mediator in the pathways to suicidality.


(256) OC-256. Higher CSF YKL-40 and GAP-43 are related to suicidal ideation in a population-based sample of older adult women without dementia

Day: 09 | Time: 08:00 | Room: Sala 3

Speaker:
Margda Waern . University of Gothenburg, Sweden

 Abstract:
Background: CSF markers of neuronal plasticity, glia-related inflammation and neurodegeneration have been shown to associate with various psychiatric conditions. The aim of the study was to test for possible relationships between suicidal ideation and 1) CSF YKL-40 (Chitinase-3-like protein 1) 2) Growth Associated Protein-43 (GAP-43) and 3) Myelin Basic Protein (MBP) in a population-based sample of older women. Further, relationships between these three CSF biomarkers and major and minor depression as well as depression severity were examined. Methods: 86 non-demented women aged 70-84 years who participated in the Prospective Population Study of Women in Gothenburg, Sweden took part in a face-to-face psychiatric examination and lumbar puncture in 1992-3. Surviving women were followed up at three subsequent study waves. Depression score was rated with the Montgomery Åsberg Rating Scale (MADRS); the suicide item was used to assess suicidal ideation. Major depression was diagnosed in accordance with DSM-IV and minor depression in accordance with DSM-IV research criteria. Results: At baseline, women with suicidal ideation had higher levels of both CSF YKL-40 (p = 0.012) and CSF GAP-43 (p= 0.037) compared with those without. No such association was seen for MBP. None of the analyzed CSF biomarkers were related to major depression, minor depression, or MADRS score. Conclusion: Higher levels of CSF YKL-40 and GAP-43 were associated with suicidal ideation in older adult women, suggesting that abnormalities in the synaptic-oligodendroglial interaction may play a role in suicidal ideation in later life.


(258) OC-258. Incidence and Predictors of Suicide Attempts in Bipolar I and II Disorders: A Five-Year Follow-Up Study

Day: 10 | Time: 16:00 | Room: Sala 3

Speaker:
Erkki Isometsä . University of Helsinki, Helsinki, Finland

 Abstract:
Objectives: Few long-term studies on bipolar disorder (BD) have investigated risk of suicide attempts related to patients’ illness phases. In this long-term prospective study we examined incidence and moderators of risk of suicide attempts during different phases of BD in a representative secondary-level sample of bipolar I (BD-I) and bipolar II (BD-II) patients. Methods: In the Jorvi Bipolar Study (JoBS), 191 BD-I and BD-II patients were followed using life chart methodology. Prospective information on suicide attempts (SAs) of 177 (92.7%) patients during different illness phases was available up to five years. Incidence of SAs, and their predictors were investigated using logistic and Poisson regression models. Moderator analyses of SAs during major depressive episodes were conducted using two-level random-intercept logistic regression models. Results: During the five-year follow-up, there were 90 SAs per 718 patient-years. The incidence was highest, over 120-fold compared to that of euthymia, during mixed states (765/1000 person years [95 % confidence interval 461-1269]). The incidence in major depressive episodes was almost 60-fold (354/1000 [95 % c.i. 277-451]). For risk of SAs during major depressive episodes, time spent in depressive episodes, severity of depression and cluster C personality disorders were significant moderators. Conclusions: We confirmed our earlier medium-term finding of highest incidences of SAs are in mixed and major depressive illness phases in BD. The variations in incidence rates between euthymia and illness phases are remarkable, suggesting that question “when” rather than “who” might be more relevant when assessing the suicide risk. Some moderating effects are likely as well.


(268) OC-268. Service providers: perspectives on the factors that support or inhibit young men from engaging in services targeted at supporting their emotional and mental wellbeing

Day: 09 | Time: 08:00 | Room: Sala 5

Speaker:
Billy Grace . Institute of Technology Carlow, Carlow - Republic of Ireland

 Abstract:
There have been increasing calls for more gender-specific service provision to support young men’s (20-29y) mental health and well-being. In Ireland, young men are the demographic group that are most likely to die by suicide but among the least likely to seek help (CSO, 2015). This study sought to investigate service providers’ perspectives on the factors that support or inhibit young men from engaging in services targeted at supporting their mental/emotional wellbeing. Qualitative methodologies (focus groups; n = 9, interviews; n = 7) were used for this study. Those service providers most likely to be in contact with young men were identified as the target sample (n=52). A grounded theory approach was used to analyse the data. Disconnection from family and community was identified as a key indicator of ‘at risk’ groups of young men who, more typically, had experienced significant disruption in their lives. The discord between demands and expectations facing young men on the one hand, and insufficient life-management and coping skills on the other, left many young men vulnerable and bereft. The desire to save face and preserve one’s masculine identity was linked to young men’s reluctance to seek help when feeling down. The essence of sustained connection with young men revolved around creating safety, trust, rapport and meaningful relationships. The findings from this study have informed the development of a Train the Trainer programme (‘Connecting with Young Men’, Fowler et al, 2015) which is currently being delivered to service providers in Ireland and which may have implications for service provision elsewhere. Central Statistics Office, (2016). Quarterly national household survey quarter 4 2015. 25/02/2016, http://www.cso.ie/en/releasesandpublications/er/qnhs/quarterlynationalhouseholdsurveyquarter42015/ Fowler, C., Richardson, N., Carroll, P., Brennan, L., & Murray, F. (2015). Connecting with young men: Unit 6, engage national men’s health training Ireland.


(271) OC-271. Assessing the core constructs of the IPTS - Psychometric properties and population based norms of the German versions of the INQ and the ACSS-FAD

Day: 10 | Time: 08:00 | Room: Sala 1

Speaker:
Nina Hallensleben . Institute of Medical Psychology and Medical Sociology, University Leipzig , Leipzig - Germany

 Abstract:
Rationale: The interpersonal theory of suicidal behavior (IPTS) is one of the recent psychological theories of suicidality. Its core constructs are mainly assessed with two psychometric instruments: the Interpersonal Needs Questionnaire (INQ) and the Acquired Capability for Suicide Scale – Fearlessness about Death (ACSS-FAD). The INQ assesses the two interpersonal constructs that lead to suicidal ideation, according to the IPTS - perceived burdensomeness and thwarted belongingness. The ACSS-FAD assesses fearlessness about death, which is one of the two components of the IPTS’ third core construct acquired capability of suicide. Aim: The aim of the study was the psychometric evaluation of the German versions of both instruments in a large population sample to further establish its reliability and validity, and to provide norm values. Methods: Beside the German versions of the INQ and the ACSS-FAD, we assessed measures of depression and history of suicidal behavior in a representative sample of the German population (n = 2,513) to analyze the instruments’ dimensionality and validity by means of confirmatory factor analysis and correlational analysis. Results: For both instruments, the proposed factor structure (two-dimensionality for the INQ and uni-dimensionality for the ACSS-FAD) could be replicated with introduction of several correlating error terms. The INQ showed to be valid as it correlated with depression and suicidality in the expected direction. Correlations with the ACSS-FAD and other measures were against expectations. Discussion: The validity of the ACSS-FAD should be further examined in clinical samples. We provide population based norm values for the German versions of the INQ (total sample and age-specific) and the ACSS-FAD (sex and age-specific) for the first time.


(272) OC-272. Social rank processes and suicidality: An investigation of the relationship between social rank variables and suicidal ideation

Day: 09 | Time: 08:00 | Room: Sala 3

Speaker:
Karen Wetherall . University of Glasgow, Glasgow

 Abstract:
This prospective study investigates the relationship between social rank and suicidal ideation. Perceiving oneself as of lower rank (comparing unfavourably to others) is linked to depression, and may lead people to feel defeated and trapped. The latter have been shown to be important in understanding suicidal thoughts within predominant models of suicide including the Integrated Motivational Volitional Model of suicidal behaviour (IMV: O’Connor, 2011). It is predicted that social rank, including a change in rank, will be useful in predicting suicidal ideation over time, and that feelings of defeat and entrapment will act as mediators. Participants (n = 311) completed two online surveys (including measures of social comparison, defeat, entrapment, suicidal ideation and depression) at baseline and 3 months later. In univariate analyses, all psychological variables were associated with time 2 suicidal ideation in the expected directions. Hierarchical regression analyses suggested that social comparison significantly predicted suicidal ideation, after controlling for baseline factors. However, in the final step, social comparison’s influence was reduced by adding defeat, internal and external entrapment; only previous ideation, depression and internal entrapment remained significant predictors. Internal entrapment was found to mediate the relationship between social comparison and time 2 suicidal ideation. Finally, change in social rank (i.e., change in comparison scores over time) along with internal entrapment, was a significant predictor of time 2 suicidal ideation. In addition, change in rank was shown to partially mediate the relationship between internal entrapment and suicidal ideation. Findings highlight the importance of internal entrapment as a key mechanism to explain how low rank may lead to suicidal ideation. Taken as a whole, this study confers support for the IMV model, as it emphasises entrapment as a proximal predictor of suicidal ideation. Finally, how social rank changes over time and its dynamic relationship with suicidal ideation needs further exploration


(274) OC-274. Physical and psycho-somatic health outcomes in people bereaved by suicide compared to people bereaved by other modes of death: a systematic review

