Suicide in mood disorders

Disparities and trends in suicidal ideations for inflammatory bowel disease hospitalizations: a decade-long national database analysis

Aim: Patients with inflammatory bowel disease (IBD) are more likely to develop anxiety or depression. The study aimed to describe the trends and disparities of suicidal ideation (SI) in hospitalized IBD patients. Methods: A retrospective study was conducted using the National Inpatient Sample (NIS) database, to analyze SI among the IBD hospitalizations from 2009 to 2019. Bivariate analysis was conducted using a chi-square test for categorical variables and an independent t-test for continuous variables. For prevalence, the trend over time was evaluated using the score test. Results: There were 1,724 IBD hospitalizations with SI for the study period. There was a male (53.8%) and white race (74.2%) predominance. The mean age was 41.47 ± 0.25 years. The hospital stay decreased for IBD hospitalizations with SI from 7.97 days in 2009 to 7.57 days in 2019 (P < 0.001). The mean hospital charge increased from $44,664 in 2009 to $66,639 in 2019 (P < 0.001). The prevalence of SIs increased from 0.17% in 2009 to 0.29% in 2019 (P < 0.001). The mean age of these hospitalizations increased from 38 years in 2009 to 42.3 years in 2019 (P = 0.02). The prevalence of generalized anxiety disorder (GAD) increased from < 1% in 2009 to 12.19% in 2019 (P < 0.001). The prevalence of depression increased from 18.04% in 2009 to 51.21% in 2019 (P < 0.001). Inpatient mortality increased from 0% in 2009 to 2.43% in 2019 (P = 0.024). Among IBD hospitalizations, the male gender had a higher association with SIs than females (odds ratio 1.32 [95% confidence intervals (CI) 1.06–1.66], P = 0.014). Conclusions: There is a rise of SI among the IBD population. Specialized protocols should be in place in clinical settings and communities to identify and assess high-risk patients.

Analysis of Attempted Suicide in a Pediatric Setting: Extracted Notes for Clinical Practice and Complexity of Help

Background and Objectives: Suicidality among adolescents is a global mental health issue. However, the post-suicidal care of minors is insufficient and lacks complexity, as repeated attempts occur. Further, little is known about the social (i.e., family setting) and psychological (for example, exposure to bullying, suicidality, or addiction within a close environment) backgrounds of minors who engage in suicidal behavior in Lithuania. Thus, the aim of our study was to evaluate and compare psychosocial factors that may influence minors’ decisions to attempt suicide for the first time and then repeatedly and to extract notes for future clinical practice. Materials and Methods: Data from 187 cases of suicide attempts by minors treated at the Children’s Hospital of Vilnius University Santara Clinics from January 2011 to January 2018 was obtained and analyzed. Results: The data showed that 48.7% of minors hospitalized because of a suicide attempt had a history of previous suicide attempts. Minors who attempted suicide repeatedly were more often engaged in non-suicidal self-injurious behavior (p = 0.033). Further, a small number had experienced suicide within their close surroundings (p = 0.045). The comparative analysis did not reveal any significant differences in psychosocial backgrounds between first-time attempters and those who attempted suicide for at least a second time. Conclusions: Social and psychological support after a suicide attempt in a pediatric setting is lacking efficiency, as minors who repeatedly attempt suicide suffer from similar psychosocial burdens. Complex and targeted follow-up care is needed.

Sense of Belonging and Youth Suicidal Behaviors: What Do Communities and Schools Have to Do with It?

Situating Thomas Joiner's concept of belonging within an ecological perspective, this study examined the associations between school and community belonging and suicidal ideation and attempts among high school students. The study used data from the 2013 Texas Youth Risk Behavior Survey (N = 2,560). Results demonstrated that community belonging reduced the odds of youth suicidal behaviors. School bullying, feeling unsafe at school, and being threatened or injured at a school increased the odds of suicidal behaviors. Findings suggest that fostering safe and inclusive environments and strengthening youth's experiences of school and community belonging may reduce suicidal behaviors in high school youth.

