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Wolford-Clevenger C, Cropsey KL. Depressive symptoms and age of alcohol use onset interact to predict suicidal ideation. DEATH STUDIES 2019; 44:540-546. [PMID: 30938583 PMCID: PMC6774920 DOI: 10.1080/07481187.2019.1586798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Distal risk factors of alcohol use may increase suicidal ideation in the presence of proximal risk factors, such as depressive symptoms. We tested whether depressive symptoms and age at onset of alcohol use interact to predict suicidal ideation in 500 individuals (67% men; 68% Black/African American) under criminal justice supervision. Regression analysis revealed that age of onset negatively associated with suicidal ideation only at average and high levels of depressive symptoms while controlling for suicide attempt history. Clinicians may consider individuals with an early age of onset of alcohol use and current depressive symptoms at risk for suicidal ideation.
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Affiliation(s)
| | - Karen L Cropsey
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama-Birmingham, Birmingham, Alabama, USA
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2
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Jacob L, Haro JM, Koyanagi A. The association of religiosity with suicidal ideation and suicide attempts in the United Kingdom. Acta Psychiatr Scand 2019; 139:164-173. [PMID: 30328099 DOI: 10.1111/acps.12972] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The goal was to analyze the association of religiosity with suicidal ideation and suicide attempts in a UK nationally representative sample. METHODS This study used cross-sectional data from 7403 people who participated in the 2007 Adult Psychiatric Morbidity Survey (APMS). Religion was assessed with the question 'Do you have a specific religion?' with 'yes' and 'no' answer options. Lifetime and past 12-month suicidal ideation and suicide attempts were assessed. The association between religiosity and suicidality was studied in multivariable logistic regression models adjusted for sociodemographic, behavioural, and psychopathological factors. RESULTS Compared to those without a religion, the prevalence of past 12-month suicidal ideation (3.2% vs. 5.4%), past 12-month suicide attempts (0.4% vs. 0.9%), lifetime suicidal ideation (11.2% vs. 16.4%), and lifetime suicide attempts (3.6% vs. 6.0%) was lower among those with a religion. In the fully adjusted model, having a religion was significantly associated with lower odds for all types of suicidality except past 12-month suicide attempts: suicidal ideation (past 12-month: OR = 0.71, 95% CI = 0.51-0.99; lifetime: OR = 0.83, 95% CI = 0.69-0.99) and suicide attempts (past 12-month: OR = 0.71, 95% CI = 0.35-1.45; lifetime: OR = 0.69, 95% CI = 0.53-0.90). CONCLUSION There is a negative association between religiosity and suicidality in the UK. Future studies should focus on the underlying mechanisms.
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Affiliation(s)
- L Jacob
- Faculty of Medicine, University of Paris 5, Paris, France
| | - J M Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - A Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
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3
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Kerr K, Romaniuk M, McLeay S, Khoo A, Dent MT, Boshen M. Increased risk of attempted suicide in Australian veterans is associated with total and permanent incapacitation, unemployment and posttraumatic stress disorder severity. Aust N Z J Psychiatry 2018; 52:552-560. [PMID: 28707521 DOI: 10.1177/0004867417718945] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Military veterans have higher rates of suicidality and completed suicides compared to the general population. Previous research has demonstrated suicidal behaviour is higher in US combat veterans who are younger, suffer from posttraumatic stress disorder, depression and anxiety and score lower on measures of health. However, research on predictors of suicide for Australian veterans is limited. The aim of this study was to identify significant demographic and psychological differences between veterans with posttraumatic stress disorder who had attempted suicide and those with posttraumatic stress disorder who had not, as well as determine predictors of suicide attempts within an Australian cohort. METHODS A retrospective analysis was conducted on 229 ex-service personnel diagnosed with posttraumatic stress disorder who had attended a Military Service Trauma Recovery Day Program as outpatients at Toowong Private Hospital from 2007 to 2014. Patients completed a battery of mental health self-report questionnaires assessing symptoms of posttraumatic stress disorder, alcohol use, anger, depression, anxiety and quality of life. Demographic information and self-reported history of suicide attempts were also recorded. RESULTS Results indicated the average age was significantly lower, and the rates of posttraumatic stress disorder, anger, anxiety and depression symptoms were significantly higher in those veterans with history of a suicide attempt. Multivariate logistic regression analyses indicated posttraumatic stress disorder symptom severity, unemployment or total and permanent incapacity pension status significantly predicted suicide attempt history. CONCLUSION Among a cohort of Australian veterans with posttraumatic stress disorder, psychopathology severity, unemployment and total and permanent incapacity status are significantly associated with suicidality. This study highlights the importance of early identification of posttraumatic stress disorder and psychopathology, therapeutic and social engagement, and prioritisation of tangible employment options or meaningful and goal-directed activities for veterans deemed unable to work.