Day: 10 | Time: 08:00 | Room: Sala 4

Speaker:
Ailbhe Spillane . National Suicide Research Foundation & University College Cork, Cork city - Ireland

 Abstract:
Introduction: Little research has been conducted to investigate the physical health implications of suicide bereavement compared to other causes of death. There is some evidence that suicide bereaved parents have higher morbidity, particularly in terms of chronic illness. This systematic review aims to clarify and compare the physical and psycho-somatic morbidities of people bereaved by a family member’s suicide death with family members bereaved by other modes of death. Methods: MEDLINE, EMBASE, CINAHL, and PsycINFO were searched from 1985 to present, using medical subject headings (MeSH) where appropriate to locate potentially relevant articles. Eligible studies are peer-reviewed articles comparing suicide-bereaved family members to family members bereaved by a non-suicide death on at least one measure of physical or psycho-somatic health. Prospective and retrospective cohort studies, cross-sectional studies, case-control studies and cohort-based registry studies are eligible for inclusion. Studies must be published in the English language, or where a translation is available. Studies will be quality assessed using a modified version of the Newcastle Ottawa Scale. Study results will be synthesised using narrative synthesis, due to the heterogeneity in outcomes among the studies. Results: The literature search located 18 studies which met the inclusion criteria. Measures of physical or psycho-somatic health investigated included somatic reactions, physical disorders and physical health problems. The physical, psycho-somatic and co-morbidities of family members bereaved by suicide will be presented. Discussion: The findings of this review will be relevant for clinicians, especially general practitioners working with people bereaved by suicide. Greater emphasis in bereavement interventions may be given to negative physical health outcomes following suicide bereavement. Future research should examine health risk behaviours of suicide-bereaved and non-suicide bereaved to examine whether any differences in health status may be related to such behaviours.


(282) OC-282. Postvention and media behaviour in Norway

Day: 09 | Time: 08:00 | Room: Sala de Cámara

Speaker:
Christoffer Back Vestli . LEVE - The Norwegian Organization for the Suicide Bereaved, Oslo, Norway

 Abstract:
Norwegian media is increasingly paying attention to suicide and has so far accounted for a non-controversial and balanced public debate. The Code of Conduct was reviewed in 2006, now encouraging journalists to “be cautious when reporting on suicide and suicide attempts” and to “avoid reporting that is not necessary to fulfil the general need for information.” This is in contrast to the pre-2006 media culture, when suicide was off-topic and should not be reported. Survivors of suicide have been central in this development. The Norwegian Organization for the Suicide Bereaved (LEVE), established in 1999, has always been promoting openness in the debate on suicide. Especially has the young members of the organization emphasized openness in their activities. National media have interviewed many of the members and contributed to give suicide survivors a face and to break down the stigmas related to suicide. In my presentation, I ask: How has the positive cooperation between NGOs and journalists affected the public debate on suicide in Norway? And how has grief after losing a close relative by suicide been featured? I estimate the time needed for my presentation to be about 20-30 minutes in a parallell session.


(283) OC-283. Correlates of Mental Health Service Utilization of Clients at High Risk for Suicide

Day: 10 | Time: 16:00 | Room: Sala 3

Speaker:
Dana Alonzo . Fordham University, New York-USA

 Abstract:
Individuals with suicidal ideation and behavior are often difficult to engage in treatment and prone to premature termination. Studies show that between 11% and 50% of suicide attempters refuse outpatient referrals or drop out of outpatient therapy very quickly. Yet, improved outcomes have been found for individuals at risk for suicide with both affective disorders and personality disorders who successfully engage in psychotherapy including interpersonal functioning and illness symptomatology, and a reduction in the likelihood of attempting suicide and medical risk across all suicide attempts and self-injurious acts combined. Therefore, helping individuals at risk for suicide to access, participate and remain in treatment is a critical step in facilitating positive outcomes. Research indicates poor patient-reported therapeutic alliance is associated with greater treatment dropout. This emphasizes the important role of the clinician in influencing a client’s decision to remain in treatment. It also points to the need to better understand mental health clinicians’ perspectives of factors associated with treatment engagement to improve our knowledge of how to effectively engage individuals at risk for suicide in treatment and to inform the development of prevention and intervention strategies that are easily translatable into practice. No prior studies have specifically focused on identifying the factors associated with treatment engagement of individuals at-risk for suicide from the perspective of the mental health clinician. To address this gap, this study examines the perspective of practicing outpatient mental health clinicians who work on a daily basis with clients at high risk for suicide. We explore mental health clinicians’ perceptions and experiences regarding: (1) the barriers that influence the treatment engagement of individuals at risk for suicide (2) the facilitators likely to increase the treatment engagement of individuals at risk for suicide.


(295) OC-295. Electrodermal hiporreactivity in patients with depression with and without previous history of suicide attempts

Day: 10 | Time: 16:00 | Room: Sala 3

Speaker:
Elsa Arrua Duarte . Hospital Fundación Jimenez Díaz, Madrid-España
Alba Sedano Capdevila . ,
Silvia Vallejo Oñate . ,
Maria Constanza Vera Varela . ,
Maria Luisa Barrigon . ,
Lucia Villoria . ,
Marco Sarchiapone . ,
Lars-håkan Thorell . ,
Enrique Baca-García . ,

 Abstract:
Background: Different studies have found electrodermal hyporeactivity (EH); related to suicide or suicide attempt, particularly in depressed patients. In this study we evaluate EH in patients with depression, comparing it according their history of suicide attempts and adjusting for potentially confounder variables. Methods: The study is part of a bigger study: “EUDOR-A Multi-centre Research Program - A Naturalistic, European Multi-centre Clinical Study of EDOR Test in adult patients with primary depression”. We measured EH by means of “EDOR Test“(developed by the Swedish company Emotra AB) in 65 depressed patients in Hospital FJD (Madrid, Spain). We also collected sociodemographic data, history of suicide attempts, intensity of depression and personality disorders. We compared the variables collected in patients with and without history of suicide attempts. Results: Our sample was composed by 21 people with suicide attempt history (SA) and 44 without it (non-SA). Forty-six women and 20 men, with a median age of 51.5 ± 12.6 years; 63 outpatients and 3 inpatients, all diagnosed with depression. Median MADRS score was 20.3 ± 11.2. We found differences in prevalence of EH between SA and non-SA [38% (8/21) vs 13.6% (6/44); p= 0.025]. We found no differences regarding sex, age and MADRS score. Regarding personality, although there were no significant differences between SA and son-SA we found a trend for schizoid, histrionic and dependent disorders, with more prevalence among those with SA (19% vs. 4.8% for schizoid PD, p=0.084; 57.1% vs 35.7% for histrionic PD, p=0.089 and 61.9% vs 38.1% for dependent PD, 0.069). When adjusted in a logistic regression for schizoid, histrionic and dependent disorders, EH remained significant. Conclusions: Patients with depression and history of suicide attempts presented more often EH; this remained significant after adjusting by personality.


(297) OC-297. Protective factors for self-harm among adolescents. The CASE Study (Child and Adolescent Self-harm) 2001-2016

Day: 10 | Time: 08:00 | Room: Sala 1

Speaker:
Lilian Zoellner . Centre for Suicide Research, Denmark, Odense - Denmark

 Abstract:
Protective factors for self-harm among adolescents. The CASE Study (Child and Adolescent Self-harm) 2001-2016 Lillian Zoellner, director of Centre for Suicide Research, Denmark, Ph.D. Introduction In 2001, The CASE Study (Child and Adolescent Self-harm in Europe) was initiated in Denmark and other European countries. Denmark, however, has continued to collect data every year since 2001. From 2001-2016, 28,000 adolescents aged 13-19 years have completed the questionnaire. Throughout the 15 years of data collection, key questions of vulnerability, serious thoughts of self-harm and self-harming behaviour have remained unchanged which provide a unique insight to the development of self-harm among adolescents. While most countries focus on risk factors for self-harm among the adolescent, the Danish study focuses on protective factors. Knowledge of protective factors contributes to the prevention of self-harm. Goals The goal of the study is to identify protective factors for self-harming behaviour among adolescents (13-19-year-olds). Methodology Data is collected through a web-based questionnaire administered to schools in Denmark. Calculations were done by multiple regression analysis to control for gender, age and household differences. Results Having a close relationship with grandparents is a protective factor for self-harming behaviour. Most adolescents have a closer confidential relationship with their maternal rather than paternal grandmother. Further protective factors for self-harm include that the adolescent aspire after good marks and that parents do not have unreasonable high demands or expect too much of the adolescent. Seeking help and guidance from others to handle his or her problems is also a consistent protective factor. Conclusion This research project is a step towards identifying circumstances and factors that prevent self-harm among adolescents – a necessary step in order to gain further knowledge of protective factors, as called for by WHO among others.