Cellular and Molecular Inflammatory Profile of the Choroid Plexus in Depression and Suicide

The inflammatory hypothesis of depression is one of the main theories that endeavors to explain and describe the underlying biological mechanisms of depression and suicide. While mounting evidence indicates altered peripheral and central inflammatory profiles in depressed patients and suicide completers, little is known about how peripheral and central inflammation might be linked in these contexts. The choroid plexus (ChP), a highly vascularized tissue that produces cerebrospinal fluid (CSF) and lacks a blood-brain-barrier, is an interface between peripheral and central immune responses. In the present study, we investigated the cellular and molecular inflammatory profile of the ChP of the lateral ventricle in depressed suicides and psychiatrically healthy controls. Gene expression of macrophages, pro- and anti-inflammatory cytokines, and various factors implicated in immune cell trafficking were measured; and density of ionized calcium-binding adaptor molecule 1-positive (Iba1+) macrophages associated with the ChP epithelial cell layer (ECL) was examined. Significant downregulations of the genes encoding interleukin 1ß (IL1ß), a pro-inflammatory acute-phase protein; intercellular cell adhesion molecule 1 (ICAM1), a protein implicated in immune cell trafficking in the ChP; and IBA1, a monocyte/macrophage marker; were detected in depressed suicides as compared to controls. No difference in the density of Iba1+ macrophages associated with the ChP ECL was observed. While interpretation of these findings is challenging in the absence of corroborating data from the CSF, peripheral blood, or brain parenchyma of the present cohort, we hypothesize that the present findings reflect a ChP compensatory mechanism that attenuates the detrimental effects of chronically altered pro-inflammatory signaling caused by elevated levels of pro-inflammatory cytokines, such as IL-1ß, peripherally and/or centrally. Together, these findings further implicate neuroimmune processes in the etiology of depression and suicide.

Association study of early-immediate genes in childhood-onset mood disorders and suicide attempt

Childhood-onset mood disorders (COMD) are serious affective disorders with deleterious developmental sequelae including interpersonal dysfunction, psychotic symptoms and suicidal behavior. The current study examines 10 markers from two early-immediate genes for association with COMD and suicide attempt (SA) - HOMER1 and human neuronal pentraxin II (NPTX2). We examined individuals diagnosed with COMD versus matched controls, as well as individuals with COMD and a history of at least one lifetime SA versus COMD participants with no history of SA. No significant genotypic association was noted between any of the single nucleotide polymorphisms (SNPs) and COMD. Our sample yielded a nominally significant allelic association between the HOMER1 rs7713917 SNP and COMD. We report significant genotype associations between HOMER1 rs2290639 and SA , and between NPTX2 markers rs705315 and rs1681248 and SA, findings that remained statistically significant after multiple test correction. A three-way interaction was observed among HOMER1 rs4704560, rs2290639 and NPTX2 rs705318. The associations we describe for HOMER1 and NPTX2 with SA should be considered preliminary until replicated.

University students' suicidal thoughts and influencing factors

This research was planned as a descriptive study for the purpose of examining the suicidal thoughts of first-year university students and the factors that might affect them. The research was conducted with the participation of first-year students (class of 1992) at Ege University between January 2003 and October 2004. The research data were collected on a form prepared by the researcher to determine the university students' socio-demographic characteristics and their suicidal thoughts, the trait anger, expression of anger inventory and the brief symptom inventory. It was determined that 2.4% of the students had suicidal thoughts, and 11.2% of the students had previously attempted suicide. The risk factors of the students' suicidal thoughts were determined to be issues of gender, school problems, family relationships, anger expression, somatization, hostility, psychotic symptoms, phobic anxiety, anxiety disorder and interpersonal sensitivity.

Functional impairment and previous suicide attempts in bipolar disorder

OBJECTIVE

The aim of the present study was to assess the association between previous suicide attempts and functional impairment among euthymic patients with bipolar disorder (BD).

