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Glorioso C, Sibille E. Between destiny and disease: genetics and molecular pathways of human central nervous system aging. Prog Neurobiol 2010; 93:165-81. [PMID: 21130140 DOI: 10.1016/j.pneurobio.2010.11.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 11/03/2010] [Accepted: 11/23/2010] [Indexed: 01/04/2023]
Abstract
Aging of the human brain is associated with "normal" functional, structural, and molecular changes that underlie alterations in cognition, memory, mood and motor function, amongst other processes. Normal aging also imposes a robust constraint on the onset of many neurological diseases, ranging from late onset neurodegenerative diseases, such as Alzheimer's (AD) and Parkinson's diseases (PD), to early onset psychiatric disorders, such as bipolar disorder (BPD) and schizophrenia (SCZ). The molecular mechanisms and genetic underpinnings of age-related changes in the brain are understudied, and, while they share some overlap with peripheral mechanisms of aging, many are unique to the largely non-mitotic brain. Hence, understanding mechanisms of brain aging and identifying associated modulators may have profound consequences for the prevention and treatment of age-related impairments and diseases. Here we review current knowledge on age-related functional and structural changes, their molecular and genetic underpinnings, and discuss how these pathways may contribute to the vulnerability to develop age-related neurological diseases. We highlight recent findings from human post-mortem brain microarray studies, which we hypothesize, point to a potential genetically controlled transcriptional program underlying molecular changes and age-gating of neurological diseases. Finally, we discuss the implications of this model for understanding basic mechanisms of brain aging and for the future investigation of therapeutic approaches.
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Affiliation(s)
- Christin Glorioso
- Department of Psychiatry, Center for Neuroscience, Translational Neuroscience Program, University of Pittsburgh, Pittsburgh, PA 15312, USA
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1202
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Abstract
BACKGROUND Hospital-treated deliberate self harm and suicide among older adults have rarely been examined at a national level. METHODS The Irish Central Statistics Office provided suicide and undetermined death data for 1980-2006. The National Registry of Deliberate Self Harm collected data relating to deliberate self harm presentations made in 2006-2008 to all 40 Irish hospital emergency departments. RESULTS Rates of female suicide among older adults (over 55 years) were relatively stable in Ireland during 1980-2006 whereas male rates increased in the 1980s and decreased in more recent decades. Respectively, the annual male and female suicide and undetermined death rate was 22.1 and 7.6 per 100,000 in 1997-2006. Male and female deliberate self harm was 3.0 and 11.0 times higher at 67.4 and 83.4 per 100,000, respectively. Deliberate self harm and suicide decreased in incidence with increasing age. Deliberate self harm generally involved drug overdose (male: 72%; female 85%) or self-cutting (male: 15%; female 9%). The most common methods of suicide were hanging (41%) and drowning (29%) for men and drowning (39%) and drug overdose (24%) for women. City and urban district populations had the highest rates of hospital-treated self harm. The highest suicide rates were in urban districts. CONCLUSIONS Older Irish adults have high rates of hospital-treated deliberate self harm but below average rates of suicide. Drowning was relatively common as a method of suicide. Restricting availability of specific medications may reduce both forms of suicidal behavior.
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Tindle HA, Omalu B, Courcoulas A, Marcus M, Hammers J, Kuller LH. Risk of suicide after long-term follow-up from bariatric surgery. Am J Med 2010; 123:1036-42. [PMID: 20843498 PMCID: PMC4296730 DOI: 10.1016/j.amjmed.2010.06.016] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 03/24/2010] [Accepted: 06/08/2010] [Indexed: 12/17/2022]
Abstract
PURPOSE Bariatric surgery is recognized as the treatment of choice for class III obesity (body mass index ≥40) and has been increasingly recommended for obese patients. Prior research has suggested an excess of deaths due to suicide following bariatric surgery, but few large long-term follow-up studies exist. We examined postbariatric surgery suicides by time since operation, sex, age, and suicide death rates as compared with US suicide rates. METHODS Medical data following bariatric operations performed on Pennsylvania residents between January 1, 1995 and December 31, 2004 were obtained from the Pennsylvania Health Care Cost and Containment Council. Matching mortality data from suicides between September 1, 1996 and December 28, 2006 were obtained from the Division of Vital Records, Pennsylvania State Department of Health. RESULTS There were 31 suicides (16,683 operations), for an overall rate of 6.6/10,000; 13.7 per 10,000 among men and 5.2 per 10,000 among women. About 30% of suicides occurred within the first 2 years following surgery, with almost 70% occurring within 3 years. For every age category except the youngest, suicide rates were higher among men than women. Age- and sex-matched suicide rates in the US population (ages 35-64 years) were 2.4/10,000 (men) and 0.7/10,000 (women). CONCLUSIONS Compared with age and sex-matched suicide rates in the US, there was a substantial excess of suicides among all patients who had bariatric surgery in Pennsylvania during a 10-year period. These data document a need to develop more comprehensive longer-term surveillance and follow-up methods in order to evaluate factors associated with postbariatric surgery suicide.
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1204
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Bhui K. Commentary: Religious, cultural and social influences on suicidal behaviour. Int J Epidemiol 2010; 39:1495-6. [DOI: 10.1093/ije/dyq196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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1205
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Santos MAF, Siqueira MVS, Mendes AM. Tentativas de suicídio de bancários no contexto das reestruturações produtivas. RAC: REVISTA DE ADMINISTRAÇÃO CONTEMPORÂNEA 2010. [DOI: 10.1590/s1415-65552010000500010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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1206
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Kato TA, Suzuki Y, Sato R, Fujisawa D, Uehara K, Hashimoto N, Sawayama Y, Hayashi J, Kanba S, Otsuka K. Development of 2-hour suicide intervention program among medical residents: first pilot trial. Psychiatry Clin Neurosci 2010; 64:531-40. [PMID: 20727109 DOI: 10.1111/j.1440-1819.2010.02114.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Suicide is associated not only with primary psychiatric disorders but also with physical disorders. Physicians' education on suicide prevention contributes to reducing suicide. Therefore, medical residents, who contact patients daily and who eventually become primary physicians in each specialty, might be the most appropriate candidates for intervention. In this article, we introduce our newly developed suicide intervention program among medical residents. METHODS We developed a 2-hour suicide intervention program among medical residents, based on the Mental Health First Aid (MHFA), which had originally been developed for the public. The program contains a 1-hour lecture and a 1-hour role-play session. As the first pilot trial, we conducted the program among 44 first-year medical residents at a university hospital and evaluated its effectiveness. Changes in confidence, attitudes and behavior toward suicidal people were evaluated using self-reported questionnaires before, immediately after, and 6 months after the program. RESULTS Participants' confidence and attitudes significantly improved after the program. The total mean score (standard deviation) of the Suicide Intervention Response Inventory improved from 18.4 (2.0) before the intervention to 19.4 (2.0) immediately after the intervention. However, the effectiveness was limited after 6 months. In the course of 6 months, the participants learned to apply the MHFA principles in their daily clinical practice. CONCLUSION Our newly developed brief suicide intervention program demonstrating its effectiveness among medical residents should be modified in order to be more effective in the long term. The next trial with a control group ought to be conducted to evaluate our developed program.
