Suicide risk in mood disorders

Gender differences in deliberate self-poisoning in Hungary: analyzing the effect of precipitating factors and their relation to depression

BACKGROUND

The suicide rate in Hungary is one of the highest in the European Union, with a male-female ratio of 3.55:1. Suicide rates correlate positively with suicide attempts, for which depression is the most frequent underlying disorder.

AIMS

The aim of this qualitative study was to examine gender differences in suicide attempts, with a focus on the effect of precipitating factors on depression.

METHOD

Semistructured interviews were conducted among 150 suicide attempters. Data on circumstances, reason, and method of attempt were recorded. Patients completed the Shortened Beck Depression Inventory, the Beck Hopelessness Scale, the Sense of Coherence Scale, and the Social Support Questionnaire.

RESULTS

Interpersonal conflict was found to be the most frequent precipitating factor. There were significant gender differences in depressive symptoms among patients with interpersonal conflicts. We found differences in depressive symptoms according to presence or absence of interpersonal conflicts among men, but not among women. Male suicide attempters who indicated interpersonal conflicts had lower levels of depression.

CONCLUSION

Depressive symptoms are frequent among suicide attempters. However, a subgroup of male attempters reporting interpersonal conflicts are characterized by a lower level of depression. This subgroup of attempters would probably not be detected with depression screening programs and may have an unmet need for other forms of screening and prevention.

Alpha2C-adrenoceptor Del322-325 polymorphism and risk of psychiatric disorders: significant association with opiate abuse and dependence

Objectives α2C-adrenoceptors (α2C-AR) are involved in behavioural responses relevant to psychiatric disorders and suicide completion. The genetic polymorphism α2CDel322-325-AR confers a loss-of-function phenotype. Functional human studies have associated α2CDel322-325-AR polymorphism with major depression pathophysiology. The aim of this study was to analyse, for the first time, the association of α2CDel322-325-AR polymorphism with suicide completion and with related psychiatric disorders: major depression, schizophrenia, opiate and alcohol abuse and dependence. Methods Post-mortem brain DNA was extracted (n = 516) and genotyping performed by HaeIII restriction endonuclease digestion of PCR products and DNA fragment analysis on capillary sequencer. Amplified products were sequenced to confirm the presence of the polymorphism. Results The frequency of α2CDel322-325-AR in suicide (9%, n = 236) and non-suicide victims (11%, n = 280) was similar. Genotype frequencies for the α2CDel322-325-AR polymorphism in depressed (15%, n = 39) and schizophrenic subjects (18%, n = 39) were higher than in controls (7%, n = 187), but these differences did not reach statistical significance (P = 0.125 and P = 0.063, respectively). A selective and significant association of α2CDel322-325-AR polymorphism with opiate abuse and dependence was found (23%, n = 35, P = 0.011). Conclusions Our results indicate that α2CDel322-325-AR may play a role in the pathophysiology of opiate abuse and dependence and raise the interest for larger genetic associative studies.

Suicide in males and females with cardiovascular disease and comorbid depression

BACKGROUND

Myocardial infarction (MI) has been associated with an increased risk of suicide, further increased among individuals with a comorbid psychiatric illness. A paucity of studies have examined details of suicide among individuals with cardiovascular disease (CVD) and comorbid depression. We aimed to compare demographic, clinical and suicide-specific characteristics between suicide victims with CVD with depression (CVD+D) and without comorbid depression (CVD-D).

METHODS

Coroner data on suicide decedents with CVD (n=413) occurring in Toronto, Canada from 1998 to 2012 were collected. Characteristics were compared between the CVD+D and CVD-D groups. Regression analysis examined for gender differences in these groups.

RESULTS

CVD+D subjects compared to CVD-D were more likely to have had a past suicide attempt (p=0.008), and to have experienced a bereavement (p=0.008) or financial stressor (p=0.005) in the past year. Each of these variables remained significantly associated with the presence of depression after the regression analysis. Within the CVD+D group, females were more likely to die from suicide by self-poisoning (p<0.0001) and males by shooting (p=0.001).

LIMITATIONS

Psychological autopsies were not available. The definition of CVD was broad and the accuracy of its diagnosis could not be confirmed.

CONCLUSION

Individuals with CVD+D who died from suicide had significant differences in clinical characteristics and specific stressors compared to those without depression. These data may help to better characterize suicide risk and prevention in this vulnerable population.

Decreased regional gray matter volume in suicide attempters compared to suicide non-attempters with major depressive disorders

OBJECTIVE

This study investigated regional gray matter (GM) volume differences between suicide attempters and suicide non-attempters with major depressive disorder (MDD) and their relationship with psychological risk factors for suicidality.

METHODS

MDD patients with and without a suicide attempt history (n=19 in each group) participated. The Hamilton Depression Rating Scale, Clinical Global Impression (severity subscale), Scale for Suicide Ideation (SSI), Risk-Rescue Rating (RRR), Beck Hopelessness Scale (BHS), Barrett Impulsivity Scale, Eysenck Personality Questionnaire, and Ways of Coping Checklist (WCCL) were administered. T1-weighted structural magnetic resonance imaging scans were acquired to evaluate changes in GM volume. Voxel-based morphometry was performed using the SPM 8 software package. Two-sample t-tests were used during second-level group comparison analysis; partial correlation analysis controlling for gender and age identified associations between regional GM volume and psychological measures.

RESULTS

Suicide attempters exhibited significantly decreased GM volume in the left angular gyrus (p<0.001, uncorrected) and right cerebellum (p<0.001, uncorrected). GM volume in the left angular gyrus was inversely correlated with BHS scores (r=-0.55, p<0.01) and positively correlated with the Seeking Social Support subscale of the WCCL (r=0.43, p<0.01).

CONCLUSION

These findings provide evidence of a neural basis of suicidal behaviors in MDD. In particular, reduced GM volume in the left angular gyrus may be a neurobiological marker of suicidality in depressed patients.

A dangerous cocktail: Alcohol consumption increases suicidal ideations among problem gamblers in the general population

The current research examined whether alcohol consumption exacerbates suicidal ideations among gamblers in the general population. While prior research suggests problem gambling severity and excessive alcohol consumption are unique predictors of suicidal behaviors, the extant literature as almost exclusively focused on gamblers in treatment. This represents a significant gap in the literature as less than 10% of gamblers seek treatment. Furthermore, gamblers in treatment are not representative of gamblers in the general population, precluding a simple generalization of research findings. We address this gap using data obtained from the Canadian Community Health Survey (Cycle 4.1)--a cross-sectional national survey that assesses health-related information among the Canadian population. To this end, we conducted a moderation analysis with problem gambling severity as the independent variable, weekly alcohol consumption as the moderator variable and suicidal ideations (in the past 12 months) as the dependent variable. The results found that alcohol consumption alone did not reliably predict suicidal ideation among gamblers who did not gamble problematically. However, as predicted, the odds of suicidal ideation were greatest among problem gamblers who frequently consumed alcohol. Thus, it may behoove policy makers to re-visit the availability of alcohol in gambling venues. Moreover, responsible gambling-oriented education initiatives may be advanced by informing gamblers about the increased risk of suicidal ideations when problematic gambling is combined with frequent alcohol consumption.

