Suicide and Suicidal Behavior

Global burden of self-harm and interpersonal violence and influencing factors study 1990-2019: analysis of the global burden of disease study

INTRODUCTION

Widespread concern exists in today's world regarding self-harm and interpersonal violence. This study to analyze the changes in temporal trends and spatial patterns of risk factors and burdens of self-harm and interpersonal violence using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.

METHODS

Temporal trends in self-harm and interpersonal violence were initially summarized using the estimated annual percentage change (EAPC). Data were compiled and visualized to delineate changes in disease burden and factors influencing self-harm and interpersonal violence from 1990 to 2019, stratified by gender, age and GBD region.

RESULTS

In 2019, the DALY rates of self-harm were 424.7(95% UI 383.25, 466.93). Over the period from 1999 to 2019, self-harm exhibited an overall decreasing trend, with the EAPC of -1.5351 (95% CI -1.6194, -1.4507), -2.0205 (95% CI -2.166, -1.8740) and -2.0605 (95% CI -2.2089, -1.9119), respectively. In contrast, the incidence rate of interpersonal violence was significantly higher than self-harm, with a rate of 413.44 (95% UI 329.88, 502.37) per 100,000 population. Mortality and DALYs of interpersonal violence were lower than those of self-harm, at 5.22 (95% UI 4.87, 5.63) and 342.43 (95% UI 316.61, 371.55). Disease burden of self-harm and interpersonal violence varied by gender, age groups and region. Specific risk factors showed that alcohol use, high temperature and drug use were the main risk factors for self-harm, while alcohol use, intimate partner violence and high temperature were associated with interpersonal violence. Low temperature was a common protective factor for both self-harm and interpersonal violence. The burden of self-harm and interpersonal violence was attributed to different factors influences in different SDI regions.

CONCLUSIONS

The study explored temporal trends and spatial distribution of the global disease burden of self-harm and interpersonal violence, emphasizing the significant impact of factors such as alcohol use, temperature, and drug use on disease burden. Further research and policy actions are needed to interpret recent changes of disease burden of self-harm and interpersonal violence, and dedicated efforts should be implemented to devise evidence-based interventions and policies to curtail risk factors and protect high-risk groups.

Depression and Suicidality: The Roles of Social Support and Positive Mental Health

OBJECTIVE

Despite being preventable, suicide remains a leading cause of death globally, with depression being one of the more prominent risk factors. This study examines the roles of social support and positive mental health in the depression-suicidality pathway.

METHODS

We utilized data from the Singapore Mental Health Study 2016. Social support and positive mental health were examined as mediators in the relationship between 12-month depression and 12-month suicidality using survey-weighted generalized structural equation modeling.

RESULTS

Overall positive mental health was found to partially mediate the relationship between depression and suicide. Of the discrete positive mental health domains, the depression-suicidality relationship was partially mediated by general coping and fully mediated by personal growth and autonomy.

CONCLUSION

While findings regarding social support were inconclusive, positive mental health may play a significant role in alleviating the effects of depression on suicidality. This highlights the multifaceted nature of suicidality and reveals positive mental health as a new area in assessing and treating at-risk people, to improve clinical outcomes.HIGHLIGHTSThe effect of depression on suicidality was partially mediated by overall positive mental health.General coping partially mediated the relationship between depression and suicidality.Personal growth and autonomy fully mediated the relationship between depression and suicidality.

Suicide attempt among Malaysian school-going adolescents: relationship with bullying

BACKGROUND

According to World Health Organization (WHO), the fourth leading cause of death among adolescents aged 15 -19 years is suicide. The National Health and Morbidity Survey (NHMS) 2017 reported that suicidal attempts among school adolescents increased from 6.8%-6.9% as compared to NHMS 2012. Suicide attempts can cause significant negative impacts on health, social and economic status. Bullying is one of the factors for adolescent suicide attempts, and its relationship to suicidality in adolescents has been shown in numerous research.

OBJECTIVES

This study examined the relationship between suicide attempts and bullying among school adolescents in Malaysia.

METHODS

Data from the Malaysia NHMS 2017, a nationwide study that adopted a two-stage cluster sampling design, were analysed. The survey used a self-administered questionnaire in bilingual language adapted from GSHS developed by WHO. Participants were secondary school students aged 13 -17 in all states. Descriptive and multiple logistic regression analyses were performed using IBM SPSS version 28.

RESULTS

A total of 27,497 school adolescents participated in the study. Results showed that 6.9% of school adolescents had attempted suicide. There was 16.2% of adolescents being bullied. Multiple logistic regression revealed that students who were bullied were more likely to have suicide attempts (aOR 4.827, 95% CI: 4.143, 5.624) P < 0.001.

DISCUSSION/CONCLUSION

This study revealed that bullying is associated with suicide attempts among school adolescents in Malaysia. The respective authority should consider and plan effective measures to curb bullying among school adolescents.

Sociodemographic Characteristics and Clinical Profile of Suicide Attempters Attending the Emergency Department at a Tertiary Care Hospital in Oman: A Retrospective Study

OBJECTIVE

This study examined the sociodemographic and clinical characteristics of individuals who attended the emergency department of a tertiary care center in Muscat, Oman following a suicide attempt.

METHODS

A retrospective study (N=154) was conducted between January 2015 and June 2018. Information that was collected included sociodemographic variables (age, nationality, sex, marital status, and occupation), risk (medical comorbidities, psychiatric history, substance misuse, alcohol misuse, and previous history of suicide attempts), and precipitating factors, as well as the chosen methods for the suicide attempts.

RESULTS

In all, 83.1% of the sample were Omanis, and women constituted 69.5%. The mean age of the sample was 27 years; 30% were students, 42% were unemployed, and 40.9% had a history of psychiatric disorders. Family conflict, suffering from chronic illness, and having social problems were the most common precipitating factors for the suicide attempt. The most common method used in the suicide attempt was drug overdose (48.1%), mainly involving paracetamol (acetaminophen) (40%). Significant gender differences emerged in precipitating factors, history of substance misuse, and methods of suicide.

CONCLUSIONS

The data from this study are consistent with international trends that suggest that women and younger age groups are the most vulnerable to suicide attempts. Although in its infancy, the type of research presented here could lay the groundwork for preventive interventions and programs.

Efficacy of a digitally supported regional systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands

OBJECTIVE

We evaluated the effect of a digitally supported systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands.

METHOD

Non-randomized stepped wedge trial design (SWTD). Stepwise implementation in the five subregions of the systems intervention. Pre-post analysis for the whole province (Exact Rate Ratio Test, Poisson count). SWTD Hazard Ratios of suicides per person-years for subregional analysis of control versus intervention conditions over five times three months. Sensitivity analysis.

RESULTS

Suicide rates dropped 17.8% (p = .013) from 14.4 suicides per 100,000 before the start of implementation of the systems intervention (2017), to 11.9 (2018) and 11.8 (2019) per 100, during implementation; a significant reduction (p = .043) compared to no changes in the rest of the Netherlands. Suicide rates dropped further by 21.5% (p = .002) to 11.3 suicides per 100,000 during sustained implementation in 2021. Sensitivity analysis confirmed the reduction (p = .02). The SWTD analysis over 15 months in 2018-2019 did not show a significant association of this reduction with implementation per subregional level, probably due to insufficient power given the short SWTD timeframe for implementation and low suicide rates per subregion.