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Affiliation(s)
- Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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1207
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Carlborg A, Winnerbäck K, Jönsson EG, Jokinen J, Nordström P. Suicide in schizophrenia. Expert Rev Neurother 2010; 10:1153-64. [PMID: 20586695 DOI: 10.1586/ern.10.82] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Schizophrenia is a disorder with an estimated suicide risk of 4-5%. Many factors are involved in the suicidal process, some of which are different from those in the general population. Clinical risk factors include attempted suicide, depression, male gender, substance abuse and hopelessness. Biosocial factors, such as a high intelligence quotient and high level of premorbid function, have also been associated with an increased risk of suicide in patients with schizophrenia. Suicide risk is especially high during the first year after diagnosis. Many of the suicides occur during hospital admission or soon after discharge. Management of suicide risk includes both medical treatment and psychosocial interventions. Still, risk factors are crude; efforts to predict individual suicides have not proved useful and more research is needed.
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1208
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Hardt J, Johnson JG. Suicidality, depression, major and minor negative life events: a mediator model. PSYCHO-SOCIAL MEDICINE 2010; 7:Doc05. [PMID: 21139987 PMCID: PMC2996056 DOI: 10.3205/psm000067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background: Major negative life events are associated with higher suicidality. In this association, two mediating paths were hypothesized: (a) via minor negative life events and (b) via depression. Methods: Ninety-six adolescent primary care patients were recruited in clinics, a physician’s office, and school nurses’ offices. Results: (1) Minor negative life events were associated with depressive symptoms and suicidality. (2) Depressive symptoms were associated with suicidality. (3) Depressive symptoms mediated the association of minor negative life events with suicidality. Conclusions: Findings suggest that minor negative life events may be associated with suicidal ideation among adolescent primary care patients, and that depressive symptoms may mediate the association of minor negative life events with suicidality.
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Affiliation(s)
- Jochen Hardt
- Institute for Medical Psychology and Medical Sociology, Clinic for Psychosomatic Medicine and Psychotherapy, Universitätsmedizin, Johannes-Gutenberg-Universität Mainz, Germany
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Abstract
This article has its roots in the consternation of head anesthetists over the loss of colleagues. Anesthesia, intensive care medicine, emergency medicine and pain therapy has lost too many first class colleagues through suicide, addiction, severe depression and other causes. It is time to direct attention not exclusively to patients but also to apply an important occupational principle in the rescue service and intensive care medicine to the profession of anesthetists: Every life counts! The following article supplies information on the frequency, methods and possible reasons for suicide by physicians and suggestions for the prevention of suicide as well as treatment of physicians who are at risk of suicide will be presented.
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1210
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Wenzel V. [Personal crises and catastrophes]. Anaesthesist 2010; 59:393-4. [PMID: 20094693 DOI: 10.1007/s00101-009-1658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- V Wenzel
- Univ.-Klinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstrasse 35, 6020 Innsbruck, Osterreich.
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1211
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Suicidal brains: a review of functional and structural brain studies in association with suicidal behaviour. Neurosci Biobehav Rev 2010; 35:688-98. [PMID: 20826179 DOI: 10.1016/j.neubiorev.2010.08.007] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 08/02/2010] [Accepted: 08/26/2010] [Indexed: 11/22/2022]
Abstract
Evidence of an association between a vulnerability to suicidal behaviour and neurobiological abnormalities is accumulating. Post-mortem studies have demonstrated structural and biochemical changes in the brains of suicide victims. More recently, imaging techniques have become available to study changes in the brain in vivo. This systematic review of comparative imaging studies of suicidal brains shows that changes in the structure and functions of the brain in association with suicidal behaviour are mainly found in the orbitofrontal and dorsolateral parts of the prefrontal cortex. Correlational studies suggest that these changes relate to neuropsychological disturbances in decision-making, problem solving and fluency, respectively. As a consequence, the findings from these studies suggest that suicidal behaviour is associated with (1) a particular sensitivity to social disapproval (2) choosing options with high immediate reward and (3) a reduced ability to generate positive future events. Further study is needed to elaborate these findings and to investigate to what extent changes in the structure and function of suicidal brains are amenable to psychological and/or biological interventions.
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1212
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Danchin CL, MacLeod AK, Tata P. Painful engagement in deliberate self-harm: The role of conditional goal setting. Behav Res Ther 2010; 48:915-20. [DOI: 10.1016/j.brat.2010.05.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 05/15/2010] [Accepted: 05/20/2010] [Indexed: 10/19/2022]
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Pierò A. Personality correlates of impulsivity in subjects with generalized anxiety disorders. Compr Psychiatry 2010; 51:538-45. [PMID: 20728013 DOI: 10.1016/j.comppsych.2010.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Revised: 01/15/2010] [Accepted: 02/08/2010] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND As yet, the relation between personality traits and impulsiveness has not been investigated in subjects affected by generalized anxiety disorder (GAD). METHOD A sample of 79 subjects with a diagnosis of GAD has been assessed at intake with Clinical Global Impression (CGI), Barratt Impulsiveness Scale (BIS-11), and with Temperament and Character Inventory. Comorbidity with cluster A or B personality disorders was excluded. RESULTS A multiple linear regression has identified 3 variables as independent predictors of impulsiveness: novelty seeking (NS) and reward dependence (RD) as for temperament and self-directedness (SD) as for character. Predictor analysis of the 3 subscales of BIS-11 showed that a higher NS is a predictor of all 3 subscales of BIS-11, whereas a higher RD is a protective factor for the attentive impulsiveness, and a low SD is predictive of a greater nonplanned impulsiveness. The CGI severity index is directly related to motor impulsiveness. DISCUSSION Preliminary results showed that in subjects with GAD only the motor component of impulsivity seems directly related to clinical severity, whereas impulsiveness is predicted by higher levels of 2 temperamental dimensions that are influenced by dopamine and norepinephrine systems and by weakness of character. CONCLUSION Subjects with GAD showed an interesting variability in NS. Differences in levels of NS and of other temperament (RD) and character (SD) dimensions seem related to different degrees of behavioral inhibition and to a different impact of the cognitive components of impulsiveness. Clinical implications are discussed.
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Affiliation(s)
- Andrea Pierò
- Mental Health Department ASL TO 4, Mental Health Centre, Via Blatta 10, 10034 Chivasso, Italy.
