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The purpose of this study was to examine how victims of sexual abuse in a community corrections population differ as a result of their sex and race. Of the 19,422 participants, a total of 1,298 (6.7%) reported a history of sexual abuse and were compared with nonabused participants. The sample was analyzed by race-gender groups (White men, White women, African American men, and African American women) using univariate and logistic regression analyses, which were conducted separately for each group. White women were the most likely to report a history of sexual abuse (26.5%), followed by African American women (16.0%), White men (4.0%), and African American men (1.1%). For all groups, histories of suicidal ideation and suicide attempts were associated with a history of sexual abuse. Sexual abuse was associated with substance abuse problems for women but not the men. Cannabis dependence was associated with sexual abuse for the White women while cocaine dependence was associated with sexual abuse for the African American women. Several other variables were associated with sexual abuse for women but not men, including lower education (White women only), a history of violent offenses (White women only), and living in a shelter (African American women only). African American men tended to have higher levels of education; this was the only variable uniquely associated with either male group. Receiving psychiatric medications was associated with sexual abuse for all groups except African American men and a history of sex for drugs was associated with sexual abuse for all groups except White men. Consistent with national sample, women, particularly White women, were more likely to be victims of sexual abuse. The gender-race differences for the sociodemographic factors associated with sexual abuse, particularly the risk of substance abuse for women, suggest the need for tailored interventions for sexual abuse prevention and treatment. (Contains 2 tables.)

Suicidal patients often present to the emergency department, where specific anti-suicidal treatment is lacking. Ketamine, a Glutamate modulator and a rapidly acting antidepressant with anti-suicidal properties, might offer relief. Evaluation of single, fixed-dosed intranasal ketamine for acute suicidal ideation in the emergency department. Between August 2016 and April 2018, 30 eligible suicidal subjects, scheduled for psychiatric hospitalization, independently of their psychiatric diagnosis, were randomized to intranasal ketamine 40 mg or saline placebo. Safety and efficacy evaluations were scheduled for 30, 60, 120 and 240 min post administration and on days 1, 2, 3, 4, 5, 7, 21 and 28. Primary outcome was suicidal ideation. Fifteen subjects were randomized for each study group. All were analyzed for primary and secondary outcomes. Four hours post administration, the mean difference in suicidal symptoms between the groups, measured by the Montgomery-Åsberg Depression Rating Scale (MADRS) item of suicidal thoughts (MADRS-SI), was 1.267 (95% confident interval 0.1–2.43, p < 0.05) favoring treatment. Remission from suicidal ideation was evident in 80% for the ketamine group compared with 33% for the controls (p < 0.05). The mean difference in depressive symptoms, measured by MADRS, at the same time was 9.75 (95% confident interval 0.72–18.79, p < 0.05) favoring ketamine. Treatment was safe and well-tolerated. Single, fixed-dose, intranasal ketamine alleviated suicidal ideation and improved depressive symptoms four hours post administration. We present here an innovative paradigm for emergency department management of suicidal individuals. Future larger-scale studies are warranted. ClinicalTrials.gov Identifier: NCT02183272. [ABSTRACT FROM AUTHOR]

Background: Depressed patients presenting to emergency departments with acute suicidal ideation are a major public health concern. Ketamine, a rapidly acting antidepressant with antisuicidal properties, might offer relief.Methods: In a randomized, double-blind, placebo-controlled, proof-of-concept trial, 18 depressed subjects with acute suicidal ideation, who required hospitalization, were randomized to either an intravenous ketamine 0.2 mg/kg group or a saline placebo group. Safety and efficacy evaluations were scheduled for 15, 30, 60, 90, 120, 180, and 240 min, and on Days 1, 2, 3, 7, and 14 after infusion. The main outcome measure was suicidal ideation with secondary measures of depression.Results: Nine subjects were randomized to each group. There were no differences between groups at baseline in any demographic or assessment scales. A reduction in suicidal ideation was noted at 90-180 min (p < .05). Ninety minutes after infusion, 88% of the ketamine group had achieved remission of suicidal ideation compared with 33% in the placebo group (p < .05). No serious adverse events were noted.Conclusions: Ketamine was safe and effective for rapid reduction in suicidal ideation in depressed, highly suicidal subjects presenting to the emergency department. Our results support further study of ketamine for acute suicidal ideation. [ABSTRACT FROM AUTHOR]

The study goal was to determine whether a significant number of high suicide risk individuals would confidentially put their own names onto a list to prevent future gun purchases. An anonymous written survey was administered in an inpatient psychiatric unit and two outpatient psychiatric clinics at an academic medical center. Two hundred forty individuals were approached to fill out the survey, of whom 200 (83.3%) did so. Forty-six percent of participants stated that they would put their own name onto the list. This novel suicide prevention proposal, a Do-Not-Sell List, would appeal to many people at high risk for suicide. [ABSTRACT FROM AUTHOR]

