Prevalence of suicide ideation and suicide attempts in nine countries

Deliberate self-harm in young people: differences in prevalence and risk factors between the Netherlands and Belgium

BACKGROUND

This study aimed to examine prevalence and risk factors of deliberate self-harm in Dutch and Dutch-speaking Belgian adolescents.

METHOD

A cross sectional survey using an anonymous self report questionnaire was performed in both countries. Data on 4,431 Belgian and 4,458 Dutch 15-16 year-old school pupils were analyzed.

RESULTS

Results showed a significant difference between the two countries indicating that lifetime and past year prevalence of deliberate self-harm were both 2.8 times higher in Belgian adolescents than in Dutch adolescents. Further analyses identified differences in the prevalence of factors associated with deliberate self-harm, with Belgian adolescents showing significant higher scores on anxiety, less problem-oriented coping and more common use of alcohol and soft drugs. Belgian adolescents were also at higher risk for the experience of several life events in the previous year and before that such as conflicts with peers, parents and partner, being bullied at school or exposure to suicidal behavior in family and friends. In addition, Belgian adolescents showed less communication with family or teachers about their problems and difficulties.

CONCLUSIONS

The results of the study suggest that the increased risk of deliberate self-harm among Belgian adolescents may be associated with an increased reporting of several important life events and with additional ineffective problem-solving such as less problem-oriented coping, more substance use and less communication about their problems. These results support the assumption that sociocultural aspects of nations can influence the risk of deliberate self-harm and are important to consider when developing prevention strategies.

Critical analysis of the impact of glottal features in the classification of clinical depression in speech

The motivation for this work is in an attempt to rectify the current lack of objective tools for clinical analysis of emotional disorders. This study involves the examination of a large breadth of objectively measurable features for use in discriminating depressed speech. Analysis is based on features related to prosodics, the vocal tract, and parameters extracted directly from the glottal waveform. Discrimination of the depressed speech was based on a feature selection strategy utilizing the following combinations of feature domains: prosodic measures alone, prosodic and vocal tract measures, prosodic and glottal measures, and all three domains. The combination of glottal and prosodic features produced better discrimination overall than the combination of prosodic and vocal tract features. Analysis of discriminating feature sets used in the study reflect a clear indication that glottal descriptors are vital components of vocal affect analysis.

Validation of the Urdu translation of the Beck Scale for Suicide Ideation

This study aimed at developing an Urdu version of the Beck Scale for Suicide Ideation (BSI) for use with Pakistani adolescents and young adults. For this purpose, the English BSI was translated into Urdu and tested for psychometric properties. The analyses were carried out with data from a sample of 904 adolescents and young adults from eight major cities of Pakistan. The Cronbach's alpha of .75 showed that the Urdu version of the BSI has reasonable internal consistency. Principal Component Analysis gave one meaningful component that indicated Active Suicidal Desire. This preliminary validation study of the Urdu version of the BSI showed that it is an acceptable measure to be used with Pakistani adolescents and young adults. The need for further research on suicide in Pakistan is discussed.

Cross-national prevalence and risk factors for suicidal ideation, plans and attempts

BACKGROUND

Suicide is a leading cause of death worldwide; however, the prevalence and risk factors for the immediate precursors to suicide - suicidal ideation, plans and attempts - are not wellknown, especially in low- and middle-income countries.

AIMS

To report on the prevalence and risk factors for suicidal behaviours across 17 countries.

METHOD

A total of 84 850 adults were interviewed regarding suicidal behaviours and socio-demographic and psychiatric risk factors.

RESULTS

The cross-national lifetime prevalence of suicidal ideation, plans, and attempts is 9.2% (s.e.=0.1), 3.1% (s.e.=0.1), and 2.7% (s.e.=0.1). Across all countries, 60% of transitions from ideation to plan and attempt occur within the first year after ideation onset. Consistent cross-national risk factors included being female, younger, less educated, unmarried and having a mental disorder. Interestingly, the strongest diagnostic risk factors were mood disorders in high-income countries but impulse control disorders in low- and middle-income countries.

CONCLUSION

There is cross-national variability in the prevalence of suicidal behaviours, but strong consistency in the characteristics and risk factors for these behaviours. These findings have significant implications for the prediction and prevention of suicidal behaviours.

Suicide risk in depression and bipolar disorder: Do impulsiveness-aggressiveness and pharmacotherapy predict suicidal intent?

The aims of the present study were to examine clinical, personality, and sociodemographic predictors of suicide risk in a sample of inpatients affected by major affective disorders. The participants were 74 inpatients affected by major depressive disorder or bipolar disorder-I. Patients completed a semi-structured interview, the Beck Hopelessness Scale, the Aggression Questionnaire, the Barratt Impulsiveness Scale, and the Hamilton scales for depression and anxiety. Over 52% of the patients were high suicide risks. Those at risk reported more severe depressive-anxious symptomatology, more impulsivity and more hostility. Impulsivity, the use of antidepressants, anxiety/somatization, and the use of mood stabilizers (a negative predictor) resulted in accurate predicting of suicide intent. Impulsivity and antidepressant use were the strongest predictors even after controlling for several sociodemographic and clinical variables.

Anxiety disorders and suicidal behaviour: an update

PURPOSE OF REVIEW

The primary aim of this review is to present the main findings from the literature published between January 2006 and May 2007 on anxiety and suicidal behaviour. The secondary aim is to present critical comments on methodological issues, highlighting areas for future research.

RECENT FINDINGS

Traditionally, anxiety disorders have not been viewed as independent risk factors for suicidal behaviour, and therefore assessment of anxiety disorders has not been particularly emphasized in clinical enquiries and suicide screening tools. This review identifies evidence suggesting that specific anxiety disorders (e.g. generalized anxiety disorder, panic disorder and obsessive-compulsive disorder) may be independently associated with suicidality, to which they particularly contribute when they are co-morbid with bipolar disorder, depression, schizophrenia, or post-traumatic stress disorder, in both child/adolescent and adult populations.

SUMMARY

Despite methodological issues preventing firm conclusions from being drawn in most cases, these findings should prompt clinicians to evaluate more specifically the impact of anxiety disorders on suicidal behaviour, particularly when they are co-morbid. Further research into treatment of anxiety disorders in relation to preventing suicide is required.

Time to emergence of severe suicidal ideation among psychiatric patients as a function of suicide attempt history

BACKGROUND

Little is known about the emergence of suicidal ideation among psychiatric inpatients with histories of no, single, or multiple suicide attempts. We investigated differences in time to reemergence of severe suicidal ideation among psychiatric patients as a function of their suicide attempt histories.

METHOD

One hundred seventeen individuals meeting criteria for a major depressive disorder who were recently discharged from a psychiatric hospital and participating in a larger study of treatments for depression were included in the current study. Suicidal ideation, depressive symptoms, hopelessness, and depressogenic cognitions were assessed at baseline, and suicidal ideation was assessed at 3-, 6-, 12-, and 18-month follow-up, as well as inpatient readmission if applicable. Time to the reemergence of severe suicidal ideation was analyzed using survival analysis.

