parent-infant interactions. For example, mothers with suicidal symptoms display reduced responsiveness and sensitivity to infant cues. Their infants have less positive affect and reduced engagement with their mothers. In addition to psychiatric disorders, other risk factors for suicide or suicidal ideation (SI) in postpartum adults include a history of self-harm or suicide attempts, suicidal thoughts, a family history of suicide, and increased levels of hopelessness. Experiences of childhood physical abuse, sexual abuse, and neglect are significantly associated with suicide attempts and thoughts of suicide in the general community and in patients with major depressive disorders. Among severely depressed patients, proximal risk factors for suicide and suicidal behaviors include acute intoxication, sleep disturbance including insomnia or nightmares, and heightened symptoms of anxiety or agitation. After delivery, women with postpartum major depression, puerperal psychosis, and recurrent episodes of bipolar disorder (BD) often had thoughts of self-harm or SI (Gressier et al., 2017). Older adults Suicide is a significant problem among older adults. Suicide rates are particularly high among older men; according to the Suicide Prevention Resource Center (SPRC), men 65 and older have the highest rate of any group in the country (SPRC, 2018b; Sheava, Hitching, & Dunn, 2019). Suicide attempts by older adults are much more likely to result in death than attempts by younger persons. Reasons for this may be that: older adults plan more carefully and use more deadly methods; older adults are less likely to be discovered and rescued; or the physical frailty of older adults means they are less likely to recover from an attempt. Military personnel and veterans Veterans of the wars in Iraq and Afghanistan have a 41 to 61% higher risk of suicide than the general U.S. population (Wood et al., 2020). This is higher than seen in veterans from earlier wars, prompting the U.S. Senate and the House of Representatives to unanimously pass a bill in early 2015 to improve suicide prevention programs at the U.S. Department of Veterans Affairs (VA). The numbers raise important questions for researchers: Which veterans will turn to suicide, and why? While risk increases for many reasons, post-traumatic stress disorder (PTSD) has emerged as one of the strongest predictors, but not every veteran develops PTSD or becomes suicidal (Moran, 2015). Suicide is influenced by multiple factors, including biological factors, such as sex; socioeconomic factors, such as employment status; and other factors, such as access to firearms. These Youth suicide in California In California in 2015, suicide took the lives of 495 young people ranging in age from 5 to 24 years (Mink, 2018). In 2019, a report revealed that the suicide rate for California youth between the ages of 15 and 19 had risen 34% in just three years; the national rate of increase for this population was 25% (Bharath, 2019). A survey found that one in five California public school students in the 9th and 11th grades had suicidal thoughts. The rates of suicidal thinking varied widely among schools, from 4% to 70%. Schools in smaller districts that promoted prevention training had lower percentages (Benbenishty, Astor, & Roziner, 2018; KCAL 9, 2019). One possible culprit in the increased rates of youth suicide is social media. Young people may feel that their lives are not as exciting or glamorous as the lives of people they see online. Furthermore, cyberbullying has been known to drive young people to suicide. Young people who post online about wanting to die should be taken seriously (Mink, 2018). However, students’ personal situations and dynamics within schools also play a role. In a study of suicidal ideation among California high school students, Benbenishty and colleagues (2018) found that “being an LGBTQ student and studying in a school with either few or
Findings from a postpartum depression screening program of 10,000 postpartum women indicated that those who screened positive for depression had high rates of self-harm ideation (19.3%) and “frequent” thoughts of self-harm. Depression screening of 4,000-plus postpartum women in the community also suggested that 4% had frequent thoughts of self-harm “sometimes” or “quite often” (Sit et al., 2015). Because affected parents can present with frequent thoughts of self-harm and a high level of clinical complexity, conducting a detailed safety assessment which includes an evaluation of childhood abuse history, current symptoms of sleep disturbance, and anxiety is a key component in the management of depressed mothers. Assessing safety should include exploration of suicidal or homicidal ideation or attempts, past or recent hospitalizations, recent medication changes, intolerable drug effects, alcohol and substance use, family history of suicide, and evaluation of protective factors. Enlisting supports to stay with the patient and remove access to lethal methods is essential. Risk factors for this population include depression and other mental health problems; substance use problems (including prescription medications); physical illness, disability, and pain; and social isolation. Protective factors include care for mental and physical health problems, social connectedness, and skills in coping with and adapting to change. Indeed, older adults may often have compounding risk factors that increase their vulnerability to suicidal ideation and behavior, especially when mental health concerns are compounded by other physical health concerns (Schmutte et al., 2019). Therefore, careful and routine screening of older adults for suicide risk is essential to identifying problems early in this population. factors can confer increased risk of suicidal behaviors and suicide. The veteran population in general tends to be more affected by these factors or has more access to these risk factors (i.e., firearms), thereby increasing their risk. Middle-aged male veterans are at the highest risk for suicide and rates for male veterans older than 65 is increasing. This number may be influenced by the fact that that these individuals represent Vietnam-era veterans who are a cohort at higher risk for suicide caused by ongoing social, economic, or psychiatric difficulties. Accordingly, any clinician working with military or veteran populations should take additional care to screen and assess for suicide risk as a part of regular, ongoing clinical services. many other LGBTQ students may be two different and additive factors that influence a student’s suicide ideation” (p. 255). The Trevor Project found that as late as 2018, a quarter of California’s school suicide prevention policies failed to address the special problems of LGBTQIA students. This is in spite of the passage of California Assembly Bill 2246, which mandates that schools serving students from grades 7 to 12 address the needs of high-risk students, including LGBTQIA youth (The Trevor Project, 2018). It is well known that LGBTQIA youth are more likely than other young people to attempt suicide. Perez-Brumer and colleagues (2017) found that the prevalence of suicidal ideation was nearly twice as high for California transgender youth than for non- transgender youth. These researchers found that two factors that helped to account for the high rate of suicidal thoughts in these young people were depression and “school-based victimization.” They conclude that “our data underscore the importance of assessing suicidal ideation among transgender youth and also suggest that depression and experiences of victimization may represent critical targets for intervention in clinical practice and care” (p. 745).
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