1
|
Grimland M, Benatov J, Yeshayahu H, Izmaylov D, Segal A, Gal K, Levi-Belz Y. Predicting suicide risk in real-time crisis hotline chats integrating machine learning with psychological factors: Exploring the black box. Suicide Life Threat Behav 2024; 54:416-424. [PMID: 38345174 DOI: 10.1111/sltb.13056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND This study addresses the suicide risk predicting challenge by exploring the predictive ability of machine learning (ML) models integrated with theory-driven psychological risk factors in real-time crisis hotline chats. More importantly, we aimed to understand the specific theory-driven factors contributing to the ML prediction of suicide risk. METHOD The dataset consisted of 17,654 crisis hotline chat sessions classified dichotomously as suicidal or not. We created a suicide risk factors-based lexicon (SRF), which encompasses language representations of key risk factors derived from the main suicide theories. The ML model (Suicide Risk-Bert; SR-BERT) was trained using natural language processing techniques incorporating the SRF lexicon. RESULTS The results showed that SR-BERT outperformed the other models. Logistic regression analysis identified several theory-driven risk factors significantly associated with suicide risk, the prominent ones were hopelessness, history of suicide, self-harm, and thwarted belongingness. LIMITATIONS The lexicon is limited in its ability to fully encompass all theoretical concepts related to suicide risk, nor to all the language expressions of each concept. The classification of chats was determined by trained but non-professionals in metal health. CONCLUSION This study highlights the potential of how ML models combined with theory-driven knowledge can improve suicide risk prediction. Our study underscores the importance of hopelessness and thwarted belongingness in suicide risk and thus their role in suicide prevention and intervention.
Collapse
Affiliation(s)
- Meytal Grimland
- Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
- Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Joy Benatov
- Department of Special Education, University of Haifa, Haifa, Israel
| | - Hadas Yeshayahu
- Department of Special Education, University of Haifa, Haifa, Israel
| | - Daniel Izmaylov
- Department of Software and Information Systems Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Avi Segal
- Department of Software and Information Systems Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Kobi Gal
- Department of Software and Information Systems Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- School of Informatics, University of Edinburgh, Edinburgh, UK
| | - Yossi Levi-Belz
- Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
- Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
| |
Collapse
|
2
|
Oquendo MA, Wall M, Wang S, Olfson M, Blanco C. Lifetime Suicide Attempts in Otherwise Psychiatrically Healthy Individuals. JAMA Psychiatry 2024; 81:572-578. [PMID: 38381442 PMCID: PMC10882500 DOI: 10.1001/jamapsychiatry.2023.5672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/17/2023] [Indexed: 02/22/2024]
Abstract
Importance Not all people who die by suicide have a psychiatric diagnosis; yet, little is known about the percentage and demographics of individuals with lifetime suicide attempts who are apparently psychiatrically healthy. If such suicide attempts are common, there are implications for suicide risk screening, research, policy, and nosology. Objective To estimate the percentage of people with lifetime suicide attempts whose first attempt occurred prior to onset of any psychiatric disorder. Design, Setting, and Participants This cross-sectional study used data from the US National Epidemiologic Study of Addictions and Related Conditions III (NESARC-III), a cross-sectional face-to-face survey conducted with a nationally representative sample of the US civilian noninstitutionalized population, and included persons with lifetime suicide attempts who were aged 20 to 65 years at survey administration (April 2012 to June 2013). Data from the NESARC, Wave 2 survey from August 2004 to September 2005 were used for replication. Analyses were performed from April to August 2023. Exposure Lifetime suicide attempts. Main Outcomes and Measures The main outcome was presence or absence of a psychiatric disorder before the first lifetime suicide attempt. Among persons with lifetime suicide attempts, the percentage and 95% CI of those whose first suicide attempt occurred before the onset of any apparent psychiatric disorders was calculated, weighted by NESARC sampling and nonresponse weights. Separate analyses were performed for males, females, and 3 age groups (20 to <35, 35-50, and >50 to 65 years). Results In the total sample of 36 309 respondents, 1948 persons had lifetime suicide attempts; 66.8% (95% CI, 64.1%-69.4%) were female, and 6.2% (95% CI, 4.9%-7.4%) had no apparent lifetime psychiatric diagnoses when surveyed. In addition, 13.4% (95% CI, 11.6%-15.2%) made their first suicide attempt prior to psychiatric disorder onset. Thus, an estimated 19.6% of respondents first attempted suicide without an antecedent psychiatric disorder. No significant age or sex differences were detected in the percentage of those with lifetime suicide attempts absent psychiatric disorders, although females were more likely than males to attempt suicide in the year of psychiatric disorder onset (14.9% [95% CI, 12.5%-17.3%] vs 8.6% [95% CI, 6.0%-11.2%]; P < .001), and attempts were less frequent among those older than 50 to 65 years (3.9% [95% CI, 3.5%-4.4%] vs 6.1% [95% CI, 5.4%-6.8%] for 35-50 years and 6.2% [95% CI, 5.6%-6.9%] for 20 to <35 years; P < .001). Conclusions and Relevance In this study, an estimated 19.6% of individuals who attempted suicide did so despite not meeting criteria for an antecedent psychiatric disorder. This finding challenges clinical notions of who is at risk for suicidal behavior and raises questions about the safety of limiting suicide risk screening to psychiatric populations.