Objective: This exploratory study examines the concurrent validity for mapping symptoms of suicidal ideation, self-harm, and suicidal behavior as recorded on the InterSePT Scale for Suicidal Thinking- Plus, the Sheehan-Suicidality Tracking Scale (clinician- and patient-rated and reconciled patient/clinician versions), and the Columbia–Suicide Severity Rating Scale to the 11 United States Food and Drug Administration- Classification Algorithm of Suicide Assessment (September 2012) categories. Method: Forty subjects with varying degrees of suicidal ideation and behavior severity (from not present to extremely severe) were recruited from inpatient, outpatient, and emergency room settings. Each patient was interviewed using all three scales (InterSePT Scale for Suicidal Thinking-Plus, the Sheehan-Suicidality Tracking Scale, and the Columbia–Suicide Severity Rating Scale) on the same day. The scales were administered in a random sequence by three independent raters who were blind to the ratings on the other scales. Results: The Sheehan-Suicidality Tracking Scale and the InterSePT Scale for Suicidal Thinking-Plus show acceptable agreement with the Columbia–Suicide Severity Rating Scale in detecting the presence or absence of the 2012 Food and Drug Administration-Classification Algorithm of Suicide Assessment categories 1, 5, 6, 10, and 11 (passive ideation; active ideation with method, intent, and plan; completed suicide; preparatory actions; and self-injurious behavior) but not of categories 2, 3, and 4 (3 other active suicidal ideation combination categories) or to 8 and 9 (aborted and interrupted attempt). Despite the significant disagreement between the Columbia–Suicide Severity Rating Scale on the one side and the InterSePT Scale for Suicidal Thinking-Plus and the Sheehan- Suicidality Tracking Scale on the other in the ability to accurately map to the 2012 Food and Drug Administration- Classification Algorithm of Suicide Assessment categories on some items, there was close agreement between the InterSePT Scale for Suicidal Thinking-Plus and the Sheehan- Suicidality Tracking Scale on these categories. Conclusion: The results of this exploratory study invite discussion and debate about the validity of the Columbia–Suicide Severity Rating Scale and its ability to accurately assess key active suicidal ideation categories, since it disagrees so much with the other two standardized scales that agree so closely with each other. [ABSTRACT FROM AUTHOR]

Objective: To explore the authors’ predictions 1) that hopelessness would positively correlate with suicidal ideation and that impulsivity (either transient urges to self-harm or impulsive acting out) would positively correlate with suicidal behavior, and 2) that the recent or long-standing nature of the traits will have corresponding effects on reported histories of suicidal ideation and behavior. Design: Questionnaire validation trial in which each subject received every measure in counterbalanced fashion. Setting: Inpatient and outpatient psychiatric settings associated with a medium-sized medical school in the southeastern United States. Participants: Forty-five subjects presenting with varying levels of suicidal ideation and behavior completed measures providing information about their histories of suicidal ideation and behavior, recent feelings of hopelessness, feelings of general hopelessness, recent feelings of difficulty controlling urges to self- harm, and feeling about general levels of impulsivity. Measurements: The InterSePT Scale for Suicidal Thinking–Plus, the Sheehan-Suicidality Tracking Scale, the Columbia–Suicide Severity Rating Scale, and six additional questions to assess hopelessness and impulsivity. Results: Recent and trait hopelessness correlated positively with suicidal ideation. Patients who reported any suicide attempt endorsed higher levels of general impulsivity than those who did not report a history of at least one suicide attempt. Those enrolled in the study secondary to a very recent suicide attempt reported more difficulties with recent suicidal impulses. Conclusion: Simple measures of hopelessness and impulsivity are associated with suicidal ideation and attempts and may add to determination of suicide risk. [ABSTRACT FROM AUTHOR]

Opiate overdose is an increasingly common cause of death, yet could be easily treated with available opioid antagonists. Opiate use is very common in criminal justice populations, and individuals recently released from prisons or jails are an especially vulnerable group for both overdose and death, particularly in the immediate postrelease period. Participants (N = 478) were individuals under community corrections supervision who were surveyed about their opioid use, overdose history, medical history, and demographics. Most participants were male (67.4 percent) and either African American (52.4 percent) or Caucasian (44.2 percent) with an average age of 35 years (SD = 11.1). Two hundred twenty participants (46 percent) reported lifetime use of opioids, whereas 88 (40 percent) reported experiencing an opioid-related overdose. Relative to those with no history of opioid overdose or lifetime opioid use, participants with a history of opioid overdose were more likely to be Caucasian, female, and report higher educational attainment; more likely to be willing to receive additional training about overdose; and reported double to triple the rates of witnessing an overdose or knowing someone who had died from overdose -78 percent and 69 percent, respectively. The rates of actions taken when witnessing overdose were relatively low: 59 percent had called 911, 33 percent had taken someone to a hospital with 23 percent providing no intervention, and only 4 percent having used an opioid antagonist, naloxone. These findings suggest that while opioid overdose is a significant problem in the criminal justice population, affected individuals are open to instruction in effective strategies, such as naloxone training, to prevent fatal opioid overdose.