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1214
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Reutfors J, Brandt L, Ekbom A, Isacsson G, Sparén P, Osby U. Suicide and hospitalization for mental disorders in Sweden: a population-based case-control study. J Psychiatr Res 2010; 44:741-7. [PMID: 20181360 DOI: 10.1016/j.jpsychires.2010.02.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 01/26/2010] [Accepted: 02/02/2010] [Indexed: 11/25/2022]
Abstract
The aim of this study was to estimate suicide risk during hospitalization and in the year following discharge for patients with mental disorders. All suicide cases in Sweden 18 years and older, between 1991 and 2003 (N=20,675; 70% male), were individually matched to 10 controls from the general Swedish population. Discharge diagnoses in the year before suicide of any mental disorder, mood disorder, schizophrenia spectrum disorder, and alcohol use disorder were identified from the Swedish Patient Register. Highest suicide risk during hospitalization and in the year following discharge was found for mood disorder [odds ratio (OR) 55 (95% CI, 47-65) for men and 86 (95% CI, 70-107) for women], with the risk peaking in the first week following discharge [OR 177 (95% CI, 78-401) for men and OR 268 (95% CI, 85-846) for women]. Compared to that for mood disorder, the suicide risk for schizophrenia spectrum disorder and alcohol use disorder was about half and more constant over time. The majority of suicide victims with a psychiatric diagnosis had been discharged from psychiatric treatment more than a month before the suicide. Over time, a constant proportion of 25% of the suicide victims had been hospitalized with a mental disorder in the year before suicide (23% of males and 31% of females), despite a significant decrease in psychiatric hospitalizations in the population. In conclusion, suicide risk was found to vary by type of mental disorder, time since discharge, and sex. This should be taken into account when planning suicide preventive efforts.
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Affiliation(s)
- Johan Reutfors
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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1215
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Chronic physical conditions and their association with first onset of suicidal behavior in the world mental health surveys. Psychosom Med 2010; 72:712-9. [PMID: 20498290 DOI: 10.1097/psy.0b013e3181e3333d] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the association of a range of temporally prior physical conditions with the subsequent first onset of suicidal ideation, plans, and attempts in large, general population, cross-national sample. The associations between physical conditions and suicidal behavior remain unclear due to sparse data and varied methodology. METHODS Predictive associations between 13 temporally prior physical conditions and first onset of suicidal ideation, plans, and attempts were examined in a 14-country sample (n = 37,915) after controlling for demographic, socioeconomic, and psychosocial covariates, with and without adjustment for mental disorders. RESULTS Most physical conditions were associated with suicidal ideation in the total sample; high blood pressure, heart attack/stroke, arthritis, chronic headache, other chronic pain, and respiratory conditions were associated with attempts in the total sample; epilepsy, cancer, and heart attack/stroke were associated with planned attempts. Epilepsy was the physical condition most strongly associated with the suicidal outcomes. Physical conditions were especially predictive of suicidality if they occurred early in life. As the number of physical conditions increased, the risk of suicidal outcomes also increased, however the added risk conferred was generally smaller with each additional condition. Adjustment for mental disorders made little substantive difference to these results. Physical conditions were equally predictive of suicidality in higher and lower income countries. CONCLUSIONS The presence of physical conditions is a risk factor for suicidal behavior even in the absence of mental disorder.
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1216
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Johnson J, Gooding P, Wood A, Taylor P, Pratt D, Tarrier N. Resilience to suicidal ideation in psychosis: Positive self-appraisals buffer the impact of hopelessness. Behav Res Ther 2010; 48:883-9. [DOI: 10.1016/j.brat.2010.05.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 05/13/2010] [Accepted: 05/18/2010] [Indexed: 11/15/2022]
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Marzano L, Fazel S, Rivlin A, Hawton K. Psychiatric disorders in women prisoners who have engaged in near-lethal self-harm: case-control study. Br J Psychiatry 2010; 197:219-26. [PMID: 20807968 DOI: 10.1192/bjp.bp.109.075424] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Female prisoners are 20 times more likely to die by suicide than women of the same age in the general population. However, risk factors and indicators of vulnerability for suicide in this group are not well-known. AIMS We investigated prevalence of psychiatric disorders in women prisoners who had recently engaged in near-lethal self-harm (cases) and others who had never carried out near-lethal attempts in prison (controls). METHOD We interviewed 60 cases and 60 controls from all closed female prison establishments in England and Wales. In addition to gathering details of sociodemographic, criminological and clinical history, we assessed participants' current and lifetime disorders using the Mini-International Neuropsychiatric Interview. Associations between near-lethal self-harm and psychiatric disorders were adjusted for age, educational qualifications (any v. none) and remand status (sentenced v. unsentenced). RESULTS At the time of their near-lethal self-harm, 53 cases (88%) were on ACCT (Assessment, Care in Custody and Teamwork), the system for the care of prisoners at risk of suicide and self-harm in England and Wales. Cases had significantly greater levels of psychiatric morbidity than controls, and more comorbidity. The strongest associations with near-lethal self-harm were with current depression (age-adjusted odds ratio (OR) = 23.7, 95% CI 9.0-62.3), the presence of two or more diagnoses (age-adjusted OR = 18.3, 95% CI 5.9-56.9), a history of psychiatric in-patient treatment (OR = 25.4, 95% CI 5.7-113.5) and previous attempted suicide, especially in prison (OR = 129, 95% CI 27-611). The only tested diagnoses not associated with near-lethal self-harm were antisocial personality disorder, substance use and eating disorders. Adjusting for sociodemographic and criminological variables did not significantly alter any of these findings. CONCLUSIONS This research underlines the importance of psychiatric risk factors for suicide in custody and in particular comorbidity. The finding that a formal care plan was in place for most cases at the time of their near-lethal act is indicative of good risk detection, but also suggests high levels of unmet need. Given the potential complexity of their mental health needs, interventions incorporating pharmacological and psychological treatments should be considered for at-risk prisoners.
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Affiliation(s)
- Lisa Marzano
- Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK
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1218
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Zhang Y, Zhang C, Yuan G, Yao J, Cheng Z, Liu C, Liu Q, Wan G, Shi G, Cheng Y, Ling Y, Li K. Effect of tryptophan hydroxylase-2 rs7305115 SNP on suicide attempts risk in major depression. Behav Brain Funct 2010; 6:49. [PMID: 20738857 PMCID: PMC2939585 DOI: 10.1186/1744-9081-6-49] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 08/25/2010] [Indexed: 02/01/2023] Open
Abstract
Background Suicide and major depressive disorders (MDD) are strongly associated, and genetic factors are responsible for at least part of the variability in suicide risk. We investigated whether variation at the tryptophan hydroxylase-2 (TPH2) gene rs7305115 SNP may predispose to suicide attempts in MDD. Methods We genotyped TPH2 gene rs7305115 SNP in 215 MDD patients with suicide and matched MDD patients without suicide. Differences in behavioral and personality traits according to genotypic variation were investigated by logistic regression analysis. Results There were no significant differences between MDD patients with suicide and controls in genotypic (AG and GG) frequencies for rs7305115 SNP, but the distribution of AA genotype differed significantly (14.4% vs. 29.3%, p < 0.001). The G-allele frequency was significantly higher in cases than control group (58.1% vs.45.6%, p < 0.001), but the A-allele carrier indicated a decreased trend in MDD with suicide behaviors than control group (41.9% vs.54.4%, p < 0.001). The multivariate logistic regression analysis indicated that TPH2 rs7305115 AA (OR 0.33, 95% CI 0.22-0.99), family history of suicide (OR 2.98, 95% CI 1.17-5.04), negative life events half year ago (OR 6.64, 95% CI 2.48-11.04) and hopelessness (OR 7.68, 95% CI 5.79-13.74) were significantly associated with the suicide behaviors in MDD patients. Conclusions The study suggested that hopelessness, negative life events and family history of suicide were risk factors of attempted suicide in MDD while the TPH2 rs7305115A remained a significant protective predictor of suicide attempts.