CONCLUSIONS

During the SUPREMOCOL systems intervention, over four years, there was a sustained and significant reduction of suicides in Noord-Brabant.

Prevalence and correlates of destructive behaviors in the US Naval Surface Forces from 2010-2020

PURPOSE

To estimate the prevalence of domestic violence, sexual assault, and suicide for United States Navy (USN) personnel between 2010 and 2020 and identify potential associated factors.

METHODS

Official report data were used to calculate prevalence rates and odds ratios, accounting for sample and general USN population demographic data to assess differences in over- or underrepresentation of destructive behaviors.

RESULTS

Domestic violence and sexual assault offenders tended to be younger lower-ranked males. For sexual assaults, offenders were three times more likely to be senior to the victim, which was not the case for domestic violence. Females were overrepresented in terms of suicidal ideation and attempts relative to the USN population, while males accounted for more actual suicides. The relative rates of suicidal ideation and attempts for females exceeded those for males (i.e., comparing the sample rate against the USN male and female populations), but the sample proportion for completed suicides (compared to the USN population) were greater for males than for females. Those in the junior enlisted (E1-E3) paygrades exhibited greater odds of suicide attempts versus suicidal ideations relative to those in the Petty Officers (E4-E6) paygrades, although E4-E6s completed more suicides.

CONCLUSION

The descriptive profile of destructive behaviors in a representative sample of USN personnel provides an overview of the possible factors associated with destructive behaviors and includes an exploration of the relational dynamics and nature of the incidents. The results suggest that sexual assault and domestic violence are characterized by unique relational dynamics and that these destructive behaviors should not necessarily be classified together as male-oriented aggressions (i.e., mainly perpetrated by males against female victims). Those in the E1-E3 and E4-E6 paygrades displayed different patterns in suicidal ideation, attempts, and actual suicides. The results highlight individual characteristics to help inform the development of targeted policies, practices, and interventions for military and other hierarchical organizations (e.g., police).

A Following Wave Pattern of Suicide-Related Pediatric Emergency Room Admissions during the COVID-19 Pandemic

The COVID-19 pandemic and response, which included physical distancing and stay-at-home orders, disrupted the daily lives of children and adolescents, isolating them from their peers, school, and other meaningful contacts. The present study aims to add to the accumulating evidence on the pandemic's impact on child and adolescent suicidal behavior. Data were extracted from Schneider Children's Medical Center of Israel's pediatric emergency room (ER) admissions for psychiatric consultation for suicidal-risk assessment between 1 January 2020, and 16 April 2022. We applied time-lagged cross-correlation analysis and a Granger causality test to assess the temporal relationships between COVID-19 infection waves and patterns of suicide-related ER admissions. The results revealed a significant lagged correlation between national COVID-19 infection rates and ER admission rates. The highest correlation was above 0.4 and was found with a lag of 80 to 100 days from infection rate to ER admission rate. The findings show that the effects of public crises change over time and may be lagged. This may have important implications for mental health services' readiness to serve growing numbers of children and adolescents at risk for suicide.

Impulsivity and aggression in suicide ideators and suicide attempters of high and low lethality

BACKGROUND

Impulsivity and aggression have been associated with all forms of suicidal behaviour and linked to theories of suicide capability. There is a need to clarify the role of impulsivity and aggression in the progression from suicidal thoughts to suicide attempts and suicide.

METHOD

In this naturalistic cross-sectional study, suicide ideators (35), low lethal suicide attempters (37), and high lethal suicide attempters (26) were compared with the Columbia-suicide severity rating scale (C-SSRS), Barratt impulsiveness scale (BIS-11), and the Buss & Perry aggression questionnaire (AQ).

RESULTS

Physical aggression score (p = 0.032) contributed to the difference between predicted low lethal suicide attempt and predicted high lethal suicide attempt. This model predicting physical aggression showed a fairly weak positive relationship (OR = 1.1) to high lethal attempt and explained 13% of the variance so there is a need for further replications to verify these results. Impulsive behaviour scores in females were significantly higher in the low lethal suicide attempt group compared to suicide ideators (F(2.51) = 3.47, p = 0.039, η²= 0.12). Hostility aggression in females was significantly higher in the high lethal suicide attempters compared to suicide ideators (F(2.52) = 3.53, p = 0.037, η² = 0.12). Physical aggression scores in females were significantly higher in the high lethal attempters compared to suicide ideators (F(2.52) = 6.79, p = 0.002, η²= 0.21). When these analyses were conducted without the participants who died in suicide, men in the high lethal attempt group scored significantly higher than men in the low lethal attempt group (F(2.37) = 3.8, p = 0.031, η² = 0.17), but men did not differ in aggression and impulsivity scores in other comparisons.

CONCLUSION

Suicide prevention should address physical aggression, as high levels can be associated with high lethal attempts. Assessment of suicidal patients should address impulsive behaviour with the insight that it can be more prominent in female low lethal suicide attempters. It could be that assessment and treatment of suicidal patients should be tailored differently for men and women. Aggression as a feature of suicide capability could be the link that makes suicide possible.

The Association Between Suicide-Related Media Coverage and Suicide: A Cross-Sectional Observational Study

OBJECTIVE

To examine the association between the publication and content of suicide-related media reports and actual suicide in Noord Brabant, a province of the Netherlands.

METHOD

Between April 2017 and March 2018, a retrospective cross-sectional observational study was conducted on suicide-related media reports and incident data regarding suicides. Linear regression, Mann-Whitney U and negative binomial regression analyses were conducted.

RESULTS

In Noord-Brabant, a total of 352 people died from suicide during the observation period and 440 reports were identified by using the search terms "suicide", "self-killing", and "self-murder". No associations between media reports and actual suicides were found for any of the analyses performed.

CONCLUSIONS

No indications were found for an association between media coverage of suicide and increases or decreases in actual suicides in Noord-Brabant. The descriptive statistics of this study reveal that the regional and national Dutch media are doing well with respect to not including elements in their reports that could encourage copycat behavior, such as simplifying, romanticizing or dramatizing. They could improve on including protective content, for example, providing supportive background information. A recommendation for further research is to evaluate causal relationships between media and actual suicide. A stepped wedge trial might be needed, as this provides an ethical research design to investigate this issue in a controlled setting. Also, in such a study, other variables influencing the decision to attempt suicide should be taken into account as much as possible.

Selective personality‐targeted prevention of suicidal ideation in young adolescents: post hoc analysis of data collected in a cluster randomised controlled trial

Objective

Design

Setting, participants

Intervention

Main outcome measure

Results

Conclusion

Trial registration (CAP study only)

The impact of macroeconomic factors on suicide in 175 countries over 27 years

BACKGROUND

Every year, more than 800,000 people die by suicide, three-quarters of which are males. Economic factors influence suicide rates, but a worldwide perspective of their impact according to age and sex is lacking.