Collapse
Affiliation(s)
- Maria A. Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Melanie Wall
- Department of Psychiatry, Columbia University, New York, New York
| | - Shuai Wang
- National Institute on Drug Abuse, Rockville, Maryland
| | - Mark Olfson
- Department of Psychiatry, Columbia University, New York, New York
| | - Carlos Blanco
- National Institute on Drug Abuse, Rockville, Maryland
| |
Collapse
|
3
|
Oquendo MA, Galfalvy HC, Choo TH, Herzog S, Burke AK, Sublette ME, Mann JJ, Stanley BH. Occurrence and characteristics of suicidal ideation in psychiatrically healthy individuals based on ecological momentary assessment. Mol Psychiatry 2024:10.1038/s41380-024-02560-2. [PMID: 38729992 DOI: 10.1038/s41380-024-02560-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 05/12/2024]
Abstract
Decedents with no known mental disorder comprise 5-40% of suicides, suggesting that suicide ideation (SI) and behavior may occur in the psychiatrically healthy with important implications for suicide risk screening. Healthy Volunteers (HV) and patients with Major Depressive Disorder (MDD) provided 7 days of Ecological Momentary Assessment (EMA) data about SI and stressors. Longitudinal mixed effects logistic regression models compared HV and patient SI and stressors. Mixed effects linear regression models compared HVs' and patients' SI score change from the previous epoch's SI score when each stressor occurred. HVs (n = 42) reported less frequent (p < 0.001) and less intense SI (p < 0.003) than patients (n = 80), yet did endorse SI and/or SI-related items in 44% of EMA epochs, endorsing SI items in 25% of epochs with non-zero SI scores. For 7 of 8 stressors, patients reported stressors more often than HVs (all p < 0.001) responding to them with increased SI (0.0001 < p < 0.0472). HVs were relatively resilient to stressors, reporting SI increases only in response to neglect (p < 0.0147). Although SI and SAs are documented among psychiatrically healthy individuals, scientific attention to these observations has been scant. Real-time SI measurement showed that HVs' SI was less pronounced than MDD patients', but was endorsed, nonetheless. Patients were more likely to report stressors than HVs, perhaps due to greater sensitivity to the environment, and reported SI in response to stressors, which was less common in HVs. Both MDD patients and HVs most often manifested passive SI (viz, "decreased wish to live"). However, passive SI (viz, "desire for death"), may predict suicide, even absent SI per se (thinking about killing yourself). This study validates the utility of real-time SI assessment, showing that HVs endorse SI items in 11% of epochs, which implies that suicide risk screening focused on those with mental disorders may be too narrow an approach.
Collapse
Affiliation(s)
- Maria A Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Hanga C Galfalvy
- Vagelos College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Tse-Hwei Choo
- Vagelos College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Sarah Herzog
- Vagelos College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Ainsley K Burke
- Vagelos College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - M Elizabeth Sublette
- Vagelos College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - J John Mann
- Vagelos College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Barbara H Stanley
- Vagelos College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| |
Collapse
|
4
|
Zerach G, Levinstein Y, Levi-Belz Y. Longitudinal associations between exposure to potentially morally injurious events and suicidal ideation among recently discharged veterans - The mediating roles of depression and loneliness. J Affect Disord 2024; 350:689-697. [PMID: 38224741 DOI: 10.1016/j.jad.2024.01.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Exposure to potentially morally injurious events (PMIEs) during military service is associated with heightened suicidal ideation (SI). However, no longitudinal study has established temporal associations between these variables and examined the possible mediating roles of depression and loneliness in this effect. METHODS Participants were 374 active-duty Israeli combatants who participated in a five-year longitudinal study with four measurement points: T1- one year before enlistment, T2- one month before discharge from army service, and then again six months and twelve months following their discharge (T3 and T4, respectively). Data were assessed through semi-structured interviews and validated self-report questionnaires. RESULTS Above and beyond pre-enlistment personal characteristics (T1) and combat exposure (T2), PMIEs-'betrayal' (T2) predicted more frequent SI over the past twelve months (T4) through the mediation of depression. Moreover, both PMIEs-'betrayal' and 'self' (T2) predicted more frequent SI over the past twelve months (T4) through the mediation of loneliness. LIMITATIONS We used self-report measures to assess PMIEs and SI, which may suffer from various biases. CONCLUSIONS Our findings are the first to provide evidence of longitudinal, temporal associations between exposure to PMIEs and SI. Notably, potential interventions might consider addressing the loneliness experienced following exposure to PMIEs during military service, among recently discharged traumatized veterans.