METHODS

Seventy-one Diagnostic Statistical Manual IV (DSM-IV) patients with BD and 61 healthy volunteers were recruited from the Bipolar Disorder Program at the Clinic Hospital of Barcelona. Patients with (n = 36, 50.7%) and without (n = 35, 49.3%) previous suicide attempts were assessed using the Structured Clinical Interview for DSM-IV-TR (SCID-P). Previous suicide attempts were carefully investigated by means of patient and caregiver interview and by a standard structured interview from the protocol of our BD Program. The Functioning Assessment Short Test (FAST) was employed to assess functional impairment.

RESULTS

Euthymic patients with previous suicide attempts showed functional impairment, particularly in occupational (F = 30.39; p = 0.001) and cognitive functioning (F = 18.43; p = 0.001). In addition, family history of psychiatric illness (χ2: 6.49; degrees of freedom (df) = 2;132; p = 0.010), family history of affective disorders (χ2 = 5.57; p = 0.017), psychotic symptoms (χ2 = 5.88; p = 0.014) and axis II comorbidity were associated with previous suicide attempts (χ2 = 5.16; p = 0.021).

CONCLUSION

Bipolar patients with previous suicide attempts had lower overall functioning than patients who did not attempt suicide. Previous suicide attempts were particularly associated with the occupational and cognitive domains of functioning.

The relations of temperament and emotion self-regulation with suicidal behaviors in a clinical sample of depressed children in Hungary

Although major depressive disorder (MDD) is associated with suicidal behaviors, some depressed individuals are not suicidal and others evidence various forms of suicidality. We thus investigated whether aspects of temperament and self-regulation of dysphoria represent risk factors for DSM-IV suicidality (recurrent thoughts of death, recurrent suicidal ideation, suicidal plan, and suicide attempt) in depressed youths. Using a sample of children with MDD (N = 407; ages 7-14 years), recruited from clinical sites across Hungary, we tested the hypotheses that: (a) suicidality is related to higher levels of trait negative emotionality as well as more maladaptive and fewer adaptive regulatory responses to dysphoria and (b) as the severity of suicidal behavior increases, levels of trait negative emotionality and dysfunctional emotion regulation also increase. We also explored if other aspects of temperament relate to suicidality. Children's DSM-IV diagnoses were based on semi-structured interviews and best-estimate psychiatric consensus. Parents independently provided ratings of their children's temperament, and children separately completed an inventory of emotion regulation (ER). Using multivariate models, we failed to confirm the hypothesized relations of negative trait emotionality and suicidality, but confirmed that high maladaptive and low adaptive ER response tendencies increase the odds of suicidal behaviors, above and beyond the risk posed by depressive illness severity. Unplanned interaction terms between temperament dimensions (other than negative emotionality) and ER suggested that at some high-extremes of temperament, ER has no impact on suicidality but in their absence, adaptive ER lowers the risk of suicidality. The practical implications of the findings are discussed.

High-end specificity of the children's depression inventory in a sample of anxiety-disordered youth

Using a receiver operating characteristic (ROC) analysis, the present study investigated the ability of the Children's Depression Inventory (CDI) to correctly detect depression in a sample of treatment-seeking anxious youth (N=44). The ADIS-C/P was used to determine diagnostic status of participants. Anxious children who met diagnostic criteria for a depressive disorder scored higher on the CDI than anxious children who did not meet criteria for a depressive disorder, supporting the CDI as a continuous measure of depressive symptomatology. In contrast, with regard to detecting a depressive disorder, CDI cut scores did not achieve favorable values across diagnostic utility indices (including the cut score of 13 that has been recommended). These findings support the CDI as a continuous measure of depressive symptoms, but do not support the CDI as a sole assessment for a diagnosis of depression within a sample of anxiety-disordered youth.

Suicidality in children and adolescents: a review

Suicide and suicide attempts by children and adolescents continue to be a major public health problem in the United States. Major risk factors include a previous suicide attempt, a mood disorder, a family history of suicide, a parental psychiatric disorder, and a history of sexual abuse. Genetic vulnerability appears to be a factor as well. Efforts to prevent subsequent attempts at suicide have not generally been successful, and many children and adolescents are not receiving treatment for the mood disorders and other psychiatric conditions that are risk factors. Evaluation of suicide risk should be carried out through multiple informants, not simply the adolescent or the parents, although a thorough clinical interview of the adolescent is essential.