METHOD

We queried publicly available datasets on economic factors and on suicide rates stratified according to sex and age, from 1991 to 2017, for 175 countries. Thus, we analyzed approximately 21 million deaths by suicide using a multivariable regression model approach.

RESULTS

Every 1% increase in global unemployment rates is associated with a 1% upsurge in male deaths by suicide (Relative risk (RR) = 1.01 [CI 95% 1.00-1.01] with respect to females) or 5000 excess male deaths. A 1% higher unemployment rate also exerts age-specific effects on suicide rates, since, among adults aged 30-59, the suicide rate is increased by 2-3%. Lastly, for every 1000 US dollar increase in the GDP per capita, suicide rates are reduced by 2% (RR = 0.98 [0.98-0.98]), corresponding to a reduction of 14,000-15,000 suicide deaths per year globally.

CONCLUSIONS

Males who have lost their jobs in adulthood are those at higher risk of suicide and to whom financial support measures should be delivered in a timely manner.

Suicide Risk Factors among Polish Adults Aged 65 or Older in 2000-2018 Compared with Selected Countries Worldwide

The aim of this study was to determine the tendencies of change in suicide frequency among Polish adults aged 65 or older, recognize the importance of available socio-demographic data (age, sex, marital status, and education attainment level) and provide an in-depth psychological understanding of the obtained results. We analysed the influence of education and marital status on suicide risk in the Polish adult population aged 65 or older, which has not been previously presented in publications related to the Central Statistical Office or any other research. Our results indicated that male adults aged 65 or older that were single or divorced and with a lower education had a higher risk of death by suicide. In female adults aged 65 or older, those with higher education and who were divorced or married had a higher risk of fatal suicide behaviour meanwhile, single women and widows had a lower risk. The dominant method of suicide among Polish older adults was suicide by hanging, regardless of sex; female older adults were more likely to die by suicide by poisoning or jumping from a height, and male older adults were more likely to die by shooting with a firearm. Although data from recent years highlights a downward trend for suicide rates in Polish older adults, the problem cannot be considered solved.

Suicide cases in developed and emerging countries: an analysis using wavelets

ABSTRACT Objective The aim of this study was to use a wavelet technique to determine whether the number of suicides is similar between developed and emerging countries. Methods Annual data were obtained from World Health Organization (WHO) reports from 1986 to 2015. Discrete nondecimated wavelet transform was used for the analysis, and the Daubechies wavelet function was applied with five-level decomposition. Regarding clustering, energy (variance) was used to analyze the clusters and visualize the clustering process. We constructed a dendrogram using the Mahalanobis distance. The number of groups was set using a specific function in the R program. Results The cluster analysis verified the formation of four groups as follows: Japan, the United States and Brazil were distinct and isolated groups, and other countries (Austria, Belgium, Chile, Israel, Mexico, Italy and the Netherlands) constituted a single group. Conclusion The methods utilized in this paper enabled a detailed verification of countries with similar behaviors despite very distinct socioeconomic, geographic and climate characteristics.

Risk factors for attempting suicide during the COVID-19 lockdown: Identification of the high-risk groups

Objectives

In the wake of the coronavirus disease 2019 (COVID-19) pandemic, we have witnessed a rise in the instances of mental health problems and the suicide-related mortality rates. This study aims to identify the suicide-related risk factors and stressors to determine the groups at a greater risk of attempting suicide during the COVID-19 lockdown.

Methods

This retrospective study examined 29 cases of attempted suicide during the 3-month COVID-19 lockdown in KSA. The suicide risk factors were evaluated using specific instrument the modified (SAD PERSONS) scale. It is an acronym for sex, age, depression, previous attempt, excess alcohol, rational thinking loss, social status, organized plan, no social supports and stated future intent.

Results

The lockdown stressors that may have triggered suicidal behaviours were identified as follows: psychological distress, relationship problems, financial difficulties, and extreme fear of the COVID-19 infection. While all age groups carried the risk of attempting suicide during the lockdown, patients with psychiatric disorders and women accounted for 69% and 65.5% of the cohort, respectively. Factors like hopelessness and depression were highly related to suicide attempts, as well as the statement of future intent to repeat the attempt, at 72.4% and 65.5% respectively. Almost two-thirds of the attempts made were serious, and many women felt unsafe in their own homes during the lockdown.

Conclusion

Patients with pre-existing psychiatric disorders and women carry high risk of attempting suicide during the COVID-19 lockdown. This study offers insights on the greater outreach efforts that can be carried out for these patients by calling for the prioritization of mental health care, improvement of domestic violence services, and strengthening of suicide prevention strategies.

BDNF gene expression association with suicide and psychiatric disorders in children and adolescents: (Relationship between BDNF gene expression and suicide)

OBJECTIVE

In the current study, it was aimed to investigate the relationship between BDNF gene expression and childhood suicide attempt, childhood traumatic experiences, and problem-solving skills in children and adolescents.

METHODS

The suicide group consisted of 100 children and adolescents aged 11-18 years who were referred to our outpatient department due to suicide attempt. For further comparisons, 100 children and adolescents who have no any psychiatric diagnosis were referred to our same outpatient department were selected. A sociodemographic data form, the Schedule for Affective Disorders and Schizophrenia for School-Age Children- Present and Lifetime version (K-SADS-PL), the Suicide Intent Scale (SIS), Problem Solving Inventory (PSI), and the Childhood Trauma Questionnaire (CTQ) were used for both groups. Total RNA was isolated from whole blood samples and BDNF gene expression levels were measured using quantitative real time-polymerase chain reaction (QRT-PCR).

RESULTS

The total and subscale scores of the PSI and CTQ were found to be significantly higher in the suicide group than in the control group. There was no significant difference between the groups in terms of BDNF gene expression levels. However, gene expression of BDNF was found significantly increased in patients who have any psychiatric disorder compared with the others.

CONCLUSION

Our results indicate that BDNF gene expression could be more associated with psychiatric disorders rather than suicide attempt in children and adolescents.

Suicide, self-harm and thoughts of suicide or self-harm in infectious disease epidemics: a systematic review and meta-analysis

AIMS

Suicide accounts for 2.2% of all years of life lost worldwide. We aimed to establish whether infectious epidemics are associated with any changes in the incidence of suicide or the period prevalence of self-harm, or thoughts of suicide or self-harm, with a secondary objective of establishing the frequency of these outcomes.

METHODS

In this systematic review and meta-analysis, MEDLINE, Embase, PsycINFO and AMED were searched from inception to 9 September 2020. Studies of infectious epidemics reporting outcomes of (a) death by suicide, (b) self-harm or (c) thoughts of suicide or self-harm were identified. A random-effects model meta-analysis for the period prevalence of thoughts of suicide or self-harm was conducted.

