Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 2: Suicide-related ideations, communications, and behaviors

Nonsuicidal self-injury as a time-invariant predictor of adolescent suicide ideation and attempts in a diverse community sample

OBJECTIVE

Longitudinal data on adolescent self-injury are rare. Little is known regarding the associations between various forms of self-injurious thoughts and behaviors over time, particularly within community samples that are most relevant for prevention efforts. This study examined nonsuicidal self-injury (NSSI) as a time-invariant, prospective predictor of adolescent suicide ideation, threats or gestures, and attempts over a 2.5-year interval.

METHOD

A diverse (55% female; 51% non-White) adolescent community sample (n = 399) reported depressive symptoms, frequency of NSSI, suicide ideation, threats or gestures, and attempts in 9th grade (i.e., baseline) and at 4 subsequent time points. Generalized estimating equations and logistic regressions were conducted to reveal the associations between baseline NSSI and the likelihood of each suicidal self-injury outcome postbaseline while controlling for depressive symptoms and related indices of suicidal self-injury as competing predictors.

RESULTS

Baseline NSSI was significantly, prospectively associated with elevated levels of suicide ideation and suicide attempts, but not threats or gestures. Neither gender nor ethnicity moderated results.

CONCLUSIONS

Above and beyond established risk factors such as depressive symptoms and previous suicidality, adolescent NSSI may be an especially important factor to assess when determining risk for later suicidality.

Belief system, meaningfulness, and psychopathology associated with suicidality among Chinese college students: a cross-sectional survey

Background

Research suggests that Chinese religious believers are more likely to commit suicide than those identifying as non-religious among rural young adults, contrary to findings in Western countries. However, one cannot conclude that religiosity is associated with elevated suicide risk without examining the effect of political and religious beliefs in a generally atheist country like China where political belief plays a dominant role in the belief system of young adults. The present study investigated the effects of political and religious belief on suicidality with meaningfulness and psychopathology as potential mediators in a large representative sample of Chinese college students.

Methods

A cross-sectional survey was conducted among 1390 first-year college students randomly sampled from 10 colleges and universities in mainland China.

Results

A total of 1168 respondents (84.0%) provided complete data on all variables. Lifetime prevalence of suicidal ideation, plan, and attempt were 45.1%, 6.8%, and 1.9% respectively, with one-year suicidal ideation showing at 19.3%. Female gender was associated with elevated risk of suicidality. Political belief but not religious belief was associated with decreased suicide risk. A significant interactive effect of political belief and religious belief was found, indicating that for political believers, being religious was associated with decreased suicide risk; for non-political believers, being religious was associated with increased suicide risk. Multi-group structural equation modeling showed that meaningfulness completely mediated and psychopathology partially mediated the effect of belief system on suicidality. Gender differences were found in pathways of political belief by religious beliefs to suicidality and political belief to psychopathology. The coefficients were significant for males but not for females.

Conclusions

In less religious societies, political belief may serve as a means of integration as does religious affiliation in religious societies. Males were more likely to benefit from the protective effect of a belief system on suicidality than females.

Genetic epistasis in female suicide attempters

BACKGROUND

Complex behaviors such as suicidal behavior likely exhibit gene-gene interactions. The main aim of this study is to explore potential single nucleotide polymorphisms combinations with epistatic effect in suicidal behavior using a data mining tool (Multifactor Dimensionality Reduction).

METHODS

Genomic DNA from peripheral blood samples was analyzed using SNPlex Technology. Multifactor Dimensionality Reduction was used to detect epistatic interactions between single nucleotide polymorphisms from the main central nervous system (CNS) neurotransmitters (dopamine: 9; noradrenaline: 19; serotonin: 23; inhibitory neurotransmitters: 60) in 889 individuals (417 men and 472 women) aged 18 years or older (585 psychiatric controls without a history of suicide attempts, and 304 patients with a history of suicide attempts). Individual analysis of association between single nucleotide polymorphisms and suicide attempts was estimated using logistic regression models.

RESULTS

Multifactor Dimensionality Reduction showed significant epistatic interactions involving four single nucleotide polymorphisms in female suicide attempters with a classification test accuracy of 60.7% (59.1%-62.4%, 95% CI): rs1522296, phenylalanine hydroxylase gene (PAH); rs7655090, dopamine receptor D5 gene (DRD5); rs11888528, chromosome 2 open reading frame 76, close to diazepam binding inhibitor gene (DBI); and rs2376481, GABA-A receptor subunit γ3 gene (GABRG3). The multivariate logistic regression model confirmed the relevance of the epistatic interaction [OR(95% CI)=7.74(4.60-13.37)] in females.

CONCLUSIONS

Our results suggest an epistatic interaction between genes of all monoamines and GABA in female suicide attempters.

Suicidal changes in patients with first episode psychosis: clinical predictors of increasing suicidal tendency in the early treatment phase

AIM

To identify predictors for developing a higher suicidal tendency during treatment of first-episode psychosis.

METHODS

In a prospective follow-up study, we examined clinical factors collected at treatment initiation as predictors for developing a higher suicidal tendency among patients in the first year of treatment of psychosis. Patients were grouped and ranked according to their highest suicidal tendency in the year before treatment: not suicidal, suicidal thoughts, suicidal plans or suicide attempt(s). Predictors for becoming more suicidal in the first year of treatment were examined on group level in multivariate logistic regression analyses. We assessed patients' suicidal tendency and clinical factors using validated interviews and rating scales. Analysis included 386 patients.

RESULTS

Among patients with some suicidal tendency a one-point increase score on hallucinations significantly predicted developing a higher suicidal tendency, whereas a one-point increase score on delusions was preventive of this. Feeling hopeless was highly associated with suicide attempt in those with earlier suicide attempt.

CONCLUSION

The risk of suicide attempt did not differ between patient groups with suicidal thoughts, plans or suicide attempt. In first year of treatment of psychosis, hallucinations increased the risk for becoming more suicidal, whereas delusions reduced this risk in already suicidal patients.

The hypothesis of a continuum in suicidality: a discussion on its validity and practical implications

The idea of a progression in suicide phenomena, from death wishes to suicide attempts and completed suicides, is quite old and widely present in literature. This model of interpreting suicidality has great relevance in preventative approaches, since it gives the opportunity of intercepting suicidal trajectories at several different stages. However, this may not be the case for many situations, and the hypothesis of a continuum can be true only in a limited number of cases, probably embedded with a specific psychopathological scenario (e.g. depression) and with a frequency that should not permit generalisations. This paper reviews the available evidence about the existence and validity of this construct, and discusses its practical implications.