(299) OC-299. PeRSEVERe: A Study of Intranasal Esketamine for Rapid Reduction of Symptoms of Major Depressive Disorder, Including Suicidal Ideation, in Subjects Assessed to be at Imminent Risk for Suicide

Day: 10 | Time: 14:30 | Room: Sala 4

Speaker:
Carla Canuso . Janssen Research & Development, USA

 Abstract:
The risk of suicide in patients with Major Depressive Disorder (MDD) is ~20 times that of the general population. Delayed onset of action of standard antidepressants limits their utility in MDD patients at imminent risk for suicide. In contrast, intranasal esketamine can improve symptoms of depression within hours of administration. PeRSEVERe is the first randomized, double-blind (DB), placebo-controlled, US multicenter study of intranasal esketamine in adults with MDD at imminent risk for suicide. Subjects had active suicidal ideation and intent requiring hospitalization. All subjects received standard-of-care oral antidepressant treatment. Primary objective: efficacy of esketamine (84 mg) vs. placebo in reducing MDD symptoms, measured by MADRS total score (Day 1, 4-hours post-dose). Secondary efficacy outcomes: MADRS total score (Days 2, 25 [DB endpoint]), and MADRS suicidal thoughts item on Days 1 (4-hours post-dose), 2, and 25. Additional efficacy measure: Clinician's Global Judgment of Suicide Risk (CGJ-SR). Safety measures: adverse events (AEs), perceptual changes, sedation, and vital signs. As a proof-of-concept study, a two-sided significance level of 0.20 was set. Sixty-eight subjects enrolled. Mean baseline MADRS total score was ~39 (severe depression); most subjects had a CGJ-SR score corresponding to risk requiring hospitalization with suicide precautions. A clinically meaningful and statistically significant difference, in favor of esketamine, was observed in MADRS total score mean change (4-hours post-dose, p=0.015). MADRS total score changes were also statistically superior in the esketamine group (Days 2, 25), as were reductions in MADRS suicidal thoughts item (all 3 time-points) and CGJ-SR (4-hours post-dose and Day 2). Common AEs included nausea, dizziness, dysgeusia, headache, and dissociation. Perceptual changes, sedation and vital sign changes were transient. Results from this study represent important new findings about the potential use of intranasal esketamine for rapid reduction of depression symptoms in patients with MDD at imminent risk for suicide.


(308) OC-308. One-year follow-up study of suicide attempts in emergency department patients

Day: 10 | Time: 08:00 | Room: Sala 3

Speaker:
Águeda Fernández-Quintana . Clinical University Hospital of La Coruña, Spain

 Abstract:
Introduction: A conscientious identification of factors that predict and protect against suicide attempts is critical, especially among Emergency Department (ED) patients. Objectives: 1. To analyse the clinical variables of patients admitted to ED after attempting suicide. 2. To underpin the socio-demographic variables associated with suicide attempts. Methods: Retrospective study performed on 376 patients admitted to ED after attempting suicide. Medical reports were reviewed to obtain clinical and socio-demographic variables. Results: Suicide attempts accounted for 18.4% of 2014 total patients admitted to ED. Women 59.3%, men 40.7%. Habitat: rural 70%, urban 30%. Prior psychiatric diagnosis 72%: Personality Disorder was the most common diagnosis, followed by Depressive Disorders, Alcohol Abuse and Anxiety Disorders. At least one previous psychiatric consultation 98.3%. Prior admissions to Acute Inpatient Psychiatric Unit (AIPU) 47%. Suicide reattempters 26.4%. Suicide attempts were most common among women aged 31-50 years. Deliberated self-poisoning present in 74% of cases: 64.6% benzodiazepines, 13.8% pain-killers, 6.2% antidepressants, 4.6% antipsychotics, 3.1% antihypertensives. Following ED consultation: 56.8% discharged, 37.6% admitted to AIPU (94% voluntary), 4.8% discharged against medical advice, 0.8% required admissions to other departments. Upon AIPU discharge, 97% of patients were followed in Outpatient Clinics. Conclusions: 1. ED Psychiatric care demand is an indicator of high prevalence of suicidality. 2. One out of five patients consulted by a psychiatrist in ED had attempted suicide. 3. Deliberate self-poisoning through benzodiazepine overdosing was the most common method. 4. The most frequent diagnoses among patients who attempted suicide were personality disorders and depression. 5. Half of patients aged 18 or less evaluated by a psychiatrist in ED had attempted suicide. Discussion: The development of effective suicide prevention programs requires targeted interventions for patients with suicidal risk. By helping clinicians through a more accurate assessment of suicidality, a better outcome for patients who attempt suicide can be achieved.


(312) OC-312. BackUp, a mobile application for people suffering from suicidal ideation and their significant others

Day: 09 | Time: 08:00 | Room: Sala 1

Speaker:
Kirsten Pauwels . Flemish Centre for Suicide Prevention - Vlaams expertisecentrum suïcidepreventie, Belgium

 Abstract:
In Flanders, Belgium, online tools for suicide prevention aregaining importance in suicide prevention. Within the context of the digital platform Zelfmoord1813.be, the Flemish Centre for Suicide Prevention (VLESP) developed and tested an app, BackUp, aimed to provide tools to cope with suicidal ideation. In this presentation we will discuss the development, testing, implementation and evaluation of BackUp. The content of BackUp is based on an extensive literature review and an evaluation of more than 30 existing/related/relevant apps. It integrates 5 different evidence based tools: ‘my BackUps’, ‘my BackUpBox’, ‘BackUpCards’, a Safety Plan and ‘Being BackUp’. BackUp offers coping tools to people in a suicidal crisis, as well information and support for significant others for. BackUp stimulates the use of internal coping strategies and reaching out for help, aiming to strengthen the resilience of those suffering from suicidal thoughts. Before launching BackUp, it was reviewed by a team of experts (on suicide prevention, online tools, mental health) and tested by a sample (N=21) of potential users who used the app during a week. The participants gave feedback on the design and the usability of BackUp, and on how the app helped them to cope with their suicidality. The impact of using the app on their suicidal ideation was measured before and after the testing period, using the Beck Scale for Suicidal Ideation. BackUp was launched in September 2015 and has reached already more than 1.000 users. Users are asked to fill out a questionnaire on their experiences with BackUp after one month, which gives the developers the chance to continuously evaluate and follow-up BackUp.


(315) OC-315. Improving patient safety - from academic research to health service action

Day: 09 | Time: 08:00 | Room: Sala 4

Speaker:
Pauline Turnbull . The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Manchester - England

 Abstract:
Background: The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH) has collected information on all UK suicides by people with mental illness since 1996. NCISH describes socio-demographic, behavioural and clinical characteristics associated with suicide in this vulnerable population. Each report carries recommendations to mental health and other services. The overall aim of NCISH is to improve patient safety, and reduce the rate and number of suicides by people in contact with mental health services. This presentation discusses how we have worked with health services towards that goal. Method: We have adopted a variety of strategies to disseminate findings and implement recommendations. We give seminars within health services, and disseminate more broadly via online media. This includes videos of key messages from all reports, and documentation for service users about what our findings mean for their care. We ask clinical staff and service users to engage with us directly via our stakeholder survey, service user portal, and call for topics. We have extracted our findings and recommendations into a freely-available self-assessment toolkit for mental health and primary care services. We also evaluated the impact of implementing our recommendations on suicide rates. Results: Suggestions from staff and service users have been incorporated into our questionnaires, and have informed the development of studies to address concerns in the field. We found health services that implemented most of our recommendations saw significant decreases in suicide rates in comparison with services that did not implement recommendations. To date, 187 people have completed our stakeholder survey, and all mental health service providers in the UK have downloaded our toolkit. Conclusions: We recognise the need for a varied and comprehensive approach to ensure that research findings are useful to service providers, and are implemented by clinical services to help improve patient safety.


(316) OC-316. Acute use of drugs and/or alcohol and suicide attempts

Day: 10 | Time: 16:00 | Room: Sala 1

Speaker:
Alba Sedano Capdevila . Fundación Jiménez Díaz Hospital, Madrid- Spain

 Abstract:
INTRODUCTION AND AIM The acute use of substances in a suicide attempt (SA) has not been yet clarify (1). In this study we compare the characteristics of SA according type of drugs and/or alcohol previous use. METHODS 351 patients were evaluated after a SA and were divided according drugs and/or alcohol use previous to the SA in users (U) and non-users (NU) with the information of items 19 and 20 from Beck’s Suicide Intent Scale’s (2). Additionally, we made two groups among users: those who use substances as a trigger (facilitator substance use-FSU) and other uses (regular substance users-RSU). We collected information about sociodemographics, Beck’s Scale for Suicide Ideation (SSI), Beck’s Suicide Intent Scale (SIS) and Barrat’s Impulsivity Scale (BIS). RESULTS: 189 out of 351 patients (53.8%) had used substances before the SA. Regarding the intention of substance use, 124 (35.3%) were FSU and 65 (18.5%) were RSU. When we compared NU and U we found greater scores in NU for SSI in suicidal ideation intensity (4.6 vs. 5.51; p= 0.009); for BIS, in total BIS (57.65 vs. 55.60; p=0.043) and in unplanned-BIS (20.49 vs. 18.99; p= 0.003). When we divided our sample in 3 groups, we found differences between NU, FSU and RSU for: SSI, in total SSI (17.83, 20.55, 17.72; p=0.059), suicidal ideation (4.60, 5.91, 4.8; p=0.03), suicidal features (3.85, 4.67, 3.27; p=0.03) and suicidal preparation (1.52, 1.96, 1.03; p=0.07); for BIS in total BIS (57.65, 54.36, 58.02; p=0.006), BIS-motor (21.94, 20.70, 23.50; p=0.003) and BIS-unplanned (20.49, 18.79, 19.38; p=0.009) and for SIS (9, 13.24, 12.58; p=0.000) CONCLUSION: When we consider the intention of substance use, we find greater scores in suicide risk assessments in those patients who use substances as a facilitator. This finding highlights the importance of the role of acute use of substances in SA.