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Affiliation(s)
- Katelyn Kerr
- 1 Toowong Private Hospital, Toowong, QLD, Australia.,2 Life Promotion Clinic, Australian Institute for Suicide Research and Prevention, Griffith University, Mt Gravatt, QLD, Australia
| | - Madeline Romaniuk
- 3 Gallipoli Medical Research Institute, Greenslopes Private Hospital, Greenslopes, QLD, Australia.,4 Institute of Health & Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia.,5 Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Sarah McLeay
- 3 Gallipoli Medical Research Institute, Greenslopes Private Hospital, Greenslopes, QLD, Australia
| | - Andrew Khoo
- 1 Toowong Private Hospital, Toowong, QLD, Australia.,3 Gallipoli Medical Research Institute, Greenslopes Private Hospital, Greenslopes, QLD, Australia.,6 School of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | | | - Mark Boshen
- 7 School of Applied Psychology, Griffith University, Southport, QLD, Australia
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4
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Athey A, Overholser J. A Systematic Review of Suicide Risk in Veterans: Depression is a More Powerful Predictor than Comorbid Psychiatric Disorders. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/21635781.2018.1442757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Alison Athey
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
| | - James Overholser
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
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5
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Cohen GH, Fink DS, Sampson L, Tamburrino M, Liberzon I, Calabrese JR, Galea S. Coincident alcohol dependence and depression increases risk of suicidal ideation among Army National Guard soldiers. Ann Epidemiol 2016; 27:157-163.e1. [PMID: 28139369 DOI: 10.1016/j.annepidem.2016.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 11/26/2016] [Accepted: 12/04/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Suicide rates among military service members have risen dramatically, while drivers remain poorly understood. We examined the relationship between coincident alcohol dependence and depression in shaping risk of suicidal ideation among National Guard forces. METHODS We performed a longitudinal analysis using a randomly selected, population-based sample of Ohio Army National Guard soldiers. Telephone-based surveys of 1582 soldiers who participated in both wave 1 (2008-2009) and wave 2 (2009-2010) were analyzed. RESULTS Odds ratios (ORs) for suicidal ideation among those with versus without alcohol dependence were similar among nondepressed (OR = 3.85 [95% confidence intervals (CIs) = 1.18-12.52]) and depressed individuals (OR = 3.13 [95% CI = 0.88-11.14]); multiplicative interaction was not observed. In contrast, the risk differences (RDs) among those with versus without alcohol dependence diverged for those without depression (RD = 0.04 [95% CI = 0.02-0.07]) compared with those with depression (RD = 0.11 [95% CI = 0.06-0.18]); strong evidence of additive interaction was observed. CONCLUSIONS We found that alcohol dependence and depression interact statistically in shaping risk for incident suicidal ideation among Army National Guard service members. A high-risk prevention approach including population-based screening for suicidality among patients with alcohol dependence, depression, and particularly those with both conditions is warranted in military populations.
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Affiliation(s)
- Gregory H Cohen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
| | - David S Fink
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Laura Sampson
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Marijo Tamburrino
- Department of Psychiatry, University of Toledo Health Science Center, Toledo, OH
| | | | - Joseph R Calabrese
- Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH
| | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, MA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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6
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Mallick F, McCullumsmith CB. Ketamine for Treatment of Suicidal Ideation and Reduction of Risk for Suicidal Behavior. Curr Psychiatry Rep 2016; 18:61. [PMID: 27194043 DOI: 10.1007/s11920-016-0680-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Ketamine, an NMDA receptor antagonist with efficacy as a rapid anti-depressant, has early evidence for action to reduce suicidal ideation. This review will explore several important questions that arise from these studies. First, how do we measure reductions in suicidal ideation that occur over minutes to hours? Second, are the reductions in suicidal ideation after ketamine treatment solely a result of its rapid anti-depressant effect? Third, is ketamine only effective in reducing suicidal ideation in patients with mood disorders? Fourth, could ketamine's action lead us to a greater understanding of the neurobiology of suicidal processes? Last, do the reductions in depression and suicidal ideation after ketamine treatment translate into decreased risk for suicidal behavior? Our review concludes that ketamine treatment can be seen as a double-edged sword, clinically to help provide treatment for acutely suicidal patients and experimentally to explore the neurobiological nature of suicidal ideation and suicidal behavior.
