Poster Index

Intervention research for prevention of suicidal behavior

Clinical and neurocognitive studies of suicidal behavior (17)  |  Clinical phenotyping of suicidal individuals (23)
Culture, ethnicity and spiritual approaches. New paradigms in suicidology (11)  |  Ethical and methodological challenges and solutions in suicide research (5)
Genetic, epigenetic and gene expression contributors to suicide risk (2)  |  Intervention research for prevention of suicidal behavior (30)
Lifespan differential aspects (from infancy to elderly) (7)  |  Miscellany (assisted suicide, minorities, legal aspects, etc.) (9)
Neurobiological underpinnings of suicidal behavior (3)  |  Novel monitoring strategies for detecting changes in risk over time (4)
Psychosocial variables: protective and risk factors. Resilience & vulnerability (38)  |  Testing the effectiveness of prevention strategies (6)




Intervention research for prevention of suicidal behavior


(42) PO-42. Suicide First Aid Guidelines for Sri Lanka

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Erminia Colucci . Centre for Psychiatry, Queen Mary University of London, London
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 Introduction:
Sri Lanka has one of the highest suicide rates in the world. Gatekeepers programs aimed at specific target groups are a promising strategy to prevent suicide. The aim of this study was to develop guidelines that help members of the public to provide first aid to someone at risk of suicide in Sri Lanka. The Delphi-consensus method was used to elicit consensus among Sri Lankan mental health and/or suicide experts on potential helping statements to include in the guidelines.
The outcome of the three Delphi rounds was a set of agreed statements that were then used to develop the Suicide First Aid Guidelines for Sri Lanka, which will be presented and discussed during the session.
The guidelines may serve as a basis for developing training for members of the public to provide mental health first aid to persons at risk of suicide as part of Sri Lanka's suicide prevention strategy. This project was a collaboration between The University of Melbourne and Mental Health First Aid.


(82) PO-82. North Atlantic Treaty Organization (NATO) Research Task Group on Military Suicide: Brief Report of Findings

Day: 09 | Time: 13:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Marjan Ghahramanlou-Holloway . Uniformed Services University of the Health Sciences, Bethesda - Maryland
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 Introduction:
Military suicide remains a significant public health problem across many nations. To date, there have been no systematic collaborative efforts across North Atlantic Treaty Organization (NATO) member and non-member (e.g., Partnership for Peace) nations to best understand suicide-related behaviors among military personnel and to identify best practices most suitable for this highly vulnerable group. Given the public health problem of suicide among the Armed Forces, representatives from 17 nations participated in the Human Factors and Medicine (HFM), Research Task Group (RTG) on military suicide, from 2010-2015. This presentation will provide a brief outline of findings from the soon-to-be released technical report. The main objectives of the RTG have been to: (1) to produce a technical report on military suicide for NATO; (2) to administer a survey to NATO member and non-member nations in order to enhance our understanding of current military suicide prevention efforts, best practices, and potential gaps; (3) to create a web-based platform to organize and make available materials pertaining to military suicide across several countries; (4) to prepare a series of white papers covering key topics on military suicide prevention relevant to NATO leadership and members; and (5) to disseminate the RTG findings at international scientific professional conference(s). Future efforts to advance this preliminary work in the area of military suicide prevention for NATO countries will be delineated.


(98) PO-98. Masculinity and suicidal thinking

Day: 09 | Time: 13:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Jane Pirkis Pirkis . University of Melbourne, Melbourne, Australia
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 Introduction:
Males feature prominently in suicide statistics, but relatively little work has been done to date to explore whether conformity to ?dominant? masculinity norms heighten the risk of or are protective against suicidal thinking.
 Goals:
To explore whether particular elements of ?dominant? masculinity heighten the risk of or are protective against suicidal thinking.
 Methodology:
We used data from 13,884 men (aged 18-55) in the Australian Longitudinal Study on Male Health (Ten to Men) cohort. These men filled in self-complete questionnaires in 2013/14 which covered a range of topics, including conformity to ?dominant? masculinity norms and suicidal thinking. We conducted logistic regression analyses to estimate the strength of association between these two variables.
 Results:
After controlling for other key predictors of suicidal thinking, one key masculine characteristic ? self-reliance ? stood out as a risk factor for suicidal thinking (AOR = 1.34; 95%CI = 1.26-1.43).
 Conclusions:
It is easy to see how self-reliance might confer risk for suicidality. Men who are self-reliant may believe that they should be strong in the face of any adversity, consider that feeling down is a sign of weakness, and be unlikely to reach out to friends, family or professional sources for help. We need to ensure that clinical and population-based suicide prevention activities that men actively address self-reliance, and promote broader definitions of masculinity at a societal level.


(106) PO-106. A programme for the prevention of suicide reattempts with telemedicine techniques

Day: 09 | Time: 10:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Andrea Gabilondo . Osakidetza, San Sebastián
- Edurne Aristegi - Jose Martin Zurimendi - Iñaki Zorrilla - Ana González Pinto - Raquel Roca - Álvaro Iruin Sanz -

 Introduction:
There is ample evidence showing that the prevention of suicide is possible and there are different approaches proven to be effective. Although the use of telemedicine in suicide prevention is relatively recent this is one of the most promising approaches today.
 Goals:
To evaluate the efficacy, feasibility and cost of a brief telephone follow-up program for the prevention of suicide in patients with a recent history of attempted suicide.
 Methodology:
This is a prospective, multicenter, controlled non randomized study. Patients with a recent history of suicide attempt were included in a brief standardized telephone follow up programme, lasting 6 months which was added to their usual treatment. Telephone calls were made by nurses, they lasted no more tan 10 min and were intended to 1) assess the risk of suicide; 2) Improve adherence to usual treatment and 3) provide general psychoeducation. Patients in the control group only received usual treatment.
 Results:
Preliminary results (includes only the intervention group): 1 month before recruitment ends 198 attempts have been identified. 63% of patients agreed to participate and have been included in the program. 69.2% are women and the average age is 41.5 years. A total of 303 phone calls (2.5 per patient) have been made. 42% of patients have completed all the calls within the programme. 4% of patients have reattempted suicide. The anual rate of reattempt is 5.6, and the average delay between attempts is of 72.5 days. No major adverse effects have been identified.
 Conclusions:
Preliminary results show reattempt rates which are similar to previos studies in the literature. Attrition rates are in line with other techniques. As a conclusión, preliminary data show promising results and give support to the use of this approach in the prevention of suicide.
 References:
Luxton D, June JD, and Comtois KA. Can Postdischarge Follow-Up Contacts Prevent Suicide and Suicidal Behavior? A Review of the Evidence. Crisis 2013; Vol. 34(1):32?41


(107) PO-107. Feasibility study and implementation of the EAAD model in a región of Gipuzkoa (Spain)

Day: 09 | Time: 10:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Andrea Gabilondo Cuellar . Osakidetza, San Sebastián
- Marian Bernaras Aguirrezabala - Ana Alustiza García - Eider Tapia - Álvaro Iruin Sanz -

 Introduction:
The suicide prevention program of the European Alliance Against Depression (EAAD; www.eaad.net ) has been implemented in 17 European countries. The introduction of the model in a new region requires a preliminary work of cultural adaptation and a a feasibility study in order to maximize its potential for success.
 Goals:
To assess the feasibility and results of the pilot implementation of the EAAD model in a region of Gipuzkoa. To propose the changes necessary to maximize it?s adaptations to the region.

 Methodology:
The EAAD program was implemented in 2 regions of Gipuzkoa (175,000 inhabitants). 4 different interventions (1 to 4, see next section) were developed.
 Results:
1. Psychological first aid training for social workers: 72 professionals were trained in 3 workshops. The evaluation indicated high satisfaction and a 10% increase in the level of knowledge.
2. Depression awareness campaign for the general population. Leaflets and posters were distributed in strategic locations. Additional dissemination of key messages was made by the local media.
3. Media training and sensitization workshops. 75 professionals and university students took part in 3 workshops. The evaluation indicated satisfaction and interest.
4. Program for improving the care of those with recent history of suicide attempt by the health system. Including training of professionals, renewed coordination mechanisms between professionals, improvements in information systems and a specific follow up program for high risk patients based on techniques of telemedicine. Reattempt rates were similar to those reported in the literature. Professional satisfaction was high.

 Conclusions:
The multidisciplinary approach to the risk of suicide increases the complexity and the resources needed. Having strategic partners outside the health system is a key factor of success. However the potential benefits seem to outweigh this initial disadvantages.
 References:
Hegerl U, Wittenburg L; European Alliance Against Depression Consortium.Focus on mental health care reforms in Europe: the European alliance against depression: a multilevel approach to the prevention of suicidal behavior. Psychiatr Serv. 2009 May;60(5):596-9.