(317) OC-317. Epidemiology of suicide risk in Andalusia: The PISMA-ep Study

Day: 10 | Time: 16:00 | Room: Sala 4

Speaker:
Berta Moreno Küstner . Universidad de Málaga. Facultad de Psicología, Málaga

 Abstract:
Epidemiological studies that take into account the prevalence and factors associated with suicide risk in different populations are scarce, and there are no previous studies on this reality in Andalusia (southern of Spain). This research aims to show the prevalence and associated factors of suicide risk. The study is a cross-sectional household survey conducted on a representative sample of noninstitutionalized adults aged 18-75 year of both sexes. 4507 subjects were interviewed using the Mini International Neuropsychiatric Interview (MINI) to assess the prevalence of current suicide risk in Andalusia. Standardized instruments were employed to evaluate the impact of the following independent variables on suicide risk: demographic variables (age, gender, marital status, employment status, education level, town size and province), psychosocial variables (stressful life events, childhood experiences of physical, emotional or sexual abuse, level of personal and social functioning, social support and personality traits: neuroticism and impulsivity) and clinical variables (family history of family history of mental disorder, suicide in first-degree family members, nicotine alcohol abuse, other drugs dependence). The prevalence of current suicide risk was calculated (IC; 95%). The chi-square test and Student t test was used for univariate analysis. Finally a multivariate logistic regression analysis multivariate logistic regression was used to model suicidal risk as a function of each independent variable.6.4 % of the sample showed current suicidal risk. The results of the multivariate model indicated that associations with the current suicide risk were being female, being older, being divorced / separated / widowed / single, family history of mental illness, greater number of stressful life events, less social support levels, higher level of neuroticism, high alcohol consumption, dependence on nicotine or other drugs. This is the first epidemiological study in Andalusia on suicide risk, offering important results of clinical interest for suicide prevention.


(318) OC-318. Differentiating adults who think about self-harm from those who engage in self-harm: the role of alcohol-related thought and actions

Day: 10 | Time: 08:00 | Room: Sala 5

Speaker:
Ambrose Melson . University of Glasgow, Glasgow - UK

 Abstract:
Background/aims: Self-harm is a pressing public health concern and self-harm episodes often occur during or following alcohol use. However, little is known about the psychological mechanisms associated with alcohol use that may propel some with thoughts of self-harm to act on those thoughts. This study investigated alcohol-related factors in adults who experience self-harm thoughts compared with those who engage in self-harm. Methods: 1444 healthy adults completed measures of self-harm, lifestyle and alcohol-related psychological factors. Analyses compared self-harm ‘enactors’ (n = 320), ‘ideators’ (n = 273) and those without ideation or enaction (n = 851). Results: Alcohol-related factors differentiated self-harm enactors and ideators in initial models adjusted for demographics and depression. Enactors reported behaving more impulsively after consuming alcohol, binge drinking more often and they held stronger self-reinforcing expectancies about the effects of consuming alcohol for specific domains of behaviour, cognition and mood (‘self-perception’, ‘risk and aggression’, ‘self-harm’). Consistent with theoretical models positing phase-specific moderators of self-harm ideation and enaction, factors associated with developing self-harm ideation (perceived stress, self-esteem, social support, mood-regulation-expectancies, optimism) did not differentiate enactors and ideators. Factors independently associated with enaction were demographics (younger, female), greater alcohol-related impulsivity, binge-drinking and stronger alcohol expectancies relating to self-harm (p=0.066). Gender differences were evident. Female enactors additionally held stronger ‘liquid courage’ alcohol expectancies than ideators, but the association was not independent of other factors and the alcohol-related impulsivity and self-harm relationship was attenuated (p=0.083). Male enactors unexpectedly held lower liquid courage expectancies than ideators; together with age, alcohol-related impulsivity and binge drinking these were independently associated with self-harm status. Conclusion: Management of self-harm requires better understanding of the factors associated with the enaction of self-harm. Psychological factors involved in alcohol use represent a promising line of enquiry for improving understanding of the mechanisms by which self-harm thoughts may become self-harm acts.


(319) OC-319. Self-poisoning with medication: a national study on the incidence, comorbidity and repetition

Day: 09 | Time: 08:00 | Room: Sala 4

Speaker:
Ping Qin . National Center for Suicide Research and Prevention, University of Oslo, Norway

 Abstract:
Background: Medication poisoning is a common method for deliberate self-harm in adult population. A better understanding of this problem is essential in prevention of suicide and self-harm and in management of the patients. In this study, we want to use data from Norwegian national registries to gain firm insights on poisoning with medications with regard to the incidence, comorbidity and repetition in the population. Methods: We retrieved all treatment contacts because of medication poisoning (T4n) by individuals of 10+ years old during 2008-2013. We obtained clinical data on diagnoses, urgency of contact, etc., along with sex, age and common socioeconomic status of the patients. Results: We identified 31 309 incident contacts because of self-poisoning with medication during the 6-year period. On average, 1678 males and 2714 females were treated for medication poisoning each year, corresponding to an annual incidence of 78.4/100 000 males and 126.2/100 000 females. A comorbid diagnosis of psychiatric illness was present in 45.7% of male and 49.6% of female contacts, with a higher proportion in patients of middle age. Meanwhile, a supplemental diagnosis of suicide attempt was present in 36.9% of female and 26.3% of male contacts, and this diagnosis was most frequent in patients of young ages. During the study period, 17.2% of the patients repeated poisoning with medication. The risk for repetition was significantly higher in females and in patients of younger ages. Moreover, psychiatric comorbidity and suicide attempt at the index poisoning were strong predictors for the repetition, and their effects were comparably strong regardless of sex and age. Conclusion: Medication poisoning is an important health problem, especially in female and young populations. Assessment of psychiatric illness and suicidal intention is crucial in treatment of the patients and in efforts to prevent repetitions.


(320) OC-320. An alternative approach for suicidal people at risk of detention; findings from the evaluation of The Place of Calm

Day: 10 | Time: 14:30 | Room: Sala 4

Speaker:
Stephen Briggs . University of East London, London - UK

 Abstract:
Local initiatives are important for people who attempt suicide in public places (Owens et al 2015). Eastbourne (UK) has elevated suicide rates, due to the proximity of Beachy Head, which many people travel to with suicide in mind. The Place of Calm, as one strand of an overarching plan to reduce suicides in the area, offers a stay of up to 24-hours, and provides practical and emotional support through a peer recovery model. Method: This paper discusses findings from the Place of Calm’s initial year of operation. Evaluation methods included case-notes analysis, semi-structured interviews with guests, referrers and staff, analysed by thematic analysis. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS), completed by guests on arrival and on leaving was analysed quantitatively. Results: Guests reported high-levels of satisfaction with the Place of Calm, including both emotional and practical support from peer recovery workers. Suicidal feelings reduced during the stay. Thematic analysis identified two categories of guests: firstly, those with recent only, or intermittent lifetime suicidality (Recent group); WEMWBS showed a statistically significant improvement in wellbeing, and guests reported the Place of Calm having longer-term impact on reducing suicidal thoughts. Individuals with long-term mental health difficulties, extensive service use, and recurring suicidal feelings (Continuous group) reported short-term relief from suicidal feelings and mental health improvement during the stay, but felt they needed a longer stay and more support afterwards. Conclusions: The Place of Calm offers a viable alternative approach for suicidal people. Initial findings for acceptability and outcomes are consistent with previous evaluations of similar resources (Briggs et al 2007). References: Briggs, S., et al. (2007) Maytree: A respite centre for the suicidal: An evaluation, Crisis: 2007 Vol 28(3) 140-147 Owens, C (2015) Preventing suicides in public places, a practice resource, PHE publications gateway number: 2015497


(321) OC-321. The pattern of hospital repeated presentations due to self-harm among young people

Day: 10 | Time: 08:00 | Room: Sala 5

Speaker:
Marco Bennardi . National Suicide Research Foundation, Ireland

 Abstract:
Objective To date no study with full national coverage has examined the pattern of hospital repeated presentations due to self-harm among young people. Method Data on consecutive self-harm presentations were obtained from the National Self-Harm Registry Ireland. Socio-demographic and behavioural characteristics of 10-to-29-year-old individuals who presented with self-harm to emergency departments in the Republic of Ireland between 2007 and 2014 were analysed. Risk of long-term repetition was assessed using survival analysis. The relation between period of time within first presentations and frequency of repetition was examined using Generalised Estimating Equation Analysis. Results The total sample comprised 28,700 individuals involved in 42,642 presentations. Self-harm was more prevalent among females, adolescents and younger emerging adults compared to children and older emerging adults. Intentional drug overdose was the most prevalent method (57.9%). Self-harm repetition occurred in 19.2% (N=2,630) of individuals. The majority (62.7%) of individuals repeating engaged in one repeated self-harm act within one year following their first presentation. Overall, the risk of repeated self-harm was similar for males and females. However, in the 20-24-year-old age group males were at higher risk than females (p= 0.047). Patients engaging in self-cutting were at higher risk of repetition compared to those using another method. A dose-response relationship was found between the number of previous self-harm acts and the number of future acts. Among low frequency repeaters, time between second and third presentation was longer than time between first and second presentation, whereas among high frequency repeaters this period was shorter. Conclusion To prevent risk of repeated self-harm in young people, all individuals presenting at emergency departments due to self-harm, should be provided with a risk assessment. In recommending interventions for self-harm, history of self-harm and potential risk of future repetition should be considered.