RESULTS

Twenty-two percent of our sample reported the occurrence of severe suicidal ideation over an 18-month period. Severe suicidal ideation emerged earlier among patients who had a history of prior suicide attempts than those who did not, but single and multiple suicide attempters did not differ significantly in time to severe suicidal ideation. Suicide attempt history remained a significant predictor of time to severe suicidal ideation when statistically controlling for hopelessness, depressive symptoms, depressogenic cognitions, and suicidal ideation at admission and initial treatment group assignment, especially between single attempters and nonattempters.

CONCLUSIONS

Although nearly a quarter of participants endorsed severe, clinically significant suicidal ideation within 18 months of discharge, those with suicide attempt histories reported the occurrence of severe suicidal ideation significantly earlier than those without suicide attempt histories.

Suicidal behaviour and associated risk factors among opioid-dependent individuals: a case-control study

AIMS

To examine suicidal behaviour and the associated risk factors among opioid-dependent cases and non-opioid-dependent controls.

DESIGN

Case-control study.

SETTING

Sydney, Australia.

PARTICIPANTS

A total of 726 opioid-dependent cases and 399 non-opioid-dependent controls, matched on age, sex and employment status.

FINDINGS

Cases had significantly higher life-time prevalence of suicidal thoughts (66% versus 55%), suicide attempts (31% versus 20%) and multiple attempts (19% versus 11%) compared to controls. Cases were significantly more likely to indicate a severe intent to die (63% versus 43%). Both cases and controls who had attempted suicide were significantly more likely than others to suffer from substance use and psychological disorders, as well as childhood maltreatment. Risk factors which predicted suicide attempts were the same among cases and controls, including screening positive for borderline personality disorder, post-traumatic stress disorder and persistent suicidal thoughts.

CONCLUSIONS

Although controls had elevated levels of suicidal behaviour compared to those seen in general population surveys, the prevalence of suicidal behaviour among cases was still much higher. Although opioid dependence was related to suicidal behaviour, it did not make a unique contribution to the risk of suicide attempts over and above the other risk factors identified.

Lifetime prevalence of suicide ideation, plan, and attempt in metropolitan China

OBJECTIVE

This is the first community-based epidemiological study examining the prevalence of suicidal behaviors, their transitional pathways, and their relationship with mental disorders in metropolitan China.

METHOD

Suicidal behaviors, including ideation, plans, and attempts were assessed by face-to-face household interviews among 5201 respondents in Beijing and Shanghai in 2001-2002. Lifetime prevalence and risk factors were examined using multivariate discrete-time survival models.

RESULTS

The lifetime prevalence estimates of suicidal ideation, plans, and attempts were 3.1%, 0.9%, and 1.0% respectively. Among suicide ideators, the conditional probability of ever making a plan and an attempt was 29.5% and 32.3% respectively. Progression from ideation to plan and attempt was the highest during the first year after onset. Suicide attempt was predicted by young adulthood, being unmarried, recent onset of ideation and plan, and the presence of mental disorders, especially mood disorder.

CONCLUSION

Suicidal behaviors in metropolitan China exhibit a low prevalence and an epidemiological profile resembling that found in Western countries.

The epidemiology of suicide-related outcomes in Mexico

Nationally representative data from the Mexican National Comorbidity Survey are presented on the lifetime prevalence and age-of-onset (AOO) distributions of suicide ideation, plan and attempt and on temporally prior demographic and DSM-IV psychiatric risk factors. Lifetime ideation was reported by 8.1% of respondents, while 3.2% reported a lifetime plan and 2.7% a lifetime suicide attempt. Onset of all outcomes was highest in adolescence and early adulthood. The risk of transition from suicide ideation to plan and attempt was highest within the first year of onset of ideation. The presence of one or more temporally prior DSM-IV/CIDI (Composite International Diagnostic Instrument) disorder was strongly related to each suicide-related outcome. Suicidal outcomes are prevalent, have an early AOO, and are strongly related to temporally prior mental disorders in Mexico. Given the early AOO, intervention efforts need to focus more than currently on children and adolescents with mental disorders to be effective in prevention.

Suicidal ideation and associated factors among school-going adolescents in rural Uganda

BACKGROUND

Mental health is a neglected area of health research and practice in most of sub-Saharan African countries where the largest burden of morbidity is from infectious diseases. This even occurs despite the fact that some mental health problems may arise from infectious diseases.

METHODS

We conducted secondary analysis of the Uganda Global School-Based Health Survey-2003 to obtain the prevalence of, and assess factors that may be associated with suicidal ideation among school-going adolescents in rural Uganda. Assessment of association was conducted through both bi-variate and multivariate logistic regression analysis.

RESULTS

Altogether 21.6% of the study participants, 21.3% males and 23.5% females had seriously considered committing suicide within the past 12 months. Loneliness, worry were positively associated with suicide ideation after adjusting for age, gender, smoking, drinking, and experience of having been bullied (OR = 1.59; 95% CI [1.12, 2.26] and OR = 1.19; 95% CI [1.12, 2.25]) respectively. Males were less likely to seriously consider committing suicide than females (OR = 0.70; 95% CI [0.50, 0.98]).

CONCLUSION

Adolescent suicidal ideation is a major public health issue in rural Uganda. Measures aimed to prevent adolescent suicides in Uganda should incorporate our understanding of factors that are associated with suicide in rural Uganda such the gender disparity and the association observed with substance use.

Risk factors for suicidality in Europe: results from the ESEMED study

BACKGROUND

Precise knowledge of the epidemiology of suicidality provides necessary information for designing prevention programs. The aims of the present study were to investigate the prevalence and correlates of suicidal ideas and attempts in the general population of Europe.

METHODS

The European Study on the Epidemiology of Mental Disorders (ESEMED) is a cross-sectional household survey carried out in a probability representative sample of non-institutionalised adults (aged 18 years or older) of six European countries (Belgium, France, Germany, Italy, the Netherlands and Spain). The Composite International Diagnostic Interview (CIDI 3.0) was administered to 21,425 individuals.

RESULTS

Lifetime prevalence of suicidal ideation was 7.8% and of suicidal attempts 1.3%. Being women, younger and divorced or widowed were associated with a higher prevalence of suicide ideation and attempts. Psychiatric diagnoses were strongly related to suicidality. Among them, major depressive episode (Rate ratio 2.9 for lifetime ideas and 4.8 for lifetime attempts), dysthymia (RR 2.0 and 1.6), GAD (RR 1.8 and 2.3 for lifetime), PTSD (RR 1.9 and 2.0) and alcohol dependence (RR 1.7 and 2.5) were the most important. Population attributable risks for lifetime suicidal attempt was 28% for major depression.

LIMITATIONS

Information about suicidal ideas and attempts was self reported, psychiatric diagnoses were made using fully structured lay interviews rather than clinician-administered interviews.