RESULTS

In total, 1354 studies were screened with 57 meeting eligibility criteria, of which 7 described death by suicide, 9 by self-harm, and 45 thoughts of suicide or self-harm. The observation period ranged from 1910 to 2020 and included epidemics of Spanish Flu, severe acute respiratory syndrome, human monkeypox, Ebola virus disease and coronavirus disease 2019 (COVID-19). Regarding death by suicide, data with a clear longitudinal comparison group were available for only two epidemics: SARS in Hong Kong, finding an increase in suicides among the elderly, and COVID-19 in Japan, finding no change in suicides among children and adolescents. In terms of self-harm, five studies examined emergency department attendances in epidemic and non-epidemic periods, of which four found no difference and one showed a reduction during the epidemic. In studies of thoughts of suicide or self-harm, one large survey showed a substantial increase in period prevalence compared to non-epidemic periods, but smaller studies showed no difference. As a secondary objective, a meta-analysis of thoughts of suicide and self-harm found that the pooled prevalence was 8.0% overall (95% confidence interval (CI) 5.2-12.0%; 14 820 of 99 238 cases in 24 studies) over a time period of between seven days and six months. The quality assessment found 42 studies were of high quality, nine of moderate quality and six of high quality.

CONCLUSIONS

There is little robust evidence on the association of infectious epidemics with suicide, self-harm and thoughts of suicide or self-harm. There was an increase in suicides among the elderly in Hong Kong during SARS and no change in suicides among young people in Japan during COVID-19, but it is unclear how far these findings may be generalised. The development of up-to-date self-harm and suicide statistics to monitor the effect of the current pandemic is an urgent priority.

Trends in suicide mortality in Montenegro from 2000 to 2018

BACKGROUND

This is an ecological study that analyzes suicides committed in Montenegro during the 2000-2018 period, taking into account gender, age and methods of suicide.

METHODS

Suicide rates and trends up until 2009 were obtained from the official registers of Bureau of Statistics of Montenegro (MONSTAT) while the later data were obtained from the Department of Interior's. MONSTAT also provided data on unemployment and average salary. As per statistical methods, descriptive and correlations were calculated.

RESULTS

The average crude suicide rate was 21.06, for males 29.93 and for females 12.42. Crude suicide rates were not associated with unemployment rate or average salary. However, the unemployment rate was significantly correlated with lethal methods of suicide, namely suicide by firearm and by hanging. Average net salary was negatively correlated with suicide by firearm.

CONCLUSIONS

The ratio of males and females who committed suicide was 2.41. In the last three years, this ratio continues to rise in favor of males (reaching 4.29 in 2018). This could be explained by specific cultural features where males are expected to be the main financial contributors to the households. The labor market of Montenegro does not offer adequate opportunities to set and maintain a stable economic situation which puts additional pressure and stress on males.

Suicide Behavior and Its Predictors in Patients with Schizophrenia in Ethiopia

BACKGROUND

People with schizophrenia (PWS) are at greater risk of suicide. However, suicide behaviors that occur in PWS are often overlooked, inadequately characterized, and not consistently integrated into treatment. Despite this burden and consequences in Ethiopia, there is a dearth of studies concerning suicide behavior in PWS. Therefore, this study is aimed at assessing the magnitude of suicide behavior and its predictors among PWS in Ethiopia.

METHODS

An institution based cross-sectional study was employed. Data were collected using the structured interviewer-administered questionnaire from a sample of 300 PWS at Amanuel Mental Specialized Hospital (AMSH). The revised version of Suicide Behavior Questionnaire (SBQ-R) was used to assess suicide behavior in PWS. The data was collected from March 1 to 30, 2019. Binary logistic regression was performed to identify independent predictors of suicidal behavior at 95% confidence level. Statistical significance was declared at p value <0.05.

RESULT

A total of 300 patients with schizophrenia participated in the study. More than two-thirds of 203 (67.7%) of the participants were males, and 116 (38.7%) participants were between the ages of 28 and 37 years. We found that the prevalence of suicide behavior among PWS was 30.3%. Being unemployed (AOR = 3.65, CI = 1.32, 10.05), family history of suicide (AOR = 3.16, CI = 1.38, 7.23), substance use (AOR = 2.51, CI = 1.13, 5.59), current positive psychotic symptoms (hallucination (AOR = 6.39, CI = 2.86, 14.29), and delusion (AOR = 4.15, CI = 1.95, 14.29) and presence of comorbid depression (AOR = 4.81, CI = 1.98, 11.68) were independent significant predictors with suicidal behavior in PWS.

CONCLUSION

The prevalence of suicidal behavior among PWS was found to be high. Hence, designing strategies for early screening and intervention is the most critical prevention strategy of suicide in PWS.

A multi factorial model of self-harm behaviors in Anorexia-nervosa and Bulimia-nervosa

BACKGROUND

Co-existence of eating disorders and NSSI, suicide attempts and ideations is well established yet much is not known about the personality traits and behavioral tendencies that maintain this relationship. To this date no empirical work has been produced that offers a multifactorial view on the contributing variables to the occurrence of self-harm behaviors in EDs.

METHOD

Binge eating, depression, impulsivity, ruminations and loss aversion were assessed in a sample of 93 patients diagnosed with Anorexia-Nervosa and Bulimia-Nervosa and other EDs with a history of NSSI and suicide attempts.

RESULTS

Binge eating was found to be a predictor of depression, which in turn was found to be related to NSSI frequency, suicide attempts and suicide ideations. Ruminations were found to mediate a relationship between depression and suicide ideations. Trait impulsivity predicted suicide attempts, while the attentional construct of impulsivity was associated to suicide ideations as well as attempts. Higher loss aversion was positively associated with NSSI frequency and suicide ideations.

CONCLUSION

Our findings suggest that trait and state aspects of impulsivity are related to different self-harm behaviors in EDs. Exploring these differences is potentially of great value in understanding the process of transition from suicidal ideation to suicide attempt and the process of NSSI and may assist clinicians formulate better interventions for patients with EDs at risk. Ways in which individual findings in our model correspond with previous research and future implications are discussed.

A regional systems intervention for suicide prevention in the Netherlands (SUPREMOCOL): study protocol with a stepped wedge trial design

BACKGROUND

In the Netherlands, suicide rates showed a sharp incline and this pertains particularly to the province of Noord-Brabant, one of the southern provinces in the Netherlands. This calls for a regional suicide prevention effort.

METHODS/DESIGN

Study protocol. A regional suicide prevention systems intervention is implemented and evaluated by a stepped wedge trial design in five specialist mental health institutions and their adherent chain partners. Our system intervention is called SUPREMOCOL, which stands for Suicide Prevention by Monitoring and Collaborative Care, and focuses on four pillars: 1) recognition of people at risk for suicide by the development and implementation of a monitoring system with decision aid, 2) swift access to specialist care of people at risk, 3) positioning nurse care managers for collaborative care case management, and 4) 12 months telephone follow up. Eligible patients are persons attempting suicide or expressing suicidal ideation. Primary outcome is number of completed suicides, as reported by Statistics Netherlands and regional Public Health Institutes. Secondary outcome is number of attempted suicides, as reported by the regional ambulance transport and police. Suicidal ideation of persons registered in the monitoring system will, be assessed by the PHQ-9 and SIDAS questionnaires at baseline and 3, 6, 9 and 12 months after registration, and used as exploratory process measure. The impact of the intervention will be evaluated by means of the RE-AIM dimensions reach, efficacy, adoption, implementation, and maintenance. Intervention integrity will be assessed and taken into account in the analysis.