(115) PO-115. Discussing firearm ownership and access as part of suicide risk assessment and prevention: Means safety versus means restriction?

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Ian Stanley . Florida State University, Tallahassee, FL USA
- Melanie Hom - Megan Rogers - Michael Anestis - Thomas Joiner -

 Introduction:
In 2014, an estimated 21,334 individuals in the United States died by an intentional self-inflicted gunshot wound, accounting for approximately 50% of all suicide deaths that year. Indeed, the assessment and management of firearm ownership and access is a key component of suicide prevention efforts. The prevailing terminology surrounding the management of firearms for a patient at risk for self-harm or harm to others is ?means restriction.? However, use of the term ?restriction? may suggest to a patient absolute limits on his or her firearm ownership.
 Goals:
This study aimed to describe the relative utility of the terms ?means safety? versus ?means restriction? in counseling individuals to limit their access to firearms in the context of a mock suicide risk assessment.
 Methodology:
Overall, 370 participants (Mage=19.35y, SD=1.77y; 71.9% female; 73.0% White) were randomized to read one of two vignettes depicting a clinical scenario in which managing firearm ownership and access was discussed either using the term ?means safety? or ?means restriction.? Participants then rated their intention to disclose firearm ownership and access to a clinician and adhere to clinician recommendations, as well as the relative acceptability and preferability of each term.
 Results:
Overall, participants rated the term ?means safety? as significantly more acceptable (t[369]=14.006, p<.001) and preferable (t[369]=16.781, p<.001) as compared to ?means restriction.? Across vignette groups, no significant differences emerged with respect to participants? reported willingness to disclose firearm ownership and access. However, participants randomized to the ?means safety? condition were significantly more likely to report intentions to adhere to clinicians? recommendations to limit access to a firearm for safety purposes (F[1,367]=7.393, p=.007, ?p2=.020).
 Conclusions:
Findings suggest that the term ?means safety? may be more clinically advantageous than ?means restriction,? resulting in greater adherence to clinician recommendations. Future research is needed to replicate these findings among more diverse samples in clinical settings.
 References:
1. Anestis MD, Anestis JC. Suicide rates and state laws regulating access and exposure to handguns. Am J Public Health. 2015 Oct;105(10):2049?58.
2. Chu C, Klein KM, Buchman-Schmitt JM, Hom MA, Hagan CR, Joiner TE. Routinized assessment of suicide risk in clinical practice: An empirically informed update. J Clin Psychol. 2015 Dec;71(12):1186?200.


(124) PO-124. Previous suicide attempts at first episode of psychosis

Day: 09 | Time: 10:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Manuel Canal-Rivero . Universitat Autònoma de Barcelona/ Hospital Universitario Virgen del Rocío, Sevilla- Spain
- María Isabel Calvo-Rubiales - Jordi E. Obiols Llandrich - Miguel Ruiz-Veguilla -

 Introduction:
Suicide has been shown to be the single major cause of premature death among patients with schizophrenia spectrum disorders. It has been suggested that history of attempts of suicide are one of the principal predictor of suicidal behavior. This study examined the influence of premorbid adjustment in attempts of suicide occurred before of first episode of psychosis (FEP). Little is known about premorbid functioning like risk factor for suicide attempts. The current study examined the association of premorbid functioning and previous attempts of suicide of FEP.
 Goals:
The objective of this study is analyses the influence of premorbid adjustment in previous suicide attempts at first episode of psychosis.
 Methodology:
Sixty-five first-episode patients participated in this study. Baseline demographic clinical data and information about suicide attempts previous at FEP were collected in the first contact with mental health services. Sociodemographic and clinical data were collected from information provided by the patients and their relatives. We used Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to screen for psychotic symptoms which were then used for diagnosis. Information about suicide attempts previous at FEP was collected using Schedules for Clinical Assessment in Neuropsychyatry SCAN. This clinical interview contains a question about attempted suicide. Premorbid Adjustment Scale (PAS) comprises 36 items describing levels of functioning before the onset of psychosis during four periods in life: childhood (up to 11 years), early adolescence (12-15 years), late adolescence (16-18 years) and adulthood (19 years and beyond).
 Results:
Poor premorbid adjustment in early adolescence was significantly associated with prior attempts of suicide at FEP (OR= 1.13, 95% CI= 1.00-1.26). The others premorbid adjustment didn´t predicted attempts of suicide before FEP


 Conclusions:
Few studies have investigated risk factors of priors? attempts of suicide at FEP. The knowledge about those risk factors could help clinicians to identify high-risk patients. In this study poor premorbid adjustment in early adolescence is associated with attempts of suicide previous at FEP. Greater attention to person with poor premorbid adjustment in early adolescence may form the basis for early interventions aimed towards reducing the risk for subsequent suicide attempts.
 References:
1. Barrett EA, Sundet K, Faerden A, Nesvåg R, Agartz I, Fosse R, et al. Suicidality before and in the early phases of first episode psychosis. Schizophr Res. 2010;119(1-3):11?7.
2. Bakst S, Rabinowitz J, Bromet EJ. Is poor premorbid functioning a risk factor for suicide attempts in first-admission psychosis? Schizophr Res. 2010;116(2-3):210?6.


(136) PO-136. Can case management and psychoeducation interventions contribute to the prevent recurrent suicidal behavior? Data from PsyMAC Study

Day: 09 | Time: 10:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Susana Al-Halabí . CIBERSAM - Área de Psiquiatría, Universidad de Oviedo, Oviedo
- Sergio Fernández-Artamendi - Patricia Burón - Julia Rodriguez - Marlen Garrido - Leticia González-Blanco - Leticia García-Álvarez - M. Paz García-Portilla - Pilar A. Saiz - Julio Bobes -

 Introduction:
The greatest risk factor for later suicide attempts is having made a previous attempt [1]. It is essential to develop preventive strategies. One of the most frequently used is case management, although no strong data is available yet as to its efficacy. An alternative strategy which has yielded promising results in many mental health contexts is psychoeducation. However, its application in this field is practically non-existent in comparison to other psychosocial interventions.
 Goals:
This study evaluated the differential effectiveness of the combination of several strategies to prevent repetition of suicide attempts [2].
 Methodology:
Sample: patients who entered the Emergency Department of the Hospital Universitario Central de Asturias (HUCA) after a suicide attempt (SA). A total of 163 participants [68.1% males, mean age (SD)=41.39 (12.91)] met the inclusion criteria and were spread across three groups: (1) passive strategy consisting of leaflets with information oriented towards suicide prevention; (2) the passive strategy combined with an active component of case management (MAC); (3) the passive strategy, case management and a psychoeducational programme (PSyMAC).The study included psychopathological assessments at the beginning of the study, and follow-ups every 6 months up to 30 months.
 Results:
There were no significant differences between the three groups in the number of SA nor in the number of patients with more than one SA. The cumulative curve of suicide events also confirms a lack of differences in the number of SA per group. Additionally, both the presence of SA prior to joining the study and the stated intention to repeat them proved to be predictor variables of a greater risk of suicidal behaviours during the period covered by the study. However, a positive trend was found for case management.
 Conclusions:
The present study showed that the use of psychoeducation is a promising strategy to prevent the repetition of SA, although more research is still needed.
 References:
Oquendo MA, Currier D, Mann JJ. Prospective studies of suicidal behavior in major depressive and bipolar disorders: what is the evidence for predictive risk factors? Acta Psychiatr Scand. 2006;114:151-158. doi: 10.1111/j.1600-0447.2006.00829.x

Sáiz PA, Rodríguez-Revuelta J, González-Blanco L, Burón P, Al-Halabi S, Garrido M et al. Study protocol of a prevention of recurrent suicidal behaviour program based on case management (PSyMAC)Rev Psiquiatr Salud Ment. 2014;7:131-138. doi: 10.1016/j.rpsm.2014.01.001.