Clinical features, impulsivity, temperament and functioning and their role in suicidality in patients with bipolar disorder

OBJECTIVE

Our aim was to analyse sociodemographic and clinical differences between non-suicidal (NS) bipolar patients (BP), BP reporting only suicidal ideation (SI) and BP suicide attempters according to Columbia-Suicide Severity Rating Scale (C-SRSS) criteria. Secondarily, we also investigated whether the C-SRSS Intensity Scale was associated with emergence of suicidal behaviour (SB).

METHOD

A total of 215 euthymic bipolar out-patients were recruited. Semistructured interviews including the C-SRSS were used to assess sociodemographic and clinical data. Patients were grouped according to C-SRSS criteria: patients who scored ≤1 on the Severity Scale were classified as NS. The remaining patients were grouped into two groups: 'patients with history of SI' and 'patients with history of SI and SB' according to whether they did or did not have a past actual suicide attempt respectively.

RESULTS

Patients from the three groups differed in illness onset, diagnosis, number of episodes and admissions, family history, comorbidities, rapid cycling and medication, as well as level of education, functioning, impulsivity and temperamental profile.

CONCLUSION

Our results suggest that increased impulsivity, higher rates of psychiatric admissions and a reported poor controllability of SI significantly increased the risk for suicidal acts among patients presenting SI.

Factors related to suicidal behavior in patients with bipolar disorder: the effect of mixed features on suicidality

OBJECTIVES

The aim of the present study was to investigate various risk factors of suicidal behaviors, including the mixed features specifier, in patients with bipolar disorder.

METHODS

We retrospectively reviewed medical charts from 2005 to 2014. A total of 334 patients diagnosed with bipolar disorder using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision were enrolled. Subjects were categorized into two groups according to their history of suicidal behavior and the demographic and clinical characteristics of the groups were compared, including the mixed features specifier. We reevaluated the index episode using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria and classified subjects into an index episode with mixed features group and an index episode without mixed features group. Logistic regression was performed to evaluate significant risk factors associated with suicidal behavior.

RESULTS

Suicidal behavior had an independent relationship to mixed features at the index episode using DSM-5 criteria [odds ratio (OR)=3.39; 95% confidence interval (CI): 1.57-7.34] and number of previous depressive episodes (OR=1.62; 95% CI: 1.34-1.95) in bipolar patients. The mixed feature specifier was the strongest risk factor for suicidal behavior in the present study.

CONCLUSIONS

This study may help clinicians understand potential risk factors and manage bipolar disorders with suicidal behaviors. Clinicians should carefully monitor patients with bipolar disorder who exhibit numerous depressive episodes or mixed features for suicidal behavior.

Social Welfare Centers Protect Outpatients with Mood Disorders from Risk of Hospital Admission

Background

South Korea faces difficulties in the management of mental disorders, and those difficulties are expected to gradually worsen. Therefore, we analyzed the relationship between social welfare centers and hospital admission after outpatient treatment for mood disorders.

Methods

We used data from the National Health Insurance Service National Sample Cohort 2002–2013, which included all medical claims filed for the 50,160 patients who were newly diagnosed with a mood disorder among the 1,025,340 individuals in a nationally representative sample. We performed a logistic regression analysis using generalized estimating equation (GEE) models to examine the relationship between social welfare centers and hospital admission after outpatient treatment for mood disorders (ICD-10: F3).

Results

There was a 3.9% admission rate among a total of 99,533 person-years. Outpatients who lived in regions with more social welfare centers were less likely to be admitted to a hospital (per increase of five social welfare centers per 100,000 people; OR: 0.958; 95% CI: 0.919–0.999). Social welfare centers had an especially strong protective effect on patients with relatively mild mood disorders and those who were vulnerable to medical expenditures.

Conclusions

Considering the protective role of social welfare centers in managing patients with mood disorders, health-policy makers need to consider strategies for activating mental healthcare.

Olfactory bulbectomy-induced changes in phospholipids and protein profiles in the hippocampus and prefrontal cortex of rats. A preliminary study using a FTIR spectroscopy

BACKGROUND

Dysfunctions in neuronal proteins can lead to development of depression. Lipids determine the localization and function of proteins in the cell membrane and thereby regulate synaptic throughput in neurons. The aim of study was to examine changes in the phospholipid-protein balance in the olfactory bulbectomy (OB) model of depression in rats using a Fourier transform infra-red (FTIR) spectroscopy.

METHODS

Sprague Dawley rats were subjected to the OB procedure and treated with amitriptyline (AMI, 10mg/kg). The FTIR measurements were performed in the hippocampus and prefrontal cortex.

RESULTS

The obtained results show a decrease in the phospholipids and protein fractions (as well as changes in their secondary structures) in both brain areas of bulbectomized rats. AMI treatment reduced phospholipids' and increased the proteins' brain level, yet did not affect the level of phospholipids or increase the proteins in OB rats. Second derivatives calculated from the FTIR spectra provided information that the proteins (but not phospholipids) in both structures of the OB_AMI rats were normalized after antidepressant treatment.

CONCLUSIONS

Our findings prove that the changes in the phospholipid-protein balance in the hippocampus and prefrontal cortex may be related to depressive disorders, thus leading to the development of adverse changes in the molecules necessary for the correct functioning of the brain. Furthermore, these results suggest a stability of the structure changes/damage of phospholipids in depression, which are present in brain tissues even after effective pharmacotherapy. This study also shows that an infrared spectroscopy can be applied for monitoring changes in mood disorders.

Association of moderate and severe food insecurity with suicidal ideation in adults: national survey data from three Canadian provinces

PURPOSE

Although the important public health issues of food insecurity and suicide may be interconnected, they are rarely studied. Using data from a national survey, we examined whether household food insecurity was associated with suicidal ideation after adjusting for relevant covariates.

METHODS

We examined cross-sectional data from three Canadian provinces (n = 5,270) that were derived from the 2007 Canadian Community Health Survey and included adults (18+ years). Suicidal ideation was based on affirmative response to the question of whether or not the participant had seriously considered committing suicide in the previous 12 months. The Household Food Security Survey Module provided measures of moderate (indication of compromise in quality and/or quantity of food consumed) and severe (indication of reduced food intake and disrupted eating patterns) food insecurity status. Logistic regression determined associations between food insecurity and suicidal ideation with adjustment for demographics, body mass index, and presence of a mood disorder.

RESULTS

There were differences in the proportion experiencing suicide ideation according to moderate (14.7 vs 10.0 % without suicide ideation) and severe (16.4 vs 7.1 % without suicide ideation) food security (p < 0.001). With covariate adjustment, suicidal ideation was significantly associated with moderate (adjusted OR = 1.32, 95 % CI 1.06-1.64) and severe (adjusted OR = 1.77, 95 % CI 1.42-2.23) food insecurity.

CONCLUSIONS

The findings of a robust association between food insecurity and suicidal ideation suggest that interventions targeted at food security may reduce suicide-related morbidity and mortality. Longitudinal investigations that examine various dimensions of food insecurity will advance understanding of etiological pathways involved in food insecurity and suicide.