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Affiliation(s)
- Yuqi Zhang
- Wuxi Psychiatric Hospital, Nanjing Medical University, Wuxi, China.
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Corcoran P, Nagar A. Suicide and marital status in Northern Ireland. Soc Psychiatry Psychiatr Epidemiol 2010; 45:795-800. [PMID: 19763365 DOI: 10.1007/s00127-009-0120-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 08/06/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Studies show marriage to be protective against suicide though with variation in the extent to which suicide rates are higher among the never married, separated or divorced and widowed. We examined suicide in Northern Ireland by marital status and examined whether the observed variation differed by sex and age. METHODS Data relating to all 1,398 suicide deaths (ICD-9 E950-959 and ICD-10 X60-84) registered in 1996-2005 were analysed using Poisson regression. RESULTS The total, male and female age-standardised suicide rates were 8.4, 13.6 and 3.3 per 100,000, respectively. Never marrying increased male suicide risk and its effect increased with age (incidence rate ratio (IRR) among 20-34 year-olds = 1.47, 95% confidence interval (CI) = 1.19-1.84; IRR among over 55 year-olds = 2.33, 95% CI = 1.55-3.50). Never marrying was a risk factor for women only if aged 20-34 years (IRR = 3.05, 95% CI = 1.70-5.47). Among over 55 year-olds, widowhood increased risk of male suicide only (IRR = 2.47, 95% CI = 1.64-3.70) whereas divorce was associated with an almost threefold increase in male (IRR = 2.61, 95% CI = 1.39-4.88) and female (IRR = 2.57, 95% CI = 0.89-7.42) suicide relative to married persons. The effect of divorce was far more pronounced in 20-34 year-old men (IRR = 5.59, 95% CI = 3.58-8.67) and women (IRR = 9.46, 95% CI = 3.81-23.37). CONCLUSIONS In Northern Ireland, marriage protects both sexes against suicide though men more so than women. Divorced young men, in particular, are a population at high risk of suicide.
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Affiliation(s)
- Paul Corcoran
- National Suicide Research Foundation, College Road, Cork, Ireland.
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1220
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Döme P, Kapitány B, Ignits G, Rihmer Z. Season of birth is significantly associated with the risk of completed suicide. Biol Psychiatry 2010; 68:148-55. [PMID: 20416861 DOI: 10.1016/j.biopsych.2010.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 03/01/2010] [Accepted: 03/02/2010] [Indexed: 01/19/2023]
Abstract
BACKGROUND Previous studies have provided somewhat inconsistent results about the effects of season of birth on the risk of suicidal behavior. Therefore, we decided to investigate this question in a large sample of suicide completers. METHODS We determined the season of birth-associated risk of completed suicide between the years 1970 and 2008 among all individuals who were born in the area of today's Hungary between 1930 and 1939, 1941 and 1942, and 1944 and 1969. RESULTS The final sample of participants included around six and a half million people. About 80,000 completed suicides occurred among participants during the period investigated (the number of suicide completers in our study greatly exceeds the number of suicide completers in any previous studies). A significantly (p < .05) elevated risk of completed suicide was found among those individuals who were born in the high-risk period (spring and summer). Quantitatively, the biggest increase (7.6% [95% confidence interval: 5.4-9.9]) in suicide risk was detected among those who were born in July compared with the average risk of suicide in the population investigated. The associations between season of birth and the risk of completed suicide were stronger among male subjects than among female subjects and among those who committed suicide using violent methods than among those who chose nonviolent methods. CONCLUSIONS Our results from a large sample of suicide completers from Hungary--a country with one of the highest suicide rates in the world over the last century--strongly support the concept that the season of birth is significantly associated with the risk of completed suicide.
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Affiliation(s)
- Péter Döme
- Department of Clinical and Theoretical Mental Health, Kutvolgyi Clinical Center, Semmelweis University, Faculty of Medicine, Budapest, Hungary.
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Runeson B, Tidemalm D, Dahlin M, Lichtenstein P, Långström N. Method of attempted suicide as predictor of subsequent successful suicide: national long term cohort study. BMJ 2010; 341:c3222. [PMID: 20627975 PMCID: PMC2903664 DOI: 10.1136/bmj.c3222] [Citation(s) in RCA: 247] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To study the association between method of attempted suicide and risk of subsequent successful suicide. DESIGN Cohort study with follow-up for 21-31 years. SETTING Swedish national register linkage study. PARTICIPANTS 48,649 individuals admitted to hospital in 1973-82 after attempted suicide. MAIN OUTCOME MEASURE Completed suicide, 1973-2003. Multiple Cox regression modelling was conducted for each method at the index (first) attempt, with poisoning as the reference category. Relative risks were expressed as hazard ratios with 95% confidence intervals. RESULTS 5740 individuals (12%) committed suicide during follow-up. The risk of successful suicide varied substantially according to the method used at the index attempt. Individuals who had attempted suicide by hanging, strangulation, or suffocation had the worst prognosis. In this group, 258 (54%) men and 125 (57%) women later successfully committed suicide (hazard ratio 6.2, 95% confidence interval 5.5 to 6.9, after adjustment for age, sex, education, immigrant status, and co-occurring psychiatric morbidity), and 333 (87%) did so with a year after the index attempt. For other methods (gassing, jumping from a height, using a firearm or explosive, or drowning), risks were significantly lower than for hanging but still raised at 1.8 to 4.0. Cutting, other methods, and late effect of suicide attempt or other self inflicted harm conferred risks at levels similar to that for the reference category of poisoning (used by 84%). Most of those who successfully committed suicide used the same method as they did at the index attempt-for example, >90% for hanging in men and women. CONCLUSION The method used at an unsuccessful suicide attempt predicts later completed suicide, after adjustment for sociodemographic confounding and psychiatric disorder. Intensified aftercare is warranted after suicide attempts involving hanging, drowning, firearms or explosives, jumping from a height, or gassing.