Sacrifice for the sake of the family: expressions of familism by Latina teens in the context of suicide

Familism is a core value promoted by many individuals of Hispanic or Latino descent that emphasizes the primacy of the family over the individual. This study illuminates some aspects of the relationship between familism and adolescent suicidal behavior. Qualitative data from 24 female Hispanic teens with and without a history of suicidal behaviors and their parents were analyzed to understand the ways in which familism is expressed in their lives. Both suicide attempters and nonattempters demonstrate familism by making material or emotional (or both) sacrifices for the sake of their families. However, for those attempters who expressed a clear intent to die, a third type of sacrifice emerged: Girls expressed a desire to kill themselves in order to make things better for their families, literally sacrificing themselves for the sake of family. Findings point to the complexity of familism in understanding the risks of suicide attempts among teen Latinas and to the value of mixed methods in studying deeply the cultural factors that influence problem behaviors.

Psychiatric comorbidity and gender differences among suicide attempters in Bangalore, India

BACKGROUND

Suicides are an entirely preventable cause of death, with current suicide rates being 11.4 per 100,000 population in India. The city of Bangalore in India is often called the suicide capital of India because of its high suicide and attempted suicide rate. This study attempted to evaluate the psychiatric comorbidity and gender differences among suicide attempters presenting to a general hospital in the city of Bangalore, India.

METHODS

Using a structured questionnaire [Structured Clinical Interview for DSM-IV (SCID)-I and SCID-II], the study gathered data on the psychiatric diagnoses as well as the reasons for and mode of attempted suicides on 100 suicide attempters after taking written informed consent. In addition, the Beck Depression Inventory was also used to evaluate the severity of depression, the most commonly detected psychiatric comorbidity.

RESULTS

Forty-two percent of the sample had a psychiatric comorbidity, with depression (14%) and dysthymia (12%) being the most common disorders. Among personality disorders (PDs), borderline PD (5%) and dependent PD (3%) were the most commonly detected. Severe depression was detected in 15% of those with a mood disorder. Gender differences were found in both mode and reasons for attempted suicide.

CONCLUSION

The presence of any psychiatric comorbidity was observed to confer a high risk of suicide. All attempters should therefore be comprehensively evaluated by a qualified health care professional, and attempts should be made for continuous follow-up.

Life stressors, emotional distress, and trauma-related thoughts occurring in the 24 h preceding active duty U.S. soldiers' suicide attempts

External life events and internal experiences (i.e., emotional distress and trauma-related thoughts) occurring in the 24 h preceding suicide attempts were examined in a sample of active duty U.S. soldiers. Seventy-two Soldiers (66 male, 6 female; 65.3% Caucasian, 9.7% African-American, 2.8% Asian, 2.8% Pacific Islander, 4.2% Native American, and 9.7% "other"; age M = 27.34, SD = 6.50) were interviewed using the suicide attempt self injury interview to assess the occurrence of external events and internal experiences on the day of their suicide attempts, and to determine their associations with several dimensions of suicide risk: suicidal intent, lethality, and deliberation about attempting. Multiple external stressors and internal states were experienced by soldiers in the 24 h preceding their suicide attempts, with emotional distress being the most common. Trauma-related thoughts were much less frequently reported in the 24 h preceding suicide attempts. Emotional experiences were directly associated with suicidal intent, and explained the relationship between external events and suicidal intent. Lethality was unrelated to any external events, emotional experiences, or trauma-related thoughts. Greater emotional distress and trauma-related thoughts were associated with shorter deliberation about whether or not to attempt suicide. Soldiers experience multiple sources of distress in the period immediately preceding their suicide attempts. Soldiers who experience more negative emotional experiences have a stronger desire for suicide and spend less time deliberating before an attempt.

Child maltreatment and onset of emergency department presentations for suicide-related behaviors

OBJECTIVES

To determine whether the rates of a first presentation to the emergency department (ED) for suicide-related behavior (SRB) are higher among children/youth permanently removed from their parental home because of substantiated maltreatment than their peers. To describe the health care settings accessed by these children/youth before a first SRB presentation to help design preventive interventions.

METHODS

A population-based (retrospective) cohort of 12-17-year-olds in Ontario, Canada was established. Children/youth removed from their parental home because of the above noted maltreatment (n=4683) and their population-based peers (n=1,034,546) were individually linked to administrative health care records over time to ascertain health service use and subsequent ED presentations for SRB during follow-up. Person-time incidence rates were calculated and Cox regression models used to estimate adjusted hazard ratios (HR) and corresponding 95% confidence intervals (CI).

RESULTS

After controlling for demographic characteristics and prior health service use, maltreated children/youth were about five times more likely to have a first ED presentation for SRB compared to their peers, in both boys (HR: 5.13, 95% CI: 3.94, 6.68) and girls (HR: 5.36, 95% CI: 4.40, 6.54).

CONCLUSIONS

Children/youth permanently removed from their parental home because of substantiated child maltreatment are at an increased risk of a first presentation to the ED for SRB. The prevention of child maltreatment and its recurrence and the promotion of resilience after maltreatment has occurred are important avenues to study toward preventing ED SRB presentations in children/youth. Provider and system level linkages between care sectors may prevent the need for such presentations by providing ongoing environmental support.

Trends in suicide case fatality in Italy, 1983-2007

The proportion of suicide attempts ending up in the death of the attempter was used in past studies as an index of suicide lethality, or case fatality. This study aimed at investigating whether case fatality of suicide has decreased in Italy over the latest 25 ears using available data, as an alternative hypothesis to the proposed general decrease in suicidal behavior resulting from better identification and treatment of people with mental disorders. The official data on completed and attempted suicides by males and females in Italy, from 1983 to 2007, were analyzed with joinpoint regression analysis, to identify the points (i.e., "joinpoints") where linear trends changed significantly in direction or magnitude. It should be noted that only the most severe suicide attempts are recorded in Italian official statistics. Suicide rates decreased in both sexes, particularly from 1990 onward. Attempted suicide rates increased progressively in males, while in females they reached their peak in 1996-1998 and then decreased. In both sexes suicide case fatalities significantly decreased from 1990 onward. Improved survival after a suicide act is probably the main reason behind this favorable trend. The spreading of emergency services may prevent suicide.

Self-harm and suicidal behaviors in Hong Kong adolescents: prevalence and psychosocial correlates

The present paper examined the prevalence and psychosocial correlates of adolescent deliberate self-harm (DSH) and suicidal behavior in a representative sample of 3,328 secondary school students in Hong Kong. With reference to the previous year, 32.7% of the students reported at least one form of DSH, 13.7% of the respondents had suicide thoughts, 4.9% devised specific suicidal plans, and 4.7% had actually attempted suicide. Adolescent girls had significantly higher rates of DSH and suicidal behavior than did adolescent boys. Having remarried parents was related to an increased likelihood of DSH and suicide. While high levels of family functioning, overall positive youth development, and academic and school performance predicted low rates of DSH and suicidal behavior, cognitive and behavioral competencies were unexpectedly found to be positively associated with DSH and suicidal behavior. Theoretical and practical implications of the findings are discussed.