Attempted suicide in people with co-occurring bipolar and substance use disorders: systematic review and meta-analysis

BACKGROUND

Both individuals with bipolar (BD) and those with alcohol (AUD) and other substance (SUD) use disorders are likely to attempt suicide. Comorbidity of BD and AUD/SUD may increase the likelihood of suicide attempts. We conducted a meta-analysis to estimate the association of comorbid AUD/SUD and suicide attempts in subjects with BD in the literature to date.

METHODS

Electronic databases through January 2013 were searched. Studies reporting rates of suicide attempts in people with co-occurring BD and AUD/SUD were retrieved. Comorbid AUD and SUD and suicide attempts rates as well as demographic, clinical, and methodological variables were extracted from each publication or obtained directly from its authors.

RESULTS

Twenty-nine of 222 studies assessed for eligibility met the inclusion criteria, comprising a total of 31,294 individuals with BD, of whom 6308 (20.1%) had documented suicide attempts. There were consistent findings across the studies included. As compared to controls, subjects with BD and comorbid AUD/SUD were more likely to attempt suicide. The cross-sectional association estimates showed random-effects pooled crude ORs of 1.96 (95% CI=1.56-2.47; p<0.01), 1.72 (95% CI=1.52-1.95; p<0.01), and 1.77 (95% CI=1.49-2.10; p<0.01), for combined AUD/SUD, AUD, and SUD. There was no publication bias and sensitivity analyses based on the highest quality studies confirmed core results.

LIMITATIONS

The effects of the number and the type of suicide attempts could not be investigated due to insufficient information.

CONCLUSIONS

Comorbid AUD and SUD in individuals with BD are significantly associated with suicide attempts. Individuals with this comorbidity should be targeted for intensive suicide prevention efforts.

Assessing the contribution of borderline personality disorder and features to suicide risk in psychiatric inpatients with bipolar disorder, major depression and schizoaffective disorder

Suicidal behavior often accompanies both borderline personality disorder (BPD) and severe mood disorders, and comorbidity between the two appears to further increase suicide risk. The current study aims to quantify the risk of suicidality conferred by comorbid BPD diagnosis or features in three affective disorders: major depressive disorder (MDD), bipolar disorder (BP) and schizoaffective disorder. One hundred forty-nine (149) psychiatric inpatients were assessed by SCID I and II, and the Columbia Suicide Severity Rating Scale. Logistic regression analyses investigated the associations between previous suicide attempt and BPD diagnosis or features in patients with MDD, BP, and schizoaffective disorder, as well as a history of manic or major depressive episodes, and psychotic symptoms. Comorbid BPD diagnosis significantly increased suicide risk in the whole sample, and in those with MDD, BP, and history of depressive episode or psychotic symptoms. Each additional borderline feature also increased risk of past suicide attempt in these same groups (excepting BP) and in those with a previous manic episode. Of the BPD criteria, only unstable relationships and impulsivity independently predicted past suicide attempt. Overall, among patients with severe mood disorders, the presence of comorbid BPD features or disorder appears to substantially increase the risk of suicide attempts.

Antidepressant use and the risk of suicide: a population-based cohort study

BACKGROUND

The existing literature provides contradictory evidence on antidepressant use and risk of suicide. Some studies have shown that the use of Selective Serotonin Reuptake Inhibitors (SSRIs) is associated with an increased risk of suicide, especially during the first months of treatment, whereas other studies did not confirm this association. For this reason, our objective was to investigate the association between antidepressant use and risk of suicide in incident antidepressant users in relation to time since starting therapy.

METHODS

We conducted a population-based cohort study within the Dutch Integrated Primary Care Information (IPCI) database, in incident users of antidepressant therapy between 1994 and 2012 (n=27,712). Cox proportional hazard models were used to study the association between current use of SSRIs, tricyclic antidepressants (TCA) and other antidepressants and risk of suicide or attempted suicide.

RESULTS

During follow-up, a total of 280 incident antidepressant users attempted or committed suicide. Current use of SSRIs (hazard ratio (HR): 0.78, 95% CI: 0.57-1.07), TCAs (HR: 0.82, 95% CI: 0.48-1.42) or other antidepressants (HR: 0.75, 95% CI: 0.47-1.18) was not statistically significantly associated with suicide compared to past use of any of the antidepressants.

LIMITATIONS

Although a large healthcare database was used, the number of reported cases of suicide (attempt) was low.

CONCLUSIONS

This study did not indicate an increase in risk of suicide after starting treatment with SSRIs, TCAs or other antidepressants compared with past antidepressant use.

Self-harm in bipolar disorder: findings from a prospective clinical database

BACKGROUND

People with bipolar disorder may be at increased risk of suicidal behaviour but there are few prospective studies of self-harm in this group. Our aim was to describe the characteristics and outcome (in terms of repetition) for individuals with bipolar disorder who presented to hospital following self-harm.

METHOD

A nested case-control study was carried out using a large prospective self-harm database (1997-2010) in Manchester, UK. Characteristics of bipolar cases and non-bipolar controls were compared using conditional logistic regression, and outcomes were assessed via survival analyses.

RESULTS

Bipolar cases (n=103) were more likely to repeat self-harm than controls (n=515): proportion with at least one repeat episode 58% vs. 25%, HR 3.08 (95% CI; 2.2-4.18). Previous self-harm, unemployment, contact with psychiatric services and sleep disturbance were all more common in cases than controls. Even after adjustment for known risk factors, the risk of repetition remained higher in the bipolar group (adjusted HR 1.68; 95% CI; 1.10-2.56).

LIMITATIONS

The study covers cases from hospital sites in Manchester, UK, and therefore only includes self-harm that was serious enough to present at hospital emergency departments.

CONCLUSION

People with bipolar disorder who self-harm have a higher risk of repetition than people who self-harm more generally. Adjusting for some known risk factors moderated, but did not abolish, this finding. Other factors, such as impulsivity, may also be important.

The use of regression methods for the investigation of trends in suicide rates in Hungary between 1963 and 2011

PURPOSE

Suicide rates in Hungary have been analyzed from different aspects in recent decades. However, only descriptive rates have been reported. The aim of our epidemiological study was to characterize the pattern of annual rates of suicide in Hungary during the period 1963-2011 by applying advanced statistical methods.

METHODS

Annual suicide rates per 100,000 population (>6 years) for gender, age group and suicide method were determined from published frequency tables and reference population data obtained from the Hungarian Central Statistical Office. Trends and relative risks of suicide were investigated using negative binomial regression models overall and in stratified analyses (by gender, age group and suicide method). Joinpoint regression analyses were additionally applied to characterize trends and to find turning points during the period 1963-2011.

RESULTS

Overall, 178,323 suicides (50,265 females and 128,058 males) were committed in Hungary during the investigated period. The risk of suicide was higher among males than females overall, in all age groups and for most suicide methods. The annual suicide rate exhibited a significant peak in 1982 and remained basically constant after 2006. Different segmented patterns were observed for the suicide rates in the various age groups.