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Affiliation(s)
- Bo Runeson
- Department of Clinical Neuroscience, Karolinska Institutet, Division of Psychiatry, St Göran, SE-112 81 Stockholm, Sweden.
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Roaldset JO, Bjørkly S. Patients' own statements of their future risk for violent and self-harm behaviour: a prospective inpatient and post-discharge follow-up study in an acute psychiatric unit. Psychiatry Res 2010; 178:153-9. [PMID: 20452048 DOI: 10.1016/j.psychres.2010.04.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 11/27/2009] [Accepted: 04/11/2010] [Indexed: 10/19/2022]
Abstract
Recently patients' responsibility for and ownership of their own treatment have been emphasised. A literature search on patients'' structured self-reported assessment of future risk of violent, suicidal or self mutilating behaviour failed to disclose any published empirical research. The present prospective naturalistic study comprised all involuntary and voluntary acutely admitted patients (n=489) to a psychiatric hospital during one year. Patients' self-reported risks of violence and self-harm at admission and at discharge were compared with episodes recorded during hospital stay and 3 months post-discharge. Patients' predictions were significant concerning violent, suicidal and self-injurious behaviour, with AUC values of 0.73 (95%CI=0.61-0.85), 0.92 (95%CI=0.88-0.96) and 0.82 (95%CI=0.67-0.98) for hospital stay, and 0.67 (95%CI=0.58-0.76), 0.63 (95%CI=0.55-0.72) and 0.66 (95%CI=0.57-0.76) after 3 months, respectively. Moderate or higher risk predictions remained significant in multivariate analysis, and risk of violence even after gender stratification. Self-harm predictions were significant for women. Moderate or higher risk scores remained significant predictors of violence one year post-discharge. Controlling for readmissions the results remained the same. Low sensitivity limits the clinical value, but relatively high positive predictive values might be clinically important. Still future research is recommended to explore if self prediction is a valid adjuvant method to established risk assessment procedures.
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Lipworth L, McLaughlin JK. Excess suicide risk and other external causes of death among women with cosmetic breast implants: a neglected research priority. Curr Psychiatry Rep 2010; 12:234-8. [PMID: 20425286 DOI: 10.1007/s11920-010-0115-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Five large epidemiologic mortality studies of women with cosmetic breast implants have consistently reported a two- to threefold higher rate of suicide compared with the general female population. Overall, 135 suicides have been observed, compared with 66.9 expected, yielding a significantly elevated standardized mortality ratio of 2.0 (95% CI, 1.5-2.6). In addition to suicides, excesses from other external causes of death related to drug and alcohol abuse/dependence, atypical motor vehicle accidents, and other self-harm causes have been consistently reported. These observations, together with limited but direct epidemiologic evidence of preimplant psychiatric hospitalization, as well as self-reports of preimplant psychiatric disorders, including depression, eating disorders, and body image dissatisfaction, among implant women raise the possibility of significant underlying psychiatric morbidity for a subgroup of implant patients. Research into the psychiatric profiles and history of the women who have committed suicide in the investigated cohorts appears warranted.
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Affiliation(s)
- Loren Lipworth
- International Epidemiology Institute, 1455 Research Boulevard, Suite 550, Rockville, MD 20850, USA.
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Rockett IRH, Wang S, Stack S, De Leo D, Frost JL, Ducatman AM, Walker RL, Kapusta ND. Race/ethnicity and potential suicide misclassification: window on a minority suicide paradox? BMC Psychiatry 2010; 10:35. [PMID: 20482844 PMCID: PMC2891687 DOI: 10.1186/1471-244x-10-35] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 05/19/2010] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Suicide officially kills approximately 30,000 annually in the United States. Analysis of this leading public health problem is complicated by undercounting. Despite persisting socioeconomic and health disparities, non-Hispanic Blacks and Hispanics register suicide rates less than half that of non-Hispanic Whites. METHODS This cross-sectional study uses multiple cause-of-death data from the US National Center for Health Statistics to assess whether race/ethnicity, psychiatric comorbidity documentation, and other decedent characteristics were associated with differential potential for suicide misclassification. Subjects were 105,946 White, Black, and Hispanic residents aged 15 years and older, dying in the US between 2003 and 2005, whose manner of death was recorded as suicide or injury of undetermined intent. The main outcome measure was the relative odds of potential suicide misclassification, a binary measure of manner of death: injury of undetermined intent (includes misclassified suicides) versus suicide. RESULTS Blacks (adjusted odds ratio [AOR], 2.38; 95% confidence interval [CI], 2.22-2.57) and Hispanics (1.17, 1.07-1.28) manifested excess potential suicide misclassification relative to Whites. Decedents aged 35-54 (AOR, 0.88; 95% CI, 0.84-0.93), 55-74 (0.52, 0.49-0.57), and 75+ years (0.51, 0.46-0.57) showed diminished misclassification potential relative to decedents aged 15-34, while decedents with 0-8 years (1.82, 1.75-1.90) and 9-12 years of education (1.43, 1.40-1.46) showed excess potential relative to the most educated (13+ years). Excess potential suicide misclassification was also apparent for decedents without (AOR, 3.12; 95% CI, 2.78-3.51) versus those with psychiatric comorbidity documented on their death certificates, and for decedents whose mode of injury was "less active" (46.33; 43.32-49.55) versus "more active." CONCLUSIONS Data disparities might explain much of the Black-White suicide rate gap, if not the Hispanic-White gap. Ameliorative action would extend from training in death certification to routine use of psychological autopsies in equivocal-manner-of-death cases.
