Understanding suicide risk: identification of high-risk groups during high-risk times

Personality vulnerabilities in adolescent suicidality: The mediating role of psychological distress

The research literature consistently indicates that self-criticism is related to suicidality. Evidence for the role of dependency, however, is more controversial. This study examines the extent to which these personality vulnerabilities are mediated by psychological distress in the prediction of suicidality. As part of a study of adolescent psychopathology, a sample of 260 Portuguese adolescents (148 [56.9 %] female and 112 [43.1%] male), ranging in age from 15 to 18 years (M = 16.32, SD = 1.19) completed measures of personality, suicidal behavior, and current distress, in counterbalanced order. The measures were: self-criticism and dependency from the Depressive Experiences Questionnaire for Adolescents; two psychological distress scales, social withdrawal from the Youth Self Report and depression from the Center for Epidemiologic Studies of Depression Scale; and a measure of suicidality from the Suicide Behaviors Questionnaire Revised. Structural equation modeling indicated that self-criticism and dependency were both significantly associated with suicidality. Psychological distress, however, as measured by withdrawal and depression, fully mediated these relationships, but did not moderate them. The authors conclude that adolescents with higher levels of self-criticism and dependency are at greater risk for experiencing intense psychological distress-high levels of social withdrawal and depression-that account for their vulnerability to suicide risk.

Testing Models Relating Rejection, Depression, Interpersonal Needs, and Psychache to Suicide Risk in Nonclinical Individuals

OBJECTIVES

Using structural equation modeling, we tested a primary model of suicide risk and 3 competing, alternative models based on 4 psychological variables deemed important in the literature (perception of parental rejection, depression, interpersonal needs comprising perceived burdensomeness and thwarted belongingness, and psychache), in a nonclinical sample of Portuguese adults.

METHOD

A convenience sample of 203 adults (100 men, 103 women; aged 18-65 years) participated in this study.

RESULTS

Analyses demonstrated that the proposed primary model had the best fit to the observed data. The differences in fit indexes for this model and one of the alternative models, however, were not substantial.

CONCLUSION

Perceived parental rejection related directly to suicide risk and indirectly via depression and interpersonal needs. Depression linked indirectly to suicide risk via interpersonal needs and psychache. Interpersonal needs related directly to suicide risk and indirectly via psychache, which related directly to suicide risk.

Suicidal ideation and distress in family members bereaved by suicide in Portugal

The present study assessed the impact of suicide and distress on suicidal ideation in a sample of 93 Portuguese family members bereaved by suicide. A control community sample of 102 adults also participated. After controlling for educational level, those bereaved by the suicide of a family member were found to have higher levels of suicidal ideation. Forty-two percent of family members had Suicide Ideation Questionnaire scores at or above the cutoff point. General distress, depression, anxiety, and hostility related to suicidal ideation, whereas time since suicide also interacted with general distress and depression in predicting suicidal ideation.

Assistência hospitalar na tentativa de suicídio

Este artigo discute pontos relevantes que podem colaborar no sucesso da assistência hospitalar direcionada à pessoa com intenção suicida. O risco de suicídio aumenta de acordo com o número de tentativas e também está associado a intervalos de tempo menores entre essas tentativas. Assim, o acolhimento à pessoa com tentativa de suicídio durante a assistência hospitalar é fundamental, pois se realizado com segurança, prontidão e qualidade é possível determinar a aceitação e a adesão do paciente ao tratamento. Essas ações devem estar direcionadas ao cuidado integral prestado à tríade – paciente/família/equipe de profissionais de saúde e da área social. Existem fatores cruciais no alcance da qualidade assistencial que estão atrelados às condições para favorecer a adesão ao tratamento e a criação de uma equipe multidisciplinar com competência de utilizar uma combinação de fatores biológicos, psicológicos e intervenções sociais por meio de educação continuada.