(328) OC-328. Cost-effectiveness of psychosocial therapy provided to persons after deliberate self-harm: a register-based, nationwide multicentre study using propensity score matching

Day: 09 | Time: 08:00 | Room: Sala 3

Speaker:
Annette Erlangsen . Research Unit, Mental Health Centre Copenhagen, Copenhagen, Denmark

 Abstract:
BACKGROUND Deliberate self-harm is a strong predictor of repeat self-harm as well as death by suicide. Effective risk management for people after an episode of self-harm is indicated. However, the evidence of effective interventions is meagre. In Denmark, psychosocial therapy has been provided to people at risk of suicide in specialised clinics in Denmark since 1992 to persons at risk of suicide. The aim of the study was to examine whether a provided psychosocial therapy after an episode of deliberate self-harm is cost-effective when comparing subsequent hospital-based care of those who received the therapy with who did not. METHODS Clinical data on people who received psychosocial therapy was obtained from the suicide preventive clinics while information on socio-demographics and hospital data were obtained from nationwide register data. Annual hospital fees for care in somatic and psychiatric hospitals and emergency departments (ED) were combined with individual-level data on hospital usage. Costs were broken down by somatic and psychiatric contacts as well as inpatients, ED, and outpatient contacts, respectively RESULTS All persons receiving who received psychosocial therapy after an episode of deliberate self-harm (n=5,678) at seven of eight suicide prevention clinics in Denmark during 1992-2010 were compared to persons who did not receive the intervention after deliberate self-harm (n=58,282). Using a 1:3 ratio, 17,034 persons from the comparison group were matched on observed characteristics. A total of 42,828 person-years were observed for the persons who received psychosocial therapy. The preliminary findings show a substantial reduction in number of somatic and psychiatric bed days as well as ED contacts while an increased usage of psychiatric outpatient care by those who received the intervention when compared to those who did not. At the time of the conference, final results will be available.


(338) OC-338. Profile of Suicides during Economic Recession and Recovery: A Comparison using Coroners? Records in Ireland

Day: 10 | Time: 16:00 | Room: Sala 4

Speaker:
Ella Arensman . National Suicide Research Foundation, Cork, Ireland

 Abstract:
Introduction: Monitoring the incidence and characteristics of suicides constitutes an important element of suicidology. In many countries and particularly among men, the incidence of suicide increased in the period of economic recession after 2008. Less is known about the characteristics of suicides during the recession compared with the characteristics of those that occurred during the subsequent economic recovery. Changes to the risk profile of suicide between recession and recovery would have implications for suicide prevention policy and practice. This paper compares characteristics of recession-era suicides (n=307) to post-recession suicides (n=121) in Cork, Ireland. Methods: As part of the Suicide Support and Information System, consecutive coroners’ records of suicides and probable suicides were reviewed for demographic, psychosocial, and psychiatric characteristics. Coroners’ records include family and witness statements, medical records, police summaries, post-mortem reports, and toxicology analysis results. Included cases went to inquest from 2008-2012 (“recession-era”) and 2014-2016 (“post-recession”) in Cork (population 119,230). Proportions with 95% confidence intervals were compared between the two groups of cases. Results: Compared with recession-era suicides, post-recession suicides were slightly more likely to be male, older, single, and to have left a suicide note, but less likely to be in paid employment or to have alcohol in their toxicology. However, none of these differences reached statistical significance (p<0.05). Hanging was the most common method in both time periods and did not significantly differ between the two. Conclusions: Although rates of suicide increased during the recession, the characteristics of suicides in Cork, Ireland do not appear to have changed significantly between recession and recovery. Our findings suggest that middle-aged males continue to be a group at risk of suicide, even at a time of economic recovery. Hanging remains the predominant suicide method used, indicating limits to means restriction in this population.


(346) OC-346. Influence of air temperature on patterns of hospital-treated self-harm presentations in Ireland.

Day: 10 | Time: 08:00 | Room: Sala 3

Speaker:
Christina Dillon . NATIONAL SUICIDE RESEARCH FOUNDATION, CORK

 Abstract:
Introduction Self-harm is a major public health issue having significant impact on quality of life, health status and future risk for suicide. Rising air temperatures have been found to significantly impact health and have previously been shown to be associated with variations in rates of suicide. The aim of this study was to examine the association between air temperatures (oC) and patterns of hospital-treated self-harm, with a particular focus on methods of self-harm. Methods Data on self-harm presentations to all emergency departments (EDs) from 2010-2013 were obtained from the National Self-Harm Registry Ireland. Daily meteorological data are recorded across all counties in Ireland by Met Eireann. Regression analyses were used to explore the association between method of self-harm and air temperature. Results A total of 44,464 self-harm acts presented to EDs between 2010 and 2013. The most common methods of self-harm recorded were drug overdose (70%) and self-cutting (23%), with alcohol present in 39% of all presentations. Attempted hanging, drowning and self-poisoning were less commonly recorded (6%, 3% and 2%, respectively). Higher air temperature was associated with higher numbers of self-harm presentations. Overall, a one unit increase in air temperature was associated with an increase of ten presentations of self-harm per month. Statistically significant associations were observed between rising air temperatures and method of self-harm. A one unit increase in air temperature was significantly associated with seven, five, two and one additional cases of overdose, alcohol, drowning and self-cutting per month respectively (P<0.02). No statistically significant differences were observed for poisoning and hanging methods of self-harm. Conclusion Air temperature was found to be significantly associated with an increase in the number of self-harm presentations and method of self-harm utilised. Further research is warranted to explore the relationship between meteorological factors and suicidal behaviour.


(348) OC-348. An approach to suicide attempts in a psychiatric interconsultation service

Day: 10 | Time: 08:00 | Room: Sala 3

Speaker:
Rafael Ángel Baena Mures . Hospital Universitario Clínico San Carlos, Madrid-Spain

 Abstract:
The OMS ´s studies on mental disorders in suicidal behavior estimate that 60% of these patients have affective disorder, most fall into major affective disorder (TAM), followed by personality disorders (TP) and disorders impulse control. OBJECTIVES To analyze the prevalence of various psychiatric diagnoses in attempts interconsultation served in a general hospital during 2014 and compare it to other specific studies. METHODOLOGY Make a retrospective study with 2014´s patients admitted to hospital for injuries on the suicide attempt. RESULTS: Out of a total of 23 patients, 12 (55%) had symptoms of affective spectrum, diagnosed with TAM 5(24%) and adaptive disorder 7(31%). The personality disorder were second, followed by non affective disorders. DISCUSSION The results corroborate previous studies. The most frequent diagnoses are mood disorders, followed by personality disorders and psychotic disorder, respectively. We note that in our sample was not the depressiver disorder predominant, but yes the adaptative disorder. This makes us consider the possibility of the existence of a change in the concept of suicide in the general population, the decreased tolerance to frustration and / or the advancement of the ideas of death in the course of affective pathology.


(350) OC-350. Mental health with net

Day: 10 | Time: 08:00 | Room: Sala de Cámara

Speaker:
Álvaro Rivera . Instituto Psiquiátrico Servicios Salud Mental José Germain, Madrid
José Manuel Carrascosa Bernáldez. Instituto Psiquiátrico José Germain, Leganés. Madrid

 Abstract:
The Community of Madrid included in its Mental Health Strategic Plan a programme, ARSUIC, (Suicidal Risk Assistance) aiming at those patients who after a suicide attempt and their aftercare at the Acute Psychiatric Hospitalization Units, so that they can receive medical care soon, in less than 7 days at their Mental Health Centre. In this study we have analysed all the appointments that have reached our Centre throw this channel, along 2015. This analysis has enabled us to know, not only whether the condition of making an appointment for the patient in less than 7 days had been achieved, but also the percentage of patients who, after having received their appointment, did not attend their meeting. The most worrying issue when analysing these findings, is the high percentage of absenteeism, due to the potential risk inherent to these patients. This piece of information has led us to define and implement new areas of improvement heading to achieve an effective follow-up of all these patients who do not attend their scheduled appointments. In order to implement those improvement areas, we are working togheter with the management and the Primary Care teams (GPs) in our health area. On the other hand, with those patients who had attended their ARSUIC appointments, some specific multidisciplinary programmes which could help us make a closer and deeper follow-up of their pathologies, will be developed.


(353) OC-353. "Reach OUT!" A regional study on prevalence, risk factors and protective factors for suicidal ideation and behaviour in LGBT people.