CONCLUSIONS

In spite of meaningful country variation in prevalence, risk factors for suicidality are consistent in the European countries. Population prevention programmes should focus on early diagnosis and treatment of major depression and alcohol abuse and in those individuals with recent appearance of suicidal ideas.

Co-occurrence of major depression or suicide attempt with migraine with aura and risk for unprovoked seizure

We hypothesized and found that the co-occurrence of migraine with aura (MA) with major depression (MD) or with suicide attempt (SA) increases the risk for developing unprovoked seizure more than these conditions alone. Number of conditions showed a linear relationship to seizure risk. This may reflect a new condition cluster defined by MA, MD, SA and unprovoked seizures. Identifying the biological underpinnings this cluster may affect clinical diagnosis and treatment.

Long-term impact of celebrity suicide on suicidal ideation: results from a population-based study

BACKGROUND

The short-term effect of celebrity suicide on the overall suicide rate is widely known, but long-term effects remain unclear.

OBJECTIVE

To examine whether celebrity suicide is associated with suicidal ideation over a longer period.

DESIGN

This is a study on the effect of the suicide of a famous Hong Kong entertainment celebrity, who committed suicide on 1 April 2003, on suicide thoughts of the community. A population-based survey was conducted between December 2003 and July 2004. Respondents were asked about their suicidal ideation, psychological well-being, life events, and whether or not they had been affected by celebrity suicide.

SETTING

Hong Kong Special Administrative Region, the People's Republic of China.

PARTICIPANTS

2016 respondents aged between 20 and 59 years.

RESULTS

After controlling for some known suicide risk factors, celebrity suicide was shown to be independently associated with suicidal ideation. People who had indicated to have been affected by celebrity suicide were 5.93 times (95% CI 2.56% to 13.72%, p = 0) more likely to have severe level of suicidal ideation (Adult Suicidal Ideation Questionnaire score > or = 31) than people who had not been affected. Respondents having greater anxiety symptoms, less reason for living and more focus on irrational values were also found to have had their suicide ideation affected by celebrity suicide.

CONCLUSIONS

Celebrity suicide is a risk factor for suicidal ideation over a short term as well as over a long term. Raising awareness of the possible negative effect of celebrity suicide through suicide prevention programmes in the community is needed.

A closer look: the benefits and effectiveness of cognitive behavioral therapy on a female-specific unit for treatment of bipolar disorder

This case study examines the benefits and effectiveness of Cognitive Behavioral Therapy (CBT) and a female-specific unit for a woman with Bipolar Disorder. For this case study, the patient, Sonia, is a pseudonym for reasons of confidentiality. Sonia has been persistently non-compliant with her psychotropic medications since being diagnosed with Bipolar Disorder. Throughout her life, she has maintained the distortion that she does not need her prescribed psychotropic medications. This thinking has served as a catalyst for Sonia to stop taking her prescribed psychotropic medications and ultimately relapse, which has resulted in approximately 20 psychiatric hospitalizations. Another intervention, in addition to psychotropic medications, was desperately needed to stop this vicious cycle, in order to address her negative conceptualization of her illness. During her last hospitalization on a specialized psychiatric inpatient program for women, Sonia received Cognitive Behavioral Therapy from a therapist in training at the Beck Institute for Cognitive Therapy. The combination of CBT, re-stabilization on psychotropic medications, and a female-specific unit led to an excellent outcome for Sonia.

Age and gender differences among Australian suicide ideators: prevalence and correlates

We investigated the prevalence and correlates of suicidal ideation in an Australian population sample at three stages of adulthood. Random sampling of a community acquired 7485 participants. Cohorts were 20 to 24, 40 to 44, or 60 to 64 years old. Twelve-month prevalence of suicidal ideation was 8.2%. Suicidal ideation was highest among the youngest cohort. Males with chronic physical illness were more prone to suicidal ideation, as were those aged 20 to 24 and 60 to 64. Furthermore, under-employed subjects 60 to 64 years old were seven times more likely to experience suicidal ideation than their counterparts working full-time. Childhood adversity and rumination had positive associations with suicidality; however, considering oneself more masterful was linked with lower levels of suicidal ideation. Contrary to clinical and popular views, our results highlight that proximal non-mental health variables such as employment, physical health, social factors, and personality are equally important to experiencing suicidal ideation as symptoms of psychological distress.

Is the bipolar spectrum the psychopathological substrate of suicidality in heroin addicts?

BACKGROUND

To describe the prevalence and the risk factors of suicidal ideation in a cohort of Italian opioid addicts presenting for treatment.

METHOD

Systematic cross-sectional clinical data on suicidal ideation, socio-demographic variables, psychiatric status, social adjustment, status and history of addiction in 616 patients were gathered.

RESULTS

Suicidal thoughts during the past week were reported by 29.1%. Suicidal thoughts were more frequent in patients with bipolar spectrum diagnoses (OR = 1.42) and in patients with depressive and aggressive symptoms (multiple R = 0.47). The odds of having suicidal thoughts were also higher for subjects receiving public welfare benefits (OR = 1.69), unemployed patients (OR = 1.37), those with early onset of heroin dependence (OR = 1.36), living alone (OR = 1.33), and experiencing problems in organizing social contacts and leisure time (OR = 1.28).

CONCLUSION

Current suicidal ideation was a common feature of patients with opioid addiction. Depression and hostility as part of the bipolar spectrum - in the context of early-onset drug dependence, work and social/leisure problems - appear independently associated with suicidal ideation. Given the elevated rates of completed suicide in heroin addiction, these data have implications for preventing suicide in patients with this type of addiction. Prospective data are needed to further address this important clinical and public health agenda.

Sex differences in clinical predictors of suicidal acts after major depression: a prospective study

OBJECTIVE

Whether sex differences exist in clinical risk factors associated with suicidal behavior is unknown. The authors postulated that among men with a major depressive episode, aggression, hostility, and history of substance misuse increase risk for future suicidal behavior, while depressive symptoms, childhood history of abuse, fewer reasons for living, and borderline personality disorder do so in depressed women.

METHOD

Patients with DSM-III-R major depression or bipolar disorder seeking treatment for a major depressive episode (N=314) were followed for 2 years. Putative predictors were tested with Cox proportional hazards regression analysis.

RESULTS

During follow-up, 16.6% of the patients attempted or committed suicide. Family history of suicidal acts, past drug use, cigarette smoking, borderline personality disorder, and early parental separation each more than tripled the risk of future suicidal acts in men. For women, the risk for future suicidal acts was sixfold greater for prior suicide attempters; each past attempt increased future risk threefold. Suicidal ideation, lethality of past attempts, hostility, subjective depressive symptoms, fewer reasons for living, comorbid borderline personality disorder, and cigarette smoking also increased the risk of future suicidal acts for women.

CONCLUSIONS

These findings suggest that the importance of risk factors for suicidal acts differs in depressed men and women. This knowledge may improve suicide risk evaluation and guide future research on suicide assessment and prevention.

