Epidemiology of Suicide and the Psychiatric Perspective

The Finnish psychiatric birth cohort consortium (PSYCOHORTS) - content, plans and perspectives

Background: Psychiatric disorders tend to be developmental, and longitudinal settings are required to examine predictors of psychiatric phenomena. Replicating and combining data and results from different birth cohorts, which are a source of reliable data, can make research even more valuable. The Finnish Psychiatric Birth Cohort Consortium (PSYCOHORTS) project combines birth cohorts in Finland. Aim: The aim of this paper is to introduce content, plans and perspectives of the PSYCOHORTS project that brings together researchers from Finland. In addition, we illustrate an example of data harmonization using available data on causes of death. Content: PSYCOHORTS includes eight Finnish birth cohorts. The project has several plans: to harmonize different data from birth cohorts, to incorporate biobanks into psychiatric birth cohort research, to apply multigenerational perspectives, to integrate longitudinal patterns of marginalization and inequality in mental health, and to utilize data in health economics research. Data on causes of death, originally obtained from Finnish Cause of Death register, were harmonized across the six birth cohorts using SAS macro facility. Results: Harmonization of the cause of death data resulted in a total of 21,993 observations from 1965 to 2015. For example, the percentage of deaths due to suicide and the sequelae of intentional self-harm was 14% and alcohol-related diseases, including accidental poisoning by alcohol, was 13%. Conclusions: PSYCOHORTS lays the foundation for complex examinations of psychiatric disorders that is based on compatible datasets, use of biobanks and multigenerational approach to risk factors, and extensive data on marginalization and inequality.

Does food insecurity link to suicidal behaviors among in-school adolescents? Findings from the low-income country of sub-Saharan Africa

BACKGROUND

Suicidal behaviors among adolescents is a major public health concern. Psychological factors have been extensively studied known risks linked to suicidal behaviors in the general population. However, the association between food insecurity and suicidal behaviors is less researched, particularly in low and middle-income countries. The present study sought to assess the link between food insecurity and suicide behaviors among in-school adolescents.

METHODS

The present study was based on the secondary analysis of the first nationally representative sample of the 2014 Tanzania Global School-based Student Health Survey (GSHS). A total sample of 3,793 in-school adolescents was included in the present analysis. The primary independent variable was food insecurity while the dependent variables of interest were suicide ideation and suicide attempt. Chi-square χ2 and multivariate logistic regression were used to ascertain the measure of statistical association. In all analyses, a p < 0.05 was considered statistically significant.

RESULTS

Of the 3,793 in-school adolescents, 254 (6·7%) were food insecure. A significantly large proportion of adolescents with suicidal ideation and suicidal attempt were food insecure than their counterparts, respectively. In the adjusted multivariate model, food insecure adolescents were more likely to have experienced suicidal ideation and suicidal attempt: [AOR; 1·8 95% C. I; 1·3-2·5] and [AOR; 2·4, 95% C. I; 1·7-3·3]; p < 0.001, respectively.

CONCLUSION

Food insecurity was an independent predictor of suicidal behaviors among in-school adolescents. An intervention that targets food security at the school level may protect adolescents of food insecure household from suicidal behaviors. Nevertheless, school-based mental health screening, evaluation, and promotion may be needed for adolescents with suicidal behaviors.

Affective Temperaments and Clinical Course of Bipolar Disorder: An Exploratory Study of Differences among Patients with and without a History of Violent Suicide Attempts

Background and Objectives: Suicide is the leading cause of death in patients with Bipolar Disorder (BD). In particular, the high mortality rate is due to violent suicide attempts. Several risk factors associated with suicide attempts in patients with BD have been identified. Affective temperaments are associated with suicidal risk, but their predictive role is still understudied. The aim of this study is to assess the relationship between affective temperaments and personal history of violent suicide attempts. Materials and Methods: 74 patients with Bipolar Disorder type I (BD-I) or II (BD-II) were included. All patients filled in the short version of Munster Temperament Evaluation of the Memphis, Pisa, Paris and San Diego (short TEMPS-M) and the Temperament and Character Inventory, revised version (TCI-R). The sample was divided into two groups on the basis of a positive history for suicidal attempts and the suicidal group was further divided into two subgroups according to violent suicide attempts. Results: Violent suicide attempts were positively associated with the cyclothymic temperament and inversely to the hyperthymic one. BD-I patients and patients with a clinical history of rapid cycling were significantly more represented in the group of patients with a history of violent suicide attempts. Conclusions: Our study highlights that several clinical and temperamental characteristics are associated with violent suicide attempts, suggesting the importance of affective temperaments in the clinical management of patients with BPI.