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Affiliation(s)
- Faryal Mallick
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Cheryl B McCullumsmith
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA.
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7
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Kenneson A, Funderburk JS, Maisto SA. Substance use disorders increase the odds of subsequent mood disorders. Drug Alcohol Depend 2013; 133:338-43. [PMID: 23906994 DOI: 10.1016/j.drugalcdep.2013.06.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 06/06/2013] [Accepted: 06/08/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is a well-known association between mood disorders and substance use disorders (SUD), but little research has been conducted on SUDs as risk factors for the development of subsequent mood disorders. METHODS We analyzed data from the National Comorbidity Survey Replication study. Diagnoses were determined using DSM-IV criteria. Odds ratios (aORs) of subsequently developing mood disorders were adjusted for age, sex and race/ethnicity. RESULTS Data from 5217 individuals were included (6.6% male; mean age 45.3 years; 72.6% White, 11.2% Black, 12.5% Hispanic and 3.7% other). Subsequent mood disorders developed in 26.4% of individuals with primary adolescent-onset SUD (12-17 years), 21.7% of those with SUD onset at 18-25 years, and 14.0% of those with SUD onset between the ages of 26 and 34 years. The mean lagtime between SUD onset and development of a mood disorder was about 11 years. Controlling for demographic variables, the aORs of developing a mood disorder in these three age groups were 2.44, 3.65, and 3.25. Substance dependence was associated with higher odds of mood disorders than was abuse. Among the specific mood disorders, the increased odds of developing bipolar disorder were particularly high among individuals with drug dependence. CONCLUSIONS Individuals with adolescent and young adult-onset SUD had increased odds of developing a secondary mood disorder. This indicates that adolescents and young adults with SUD should be closely monitored for both positive and negative mood symptoms. SUD treatment and aftercare offer opportunities for the early identification of secondary mood disorders.
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Affiliation(s)
- Aileen Kenneson
- Center for Integrated Healthcare, Veterans Affairs Medical Center, Syracuse, NY 13210, USA.
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8
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Bryan CJ, Hernandez AM, Allison S, Clemans T. Combat Exposure and Suicide Risk in Two Samples of Military Personnel. J Clin Psychol 2012; 69:64-77. [DOI: 10.1002/jclp.21932] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Sybil Allison
- University of Texas Health Science Center at San Antonio
| | - Tracy Clemans
- University of Texas Health Science Center at San Antonio
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9
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Abstract
Military veterans represent a unique, heterogeneous population with suicide prevalence rates, risk factors and preventative management needs that differ from those of the rest of community. Veterans worldwide receive high proportions of their healthcare from community providers, and sensitivity to these distinct needs is required for optimized care. An overview of the recent prevalence-study literature, with a focus upon statistical design, is presented in order to provide a critical orientation within this field with high levels of popular media attention. Attention to psychiatric comorbidity, subthreshold symptomology, select signature disorders of contemporary conflicts (namely, post-traumatic stress disorder and traumatic brain injury), and veteran life narratives before, within and beyond military service will guide our review of risk factor assessment and management strategies. This critical review of the literature provides an overview of this active field of neuropsychiatric research with a select focus upon these topics of special interest.
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Affiliation(s)
- Timothy R Rice
- Department of Psychiatry, The Mount Sinai School of Medicine, 1425 Madison Avenue, Box 1230, New York, NY 10029, USA.
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10
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Lemaire CM, Graham DP. Factors associated with suicidal ideation in OEF/OIF veterans. J Affect Disord 2011; 130:231-8. [PMID: 21055828 DOI: 10.1016/j.jad.2010.10.021] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 10/10/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND The purpose of this project was to examine factors associated with suicidal ideation in returning Iraq and Afghanistan war veterans. METHODS A cross-sectional review of 1740 veterans' initial mental health screening evaluations. One-hundred and thirteen (6.5%) OEF/OIF veterans reported active suicidal ideation at the time of the interview. RESULTS Prior exposures of physical or sexual abuse and having a history of a prior suicide attempt(s) were associated with the presence of current suicidal ideation, as were having a diagnosis of a psychotic disorder, a depressive disorder, or posttraumatic stress disorder (PTSD). Deployment concerns related to training (protective), the deployment environment, family concerns, deployment concerns, post-deployment support (protective), and post-deployment stressors were also associated with current suicidal ideation. Logistic regression analysis revealed the major risk factors were having a prior suicide attempt, female gender, and a depressive disorder diagnosis; while more perceived current social support was a protective factor. Logistic regression analysis also revealed having comorbid PTSD and depression carried a higher odds ratio for risk than did having either PTSD or depression alone; and that the PTSD avoidance symptom-cluster was associated with more risk than either the re-experiencing or hyper-arousal symptom clusters for current suicidal ideation. LIMITATIONS As a cross-sectional retrospective medical chart review, limitations include limited generalizability and causal relationships cannot be evaluated. CONCLUSIONS Further investigation of these risk factors is warranted to aid in suicide risk assessment and in the development of targeted interventions to mitigate the identified risk factors and bolster the identified protective factor.