Factors associated with suicidal ideation in the general population: five-centre analysis from the ODIN study

BACKGROUND

Very few studies have examined the cross-national prevalence of suicidal ideation in the general population or variables associated with it.

AIMS

To examine the risk factors for suicidal ideas in the general population.

METHOD

As part of a five-country two stage epidemiological study of depressive disorder (the ODIN study) a random sample of over 12 000 people were screened using the Beck Depression Inventory (BDI). There followed detailed analysis of item 9 of the BDI, which measured the severity of suicidal ideation.

RESULTS

Age, marriage, concern by others and severity of depressed mood independently increased or decreased the odds of suicidal ideation overall. An interaction between life events and social supports was identified, although this differed between men and women. Only concern by others and severity of depression were independently associated with serious suicidal ideation. The study does not allow for interpretation of the direction of the association.

CONCLUSIONS

A number of social, clinical and demographic variables were independently associated with all suicidal ideation and with serious suicidal ideation. Longitudinal studies are required to confirm whether these are risk factors for or the result of suicidal ideation or have some other relationship.

Suicide and attempted suicide in eating disorders, obesity and weight-image concern

Suicide in anorexia nervosa and bulimia nervosa is a major cause of death. Meta-analyses have shown that individuals suffering from anorexia nervosa and bulimia nervosa commit suicide more often than their counterparts in the general population; also a few studies have suggested that suicide is the major cause of death among patients with anorexia nervosa, refuting the assumption that inanition generally threatens the life of these patients. Data concerning suicide in bulimia nervosa, on the other hand, are still scarce but suicide attempts are easily found among cohorts of patients with bulimia nervosa, which constitutes a risk factor for completed suicide. Suicidality in obesity and individuals with disturbed weight status has been reported. Both in the case of bulimia nervosa and obesity more long-term follow-up studies need to be completed before the risk of suicide for such disorders may be compared with that for anorexia nervosa.

Suicide and cancer: a gender-comparative study

BACKGROUND

Persons with cancer commit suicide more frequently than those without, and males generally commit suicide more frequently than females. A population-based analysis of cancer patients was carried out here, comparing suicide risk between the genders, to elucidate the features specific to each gender.

PATIENTS AND METHODS

A total of 1.3 million cancer cases from the Surveillance, Epidemiology, and End Results program were analyzed. Cox proportional hazards models were fitted to personal, tumor-related, and social variates.

RESULTS

A total of 265 female and 1307 male suicides were enumerated, reflecting 0.04% and 0.19% from each gender, and providing an overall hazard ratio for male suicide of 6.2 [95% confidence interval (CI) 5.4-7.1]. Females with colorectal (P = 0.01) and cervical (P < 0.0001) cancers showed decreased suicide rates. Males with head and neck cancers (P < 0.0001) and myeloma (P = 0.02) had increased rates, whereas rates were decreased in males with lung cancer (P = 0.01), liver (P = 0.01), brain tumors (P = 0.04), and leukemia (P = 0.007). The hazard ratio associated for male suicide with distant metastasis was 2.84 (95% CI 2.49-3.24); for married status, 0.46 (95% CI 0.39-0.54); and for African-American ancestry, 0.24 (95% CI 0.17-0.34)-comparable ratios were seen here for female suicides. In head and neck cancers, with both genders analyzed together, the suicide hazard was increased if surgery was contraindicated (3.0, 95% CI 1.3-6.8), but not if refused.

CONCLUSIONS

The high-risk patient was male, with head and neck cancer or myeloma, advanced disease, little social or cultural support, and limited treatment options. Oncologists and allied health professionals should be aware of the potential for suicide in cancer patients and their associated risk factors.

Suicidal behaviour in Te Rau Hinengaro: the New Zealand Mental Health Survey

OBJECTIVE

To describe prevalence and correlates of suicidal behaviour in the New Zealand population aged 16 years and over.

METHOD

Data are from Te Rau Hinengaro: The New Zealand Mental Health Survey, a nationally representative household survey conducted from October 2003 to December 2004 in a sample of 12,992 participants aged 16 years and over to study prevalences and correlates of mental disorders assessed using the World Mental Health Composite International Diagnostic Interview. Lifetime and 12 month prevalences and onset distributions for suicidal ideation, plans and attempts, and sociodemographic and mental disorder correlates of these behaviours were examined.

RESULTS

Lifetime prevalences were 15.7% for suicidal ideation, 5.5% for suicide plan and 4.5% for suicide attempt, and were consistently significantly higher in females than in males. Twelve-month prevalences were 3.2% for ideation, 1.0% for plan and 0.4% for attempt. Risk of ideation in the past 12 months was higher in females, younger people, people with lower educational qualifications, and people with low household income. Risk of making a plan or attempt was higher in younger people and in people with low household income. After adjustment for sociodemographic factors, there were no ethnic differences in ideation, although Māori and Pacific people had elevated risks of plans and attempts compared with non-Māori non-Pacific people. Individuals with a mental disorder had elevated risks of ideation (11.8%), plan (4.1%) and attempt (1.6%) compared with those without mental disorder. Risks of suicidal ideation, plan and attempt were associated with mood disorder, substance use disorder and anxiety disorder. Major depression was the specific disorder most strongly associated with suicidal ideation, plan and attempt. Less than half of those who reported suicidal behaviours within the past 12 months had made visits to health professionals within that period. Less than one-third of those who had made attempts had received treatment from a psychiatrist.

CONCLUSIONS

Risks of making a suicide plan or attempt were associated with mental disorder and sociodemographic disadvantage. Most people with suicidal behaviours had not seen a health professional for mental health problems during the time that they were suicidal.

Te Rau Hinengaro: the New Zealand Mental Health Survey: overview of methods and findings

OBJECTIVE

To estimate the prevalence and severity of anxiety, mood, substance and eating disorders in New Zealand, and associated disability and treatment.

METHOD

A nationwide face-to-face household survey of residents aged 16 years and over was undertaken between 2003 and 2004. Lay interviewers administered a computerized fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. Oversampling doubled the number of Māori and quadrupled the number of Pacific people. The outcomes reported are demographics, period prevalences, 12 month severity and correlates of disorder, and contact with the health sector, within the past 12 months.

RESULTS

The response rate was 73.3%. There were 12,992 participants (2,595 Māori and 2,236 Pacific people). Period prevalences were as follows: 39.5% had met criteria for a DSM-IV mental disorder at any time in their life before interview, 20.7% had experienced disorder within the past 12 months and 11.6% within the past month. In the past 12 months, 4.7% of the population experienced serious disorder, 9.4% moderate disorder and 6.6% mild disorder. A visit for mental health problems was made to the health-care sector in the past 12 months by 58.0% of those with serious disorder, 36.5% with moderate disorder, 18.5% with mild disorder and 5.7% of those not diagnosed with a disorder. The prevalence of disorder and of serious disorder was higher for younger people and people with less education or lower household income. In contrast, these correlates had little relationship to treatment contact, after adjustment for severity. Compared with the composite Others group, Māori and Pacific people had higher prevalences of disorder, unadjusted for sociodemographic correlates, and were less likely to make treatment contact, in relation to need.