(138) PO-138. Suicide rates under the microscope: A fine-scale analysis of a 1.8 million-inhabitants city

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Viktoria Zeilinger . Department of Basic Psychological Research and Research Methods, School of Psychology, University of, Vienna
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 Introduction:
The geography of suicide prevalence is a well-established topic within suicidology, documenting substantial differences in suicide rates between world regions and countries. As for one example, there is evidence that national suicide rates across Europe differ by more than one order of magnitude, with the lowest rates found in Southeast Europe (Balkans, Mediterranean area) and the highest in Northeast Europe (Belarus, Baltic countries) [1]. Although geographic analyses have been extended to the intranational (i.e., regional or state level of analysis), owing to a dearth of appropriate data such analyses have rarely been conducted on more fine-scale levels. Here, we took the opportunity to examine the district-level suicide rates within the 1.8 million-inhabitants city of Vienna, the capital city of Austria and second-largest city of German-speaking Central Europe
 Goals:
By international comparisons, Austria?s suicide rate historically has ranked above average, but presently is mid-field (12.8/100,000 inhabitants per yr.; 2007-11 average) in European Rankings [2]. Our findings might be helpful for identifying catchment areas to reduce this even further.
 Methodology:
From district-level suicide statistics and population figures, obtained from Statistics Austria for all 23 districts of Vienna for the 10-yr. period 2003-12, we calculated annualized (2003-12 average) sex-specific suicide rates for analysis. In order to identify possible risk factors and potentially problematic districts, we entered district-level indicators (e.g., proportion of public green area, migrant proportion, income) in a correlational analysis vis-à-vis the districts? suicide rates.
 Results:
We found nontrivial differences in suicide rates between men (ranging from 14 to 26) and women (ranging from 5 to 13). Moreover we identified regional distinctions: most committed male suicides were located for the 5th district (26), whereas the highest female suicide rate (13) is reported for the 8th district.
 Conclusions:
These findings might be useful for planning district-specific outreach activities for suicide prevention and informative for existing extramural psychosocial service facilities.
 References:
[1] WHO. (10. 12 2015). http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/. Von http://apps.who.int/iris/bitstream/10665/131056/1/9789241564779_eng.pdf?ua=1&ua=1 abgerufen
[2]WHO. (27. Dezember 2015). Preventing suicide. A global imperative. Von http://www.who.int/en/: http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/ abgerufen


(145) PO-145. Evaluation of benefit to patients of training mental health professionals in suicide guidelines: cluster randomised trial

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

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

 Introduction:
Background
Randomised studies examining the effect on patients of
training professionals in adherence to suicide guidelines are
scarce.
Aims
To assess whether patients benefited from the training of
professionals in adherence to suicide guidelines.
Method
In total 45 psychiatric departments were randomised (Dutch
trial register: NTR3092). In the intervention condition, all
staff in the departments were trained with an e-learning
supported train-the-trainer programme. After the intervention,
patients were assessed at admission and at 3-month
follow-up. Primary outcome was change in suicide ideation,
assessed with the Beck Scale for Suicide Ideation.
Results
For the total group of 566 patients with a positive score on
the Beck Scale for Suicide Ideation at baseline, intention-totreat
analysis showed no effects of the intervention on
patient outcomes at 3-month follow-up. Patients who were
suicidal with a DSM-IV diagnosis of depression (n = 154)
showed a significant decrease in suicide ideation when
treated in the intervention group. Patients in the intervention
group more often reported that suicidality was discussed
during treatment.
Conclusions
Overall, no effect of our intervention on patients was found.
However, we did find a beneficial effect of the training of
professionals on patients with depression.


(161) PO-161. Combining biological and psychological approaches in the prediction of suicidal behaviour

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Abel D Fernández-Peláez . Department of Psychiatry, University of Oviedo - CIBERSAM, Oviedo, Spain
- Patricia Burón - Elena Riesco - Susana Al-Halabí - Leticia García-Alvarez - Lorena De La Fuente Tomás - Lars-hakan Thorell - María Paz García-Portilla - Pilar A Saiz - Julio Bobes -

 Introduction:
Suicidal behavior (SB) is a major public health concern. Predicting SB is matter of particular interest for behavioral scientists. However, when studying complex behaviours such us SB, it is anticipate that only biomarkers of small size will be in play. Recently, it has been suggested that the combination of biological factors with other variables (clinical, psychological) associated with SB may be a good strategy to improve the predictive capacity of explanatory models. Data suggest that the Short Personality and Life Events (S-PLE) scale discriminates between past suicide and past non-suicide attempters with high sensitivity and specificity. On the other hand, electrodermal hyporeactivity has been suggested as a trait marker for suicidal propensity in depression.
 Goals:
The aim of this study is to check the predictive value of combination models requiring positive results on more than one test or requiring a positive result on either one or two of the above described tests.
 Methodology:
We included 144 depressed outpatients [males=94 (65.3%), mean age (SD)=54.36 (9.72)] from Oviedo (Spain). All patients were assessed using the S-PLE (Artieda-Urrutia et al., 2015) and electrodermal reactivity was measured by the EDOR test (Emotra AB).
 Results:
Forty eight patients (33.3%) have personal history of SB. No differences in gender, age, civil status, education level or socioeconomic status were found between those with previous history of SB and depressed patients without SB. The prediction model that requires both S-PLE (> 1.70) and EDOR hyporeactivity results in 35.4% sensitivity, 87.5% specificity, and has a positive predictive value of 58.6%. The prediction model that requires either S-PLE or EDOR hyporeactivity to be positive has a sensitivity of 85.4%, specificity of 22.3%, and positive predictive value of 35.6%.
 Conclusions:
Due to the different performance of these models, prospective data are needed in other to establish their real clinical utility in the prediction of SB.
 References:
Artieda-Urrutia P, Delgado-Gómez D, Ruiz-Hernández D, García-Vega JM, Berenguer N, Oquendo MA, Blasco-Fontecilla H. Short Personality and Life Event scale for detection of suicide attempters. Rev Psiquiatr Salud Ment. 2015; 8(4):199-206. doi: 10.1016/j.rpsm.2015.02.004.
Mann JJ, Currier D, Stanley B, Oquendo MA, Amsel LV, Ellis SP. Can biological tests assist prediction of suicide in mood disorders? Int J Neuropsychopharmacol. 2006; 9(4):465-74.
Thorell LH, Wolfersdorf M, Straub R, Steyer J, Hodgkinson S, Kaschka WP, Jandl M. Electrodermal hyporeactivity as a trait marker for suicidal propensity in uni- and bipolar depression. J Psychiatr Res. 2013; 47(12):1925-31. doi: 0.1016/j.jpsychires.2013.08.017.


(165) PO-165. The Clinical Utility and Reliability of the Assessment of Suicide Intent using Becks Suicide Intent Scale

Day: 09 | Time: 10:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Aislinne Freeman . Univeristy of Leipzig, Germany
-

 Introduction:
High scores of suicide intent at the time of self-harm is associated with an elevated risk of suicide. Assessing suicide intent in hospital settings is of clinical importance, and has been strongly endorsed in the evaluation of future suicide risk. The Becks Suicide Intent Scale (SIS) is the most commonly used tool for measuring suicide intent, however, uncertainties over its suitability as a reliable measure of suicide intent within clinical settings has motivated the current study.
 Goals:
Thus, the aim of the current study was to assess the utility and inter-rater reliability of the objective component of the Suicide Intent Scale in order to evaluate its utility and appropriateness in clinical settings.
 Methodology:
Individuals who were consecutively admitted to the emergency department in Cork City between January and May 2015, for self-harming were included in the study (n=94). Information from the self-harm patients was recorded by a crisis nurse using the Biopsychosocial assessment measure. In order to explore the inter-rater reliability of Becks Suicide Intent Scale, data on suicide intent was inferred from the Biopsychosocial assessment and the crisis nurses? case notes, and translated into a SIS score by two independent raters. Cohen?s Kappa coefficient was calculated in order to rate the inter-rater reliability of the objective component of Beck?s Suicide Intent Scale,
 Results:
Cohen?s kappa was calculated with this data and found to reflect a low-level of inter-rater agreement (kappa = 0.25). Disagreement was consistent across all items on the scale.
 Conclusions:
The relatively low agreement across all items of the scale implies that there is much uncertainty surrounding the interpretation of the scale and that caution should be exercised when using this scale in a clinical setting.