Comparative analysis of suicide, accidental, and undetermined cause of death classification

Suicide determination is not standardized across medical examiners, and many suspected suicides are later classified as accidental or undetermined. The present study investigated patterns between these three groups using a medical examiner database and 633 structured interviews with next of kin. There were similarities across all three classification groups, including rates of mental illness and psychiatric symptoms. Those classified suicide were more likely to be male, to have died in a violent fashion, and have a stronger family history of suicide. Chronic pain was very common across all three groups, but significantly higher in the accidental and undetermined groups.

Impact of some types of mass gatherings on current suicide risk in an urban population: statistical and negative binominal regression analysis of time series

BACKGROUND

Many studies have investigated the impact of a wide range of social events on suicide-related behaviour. However, these studies have predominantly examined national events. The aim of this study is to provide a statistical evaluation of the relationship between mass gatherings in some relatively small urban sub-populations and the general suicide rates of a major city.

METHODS

The data were gathered in the Ukrainian city of Dnipropetrovsk, with a population of 1 million people, in 2005-2010. Suicide attempts, suicides, and the total amount of suicide-related behaviours were registered daily for each sex. Bivariate and multivariate statistical analysis, including negative binomial regression, were applied to assess the risk of suicide-related behaviour in the city's general population for 7 days before and after 427 mass gatherings, such as concerts, football games, and non-regular mass events organized by the Orthodox Church and new religious movements.

RESULTS

The bivariate and multivariate statistical analyses found significant changes in some suicide-related behaviour rates in the city's population after certain kinds of mass gatherings. In particular, we observed an increased relative risk (RR) of male suicide-related behaviour after a home defeat of the local football team (RR = 1.32, p = 0.047; regression coefficient beta = 0.371, p = 0.002), and an increased risk of male suicides (RR = 1.29, p = 0.006; beta =0.255, p = 0.002), male suicide-related behaviour (RR = 1.25, p = 0.019; beta =0.251, p < 0.001), and total suicide-related behaviour (RR = 1.23 p < 0.001; beta =0.187, p < 0.001) after events organized by the new religious movements.

CONCLUSIONS

Although football games and mass events organized by new religious movements involved a relatively small part of an urban population (1.6 and 0.3%, respectively), we observed a significant increase of the some suicide-related behaviour rates in the whole population. It is likely that the observed effect on suicide-related behaviour is related to one's personal presence at the event rather than to its broadcast. Our findings can be explained largely in terms of Gabennesch's theory of the 'broken-promises effect' with regard to intra- and interpersonal conflict and, in terms of crowd behaviour effects.

Characterizing suicide in Toronto: an observational study and cluster analysis

OBJECTIVE

To determine whether people who have died from suicide in a large epidemiologic sample form clusters based on demographic, clinical, and psychosocial factors.

METHOD

We conducted a coroner's chart review for 2886 people who died in Toronto, Ontario, from 1998 to 2010, and whose death was ruled as suicide by the Office of the Chief Coroner of Ontario. A cluster analysis using known suicide risk factors was performed to determine whether suicide deaths separate into distinct groups. Clusters were compared according to person- and suicide-specific factors.

RESULTS

Five clusters emerged. Cluster 1 had the highest proportion of females and nonviolent methods, and all had depression and a past suicide attempt. Cluster 2 had the highest proportion of people with a recent stressor and violent suicide methods, and all were married. Cluster 3 had mostly males between the ages of 20 and 64, and all had either experienced recent stressors, suffered from mental illness, or had a history of substance abuse. Cluster 4 had the youngest people and the highest proportion of deaths by jumping from height, few were married, and nearly one-half had bipolar disorder or schizophrenia. Cluster 5 had all unmarried people with no prior suicide attempts, and were the least likely to have an identified mental illness and most likely to leave a suicide note.

CONCLUSIONS

People who die from suicide assort into different patterns of demographic, clinical, and death-specific characteristics. Identifying and studying subgroups of suicides may advance our understanding of the heterogeneous nature of suicide and help to inform development of more targeted suicide prevention strategies.

Suicide ideation and behaviours after STN and GPi DBS surgery for Parkinson's disease: results from a randomised, controlled trial

BACKGROUND

The risk of suicide behaviours post-deep brain stimulation (DBS) surgery in Parkinson's disease (PD) remains controversial. We assessed if suicide ideation and behaviours are more common in PD patients (1) randomised to DBS surgery versus best medical therapy (BMT); and (2) randomised to subthalamic nucleus (STN) versus globus pallidus interna (GPi) DBS surgery.