Management of mental health emergencies in elite athletes: a narrative review

Mental health emergencies require a rapid, effective response. We searched the literature on mental health emergencies in athletes and found five papers. None of these addressed elite athletes. Nonetheless, common mental health emergencies may present in the sports environment and may place the athlete and others at risk. Sports teams and organisations should anticipate which emergencies are likely and how medical and support staff can best respond. Responses should be based on general non-sporting guidelines. We stress the importance of clinicians following standard procedures.

iTRAQ-Based Protein Profiling in CUMS Rats Provides Insights into Hippocampal Ribosome Lesion and Ras Protein Changes Underlying Synaptic Plasticity in Depression

Hippocampal atrophy is one of the key changes in the brain implicated in the biology of depression. However, the precise molecular mechanism remains poorly understood due to a lack of biomarkers. In this research, we used behavioral experiments to evaluate anxiety and anhedonia levels in depressed rats using chronic unpredictable mild stress (CUMS) modeling. We also used isobaric tag for relative and absolute quantitation (iTRAQ) to identify the differentially expressed hippocampal proteins between depressed and normal rats. Bioinformatics analyses were also performed for a better understanding. The results showed that CUMS rats had higher anxiety and anhedonia levels than control rats, along with hippocampal lesions. Through iTRAQ and bioinformatics analyses, we found that ribosome proteins were significantly downregulated and Ras proteins exhibited a mixed change in the hippocampus of depressed rats. These findings suggest that the expression of hippocampal ribosome lesions and Ras proteins is significantly different in depressed rats than in control rats, providing new insights into the neurobiology of depression.

Genome-wide association study of suicide attempt in a Mexican population: a study protocol

INTRODUCTION

Suicidality is a complex behaviour and a major health problem; the specific features that could predispose to suicidal behaviour have been extensively investigated, most frequently in European and Asian populations. Therefore, our aim is to present a protocol that will explore suicide attempt in Mexican individuals diagnosed with psychiatric disorders, through a genome-wide association study (GWAS).

METHOD AND ANALYSIS

We will perform a GWAS by comparing 700 individuals who have suicide attempt history, with control subjects without suicide attempt history (n=500). The genotyping will be conducted using the Infinium PsychArray BeadChip and quality controls will be applied to single nucleotides (SNPs) genotyped. After that, we will perform the imputation using reference panels provided by the Haplotype Reference Consortium. We will perform two different workflows: (A) the classic GWAS analysis applying the same weight to all the variants and (B) an algorithm with prediction of deleteriousness of variants.

ETHICS AND DISSEMINATION

This study was approved by the ethics and investigation committees of the National Institute of Genomic Medicine on 22 July 2015, No CEI 215/13. We plan to disseminate research findings in scientific conferences and as a manuscript in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

CEI 215/13.

The psychological wellbeing of the Lebanese society lies between incremental suicide rates and financial stress

Suicide rates have been suspected to increase in Lebanon during the last couple of years. While these rates might be increasing due to an increase in the probability of declaring suicide, it seems important to study why suicide, as a phenomenon, might be possibly increasing in the Lebanese society. One of the most important reasons behind this rise in suicide rates could be related to the economical crisis that has been striking the country for more than two years.

Prevalence of suicidal ideation, suicidal attempt and completed suicide in Ethiopia: a systematic review and meta-analysis protocol

BACKGROUND

Suicide is an emergency psychiatric problem that needs an urgent intervention. Ethiopia, as a nation, has been experiencing high burden of suicide. Cultural taboo, stigma, and criticism associated with suicidal behaviors affect the communities' attitude and practice toward suicide and its help-seeking behaviors. Thus, this systematic review and meta-analysis will provide the pooled prevalence of suicidal ideation, suicidal attempt, and completed suicide in Ethiopia.