(176) PO-176. Assessment of medical and non-medical student?s stigmatizing attitudes toward suicide

Day: 09 | Time: 10:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Pirlog Mihail Cristian . University of Medicine and Pharmacy of Craiova, Craiova - Romania
- Gheorman Victor - Udristoiu Ion - Cazacu Sorin - Niculescu Mariana - Alexandru Dragos Ovidiu -

 Introduction:
Understanding attitudes toward suicide may help building new strategies for its prevention. Previous research showed that people with any kind of connection with suicidal behavior have more permissive attitudes toward suicide (Limbacher & Domino, 1985?86), and the attitudes of medical professional towards this phenomenon affect their provision of care to suicidal patients (Bagley & Ramsay, 1989).
 Goals:
Our study aimed to find out if there are differences between attitudes toward suicide among medical students from University of Medicine and Pharmacy of Craiova (UMF), Romania, and students from other study programmes (literature and agriculture) of University of Craiova (UCV).
 Methodology:
Attitudes were measured using Stigma of Suicide Scale (SOSS) (Batterham, Calear & Christensen, 2012) on two samples including 129 UMF students, respectively 81 UCV students, and were approved by local IRB.
 Results:
Higher scores on the three SOSS subscales indicated higher stigma, greater attribution to isolation/depression, and greater normalisation/glorification. For medical students, the average scores were 3.00 (Standard Deviation - SD 0.52), 3.76 (SD 0.49), and glorification 2.15 (SD 0.67), while for UCV students the scores were 2.89 (SD 0.59), 3.28 (SD 0.72), and glorification 2.45 (SD 0.64). These results highlighted significant differences between those two categories of students, for isolation and glorification (p student <0.01). Also, connections with persons with suicidal behavior lead to significant differences for stigma and glorification (p<0.05), respectively isolation (p<0.01), while the female gender was also influenced by glorification attitudes (p<0.05).
 Conclusions:
The data obtained showed that medical students have more stigmatizing attitudes toward suicidal individuals, while glorification of suicidal behavior is more frequent in other category of students, and exposure to suicidal people is a factor for more restrictive attitudes. In this respect, it becomes important to intervene at this level in order to reduce stigmatizing attitudes and limit the glorification of suicide.
 References:
Limbacher, M. & Domino, G. (1985?86) Attitudes toward suicide among attempters, contemplators and non-attempters. Omega: Journal of Death and Dying, 16, 325?334.
Bagley, C.h. & Ramsay, R. (1989) Attitudes toward suicide, religious values and suicidal behaviour: Evidence from a community survey. In Suicide and its Prevention: The Role of Attitude and Limitation (eds. R.F.W. Diekstra, R. Maris, S. Platt, A. Schmidtke & G. Sonneck). Leiden: E.J. Brill.
Batterham PJ, Calear AL and Christensen H. The Stigma of Suicide Scale. Psychometric properties and correlates of the stigma of suicide. Crisis 2013; 34: 13?21.


(193) PO-193. The role of Danish clergies in preventing of suicidal behavior among vulnerable groups

Day: 09 | Time: 10:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Agnieszka Konieczna . Centre for Suicide Research, Odense C - Denmark
- Anne Bundgaard Hansen -

 Introduction:
Clergies have extensive contact with suicidal people and their relatives, but a lack of knowledge and understanding of suicidal thoughts and behaviour can be stressful for the prevention of suicide attempts and suicides. Among working clergies there is often a great uncertainty how suicidal thoughts and behavior should be managed and prevented. The clergies have different opinions on whether or not it is sinful and wrong to commit suicide. A big discussion among clergies is whether we are obliged to live, or whether we have the right to die.
 Goals:
The goal of this project is to reduce the vulnerable groups’ suicidal thoughts and behavior by increasing preventional work among clergies.
 Methodology:
A quantitative and qualitative approach was used for evaluating the data collected. Calculations were done by multiple logistic regression analysis to control for gender, age, experience and region.
 Results:
A total of 914 clergies completed a questionnaire and 47 clergies were interviewed. The clergies displayed inadequate knowledge of suicidal behavior. Most clergies were of the opinion that life is God's gift, and therefore people do not have the right to choose the circumstances of their own death. Male clergies agreed the most that suicide is a sin against God and against other people, but that it can be forgiven. More men than women also disagreed that life and not death has an ethical value and life's dignity does not depend on quality of life.
 Conclusions:
The current results showed that the suicide prevention can be a challenge for clergies and therefore as a part of the project we are currently working on an educational material aimed for mainly clergies. The material will be containing primarily information on how to prevent suicides among vulnerable groups.


(222) PO-222. The Self-help Online against Suicidal thoughts (SOS) trial - a Danish randomized controlled trial

Day: 09 | Time: 13:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Charlotte Mühlmann . Mental Health Centre Copenhagen, Copenhagen -Denmark
-

 Introduction:
Background: Denmark is, to our knowledge, the only country in the world with specialized out-patient Clinics for Suicide Prevention where people at risk of suicide can get psychotherapeutic help free of charge. Still, the suicide rate has remained fairly stable over recent years and additional suicide preventive efforts are needed. A Dutch online self-help program has been found to be effective and cost-effective in terms of reducing suicide thoughts.
 Goals:
This study aims to examine the effectiveness of the Danish version of the online self-help program, Self-help Online against Suicidal thoughts, in Denmark.
 Methodology:
A total of 450 people with suicide thoughts will be recruited from the Danish suicide hotline “The Lifeline” and randomly allocated to the intervention (N=250) or a waiting list (N=250). Participants assigned to the intervention will be offered a self-help cognitive behavioural therapy program for six weeks via the Internet. The control group will be assigned to a waiting position for 32 weeks. The primary outcome is frequency and intensity of suicidal ideation. Secondary outcomes include depressive symptoms, hopelessness, worrying, quality of life, negative effects of the intervention as well as costs related to health care utilisation and productivity loss. Follow-ups will be conducted at 6 and 32 weeks after inclusion.
 Results:
The pilot study is scheduled to be completed by August 2016.
 Conclusions:
If the intervention is found to be linked to reductions in suicidal ideation, this will strengthen the evidence that online self-help interventions might be a relevant tool for people with at risk of suicide.


(234) PO-234. Involuntary hospital admission as preventive intervention after suicidal behavior? A 2-year case records in an acute psychiatric unitin a general hospital in Gijón (Spain).

Day: 09 | Time: 13:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Danny Francisco Frías Ortiz . SESPA, Area Gestion Clinica V , Asturias - Spain
- Juan José Fernández Miranda - Omar Walid Muquebil Ali Al Shaban Rodriguez - Laura Rubio Rodriguez - Aida González Fernández - Elena Pérez Fernández - Susana Pereira - Manuela Valle Neila -

 Introduction:
Commitment proceedings often follow a period of emergency hospitalization, during which an individual with acute psychiatric symptoms is confined for a relatively short duration in a treatment facility for evaluation and stabilization by mental health professionals. Patients with a plan, access to lethal means, recent social stressors and symptoms suggestive of a psychiatric disorder should be hospitalized immediately; sometimes involuntary hospital admission is used by the specialist to avoid a suicidal behaviour, taking into account that after a suicide attempt 25% of people repeat attempt and 10% die by suicide.
 Goals:
The aim of this study was to know hospital admission due to suicide attempts, and which of them were involuntary.
 Methodology:
A 2-year retrospective study (2014-2015) of all cases admitted after suicidal behaviour in an acute psychiatric ward in a general hospital in Gijón (Spain). Reasons for hospital admission were registered, including suicide attempts, and also if they were involuntary.
 Results:
The total number of admissions to the psychiatric unit in 2014-2015 was Admissions due to suicide attempts were 427; 300 of them were involuntary admissions. There were a total of 347 involuntary admissions these two years; among them, due to suicide attempt: 300.
 Conclusions:
Although criteria for involuntary admission sometimes has no clinical considerations, emergency room is a vital setting for suicide prevention, and hospital admission is indicated until patient’s condition has been stabilized, in many cases involuntary. In fact, most of involuntary admissions in the psychiatric unit of the hospital studied followed a suicide attempt. Prevention of suicidal behaviour; Obvious high risk of repeat suicide attempt generates an urgency to make an accurate assessment and create a safe treatment plan and determine to retain suicidal patients
 References:
1.- Sáiz PA, Bobes J. Prevención del suicidio en España: una necesidad clínica no resuelta. Rev Psiquiatr Salud Ment. 2014;7:1---4. 2.- Mittendorfer-Rutz E, Schmidtke A. Suicide attempts in Europe. En: Wasserman D, Wasserman C, editores. Oxford textbook of suicidology and suicide prevention. Oxford: Oxford University, Press; 2009. p. 123---6. 3.- Jimenez-Trevino L, Sáiz PA, Corcoran P, García-Portilla MP, Burón, P, Garrido M, et al. The incidence of hospital-treated attempted suicide in Oviedo, Spain. Crisis. 2012;33:46---53. 4.-Ayuso-Mateos JL, Baca-Garcia E, Bobes J, Giner J, Giner L, Perez V, et al. Recomendaciones preventivas y manejo del comportamiento suicida en Espa˜na. Rev Psiquiatr Salud Ment. 2012;5:8---23.