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Affiliation(s)
- Chad M Lemaire
- The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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11
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Oquendo MA, Currier D, Liu SM, Hasin DS, Grant BF, Blanco C. Increased risk for suicidal behavior in comorbid bipolar disorder and alcohol use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). J Clin Psychiatry 2010; 71:902-9. [PMID: 20667292 PMCID: PMC2914308 DOI: 10.4088/jcp.09m05198gry] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 06/09/2009] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Bipolar disorder is associated with a high rate of suicide attempt, and alcohol use disorders have also been associated with elevated risk for suicidal behavior. Whether risk for suicidal behavior is elevated when these conditions are comorbid has not been addressed in epidemiologic studies. METHOD 1,643 individuals with a DSM-IV lifetime diagnosis of bipolar disorder were identified from 43,093 general-population respondents who were interviewed in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. Assessments were made using the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (AUDADIS-IV). Lifetime prevalence of reported history of suicide attempt and suicidal thoughts among bipolar disorder respondents with and without DSM-IV lifetime alcohol use disorders (abuse or dependence) was assessed using chi-squared and adjusted odds ratios with confidence intervals. Logistic regression was used to test the relevance of other comorbid clinical conditions to suicide risk in bipolar respondents with and without comorbid alcohol use disorders. RESULTS More than half of the respondents (54%) who met criteria for bipolar disorder also reported alcohol use disorder. Bipolar individuals with comorbid alcohol use disorder were at greater risk for suicide attempt than those individuals without alcohol use disorder (adjusted odds ratio=2.25; 95% CI, 1.61-3.14) and were more likely to have comorbid nicotine dependence and drug use disorders. Nicotine dependence and drug use disorders did not increase risk for suicidal behavior among those with bipolar disorder, nor did they confer additional risk among bipolar respondents who also reported alcohol use disorder. Despite greater psychopathological burden, individuals with comorbid bipolar disorder and alcohol use disorder did not receive more treatment or more intensive treatment. CONCLUSIONS Suicidal behavior is more likely to occur in bipolar respondents who also suffer from alcohol use disorder. Interventions to reduce suicide risk in bipolar disorder need to address the common and high-risk comorbidity with alcohol use disorders.
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Affiliation(s)
- Maria A Oquendo
- Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, USA.
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12
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Panagioti M, Gooding P, Tarrier N. Post-traumatic stress disorder and suicidal behavior: A narrative review. Clin Psychol Rev 2009; 29:471-82. [DOI: 10.1016/j.cpr.2009.05.001] [Citation(s) in RCA: 173] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 05/29/2009] [Accepted: 05/30/2009] [Indexed: 01/07/2023]
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13
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Sullivan LE, Saitz R, Cheng DM, Libman H, Nunes D, Samet JH. The impact of alcohol use on depressive symptoms in human immunodeficiency virus-infected patients. Addiction 2008; 103:1461-7. [PMID: 18637000 PMCID: PMC2661114 DOI: 10.1111/j.1360-0443.2008.02245.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS To examine the impact of alcohol use on depressive symptoms in human immunodeficiency virus (HIV)-infected patients. DESIGN Data were collected at 6-month intervals and analyzed to evaluate the association between alcohol dependence and consumption on depressive symptoms using longitudinal mixed-effects regression models controlling for specified covariates. MEASUREMENTS The two independent variables were current alcohol dependence assessed using the Composite International Diagnostic Interview (CIDI) and past month consumption (heavy versus not heavy drinking) using a validated calendar-based method. The primary outcome was depressive symptoms as measured by the Center for Epidemiologic Studies Depression Scale (CES-D). PARTICIPANTS HIV-infected adults with current or past alcohol problems. FINDINGS Alcohol dependence and heavy alcohol use were significantly associated with higher CES-D scores in unadjusted models. In adjusted analyses, the association of current alcohol dependence persisted [mean difference in CES-D was 3.49 for dependence versus non-dependence; 95% confidence interval (CI): 1.76-5.22]; however, the effect of heavy drinking was no longer statistically significant (mean difference in CES-D was 1.04 for heavy versus not heavy drinking; 95% CI: -0.24-2.32). CONCLUSIONS Alcohol use is associated with more depressive symptoms in HIV-infected patients with alcohol problems. This association remains significant after adjusting for potential confounders only when alcohol use meets the criteria for alcohol dependence.