CONCLUSIONS

Suicide rates revealed segmented linear pattern. This is the first detailed trend analysis with risk estimates obtained via joinpoint and negative binomial regression methods simultaneously for age-specific suicide frequencies in Hungary.

Antidepressant-like activity of magnesium in the olfactory bulbectomy model is associated with the AMPA/BDNF pathway

RATIONALE

Numerous studies suggest agents that act on glutamatergic transmission as potential antidepressants. Preclinical and clinical evidence suggests that magnesium, an N-methyl-D-aspartate receptor blocker, may be useful in the treatment of depression.

OBJECTIVE

The aim of this study was to investigate the effects of magnesium on behavior; protein levels of GluN2A, GluN2B [N-methyl-D-aspartate receptor (NMDAR) subunits], GluA1 [α-amino-3-hydroxy-5 methyl-4-isoxazolepropionic acid (AMPA) subunit], phospho-Ser-831-GluA1 (P-S831), phospho-Ser-845-GluA1 (P-S845), and brain-derived neurotrophic factor (BDNF); and messenger RNA (mRNA) levels of GluN2A and GluN2B in different brain areas in the olfactory bulbectomy (OB) model of depression in rats.

METHODS

Magnesium was administered once daily for 14 days at three doses (10, 15, and 20 mg/kg, intraperitoneal) to sham and OB rats. Following treatment, open field and passive avoidance tests were performed in the sham and OB rats. After 24 h, the hippocampus, the prefrontal cortex (PFC), and the amygdala of rats treated with the most active dose (15 mg/kg) were harvested, and the protein and mRNA levels were determined.

RESULTS

Chronic administration of magnesium (15 and 20 mg/kg) reduced the number of trials required to learn passive avoidance and reduced the OB-induced hyperactivity. OB increased the P-S845 level in the hippocampus, which was reduced by magnesium treatment. Magnesium significantly increased the levels of BDNF, GluN2B, P-S831, and P-S845 protein (and mRNA) primarily in the PFC and the hippocampus in OB rats.

CONCLUSION

For the first time, the present results demonstrate the antidepressant-like activity of magnesium in the OB animal model of depression and indicate the potential involvement of the AMPA/BDNF pathway in this activity.

Antidepressant drugs and teenage suicide in Hungary: Time trend and seasonality analysis

OBJECTIVE

The aim of the present study was to analyze the relationship between increasing utilization of antidepressants and lithium, and suicide rate of persons less than 20 years of age in Hungary, with particular regard to seasonal patterns.

METHODS

Time trend analysis was carried out to determine the correlation between antidepressant and lithium prescription patterns in Hungarian persons under age of 20 years as well as seasonal variations within the study period from January 1998 to December 2006.

RESULTS

There was a significant correlation (P = 0.03) between the eight-fold increase in antidepressant + lithium prescriptions and decreasing suicides in young Hungarian people under 20 years of age within the study period. Lithium, selective serotonin reuptake inhibitors (SSRIs) and the group of "other antidepressant drugs" rather than nonselective monoamine reuptake inhibitors and monoamine oxidase-A inhibitors were responsible for this association. No significant association could be drawn from seasonal variation with boys (P = 0.964), girls (P = 0.140), or both genders (P = 0.997).

LIMITATION

Ecological study design.

CONCLUSION

Our findings are in good agreement with large-scale ecological studies showing that the beneficial effect of more widely used antidepressants at a given point could appear on the level of suicide rate of the general population even among patients under the age of 20 years.

Report of the WPA section of pharmacopsychiatry on the relationship of antiepileptic drugs with suicidality in epilepsy

INTRODUCTION

This report from the World Psychiatric Association Section on Pharmacopsychiatry examines the possible relationship of antiepileptic drugs with suicide-related clinical features and behaviors in patients with epilepsy.

MATERIALS AND METHODS

A systematic review of the MEDLINE search returned 1039 papers, of which only 8 were considered relevant. A critical analysis of the Food and Drug Administration (FDA) report on the increase risk for patients under antiepileptics to manifest suicidality is also included in this report.

RESULTS

The analysis of these studies revealed that the data are not supportive of the presence of a "class effect" on suicide-related behavior; on the contrary, there are some data suggesting such an effect concerning treatment with topiramate, lamotrigine, and levetiracetam for which further research is needed.

DISCUSSION

For the majority of people with epilepsy, anticonvulsant treatment is necessary and its failure for any reason is expected to have deleterious consequences. Therefore, clinicians should inform patients and their families of this increased risk of suicidal ideation and behavior, but should not overemphasize the issue. Specific subgroups of patients with epilepsy might be at a higher risk, and deserve closer monitoring and follow-up. Future research with antiepileptics should specifically focus on depression and suicidal thoughts.

Mental health emergency detentions and access to firearms

Following the tragic shootings in Newtown (Connecticut), Aurora (Colorado), Isla Vista (California) and others, increased national attention has focused on the relationship between mental illness and gun violence. While some have called for enhanced regulation of firearm possession by persons with mental illness, others have argued that such actions would be ineffective and enhance stigma associated with mental illness while discouraging treatment seeking.

Is antiepileptic-induced suicidality a data-based class effect or an exaggeration? A comment on the literature

A few years ago the Food and Drug Administration, based on a meta-analysis, issued a warning stating that antiepileptic drugs (AEDs) are associated with an increased risk of suicidal ideation, suicide attempts, and completed suicide. This warning generated significant concern about the use of AEDs, especially in patients with epilepsy and affective disorders. Following the FDA report, several studies addressed this issue but only served to generate further concern and confusion. There seems to be no convincing data concerning a "class effect" of AEDs in inducing any type of suicide-related behaviors. Some data suggest a possible association of lamotrigine, levetiracetam, and topiramate with suicidality, but further research is needed. In any case, clinicians need to carefully assess suicidality in all patients treated with AEDs and inform them and their families on the possible increased risk of suicidality, though preferably in a way that keeps open the continuing use of AEDs.

A systematic review of amyloid-β peptides as putative mediators of the association between affective disorders and Alzheimer׳s disease

BACKGROUND

Affective disorders are associated with an increased occurrence of cognitive deficits and have been linked to cognitive impairment and Alzheimer׳s disease. The putative molecular mechanisms involved in these associations are however not clear. The aim of this systematic review was to explore clinically founded evidence for amyloid-β peptides in cerebrospinal fluid and blood as putative biomarkers for affective disorders.

METHOD

Systematic searches in Embase and PubMed databases yielded 23 eligible, observational studies.

RESULTS

Despite inconsistencies that were partly ascribed to the application of different assay formats, study results indicate a potentially altered amyloid-β metabolism in affective disorder.

LIMITATIONS

Since most studies used a cross-sectional design, causality is difficult to establish. Moreover, methodological rigor of included studies varied and several studies were limited by very low sample numbers. Finally, different assays for amyloid-β were utilized in the different studies, thus hampering comparisons.

CONCLUSION

To unravel possible risk relations and causalities between affective disorder and Alzheimer׳s disease and to determine how amyloid-β concentrations change over time and are associated with cognition as well as affective symptomatology, future research should include prospective, longitudinal studies, implemented in large study populations, where peripheral and central amyloid-β ratios are quantified concomitantly and continuously across various affective phases. Also, to enable inter-survey comparisons, the use of standardized pre-analytical/analytical procedures is crucial.