CONCLUSIONS

Mental disorder is common in New Zealand. Many people with current disorder are not receiving treatment, even among those with serious disorder.

Fatores associados à ideação suicida na comunidade: um estudo de caso-controle

Este estudo tem como objetivo identificar variáveis associadas à ideação suicida ao longo dos últimos 12 meses, na cidade de Campinas, São Paulo, Brasil. Através de um estudo de caso-controle investigou-se fatores associados a ideação suicida mediante análise de variáveis independentes relacionadas ao indivíduo, à família e à saúde. Foram entrevistados 29 casos de ideação e 166 controles. Os casos foram identificados através de um inquérito de prevalência e os controles, selecionados aleatoriamente da mesma base populacional, entre os que não relataram pensamento suicida nos últimos 12 meses. Modelos de análise de regressão foram propostos para controlar a ação dos fatores de confusão ou modificadores de efeito. Nos resultados obtidos, as variáveis demográficas não estiveram associadas à ideação. Na análise final permaneceram com significância estatística as variáveis falta de energia e humor deprimido, derivadas do SRQ-20, dificuldades emocionais relatadas, vizinhança não solidária e menor freqüência à igreja. Ideação suicida mostrou-se consistentemente associada a fatores relacionados a sintomas depressivos, principalmente falta de energia e humor deprimido.

Adolescent violence screening in the ED

Youth violence is widely recognized as a major public health problem. Adolescent suicidality (ideation, behavior, or both) is disturbingly common in the United States, and homicide remains one of the leading causes of death for young people aged 10 to 24 years. Assessing youth suicidality and homicidality in the emergency department (ED) is a complex and challenging task. Evidence about the value of available ED risk assessments is not encouraging. Attempts to develop models that predict violence have in part been unsuccessful from the fact that ideation is common and the value of depression is hard to determine. The current study presents an empirically based assessment (adolescent and child urgent threat evaluation) and algorithm (violence ideation and suicidality treatment algorithm) evaluating the impact of ideation and nonideation states on attempt among clinical samples, such as serotonin reuptake inhibitor akathisia and acute adjustment disorders. The authors suggest important time-related factors and easy-to-administer procedures when assessing near-future youth violence. A validated suicide-homicide final common pathway model is discussed.

Suicidal Ideation in Multiple Sclerosis

OBJECTIVE

To examine risk factors for suicidal ideation among people with multiple sclerosis (MS).

DESIGN

Cohort study linking computerized medical records with a mailed self-report survey.

SETTING

Veteran's Health Administration (VHA) region covering the northwestern United States.

PARTICIPANTS

VHA patients with MS (N=445) who returned mailed surveys.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Suicidal ideation is assessed by the Patient Health Questionnaire (PHQ) suicide item with suicidal ideation more than half the days considered persistent.

RESULTS

One hundred thirty-one (29.4%) of 445 respondents (95% confidence interval [CI], 25.4%-33.9%) endorsed suicidal ideation, and 35 (7.9%; 95% CI, 5.7%-10.8%) endorsed persistent suicidal ideation over the last 2 weeks. In bivariate analyses, suicidal ideation was associated with younger age, earlier disease course, progressive disease subtype, lower income, not being married, lower social support, not driving, higher levels of physical disability (mobility, bowel, bladder), and depression. Analyses on persistent suicidal ideation yielded similar results. In fully adjusted multivariate logistic regression, only depression severity and bowel disability were independently associated with suicidal ideation. Only depression severity was independently associated with persistent suicidal ideation. By using the 2-question depression screen (U.S. Preventive Services Task Force) consisting of the depression and anhedonia items from the PHQ-9, sensitivity and specificity were marginal for suicidal ideation (65.6% and 79.9%) but acceptable for persistent suicidal ideation (88.6% and 71.2%).

CONCLUSIONS

Suicidal ideation is common among VHA patients with MS, and depression severity is the best risk marker. Brief screening for depression in MS should include the assessment of suicidal ideation.

The relationship between nonstandard working and mental health in a representative sample of the South Korean population

In light of escalating job insecurity due to increasing numbers of nonstandard workers, this study examined the association between nonstandard employment and mental health among South Korean workers. We analyzed a representative weighted sample of 2086 men and 1194 women aged 20-64 years, using data from the 1998 Korean National Health and Nutrition Examination Survey. Nonstandard employment included part-time work, temporary work, and daily work. Mental health was measured with indicators of self-reported depression and suicidal ideation. Based on age-adjusted prevalence of mental health, nonstandard employees were more likely to be mentally ill compared to standard employees. Furthermore, nonstandard work status was associated with poor mental health after adjusting for socioeconomic position (education, occupational class, and income) and health behaviors (smoking, alcohol consumption, and exercise). However, the pattern of the relationship between nonstandard work and mental health differed by gender. Female gender was significantly associated with poor mental health. Although males tended to report more suicidal ideation, this difference was not statistically significant. Considering the increasing prevalence of nonstandard working conditions in South Korea, the results call for more longitudinal research on the mental health effects of nonstandard work.

Suicidal and deliberate self-harm ideation among patients with physical illness: the role of coping styles

The relationship between coping styles and suicidal ideation (SI) or deliberate self-harm (DSH) ideation among patients with physical illness was examined. Four hundred fifteen adult male medical inpatients completed the Coping Styles Questionnaire. Patients with and without SI, and with and without DSH, were compared on coping styles. Sixteen percent of patients (n = 67) had SI and 18.3% (n = 76) had DSH. SI was associated with higher scores on emotional coping and lower scores on rational and detachment coping styles, compared with those without SI. DSH, compared with those without DSH, was associated with significantly higher scores on avoidance coping strategies. These data suggest coping styles among medical patients with and without SI or DSH may differ. The mechanism of this link is not entirely clear, but it may be that coping styles reflect one possible pathway of the association between poor physical health and SI and DSH. Replication of these results in a longitudinal study is needed. If replicated, incorporation of these data into the development of intervention strategies focused on improving coping strategies may be worthwhile.

Gender in suicide attempt rates and childhood sexual abuse rates: is there an interaction?

Two competing explanations for higher rates of attempted suicide in women than men were compared. Because childhood sexual abuse is more prevalent in girls than boys, one explanation of higher rates of suicide attempts in women is that it is a direct result of the higher incidence of sexual abuse in girls. Alternatively, higher rates of suicide attempts might result from gender differences in the impact of childhood sexual abuse on suicidal behavior. To compare these theories, data from 1,889 abstinent, substance-dependent patients who completed the Childhood Trauma Questionnaire (CTQ) and who were interviewed about suicide attempts was examined. Scores on each scale of the CTQ were examined as a function of gender and attempter status. Results showed higher rates of suicide attempts in women than in men, higher CTQ scores in women than men, and a higher CTQ score in attempters than nonattempters. However, logistic regression indicated that gender and abuse did not interact to determine attempter status. Thus, the data support the first hypothesis that the greater frequency of suicide attempts in women may be partly attributed to the higher prevalence of childhood sexual abuse in girls. The generalizability of these results to the general population and to other diagnostic groups requires further study.