METHODS

This review protocol is designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P 2015 Guidelines). Studies reporting the prevalence of suicidal ideation, suicidal attempt, and completed suicide will be included from the databases of PubMed/MEDLINE, Cochrane Library, SCOPUS, EMBASE, and Web of Sciences. The reference lists of retrieved articles, Google Scholar, and national health database reporting suicide will be also searched. No time and language restrictions will be imposed on the search strategy. The methodological quality of included studies will be assessed using the Joanna Briggs Institute critical appraisal tool. The heterogeneity between studies will be measured by the index of heterogeneity (I2 statistics) test. Funnel plots and Egger's test will be used to determine publication bias. Moreover, subgroup and sensitivity analyses will be carried out. The pooled prevalence of suicidal ideation, suicidal attempt, and completed suicide will be calculated by metaprop command using random effects model with the Dersimonian and Laird method.

DISCUSSION

This systematic review and meta-analysis aims to explore the available epidemiological evidences about suicidal ideation, suicidal attempt, and completed suicide. The final results of this review will be submitted for publication in a peer-reviewed journal and presented at conferences. The review of the results will help to raise awareness about the burden of suicidal ideation, suicidal attempt, and completed suicide in Ethiopia.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018112836.

Suicide in older people, attitudes and knowledge of emergency nurses: A multi-centre study

INTRODUCTION

Suicide in older people is a public health concern. Emergency nurses are ideally placed to identify suicide risk. Therefore, the aim of this research was to explore emergency nurses' knowledge, confidence and attitudes about suicide in older people.

METHODS

This descriptive exploratory study was conducted in four emergency departments in Sydney, Australia. Data were collected using a 28-item survey from a convenience sample of emergency nurses. Descriptive quantitative statistics and conventional content analysis were performed. Ethics approval was provided.

RESULTS

The response rate was 58% (n = 136); the majority were female with an average of seven years emergency experience. The majority (n = 124, 91%) reported that they frequently managed suicidal behaviour and recognized suicide as a common event (80%). 51% (n = 69) recognized that suicide was a common event for older people. Only 16% (n = 22) reported receiving suicide prevention training with 11% feeling confident in managing suicidal behaviour.

CONCLUSION

The findings contribute to the discourse on how suicide in older people is recognised by emergency nurses. Few nurses considered it a problem for older people and were not confident about their knowledge. There is a need for suicide prevention training as a priority particularly to identify risks in older people.

Alcohol consumption and suicide risk in medical internship: A Peruvian multicentric study

INTRODUCTION AND AIM

Suicide and harmful alcohol consumption are major health problems, especially in medical students. This study aimed to evaluate the association between risk for alcohol abuse and suicide risk in medical interns of Peruvian hospitals.

DESIGN AND METHODS

We conducted a multicentre cross-sectional study in medical interns from 18 Peruvian hospitals. We measured suicide risk, risk for alcohol abuse, depression and self-esteem using the Plutchik Suicide Risk Scale, CAGE, Zung Self-Rating Depression Scale and Rosenberg Self-Esteem Scale, respectively. We used χ² and Student t-tests for descriptive analysis. To evaluate the association between risk for alcohol abuse and suicide risk we generated crude and adjusted Poisson regression models with robust variance and estimated prevalence ratios with 95% confidence intervals.

RESULTS

We surveyed 433 medical interns. The prevalence of suicide risk and risk for alcohol abuse was 19.6% and 27.5%, respectively. We found significant differences in suicide risk according to age (P < 0.001), region of origin (P = 0.002), with whom the participant lived (P < 0.001), university of origin (P = 0.040), type of hospital (P = 0.042), family history of attempted suicide (P = 0.043), self-esteem level (P < 0.001) and alcohol consumption (P < 0.001). In the adjusted model, age (PRa: 1.11, 95% confidence interval 1.05-1.17) and risk for alcohol abuse (PRa: 7.60, 95% confidence interval 4.46-12, 96) were associated with suicide risk.

DISCUSSION AND CONCLUSIONS

Two out of 10 medical interns had a positive screening for suicide risk. Age and especially risk for alcohol abuse were the associated variables.

[The risk of suicidal behavior in patients with epilepsy]

AIM

To study a role of psychopathological and social factors in the development of suicidal behavior in patients with different forms of epilepsy.

MATERIAL AND METHODS

One hundred and nineteen patients with epilepsy, 57 men and 62 women, mean age 40.7±0.54 years, were studied using neurological and psychiatric examinations, along with a large battery of scales for assessment patient's state and suicidal behavior.