Association among depressive disorder, adjustment disorder, sleep disturbance, and suicidal ideation in Taiwanese adolescent

INTRODUCTION

The aim of this study is to investigate the association among depressive disorder, adjustment disorder, sleep disturbance, and suicidal ideation in Taiwanese adolescent.

METHODS

We recruited 607 students (grades 5-9) to fill out the investigation of basic data and sleep disturbance. Psychiatrists then used the Mini International Neuropsychiatric Interview-Kid to interview these students to assess their suicidal ideation and psychiatric diagnosis. Multiple logistic regression with forward conditionals was used to find the risk factors for multivariate analysis.

RESULTS

Female, age, depressive disorder, adjustment disorder, and poor sleep all contributed to adolescent suicidal ideation in univariate analysis. However, poor sleep became non-significant under the control of depressive disorder and adjustment disorder.

DISCUSSION

We found that both depressive disorder and adjustment disorder play important roles in sleep and adolescent suicidal ideation. After controlling both depressive disorder and adjustment disorder, sleep disturbance was no longer a risk of adolescent suicidal ideation. We also confirm the indirect influence of sleep on suicidal ideation in adolescent.

Dysfunction of neural circuitry in depressive patients with suicidal behaviors: a review of structural and functional neuroimaging studies

Suicide is an important public problem. Understanding the neurobiological mechanisms of suicidal behavior in depression will facilitate the development of more effective prevention strategies for suicide. There are several reviews of imaging studies of suicidal behavior, but none of these reviews have focused only on suicide in depression. We reviewed neuroimaging studies of suicide in depression in recent years. The majority of studies found structural and functional alterations in the orbital frontal cortex, anterior cingulate cortex and striatum in depressive patients with suicidal behaviors. The evidence suggests that the frontal-striatal circuitry, which includes the striatum, orbital frontal and anterior cingulate cortices, is involved in the neurobiology of suicide in depressive patients. These findings also indicate that not all suicides have the same underlying neuropathology. Future studies require larger samples and more accurate subtypes of suicide. Furthermore, combining neuroimaging and other new technologies in molecular biology will be helpful to reveal the pathogenesis of suicidal behavior in depression.

Application of proteomics in diagnosis of ADHD, schizophrenia, major depression, and suicidal behavior

This report focuses on the application of different proteomic techniques in diagnosis and treatment of psychiatric disorders such as major depression, suicidal behavior, schizophrenia, and attention deficit/hyperactivity disorder (ADHD). Firstly, we briefly describe different analytic approaches that can be applied for the discovery of specific biomarkers for diagnosing the above disorders, as well as for monitoring the effect of their treatment. Secondly, we discussed the types of biomarkers in general used in biomedicine for characterizing different disorders and diseases. Next, the potential applications of these biomarkers for diagnosing and managing major depression, suicidal behavior, schizophrenia, and ADHD are discussed in details. Forensic aspects of these biomarkers for the above disorders are also considered. Finally, we discuss the potential of specific biomarkers for distinguishing between comorbid psychiatric disorders in clinical setup as well as their potential for understanding mechanisms underlying the disorders and in discovery of new treatment strategies.

White matter abnormalities: Insights into the pathophysiology of major affective disorders

The presence of white matter hyperintensities (WMHs) has been commonly associated with poor outcome in subjects with major affective disorders. Unfortunately, WMHs may be frequently confounded by the use of psychoactive medications and duration of illness. Although findings from the current literature are quite conflicting, we proposed that subjects with WMHs may be at higher suicidal risk when compared to other subgroups without. Based on the Fazekas modified scale, the severity of WMHs may serve as a trait marker of disease. Interestingly, the presence of WMHs may represent a neurobiological marker between the underlying vulnerability and clinical presentation of major affective disorders.

Risk factors for suicidal behaviour in individuals on disability pension due to common mental disorders - a nationwide register-based prospective cohort study in Sweden

BACKGROUND

Common mental disorders (CMD) have become one of the leading causes for disability pension (DP). Studies on predictors of adverse health outcome following DP are sparse. This study aimed to examine the association of different socio-demographic factors and health care consumption with subsequent suicidal behaviour among individuals on DP due to CMD.

METHOD

This is a population-based prospective cohort study based on register data. All individuals aged 18-64 years, living in Sweden on 31-Dec-2004 who in 2005 were on DP due to CMD (N = 46 745) were followed regarding suicide attempt and suicide (2006-10). Univariate and multivariate hazard ratios (HR) and 95% confidence intervals (CI) for suicidal behaviour were estimated by Cox regression.

RESULTS

During the five-year follow-up, 1 046 (2.2%) and 210 (0.4%) individuals attempted and committed suicide, respectively. Multivariate analyses showed that young age (18-24 years) and low education predicted suicide attempt, while living alone was associated with both higher suicide attempt and suicide (range of HRs 1.23 to 1.68). Combined prescription of antidepressants with anxiolytics during 2005 and inpatient care due to mental diagnoses or suicide attempt (2001-05) were strongly associated with suicide attempt and suicide (range of HRs 1.3 to 4.9), while inpatient care due to somatic diagnoses and specialized outpatient care due to mental diagnoses during 2001-05 only predicted suicide attempt (HR 1.45; 95% CI: 1.3-1.7; HR 1.30; 95% CI: 1.1-1.7).

CONCLUSIONS

Along with socio-demographic factors, it is very important to consider type of previous healthcare use and medication history when designing further research or intervention aiming at individuals on DP due to CMD. Further research is warranted to investigate both characteristics of disability pension due to CMD, like duration, diagnoses and grade as well as mechanisms to subsequent suicidal behavior, taking potential gender differences into consideration.

Suicide risk in major affective disorder: results from a national survey in China

BACKGROUND

This study investigated suicide risk and its correlates among major affective disorder patients in China and examined possible risk factors for future suicide among individuals with major affective disorder to inform appropriate interventions and management approaches to minimize and prevent suicide.

METHODS

A total of 1478 major affective disorder patients were consecutively examined in 13 mental health centers in China. The patients' socio-demographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. DSM-IV diagnoses were established using the Mini International Neuropsychiatric Interview (MINI), and suicide risk was assessed by the suicide risk module of the MINI.

RESULTS

Of the patients, 963 (65.2%) were in the nonsuicidal risk group and 515 (34.8%) were in the suicidal risk group. Compared to major depressive disorder patients, bipolar disorder patients had higher suicide risk levels (χ2=10.0, df=1, P=0.002); however, there were no statistically significant differences (χ2=2.6, df=1, P=0.1) between bipolar disorder-I and bipolar disorder-II patients. Suicide risk factors were associated with 6 variables in major affective disorder patients, as follows: male gender, unemployed, more frequent depressive episodes (>4 in the past year), depressive episodes with suicidal ideation and attempts, depressive episodes with psychotic symptoms, and no current antidepressant use.

LIMITATIONS

Most of the data were retrospectively collected and, therefore, subject to recall bias.