The co-occurrence of non-suicidal self-injury and attempted suicide among adolescents: distinguishing risk factors and psychosocial correlates

Although attempted suicide and non-suicidal self-injury (NSSI) are distinct behaviors differing in intent, form, and function, the behaviors co-occur at a high rate in both adults and adolescents. Researchers have begun to investigate the association between attempted suicide and NSSI among adolescents. The purpose of this paper is to present current research on this association. First, we discuss definitional issues associated with self-injurious behaviors. Next, we present research on the co-occurrence of attempted suicide and NSSI, including prevalence and associations with self-injury characteristics. We then discuss psychosocial variables associated with engaging in both NSSI and attempted suicide or one type of self-injury alone. Finally, we present the research to date on risk factors uniquely associated with either attempted suicide or NSSI. Implications for mental health professionals and future avenues of research are discussed.

International prevalence of adolescent non-suicidal self-injury and deliberate self-harm

BACKGROUND

The behaviours of non-suicidal self-injury (NSSI) and deliberate self-harm (DSH) are prevalent among adolescents, and an increase of rates in recent years has been postulated. There is a lack of studies to support this postulation, and comparing prevalence across studies and nations is complicated due to substantial differences in the methodology and nomenclature of existing research.

METHODS

We conducted a systematic review of current (2005 - 2011) empirical studies reporting on the prevalence of NSSI and DSH in adolescent samples across the globe.

RESULTS

Fifty-two studies fulfilling the inclusion criteria were obtained for analysis. No statistically significant differences were found between NSSI (18.0% SD = 7.3) and DSH (16.1% SD = 11.6) studies. Assessment using single item questions led to lower prevalence rates than assessment with specific behaviour checklists. Mean prevalence rates have not increased in the past five years, suggesting stabilization.

CONCLUSION

NSSI and DSH have a comparable prevalence in studies with adolescents from different countries. The field would benefit from adopting a common approach to assessment to aide cross-cultural study and comparisons.

Concurrent binge drinking and depression among Canadian youth: prevalence, patterns, and suicidality

This study compared differences in risk for suicidality among youth living in the community who met criteria for comorbid depression and binge drinking, depression without binge drinking, and binge drinking without depression relative to a reference group with neither condition. Logistic regression analysis was used to analyze data from the Canadian Community Health Survey, Cycle 3.1 (CCHS 3.1, 2005): a cross-sectional survey of respondents from the Canadian population. To restrict the sample to youth, respondents were excluded who were younger than 15 or older than 24 years. Over 17,000 respondents were assessed to determine whether they met criteria for depression, binge drinking, the comorbid condition, or neither condition (reference group). Binge drinking was defined as five drinks or more on an occasion. The 12-month prevalence rates for comorbid binge drinking and depression were 2.7% for male respondents and 2.1% for female respondents. When adjusted for demographic factors and when compared with the reference group, the risk of suicidality was increased for the depressed group (odds ratio [OR] 5.23, 95% confidence interval [CI]: 3.34-8.2) and the comorbid group (OR 6.28, 95% CI: 3.68-10.70), but not for the binge-drinking group. With the exception of increasing age, sociodemographic factors were not correlates of comorbidity. In conclusion, binge drinking was not associated with an increased risk of suicidality among Canadian youth living in the community, although depression and comorbidity were associated with suicidality.

Medically serious versus non-serious suicide attempts: relationships of lethality and intent to clinical and interpersonal characteristics

BACKGROUND

The study of near-fatal suicide attempts may provide insight into the minds of suicidal subjects. The aim of the study was to investigate the relationship of intent and lethality in medically serious and medically non-serious suicide attempts and to examine relationship of specific psychological and clinical variables with the subjective and objective components of suicide intent.

METHODS

The study group included 102 participants, 35 consecutive subjects hospitalized for a medically serious suicide attempt and 67 subjects who presented to the same tertiary medical center after a medically non-serious suicide attempt. All were interviewed with the SCID-I and completed the Suicide Intent Scale (SIS), the Lethality Rating Scale, and instruments measuring mental pain and communication difficulties.

RESULTS

Patients who made medically serious suicide attempts had higher total SIS score and higher objective and subjective subscale scores. The objective component of the SIS was highly correlated with the lethality of the suicide attempt and communication difficulties; the subjective component was associated with mental pain variables. The interaction of mental pain and communication difficulties was predictive of the severity of the objective suicide intent.

LIMITATIONS

Relatively small number of patients with medically serious suicide attempt and the relatively large number of questionnaires which may to some extent have diminished informant reliability.

CONCLUSIONS

Suicidal individuals with depression and hopelessness who cannot signal their pain to others are at high risk of committing a medically serious suicide attempts.

Stressful life events and suicidal behavior in adults with alcohol use disorders: role of event severity, timing, and type

BACKGROUND

Stressful life events (SLEs) play a key role in suicidal behavior among adults with alcohol use disorders (AUD), yet there are meager data on the severity of SLEs preceding suicidal behavior or the timing of such events.

METHOD

Patients in residential substance use treatment who made a recent suicide attempt (cases, n=101) and non-suicidal controls matched for site (n=101) were recruited. SLEs that occurred within 30 days of the attempt and on the day of the attempt in cases were compared to SLEs that occurred in the corresponding periods in controls. SLEs were categorized by type (interpersonal, non-interpersonal) and severity (major, minor) and were dated to assess timing. Degree of planning of suicide attempts was also assessed.

RESULTS

Major interpersonal SLEs conferred risk for a suicide attempt, odds ratio (95% CI)=5.50 (1.73, 17.53), p=0.005. Cases were also more likely to experience an SLE on the day of the attempt than on the corresponding day in controls, OR (95% CI)=6.05 (1.31, 28.02), p=0.021. However, cases that made an attempt on the day of a SLE did not make lower planned suicide attempts compared to other cases, suggesting that suicide attempts that are immediately preceded by SLEs cannot be assumed to be unplanned.

CONCLUSIONS

Results suggest the central importance of major interpersonal SLEs in risk among adults with AUD, a novel finding, and documents that SLEs may lead to suicide attempts within a short window of time (i.e., same day), a daunting challenge to prevention efforts.