RESULTS AND CONCLUSION

Clinical and psychological risk factors for suicidal behavior as well as for motivation of suicide prevention are identified. The formation of psychopathology determines the model of personality changes associated with epilepsy and the patients' response to social exclusion and stigma that lead to suicide.

[Suicidological research in epilepsy: problems of methodology]

The review highlights contemporary views on the problem of suicide in patients with epilepsy. The most relevant theories are presented that describe the emergence of suicidal thoughts and the transition to suicidal attempts. Along with a description of risk factors, protective factors, as well as the possible impact of comorbidity, a description of methodological deficiencies in papers on suicide in patients with epilepsy is given. Recommendations for studies related to suicidal behaviour in patients with epilepsy are discussed.

Poisoning-The Road Less Travelled

How to cite this article: Chacko B, Krishna B, Kulkarni AP. Poisoning-The Road Less Travelled. Indian J Crit Care Med 2019;23(Suppl 4):S233.

Current challenges of suicide and future directions of management in Bangladesh: a systematic review

Objectives

Bangladesh is a densely populated country in south-east Asia with paucity of research in suicide. This systematic review was aimed at critical appraising various aspects of suicide in Bangladesh based on available literature and systematic search.

Methods

Extensive literature search was conducted in Scopus, PubMed, PubMed Central, Google, Google Scholar and BanglaJOL with searching key words without any date boundary and without any basis of types of studies, that is, all types of studies were scrutinised. The author focused on sources of suicide data along with epidemiological variables of suicides in Bangladesh such as suicide rate, gender of victims, methods of suicides, risk factors and prevention activities and role of media in suicide.

Results

After exclusion of repetitions, screening was performed, and finally, 35 articles were selected for review. Amongst the 35 articles, 16 articles were original contributions, 2 systematic reviews, 6 narrative reviews, 2 scoping reviews, 3 editorials, 3 case reports and rest correspondence article. The review revealed that the actual rate of suicide in Bangladesh is yet to come out and quality data is a real challenge. Women are dying more than the men, and early adulthood is the most vulnerable time of life.

Discussion

Suicide is a under attended problem in Bangladesh, as the country yet to reveal the actual rate of suicide along with the challenge of quality data. Prevention activities have been started but yet to be visualised. Decriminalisation of suicide in the legal criteria and establishment of suicide surveillance can be the top priorities in the country.

Association Between Suicidal Behavior and Clinical Features of Premenstrual Syndrome and Menstrual History: A Cross Sectional Study

BACKGROUND

The link between suicidal behavior and premenstrual syndrome has been poorly studied. This study aimed to determine the association of suicide attempts, and suicidal ideation and signs and symptoms of premenstrual syndrome and menstrual history in women in Durango City, Mexico.

METHODS

Using a cross-sectional study design, 437 women were interviewed to obtain clinical data about their premenstrual period, menstrual history and suicidal behavior. Logistic regression was used to assess the association between suicide behavior and clinical features of women. Odds ratio (OR) adjusted by age, presence of mental illness, and residence area, and 95% confidence interval (CI) were obtained.

RESULTS

Of these women, 29 (6.6%) had a history of suicidal ideation, and 15 (3.4%) had a history of suicide attempts. Logistic regression showed that suicidal ideation was associated with the variables: presence of irregular periods (OR = 2.89; 95% CI: 1.10 - 7.55; P = 0.03), low back pain (OR = 4.57; 95% CI: 1.31 - 15.92; P = 0.01), desire to eat certain food or eat a lot (OR = 2.47; 95% CI: 1.10 - 5.57; P = 0.02), guilty feeling (OR = 2.43; 95% CI: 1.06 - 5.59; P = 0.03), and aggressiveness (OR = 3.19; 95% CI: 1.42 - 7.13; P = 0.005). Whereas logistic regression showed that a history of suicide attempts was associated with the variables: presence of irregular periods (OR = 9.57; 95% CI: 1.23 - 74.44; P = 0.03), and desire to eat certain food or eat a lot (OR = 3.08; 95% CI: 1.04 - 9.15; P =0.04).

CONCLUSIONS

In this first study on the link of suicide behavior and clinical features of premenstrual syndrome, results suggest that suicidal ideation and suicide attempts are associated to specific signs or symptoms of premenstrual syndrome. Further research to confirm the findings of this study is needed. Results might help for an optimal planning of preventive measures against suicide.