CONCLUSIONS

This study suggested that bipolar disorder patients have a higher suicide risk than major depressive disorder patients. The factors that were significantly associated with suicide risk may aid in identifying major affective disorder patients who are at risk for future suicidal behavior.

Investigation of the marked and long-standing spatial inhomogeneity of the Hungarian suicide rate: a spatial regression approach

BACKGROUND

In the last century Hungary had astonishingly high suicide rates characterized by marked regional within-country inequalities, a spatial pattern which has been quite stable over time.

AIMS

To explain the above phenomenon at the level of micro-regions (n=175) in the period between 2005 and 2011.

METHODS

Our dependent variable was the age and gender standardized mortality ratio (SMR) for suicide while explanatory variables were factors which are supposed to influence suicide risk, such as measures of religious and political integration, travel time accessibility of psychiatric services, alcohol consumption, unemployment and disability pensionery. When applying the ordinary least squared regression model, the residuals were found to be spatially autocorrelated, which indicates the violation of the assumption on the independence of error terms and - accordingly - the necessity of application of a spatial autoregressive (SAR) model to handle this problem. According to our calculations the SARlag model was a better way (versus the SARerr model) of addressing the problem of spatial autocorrelation, furthermore its substantive meaning is more convenient.

RESULTS

SMR was significantly associated with the "political integration" variable in a negative and with "lack of religious integration" and "disability pensionery" variables in a positive manner. Associations were not significant for the remaining explanatory variables.

LIMITATIONS

Several important psychiatric variables were not available at the level of micro-regions. We conducted our analysis on aggregate data.

CONCLUSION

Our results may draw attention to the relevance and abiding validity of the classic Durkheimian suicide risk factors - such as lack of social integration - apropos of the spatial pattern of Hungarian suicides.

Clinical differentiation of bipolar II disorder from borderline personality disorder

PURPOSE OF REVIEW

Differentiating bipolar II disorder (BP II) from borderline personality disorder (BPD) is a common diagnostic dilemma. The purpose of this review is to focus on recent studies that have considered clinical differences between the conditions including family history, phenomenology, longitudinal course, comorbidity and treatment response, and which might advance their clinical distinction.

RECENT FINDINGS

Findings suggest key differentiating parameters to include family history, onset pattern, clinical course, phenomenological profile of depressive and elevated mood states, and symptoms of emotional dysregulation. Less specific differentiation is provided by childhood trauma history, deliberate self-harm, comorbidity rates, neurocognitive features, treatment response and impulsivity parameters.

SUMMARY

This review refines candidate variables for differentiating BP II from BPD, and should assist the design of studies seeking to advance their phenomenological and clinical distinction.

Rejection Sensitivity is Associated with Quality of Life, Psychosocial Outcome, and the Course of Depression in Euthymic Patients with Bipolar I Disorder

Rejection sensitivity has been found to predict the course of unipolar depression as well as key outcomes, but has not yet been considered within bipolar disorder. The present study investigated the effects of rejection sensitivity on outcome in bipolar disorder. Fifty-three participants diagnosed with bipolar I disorder in remission using the Structured Clinical Interview for DSM-IV were compared to 44 controls with no history of mood disorder. A subset of 38 bipolar participants completed follow-up interviews using standard symptom severity measures at 6 months. People with bipolar I disorder reported higher rejection sensitivity scores than did controls. Within the bipolar sample, rejection sensitivity at baseline predicted increases in depression, but not mania, over the following 6 months; heightened rejection sensitivity was also correlated with poorer quality of life, social support, and psychological well-being. Findings highlight the importance of interpersonal-cognitive factors for treating depression and improving outcome within bipolar I disorder.

Suicide in bipolar disorder in a national English sample, 1996-2009: frequency, trends and characteristics

BACKGROUND

Bipolar disorder (BD) has been reported to be associated with high risk of suicide. We aimed to investigate the frequency and characteristics of suicide in people with BD in a national sample.

METHOD

Suicide in BD in England from 1996 to 2009 was explored using descriptive statistics on data collected by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI). Suicide cases with a primary diagnosis of BD were compared to suicide cases with any other primary diagnosis.

RESULTS

During the study period 1489 individuals with BD died by suicide, an average of 116 cases/year. Compared to other primary diagnosis suicides, those with BD were more likely to be female, more than 5 years post-diagnosis, current/recent in-patients, to have more than five in-patient admissions, and to have depressive symptoms. In BD suicides the most common co-morbid diagnoses were personality disorder and alcohol dependence. Approximately 40% were not prescribed mood stabilizers at the time of death. More than 60% of BD suicides were in contact with services the week prior to suicide but were assessed as low risk.

CONCLUSIONS

Given the high rate of suicide in BD and the low estimates of risk, it is important that health professionals can accurately identify patients most likely to experience poor outcomes. Factors such as alcohol dependence/misuse, personality disorder, depressive illness and current/recent in-patient admission could characterize a high-risk group. Future studies need to operationalize clinically useful indicators of suicide risk in BD.

Differential effect of lithium on spermidine/spermine N1-acetyltransferase expression in suicidal behaviour

An altered polyamine system has been suggested to play a key role in mood disorders and suicide, a hypothesis corroborated by the evidence that lithium inhibits the polyamine mediated stress response in the rat brain. Recent post-mortem studies have shown that spermidine/spermine N1-acetyltransferase (SAT1), the key regulator of cellular polyamine content, is under-expressed in brains from suicide victims compared to controls. In our study we tested the effect of in vitro lithium treatment on SAT1 gene and protein expression in B lymphoblastoid cell lines (BLCLs) from bipolar disorder (BD) patients who committed suicide (and for which BLCLs were collected prior to their death), BD patients with high and low risk of suicide and a sample of non-psychiatric controls. Baseline mRNA levels were similar in the four groups of subjects (p > 0.05). Lithium had no effect in suicide completers (p > 0.05) while it significantly increased SAT1 expression in the high risk (p < 0.001) and low risk (p < 0.01) groups as well as in controls (p < 0.001). Protein and mRNA levels were not correlated; lithium significantly reduced protein levels only in the control sample (p < 0.05). Our findings suggest that SAT1 transcription is influenced by lithium and that this effect is altered in BD patients who completed suicide, further supporting a role for polyamines in suicide.

[Predominant polarity, mixed states and suicide]

Bipolar disorders are linked to a high suicidal risk. Many risk factors are identified but it seems relevant to highlight the relationship between suicidal behavior and the different subtypes of bipolar disorder, or the different kinds of outcomes, or the clinical characteristics of a recurrence. A high frequency of depressive episodes in the story of the illness, like in predominant depressive polarity forms, or mixed features during symptomatic recurrences seem to be linked to a higher suicidal risk in the course of the disorder. Underlying mechanisms are yet to be identified. The investigation of these specifics lead into considering specific therapeutic actions based upon the clinical identification of mixed symptomatology during a recurrence for a tailored treatment or a thorough screening and assessment of depressive states during the course of the bipolar illness in order to try to prevent them.