(248) PO-248. Reconnecting AFTer deliberate self-harm (RAFT): a pilot study of SMS brief intervention

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

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

 
 Goals:
Engaging patients following hospital-treated self-harm presents a number of challenges for both health systems and patients. Our previous research identified high levels of dissatisfaction with health system responses to self-harm, including failure to follow-up. One potential response is to test low-intensity follow-up which is easy to implement through hospital emergency departments. Several agencies are exploring the use of technology-based brief interventions as an extension to postcard, letter, and green card interventions. Using SMS allows the inclusion of links to additional material, and patients have the option to engage or not with this material. This paper describes the design and piloting of the RAFT intervention which combines brief contact text messages with links to therapeutic content.
 Methodology:
Following a review of research on effective follow-up interventions, RAFT was co-designed with consumers and suicide prevention experts. The intervention combines brief messages with links to brief therapeutic content targeting proximal risk factors. These messages are delivered at specified intervals over a 12 month period, beginning within 24-hours of leaving hospital. Based on feedback from consumers, easy-to-use content is delivered first to allow for the still-difficult feelings which may still be present for some patients.
 Results:
The feasibility of the intervention will be tested at two Australian hospitals, one urban and one regional. This pilot study aims to recruit 50 participants in order to test the feasibility and acceptability of the prototype, and to establish the parameters for a larger trial. Ethics approvals are in place to commence the pilot study, and baseline results will be presented.
 Conclusions:
If successful, RAFT has potential to reduce repeat episodes by approximately one-third, based on data for offline brief interventions. Using mobile phone technology is likely to be more acceptable to a younger population, and offers the opportunity to scale up to national and international settings.


(250) PO-250. Compare the paper version of the safety plan with a new-developed safety plan app in reducing suicide ideation and other symptoms

Day: 09 | Time: 10:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Kate Andreasson . Psychiatric Research Unit, Psychoatric Centre North Zealand,, Denmark
- Merete Nordentoft - Annette Erlangsen -

 Introduction:
A recent report from the World health Organization estimates that approximately 800.000 individuals die by suicide each year, and there are twenty times more suicide attempts (WHO 2014). Previous studies have shown that a safety plan will assist patients with suicide ideation in providing instant support and help seeking professional assistance (Stanley et al. 2012).
 Goals:
The aim of the trial is to compare the paper version of the safety plan with a new-developed safety plan app in reducing suicide ideation and other symptoms, as an add-on to the supportive psychotherapy delivered in the clinics.
 Methodology:
The trial is designed as a 2-arm observer-blinded parallel group randomized clinical superiority trial, where participants will either receive: 1) Experimental intervention: the safety plan provided as the app MYPLAN, or 2) Treatment as Usual: the safety plan in the original paper format. Based on a power calculation,, a total of 560 participants. They will be recruited from national suicide preventive clinics. Both intervention groups will also receive standard psychosocial therapeutic care, up to 8-10 sessions of supportive psychotherapy. Follow-ups will be conducted at 3, 6, 9, and 12 months after date of inclusion. Participants, inclusion and exclusion criteria: All participants will be recruited from the suicide preventive clinics in Denmark. There are no age restriction on participation in the study and participants must have a smartphone. Exclusion criteria: alcohol or substance abuse disorder (DSM-V), Primary outcome is suicide ideation measured by Becks suicide ideation scale. Secondary outcomes are: suicide intensity, hopelessness, depressive symptoms, quality of life, Statistics: Data analyses will be based on intention-to-treat principle. We will use repeated measurement in mixed model with unstructed variance, and missing data will be handled with multiple imputations.
 Results:
The patient recruitment will start in November 2016 and finish November 2017. Analyses and results are expected in 2018.
 References:
1.World Health Organization WHO, Preventing suicide: A global imperative. Luxembourg, WHO cataloguing-in publication data; 2014. 2. Stanley B, Brown GK. Safety planning Intervention: A brief intervention to mitigate suicide risk. Cognitive and beheavorial practice 2012;19:256-64.


(294) PO-294. The Collaborative Assessment and Management of Suicidality project in Denmark (CAMS-DK)

Day: 09 | Time: 13:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Bent Rosenbaum . Psychiatric Center Copenhagen, Capital Region, Copenhagen, Denmark
- Malene Grundahl - Hanne Frandsen - Lone Fogholm - August Wang - Jan-henrik Winsløv -

 Introduction:
The Competence Center for Suicide Prevention in the Capital Region of Denmark (ESSSP-CRD) has since 2009 provided psychotherapeutic help for people at risk of suicide under the premise that early intervention will help reduce risk of suicide and prevent future suicidal attempts. Since 2006 the CAMS approach (Jobes 2006, 2012) has been applied randomly all over the country of Denmark, and lately an RCT has demonstrated that CAMS is equally effective as Dialectic Behavior Therapy for persons with traits of Borderline Personality Disorder (Andreasson 2015, Andreasson et al. 2016). However, little is known as to which elements of CAMS facilitate the positive effect.
 Goals:
The goal of this sub-study of CAMS is to investigate in depth each of the specific elements of CAMS and evaluate their strengths and weaknesses from the patient-perspective as well as the therapist perspective.
 Methodology:
Successively included persons referred to ESSSP-CRD and treated with CAMS due to suicidal thoughts and/or suicide behavior are interviewed with a semi-qualitative approach. Essential elements of the CAMS therapy are studied in depth, and the subjectively experienced short-term supportive and curing capacities are systematized. Statements of therapists of different theoretical orientations are also included in the evaluation of positive and negative aspects of the CAMS approach.
 Results:
The presentation will describe the initial results of a pilot project with interviews from 20 patients. Pre-post therapy measures of psychache, stress, perturbation, hopelessness, self-hate, changes in reasons for living and reasons for dying, core-self evaluation as well as quality of life, will, in addition to the empirical material for the interviews, be taken into consideration.
 Conclusions:
The necessity for knowing more details about the qualitatively effective element of any suicide prevention therapy is usually underestimated. This lack of knowledge is mended in an ongoing large-scale, prospective, exploratory project with follow-up on the CAMS approach.
 References:
Andreasson, K.T. (2015). Suicide prevention and borderline personality disorder - the DiaS trial. Copenhagen University, Faculty of Health and Medical Sciences, Ph.D. thesis. Andreasson, K.T., Krogh, J., Wenneberg, C., Jessen, H.K.L., Krakauer, K., Gluud, C., Thomsen, R.R., Randers, L., Nordentoft, M. (2016). Effectiveness of Dialectical Behaviour Therapy versus Collaborative Assessment and Management of Suicidality treatment for reduction of self-harm in adults with vorderline personality traits and disorder - A randomized observer-blinded clinical trial. Depression and Andreasson, KT. Suicide prevention and borderline personality disorder - the DiaS trial. Copenhagen University, Faculty of Health and Medical Sciences, Ph.D. thesis, 2015 Andreasson, KT, et al. Effectiveness of Dialectical Behaviour Therapy versus Collaborative Assessment and Management of Suicidality treatment for reduction of self-harm in adults with vorderline personality traits and disorder - A randomized observer-blinded clinical trial. Depression and Anxiety, 2016, (online february): 1–11 Colleen Nielsen, A, Alberdi, F, Rosenbaum, B. Collaborative Assessement and Management of Suicidality method shows effect. Danish Medical Bulletin, 2011;58/8: 1-5 Jobes, DA. Managing suicidal risk. New York: Guilford Press, 2006 Jobes, D.The Collaborative Assessment and Management of Suicidality (CAMS): An Evolving Evidence- Based Clinical Approach to Suicidal Risk. Journal of Suicide and Life-Threatening Behavior, 2012; 42(6):640-53


(298) PO-298. The association between suicidal behaviour and antidepressant medication

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Nikita Vancayseele . Ghent University, Ghent-Belgium
- Gwendolyn Portzky - Kees Van Heeringen -