DISCUSSION

The present manuscript presents the design and development of the SUPREMOCOL study. The ultimate goal is to lower the completed suicides rate by 20%, compared to the control period and compared to other provinces in the Netherlands. Moreover, our goal is to provide specialist mental health institutions and chain partners with a sustainable and adoptable intervention for suicide prevention.

TRIAL REGISTRATION

Netherlands Trial Register under registration number NL6935 (5 April 2018). This is the first version of the study protocol (September 2019).

The Fear of Losing-Nonsuicidal Self-Injury as a Protective Mechanism in Eating Disorders

Background: This study examined the moderating role of loss aversion (LA) on the relationship between impulsivity, nonsuicidal self-injury (NSSI), suicidal attempts, and ideations among Eating Disorder (ED) patients. Methods: Data was collected on 81 ED patients and 37 healthy controls. ED patients were divided into 2 groups: 25 AN-Rs, 56 AN-BPs and BNs. Measurements of trait impulsivity, LA, NSSI, suicide attempts, and suicide ideations were collected. Results: The rate of attempting suicide was highest in the AN-BP/BN (34.8%), lower in the AN-Rs (8%), and the lowest in the controls (2.7%). Suicide ideation was also higher in AN-BP/BN compared to both AN-R and controls. NSSI was higher in the AN-BP/BN group compared to both AN-R and control groups. LA scores were lower among participants with EDs compared to controls. BMI and depression were positively associated with suicide ideation and NSSI. Impulsivity was associated to suicide attempt and suicide ideation. Contrary to our hypothesis, LA scores were positively correlated with NSSI and SI. A stepwise regression revealed that contradictory to our hypothesis, higher LA predicted NSSI prevalence severity of NSSI and suicide ideation. Limitations: (1) Cross-sectional design; (2) Relatively small sample size of clinical subjects and only female participants; (3) Heterogeneity of treatment status. Conclusions: EDs are associated with lower levels of LA compared to general population. Although high LA is considered a protective factor against "high damage" decisions, it may serve as a facilitator of lower risk decisions which help the individual soothe and communicate his or her own suffering such as NSSI.

Violent interpersonal trauma predicts aggressive thoughts and behaviors towards self and others: findings from the National Comorbidity Survey-Adolescent Supplement

PURPOSE

The purpose of the current study is to examine the relation between adolescent traumatic event exposure and aggression directed towards the self and others. Theoretical perspectives underscore the particularly pernicious effects of violent traumas intentionally perpetrated by others in terms of negative posttraumatic outcomes. However, a careful comparison of trauma type in relation to aggression has not been done with youth. The current project, therefore, examined differences between youth with a history of violent interpersonal trauma (VIT) compared to those with a non-violent trauma type history in terms of aggressive behavior directed towards others as well as aggressive self-directed thoughts (suicidal ideation).

METHOD

The sample was drawn from the National Comorbidity Survey-Replication and consisted of 1928 adolescents (M = 15.4; SD = 1.47 years), each assigned to one of four age- and gender-matched trauma history groups.

RESULTS

Consistent with hypotheses, among trauma-exposed youth, those who had experienced or witnessed a VIT (compared to those reporting a non-VIT only) evidenced elevated aggression, even after controlling for a number of theoretically relevant covariates (e.g., gender, age, household income, demographic factors).

CONCLUSION

Results indicate that youth with a history of VIT may be at unique risk for experiencing aggression directed towards others and the self compared to those without this specific trauma history. This is important because trauma type is an easily assessed indicator of potentially elevated risk for these types of deleterious outcomes. Findings are situated in a research agenda aimed at continuing to refine our understanding of the link between interpersonal trauma and aggression.

Modeling suicide in bipolar disorders

INTRODUCTION

Suicide is a multicausal human behavior, with devastating and immensely distressing consequences. Its prevalence is estimated to be 20-30 times greater in patients with bipolar disorders than in the general population. The burden of suicide and its high prevalence in bipolar disorders make it imperative that our current understanding be improved to facilitate prediction of suicide and its prevention. In this review, we provide a new perspective on the process of suicide in bipolar disorder, in the form of a novel integrated model that is derived from extant knowledge and recent evidence.

METHODS

A literature search of articles on suicide in bipolar disorder was conducted in recognized databases such as Scopus, PubMed, and PsycINFO using the keywords "suicide", "suicide in bipolar disorders", "suicide process", "suicide risk", "neurobiology of suicide" and "suicide models". Bibliographies of identified articles were further scrutinized for papers and book chapters of relevance.

RESULTS

Risk factors for suicide in bipolar disorders are well described, and provide a basis for a framework of epigenetic mechanisms, moderated by neurobiological substrates, neurocognitive functioning, and social inferences within the environment. Relevant models and theories include the diathesis-stress model, the bipolar model of suicide and the ideation-to-action models, the interpersonal theory of suicide, the integrated motivational-volitional model, and the three-step theory. Together, these models provide a basis for the generation of an integrated model that illuminates the suicidal process, from ideation to action.

CONCLUSION

Suicide is complex, and it is evident that a multidimensional and integrated approach is required to reduce its prevalence. The proposed model exposes and provides access to components of the suicide process that are potentially measurable and may serve as novel and specific therapeutic targets for interventions in the context of bipolar disorder. Thus, this model is useful not only for research purposes, but also for future real-world clinical practice.

Self-compassion and suicidal behavior in college students: Serial indirect effects via depression and wellness behaviors

OBJECTIVE

College students may be at heightened risk for suicide and suicidal behavior due to maladaptive cognitive-emotional factors and failure to practice basic health behaviors. However, self-compassion and wellness behaviors may protect against risk. The relation between self-compassion and suicidal behavior and the contributing roles of depressive symptoms and wellness behaviors was examined.

PARTICIPANTS

Participants were 365 undergraduate students. Data were collected in April 2015.

METHODS

A cross-sectional, survey design was employed. Participants completed measures assessing self-compassion, depressive symptoms, wellness behaviors, and suicidal behavior. Serial mediation analyses were conducted covarying age, sex, and ethnicity.

RESULTS

Self-compassion was inversely related to suicidal behavior, and this relationship was serially mediated by depressive symptoms and wellness behaviors.

CONCLUSIONS

Self-compassion may protect against suicidal behavior, in part, due to reduced depressive symptoms and heightened engagement in wellness behaviors. Individual and campus-wide strategies promoting self-compassion and wellness behaviors may reduce suicide risk on college campuses.

Springtime Peaks and Christmas Troughs: A National Longitudinal Population-Based Study into Suicide Incidence Time Trends in the Netherlands

BACKGROUND

Time trends are one of the most studied phenomena in suicide research; however, evidence for time trends in the Dutch population remains understudied. Insight into time trends can contribute to the development of effective suicide prevention strategies.

METHODS

Time trends in national daily and monthly data of 33,224 suicide events that occurred in the Netherlands from 1995 to 2015 were examined, as well as the influence of age, gender, and province, in a longitudinal population-based design with Poisson regression analyses and Bayesian change point analyses.