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Affiliation(s)
- Ian RH Rockett
- Department of Community Medicine and the Injury Control Research Center, PO Box 9190 West Virginia University, Morgantown, West Virginia, 26506, USA
| | - Shuhui Wang
- National Institute for Occupational Safety and Health, 1095 Willowdale Road, Morgantown, West Virginia, 26505-2845, USA
| | - Steven Stack
- Department of Criminal Justice, 2305 FAB, Wayne State University, Detroit, Michigan, 48202, USA
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt, Queensland, 4122, Australia
| | - James L Frost
- Department of Pathology, PO Box 9203, West Virginia University, Morgantown, West Virginia, 26506, USA
| | - Alan M Ducatman
- Department of Community Medicine and the Injury Control Research Center, PO Box 9190 West Virginia University, Morgantown, West Virginia, 26506, USA
| | - Rheeda L Walker
- Department of Psychology, Psychology Building, University of Georgia, Athens, Georgia, 30602-3013, USA
| | - Nestor D Kapusta
- Medical University of Vienna, Department of Psychoanalysis and Psychotherapy, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Schneeweiss S, Patrick AR, Solomon DH, Mehta J, Dormuth C, Miller M, Lee JC, Wang PS. Variation in the risk of suicide attempts and completed suicides by antidepressant agent in adults: a propensity score-adjusted analysis of 9 years' data. ACTA ACUST UNITED AC 2010; 67:497-506. [PMID: 20439831 DOI: 10.1001/archgenpsychiatry.2010.39] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT A US Food and Drug Administration advisory has warned that antidepressants may be associated with an increased risk of suicidal thoughts and behaviors in adolescents. This prompted a meta-analysis of trials in adults that found no overall increase in risk, but individual agents could not be studied. OBJECTIVE To assess the risk of suicide and suicide attempts associated with individual antidepressant agents. DESIGN Cohort study of incident users of antidepressant agents. SETTING Population-based health care utilization data of all residents of British Columbia, Canada, aged 18 years and older between January 1, 1997, and December 31, 2005. PATIENTS British Columbia residents who had antidepressant therapy initiated and had a recorded diagnosis of depression. INTERVENTION Initiation of various antidepressant medications. MAIN OUTCOME MEASURES Combined suicide death or hospitalization due to self-harm. RESULTS In a population of 287,543 adults aged 18 years and older with antidepressant therapy initiated, we observed outcome rates ranging from 4.41/1000 person-years to 9.09/1000 person-years. Most events occurred in the first 6 months after treatment initiation. After extensive propensity score adjustment, we found no clinically meaningful variation in the risk of suicide and suicide attempt between antidepressant agents compared with fluoxetine hydrochloride initiation: citalopram hydrobromide, hazard ratio = 1.00 (95% confidence interval, 0.63-1.57); fluvoxamine maleate, hazard ratio = 0.98 (95% confidence interval, 0.63-1.51); paroxetine hydrochloride, hazard ratio = 1.02 (95% confidence interval, 0.77-1.35); and sertraline hydrochloride, hazard ratio = 0.75 (95% confidence interval, 0.53-1.05). Compared with selective serotonin reuptake inhibitors as a drug class, other classes including serotonin-norepinephrine reuptake inhibitors, tricyclic agents, and other newer and atypical agents had a similar risk. Restriction to patients with no antidepressant use in the past 3 years further reduced apparent differences between groups. CONCLUSIONS Our finding of equal event rates across antidepressant agents supports the US Food and Drug Administration's decision to treat all antidepressants alike in their advisory. Treatment decisions should be based on efficacy, and clinicians should be vigilant in monitoring after initiating therapy with any antidepressant agent.
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Affiliation(s)
- Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02120, USA.
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Knox KL, Pflanz S, Talcott GW, Campise RL, Lavigne JE, Bajorska A, Tu X, Caine ED. The US Air Force suicide prevention program: implications for public health policy. Am J Public Health 2010; 100:2457-63. [PMID: 20466973 DOI: 10.2105/ajph.2009.159871] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the effectiveness of the US Air Force Suicide Prevention Program (AFSPP) in reducing suicide, and we measured the extent to which air force installations implemented the program. METHODS We determined the AFSPP's impact on suicide rates in the air force by applying an intervention regression model to data from 1981 through 2008, providing 16 years of data before the program's 1997 launch and 11 years of data after launch. Also, we measured implementation of program components at 2 points in time: during a 2004 increase in suicide rates, and 2 years afterward. RESULTS Suicide rates in the air force were significantly lower after the AFSPP was launched than before, except during 2004. We also determined that the program was being implemented less rigorously in 2004. CONCLUSIONS The AFSPP effectively prevented suicides in the US Air Force. The long-term effectiveness of this program depends upon extensive implementation and effective monitoring of implementation. Suicides can be reduced through a multilayered, overlapping approach that encompasses key prevention domains and tracks implementation of program activities.
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Affiliation(s)
- Kerry L Knox
- Canandaigua VA Medical Center, US Department of Veterans Affairs, Canandaigua, NY, USA.
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1229
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Holmgren A, Jones AW. Demographics of suicide victims in Sweden in relation to their blood–alcohol concentration and the circumstances and manner of death. Forensic Sci Int 2010; 198:17-22. [DOI: 10.1016/j.forsciint.2009.12.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 12/04/2009] [Accepted: 12/08/2009] [Indexed: 10/20/2022]
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Cohidon C, Santin G, Geoffroy-Perez B, Imbernon E. Suicide et activité professionnelle en France. Rev Epidemiol Sante Publique 2010; 58:139-50. [DOI: 10.1016/j.respe.2010.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 11/30/2009] [Accepted: 01/05/2010] [Indexed: 10/19/2022] Open
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Preti A, Tondo L, Sisti D, Rocchi MB, de Girolamo G. Correlates and antecedents of hospital admission for attempted suicide: a nationwide survey in Italy. Eur Arch Psychiatry Clin Neurosci 2010; 260:181-90. [PMID: 19657687 DOI: 10.1007/s00406-009-0037-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 07/20/2009] [Indexed: 11/29/2022]
Abstract
The present study examined data on symptom patterns in the week prior to admission for suicide attempt, in a nationwide representative sample of patients. Socio-demographic, clinical, and treatment data was gathered for 1,547 patients admitted over a 12-day index period during the year 2004 to 130 public and 36 private psychiatric facilities in Italy. Patients were evaluated in terms of whether they had been admitted for having attempted suicide or not. A detailed checklist was used to assess symptom pattern at admission; diagnoses were based on ICD-10 categories. Two-hundred thirty patients (14.8%) in the sample had been admitted for suicide attempt. Patients with depression or with personality disorders were more frequently observed among suicide attempters. First-contact patients were significantly more likely to have been admitted after a suicide attempt, the only exception being individuals with bipolar disorder, manic phase. No diagnosis was statistically related to admission after suicide attempt, once symptoms pattern at admission had been accounted for. Disordered eating behavior, depressive symptoms, substance abuse, and non-prescribed medication abuse were positively related to attempted suicide, as were any traumatic events in the week prior to admission; symptoms of psychosis (hallucinations/delusions) and lack of self-care were negatively associated with suicide attempt admission. Greater attention to symptoms immediately preceding or concomitant with admission after a suicide attempt can be a key factor in establishing the best treatment plan and discharge strategy, the most effective community-service referral, and targeted intervention programmes for patients hospitalized for a suicide attempt.
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Affiliation(s)
- Antonio Preti
- Department of Psychology, University of Cagliari, Loc. Sa Duchessa, 09123, Cagliari, Italy.