 Introduction:
The association between suicidal behaviour and antidepressant medication is a matter of debate. While clinical trials of antidepressants report increased rates of (non-fatal) suicidal behaviour, particularly in young people, pharmaco-epidemiological studies show a protective effect of antidepressants on suicide rates, particularly in the elderly. Pharmaco-epidemiological studies of the relationship between antidepressant and attempted suicide are scarce.
 Goals:
To investigate the relationship between the occurrence of attempted suicide and antidepressant prescriptions in Flanders, Belgium.
 Methodology:
By means of a standardized monitoring form, information on all attempted suicide episodes involving deliberate self-poisoning presented at A&E departments was collected in general hospitals in the 5 provinces of Flanders between January 2010 and December 2013. We analyzed data on 8.143 patients. Data on prescriptions of antidepressants at a provincial level in Flanders for 2010-2013 were available from health insurance funds. Pearson correlations were used to explore the direction and magnitude of associations, and the poisson regression model was used to relate numbers of antidepressant prescriptions to the attempted suicide rates.
 Results:
There was a negative correlation between rates of attempted suicide and the numbers of antidepressant prescriptions in Flanders. The number of prescriptions of antidepressants increased by 3.5%, while the rate of attempted suicides decreased by 5.6% during the study period. There was an effect of province on this overall correlation. An inverse correlation between rates of attempted suicide, and the number of prescriptions of antidepressants was observed in two of the five provinces in Flanders while in the three other provinces there was a significant positive correlation.
 Conclusions:
There was a significant negative correlation between rates of attempted suicide and numbers of antidepressant prescriptions in Flanders, with an effect of province. The effect of age and gender needs to be taken into account in further study.
 References:
Gusmão R, Quintão S, McDaid D, Arensman E, Van Audenhove C, Coffey C, et al. Antidepressant utilization and suicide in Europe: An ecological multi-national study. Plos One. 2013 June. 8(6). Gibbons RD, Hur K, Bhaumik DK, Mann JJ. The relationship between antidepressant prescription rates and rate of early adolescent suicide. Am J Psychiatry. 2006 November, 163 (11): 1898-1904. Corcoran P, Heavey B, Griffin E, Perry IJ, Arensman E. Psychotropic medication involved in intentional drug overdose: Implications for treatment. Neuropsychiatry. 2013, 3(3): 285-293. Reseland S, Bray I, Gunnell D. Relationship between antidepressant sales and secular trends in suicide rates in the Nordic countries. British journal of psychiatry. 2006, 188: 354-358. Isacsson G, Bergman U, Rich CL. Epidemiological data suggest antidepressants reduce suicide risk among depressives. Journal of affective disorders. 1996, 41: 1-8. Olfson M, Shaffer D, Marcus SC, Greenberg T. Relationship between antidepressant medication treatment and suicide in adolescents. Arch gen psychiatry. October 2003, 60: 978-982.


(304) PO-304. Raising Media Awareness in French-speaking Switzerland: Best Practices and a new study

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Irina Inostroza . STOP SUICIDE, Switzerland
-

 Introduction:
At STOP SUICIDE, we think that appropriate ways to inform about suicide can help preventing suicide among youth people. Through on going funding from one of the Swiss federal states, STOP SUICIDE has worked since 2011 to improve the suicide-protective effect of the media and limit its copycat effect. We work closely with media to promote sensitive and appropriate reporting of suicide. STOP SUICIDE’s “Media program” leads three main activities: media observation, briefing editorial staff and journalism students’ training. Our oral presentation will provide a brief overview of the best practices we identified during the four past years of working with media outlets and journalists. We have developed an innovative and pragmatic approach that media appreciate. Beginning with monitoring the press and writing letters to the press, STOP SUICIDE followed the Swiss experience of Konrad Michel and all (Michel, Frey, Wyss & Valach, 2000) and started to implement a proactive and preventative strategy. STOP SUICIDE offers in-house briefings and has fostered sustainable and interpersonal relationships with newspaper titles. We also work together with schools of journalism and youth medias. Raising awareness amongst the journalists of the future is crucial to change practices. According to one student, “if we don’t have enough time to report carefully about suicide, I’d rather not poke this issue.”
 Goals:
STOP SUICIDE aims to prevent youth suicide in the French-speaking part of Switzerland. www.stopsuicide.ch/site/medias
 Methodology:
In January 2016, we started a qualitative study among Swiss French-Speaking journalists in order to evaluate and develop our strategy towards media outlets and to face the new challenges of online media.
 Results:
The results will be presented in June in Switzerland and it would be nice to present them in September in Oviedo!


(311) PO-311. Feasibility of a suicide mortality review mechanism: A trial in New Zealand

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Sunny Collings . Otago Univeristy, Wellington, New Zealand
- Gabrielle Jenkin - Sarah Mckenzie - Debbie Peterson - June Atkinson -

 Introduction:
Suicide is a major cause of death in New Zealand. While there is publication of suicide data through various government agencies, there has been no systematic review of suicide deaths. In 2014 the Suicide Mortality Review Committee (SuMRC) was established on a trial basis to determine the feasibility of setting up a permanent suicide mortality review mechanism.
 Goals:
The aim of the SuMRC feasibility study was to investigate contributing factors and patterns of suicidal behaviour in NZ and identify points for suicide prevention.
 Methodology:
Files and data from a wide range of government agencies and services were requested for three priority population groups (indigenous Māori youth, males aged 25-64 and those who had recently accessed mental health services) who had died by suicide in a five year period (between 1 January 2007 and 31 December 2011). A tiered approach was used to explore a variety of quantitative and qualitative research methods and analyses for the subgroups. These included: demographic overviews and more specific overviews on the lives of the subgroups, paper-based systems review for the mental health service users and qualitative story-based inquiry (family suicide stories) for the Māori youth subgroup.
 Results:
The study cohort was 1797 people who died by suicide between 1 January 2007 and 31 December 2011. Data retrieved from 16 government agencies and services found that a large number of these were known to Government agencies. The study found a number of potential intervention points for suicide reduction.
 Conclusions:
The SuMRC feasibility study demonstrated that mortality review for suicide in New Zealand is possible and that an ongoing SuMRC could exhaustively analyse existing data, in conjunction with other agencies and in ways that are not currently possible to inform future suicide prevention work.
 References:
Ministry of Health. 2015. Suicide facts: Deaths and intentional self-harm hospitalisations 2012. Wellington: Ministry of Health. Associate Minister of Health. 2006. The New Zealand suicide prevention strategy 2006–2016. Wellington: Ministry of Health.


(340) PO-340. The treatment in the Danish Suicide Prevention Clinics: A qualitative description.

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Titia Lahoz . Suicide Prevention Clinic, Copenhagen University Hospital, Copenhagen
- August Garbriel Wang - Winsløv Jan-Henrik - Krogh Søren - Christiansen Helle - Lykkeskov Hanne - Rass Dorte - Kirketerp Marlene - Bjørnkjær Loft Dianna - Erlangsen Annette -

 Introduction:
Since 1992 psychosocial therapy for people at risk of suicide has been offered in specialised clinics in Denmark. The intervention was at first only available in two cities but became more widespread over time. In 2007 the Danish National Board of Health was possibly the first authority in the world to implement the psychosocial therapy intervention nationally and suicide prevention clinics continue to emerge reaching 19 clinics in 2016 covering all regions of Denmark. The generally lower risk of suicidal behaviour demonstrated for suicide attempters receiving treatment within one of such suicide clinics provides a basis for interest and the point of departure for a more detailed description of the treatment in the Danish suicide prevention clinics.
 Goals:
The aim of this study is to describe the psychosocial intervention offered to people at risk of suicide in out-patient settings in Denmark.
 Methodology:
A qualitative study is applied to describe the psychosocial therapy from the perspective of the clinician. Data were collected through 10 semi-structured interviews with therapists. A purposive sampling strategy was selected with respect to educational backgrounds and geographical locations, i.e. across all five regions in Denmark. All interviews were transcribed verbatim and analyzed using phenomenologic condensation of meaning according to Kvale and Brinkmann aiming to identify central themes of suicide prevention therapy regarding stages of treatment: initial, intermediate and final.
 Results:
The study is expected to provide a detailed description of the suicide prevention therapy, normally categorized as a psychosocial or a rapid and active outreach intervention.
 Conclusions:
The study aims to conclude upon themes that characterize the psychosocial intervention as it currently takes place at the suicide prevention clinics in Denmark, 2016.
 References:
Erlangsen A, Lind BD, Stuart EA, Qin P, Stenager E, Larsen KJ, et al. Short-term and long-term effects of psychosocial therapy for people after deliberate self-harm: A register-based, nationwide multicentre study using propensity score matching, Lancet 2015: 49-58. Acknowledgements: Mette Riis Søgaard, Hanne Frandsen, Mikkel Christoffer Berg Arendt, Berdel Dam Lind.


(342) PO-342. How to implement a clinical guideline for suicide prevention: Development of an e-learning website

Day: 09 | Time: 13:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Saskia Aerts . Flemish Centre for Suicide Prevention (VLESP), Ghent - Belgium
-

 Introduction:
In 2017 the first multidisciplinary clinical guideline on detection and treatment of suicidal patients in Flanders will be implemented in different health care settings. The success of this guideline will depend on the dissemination and implementation in daily health care practice.
 Goals:
To support this implementation, the Flemish Centre for Suicide Prevention (VLESP) is developing an online e-learning platform for health professionals.
 Methodology:
To improve the accessibility and usability of the guideline’s recommendations, an online e-learning platform for health professionals will be created.
 Results:
The guideline addresses five clinical questions: • How to detect and discuss suicidal behavior? • How to treat suicidal patients? • How to act after a patient suicide attempt? • How to act after a patient suicide? • How to develop a suicide prevention policy? The guideline contains evidence-based recommendations for health care professionals of different disciplines (e.g. general practitioners, psychologists, psychiatrists, nurses, …).
 Conclusions:
This platform will be integrated in Zelfmoord1813.be, the online suicide prevention portal of Flanders. On this website, the health professional will be able to browse the content of the guideline through video animations, interviews with experts, infographics and different tools like a custom-made safety plan and checklists that can be put directly into practice.