Collapse
Affiliation(s)
- Gadi Zerach
- Dept. of Psychology, Ariel University, Ariel, Israel.
| | - Yoav Levinstein
- Dept. of Health and Well-being, Medical Corps, IDF, School of Social Work, Bar-Ilan University, Ramat-Gan, Israel
| | - Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| |
Collapse
|
5
|
Ikhtabi S, Pitman A, Maconick L, Pearce E, Dale O, Rowe S, Johnson S. The prevalence and severity of loneliness and deficits in perceived social support among who have received a 'personality disorder' diagnosis or have relevant traits: a systematic review. BMC Psychiatry 2024; 24:21. [PMID: 38172738 PMCID: PMC10765693 DOI: 10.1186/s12888-023-05471-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Loneliness and struggles with unmet social needs are a common experience among people with 'personality disorder' diagnoses/traits. Given the impact of loneliness and poor perceived social support on mental health, and the importance of a sense of belonging for recovery, a systematic review examining the prevalence/severity of loneliness and deficits in perceived social support among people with 'personality disorder' diagnoses/traits is an essential step towards developing an intervention targeting the social needs of people with diagnoses/traits 'personality disorder'. Despite an extensive literature on loneliness and deficits of perceived social support among people with 'personality disorder' diagnosis/traits, to date there has been no systematic review of this evidence. METHOD We conducted a systematic review synthesising quantitative data on the prevalence/severity of loneliness and deficits of perceived social support among people with diagnoses/traits of 'personality disorder' in comparison with other clinical groups and the general population. We searched Medline, Embase, PsycINFO, Web of Social Science, Google scholar and Ethos British Library from inception to December 2021. We conducted quality appraisals using the Joanna Briggs Critical appraisal tools and rated the certainty of evidence using the Grading of Recommendation, Assessment, Development and Evaluation approach. A narrative synthesis was used describing the direction and strength of associations prioritising high quality studies. FINDINGS A final set of 70 studies are included in this review, most of which are cross-sectional studies (n = 55), based in the United States (51%) and focused on community samples. Our synthesis of evidence found that, across all types of 'personality disorders' (except 'narcissistic personality' traits), people with traits associated with 'personality disorder' or meeting criteria for a diagnosis of 'personality disorder', have higher levels of loneliness, lower perceived relationship satisfaction, and poorer social support than the general population or other clinical samples. CONCLUSION The quality of evidence is judged as low quality. However, given the distressing nature of loneliness and the known negative effects of loneliness on mental health and recovery, it is important for future research to explore mechanisms by which loneliness may exacerbate 'personality disorder' symptoms and the impact this has on recovery.
Collapse
Affiliation(s)
| | - Alexandra Pitman
- UCL Division of Psychiatry, Camden and Islington NHS Foundation Trust, London, UK
| | - Lucy Maconick
- UCL Division of Psychiatry, NIHR Doctoral Research Fellow, Camden and Islington NHS Foundation Trust, London, UK
| | | | - Oliver Dale
- Sussex Partnership Foundation Trust, London, UK
| | | | - Sonia Johnson
- UCL Division of Psychiatry, Camden and Islington NHS Foundation Trust, London, UK
| |
Collapse
|
6
|
Wang R, Yang Y, Li Y, Liu Y, Zhao X, Jia J, Su Y. Social support moderates suicidal ideation among Chinese nursing home residents with limited activities of daily living and loneliness. Arch Psychiatr Nurs 2021; 35:638-644. [PMID: 34861957 DOI: 10.1016/j.apnu.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/09/2021] [Accepted: 07/11/2021] [Indexed: 01/03/2023]
Abstract
Rare studies are available exploring the impact of limited activities of daily living (ADL), loneliness on suicidal ideation, and protective effect of social support on their relationships in nursing home residents. This study aims to examine these links in a sample of older adults from nursing homes. A stratified random sampling was adopted to recruit 538 respondents from 37 nursing homes in Jinan. Suicidal ideation, limited ADL, social support and loneliness were assessed through instruments of Beck Suicidal Ideation Scale, ADL scale, Perceived Social Support Scale and UCLA Loneliness Scale. Relationships of latent variables were tested using Path Analysis in this cross-sectional study. The mediating effect of loneliness was significant on the association between limited ADL and suicidal ideation, and the mediation model was multiply moderated by social support with significant coefficients and acceptable model fitness. This study demonstrated the multiple moderating role of social support in the effect of limited ADL and loneliness on suicidal ideation among nursing home residents. More efforts are suggested in providing more available external resources to seniors' mental health for reducing risk of influencing factors of suicidal ideation.