Use of efavirenz is not associated with a higher risk of depressive disorders: a substudy of the randomized clinical trial ALIZE-ANRS 099

BACKGROUND

Efavirenz (EFV) is a highly active antiretroviral drug, use of which is associated with frequent (although transient) neurosensorial adverse reactions. Whether the use of EFV is associated with the risk of depression or suicide remains controversial.

METHODS

ALIZE-ANRS (Agence Nationale de Recherches sur le SIDA et les Hepatites Virales) 099 was a 48-week randomized trial involving virologically suppressed, human immunodeficiency virus (HIV)-infected patients that compared the maintenance of a treatment regimen that contained protease inhibitors (177 subjects) with a switch to a once-daily combination of EFV, didanosine, and emtricitabine (178 subjects). We used the trial's adverse events reporting system and a self-administered Center for Epidemiologic Studies-Depression Scale questionnaire to assess depressive disorders. Determinants were studied using a multivariate proportional hazards model adjusted for antiretroviral treatment, sex, age, HIV risk factor, history of depression, hepatic disorder, alcohol abuse, and HIV-related or non-HIV-related events.

RESULTS

Thirty cases of depressive disorder (26 cases of depression and 4 suicide attempts) occurred during treatment in 27 patients (12 patients [7%] and 15 patients [8%] in the protease inhibitor-based and EFV-based treatment arms, respectively; P = .56). In the proportional hazards model, only age (hazard ratio, 1.6 per 10 years younger; 95% confidence interval, 1.0-2.6) and a history of depressive disorder (hazard ratio, 5.0; 95% confidence interval, 2.1-12.0) were associated with a risk of depressive disorders. The proportion of depressive patients (24%), as determined on the basis of the Center for Epidemiologic Studies-Depression Scale data, was stable during the follow-up period, without difference between treatment groups. Patients with a history of depressive disorder were more frequently depressed (53%) than were those without such history (22%; P = .03).

CONCLUSIONS

The frequency of depressive disorders was high in this population, but the disorders were not related to EFV treatment. Younger age and a history of depression are important determinants for depression and should be considered for early detection and case management.

Life time suicidal thoughts in an urban community in Hanoi, Vietnam

Background

Suicidal thought is a risk factor and a stage in the suicidal process from planning to attempting and dying by suicide. To date, studies on suicidal thought in the general population, especially in Asian communities, have been limited.

Method

The WHO SUPRE-MISS (the multisite intervention study on suicidal behaviours) community survey questionnaire was filled in for 2,280 randomly selected residents of the DongDa district of Hanoi, Vietnam by means of face-to-face interviews. This multi-factor questionnaire includes such variables as sociodemographic information, suicidal thought and history of suicide attempts, physical health, alcohol consumption and medication.

Results

Prevalence rates for life time suicidal thoughts, suicide plans and suicide attempts were 8.9%, 1.1% and 0.4% respectively. Suicidal thoughts are associated with multiple characteristics, such as female gender, single/widowed/separated/divorced marital status, low income, lifestyle (use of alcohol, sedatives and pain relief medication), but not with low education or employment status. Having no religion and being a Buddhist appear to be protective factors for suicidal thought.

The ratio of suicidal thoughts, suicide plans and suicide attempts on a lifetime basis is 22.3:2.8:1.

Conclusion

In Vietnam, as in Western and other Asian countries, suicidal thoughts are associated with similar negative psychosocial risk factors, lifestyle and emotional problems, which implies that suicide preventive measure developed elsewhere can be adjusted to Vietnamese condition. Understanding the unique and common risks in a culture may assist in prediction and control.

Time patterns of attempted suicide

BACKGROUND

The association of mental disorders with time patterns of attempted suicide is poorly understood.

METHODS

The study material consisted of all consecutive suicide attempts admitted to health care in Helsinki during a one-year period from 15 January 1997 to 14 January 1998. Clinical diagnosis was made according to ICD-10.

RESULTS

Overall, the rate of suicide attempts varied markedly during the study period, peaking in autumn and being lowest during winter. Substance use disorders best explained suicide attempts occurring at weekends. There was considerable temporal variation among patients with mood disorders, compared to only slight variation among patients with schizophrenia spectrum disorders. Study subjects tended to contact health services in the late evening and around midnight. Those contacting health services outside normal hours received psychiatric consultation less frequently than others and were referred to aftercare less often.

LIMITATIONS

Structured Clinical Interviews for DSM-IV Axis I and II Disorders were not used.

CONCLUSIONS

There were marked time patterns of attempted suicide, especially among patients with mood disorders and substance use disorders. This contrasted with the limited fluctuation among patients with schizophrenia spectrum disorders. Contacts with the health care system occurred most often in the late evening and around midnight. The findings question the adequacy of staff numbers for psychiatric consultations and of time to plan aftercare.

Assessment of suicidality in a Moroccan metropolitan area

BACKGROUND

The aim of the study was to evaluate the prevalence of suicidal ideations and suicide attempts in a representative sample of the general population of the urban area of Casablanca, Morocco.

METHODS

The survey was conducted based on face-to-face household interviews. The Mini International Neuropsychiatric Interview (M.I.N.I.) was used to assess axis I diagnoses according to DSM-IV criteria and the M.I.N.I. suicidality module to rate the severity of active suicidality.

RESULTS

The 1-month prevalence of suicidal ideation was 6.3%. Seventeen subjects (2.1%) reported at least one suicide attempt during their lifetime. Some variables were positively associated to suicidal ideation: the non-married status, subjects with a history of psychiatric disorders, and subjects without children. At least one mental disorder was present among 88.2% of subjects with suicidal ideation. Major depressive disorder was the most prevalent one (23.5%).

LIMITATIONS

The sample was small and the prevalence was not determined longitudinally.

CONCLUSION

Suicidal ideation being relatively frequent in the general population, there is a need to develop programs of prevention of suicide.

National study of US emergency department visits for attempted suicide and self-inflicted injury, 1997-2001

STUDY OBJECTIVE

We describe the epidemiology of emergency department (ED) visits for attempted suicide and self-inflicted injury.

METHODS

Data were obtained from the National Hospital Ambulatory Medical Care Survey, a national probability sample of ED visits. All visits for attempted suicide or self-inflicted injury (E950 to E959) during 1997 to 2001 were included in these analyses.

RESULTS

During the 5-year period, there were approximately 412,000 annual ED visits for attempted suicide and self-inflicted injury, or 0.4% of all ED visits. The annual visit rate was 1.5 (1.3 to 1.7) visits per 1,000 US citizens. The mean patient age was 31 years, and visits were most common among patients aged 15 to 19 years, at a rate of 3.3 (95% confidence interval 2.1 to 4.4). ED visit rates were higher among female patients (1.7) than male patients (1.3) and among blacks (1.9) than whites (1.5). Visit rates did not differ by metropolitan status or US region. The most common method of injury was poisoning (68%), followed by cutting or piercing (20%). One third of visiting patients were admitted to the hospital, with 31% of admissions going to the ICU. A psychiatric disorder was coded for 55% of visits, with depressive disorder accounting for 34% and alcohol abuse for 16%.