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1233
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Kposowa AJ, D’Auria S. Association of temporal factors and suicides in the United States, 2000-2004. Soc Psychiatry Psychiatr Epidemiol 2010; 45:433-45. [PMID: 19536447 PMCID: PMC2834764 DOI: 10.1007/s00127-009-0082-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2008] [Accepted: 06/03/2009] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of the study was to examine the association of temporal factors, in particular days of the week and seasons of the year and death from suicide in the United States. METHOD Data were pooled from the Multiple Cause of Death Files. Hierarchical logistic regression models were fitted to all deaths occurring in 2000 through 2004 by suicide. RESULTS The incidence of suicide was significantly higher on Wednesdays, compared to Sunday. Specifically, individuals were 99% more likely to kill themselves on Wednesday than on Sunday. Suicides were more prevalent in the summer months, and they were less likely to occur in winter. The state suicide rate significantly elevated individual suicide risk. The results held even after controlling for the potentially confounding effects of socio-economic and demographic variables at both the individual and state levels. CONCLUSION It was concluded that the observed association between seasonality and suicide cannot be discounted as a mere coincidence. Future research ought to focus on integrating individual level data and contextual variables when testing for seasonality effects.
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Affiliation(s)
- Augustine J. Kposowa
- Department of Sociology, University of California, 1150 Watkins Hall, Riverside, CA 92521 USA
| | - Stephanie D’Auria
- Department of Sociology, University of California, 1150 Watkins Hall, Riverside, CA 92521 USA
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1234
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Katsumata Y, Matsumoto T, Kitani M, Akazawa M, Hirokawa S, Takeshima T. School problems and suicide in Japanese young people. Psychiatry Clin Neurosci 2010; 64:214-5. [PMID: 20447021 DOI: 10.1111/j.1440-1819.2010.02064.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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1235
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Pompili M, Serafini G, Innamorati M, Dominici G, Ferracuti S, Kotzalidis GD, Serra G, Girardi P, Janiri L, Tatarelli R, Sher L, Lester D. Suicidal behavior and alcohol abuse. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:1392-431. [PMID: 20617037 PMCID: PMC2872355 DOI: 10.3390/ijerph7041392] [Citation(s) in RCA: 225] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 03/15/2010] [Accepted: 03/19/2010] [Indexed: 12/22/2022]
Abstract
Suicide is an escalating public health problem, and alcohol use has consistently been implicated in the precipitation of suicidal behavior. Alcohol abuse may lead to suicidality through disinhibition, impulsiveness and impaired judgment, but it may also be used as a means to ease the distress associated with committing an act of suicide. We reviewed evidence of the relationship between alcohol use and suicide through a search of MedLine and PsychInfo electronic databases. Multiple genetically-related intermediate phenotypes might influence the relationship between alcohol and suicide. Psychiatric disorders, including psychosis, mood disorders and anxiety disorders, as well as susceptibility to stress, might increase the risk of suicidal behavior, but may also have reciprocal influences with alcohol drinking patterns. Increased suicide risk may be heralded by social withdrawal, breakdown of social bonds, and social marginalization, which are common outcomes of untreated alcohol abuse and dependence. People with alcohol dependence or depression should be screened for other psychiatric symptoms and for suicidality. Programs for suicide prevention must take into account drinking habits and should reinforce healthy behavioral patterns.
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Affiliation(s)
- Maurizio Pompili
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
- McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
- Author to whom correspondence should be addressed; E-Mail:
or
; Tel. +39-06 33775675; Fax +39-0633775342
| | - Gianluca Serafini
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Marco Innamorati
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Giovanni Dominici
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Stefano Ferracuti
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Giorgio D. Kotzalidis
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Giulia Serra
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Paolo Girardi
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Luigi Janiri
- Department of Psychiatry, Catholic University Medical School, Largo F. Vito 1, Rome 00168, Italy; E-Mail:
| | - Roberto Tatarelli
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Leo Sher
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; E-Mail:
| | - David Lester
- The Richard Stockton College of New Jersey, Pomona, NJ 08240-0195, USA; E-Mail:
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Nock MK, Park JM, Finn CT, Deliberto TL, Dour HJ, Banaji MR. Measuring the suicidal mind: implicit cognition predicts suicidal behavior. Psychol Sci 2010; 21:511-7. [PMID: 20424092 DOI: 10.1177/0956797610364762] [Citation(s) in RCA: 362] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Suicide is difficult to predict and prevent because people who consider killing themselves often are unwilling or unable to report their intentions. Advances in the measurement of implicit cognition provide an opportunity to test whether automatic associations of self with death can provide a behavioral marker for suicide risk. We measured implicit associations about death/suicide in 157 people seeking treatment at a psychiatric emergency department. Results confirmed that people who have attempted suicide hold a significantly stronger implicit association between death/suicide and self than do psychiatrically distressed individuals who have not attempted suicide. Moreover, the implicit association of death/suicide with self was associated with an approximately 6-fold increase in the odds of making a suicide attempt in the next 6 months, exceeding the predictive validity of known risk factors (e.g., depression, suicide-attempt history) and both patients' and clinicians' predictions. These results provide the first evidence of a behavioral marker for suicidal behavior and suggest that measures of implicit cognition may be useful for detecting and predicting sensitive clinical behaviors that are unlikely to be reported.
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Clinical Considerations for the Diagnosis of Major Depression After Moderate to Severe TBI. J Head Trauma Rehabil 2010; 25:99-112. [DOI: 10.1097/htr.0b013e3181ce3966] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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1238
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Ozawa T. [Gerontology as a comprehensive human science: past, present and future of gerontology]. Nihon Ronen Igakkai Zasshi 2010; 47:17-23. [PMID: 20339197 DOI: 10.3143/geriatrics.47.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Mehlum L, Jørgensen T, Diep LM, Nrugham L. Is organizational change associated with increased rates of readmission to general hospital in suicide attempters? A 10-year prospective catchment area study. Arch Suicide Res 2010; 14:171-81. [PMID: 20455152 DOI: 10.1080/13811111003704811] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The objective of this study was to examine predictors for readmissions in patients admitted to a general hospital emergency ward for suicide attempts before and after organizational changes potentially affecting the chain of care. Socio-demographic and clinical variables were collected by clinicians from 1997 thru 2007. Data from the periods before and after 2004--when the hospital changed its catchment area--were compared. A substantial increase in readmission rates in the period after the organizational change was observed. This increase was not associated with any of the socio-demographic or clinical patient characteristics. Although no causal connection can be inferred, the observed association between organizational change and readmission rates could indicate that established post-discharge care systems for suicide attempters may be vulnerable to such change.
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Affiliation(s)
- Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Psychiatry, University of Oslo, Sognsvannsveien 21, Oslo, Norway.