Day: 09 | Time: 08:00 | Room: Sala 5

Speaker:
Eva Dumon . VLESP (Flemish Suicide Prevention Centre), Belgium

 Abstract:
Background Lesbian, gay, bisexual, and transgender (LGBT) individuals have repeatedly been identified as being at risk for suicidal thoughts and suicidal behaviour. However, little is known about the contributing factors which increase the likelihood of suicidal ideation and behaviours in LGBTs. The present study was designed to identify the prevalence, risk factors and protective factors for suicidal ideation and behaviour in LGBT people in Flanders (Belgium). Method Between September 2015 and March 2016 a sample of 919 LGBT people (16-75 years old) were recruited to complete an anonymous online survey. The survey included questionnaires on sexual orientation and gender identity, risk factors, protective factors, coping strategies and suicidal ideation and attempts. The prevalence of suicidal thoughts and attempts were determined in the different subgroups (L, G, B, and T individuals) and risk and protective factors for suicidal thoughts and (lifetime) suicide attempts were identified, using a series of logistic regression analyses. Results 65.2% of the (non-transgender) lesbian, gay and bisexual individuals reported lifetime suicidal thoughts and 22.4% made one or more suicide attempts in the past. For transgender individuals, a prevalence of 80.3% was found for lifetime suicidal thoughts and a prevalence of 38.7% for one or more suicide attempts in the past. Results regarding risk and protective factors (such as self-acceptance, coming-out experiences, experiences of homo-or transphobia, social support, and coping strategies) will be discussed. Conclusions This study demonstrates that LGBT people are at increased risk for developing suicidal thoughts and behaviours, supporting previous research. An in-depth focus on both risk and protective factors make this study an important contribution to the knowledge on prevention of suicidal behaviour for this vulnerable population group.


(357) OC-357. Strengthening competencies and training police officers for suicide prevention

Day: 09 | Time: 08:00 | Room: Sala 4

Speaker:
Nuša Zadravec Sedivy . University of Primorska, Andrej Maru?i? Institute, Slovene centre for suicide research, Koper, Slovenia
Janina Žiberna . University of Primorska, Andrej Marušič Institute, Slovene centre for suicide research,
Vita Poštuvan . University of Primorska, Andrej Marušič Institute, Slovene centre for suicide research,
Nuša Konec Juričič . National Institute of Public health,
Mojca Vatovec . Slovene Association for Suicide Prevention – Posvet,
Bogdan Dobnik . National Organization for Quality of Life – OZARA,
Saška Roškar . National Institute of Public health,

 Abstract:
Police officers have become one of the frontline professionals who manage people when they are in crisis. They are often the first responders to deal with persons having mental health emergencies and for this reason an important component of effective community-based suicide prevention strategies. Objective of the study is to explore competencies and feelings among Slovene police officers while dealing with suicidal persons and to discuss the contribution and importance of the training programme for police officers in strengthening competencies and increasing the number of trained police officers for recognition of mental health distress and suicidal risk. As a part of project MOČ (Strength) — an integrative approach addressing public mental health by enhancing local health care support, spreading knowledge among professionals and empowering them to better cope with stressful situations, we conducted a 3-hour training programme with 6 groups of police officers with a total number of 103 participants. The training programme aimed to (i) strengthen competencies for better recognition of mental health problems and suicidal behaviour, (ii) provide knowledge on how to deal with suicidal persons. Participants’ feelings of competency and experiences with suicide-related situations were assessed prior the training and evaluation was conducted in the end of the training. Results show that 85.4% of the participants already have experiences with suicidal persons. However, they perceived their competencies and knowledge regarding suicidal behaviour as inadequate and they were willing to improve it. They also found dealing with suicidal persons rather difficult and they reported training programme as helpful to increase quality of their work and gaining better understanding of the topic. In the future, there is a need to establish an accessible training programme for all police officers in recognizing mental illness and knowing how to access mental health resources.


(358) OC-358. Predictive Models for Suicidal Thoughts and Behaviors among Spanish University Students: the UNIVERSAL (University & Mental Health) Project

Day: 10 | Time: 08:00 | Room: Sala 1

Speaker:
Jordi Alonso . IMIM-Hospital del Mar Medical Research Institute-CIBERESP, Barcelona - SPAIN

 Abstract:
Background/Aim: Suicide is a leading cause of death among young people and longitudinal evidence is needed to identify risk and protective factors associate with suicidal thoughts and behaviors. Here we present the UNIVERSAL (University and Mental Health) project, which aims to estimate frequency of suicidal thoughts and behaviors among university students in Spain and to identify their risk and protective factors. Methods: Multicenter, observational, prospective cohort study of first year university students in 5 Spanish universities. Students are assessed annually during a 36 month follow-up. The surveys are administered through an online, secure web-based platform. A clinical reappraisal of a subsample of respondents is included. Suicidal thoughts and behaviors are assessed with the Self-Injurious Thoughts and Behaviors Interview (SITBI) and the Columbia-Suicide Severity Rating Scale (C-SSRS). Risk and protective factors include: mental disorders, measured with the Composite International Diagnostic Interview version 3.0 (CIDI 3.0) and Screening Scales (CIDI-SC), and the Epi-Q Screening Survey (EPI-Q-SS), socio-demographic variables, self-perceived health status, health behaviors, well-being, substance use disorders, service use and treatment. UNIVERSAL is part of the International College Surveys initiative of the World Mental Health (WMH) consortium. Expected results: Lifetime and the 12-month prevalence will be estimated for suicide ideation, plans and attempts. Cumulative incidence of suicidal thoughts and behaviors, and mental disorders will be measured using the actuarial method. Risk and protective factors of suicidal thoughts and behaviors will be analyzed by Cox proportional hazard models. Discussion: The study will provide for the first time data on suicidal thoughts and behaviors in Spanish university students. This innovative information will be useful for developing suicide prevention programs among youth. The World Mental Health Survey collaboration will permit accurate cross-national comparisons. FUNDING: ISCIII (CM14/00125 and CD12/00440), ISCIII- FEDER (PI13/00343), PNSD (Exp. 2015I015); AGAUR (2014 SGR 748).


(359) OC-359. Suicide Sleep Monitoring (SSleeM): a feasibility and acceptability study of a wearable sleep tracking monitoring device in suicide attempters

Day: 10 | Time: 08:00 | Room: Sala 1

Speaker:
Elise Guillodo . Psychiatric Unit of the University Hospital, Brest - France

 Abstract:
Elise Guillodo (1), Sofian Berrouiguet (1), Mathieu Simonnet (2), Ismael Conejero (3), Philippe Courtet (3), Enrique Baca Garcia (4), Romain Billot (2), Philippe Lenca (2), Michel Walter (1) (1) Brest, (2), Telecom-Bretagne, (3) Montpellier, (4) Madrid Introduction Sleep disturbances are associated with an increased risk of suicidal behavior. The evidence primarily stems from studies based on questionnaires about sleep quality and duration. In recent years, the availability of wearable health technology has increased and offers an inexpensive, appealing, and accessible way to measure sleep. Our aim is to assess the feasibility and acceptability of wearable sleep tracking monitoring devices in a sample of suicide attempters and healthy controls. Methods A prospective, open-label, 12-months study will be conducted in the emergency department (ED) and psychiatric unit (PU) of the University Hospital of Brest, France. Inclusion criteria are male or female, aged 18 or over, surviving a suicide attempt, discharged from ED or PU, with an Internet connection via Wi-Fi, and giving consent. The sleep tracker and a smartphone will be given to the patient after discharge. He or she will receive brief training on how to use the sleep tracker. Patient will be asked to monitor their sleep during the two weeks following the discharge. The feasibility will be explored by analysing the data proceeding from the sleep tracker. The acceptability will be assessed during the two-weeks follow up visit, using a standardized questionnaire. We also will perform a similar assessment in a group of 10 healthy controls recruited via announcement in social networks. Results : Preliminary results of this ongoing study show that feasibility and acceptance may be related to technical features of wearable devices. Discussion A better understanding of the bidirectional mechanism between sleep disturbances and suicide behavior will allow the design of tailored interventions to prevent suicide attempts.


(370) OC-370. Experiences of parents whose children have attempted suicide: What is already known and what is unknown?

Day: 10 | Time: 08:00 | Room: Sala 4

Speaker:
Ines Rothes . Faculty of Psychology and Educational Sciences of Porto University, Portugal , Porto

 Abstract:
GOAL: The goal of the presentation is to provide a broad and systematic overview of what is empirically known about the experiences of parents whose sons or daughters have attempted suicide, based on a systematic review. The study explored how parents react to this experience and the emotional impact this experience has on them. METHODOLOGY: This systematic review was conducted using the principles of the PRISMA statement (Moher, Liberati, Tetzlaff et al., 2009). The studies included in this review were identified using EBSCOhost. More than 15 databases were searched, including: MEDLIN, PsycARTICLES, PsycINFO, ERIC, Academic search complete, CINAHL Plus with Full Text, Education Source, Psychology and Behavioural Sciences Collection and SocINDEX. The literature was searched from 1960 to the present. The articles that fulfilled the inclusion criteria were subjected to a qualitative analysis. Inclusion criteria: (a) Studies having as main focus the impact, the experience, the reactions, the difficulties, the needs or the perspective of parents towards the suicide attempt of a son or daughter; (b) English, French, Spanish and Portuguese articles; (c) articles of primary research. RESULTS: A diagram illustrating the process of identification, screening, eligibility assessment, and inclusion of studies with the corresponding N will be presented. As main results it will be emphasized the disturbing effect of this experience for the parents, who questioning their parenting sense of competence, and the psychosocial impact of this experience in the family well-being. The implications of the results for future research will be approached.