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Affiliation(s)
| | - Richard Saitz
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine ,Department of Epidemiology and Youth Alcohol Prevention Center, Boston University School of Public Health
| | - Debbie M. Cheng
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine ,Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Howard Libman
- Divisions of General Medicine and Primary Care and Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - David Nunes
- Section of Gastroenterology, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Jeffrey H. Samet
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine ,Department of Social and Behavioral Sciences, Boston University School of Public Health, Boston, MA
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Zivin K, Kim HM, McCarthy JF, Austin KL, Hoggatt KJ, Walters H, Valenstein M. Suicide mortality among individuals receiving treatment for depression in the Veterans Affairs health system: associations with patient and treatment setting characteristics. Am J Public Health 2007; 97:2193-8. [PMID: 17971541 DOI: 10.2105/ajph.2007.115477] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We sought to report clinical and demographic factors associated with suicide among depressed veterans in an attempt to determine what characteristics identified depressed veterans at high risk for suicide. METHODS We used longitudinal, nationally representative data (1999-2004) to determine suicide rates among depressed veterans, estimating time until suicide using Cox proportional hazards regression models. RESULTS Of 807694 veterans meeting study criteria, 1683 (0.21%) committed suicide during follow-up. Increased suicide risks were observed among male, younger, and non-Hispanic White patients. Veterans without service-connected disabilities, with inpatient psychiatric hospitalizations in the year prior to their qualifying depression diagnosis, with comorbid substance use, and living in the southern or western United States were also at higher risk. Posttraumatic stress disorder (PTSD) with comorbid depression was associated with lower suicide rates, and younger depressed veterans with PTSD had a higher suicide rate than did older depressed veterans with PTSD. CONCLUSIONS Unlike the general population, older and younger veterans are more prone to suicide than are middle-aged veterans. Future research should examine the relationship between depression, PTSD, health service use, and suicide risks among veterans.
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Affiliation(s)
- Kara Zivin
- Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Health Services Research and Development (HSR&D) Center of Excellence, Department of Veterans Affairs, Ann Arbor, Mich, USA.
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15
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Abstract
The relationship between alcohol use and later-life depression is complex. At-risk and problem drinking elevates the risk of depressive symptoms. The co-occurrence of alcohol use disorders and depression increases the potential for poor mental and physical health outcomes in older adults. Many older adults who are experiencing problems related to alcohol use do not meet alcohol abuse/dependence criteria. Depressive symptoms among older adults often are overlooked or misdiagnosed. The role of at-risk and problem alcohol use in depressive symptoms and vice versa may be underestimated. After a review of the literature, clinical recommendations for addressing late-life alcohol misuse and depression are presented.
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Affiliation(s)
- Frederic C Blow
- University of Michigan Department of Psychiatry, 4250 Plymouth Road, Campus Box 5765, Ann Arbor, MI 48109-2700, USA.
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16
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Marangell LB, Bauer MS, Dennehy EB, Wisniewski SR, Allen MH, Miklowitz DJ, Oquendo MA, Frank E, Perlis RH, Martinez JM, Fagiolini A, Otto MW, Chessick CA, Zboyan HA, Miyahara S, Sachs G, Thase ME. Prospective predictors of suicide and suicide attempts in 1,556 patients with bipolar disorders followed for up to 2 years. Bipolar Disord 2006; 8:566-75. [PMID: 17042830 DOI: 10.1111/j.1399-5618.2006.00369.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Bipolar disorders are associated with high rates of suicide attempts (SAs) and completions. Several factors have been reported to be associated with suicide in persons with bipolar disorder, but most studies to date have been retrospective and have not utilized multivariate statistics to account for the redundant prediction among variables submitted for analysis. METHODS This study examined the association between baseline clinical and demographic variables and subsequent SAs and completions through 2 years of follow-up of participants in the Systematic Treatment Enhancement Program for Bipolar Disorder using a pattern-mixture model. RESULTS Of the sample with complete data (n = 1,556), 57 patients (3.66%) experienced an SA or completion (CS). Several variables predicted suicidality (SA + CS) in this data set when considered alone, but after controlling for redundant prediction from other baseline characteristics, only history of suicide [odds ratio (OR) = 4.52, p < 0.0001] and percent days depressed in the past year (OR = 1.16, p = 0.036) were significantly associated with SAs and completions. A secondary analysis included a greater number of variables but a smaller sample size (n = 1,014). In the secondary analyses, only prior SAs predicted prospective suicidality (OR = 3.87, p = 0.0029). CONCLUSIONS These results indicate that patients with bipolar disorder who present with a history of SAs are over four times as likely to have a subsequent SA or completion. Further studies are needed to evaluate and prevent future attempts in this high-risk cohort.