(360) PO-360. Chronic Suicidality and Its Treatment: A Case Series and Review of the Literature

Day: 09 | Time: 10:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Alejandra Cabello . Universidad Autónoma de Nuevo León Departamento de Psiquiatría, Monterrey México
- María Eugenia Corral -

 Introduction:
Evidence-based guidance on how best to treat chronic suicidality is limited. The statistics show that over 3.5% of the general population experienced suicidal thoughts, albeit there is no evidence about people with chronic suicidality
 Goals:
Elucidate the evidence for chronic suicidality treatment. A case series of 3 patients and review of the literature was performed.
 Methodology:
In order to illustrate the complexities of chronic suicidality, we selected a case series of 3 young patients with chronic suicidality. We assessed clinical and personality features, cognition, family history and pharmacological response with clinical interviews and psychological collaborative assessment with the WAIS IV and Rorschach Test. Bibliographic reference searches for suicidality, suicide and chronic were performed in PubMed and Science-Direct search engines with language restriction for English and Spanish from January 1st, 2006, to January 1st, 2016. The sensitive keywords suicidality and suicide were crossed with keywords chronic, recurrent and treatment and were searched in the title
 Results:
All patients have a long history of suicidal ideation, self/injurious behavior and suicide attempts. Also, they have early onset of depressive mood symptoms and meeting DSM5 criteria for MDD and Personality Disorders. Likewise, all patients were unemployed and there is evidence that the risk is greater in the first five years for unemployment and history of violence prevails in their family and personal development. This was observed in spite of 3 different IQ score ranges: extremely low, average and high average. The review identified 17 eligible studies, out of 224.
 Conclusions:
Because there is no guidance in the treatment of chronic suicidality, the work with these patients is challenging, at the end, the physician appeals to his decision making process and clinical judgement. The common history of family violence is concerning since literature supports that friends and family are considered the first line in providing assistance in suicidal crisis.
 References:
1. Cooper SL, Lezotte D, Jacobellis J, Diguiseppi C. Does availability of mental health resources prevent recurrent suicidal behavior? An ecological analysis. Suicide Life Threat Behav [Internet]. 2006 Aug [cited 2016 Feb 17];36(4):409–17. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16978095 2. Chesin MS, Jeglic EL. Factors Associated with Recurrent Suicidal Ideation among Racially and Ethnically Diverse College Students with a History of Suicide Attempt: The Role of Mindfulness. Arch Suicide Res [Internet]. Jan [cited 2016 Feb 17];20(1):29–44. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26212484 3. Pompili M, Lester D, Tatarelli R, Girardi P. Incomplete oedipism and chronic suicidality in psychotic depression with paranoid delusions related to eyes. Ann Gen Psychiatry [Internet]. 2006;5:18. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1661590&tool=pmcentrez&rendertype=abstract 4. Bergmans Y, Links PS. Reducing potential risk factors for suicide-related behavior with a group intervention for clients with recurrent suicide-related behavior. Ann Clin Psychiatry [Internet]. Jan [cited 2016 Feb 17];21(1):17–25. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19239829 5. Bryan CJ, Clemans TA, Leeson B, Rudd MD. Acute vs. chronic stressors, multiple suicide attempts, and persistent suicide ideation in US soldiers. J Nerv Ment Dis [Internet]. 2015 Jan [cited 2016 Feb 17];203(1):48–53. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25503959 6. Williams JMG, Crane C, Barnhofer T, Van der Does AJW, Segal Z V. Recurrence of suicidal ideation across depressive episodes. J Affect Disord [Internet]. 2006 Apr [cited 2016 Jan 5];91(2-3):189–94. Available from: http://www.sciencedirect.com/science/article/pii/S0165032706000036 7. De Gioannis A, De Leo D. Oral ketamine augmentation for chronic suicidality in treatment-resistant depression. Aust N Z J Psychiatry [Internet]. 2014 Jul [cited 2016 Feb 17];48(7):686. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24452289 8. Dugas EN, Low NC, O’Loughlin EK, O’Loughlin JL. Recurrent suicidal ideation in young adults. Can J public Heal = Rev Can santé publique [Internet]. Jan [cited 2016 Feb 9];106(5):e303–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26451992 9. Fishbain DA, Bruns D, Bruns A, Gao J, Lewis JE, Meyer LJ, et al. The Perception of Being a Burden in Acute and Chronic Pain Patients is Associated with Affirmation of Different Types of Suicidality. Pain Med [Internet]. 2015 Sep 1 [cited 2016 Feb 17]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/26332796 10. Mousavi SG, Bateni S, Maracy MR, Mardanian F, Mousavi SH. Recurrent suicide attempt and female hormones. Adv Biomed Res [Internet]. 2014 Jan [cited 2016 Feb 17];3:201. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4202501&tool=pmcentrez&rendertype=abstract 11. Sáiz PA, Rodríguez-Revuelta J, González-Blanco L, Burón P, Al-Halabí S, Garrido M, et al. [Study protocol of a prevention of recurrent suicidal behaviour program based on case management (PSyMAC)]. Rev Psiquiatr y salud Ment [Internet]. Jan [cited 2016 Jan 29];7(3):131–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24656762 12. Sockalingam S, Flett H, Bergmans Y. A pilot study in suicide intervention training using a group intervention for patients with recurrent suicide attempts. Acad Psychiatry [Internet]. Jan [cited 2016 Feb 17];34(2):132–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20224024 13. Angelica MD, Fong Y. NIH Public Access. October. 2008;141(4):520–9. 14. Lopez-Castroman J, Cerrato L, Beziat S, Jaussent I, Guillaume S, Courtet P. Heavy tobacco dependence in suicide attempters making recurrent and medically serious attempts. Drug Alcohol Depend [Internet]. Elsevier Ireland Ltd; 2016;1–6. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0376871616000284


(366) PO-366. Gender differences in triggers of suicidal behavior and other risk factors in adolescents

Day: 09 | Time: 10:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Tania Prieto Toribio . Sant Joan de Déu University Hospital. UB, Barcelona- Spain
- Sandra Yazmín Valdez Amaral - Bernardo Sánchez Fernández - Carmina Castellano Tejedor - Francisco Villar Cabeza -

 Introduction:
Adolescent suicide attempts are a major public health problem. Although rates of completed suicide are higher for male adolescents, rates of suicide attempt are 2-3 times greater for female adolescents[1]. Thus, to identify risk factors and gender-related variables related to greater risk of suicide attempts becomes crucial[2].
 Goals:
To assess gender differences in relation to triggers of suicidal behavior and other selected risk factors (specifically, bullying, family history of suicidal behavior, history of childhood sexual abuse and self-harm)
 Methodology:
Patients evaluated in a psychiatric emergency unit of a Pediatric Hospital were included in a cross-sectional study during 2014-2015
 Results:
526 episodes of 402 patients were registered (82.08% females and 17.91% males). More than 50% of the suicidal behaviors registered were preceded by relationship conflicts. Specifically, family relationship problems were main triggers in both genders (34% females, 35% males), followed by sentimental breakups (11% females, 14% males) and conflicts with peers (7% females, 4% males). Emotional dysregulation was the second most mentioned trigger in both genders (29% females, 18% males). When considering the selected risk factors, 11% of the treated patients said that they had suffered bullying and 12% had a family history of suicidal behavior, with no significant differences between genders. Significant differences between genders were found in patients with a history of childhood sexual abuse (11% males, 4% females; p <0.05) and with a history of self-harm (40% females, 18% males; p <0.001).
 Conclusions:
No relevant differences between genders were found regarding possible triggers of suicidal behavior. Considering that relationship conflicts represent more than 50% of the mentioned triggers, suicidal behaviors in populations at risk could be expected to be reduced by intensifying the interventions aimed to reduce family conflicts, emotional management and solving interpersonal conflicts in adolescents of both genders. Further research is needed to validate these results.
 References:
1) Lewinsohn PM, Rohde P, Seeley JR, Baldwin CL. Gender Differences in Suicide Attempts From Adolescence to Young Adulthood. J Am Acad Child Adolesc Psychiatry. 2001 April; 40 (4): 427-434. 2)Qin P, Agerbo E, Westergård-Nielsen N, Eriksson T, Mortensen PB. Gender differences in risk factors for suicide in Denmark. Br J Psychiatry. 2000 Dec;177:546-50.