CONCLUSION

ED visits for attempted suicide and self-inflicted injury are relatively common, serious, and most frequent among adolescents and young adults. Self-poisoning is the most common method. The high prevalence of psychiatric and substance abuse disorders in this population suggests these issues should be considered during management and disposition.

High cholesterol, triglycerides, and body-mass index in suicide attempters

Low cholesterol concentrations and cholesterol-lowering therapies have been suggested to be associated with increased suicidality. This article examined the association of cholesterol, triglycerides, and body-mass index (BMI) with suicidal ideation and suicide attempts. Findings are based on a nationally representative community sample of n = 4,181 subjects (18-65 years) examined with a standardized diagnostic interview (CIDI) for (DSM-IV) mental disorders. Controlling for age and gender the study revealed a moderate positive association between cholesterol, triglycerides, BMI, and suicide attempts in subjects with depressive symptoms during the past 12 months (n = 1,205). The results of this study are compatible with two recent epidemiological cohort studies showing a positive association between cholesterol and completed suicide.

Psychometric properties of the Beck Scale for Suicide Ideation: a Norwegian study with university students

This study presents the psychometric properties of the Norwegian language version of the Beck Scale for Suicide Ideation (BSI). The participants were 314 university students (71 males and 243 females) enrolled in one of the introductory courses in psychology or sociology at the Norwegian University of Science and Technology, Norway. The results revealed satisfactory internal consistency and good temporal stability. Moderately high correlations with other measures of suicide ideation suggested satisfactory concurrent validity. Similarly, the construct validity was evidenced by moderate correlations among the BSI, the Hopkins Symptom Check List (HSCL-25) depressive scale, and the Beck Hopelessness Scale (BHS). In general, the findings suggest that the BSI is a reliable and valid instrument to assess severity of suicide ideation in college students.

The accuracy of prevalence estimations for suicide attempts. how reliably do adolescents and young adults report their suicide attempts?

This study explores the accuracy of prevalence estimations for suicide attempts. Data came from the Early Developmental Stages of Psychopathology (EDSP) Study, a prospective community study (mean follow-up period was 42 months) of 3,021 respondents aged 14 to 24 years at the outset of the study. Suicide attempters are at least 1.6 times more likely to drop out than subjects with no suicide attempts and suicidal ideas. A total of 8% of all suicide attempters answered in the negative the depression-related gate questions of all surveys. One-third of all baseline suicide attempters did not report their suicide attempt again at the four years later assessment. In particular, 80% of all nonreporters were female, and almost 60% were aged 14-17 at baseline.

The economic burden of schizophrenia in Canada in 2004

OBJECTIVE

To estimate the financial burden of schizophrenia in Canada in 2004.

METHODS

A prevalence-based cost-of-illness (COI) approach was used. The primary sources of information for the study included a review of the published literature, a review of published reports and documents, secondary analysis of administrative datasets, and information collected directly from various federal and provincial government programs and services. The literature review included publications up to April 2005 reported in MedLine, EMBASE and PsychINFO. Where specific information from a province was not available, the method of mean substitution from other provinces was used. Costs incurred by various levels/departments of government were separated into healthcare and non-healthcare costs. Also included in the analysis was the value of lost productivity for premature mortality and morbidity associated with schizophrenia. Sensitivity analysis was used to test major cost assumptions used in the analysis. Where possible, all resource utilization estimates for the financial burden of schizophrenia were obtained for 2004 and are expressed in 2004 Canadian dollars (CAN dollars).

RESULTS

The estimated number of persons with schizophrenia in Canada in 2004 was 234 305 (95% CI, 136 201-333 402). The direct healthcare and non-healthcare costs were estimated to be 2.02 billion CAN dollars in 2004. There were 374 deaths attributed to schizophrenia. This combined with the high unemployment rate due to schizophrenia resulted in an additional productivity morbidity and mortality loss estimate of 4.83 billion CAN dollars, for a total cost estimate in 2004 of 6.85 billion CAN dollars. By far the largest component of the total cost estimate was for productivity losses associated with morbidity in schizophrenia (70% of total costs) and the results showed that total cost estimates were most sensitive to alternative assumptions regarding the additional unemployment due to schizophrenia in Canada.

CONCLUSIONS

Despite significant improvements in the past decade in pharmacotherapy, programs and services available for patients with schizophrenia, the economic burden of schizophrenia in Canada remains high. The most significant factor affecting the cost of schizophrenia in Canada is lost productivity due to morbidity. Programs targeted at improving patient symptoms and functioning to increase workforce participation has the potential to make a significant contribution in reducing the cost of this severe mental illness in Canada.

Suicidality and associated risk factors among lesbian, gay, and bisexual compared to heterosexual Austrian adults

This is the first study in German-speaking countries to compare the suicidality of lesbian, gay, and bisexual adults (n = 358) with matched heterosexual adults (n = 267). The former had significantly elevated incidences of current suicide ideation (28% vs. 13%) and lifetime suicide attempts defined in three ways (14% vs. 1% to 10% vs. 2%), including higher incidences for most suicidality-related risk factors. Increased psychosocial stress and vulnerability is indicated, especially with respect to a lack of family support. Controlling for risk factors in multivariate analysis diminished the association of sexual orientation with current suicide ideation.

Family history of suicide, female sex, and childhood trauma: separate or interacting risk factors for attempts at suicide?

OBJECTIVE

Female sex, childhood trauma, and a family history of suicidal behavior are three well established risk factors for attempting suicide. However, interactions between these three factors in attempting suicide have been little studied.

METHOD

One thousand eight hundred and eighty-nine abstinent substance dependent patients were interviewed about their lifetime and family history of suicidal behavior and completed the Childhood Trauma Questionnaire (CTQ). Gender, family history of suicidal behavior, and CTQ scores--and their interaction--were examined in relation to suicidal behavior.

RESULTS

Each of the three risk factors was associated with at least a doubling of the risk for an attempt at suicide. There were no significant interactions in relation to the risk of making an attempt. However, female sex and higher levels of childhood trauma each discriminated patients at risk for both a younger age of first attempting suicide and for making more attempts.

CONCLUSION

Female sex, childhood trauma, and a family history of suicidal behavior are each independent, and non-interacting, risk factors for attempting suicide. Additionally, female sex and high childhood trauma are independent risk factors for both an early onset of first attempting suicide and for making more attempts.