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Affiliation(s)
- Lauren B Marangell
- Mood Disorders Center, Menninger Department of Psychiatry, Baylor College of Medicine and the Department of Veterans Affairs, VISN 16 MIRECC, Houston, TX 77030, USA.
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17
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Abstract
Suicide is among the leading causes of death in the United States, ranking 10th to 12th annually, depending on the year. Rates of suicide increase markedly among Americans over age 75, especially among white men. After age 85, rates are >5-fold higher in this group than in the general population. The relationship between alcohol use and later-life suicide is complex and currently ill defined. Substance use disorders, particularly alcohol abuse and dependence, are the second most common category of axis I disorders associated with completed suicide among adults aged 65 and older, following only depression. The co-occurrence of alcohol use disorders and depression heightens suicide risk. Most studies that have evaluated the effects of alcohol in geriatric suicide have focused on older adults who met DSM criteria for abuse and/or dependence. However, the majority of older adults who are experiencing problems related to their alcohol use do not meet alcohol abuse/dependence criteria. Therefore, the role of at-risk and problem alcohol use in geriatric suicide may be underestimated. Drinking among elders elevates suicide risk through interactions with other factors that are more prevalent in this age group, such as depressive symptoms, medical illness, negatively perceived health status, and low social support. This article reviews the literature related to alcohol use and suicide among older adults. Clinical and research recommendations for addressing this problem are also presented.
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Affiliation(s)
- Frederic C Blow
- University of Michigan, Department of Psychiatry Division of Substance Abuse, Ann Arbor, Michigan, USA.
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19
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Demirbas H, Celik S, Ilhan IO, Doğan YB. An examination of suicide probability in alcoholic in-patients. Alcohol Alcohol 2003; 38:67-70. [PMID: 12554611 DOI: 10.1093/alcalc/agg019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS This study evaluated correlations of self esteem, depression, and state-trait anxiety with suicide probability in alcohol dependence. METHODS The sample consists of 70 patients who were hospitalized in the Alcohol and Substance Abuse Treatment Unit in the Psychiatry Clinic of Ankara University between the years 1999 and 2000. Patients' histories, the Suicide Probability Scale, the Coopersmith Self-Esteem Inventory, the Beck Depression Inventory and the Spielberger State-Trait Anxiety Scales were used. Correlation, linear regression and t-test statistical analyses were performed. RESULTS AND CONCLUSIONS It was found that self-esteem, depression and trait anxiety predict suicide probability. Suicide probability was higher within the sub-sample with a history of a suicidal act in comparison to those without such a history.
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Affiliation(s)
- Hatice Demirbas
- Alcohol and Substance Abuse Treatment Unit, Ankara University Faculty of Medicine, Ankara, Turkey
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Abstract
Attempted suicide is an act associated with childhood sexual abuse, depression, bipolar illness, substance abuse, and other diagnoses, as documented in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (American Psychiatric Association [APA], 1994). Three women, who attended a group to decrease their depression and increase their self-esteem and who had histories of multiple suicide attempts, agreed to participate in interviews designed to determine the common factors associated with their suicide attempts and to examine the assertion that their suicide attempts were an addiction, similar to their addictions to alcohol and drugs. The common factors found were depression, substance use disorders with early abuse and risky behaviors, history of sexual abuse, faulty relationships, alteration of mood with a suicide plan, and distorted and illogical thinking and motivation. The similarities to addiction also were described. Based on the complexity of factors that emerged and the addictive nature of the suicide attempts, treatment for similar patients needs to be multidimensional and ongoing to allow sufficient time to monitor progress and address the numerous factors involved.
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Affiliation(s)
- S Mynatt
- Psychiatric Family Nurse Practitioner, College of Nursing, University of Tennessee Health Science Center, 877 Madison Avenue, Memphis, TN 38163, USA
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