(378) OC-378. The importance of gatekeeper training as part of national strategies to prevent suicide

Day: 10 | Time: 16:00 | Room: Sala 4

Speaker:
Martin Steendam . MHC GGZ Friesland, Netherlands

 Abstract:
In the Netherlands 1,650 people commit suicide annually, around 100,000 attempt suicide, 14.000 visit an ED and 462,500 suffer from suicidal ideation. Many people who are suicidal do not seek treatment. The inclination not to seek help is one of the core symptoms of the suicidal syndrome.
 Goals:
The project addresses three questions: • Is gatekeeper training effective in enhancing relevant skills? • Does the intervention impact on rates of (attempted) suicides at regional level? • Is the intervention cost-effective relative to routine medical care?
 Methodology:
The GPS study - in collaboration with Prof. Dr. AJFM Kerkhof and VU Amsterdam - envisions the evaluation of an intensive skills training program for gatekeepers to prevent suicide. The project started in April 2012. The gatekeeper training has been delivered in two Dutch regions. Together they cover about 8 percent of the Dutch population. Outcome measurements: • ATTS and referral behavior • Changes in rates of suicide-attempts between trained regions and control regions. • Calculation of incremental cost-effectiveness ratios
 Results:
More than 1,000 people have been trained as gatekeepers during the inclusion period (August 2013 till January 2015). First results will be presented about the effectiveness of the training.
 Conclusiones:
The importance of gatekeeper training as part of national strategies to prevent suicide was underlined by UN in 1996 and WHO in 2012. Every country should maintain a comprehensive training program for identified gatekeepers (e.g. police, educators, mental health professionals). The effects of gatekeeper training on competence, referral behaviour and rates of attempted suicide will be discussed.
 Bibliography:
• M. Steendam, Clinical psychologist Mental Health Center GGZ Friesland, PhD candidate VU Amsterdam • A.J.F.M. Kerkhof, Professor of Clinical Psychology, VU Amsterdam • F. Smit, Professor of Evidence-Based Public Mental Health, VU Amsterdam • A. Verhoeff, Professor of Urban Health and Health Care, UVA Amsterdam • A. de Keijser, Professor Cilinical Psychology, RUG Groningen


(381) OC-381. Social response of environemnt as a part of suicide bereavement process in Growing flower model

Day: 09 | Time: 08:00 | Room: Sala 5

Speaker:
Vita Poštuvan . Slovene Centre for Suicide Research, Andrej Marusic Institute, University of Primorska , Koper

 Abstract:
Suicide survivors experience many emotions during the process of bereavement. These can be conceptualised or understood in different ways. The aim of the presentation is to understand the experiences of bereaved in accordance to their relationship to their environment. The qualitative study design based on 16 semi structured interviews analysed according to grounded theory method. We identified five main topics explaining how suicide survivors perceived the importance of social interactions. They reported of feeling that people consisting of social network many times (i) avoided the topic of suicide, they felt that others (ii) experienced uneasiness and used cliches, some were (iii) looking for the guilty one for suicide and other (iv) were looking for reasons how to uderstand suicide. Also some reported that (v) honest support was offered to them. We conceptualised the importance of social network in experiences of suicide survivors within the Growing flower model of reintegration and bereavement after suicide. The findings suggest that working with suicide bereaved is not enough. Our activities must raise the awareness about bereavement and suicide in lay public. Thus, the topic must become one of the public-health concerns.


(382) OC-382. Prevalence and related factors of Suicidal Thoughts and Behaviors among Spanish University Students: Results of UNIVERSAL (University and Mental Health) Project.

Day: 10 | Time: 16:00 | Room: Sala 4

Speaker:
Maria Jesús Blasco . Hospital del Mar Medical Research Institute (IMIM), Spain

 Abstract:
BACKGROUND: Prevalence and risk factors for suicidal thoughts and behaviors among university students are not well-known in Spain. AIMS: To estimate lifetime and 12-month prevalence of suicidal ideation, plans and attempts and related factors among first year Spanish university students. METHODS: UNIVERSAL project is a multicentre prospective cohort study from 5 Spanish universities (Cádiz, Illes Balears, Miguel Hernández, Basque Country and Pompeu Fabra). Participants fulfilled an online survey (October 2014 to August 2015). Lifetime and 12-month suicidal thoughts and behaviors were assessed with adapted items from “Self-Injurious Thoughts and Behaviors Interview” (SITBI) and “Columbia-Suicide Severity Rating Scale” (C-SSRS). Socio-demographic and sintoms of mental disorders were evaluated. RESULTS: 2,155 participants completed the suicidal thoughts and behavior section in the survey (RR= 12%). Mean age was 18.6 years (SD=1.2), and 72.2% were females. Lifetime prevalence estimates of suicidal ideation (33.7%), plans (15%) and attempts (2.2.%); and for 12-month prevalence: suicidal ideation (14.9%), plans (6.4%) and attempts (0.6%). No statistically significant differences by sex were found. Mean age of onsets were: suicidal ideation 14.8 (SD = 2.6), plans 14.8 (SD = 2.4), and attempts 15. 1 (SD = 2.3) years-old. Among the 33.64% of students with any lifetime thought or behavior, the majority (76.6%) had not received any psychological or pharmacological treatment. Students with lifetime symptoms of any mental disorder were more likely to report any 12-month suicidal behavior (OR=5.1 95%CI 3.9-6.7). CONCLUSIONS: A high prevalence of suicidal thoughts and behaviors in first year university students was observed. In this population, awareness of suicidal thoughts and behaviors must be raised to improve suicide prevention. FUNDING: ISCIII (CM14/00125 and CD12/00440), ISCIII- FEDER (PI13/00343), PNSD (Exp. 2015I015); AGAUR (2014 SGR 748)


(385) OC-385. Successful suicide prevention in Estonia

Day: 10 | Time: 08:00 | Room: Sala de Cámara

Speaker:
Merike Sisask . Estonian-Swedish Mental Health and Suicidology Institute (ERSI) AND Tallinn University, Tallinn
Airi Värnik . ,

 Abstract:
Suicide rate in Estonia has decreased tremendously during the last two decades – from 42.1 per 100,000 in 1994 to 18.0 in 2014 (source: Estonian Statistics). Although there has never been officially approved suicide prevention strategy in Estonia, a lot of systematic activities have been implemented since the Estonian-Swedish Mental Health and Suicidology Institute (ERSI) was established in 1993. The key factors of successful suicide prevention in Estonia are: -- Overall socio-political stabilisation in Estonia after transition period -- Establishment of ERSI in 1993, support from the National Swedish Prevention of Suicide and Mental Ill-Health (NASP), Stockholm Care, Stockholm County Council, Swedish Eastern European Committee -- From rejection to appreciation of the subject in the Estonian society -- Work has gradually shifted towards earlier stages of suicidal process and towards promotion of mental health in general -- Involvement in the WHO and EU projects (Public Health Programme, FP7) and International networks on suicide prevention and mental health promotion -- Systematic initiatives implemented by ERSI: - Trainings on suicidology for different target groups (primary care specialists, gatekeepers, volunteers, university students etc) - Establishment of Estonian Lifeline (Eluliin) in 1995 (currently independent NGO) - Consultations and supervision for medical staff and other specialists - Public relation activities and media work to increase awareness and to diminish taboo and stigma concerning suicidal behaviours - Information to politicians and decision-makers, involvement in expert groups - Draft of national suicide-prevention programme and action plan in 2001 (although officially never approved) - Various international conferences and workshops on suicidology held in Tallinn (the latest in 2014, ESSSB15, www.esssb15.org) - High-level research (epidemiological, clinical, community based interventions)


(387) OC-387. Increase of self-perceived competence for management of suicidal people among Slovenian psychologists, participating in the SUPER PSYCHOLOGIST project

Day: 09 | Time: 08:00 | Room: Sala 1

Speaker:
Tina Podlogar . UP IAM Slovene Centre for Suicide Research, Slovenia
Urša Mars Bitenc . UP IAM Slovene Centre for Suicide Research,
Vita Poštuvan . UP IAM Slovene Centre for Suicide Research,
Katarina Kocbek . University of Ljubljana, Faculty of Arts,
Vlasta Zabukovec . Slovenian Psychologists’ Association,
Mateja Štirn . ISA institute,
Mona Duckert . Norwegian Psychological Association,
Bjarte Kyte . Norwegian Psychological Association,
Anja Podlesek . University of Ljubljana, Faculty of Arts,

 Abstract:
Background For many psychologists, working with suicidal people can be one of the most stressful parts of their work; however, adequate management of these individuals is of crucial importance. Therefore, it is necessary to study and enhance psychologists’ competences in this field. SUPER PSYCHOLOGIST is a project of a one-year professional development for psychologists and combines supervised practice for young psychologists and educational programme for mentors, which includes group supervisions and educational workshops. The project was first launched in 2015 and was funded by the Norway grants and national funds. The aim of this study was to assess levels of self-perceived competence for working with suicidal people among psychologists, participating in the project. Specifically, we were interested if psychologists’ self-assessment of their competences increased after the educational workshops, in comparison to their previous self-assessment. Methods We used Risk Assessment and Management Self-Efficacy Scale RAMSES, consisting of three sub-scales: risk assessment, case management and application of interventions; each assessing the self-perceived competence of applying these aspects in management of suicidal behaviour. The participating psychologists filled in the questionnaire before and after implementation of the educational workshops. Results Nonparametric tests revealed statistically significant before-after differences in self-assessed competences regarding all three aspects of working with suicidal people, showing that psychologists in general felt more competent in risk assessment, case management and application of interventions after participating in the workshops than previously. The effect sizes were medium to large. Conclusions Participation in the project might have influenced the increase of self-perceived competence for management of suicidal people among psychologists. Several types of activities within the project could be connected to this growth in self-confidence; educational workshops, among which one was specifically focused on suicidal behaviour, and also group supervisions at which different topics were addressed.