RESULTS

Suicide incidence among Dutch residents increased from 2007 until 2015 by 38%. Suicide rates peak in spring, up to 8% higher than in summer (p < 0.001). Suicide incidence was 42% lower at Christmas, compared to the December-average (IRR = 0.580, p < 0.001). After Christmas, a substantial increase occurred on January 1, which remained high during the first weeks of the new year. Suicide occurred more than twice as often in men than in women. For both genders, the results indicated a spring time peak in suicide incidence and a trough at Christmas. Suicide rates were highest in the elderly (age group, 80+), and no evidence was found of a differential effect by season in the age groups with regard to suicide incidence. No interaction effect was found with regard to province of residence for both season and Christmas, indicating that no evidence was found that these time trends had differential effects in the Dutch provinces in terms of suicide incidence.

CONCLUSION

Evidence was found for time trends in suicide incidence in the Netherlands. It is recommended to plan (mental) health care services to be available especially at high-risk moments, at spring time, and in the beginning of January. Further research is needed to explore the protective effect of Christmas in suicide incidence.

Relationship between chronobiological thyrotropin and prolactin responses to protirelin (TRH) and suicidal behavior in depressed patients

BACKGROUND

So far, investigations of the relationships between suicidality and the activity of the thyrotropic and lactotropic axes are scarce and have yielded conflicting results.

METHODS

We studied the thyrotropin (TSH) and prolactin (PRL) responses to 0800h and 2300h protirelin (TRH) stimulation tests, carried out on the same day, in 122 euthyroid DSM-5 major depressed inpatients with suicidal behavior disorder (SBD) (either current [n=71], or in early remission [n=51]); and 50 healthy hospitalized controls.

RESULTS

Baseline TSH and PRL measurements did not differ across the 3 groups. In SBDs in early remission, the TSH and PRL responses to TRH tests (expressed as the maximum increment above baseline value after TRH [Δ]) were indistinguishable from controls. Current SBDs showed (1) lower 2300h-ΔTSH and lower ΔΔTSH values (differences between 2300h-ΔTSH and 0800h-ΔTSH) than controls and SBDs in early remission; and (2) lower baseline free thyroxine (FT_4B) levels than controls. In the current SBD group, ΔΔPRL values (differences between 2300h-ΔPRL and 0800h-ΔPRL) were correlated negatively with lethality. Moreover, in current SBDs (1) violent suicide attempters (n=15) showed lower FT_4B levels, lower TSH-TRH responses (both at 0800h and 2300h), and lower ΔΔTSH and ΔΔPRL values than controls, while (2) non-violent suicide attempters (n=56) showed lower ΔΔTSH values than controls and higher TSH-TRH responses (both at 0800h and 2300h) than violent suicide attempters.

CONCLUSIONS

Our results suggest that central TRH secretion is not altered in depressed patients with SBD in early remission. The findings that current SBDs exhibit both decreased FT_4B levels and decreased evening TSH responses (and consequently, decreased ΔΔTSH values) support the hypothesis that hypothalamic TRH drive is reduced-leading to an impaired TSH resynthesis in the pituitary during the day after the morning TRH challenge. In violent suicide attempters, the marked abnormalities of TRH test responses might indicate a greatest reduction in hypothalamic TRH drive. These results further strengthen the possibility that a deficit in central TRH function may play a key role in the pathogenesis of suicidal behavior.

Spatial Patterns and Neighborhood Characteristics of Overall Suicide Clusters in Florida From 2001 to 2010

INTRODUCTION

Although spatial examination of mortality and morbidity is becoming more common in health studies, the investigation of suicide death clusters within the neighborhood context is underutilized. The purpose of this ecological study is to detect high- and low-risk clusters of suicide deaths in Florida and determine which neighborhood characteristics distinguish clusters from non-clusters.

METHODS

The scan statistic method was used to detect overall clusters of completed suicides in Florida from 2001 to 2010. Regression analysis was used to investigate the association of neighborhood characteristics with identified clusters. All data synthesis and statistical analyses were conducted in 2015.

RESULTS

Twenty-four high-risk and 25 low-risk clusters were identified. The risk of suicide was up to 3.4 times higher in high-risk clusters than in areas outside of clusters (relative risk ranged from 1.36 to 3.44, p≤0.05). Low-risk clusters were associated with 30%-94% decreased risk of suicide (relative risk ranged from 0.06 to 0.70, p≤0.05). Areas with high levels of elderly concentration and household singularity were more likely to be in high-risk clusters, whereas areas with higher economic deprivation and residential density were more likely to be in low-risk clusters.

CONCLUSIONS

This study identified general suicide patterns across space in the state of Florida and described the characteristics of those areas.

Predictive value of psychological characteristics and suicide history on medical lethality of suicide attempts: A follow-up study of hospitalized patients

BACKGROUND

This study examined the role of mental pain, communication difficulties, and suicide history in predicting the medical severity of follow-up suicide attempts.

METHODS

The cohort included 153 consecutive psychiatric in-patients who participated in earlier studies 1-9 years previously. Fifty-three had a history of a medically serious suicide attempt (MSSA), 64 had a history of a medically non-serious suicide attempt (MNSSA), and 36 had no history of suicide. A MSSA was defined as a suicide attempt that warranted hospitalization for at least 24h and extensive medical treatment. Participants completed a battery of instruments measuring mental pain and communication difficulties. Findings were analyzed in relation to follow-up suicide attempts and their severity.

RESULTS

Fifty-three patients (35.5%) had attempted suicide: 15 (9.9%) a MSSA (including 5 fatalities) and 38 (25%) a MNSSA. The medical severity of the index attempt and level of hopelessness at the index attempt were significantly correlated with medical severity of the follow-up attempt. In younger patients, high levels of depression and self-disclosure predicted the medical severity of the follow-up attempt. In patients with relatively low hopelessness, the medical severity of the attempt increased with the level of self-disclosure.

LIMITATIONS

(i) Possibly incomplete patient information, as some of the patients who participated in the index studies could not be located. (ii) Relatively small group of patients with an index MSSA.

CONCLUSIONS

Patients who have made a suicide attempt should be assessed for medical severity of the attempt, hopelessness, and communication difficulties, which are important factors in follow-up attempts.

A descriptive study of female suicide deaths from 2005 to 2011 in Van city, Turkey

BACKGROUND

Female suicide is an important problem not only for women but for public health in general.

METHODS

Autopsy reports from the Van Chief Public Prosecutor's Office from 2005 to 2011 were reviewed retrospectively in order to analyse female deaths from suicide.

RESULTS

Sixty-six female suicide cases were recorded during 2005-2011. The mean age of the cases was 22.64 (sd = 10.09) years, and nine were below the age of 15. The most common method of suicide was hanging (44 cases, 66.7 %). Five (7.6 %) of the cases were under treatment for depression, and 12 (18.2 %) cases had a previous suicide attempt.

CONCLUSIONS

Cultural suppression of females and prevention of their socialization in enclave societies are risk factors for female suicides. The number of female suicide attempts, especially recurring attempts, should be reduced via psychiatric scanning, follow-up sessions and therapy for high-risk individuals.