Collapse
Affiliation(s)
- Rui Wang
- School of Nursing and Rehabilitation, Shandong University, 250012 Jinan, Shandong, China
| | - Yang Yang
- School of Nursing and Rehabilitation, Shandong University, 250012 Jinan, Shandong, China
| | - Yanwen Li
- Shandong Academy of Social Sciences, 250012 Jinan, Shandong, China
| | - Yanzheng Liu
- Department of Research, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 250012 Jinan, Shandong, China
| | - Xia Zhao
- Department of Health Management, Heze Medical College, 274000 Heze, Shandong, China
| | - Jihui Jia
- School of Basic Medical Sciences, Shandong University, 250012 Jinan, Shandong, China
| | - Yonggang Su
- School of Foreign Languages and Literature, Shandong University, 250012 Jinan, Shandong, China; School of Basic Medical Sciences, Shandong University, 250012 Jinan, Shandong, China.
| |
Collapse
|
7
|
Almoammar S, Alqarni KA, Alnazeh AA, Alshahrani RM, Sundram F, Alyami M, Alyami H. Depression and suicidal ideation among dental students of Southern Saudi Arabia: A cross sectional study. J Dent Educ 2021; 85:1837-1846. [PMID: 34416011 DOI: 10.1002/jdd.12763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/12/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE To assess depression and suicidal ideation among dental students at King Khalid University College of Dentistry, Abha, Saudi Arabia. METHODS A cross-sectional questionnaire-based study was carried out among dental students between January and March 2020. The Arabic version of the Patient Health Questionnaire (PHQ-9) was used to assess depression, while suicidal ideation was assessed using three questions related to suicidal behaviors drawn from the literature. RESULTS A total of 218 participants completed the questionnaires. More than 40% of the participants experienced depression while the prevalence of suicidal ideation was 48.2%; around a third of the sample had suicidal ideation, and half of which made a suicidal attempt in the preceding year (p < 0.05). There was a lack of association between depression severity and suicidal ideation. CONCLUSION A large proportion of dental students experienced depression and suicidal ideation. These findings invite in depth analysis of the causative and contributing factors for such high rates as well as ways for addressing them.
Collapse
Affiliation(s)
- Salem Almoammar
- Department of Pediatric Dentistry and Orthodontic Sciences, King Khalid University College of Dentistry, Abha, Saudi Arabia
| | - Kholod Abdurhman Alqarni
- Department of Pediatric Dentistry and Orthodontic Sciences, King Khalid University College of Dentistry, Abha, Saudi Arabia
| | - Abdullah A Alnazeh
- Department of Pediatric Dentistry and Orthodontic Sciences, King Khalid University College of Dentistry, Abha, Saudi Arabia
| | - Razan Mohamed Alshahrani
- Department of Pediatric Dentistry and Orthodontic Sciences, King Khalid University College of Dentistry, Abha, Saudi Arabia
| | - Frederick Sundram
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Mohsen Alyami
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Hussain Alyami
- College of Medicine, Taif University, Taif, Saudi Arabia
| |
Collapse
|
8
|
Yang Y, Wang R, Zhang D, Su Y, Zang Y. The protective effect of self-esteem on suicidal ideation among nursing home residents with limited social support in China: A cross-sectional study. Nurs Open 2021; 9:2729-2738. [PMID: 34190426 PMCID: PMC9584493 DOI: 10.1002/nop2.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/29/2021] [Accepted: 06/02/2021] [Indexed: 11/20/2022] Open
Abstract
Aim This cross‐sectional study aimed to assess the impact of limited social support and loneliness on suicidal ideation, under the influence of self‐esteem, an important inner resource for quality living. Design An observational cross‐sectional study conducted from September 2018–April 2019. Methods The participants comprised 538 nursing home residents selected by a stratified sampling method from all seven administrative districts in a capital city of eastern China. All the participants completed the survey that constituted the measurement of suicidal ideation, self‐esteem, social support and loneliness. Path analysis was performed using the structural equation modelling method. Results A moderating effect, with satisfactory model fit indices and significant path coefficients, was detected between self‐esteem and suicidal ideation through limited social support and loneliness, revealing the multiple protective mechanisms of this psychological characteristic on the change of suicidal ideation.
