The latest medical research on Forensic Psychiatry

This study aimed to adapt and expand an evidence-based lethal means counseling intervention for peer-delivery among firearm owning Veterans. We further sought to assess Veteran interventionists' fidelity to motivational interviewing (MI) in the context of the adapted intervention.

An iterative expert panel comprised of experts in suicide prevention, lethal means counseling, MI, and Veteran peer engagement (N = 9) informed intervention adaptation. Experts rated the appropriateness of the adapted intervention, named Peer Engagement and Exploration of Responsibility and Safety (PEERS), and associated interventionist training plan across six criteria. Veteran interventionists (N = 3) were trained to deliver PEERS and their fidelity to MI in the context of PEERS was evaluated.

Expert panelists' average rating was 7.6 (out of 9). Ratings across all criteria (e.g., quality of the training plan; perceived ability of interventionists to engage in the intervention) were high. Interventionists' composite MI fidelity scores suggested most were client-centered, but not MI-competent in their delivery.

Findings suggest that PEERS is an appropriate lethal means counseling intervention for firearm owning Veterans that can be somewhat feasibly delivered by Veteran interventionists. This intervention could help expand the reach and effectiveness of lethal means counseling.

Risk factors for suicide after parental suicide may include points in the lifecourse when reminders of the deceased trigger grief resurgence. We hypothesized that risk of suicide attempt and suicide is elevated among suicide-bereaved offspring on reaching the age at which a parent died by suicide.

We conducted a self-controlled case series (SCCS) study using national register data on all individuals bereaved by parental suicide living in Denmark from 1980 to 2016. We compared relative incidence of our combined outcome (any secondary-care episode of self-harm or suicide) during the exposure period (2 years centred on the birthday representing age correspondence) and the 15-year unexposed periods either side. We repeated these models for offspring bereaved by parental non-suicide death as an indirect comparison.

Risk of self-harm or suicide was elevated on reaching the age at parental suicide (n = 188; IRRadj: 2.02, 95% CI: 1.21-3.38) relative to flanking periods, but not at parental non-suicide death (n = 734; IRRadj: 0.76; 95% CI: 0.39-1.50).

Reaching the age at which a parent died by suicide appears to represent a vulnerable period for suicidality, countering public perceptions that time heals linearly. This indicates a need for support in the lead up to age correspondence.

This study sought to better understand discussions of emergency dispatches (i.e., activation of local crisis services to conduct a welfare check) and the circumstances under which Veterans Crisis Line (VCL) callers and responders feel they are able contribute to (collaboration) and agree upon (consent) the decision to initiate an emergency dispatch.

Semi-structured interviews gathered data on veterans' (n = 40) experiences receiving an emergency dispatch and VCL responders' (n = 35) perspectives on initiating dispatches. Data were analyzed using a thematic analysis approach.

Veterans calling the VCL were often seeking emotional support and were surprised to receive a suicide risk assessment and emergency dispatch. Responders reported they strive for collaboration and consent prior to sending a dispatch, but the crisis setting challenged this ideal. Overall, veterans and responders described similar features of the ideal, collaborative conversation about dispatches yet noted threats to achieving collaboration: complex standard operating procedures, responder training quality, and responder lack of comfort with de-escalation.

Increasing veteran awareness of VCL services, altering the timing and type of suicide risk assessment, enhancing de-escalation skill, increasing consistency of VCL responder proficiencies, and revising guidelines for dispatch disclosure were identified as ways to improve collaboration and consent around emergency dispatches.

Despite the bidirectional relationship between alcohol use and STB, the two issues are often treated separately in adolescent inpatient psychiatric hospitals, highlighting the need for brief interventions that address both alcohol use and STB in an integrated fashion.

This study tested the feasibility, acceptability, and preliminary effectiveness of a brief integrated Alcohol and Suicide Intervention for Suicidal Teens (iASIST) with a post-discharge mHealth booster for adolescents in inpatient psychiatric treatment.

We conducted an RCT of iASIST relative to an attention-matched comparison condition with adolescents hospitalized following STB (N = 40).

iASIST demonstrated feasibility and acceptability and mixed models indicated that both groups had significant decreases in substance use over the 3-month follow-up, but post-intervention group differences were not significant. In terms of cannabis use, however, iASIST participants significantly improved over time. Intervention group participants showed a significant decrease in suicide plans from baseline to follow-up, which was not the case for control group participants.

iASIST shows promise in its ability to target the public health problems of alcohol use and STB in an integrated fashion with a high-risk adolescent population receiving acute psychiatric care.

This study investigated the trajectories of interpersonal stress and psychological pain and their effects on self-harm behaviors in adolescents and explored the reciprocal associations between interpersonal stress and NSSI/SA.

The participants included 1149 adolescents (50.3% women; Mage = 12.86, SD = 0.69) who participated in three waves of data collection. Latent class growth models and cross-lagged panel models were used to identify subgroups of individuals and interactions between interpersonal stress and NSSI/SA.

Controlling for sex and age, compared to the low interpersonal stress class, the moderate to high and increasing classes have higher risks of NSSI and SA. Compared to adolescents in the low increasing feelings with high increasing avoidance class, those in the low increasing feelings with low decreasing avoidance class reported lower probabilities of NSSI and SA. Pain avoidance and painful feelings mediated the pathway from interpersonal stress to NSSI/SA, whereas pain arousal mediated the pathway from NSSI/SA to interpersonal stress.

Shared impact of interpersonal stress and distinct effects of psychological pain over time on maintaining and distinguishing self-harm behaviors were found. Adolescent crisis interventions should simultaneously focus on building social networks within the school context and regulating maladaptive minds.