The epidemiology of depression across cultures

Epidemiological data are reviewed on the prevalence, course, socio-demographic correlates, and societal costs of major depression throughout the world. Major depression is estimated in these surveys to be a commonly occurring disorder. Although estimates of lifetime prevalence and course vary substantially across countries for reasons that could involve both substantive and methodological processes, the cross-national data are clear in documenting meaningful lifetime prevalence with wide variation in age-of-onset and high risk of lifelong chronic-recurrent persistence. A number of sociodemographic correlates of major depression are found consistently across countries, and cross-national data also document associations with numerous adverse outcomes, including difficulties in role transitions (e.g., low education, high teen childbearing, marital disruption, unstable employment), reduced role functioning (e.g., low marital quality, low work performance, low earnings), elevated risk of onset, persistence and severity of a wide range of secondary disorders, and increased risk of early mortality due to physical disorders and suicide.

Mood instability, mental illness and suicidal ideas: results from a household survey

PURPOSE

There is weak and inconsistent evidence that mood instability (MI) is associated with depression, post traumatic stress disorder (PTSD) and suicidality although the basis of this is unclear. Our objectives were first to test whether there is an association between depression and PTSD, and MI and secondly whether MI exerts an independent effect on suicidal thinking over and above that explained by common mental disorders.

METHODS

We used data from the Adult Psychiatric Morbidity Survey 2007 (N = 7,131). Chi-square tests were used to examine associations between depression and PTSD, and MI, followed by regression modelling to examine associations between MI and depression, and with PTSD. Multiple logistic regression analyses were used to assess the independent effect of MI on suicidal thinking, after adjustment for demographic factors and the effects of common mental disorder diagnoses.

RESULTS

There are high rates of MI in depression and PTSD and the presence of MI increases the odds of depression by 10.66 [95% confidence interval (CI) 7.51-15.13] and PTSD by 8.69 (95% CI 5.90-12.79), respectively, after adjusting for other factors. Mood instability independently explained suicidal thinking, multiplying the odds by nearly five (odds ratio 4.82; 95% CI 3.39-6.85), and was individually by some way the most important single factor in explaining suicidal thoughts.

CONCLUSIONS

MI is strongly associated with depression and PTSD. In people with common mental disorders MI is clinically significant as it acts as an additional factor exacerbating the risk of suicidal thinking. It is important to enquire about MI as part of clinical assessment and treatment studies are required.

Genetic risk of suicidal behavior in bipolar spectrum disorder: analysis of 737 pedigrees

OBJECTIVES

Suicide is a significant cause of mortality in patients with major affective disorders (MAD), and suicidal behavior and MAD co-aggregate in families. However, the transmission of suicidal behavior is partially independent from that of MAD. We analyzed the lifetime prevalence of completed and attempted suicides in a large sample of families with bipolar disorder (BD), its relation to family history of MAD and BD, and the contribution of clinical and treatment factors to the risk of suicidal behavior.

METHODS

We studied 737 families of probands with MAD with 4919 first-degree relatives (818 affected, 3948 unaffected, and 153 subjects with no information available). Lifetime psychiatric diagnoses and suicidal behavior in first-degree relatives were assessed using semi-structured interviews, family history methods, and reviews of clinical records. Cox proportional hazard and logistic regression models were used to investigate the role of clinical covariates in the risk of suicidal behavior, and in the prevalence of MAD and BD.

RESULTS

The estimated lifetime prevalence of suicidal behavior (attempted and completed suicides) in 737 probands was 38.4 ± 3.0%. Lithium treatment decreased suicide risk in probands (p = 0.007). In first-degree relatives, a family history of suicidal behavior contributed significantly to the joint risk of MAD and suicidal behavior (p = 0.0006).

CONCLUSIONS

The liability to suicidal behavior is influenced by genetic factors (particularly family history of suicidal behavior and MAD). Even in the presence of high genetic risk for suicidal behavior, lithium treatment decreases suicide rates significantly.

Affective temperament, history of suicide attempt and family history of suicide in general practice patients

BACKGROUND

Untreated major affective disorders are strongly associated with suicidal behaviour; however, clinical, psychological and psycho-social risk factors also play a contributory role. Personal history and family history of suicide are also important predictors of suicidal behaviours, and are also a powerful marker of current major depressive episode in general practice patients. Affective temperaments, which can be considered the subaffective manifestations of major mood disorders also show a specific pattern of association with suicidal behaviour. In the present study our aim was to investigate the association between affective temperaments, personal history of suicide attempts and family history of completed suicide in primary practice patients.

METHODS

Five hundred and nine patients from 6 primary care practices completed the TEMPS-A, and were assessed concerning self-reported history of personal or family suicide.

RESULTS

We found that among those answering questions concerning suicide, 9.1% reported a family history of suicide in first and second degree relatives and 4.8% had at least one prior suicide attempt. Among those giving a positive answer to both questions, those who had a positive family history had significantly more frequent suicide attempts (15.4% vs. 4.0%). Patients with prior suicide attempts had a significantly higher score on the cyclothymic and depressive, and those with positive family history of suicide had on cyclothymic and anxious subscales.

LIMITATIONS

In the present study, personal and family history of suicide was assessed retrospectively and in a self-report way. The cross-sectional nature of this study and the facts that no current psychiatric morbidity has been investigated and only the documented history of depressive and anxiety disorders have been detected limit the generalisability of this study.

DISCUSSION

We found a significant relationship between depressive and cyclothymic affective temperament and personal history of suicide attempts, and between cyclothymic and anxious temperament and family history of completed suicide in first and second degree relatives. This is in line with previous findings showing a strong relationship between these affective temperaments and major mood episodes and that these temperaments are overrepresented among suicide attempters. Our findings also suggest that the presence of cyclothymic (and to lesser extent depressive) affective temperament in a patient with family history of completed suicide indicates a very high risk of suicidal behaviour.

Suicide in Hungary-epidemiological and clinical perspectives

Annual suicide rates of Hungary were unexpectedly high in the previous century. In our narrative review, we try to depict, with presentation of the raw data, the main descriptive epidemiological features of the Hungarian suicide scene of the past decades. Accordingly, we present the annual suicide rates of the period mentioned and also data on how they varied by gender, age, urban vs. rural living, seasons, marital status, etc. Furthermore, the overview of trends of other factors that may have influenced suicidal behavior (e.g., alcohol and tobacco consumption, antidepressant prescription, unemployment rate) in the past decades is appended as well. Based on raw data and also on results of the relevant papers of Hungarian suicidology we tried to explain the observable trends of the Hungarian suicide rate. Eventually, we discuss the results, the possibilities, and the future tasks of suicide prevention in Hungary.

Pharmacological treatment of depression in patients with a primary brain tumour

BACKGROUND

This is an updated version of the original Cochrane review published in Issue 3, 2010.Patients with a primary brain tumour often experience depression, for which drug treatment may be prescribed. However, these patients are also at high risk of epileptic seizures, cognitive impairment and fatigue, all of which are potential side effects of antidepressants. The benefit, or harm, of pharmacological treatment of depression in brain tumour patients is unclear.

OBJECTIVES

To assess the benefits and harms of pharmacological treatment of depression in patients with a primary brain tumour.