METHODS

In Phase 1 of the Veterans Affairs CSP 468 study, 255 PD patients were randomised to DBS surgery (n=121) or 6 months of BMT (n=134). For Phase 2, a total of 299 patients were randomised to STN (n=147) or GPi (n=152) DBS surgery. Patients were assessed serially with the Unified Parkinson's Disease Rating Scale Part I depression item, which queries for suicide ideation; additionally, both suicide behaviour adverse event data and proxy symptoms of increased suicide risk from the Parkinson's Disease Questionnaire (PDQ-39) and the Short Form Health Survey (SF-36) were collected.

RESULTS

In Phase 1, no suicide behaviours were reported, and new-onset suicide ideation was rare (1.9% for DBS vs 0.9% for BMT; Fisher's exact p=0.61). Proxy symptoms of relevance to suicide ideation were similar in the two groups. Rates of suicide ideation at 6 months were similar for patients randomised to STN versus GPi DBS (1.5% vs 0.7%; Fisher's exact p=0.61), but several proxy symptoms were worse in the STN group.

CONCLUSIONS

Results from the randomised, controlled phase of a DBS surgery study in PD patients do not support a direct association between DBS surgery and an increased risk for suicide ideation and behaviours.

Attempted and completed suicide: not what we expected?

BACKGROUND

Suicide attempters and suicide completers are two overlapping but distinct suicide populations. This study aims to present a more accurate characterization by comparing populations of suicide attempters and completers from the same geographical area.

METHODS

Samples and procedure: All cases of attempted suicide treated at the emergency room of the Corporacio Sanitària i Universitària Tauli Parc de Sabadell in 2008 (n=312) were compared with all completed suicides recorded in the same geographical area from 2008 to 2011 (n=86). Hospital and primary care records were reviewed for sociodemographic and clinical variables.

STATISTICAL ANALYSIS

Chi-square, ANOVA, and Mann-Whitney U tests were used to identify characteristics related to suicide completion.

RESULTS

Compared to suicide attempters, suicide completers were more likely to be male (73.3% vs. 37.8%; p<0.001), pensioners (73.7% vs. 23.4%; p<0.001), and people living alone (31.8% vs. 11.4%; p=0.006). Suicide completers more frequently presented somatic problems (71.7 vs. 15.7; p<0.001), Major Depressive Disorder (54.7% vs. 27.9%; p<0.001), and made use of more lethal methods (74.1 vs. 1.9; p<0.001). Suicide completers were more likely to have been followed by a primary care provider (50.0% vs. 16.0%; p<0.001). 92.3% of the suicides committed were completed during the first or second attempt.

LIMITATIONS

Suicide completers were not evaluated using the psychological autopsy method.

CONCLUSIONS

Despite presenting a profile of greater social and clinical severity, suicide completers are less likely to be followed by Mental Health Services than suicide attempters. Current prevention programs should be tailored to the specific profile of suicide completers.

Clinical implications of drug abuse epidemiology

Research on the epidemiology of illicit drug use disorders provides continued critical insights into the distribution and determinants of drug use and drug use disorders in the United States. This research serves as a foundation for understanding the etiology of these disorders, helping to disentangle the complex interrelationship of developmental, genetic, and environmental risk and protective factors. Building on an understanding of this research in substance abuse epidemiology, it is important for clinicians to understand the unique trends in drug use in the overall communities that they serve and the unique risk factors for given individuals. The generally high prevalence of substance use disorders, along with their high comorbidity with other psychiatric disorders and with the HIV epidemic, make prevention, evaluation, and referral for treatment for drug abuse an important part of routine clinical practice in a range of clinical settings, including primary care, psychiatric, and emergency department settings. Ongoing efforts to ensure insurance coverage parity for the treatment of mental health and substance use disorders offer the promise of continued improvements in the integration and availability of such services in the broader US health care system.