The Incidence of Hospital-Treated Attempted Suicide in Oviedo, Spain

Background: The incidence of hospital-treated attempted suicide has not been well established in Spain. Aims: To determine the incidence of suicide attempters presenting to a hospital in Oviedo, Spain, to describe the nature of the suicidal behavior, and to identify sociodemographic subgroups of the population with high rates. Methods: All admitted to the Hospital Universitario Central de Asturias, Oviedo, during the period 1 May 2008 to 30 April 2009 were examined and those meeting the internationally-recognized case definition were identified. Results: A total of 308 suicide attempt presentations (39% male, 61% female) were made by 279 individuals. Almost 90% of the suicide attempts involved a drug overdose. The age-adjusted total, male, and female attempted suicide rates were 83, 66, and 99 per 100,000, respectively. The highest rate was among 35–44-year-olds for men and women (141.1 and 191.8 per 100,000, respectively). Incidence rates varied widely by sociodemographic characteristics with especially high rates among separated/divorced men (2.4%) and women (1.1%). Conclusions: The reported incidence of hospital-treated attempted suicide is below average in the European context but higher than that reported by previous Spanish studies. Persons separated or divorced constitute a high-risk group.

Predictive validity of the MINI suicidal scale for self-harm in acute psychiatry: a prospective study of the first year after discharge

The aim of the study was to explore the predictive validity of the Suicidal Scale of the Mini-International Neuropsychiatric Interview as a screen for suicidal behavior and non-suicidal self-injury following discharge from an acute psychiatric ward. Using a prospective, naturalistic design, the patients were screened with the Suicidal Scale when discharged (n = 307). At 12 months post-discharge, the Suicidal Scale was a significant predictor of suicidal behavior (n = 48) and suicidal behavior+non-suicidal self-injury (n = 49) but not for non-suicidal self-injury (n = 15). For patients without any known previous suicide attempts (n = 180), the Suicidal Scale was a significant predictor of suicidal behavior (n = 21) and suicidal behavior+non-suicidal self-injury (n = 11). Further research is needed to determine the overall utility of the routine screening of self-harm.

Can the Holmes-Rahe Social Readjustment Rating Scale (SRRS) be used as a suicide risk scale? An exploratory study

The objective of this research was to examine whether the Holmes-Rahe Social Readjustment Rating Scale, a life event scale, can be used to identify suicide attempters. The Holmes-Rahe Social Readjustment Rating Scale's ability to identify suicide attempters was tested in 1183 subjects (478 suicide attempters, 197 psychiatric inpatients, and 508 healthy controls) using the Fisher Linear Discriminant Analysis and traditional psychometric methods. The Fisher Linear Discriminant Analysis outperformed traditional psychometric approaches (area under the curve: 0.85 vs. 0.78; p < 0.05) and indicated that this scale may be used to identify suicide attempters. The life events that better characterized suicide attempters were change in frequency of arguments, marital separation, and personal injury. The Holmes-Rahe Social Readjustment Rating Scale may help identify suicide attempters.

Sociodemographic and psychopathological risk factors in repeated suicide attempts: gender differences in a prospective study

BACKGROUND

The prevention of the repetition of suicide attempts is an important feature of the care of attempters but current data fail to give actual predictors of repetition. The aim of this study was to characterize sociodemographic and psychopathological features and risk factors associated with future repetition of suicide attempts in two years. The study focused on differences between men and women.

METHODS

273 participants selected in psychiatric emergency units after their admission for a suicide attempt (index) were included in the study. Subsequent suicide attempts occurring within a two year follow-up were identified from the regional observatory of suicide attempts. At inclusion, sociodemographic variables and psychopathological data were collected. In particular, psychometric evaluations were performed using the following scales: BDI-SF, SIS, BIS and BDHI. The lifetime history of suicide attempt was also noted.

RESULTS

Repetition of suicide attempt in 2 years was associated with current follow up and treatment, a personal history of multiple suicide attempt, post traumatic stress disorder, current recurrent psychotic syndrome and substance misuse. Specific features of men and women repeaters have been identified. Men repeaters were characterized by substance use disorders whereas the re-attempt in women was associated with current follow up and treatment, post traumatic stress disorder and higher BDI-SF score.

CONCLUSIONS

Repeaters must be considered as a specific population among suicide attempters and gender differences must be taken into account in this particular population in order to promote more personalized prevention programs for suicidal recurrence and completed suicide.

The European Psychiatric Association (EPA) guidance on suicide treatment and prevention

Suicide is a major public health problem in the WHO European Region accounting for over 150,000 deaths per year. SUICIDAL CRISIS: Acute intervention should start immediately in order to keep the patient alive.

DIAGNOSIS

An underlying psychiatric disorder is present in up to 90% of people who completed suicide. Comorbidity with depression, anxiety, substance abuse and personality disorders is high. In order to achieve successful prevention of suicidality, adequate diagnostic procedures and appropriate treatment for the underlying disorder are essential.

TREATMENT

Existing evidence supports the efficacy of pharmacological treatment and cognitive behavioural therapy (CBT) in preventing suicidal behaviour. Some other psychological treatments are promising, but the supporting evidence is currently insufficient. Studies show that antidepressant treatment decreases the risk for suicidality among depressed patients. However, the risk of suicidal behaviour in depressed patients treated with antidepressants exists during the first 10-14 days of treatment, which requires careful monitoring. Short-term supplementary medication with anxiolytics and hypnotics in the case of anxiety and insomnia is recommended. Treatment with antidepressants of children and adolescents should only be given under supervision of a specialist. Long-term treatment with lithium has been shown to be effective in preventing both suicide and attempted suicide in patients with unipolar and bipolar depression. Treatment with clozapine is effective in reducing suicidal behaviour in patients with schizophrenia. Other atypical antipsychotics are promising but more evidence is required. TREATMENT TEAM: Multidisciplinary treatment teams including psychiatrist and other professionals such as psychologist, social worker, and occupational therapist are always preferable, as integration of pharmacological, psychological and social rehabilitation is recommended especially for patients with chronic suicidality. FAMILY: The suicidal person independently of age should always be motivated to involve family in the treatment. SOCIAL SUPPORT: Psychosocial treatment and support is recommended, as the majority of suicidal patients have problems with relationships, work, school and lack functioning social networks.

SAFETY

A secure home, public and hospital environment, without access to suicidal means is a necessary strategy in suicide prevention. Each treatment option, prescription of medication and discharge of the patient from hospital should be carefully evaluated against the involved risks. TRAINING OF PERSONNEL: Training of general practitioners (GPs) is effective in the prevention of suicide. It improves treatment of depression and anxiety, quality of the provided care and attitudes towards suicide. Continuous training including discussions about ethical and legal issues is necessary for psychiatrists and other mental health professionals.