SEARCH METHODS

We updated the search to include the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 10), MEDLINE to October 2012, EMBASE to October 2012 and PsycINFO to October 2012. We searched the British Nursing Index, LILACS, PSYNDEX, the NHS National Research Register, the NHS Centre for Reviews and Dissemination's Database of Abstracts of Reviews of Effectiveness (DARE) and Web of Knowledge (covering Science Scisearch, Social Sciences Citation Index and Biological Abstracts) for the original review (to July 2009). In the original review we also handsearched Neuro-oncology, the Journal of Neuro-oncology, the Journal of Neurology, Neurosurgery and Psychiatry and the Journal of Clinical Oncology (July 1999 to June 2009) and wrote to all the pharmaceutical companies manufacturing antidepressants for use in the UK.

SELECTION CRITERIA

We searched for all randomised controlled trials (RCTs), controlled clinical trials, cohort studies and case-control studies of any pharmacological treatment of depression in patients with a histologically diagnosed primary brain tumour.

DATA COLLECTION AND ANALYSIS

No studies met the inclusion criteria.

MAIN RESULTS

We found no eligible studies evaluating the benefits of any pharmacological treatment of depression in brain tumour patients.

AUTHORS' CONCLUSIONS

No high-quality studies have examined the value of pharmacological treatment of depression in patients with a primary brain tumour. RCTs and detailed prospective studies are required to inform the effective pharmacological treatment of this common and important complication of brain tumours. Since the last version of this review none of the new relevant studies have provided additional information to change these conclusions.

Epidemiology of suicide in South Africa: Setting an agenda for future research

This article offers a synthesis and critical overview of published studies on the prevalence and correlates of completed suicide in South Africa. It examines the evidence that suicide is a serious public health problem and highlights what remains unknown about suicide in South Africa. Reflections are offered on the implications of these studies for subsequent research. Focus areas are suggested for future research in order to provide the information needed to inform public health efforts to reduce the morbidity and mortality associated with suicidal behaviour. This article is of interest to scholars who seek to plan suicide research in South Africa, public health officials who wish to design suicide prevention programmes, and others who wish to gain an overview of the prevalence and correlates of completed suicide in the country.

Correlates of current suicide risk among Thai patients with bipolar I disorder: findings from the Thai Bipolar Disorder Registry

BACKGROUND

The Thai Bipolar Disorder Registry was a prospective, multisite, naturalistic study conducted in 24 hospitals across Thailand. This study aimed to examine the correlates of current suicide risk in Thai patients with bipolar I disorder.

METHODS

Participants were adult inpatients or outpatients with bipolar disorder, based on the Diagnosis and Statistical Manual of Mental Disorders, fourth edition. All were assessed by using the Mini International Neuropsychiatric Interview (MINI), version 5. The severity of current suicide risk was determined by using the total score of the MINI suicidality module. Mood symptoms were assessed by using the Young Mania Rating Scale and the Montgomery Asberg Depression Rating Scale.

RESULTS

The data of 383 bipolar I disorder patients were included in the analyses. Of these, 363 (94.8%) were outpatients. The mean (standard deviation) of the MINI suicide risk score was 1.88 (5.0). The demographic/clinical variables significantly associated with the MINI suicide risk scores included age, number of overall previous episodes, the Young Mania Rating Scale score, the Montgomery Asberg Depression Rating Scale scores, and the Clinical Global Impression Severity of Illness Scale for Bipolar Disorder mania score, depression score, and overall score. The variables affecting the differences of suicide risk scores between or among groups were type of first mood episode, a history of rapid cycling, anxiety disorders, and alcohol use disorders. The stepwise multiple linear regression model revealed that the Montgomery Asberg Depression Rating Scale score (β=0.10), a history of rapid cycling (β=6.63), anxiety disorders (β=2.16), and alcohol use disorders (β=2.65) were significantly correlated with the suicide risk score (all P<0.01).

CONCLUSION

A history of rapid cycling, severity of depressive episode, current anxiety disorders, and current alcohol use disorders correlate with current suicide risk among Thai bipolar I disorder patients. Further studies in larger sample sizes are warranted.

Suicidal behavior in bipolar disorder: epidemiology, characteristics and major risk factors

BACKGROUND

Suicide is one of the leading causes of death and a major public health problem worldwide, and the majority of suicide attempters and completers suffer from some major affective disorder at the time of their death, which, in the majority of cases is unrecognized, under- or misdiagnosed and untreated.

METHODS

Based on a systematic literature search, the authors give a detailed and critical overview of established risk factors of suicide in bipolar disorder.

RESULTS

Among affective disorders, bipolar disorder carries the highest risk of suicide, yet not all bipolar patients commit or even attempt suicide during their illness. While the general suicide risk factors also apply for bipolar disorders, there are several disease-specific risk factors as well which should be taken into account when evaluating suicide risk in case of patients.

CONCLUSION

It is crucial to identify suicide risk factors in bipolar disorder to be able to differentiate those patients within this already increased-risk illness group who are at especially high risk and therefore to allow for better prediction and prevention of suicidal acts.

Fluctuations of suicidality in the aftermath of a marital separation: 6-month follow-up observations

BACKGROUND

There is a lack of understanding of how the changing nature of the separation process impacts on suicidality.

AIMS

This paper aims to identify factors contributing to fluctuations in suicidality during the process of marital/de facto separation along a 6-month follow-up.

METHOD

Separated persons who had contacted relationship-counselling services, help-line services, and variety of support and self-help groups were asked to participate in the first assessment. A 'Follow-Up Questionnaire' was sent 6 months later. Participants were required to be 18 years or older and separated from their married/de facto partner within the previous 18 months but not yet divorced.

RESULTS

Overall, in the first assessment, separated females presented lower levels of suicidality than males. During the follow-up suicidality decreased. There were some gender differences in terms of predictors of changes in suicidality. Separated males who showed an increase or stability in suicidality were more affected by stressful experiences such as legal negotiations on obtaining a divorce, feelings of loss and loneliness, loss of social networks and financial difficulties than males who were not suicidal in either assessment. Separated males and females who remained suicidal were more likely to report different mental and physical illnesses.

LIMITATIONS

Relatively low response rates of the follow-up (60%) limited our statistical analyses as some of the groups were too small and did not enable modelling.

CONCLUSIONS

Suicidality decreased, which seems to indicate that individuals adjusted to their new life circumstances. However, persons whose suicidality remained or increased reported more frequently stressful life events, physical and mental illnesses.

Can we really prevent suicide?

Every year, suicide is among the top 20 leading causes of death globally for all ages. Unfortunately, suicide is difficult to prevent, in large part because the prevalence of risk factors is high among the general population. In this review, clinical and psychological risk factors are examined and methods for suicide prevention are discussed. Prevention strategies found to be effective in suicide prevention include means restriction, responsible media coverage, and general public education, as well identification methods such as screening, gatekeeper training, and primary care physician education. Although the treatment for preventing suicide is difficult, follow-up that includes pharmacotherapy, psychotherapy, or both may be useful. However, prevention methods cannot be restricted to the individual. Community, social, and policy interventions will also be essential.