Loneliness and depressive symptoms among older adults: The moderating role of subjective life expectancy

Loneliness and depressive symptoms are closely related, and both are indicators of reduced physical and mental well-being in old age. In recent years, the subjective perception of how long an individual expects to live (subjective life expectancy) has gained importance as a significant predictor of future psychological functioning, as well as of physical health. The current study examined whether subjective life expectancy moderates the connection between loneliness and depressive symptoms in a representative sample of older adults. Data was collected from the Israeli component of the fifth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel). Participants (n=2210; mean age=70.35) completed measures of loneliness, depressive symptoms, and life expectancy target age. A hierarchical regression analysis predicting depressive symptoms yielded a significant interaction of loneliness and subjective life expectancy. Further analyses demonstrated that low subjective life expectancy mitigated the loneliness-depressive symptoms connection. Findings are discussed in light of the potential burden of higher subjective life expectancy for lonesome older adults, and practical implications are suggested.

'Give Me a Reason to Live!' Examining Reasons for Living Across Levels of Suicidality

Scholarly research focusing on social psychological factors (e.g. mental health) and social environmental factors (e.g. childhood trauma) has found these measures to be correlated with suicidality. However, such literature has tended to overlook what may impact one's reasons for living. Using a sample of over 1,200 students from a Canadian university, the goal of the current study is to empirically test, by employing multivariate nested regression models (by levels of suicidal behaviour), known and relative unknown correlates with reasons for living, with a particular focus on strength of religious faith, which is a well-known predictor for suicidality, but less studied as a reason for living. Results show that, among students with serious suicidal ideation and/or a previous suicide attempt, the strongest predictor for student's reasons for living was strength of religious faith. Strength of religious faith has seldom been acknowledged or identified as an important measure in assessing one's reasons to live. These findings have implications for the role of religiosity among suicidality research, especially studies that focus on reasons for living.

Effects of acute or repeated paroxetine and fluoxetine treatment on affective behavior in male and female adolescent rats

RATIONALE

The SSRI antidepressant fluoxetine is one of the few drugs that is effective at treating depression in adolescent humans. In contrast, the SSRI paroxetine has limited efficacy and is more at risk for inducing suicidal behavior.

OBJECTIVE

The purpose of the present study was to more fully characterize the differential actions of paroxetine and fluoxetine.

METHODS

In experiment 1, male and female rats were injected with paroxetine (2.5 or 10 mg/kg), fluoxetine (10 mg/kg), or vehicle for 10 days starting on postnatal day (PD) 35, and affective behaviors were assessed using sucrose preference and elevated plus maze tasks. A separate set of rats were used to examine monoamine levels. In experiment 2, rats were injected with paroxetine (2.5, 5, or 10 mg/kg), fluoxetine (5, 10, or 20 mg/kg), or vehicle during the same time frame as experiment 1, and anxiety-like behaviors were measured using elevated plus maze, light/dark box, and acoustic startle.

RESULTS

Repeated SSRI treatment failed to alter sucrose preference, although both paroxetine and fluoxetine reduced time spent in the open arms of the elevated plus maze and light compartment of the light/dark box. Paroxetine, but not fluoxetine, enhanced acoustic startle and interfered with habituation. Serotonin turnover was decreased by both acute and repeated fluoxetine treatment but unaltered by paroxetine administration.

DISCUSSION

These results show that repeated treatment with paroxetine and fluoxetine has dissociable actions in adolescent rats. In particular, paroxetine, but not fluoxetine, increases acoustic startle at low doses and may increase sensitivity to environmental stressors.

Association between personality factors and suicide intent in attempted suicide: Gender as a possible mediator?

BACKGROUND

Gender appears to be a factor closely related to key suicide-related constructs.

AIMS

The study aims to assess gender differences in personality factors among suicide attempters and to examine the role of gender in mediating the relationship between suicide attempts and selected personality attributes in the same group.

METHODS

A chart review of 156 consecutive suicide attempters was carried out. All participants were administered the Beck Suicide Intent Scale (BSIS), Barratt Impulsivity Scale-11 (BIS-11), Buss-Perry Aggression Questionnaire (BPAQ) and Past Feelings and Acts of Violence (PFAV) Scale.

RESULTS

The suicidal intent and impulsiveness did not differ significantly between men and women, although men had significantly greater PFAV scores (t = 3.361, p = 0.001). BPAQ showed a significant difference between the genders (F = 3.621, p = 0.008; Wilk's Λ = 0.950, partial η(2) = 0.100), mainly for physical aggression (F = 11.006; p = 0.001; partial η(2) = 0.076) and anger (F = 4.298; p = 0.040; partial η(2) = 0.031).

CONCLUSION

Certain differences seem to be present between Indian male and female suicide attempters with regard to baseline personality attributes and their role in predicting suicide intent. The import of personality traits as potential targets for suicide prevention is worth exploring further.

Understanding Suicide Attempts Among Gay Men From Their Self-perceived Causes

Gay men are at higher risk of suicidality. This paper describes the causes of suicide attempts as perceived by the men themselves and analyzes their impact on severity and recidivism. Mental health surveys conducted among gay men in Geneva, Switzerland, from two probability-based time-space samples in 2007 and 2011, were merged to yield a combined sample N = 762. Suicide ideation, plans, and attempts were assessed, and respondents who had ever attempted suicide answered open questions about perceived causes which were coded and categorized for analysis within the framework of cultural epidemiology. In all, 16.7% of the respondents reported a suicide attempt in their lifetime (59.5% of them with multiple attempts). At their latest attempt, over two thirds asserted intent to die, and half required medical assistance. There was a wide variety of perceived causes, with most individuals reporting multiple causes and many of the most common causes cited at both the first and most recent subsequent attempts. Social/inter-personal problems constitute the most prominent category. Problems with love/relationship and accepting one's homosexuality figure consistently among the top three causes. Whereas the former tend to be associated with weaker intent to die, the latter are associated with the strongest intent to die and reported at multiple attempts. Problems with family are among the most common perceived causes at first attempt but not at the most recent subsequent attempt. Nevertheless, they tend to be related to the strongest intent to die and the greatest medical severity of all the perceived causes. Ten percent of men attempting suicide cited depression as a cause. Although it tended to be associated with weaker intent to die, depression was most likely to be reported at multiple attempts. Respondent-driven assessment yielded both common and idiosyncratic causes of suicide and their distinct effects. Some of these perceived causes are not prominent in the current literature, yet they have important implications for understanding risk and preventing suicide among gay men.

Symptoms Moderating the Association Between Recent Suicide Attempts and Trauma Levels: Fan-Shaped Effects

The present study focuses on variables moderating the incidence of recent suicide attempt in a large community sample (n = 39,617) of French citizens with various levels of trauma. Five trauma levels were established based on posttraumatic stress disorder items of the Mini International Neuropsychiatric Interview. Twenty-three symptoms were examined as potential moderating variables with a fan-shaped pattern. Seven symptoms regarding desire for death, self-harm intention, suicidal ideation, lifetime suicide attempt, depressed mood, loss of interest, and panic attack exhibited the fan-shaped pattern. The absence of these moderating symptoms decreases the incidence of suicide attempt and their presence leads to a gradual increase.