Suicide attempts and overdoses among adults entering addictions treatment: comparing correlates in a U.S. National Study

BACKGROUND

Suicide attempts and non-fatal overdoses are both associated with substance use. The aim of the present study was to examine correlates of suicide attempts and non-fatal overdoses simultaneously among individuals seeking addictions treatment.

METHODS

A large U.S. national sample of individuals entering addictions treatment participated in a cross-sectional survey (n=5892). Multinomial logistic regression modeling tested the adjusted associations of violence, injection drug use, specific substances, and depressive symptoms with a four-category outcome variable based on prior histories of suicide attempt and non-fatal overdose (neither, suicide attempt only, overdose only, both), adjusting for demographic and treatment characteristics.

RESULTS

Sexual and physical victimization was associated with suicide attempts with or without overdoses (ORs 1.25-2.84), while perpetrating violence was associated with having experienced either or both outcomes (ORs 1.25-1.56). Depressive symptoms had a stronger association with suicide attempts (OR=3.05) than overdoses (OR=1.29). Injection drug use was associated with overdoses with or without suicide attempts (ORs 2.65-3.22). Individuals seeking treatment for marijuana use were less likely have overdosed or attempted suicide (ORs 0.39-0.67), while individuals seeking treatment for heroin use were more likely to have overdosed (OR=1.46). Seeking treatment for use of more than one substance was associated with overdose and overdose and suicide attempt (ORs 1.58-2.51), but not suicide attempt alone.

CONCLUSIONS

The present findings indicate that suicide and overdose are connected yet distinct problems. Individuals who have had a history of both may be a group with particularly poor psychological functioning as well as more severe drug-related problems.

An examination of the validity of retrospective measures of suicide attempts in youth

PURPOSE

This study used prospective data to investigate the validity of a retrospective measure of suicide attempts from four different perspectives.

METHODS

Data were retrieved from 883 participants in the Raising Healthy Children project, a longitudinal study of youth recruited from a Pacific Northwest school district. The retrospective measure was collected when participants were 18-19 years of age and results were compared with measures of depressive symptoms collected prospectively.

RESULTS

Results showed strong corroboration between retrospective reports of first suicide attempt and prospective measures of depression, with attempters experiencing significantly more depression than their nonattempting peers, t (df = 853) = 10.26, p < .001. In addition, within the attempter group, depression scores during the year of their reported first attempt were significantly higher than the average depression score across previous years, t (df = 67) = 3.01, p < .01.

CONCLUSIONS

Results from this study suggest that the reports of older adolescents regarding their suicide attempts are corroborated by their prospective reports of depression in childhood and earlier adolescence. Thus, there is support that retrospective measures of suicidal behavior, namely suicide attempts, may be a valid method of assessment.

Self-harm subscale of the Schedule for Nonadaptive and Adaptive Personality (SNAP): predicting suicide attempts over 8 years of follow-up

OBJECTIVE

We examined the predictive power of the self-harm subscale of the Schedule for Nonadaptive and Adaptive Personality (SNAP) to identify suicide attempters in the Collaborative Longitudinal Study of Personality Disorders (CLPS).

METHOD

The SNAP, a self-report personality inventory, was administered to 733 CLPS participants at baseline, of whom 701 (96%) had at least 6 months of follow-up data. Cox proportional hazards regression analyses were performed to examine the SNAP-self-harm subscale (SNAP-SH) in predicting the 129 suicide attempters over 8 years of follow-up. Possible moderators of prediction were examined, including borderline personality disorder, major depressive disorder (MDD), and substance use disorder. We also compared baseline administration of the SNAP-SH to subsequent administrations more proximal to the suicide attempt, and to a higher-order SNAP-negative temperament (SNAP-NT) subscale. Receiver operating characteristic analyses were conducted using suicide attempts (n = 58) over the first year of follow-up to provide reference points for sensitivity and specificity.

RESULTS

The SNAP-SH demonstrated good predictive power for suicide attempts (hazard ratio = 1.28, P < .001) and appeared relatively consistent across borderline personality disorder, MDD, and substance use disorder diagnoses. Using more proximal scores did not increase predictive power. The SNAP-SH compared favorably to the predictive power of the higher-order SNAP-NT. Receiver operating characteristic analyses indicate several cutoff scores on the SNAP-SH that yield moderate to high sensitivity and specificity for predicting suicide attempts over the first year of follow-up.

CONCLUSIONS

The SNAP-SH may be a useful screening instrument for risk of suicide attempts in nonpsychotic psychiatric patients.

Association between leukotriene-modifying agents and suicide: what is the evidence?

The US FDA has issued safety alerts and required manufacturers of leukotriene-modifying agents (LTMAs), including montelukast, zafirlukast and zileuton, to include suicide and neuropsychiatric events as a precaution in the drug label. This paper reviews the existing evidence on the potential association between the LTMAs and suicidal behaviour. We conducted a literature search of MEDLINE, EMBASE and International Pharmaceutical Abstracts from 1995 to 2010 (inclusive) to identify pertinent studies and reports. We also examined data obtained from the FDA adverse event reporting system. To date, there are no well conducted, comparative, observational studies of this association, and the safety alerts are based primarily on case reports. While the FDA safety alerts apply to all three LTMAs, montelukast (known by its trade name Singulair®) is by far the most widely used of these drugs and most of the reports to date regarding suicide pertain to montelukast. From 1998 to 2009 there were 838 suicide-related adverse events associated with leukotrienes reported to the FDA, of which all but five involved montelukast. Nearly all cases were reported in 2008 and 2009 (96.1%) after the FDA warnings. LTMAs are approved for use in asthma and allergic rhinitis, and are effective drugs. Both of these diseases are also associated with suicide, making confirmation of the association more difficult. Given the lack of good evidence, we recommend that a large observational cohort or case-control study be conducted to quantify the association between LTMAs and suicide. Until then, when prescribing LTMAs, clinicians should consider the potential for suicide and monitor patients who may be at elevated risk carefully for suicidal ideation or psychiatric symptoms associated with suicidal behaviour.

Effects of combat deployment on risky and self-destructive behavior among active duty military personnel

Although research has documented negative effects of combat deployment on mental health, few studies have examined whether deployment increases risky or self-destructive behavior. The present study addressed this issue. In addition, we examined whether deployment effects on risky behavior varied depending on history of pre-deployment risky behavior, and assessed whether psychiatric conditions mediated effects of deployment on risky behavior. In an anonymous survey, active duty members of the U.S. Marine Corps and U.S. Navy (N = 2116) described their deployment experiences and their participation in risky recreational activities, unprotected sex, illegal drug use, self-injurious behavior, and suicide attempts during three time frames (civilian, military pre-deployment, and military post-deployment). Respondents also reported whether they had problems with depression, anxiety, or PTSD during the same three time frames. Results revealed that risky behavior was much more common in civilian than in military life, with personnel who had not deployed, compared to those who had deployed, reporting more risky behavior and more psychiatric problems as civilians. For the current time period, in contrast, personnel who had deployed (versus never deployed) were significantly more likely to report both risky behavior and psychiatric problems. Importantly, deployment was associated with increases in risky behavior only for personnel with a pre-deployment history of engaging in risky behavior. Although psychiatric conditions were associated with higher levels of risky behavior, psychiatric problems did not mediate associations between deployment and risky behavior. Implications for understanding effects of combat deployment on active duty personnel and directions for future research are discussed.