Self-harm

The term self-harm is commonly used to describe a wide range of behaviours and intentions including attempted hanging, impulsive self-poisoning, and superficial cutting in response to intolerable tension. As with suicide, rates of self-harm vary greatly between countries. 5-9% of adolescents in western countries report having self-harmed within the previous year. Risk factors include socioeconomic disadvantage, and psychiatric illness--particularly depression, substance abuse, and anxiety disorders. Cultural aspects of some societies may protect against suicide and self-harm and explain some of the international variation in rates of these events. Risk of repetition of self-harm and of later suicide is high. More than 5% of people who have been seen at a hospital after self-harm will have committed suicide within 9 years. Assessment after self-harm includes careful consideration of the patient's intent and beliefs about the lethality of the method used. Strong suicidal intent, high lethality, precautions against being discovered, and psychiatric illness are indicators of high suicide risk. Management after self-harm includes forming a trusting relationship with the patient, jointly identifying problems, ensuring support is available in a crisis, and treating psychiatric illness vigorously. Family and friends may also provide support. Large-scale studies of treatments for specific subgroups of people who self-harm might help to identify more effective treatments than are currently available. Although risk factors for self-harm are well established, aspects that protect people from engaging in self-harm need to be further explored.

Suicide attempts and associated factors in Newfoundland and Labrador, 1998-2000

OBJECTIVE

This study examined the epidemiology and associated factors for suicide attempts requiring hospitalization in the province of Newfoundland and Labrador.

METHOD

We extracted data from the provincial hospital separation database. Outcome measures included incidence rates (IRs) of suicide attempts by age, sex, and geographical region of residence. We also analyzed sociodemographic data to determine associated factors.

RESULTS

A total of 978 patients who were hospitalized owing to suicide attempts were identified for 1998-2000, giving an overall IR of 68.7 per 100,000 person-years (P-Y). The age-specific rate for people aged 15 to 19 years was much greater, at 143.0 per 100,000 P-Y. The overall female-to-male ratio was 1.3, with an attempted suicide rate of 76.1 per 100,000 P-Y for female patients and 60.3 per 100,000 P-Y for male patients (P = 0.001). Labrador (210.2 per 100,000 P-Y), a region with a high Aboriginal population, had a higher rate of suicide attempts, compared with the island portion of the province (59.0 per 100,000 P-Y) (P < 0.001). More than 70% of hospitalizations were associated with psychiatric diagnosis. Poisoning was the most frequent method of attempting suicide. Higher IRs of suicide attempts were found among people who were divorced or separated and among those who were less educated (P < 0.001).

CONCLUSIONS

Suicide attempt represents a significant public health concern in the province, particularly in Labrador. An increased risk of suicide attempts was associated with single status, female sex, younger age (teen or young adult), and low educational level during the index attempt. Further research is needed to explicate these findings and increase our understanding of attempted suicide.

Size and burden of mental disorders in Europe--a critical review and appraisal of 27 studies

Epidemiological data on a wide range of mental disorders from community studies conducted in European countries are presented to determine the availability and consistency of prevalence, disability and treatment findings for the EU. Using a stepwise multimethod approach, 27 eligible studies with quite variable designs and methods including over 150,000 subjects from 16 European countries were identified. Prevalence: On the basis of meta-analytic techniques as well as on reanalyses of selected data sets, it is estimated that about 27% (equals 82.7 million; 95% CI: 78.5-87.1) of the adult EU population, 18-65 of age, is or has been affected by at least one mental disorder in the past 12 months. Taking into account the considerable degree of comorbidity (about one third had more than one disorder), the most frequent disorders are anxiety disorders, depressive, somatoform and substance dependence disorders. When taking into account design, sampling and other methodological differences between studies, little evidence seems to exist for considerable cultural or country variation. Disability and treatment: despite very divergent and fairly crude assessment strategies, the available data consistently demonstrate (a) an association of all mental disorders with a considerable disability burden in terms of number of work days lost (WLD) and (b) generally low utilization and treatment rates. Only 26% of all cases had any consultation with professional health care services, a finding suggesting a considerable degree of unmet need. The paper highlights considerable future research needs for coordinated EU studies across all disorders and age groups. As prevalence estimates could not simply be equated with defined treatment needs, such studies should determine the degree of met and unmet needs for services by taking into account severity, disability and comorbidity. These needs are most pronounced for the new EU member states as well as more generally for adolescent and older populations.

Protective factors against suicidal behavior in Latinos

Latinos appear to be relatively protected against suicidal behavior, but the factors that mediate this effect are not known. Some protective factors may be related to cultural constructs that provide a buffer against suicidal behavior in the face of psychiatric illness. We sought to determine whether the Reasons for Living Inventory (RFLI) might capture protective factors against suicidal behavior in Latinos and non-Latinos. Patients with major depression, bipolar disorder, or schizophrenia were interviewed regarding their depressive symptomatology and lifetime history of suicidal behavior. The RFLI, which measures protective factors against suicidal acts, was also administered. Multivariate analyses were used to assess the relationship between suicide measures, ethnicity, and selected clinical and demographic variables. Although Latinos and non-Latinos did not differ significantly in attempter status (attempter/nonattempter), number of attempts, or suicide intent, Latinos reported significantly less suicidal ideation and made less lethal attempts. On the RFLI, Latinos scored significantly higher on subscales regarding survival and coping beliefs, responsibility to family, and moral objections to suicide, possibly reflective of cultural norms endorsed by Latino groups. Multivariate analyses suggested that although being Latino was independently associated with less suicidal ideation, other suicidal behaviors held a stronger relationship to moral objections to suicide and survival and coping skills than to ethnicity. Self-identification as Latino may be associated with espousing cultural constructs that mediate protective effects against suicidal behavior. Constructs identified in the RFLI may protect Latinos from acting on suicidal thoughts, affecting moral objections to suicide and survival and coping beliefs. Further studies to elucidate the impact of these factors on suicidal behavior and their relationship to specific cultural constructs would be of interest.

Depression and Suicidal Behavior in Acne Patients Treated With Isotretinoin: A Systematic Review

Isotretinoin (13-cis retinoic acid) is an effective treatment for severe cystic or recalcitrant acne vulgaris; however, concerns have been raised regarding its potential association with depression and suicidal behavior. We sought to explore the proposed relationship between isotretinoin use and the risk of depression and attempted and completed suicide in patients with acne vulgaris by performing a systematic literature search for studies reporting primary data on depression and suicidal behavior in patients treated with isotretinoin for acne vulgaris. Nine studies met the qualifying criteria for our analysis. Rates of depression among isotretinoin users ranged from 1% to 11% across studies, with similar rates in oral antibiotic control groups. Overall, studies comparing depression before and after treatment did not show a statistically significant increase in depression diagnoses or depressive symptoms. Some, in fact, demonstrated a trend toward fewer or less severe depressive symptoms after isotretinoin therapy. This decrease was particularly evident in patients with pretreatment scores in the moderate or clinical depression range. No correlation between isotretinoin use and suicidal behavior was reported, although only one retrospective study presented data on this topic. Although the current literature does not support a causative association between isotretinoin use and depression, there are important limitations to many of the studies. The available data on suicidal behavior during isotretinoin treatment are insufficient to establish a meaningful causative association.