(395) OC-395. Is there anybody out there? Self-Disclosure as a moderator of Stress-Related Growth among Suicide Survivors

Day: 09 | Time: 8:00 | Room: Sala de Cámara

Speaker:
Yossi Levi-Belz . Ruppin Academic Center, Israel

 Abstract:
This study examined to what extent can suicide survivors experience growth in the aftermath of suicide loss, as well as the role of self-disclosure and coping strategies in stress-related growth (SRG) among suicide survivors, compared to bereavement following sudden and expected death types. One hundred forty-five bereaved individuals (aged 18-73) completed questionnaires measuring SRG, self-disclosure, and coping strategies. Significant interaction between self-disclosure and types of death was found, in which suicide survivors with low levels of self-disclosure manifested the lowest level of SRG compared to other subgroups. This finding suggests that sharing intimate information can be beneficial in struggling with a situation of suicide in the family.


(425) OC-425. Suicide Prevention in Doctors.

Day: 10 | Time: 08:00 | Room: Sala 3

Speaker:
Matilde Hernández . PAIME-ICOMEM / OMC,
Carlos Mingote . ,

 Abstract:
“Suicide Prevention in Doctors” This paper focuses on stress, burnout and suicide in the medical profession and how they can be prevented. Herbert Freudenberger (1974) described “burnout syndrome” as a state of exhaustion or frustration resulting from dedication to a cause, way of life, or relationship that does not result in the expected reinforcement. It is more frequent in helping professions, where facing intense emotions of pain, disease, and/or psychological suffering is common and may lead to negative attitudes and behaviour towards the work, patients, colleagues or relatives. It can also harm self-image and result in absentism, alcohol abuse, depression, etc ... with significant repercussions in terms of personal suffering, family disturbance, malpractice, and work related problems. Despite considerable and increasing evidence that morbidity and mortality are high in the profession and of the severe physical, mental and social consequences that toxic stress entails for the individual, doctors are often reluctant and delay asking for help. Resistance may be related to fear of professional consequences and may lead to self-medication, chronicity, complications and suicide. It also entails negative consequences for patients, colleagues and the employing organization and must be addressed globally. In the second part, the specific factors related to the higher rates of suicide among doctors, even higher in female physicians, than in the general population and other professions will be discussed. Access to means is clearly an important factor, particularly for anaesthetists, dentists and psychiatrists but others are also relevant and many are related to stress.


(428) OC-428. Predicting suicide risk in emergency responders using alexithymia

Day: 10 | Time: 08:00 | Room: Sala 3

Speaker:
Derrick L. Edwards . Tennessee Technological University, USA
Mark Loftis . Tennessee Technological University, USA

 Abstract:
Emergency responders, including firefighters and emergency medical personnel, work in highly stressful environments, and are frequently subjected to repetitive traumatic events. According to the United States Institute of Medicine (2007) this repeated exposure to stress places emergency responder at risk for a stress related psychological injury. As a result, emergency responders experience pathological behaviors such as domestic violence, drug and alcohol abuse, and suicide.
 Goals:
The currently study evaluated the ability to predict suicide risk through the measurement of alexithymia, as described by Sifneos (1972).
 Methodology:
A final sample of 653 emergency responders consisting of firefighters, emergency medical personnel, and rescue members were recruited, through an email distribution campaign, to complete a web-based survey .The Suicide Behaviors Questionnaire – Revised SBQ-R) and the Toronto Alexithymia Scale – 20, (TAS-20) were used in the study.
 Results:
The majority of the participants were male (68%) and Caucasian (93%). Age of participants averaged 41 (SD = 11.9) years and ranged from 20 to 74. Based on the cutoff score of 7, for the SBQ-R, 28% (n = 185) of participants were at risk of suicide. The average SBQ-R score for all participants was 5.6 (SD = 2.8). Alexithymia scores of the current sample (M = 50.8) were slightly elevated and approached the “non-alexithymia” range cutoff of 51. A moderate correlation was found between alexithymia and suicide risk (r = .38, p < .001). When combined with participant age, alexithymia accounted for 15% of suicide risk variance F(1, 651) = 115.13, p < .001.
 Conclusiones:
Alexithymia was found to be a significant predictor of suicide risk in emergency responders. This prediction was strengthened by the inclusion of basic demographic information. Emergency responder suicide risk should be evaluated at several intervals throughout employment, and the relative ease of obtaining an alexithymia score increases its utility during these evaluations. Furthermore, several researchers have developed treatment protocols specifically designed to decrease levels of alexithymia. Accordingly, these treatment protocols may have an ancillary, and previously unexplored, benefit of suicide risk reduction. Further research in this field is indicated. Other emotional personality traits should be explored for their contribution to emergency responder suicide rick
 Bibliography:
Institute of Medicine. (2007). Emergency medical services at the crossroads: Future of emergency care. Washington, DC: National Academies Press.

Sifneos, P. (1972). Short-term psychotherapy and emotional crisis. Cambridge, MA:
Harvard University Press




Clinical phenotyping of suicidal individuals


(157) OC-157. Dissociation, suicide attempts and non-suicidal self-injury: meta-analyses

Day: 10 | Time: 08:00 | Room: Sala 1

Speaker:
Raffaella Calati . INSERM U1061, La Colombière Hospital, University of Montpellier UM1, Montpellier, France, Montpellier, France

 Abstract:
Dissociative disorders (DD) are frequently associated with suicidal behaviors. We performed the first meta-analysis of studies comparing rates of suicide attempts (SA) and non-suicidal self-injury (NSSI) in psychiatric individuals with and without DD.
We searched MEDLINE and PsycINFO (March 2016) for: 1) studies comparing SA and NSSI rates in psychiatric individuals (borderline personality disorder, major depressive disorder, alcohol or drug dependence, schizophrenia, panic disorder, conversion disorder, gender dysphoria) with and without DD; 2) studies comparing Dissociative Experiences Scale (DES) scores in both SA and NSSI patients versus non SA and non NSSI ones. Data were analyzed with Cochrane Collaboration Review Manager Software (RevMan, version 5.3). We assessed the methodological quality of the studies with the STROBE statement.
Of the 19 included studies, eleven focused on previous SA and DD while six focused on NSSI and DD. DD patients were more likely to report both previous SA (p<0.00001) and NSSI (p<0.0001) in comparison to non DD patients. The between study heterogeneity was high in both analyses. However, in sensitivity analyses, when only studies utilizing the same method to diagnose DD were considered, results remained highly significant in both outcomes (p<0.0001) but with no more heterogeneity. Moreover, six studies focused on DES scores in previous SA patients while five focused on DES scores in NSSI. Both SA and NSSI patients reported higher DES scores (p<0.00001) in comparison to non SA and non NSSI patients, with no heterogeneity.
The presence of both DD diagnosis and higher DES scores seems to be a risk factor for both SA and NSSI. Hence, it may be reasonable to hypothesize the presence of a dissociative subtype in a subset of these patients, which should be considered as a transdiagnostic factor and should be carefully assessed.




Testing the effectiveness of prevention strategies


(26) OC-26. Multi-level Intervention for Suicide Prevention: The New Zealand Experience

Day: 09 | Time: 08:00 | Room: Sala 1

Speaker:
Sunny Collings . University of Otago Wellington, New Zealand

 Abstract:
Background: This presentation will describe the results of a 25 month Multilevel community Intervention for Suicide Prevention designed for and implemented in New Zealand (MISP-NZ) with the aim of reducing rates of suicidal behaviours (trial registration ACTRN12613000399796).

Methods: MISP-NZ was a cluster randomised controlled trial with eight District Health Boards (hospital) regions matched into four pairs (based on key socio-demographic factors) randomised to either the intervention or practice as usual (PAU) i.e. control arm of the study. Each intervention region received 25 months of interventions (01 June 2010 to 30 June 2012) including: 1) training in recognition of suicide risk factors; 2) workshops on mental health issues; 3) community based interventions (linking in with community events); and 4) Distribution of print material and information on web-based resources. The main outcome was the annual rate per 100,000 people of suicidal behaviours: intentional self-harm (ISH) and self-inflicted deaths.

Results: There was no significant difference between the change in rate of suicidal behaviours (ISH or self-inflicted deaths) in the intervention group compared with the control group.

Conclusion: These findings suggest that MISP-NZ had no effect on suicidal behaviours. Multi-level interventions for suicide prevention do not appear to have an impact on suicide in New Zealand. We discuss some of the possible reasons for this finding.