(375) PO-375. Treating high suicidal patients with Asperger syndrome (DSM-IV-RT) with DBT principles

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Shu Chin Chen . Suicide Prevention Center, MacKay Memorial Hospital, Taipei, Taiwan
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 Introduction:
DBT is an effective treatment for BPD clients. Some researchers report that BPD and Asperger syndrome (DSM-IV-TR) are sometimes confused. Yet, there is no research mention about treating suicidal patients with Asperger.
 Goals:
This report tries to modify DBT for high sundial patients with AS syndrome.
 Methodology:
The therapist finished intensive DBT training, is on DBT team for 8 years. She used DBT principles to treat two clients in this report. They are both female, around 20, drop out from collage, had suicide attempts and threats. They also have significant AS traits, Autism-spectrum Quotient Chinese Version total score > 30. It means that they have more difficulties in social skills, more rigid behavior, and easy to focus on details not very fit the context. Case A finished one year standard DBT. Case B received DBT individual therapy for one year. But because of her serious interrupted behavior, such as threaten to burn clinic, rejected diary card record and blamed therapist all the time. Therapist used 8 months to prepare case B to get into a skills training group, and it only left 4 months.
 Results:
Their suicidal behaviors and threats decreased after one year treatment. Their life worth living goals are extending. Case A changed her major and back to college in 0.5 years after treatment. Case B back to school in 3 months during treatment. Both of them stayed in their school work. Their interpersonal conflicts decreased. These two cases see therapist one or two times per month continually.
 Conclusions:
This is not a strict study, yet showed some effect of modified DBT treating suicidal clients with Asperger symptoms. Individual help especially needed while applied DBT skills to real life. If the client had tremendous dysregulated behavior, these behaviors need to decrease to certain level before she got into a group.


(391) PO-391. Predictors of suicide attempt with violent methods compared with poisoning

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Per Sverre Persett . Oslo University Hospital, Oslo - Norway
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 Introduction:
In Norway about 550 suicides are recorded each year (Statistics Norway). Probably, the number of suicide attempts is 10-15 times higher (Hawton). Suicide is one of the most common causes of death among those aged 15-44 years. In Norway, research om suicide attempt caused by self-poisoning is fairly widespread, suicide attempt by violent method has not been studied.
 Goals:
1: The main objective of this study was to describe patients who admitted to somatic hospital after attempted suicide using violent methods (hanging, drowning, jumping from heights, using firearms, cutting or others). 2: An additional objective of the study was to compare patients after attempted suicide using violent methods with non-violent methods.
 Methodology:
A prospective cohort study included patients (>18 years), 80 patients admitted by violent method (median age 42 years, male=63%) and 81 admitted by other methods (median age 41 years, male 47%). Its designed to examine psychological and somatic outcomes of patients admitted to somatic hospital in Norway after suicide attempt, and to compare patients with suicide attempt using violent methods with suicide attempt by other methods. Their demographics and previous health background was examined.
 Results:
159 patients was attending the Emergency Room with suicide attempt by violent method during 2011 to 2014. The methods used in violation was cutting (34%),, jumping from heights (32%), hanging (14%), different (10%), firearms (7%) and drowning (4%). Patients admitted with violent methods had a more widespread history with psychosis than patients admitted with self-poisoning. Patients admitted with self-poisoning were previously more frequent of anxiety and affective disorders. Patients with violent method used health services infrequently before suicide attempt, but more reported suicide thoughts when attending health service.
 Conclusions:
From the 159 patients admitted the hospital by violent methods were more men than women. They had a severe damage and longer hospital stay than patients. The incidence of hospitalized suicide attempt by violent methods in Oslo University Hospital was 159, with a not equal sex distribution. One in ten patients died during the hospital stay and 14 suffered a cerebral damage. The in-hospital mortality was 11%. Method by firearms had highest mortality. Compared to the outcome of suicide by poisoning (Lund. 2012) this patient group is in serious dangerous conditions after a suicide attempt.
 References:
Hawton, K., & Harriss, L. (2008). How often does deliberate self-harm occur relative to each suicide? A study of variations by gender and age. Suicide and Life-Threatening Behavior, 38(6), 650-660. doi:10.1521/suli.2008.38.6.650 Lund, C., Drottning, P., Stiksrud, B., Vahabi, J., Lyngra, M., Ekeberg, I., . . . Hovda, K. E. (2012). A one-year observational study of all hospitalized acute poisonings in Oslo: complications, treatment and sequelae. Scand J Trauma Resusc Emerg Med, 20, 49. doi:10.1186/1757-7241-20-49 Nordentoft, M. (2007). Prevention of suicide and attempted suicide in Denmark. Epidemiological studies of suicide and intervention studies in selected risk groups. Danish Medical Bulletin, 54(4), 306-369. Statistic Norway


(399) PO-399. Evaluation of the Implementation of the Project Integrated Care for Suicide Attempters in 44 General Hospitals in Flanders, Belgium

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Peter Beks . Integrated Care for Suicide Attempters, DAGG vzw, Lommel, Belgium
- Marie Van Broeckhoven - Anneleen Depaire -

 Introduction:
In 2005 we started to focus on the high risk group of suicide attempters (SA) in Flanders. In the last ten years we managed to develop a set of tools and instruments to support caregivers in their work with suicide attempters. In 2015 approximately 80% of the general hospitals in flanders use our instruments.These participating hospitals are evaluated biennially.
 Goals:
The evaluation's main goals is to detect problems en discuss solutions concerning the implementation of our tools and instruments (IPEO, KIPEO, Toolkit On Track Again and leaflets). Further we detect the needs of workers in the care of SA and promote a professional attitude, support and referral (adequate risk assessment, continuity of care, communication between hospital and general practitioners)
 Methodology:
Evaluation: a standard questionnaire following a semi-structured interview with key persons in the hospital, carried out by suicide prevention workers.
 Results:
More than 50% of the hospitals had a standard procedure developed by a planning group. In 43.2% of the hospitals a standard procedure is guaranteed 24/7. About 40% of the hospitals say to use the IPEO tool for ‘all’ patients and 22.7% for ‘almost all’ patients. In 65.9% of the cases the patient leaflet is used. In 70.5% of the cases the GP is informed and involved in the follow-up care. Hospitals report a change of attitude, improved knowledge and understanding, improved assessment and care, improved cooperation between caretakers and optimized care for patients.
 Conclusions:
The introduction of good practices for suicide attempters, has been well received by the participating hospitals. The training and the use of the instrument promote knowledge and positive attitudes towards SA. The introduced good practices need to be constantly promoted to render them permanent. In-service-trainings, repeated trainings for hospital staff and evaluations are ways to do this.


(417) PO-417. Suicide Survivors in Lithuania: I have to cope with it on my own

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Intervention research for prevention of suicidal behavior

Authors:Odeta Geležėlytė . Vilnius University ,
- Vaiva Klimaitė - Danutė Gailienė -

 Introduction:
Every suicide leaves 10 to 15 suffering people. Bereaved by suicide face emotional, somatic and social difficulties (Pitman et al., 2014). As a result, they are often in need of help (Dyregrov, 2011). Lithuania is a country with one of the highest suicide rates in the world, but suicide prevention and postvention system is very poor. We believe, this situation has a significant effect on the bereaved.
 Goals:
As part of a larger study, the objective of this presentation is to analyze and describe professional help-seeking difficulties of those bereaved by suicide in Lithuania.
 Methodology:
23 suicide survivors (20 female, 3 male, average age 42 y.), who lost a close relative (parent, child, sibling or spouse) from 1 to 2 years before, were interviewed (average duration 67 min.). Thematic analysis was used for the data examination. 2429 citations, 299 themes, 44 subcategories and 15 categories were discovered.
 Results:
Results revealed that the bereaved didn’t get help needed. They often felt confused about what kind of help they could ask. Survivors avoided participating or initiating helpful activities (eg. self-help groups), although expressed the need for it. As a result, they felt they have to cope with extensive difficulties on their own and accept it as it is in the nature of the case. The study also revealed interviewees‘ mistrust in public health care and other institutions. Suicide stigma played an important role too. Results showed beliefs about inappropriateness, sinfulness of suicide that discouraged the bereaved from seeking help, stimulated avoidance and withdrawal.
 Conclusions:
These results suggest that lack of help offered, mistrust, isolation and suicide stigma play an important role that bereaved by suicide don’t get help needed in Lithuania. Systematic essential changes are necessary to change the situation.
 References:
Dyregrov, K. (2011). What do we know about needs for help after suicide in different parts of the world? A phenomenological perspective. Crisis, 32 (6), 310-318.
Pitman, A., Osborn, D., King, M., & Erlangsen, A. (2014). Effects of suicide bereavement on mental health and suicide risk. Lancet Psyciatry. doi:10.1016/S2215-0366(14)70224-X