Suicide attempts: prevention of repetition

OBJECTIVE

To present an overview of promising strategies to prevent repetition of suicidal behaviours.

METHOD

This literature review on tertiary preventive interventions of suicide attempts was produced using the computerized databases PubMed and PsycINFO from January 1966 to September 2010, using French- and English-language limits and the key words: suicid* or deliberate self-harm and treatment* or therapy or intervention* or management.

RESULTS

Thirteen of the 35 included studies showed statistically significant effects of fewer repeated attempts or suicides in the experimental condition. Overall, 22 studies focused on more traditional approaches, that is, pharmacological or psychological approaches. Only 2 of the 6 pharmacological treatments proved significantly superior to a placebo- a study of lithium with depression and flupenthixol with personality disorders. Eight out of 16 psychological treatments proved superior to treatment as usual or another approach: cognitive-behavioural therapy (CBT) (n = 4), (including dialectical behaviour therapy [n = 2]); psychodynamic therapy (n = 2); mixed (CBT plus psychodynamic therapy [n = 1]); and motivational approach and change in therapist (n = 1). Among the 8 studies using visit, postal, or telephone contact or green-token emergency card provision, 2 were significant: one involving telephone follow-up and the other telephone follow-up or visits. Hospitalization was not related to fewer attempts, and 1 of the 4 outreach approaches had significant results: a program involving individualized biweekly treatment. The rationale behind these single or multiple approaches still needs to be clarified. There were methodological flaws in many studies and some had very specific limited samples.

CONCLUSIONS

There is a need for more research addressing the problem in definitions of outcomes and measurement of the dependent variables, gender-specific effects, and inclusion of high-risk groups. There is a need for the development and evaluation of new approaches that support collaboration with community resources and more careful assessment and comparisons of existing treatments with different populations.

Short self-reported sleep duration and suicidal behavior: a cross-sectional study

BACKGROUND

Prior studies on the association between sleep disturbances and suicidal behavior did not explore whether or not short sleep is a marker of suicide intent, lethality or risk.

DESIGN

Cross-sectional.

PARTICIPANTS

Suicide attempters (SAs) (n=434). Controls included 83 psychiatric inpatients who have never been SAs, and 509 healthy controls.

MEASUREMENTS

Short sleep was defined by self-assessment as ≤ 5 h per day. The MINI and the DSM-IV version of the International Personality Disorder Examination Screening Questionnaire were used to diagnose Axis I and Axis II diagnoses, respectively. Suicide intent and lethality were evaluated through the Beck's Suicidal Intent Scale (SIS) and the Risk-Rescue Rating Scale (RRRS), respectively. Beck's Medical Lethality Scale (BMLS) was administered to assess the degree of medical injury, and the SAD PERSONS mnemonic scale was used to evaluate suicide risk.

STATISTICAL ANALYSES

Chi-square tests and logistic regression analyses explored frequencies of short sleep in 3 samples. Chi-square tests explored whether or not suicide intent, lethality and risk were greater in SAs with short-sleep versus those without short-sleep.

RESULTS

Short sleep was more prevalent in SAs than in psychiatric controls only in males. In female SAs, short sleep was significantly associated with several SIS items and high scores in the SAD PERSONS.

LIMITATIONS

Sleep duration was assessed only by self-report.

CONCLUSIONS

The association between short sleep and suicidal behavior may be partly explained by confounders. Short sleep may be a marker of severity of suicidal behavior among female SAs.

Suicide-related behaviors and anxiety in children and adolescents: a review

This paper reviews empirical evidence of the association between suicide-related behaviors and anxiety among children and adolescents. It begins with a review of suicide-related behaviors and anxiety, discusses methodological issues related to measurement, and reviews empirical findings published since the last review of this topic in 1988. Evidence is summarized on four criteria necessary to establish anxiety as a causal risk factor for suicide-related behaviors among children and adolescents. There is consistent evidence for a significant association between anxiety and suicide-related behaviors (Criterion 1). Evidence that the influence of anxiety on suicide-related behaviors is not due to a third variable (Criterion 2) is mixed and hindered by methodological limitations. The literature is also unclear as to whether anxiety temporally precedes suicide-related behaviors (Criterion 3). Finally, this review found no evidence to support or refute anxiety's stability independent of and across instances of suicide-related behaviors (Criterion 4). Theoretical and clinical implications of these findings and directions for future research are discussed.

Familism, family environment, and suicide attempts among Latina youth

In this study, we examined the relationship between familism and family environment type as well as the relationship between family environment type and suicide attempts among Latina youth. Latina teen attempters (n = 109) and nonattempters (n = 107) were recruited from the New York City area. Latent class analysis revealed three family environment types: tight-knit, intermediate-knit, and loose-knit. Tight-knit families (high cohesion and low conflict) were significantly less likely to have teens who attempted suicide as compared with intermediate-knit families or loose-knit families. Moreover, familism increased the odds of being in a tight-knit family versus a loose-knit family and the odds of being in a tight-knit family versus a intermediate-knit. The results suggest that familism may protect against suicide behavior among Latinas via its influence on family environment.

Sex differences in childhood sexual abuse and suicide-related behaviors

Child sexual abuse and suicide-related behaviors are associated, but it remains unclear if the strength of this association differs in boys and girls. In a systematic review of this association in children and youth, we identified 16 relevant studies, all cross-sectional surveys of students. The association is stronger in boys specific to suicide attempt(s). Adjustments for potential confounding variables explained some, but not all of this sex difference. While additional research would strengthen causal inferences, this sex difference may be influenced by the nature and timing of child sexual abuse as well as the sex of the perpetrator, which in turn shapes the disclosure of these events.