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Attempted suicide in the elderly: characteristics of suicide attempters 70 years and older and a general population comparison group. Am J Geriatr Psychiatry 2010; 18:57-67. [PMID: 20094019 DOI: 10.1097/jgp.0b013e3181bd1c13] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify factors associated with attempted suicide in the elderly. DESIGN Social, psychological, and psychiatric characteristics were compared in suicide attempters (70 years and older) and a representative population sample. SETTINGS Emergency departments at five hospitals in western Sweden and a representative sample of the elderly population. PARTICIPANTS Persons with Mini Mental State Examination (MMSE) score <15 were excluded. One hundred forty persons who sought hospital treatment after a suicide attempt were eligible and 103 participated (57 women, 46 men, and mean age 80 years). Comparison subjects matched for gender and age group (N = 408) were randomly selected among participants in our general population studies. MEASUREMENTS Symptoms were rated with identical instruments in cases and comparison subjects. The examination included the MMSE and tests of short- and long-term memory, abstract thinking, aphasia, apraxia, and agnosia. Depressive symptomatology was measured using the Montgomery-Asberg Depression Rating Scale, and major and minor depressions were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, using symptom algorithms. RESULTS Factors associated with attempted suicide included being unmarried, living alone, low education level, history of psychiatric treatment, and previous suicide attempt. There was no association with dementia. Odds ratios were increased for both major (odds ratio [OR]: 47.4, 95% confidence interval [CI]: 19.1-117.7) and minor (OR: 2.6, 95% CI: 1.5-4.7) depressions. An association was observed between perceived loneliness and attempted suicide; this relationship was independent of depression (OR: 2.8, 95% CI: 1.3-6.1). CONCLUSIONS Observed associations mirrored those previously shown for completed suicide. Results may help to inform clinical decisions regarding suicide risk evaluation in this vulnerable and growing age group.
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Mezuk B, Larkin GL, Prescott MR, Tracy M, Vlahov D, Tardiff K, Galea S. The influence of a major disaster on suicide risk in the population. J Trauma Stress 2009; 22:481-8. [PMID: 19902463 DOI: 10.1002/jts.20473] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The authors investigated the relationship between the September 11, 2001 terrorist attacks and suicide risk in New York City from 1990 to 2006. The average monthly suicide rate over the study period was 0.56 per 100,000 people. The monthly rate after September 2001 was 0.11 per 100,000 people lower as compared to the rate in the period before. However, the rate of change in suicide was not significantly different before and after the disaster, and regression discontinuity analysis indicated no change at this date. There was no net change in the suicide rate in New York City attributable to this disaster, suggesting that factors other than exposure to traumatic events (e.g., cultural norms, availability of lethal methods) may be key drivers of suicide risk in this context.
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Affiliation(s)
- Briana Mezuk
- Department of Epidemiology and Community Health, Virginia Commonwealth University, School of Medicine, Richmond, VA 23298-0212, USA.
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McKibben JBA, Ekselius L, Girasek DC, Gould NF, Holzer C, Rosenberg M, Dissanaike S, Gielen AC. Epidemiology of burn injuries II: psychiatric and behavioural perspectives. Int Rev Psychiatry 2009; 21:512-21. [PMID: 19919204 DOI: 10.3109/09540260903343794] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Modern technological advances have decreased the incidence and severity of burn injuries, and medical care improvements of burn injuries have significantly increased survival rates, particularly in developed countries. Still, fire-related burn injuries are responsible for 300,000 deaths and 10 million disability-adjusted life years lost annually worldwide. The extent to which psychiatric and behavioural factors contribute to the incidence and outcomes of these tragedies has not been systematically documented, and the available data is often insufficient to reach definitive conclusions. Accordingly, this article reviews the evidence of psychiatric and behavioural risk factors and prevention opportunities for burn injuries worldwide. Psychiatric prevalence rates and risk factors for burn injuries, prevalence and risks associated with 'intentional' burn injuries (self-immolation, assault, and child maltreatment), and prevention activities targeting the general population and those with known psychiatric and behavioural risk factors are discussed. These issues are substantially interwoven with many co-occurring risk factors. While success in teasing apart the roles and contributions of these factors rests upon improving the methodology employed in future research, the nature of this entanglement increases the likelihood that successful interventions in one problem area will reap benefits in others.
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Affiliation(s)
- Jodi B A McKibben
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814-4799, USA.
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Lovisi GM, Santos SA, Legay L, Abelha L, Valencia E. Análise epidemiológica do suicídio no Brasil entre 1980 e 2006. BRAZILIAN JOURNAL OF PSYCHIATRY 2009; 31 Suppl 2:S86-94. [DOI: 10.1590/s1516-44462009000600007] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: O objetivo deste estudo foi realizar uma análise epidemiológica dos índices de suicídio registrados entre 1980 e 2006 nas regiões e capitais estaduais. MÉTODO: Dados referentes à taxa de mortalidade devido ao suicídio foram coletados do Departamento de Informática do Sistema Único de Saúde. RESULTADOS: Entre 1980 e 2006, foi registrado um total de 158.952 casos de suicídio, excluindo-se os casos nos quais os indivíduos tinham menos de 10 anos de idade (n = 68). No período estudado, o índice total de suicídio cresceu de 4,4 para 5,7 mortes por 100.000 habitantes (29,5%). Os índices médios mais altos foram registrados nas regiões Sul (9,3) e Centro-Oeste (6,1). Os homens são os que têm a maior probabilidade de cometer suicídio. Os índices mais altos de suicídio foram registrados na faixa etária de 70 anos ou mais, enquanto que os maiores aumentos aconteceram na faixa etária dos 20 aos 59 anos. As principais características sociodemográficas das pessoas que cometeram suicídio durante o período estudado foram baixo nível educacional e estado civil solteiro. Os métodos mais comuns de suicídio foram por enforcamento, armas de fogo e envenenamento. CONCLUSÃO: Embora o índice brasileiro tenha crescido 29,5% em 26 anos, o índice nacional ainda é considerado baixo se comparado aos índices de suicídio mundiais (média de 4,9 por 100.000 habitantes). Os índices de suicídio nas regiões brasileiras variam muito, ou seja, estão entre 2,7 e 9,3.
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Voros V, Osvath P, Fekete S. Assessing and managing suicidal behaviour in the primary care setting: A model for an integrated regional suicide prevention strategy. Int J Psychiatry Clin Pract 2009; 13:307-11. [PMID: 24916942 DOI: 10.3109/13651500903056541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although suicide rates are decreasing in most countries, suicide is still a major health concern. Our aim was to introduce a complex, integrative, regional suicide prevention strategy. Based on reviewing the literature and on our previous studies we developed a suicide prevention model, which includes recognition, risk assessment and intervention. The main steps of the model are the recognition of warning signs (communicative or behavioural), exploration of crisis situation and/or psychopathologic symptoms, assessment of protective and risk factors, estimation of suicide risk and a plan for management of suicidal patients through different levels of interventions. In the management of suicidal behaviour, the complex stress-diathesis model has to be adjusted by considering biological markers and psycho-social factors. Only after the assessment of these factors can primary care professionals, as gatekeepers, manage suicidal patients effectively by using adequate psychopharmacotherapeutic and psychotherapeutic interventions in the recognition, treatment and prevention of suicidal behaviour.
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Affiliation(s)
- Viktor Voros
- Department of Psychiatry and Psychotherapy, University of Pecs, Pecs, Hungary
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