Predictors of suicidal ideation in coronary artery disease

CONTEXT

In clinical practice, the importance of screening for anxiety and depression in patients with medical illness is highlighted. In many cases, the suicidal ideation makes up the framework of mental disorders, which may be exacerbated in these individuals.

OBJECTIVE

To investigate the role of symptoms of mental disorders in the presence of suicidal ideation.

METHODS

A total of 103 patients with diagnosis of coronary artery disease in cardiac treatment were interviewed for symptoms of anxiety and depression using the Beck Depression Inventory and Hospital Anxiety and Depression Scale. All patients were also analyzed for presence of suicidal ideation, wishes, attitude and suicidal plans using the Beck Suicidal Ideation Scale. The relationship between social and demographic variables and mental disturbances and the presence of suicidal ideation was assessed using chi-square test and coefficient of sperm. Logistic regression analysis was used to explain the change in the role of each of the variables in suicidal ideation.

RESULTS

The results showed that predictors for suicidal ideation were isolated anxiety (B=0.29; Wald 4.77; p=0.03) with an odds ratio of 1.34 (CI 1.03-1.75) and isolated depression (B=0.33; Wald 5.35; p=0.02) with an odds ratio of 1.39 (CI 1.05-1.85). Frequencies of interaction depression and anxiety were higher among patients who were single, widowed and divorced. Chi-square test and the coefficient of sperm showed an association between marital status and suicidal ideation (χ(2)(2)=9.17; p=0.01).

CONCLUSION

Anxiety and depression are risk factors for isolated patients with suicidal ideation. Early clinical identification of mental disorders in patients with medical illness contributed to preventing the risk of suicide.

A proposed model of the development of suicidal ideations

BACKGROUND

Suicidal ideations may precede suicide attempts. They are of particular concern in psychiatric populations because psychopathology is a major risk factor for suicide. The factors affecting the development of suicide ideations may differ among psychiatric patients with and without a previous suicide attempt and individuals without a psychiatric diagnosis.

OBJECTIVES

The aim of this study is to develop a model of suicide ideation in psychiatric patients and the general population.

METHOD

The study included 196 participants: 92 psychiatric patients with a previous suicide attempt ("attempters"); 47 psychiatric patients who had never attempted suicide ("non-attempters"); and 57 healthy control subjects. Data were collected on socio-demographic parameters, clinical history, and details of the suicide attempts. Participants completed a battery of psychological instruments assessing aggression-impulsivity, mental pain (including depression and hopelessness) and communication difficulties, in addition to negative life events. Findings were correlated with suicidal ideation by group.

RESULTS

The correlations of the different variables with suicidal ideation differed between suicide attempters and non-attempters; therefore, the model was analyzed separately for each group. The study yielded three major findings: negative life events had a significant effect on both anger-in and impulsivity in non-attempters but not in attempters; hopelessness moderately contributed to suicidal ideations in attempters but not in non-attempters; loneliness contributed significantly to depression in non-attempters but was less distressing in attempters.

CONCLUSION

The mechanism underlying suicidal ideation appears to differ between psychiatric patients who have previously attempted suicide and those who have not, supporting a dual model of suicidal ideation. Although this is only a preliminary study, these findings are important for furthering our understanding of the process of transition of suicidal thoughts to completion of suicide. These results need further replication with a larger cohort of subjects.

Aggression-impulsivity, mental pain, and communication difficulties in medically serious and medically non-serious suicide attempters

BACKGROUND

Unbearable mental pain, depression, and hopelessness have been associated with suicidal behavior in general, while difficulties with social communication and loneliness have been associated with highly lethal suicide attempts in particular. The literature also links aggression and impulsivity with suicidal behavior but raises questions about their influence on the lethality and outcome of the suicide attempt.

OBJECTIVES

To evaluate the relative effects of aggression and impulsivity on the lethality of suicide attempts we hypothesized that impulsivity and aggression differentiate between suicide attempters and non-attempters and between medically serious and medically non-serious suicide attempters.

METHOD

The study group included 196 participants divided into four groups: 43 medically serious suicide attempters; 49 medically non-serious suicide attempters, 47 psychiatric patients who had never attempted suicide; and 57 healthy control subjects. Data on sociodemographic parameters, clinical history, and details of the suicide attempts were collected. Participants completed a battery of instruments for assessment of aggression-impulsivity, mental pain, and communication difficulties.

RESULTS

The medically serious and medically non-serious suicide attempters scored significantly higher than both control groups on mental pain, depression, and hopelessness (p<.001 for all) and on anger-in, anger-out, violence, and impulsivity (p<.05 for all), with no significant difference between the two suicide attempter groups. Medically serious suicide attempters had significantly lower self-disclosure (p<.05) and more schizoid tendencies (p<.001) than the other three groups and significantly more feelings of loneliness than the medically non-serious suicide attempters and nonsuicidal psychiatric patients (p<.05). Analysis of aggression-impulsivity, mental pain, and communication variables with suicide lethality yielded significant correlations for self-disclosure, schizoid tendency, and loneliness. The interaction between mental pain and schizoid traits explained some of the variance in suicide lethality, over and above the contribution of each component alone.

CONCLUSIONS

Aggression-impulsivity and mental pain are risk factors for suicide attempts. However, only difficulties in communication differentiate medically serious from medically non-serious suicide attempters. The combination of unbearable mental pain and difficulties in communication has a magnifying effect on the risk of lethal suicidal behavior.

Household composition and suicidal behaviour in the adult population of Belgium

PURPOSE

We aimed to estimate the prevalence of suicidal behaviours, i.e. ideation and attempt, in the adult population of Belgium, and to explore their association with household composition.

METHODS

Data of 4,459 adults (25-64 years) from the 2004 Belgian Health Interview Survey were used for analyses. Bivariate and multivariate logistic regressions were used to calculate the odds of engaging in suicidal behaviours according to household type, further controlling for age, sex, income, employment status and social support.

RESULTS

Lifetime prevalence of ideation and attempts was 14 and 4.7 %, respectively. Current prevalence of ideation was 4.0 % and past year prevalence of attempts was 0.5 %. Compared to other household compositions, living alone (A) and as lone parent (P) increased the odds of lifetime and current suicidal thoughts (ORA 2.3, 95 % CI 1.7-2.9 and ORP 3.8, 95 % CI 1.9-7.7) and lifetime attempts (ORA 2.3, 95 % CI 1.4-3.6 and ORP 4.5, 95 % CI 2.4-8.5). When controlling for confounders, single person and single parent households still presented increased adjusted-odds of lifetime and current suicidal thoughts (a-ORA 1.8, 95 % CI 1.1-2.9 and a-ORP 2.3, 95 % CI 1.0-5.5). The likelihood of ever attempted suicide was also higher among single parent households (a-ORP 4.5, 95 % CI 2.4-8.5) after adjustment, but not among those living alone (a-ORA 1.4, 95 % CI 0.8-2.8).

CONCLUSION

Living alone or as lone parent place adults at higher risk for suicide behaviour, and this is only partly explained by lower socio-economic status or poor perceived support.