Suicide attempt, smoking, comorbid depression, and platelet serotonin in alcohol dependence

The risk of suicide in patients with alcoholism increases if alcoholism is related to comorbid depression. Both alcoholism and suicidal behavior are associated with reduced serotonin (5-hydroxytryptamine [5-HT]) function. Because suicide is enormous public health problem worldwide, to prevent suicide attempts, it is important to find peripheral marker of suicidal behavior. The aim of this study was to assess whether platelet 5-HT concentration is altered in alcoholic patients with or without suicide attempt. Platelet 5-HT concentration was evaluated in 397 male and 108 female ethnically homogenous medication-free patients with alcoholism, subdivided according to smoking status, comorbid depression, and a history of suicide attempt and in 450 male and 139 female healthy control (nonsuicidal) subjects. Suicide attempt was assessed by two measures: according to the score 4 on the item 3 from the Hamilton Rating Scale for Depression and according to the Structured Clinical Interview regarding suicidal attempt during lifetime. Both male and female patients with alcoholism who were nonsmokers had significantly lower platelet 5-HT concentration than the corresponding healthy subjects. Multifactor analyses of variance revealed the significant effects of alcoholism and smoking, but the lack of significant effects of suicide attempt, sex, or comorbid depression, and no interactions between variables, on platelet 5-HT concentration. Platelet 5-HT concentration did not differ significantly between suicidal patients compared with nonsuicidal patients with alcoholism. Because the results from the present study showed similar platelet 5-HT values between patients with or without a history of suicide attempt, our data did not support the hypothesis that platelet 5-HT concentration might be used as a peripheral marker of the pronounced suicidal behavior in alcoholism.

Life events as precipitants of suicide attempts among first-time suicide attempters, repeaters, and non-attempters

The aims of this study were to investigate risk factors for suicide attempts and propose a model explaining the associations among life events and suicide status. We assessed 263 subjects admitted following a suicide attempt to the Division of Psychiatry of the Department of Neurosciences of the University of Parma and compared them with 263 non-attempter clinical control subjects. Attempters reported significantly more adverse life events both in the last 6 months, and between the ages of 0-15 years than non-attempters. A multinomial logistic regression analysis with stepwise forward entry indicated that the best model to explain suicide status was one which included life events in the last 6 months, life events during age 0-15 years, and their interaction. First-time attempter status (vs. non-attempters) was more likely to be linked to life events in the last 6 months, the interaction between life events in the last 6 months and life events during age 0-15 years, and low social support. Those attempters with one or more prior attempts (repeat attempters) were more likely than non-attempters to be linked to the interaction between life events in the last 6 months and life events during age 0-15 years, and to higher rates of psychopharmacological treatment before the index admission. Guided by these findings, monitoring the impact of early-life and recent events in vulnerable individuals should be part of risk assessment and treatment.

Suicidal ideation in adolescence: examining the role of recent adverse experiences

Although there is a well-known link between adverse experiences and suicidal ideation, there has been little study of the effects of recent adverse experiences on suicidal ideation in teenagers. This study examined the association between recent adverse experiences and suicidal ideation in a sample of 740 at-risk 16-year-old youth in the LONGSCAN studies, as well as potential mediators. 8.9% of the youth reported suicidal ideation. Recent adverse experiences, as a class, were associated with suicidal ideation; both recent physical abuse and recent psychological maltreatment were uniquely associated with suicidal ideation. The links between recent adverse experiences and suicidal ideation were significantly mediated by psychological distress. There were also significant main effect associations between both internalizing behavioral problems and low positive achievement expectations and suicidal ideation. Recent adverse experiences are important in understanding suicidal ideation in high risk youth.

Changes in mental health services and suicide mortality in Norway: an ecological study

Background

Mental disorders are strongly associated with excess suicide risk, and successful treatment might prevent suicide. Since 1990, and particularly after 1998, there has been a substantial increase in mental health service resources in Norway. This study aimed to investigate whether these changes have had an impact on suicide mortality.

Methods

We used Poisson regression analyses to assess the effect of changes in five mental health services variables on suicide mortality in five Norwegian health regions during the period 1990-2006. These variables included: number of man-labour years by all personnel, number of discharges, number of outpatient consultations, number of inpatient days, and number of hospital beds. Adjustments were made for sales of alcohol, sales of antidepressants, education, and unemployment.

Results

In the period 1990-2006, we observed a total of 9480 suicides and the total suicide rate declined by 26%. None of the mental health services variables were significantly associated with female or male suicide mortality in the adjusted analyses (p > 0.05). Sales of antidepressants (adjusted Incidence Rate Ratio = 0.98; 95% CI = 0.97-1.00) and sales of alcohol (adjusted IRR = 1.41; 95% CI = 1.18-1.72) were significantly associated with female suicide mortality; education (adjusted IRR = 0.86; 95% CI = 0.79-0.94) and unemployment (adjusted IRR = 0.91; 95% CI = 0.85-0.97) were significantly associated with male suicide mortality.

Conclusions

The adjusted analyses in the present study indicate that increased resources in Norwegian mental health services in the period 1990-2006 were statistically unrelated to suicide mortality.

The Role of Suicide Risk in the Decision for Psychiatric Hospitalization After a Suicide Attempt

Background: Suicide prevention can be improved by knowing which variables physicians take into account when considering hospitalization or discharge of patients who have attempted suicide. Aims: To test whether suicide risk is an adequate explanatory variable for predicting admission to a psychiatric unit after a suicide attempt. Methods: Analyses of 840 clinical records of patients who had attempted suicide (66.3% women) at four public general hospitals in Madrid (Spain). Results: 180 (21.4%) patients were admitted to psychiatric units. Logistic regression analyses showed that explanatory variables predicting admission were: male gender; previous psychiatric hospitalization; psychiatric disorder; not having a substance-related disorder; use of a lethal method; delay until discovery of more than one hour; previous attempts; suicidal ideation; high suicidal planning; and lack of verbalization of adequate criticism of the attempt. Conclusions: Suicide risk appears to be an adequate explanatory variable for predicting the decision to admit a patient to a psychiatric ward after a suicide attempt, although the introduction of other variables improves the model. These results provide additional information regarding factors involved in everyday medical practice in emergency settings.

A closer look at self-reported suicide attempts: false positives and false negatives

The validity of self-reported suicide attempt information is undermined by false positives (e.g., incidences without intent to die), or by unreported suicide attempts, referred to as false negatives. In a sample of 1,385 Austrian adults, we explored the occurrence of false positives and false negatives with detailed, probing questions. Removing false positives decreased the rate of suicide attempters from 4.3% to 2.7%. Probing questions also revealed 0.8% false negatives. We recommend using probing questions with both those who report a suicide attempt and those who do not report a suicide attempt to increase the validity of self-reported suicide-related information.

Dimensions of adolescent psychopathology and relationships to suicide risk indicators

Youth suicide represents an area of important public and mental health concern. Although diagnostic correlates (e.g., depression) of suicidality have been identified, very few studies of youth have analyzed relationships between empirically-derived dimensions of psychopathology, representing broader dimensions of risk, and different suicidality indicators. We recruited 223 adolescents (57% female; 32% ethnic minority) from mental health agencies and the community to assess psychopathology, substance use, and suicidality relying on multiple measures and reporters (youth, parent, and clinician). Using a 3-factor model of psychopathology, we found that the Internalizing factor (including depression and generalized anxiety) was associated with both suicidal thinking and behaviors (threats/attempts), the Externalizing factor (conduct, oppositional, and attention deficit disorders) was negatively related only to suicidal thinking, and the Substance Use factor (alcohol and cannabis use) related to suicidal behaviors of threats/attempts but not suicidal thinking. The results show the utility of a dimensional conceptualization for clarifying distinct vulnerabilities to suicidal thinking versus overt behaviors and have implications for the construct validity of distinct dimensions of psychopathology.

Repetition of suicide attempts across episodes of severe depression. Behavioural sensitisation found in suicide group but not in controls

BACKGROUND

Those who die by suicide and suffer from depression are known to have made more suicide attempts during their life-span as compared to other people with depression. A behavioural sensitisation or kindling model has been proposed for suicidal behaviour, in accordance with a sensitisation model of depressive episodes. The aim of the present study was to test such a model by investigating the distribution of initial and repeated suicide attempts across the depressive episodes in suicides and controls with a unipolar severe depression.

METHOD

A blind record evaluation was performed of 80 suicide victims and controls admitted to the Department of Psychiatry between 1956 and 1969 and monitored to 2010. The occurrence of initial and repeated suicide attempts by order of the depressive episodes was compared for suicides and controls.

RESULTS

The risk of a first suicide attempt decreased throughout the later episodes of depression in both the suicide group (p < .000) and control group (p < .000). The frequencies of repetition early in the course were actually higher in the control group (p < .007). After that, the risk decreased in the control group, while the frequencies remained proportional in the suicide group. At the same time, there was a significantly greater decreased risk of repeated attempts during later episodes in the control group as compared to the suicide group (p < .000). The differences were found despite a similar number of episodes in suicides and controls.

CONCLUSION

Repeated suicide attempts in the later episodes of depression appear to be a risk factor for suicide in severe depression. This finding is compatible with a behavioural sensitisation of attempts across the depressive episodes, which seemed to be independent of a corresponding kindling of depression.

Variability in the definition and reporting of adverse events in suicide prevention trials: an examination of the issues and a proposed solution

Adverse events (AEs) and serious adverse events (SAEs) are important outcomes of any intervention study yet are under-researched. Vague and variable definitions and substantial underreporting make comparisons of risk between studies difficult and evaluation of the safety of a particular intervention almost impossible. These realities may deter researchers from studying at-risk populations. Suicidal behavior is an adverse event in any study, and potentially a very serious one. Thus the issues of reporting and definition are particularly salient for researchers who work with populations at risk for suicidal behavior, especially when the suicidal behavior is the outcome of interest. We conducted a qualitative study with experienced suicide researchers and intervention experts to delineate the issues related to reporting serious adverse events faced by investigators conducting trials in suicide prevention. Participants from multiple sites were interviewed by phone, interviews transcribed and coded for definition and reporting issues and suggested solutions. A narrative synthesis was prepared and validated by all participants. Participants highlighted the difficulties in defining AEs and SAEs and stressed the importance and complexity of ensuring the AE was related to the study and reported properly, and were in agreement about the consequences of AEs to both institutions and individuals. Participants identified the need for the development of clear and consistent AE definitions and reporting requirements. Clear and consistently applied definitions of adverse and serious adverse events and reporting requirements would enhance the comparability of intervention studies in suicidal populations.

Non-suicidal and suicidal self-injurious behavior among Flemish adolescents: A web-survey

The present study investigated the prevalence of non-suicidal self-injury (NSSI) and suicidal self-injury (SSI) in a sample of 1,417 Flemish adolescents aged 12 to 18, as well as psychosocial differences between adolescents engaging in NSSI and adolescents engaging in SSI. Participants completed an anonymous online survey inquiring about NSSI and SSI functions, sociodemographic correlates, help seeking behaviors, and stressful life events. Lifetime prevalence of NSSI was 13.71% and SSI was 3.93%. No gender or age differences appeared between adolescents engaging in NSSI or SSI; however, differences in educational level were observed. Significant differences in functions of the behavior and number of stressful life events were noted between groups. Finally, the likelihood of receiving professional help differed between adolescents engaging in NSSI and adolescents engaging in SSI. Implications of the findings for assessment and treating NSSI and SSI are discussed.

Suicide attempters in the emergency department before hospitalization in a psychiatric ward

PURPOSE

The study aims to compare the current suicidal risk of mood disorder patients who had just attempted suicide, as compared with those who had not attempted suicide, admitted to an emergency department (ED), and then hospitalized in a psychiatric unit.

METHOD

One hundred sixty-one mood disorder patients admitted to the ED were studied. A total of 22.4% of the participants were admitted for a suicide attempt. Patients were assessed for psychopathology and diagnosis.

FINDINGS

Suicide attempters were nearly 12 times more likely to report ongoing suicidal ideation during the psychiatric evaluation in the ED than nonattempters. Men and women did not differ for current and previous suicide attempts or for ongoing suicidal ideation.

PRACTICAL IMPLICATIONS

It is important to conduct a suicide risk assessment when individuals are admitted to an ED.

A psychometric study of the Suicide Ideation Scale

An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted on the Suicide Ideation Scale (SIS) with a large military clinical sample (total N = 3,072). The EFA identified a two-factor solution with the first factor (Resolved Plans/Preparation) accounting for 17.3% of the variance and the second (Suicidal Desire) accounting 15.1% of the variance. This 2-factor solution demonstrated a good fit to the data in the CFA. SIS construct validity and internal reliability data are also reported. The results of this study provide additional psychometric data for the SIS that support use of the measure in clinical work and research. Implications for theories related to suicide assessment and clinical practice are discussed.

Aggression, impulsivity, and suicide behavior: a review of the literature

This article reviews the literature on the association between impulsivity aggression and suicide. The key words impulsivity, aggression, and suicide were entered into the pubmed, psychlit, and proqest databases. Significant articles were scrutinized for relevant information. Impulsivity and aggression are highly correlated with suicidal behavior across psychiatric samples, nosological borders, and non-psychiatric populations. Impulsivity and aggression are related but the nature of this relationship remains unclear. The literature is confusing and contradictory. This is probably due to the difficulty in defining and separating out these concepts and the fact that there is much overlap between them. Future research should aim at clarifying and refining these concepts as well as their link to all the different forms of suicidal behavior.