Collapse
Affiliation(s)
- Yang Yang
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Rui Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Dan Zhang
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Yonggang Su
- School of Basic Medical Sciences, Shandong University, Jinan, China.,School of Foreign Languages and Literature, Shandong University, Jinan, China
| | - Yuli Zang
- Faculty of Medicine, The Nethersole School of Nursing, Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
9
|
How Loneliness Worked on Suicidal Ideation among Chinese Nursing Home Residents: Roles of Depressive Symptoms and Resilience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105472. [PMID: 34065364 PMCID: PMC8160705 DOI: 10.3390/ijerph18105472] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/07/2021] [Accepted: 05/14/2021] [Indexed: 01/21/2023]
Abstract
Suicide in later life is becoming severe under rapid population aging, especially for nursing home residents. Loneliness, an increasingly represented issue among nursing home residents, is found to be a risk factor for depressive symptoms. Both loneliness and depressive symptoms may contribute to the development of suicidal ideation. According to the Protective Factor Model, resilience can act as a moderating role interacting with risk factors to buffer the negative effects on the outcome. The present study aimed to assess the mediating role of depressive symptoms and the moderating effect of resilience on the risk factors of suicidal ideation to attenuate the adverse contribution among nursing home residents. A total of 538 nursing home residents participated in this cross-sectional study, and their suicidal ideation, resilience, loneliness, and depressive symptoms were measured. The mediating effect and moderated mediation model were tested using the Macro Process of SPSS 21.0. Statistics showed that 19.7% of participants had suicidal ideation. The mediating model (H1: B = 0.477, p < 0.001; H2: B = 0.325, p < 0.001; H3: B = 0.308, p < 0.001) and the moderating effect of resilience interacting loneliness (H4: B = −0.133, p < 0.001; H6: B = −0.109, p < 0.001) and depressive symptoms (H5: B = −0.077, p < 0.001) were statistically significant. The findings indicated the protective effect of resilience in alleviating the negative influence of risk factors for suicidal ideation, suggesting that positive psychological interventions for resilience building might be effective in suicide prevention among nursing home residents.
Collapse
|
10
|
Burish MJ, Pearson SM, Shapiro RE, Zhang W, Schor LI. Cluster headache is one of the most intensely painful human conditions: Results from the International Cluster Headache Questionnaire. Headache 2021; 61:117-124. [PMID: 33337540 PMCID: PMC7898696 DOI: 10.1111/head.14021] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine the pain intensity of cluster headache through a large survey by comparing it to other painful disorders. Furthermore, to investigate the relationship between maximal pain, autonomic, and other clinical symptoms, as well as demographic attributes of cluster headache. BACKGROUND The pain of cluster headache is anecdotally considered to be one of the worst pains in existence. The link between pain and autonomic features of cluster headache is understood mechanistically through the trigeminovascular reflex, though it is not clear if this is a graded response. Links between pain and other features of cluster headache are less well understood. METHODS This Internet-based cross-sectional survey included questions on cluster headache diagnostic criteria, which were used as part of the inclusion/exclusion criteria for the study. Respondents were asked to rate a cluster headache attack on the 0-10 numerical rating scale. Additionally, they were asked if they had experienced a list of other painful conditions such as labor pain or nephrolithiasis; if so they were asked to rate that pain as well. The survey also included demographics, mood scores, and treatment responses. RESULTS A total of 1604 cluster headache respondents were included in the analysis. Respondents rated cluster headache as significantly (p < 0.001) more intense than every other pain condition examined. Cluster headache attacks were rated as 9.7 ± 0.6 (mean ± standard deviation) on the numerical rating scale, followed by labor pain (7.2 ± 2.0), pancreatitis (7.0 ± 1.5), and nephrolithiasis (6.9 ± 1.9). The majority of cluster headache respondents rated a cluster headache attack at maximal or 10.0 pain (72.1%, 1157/1604). Respondents with maximal pain were statistically significantly more likely to have cranial autonomic features compared to respondents with less pain: conjunctival injection or lacrimation 91% (1057/1157) versus 85% (381/447), eyelid edema 77% (887/1157) versus 66% (293/447), forehead/facial sweating 60% (693/1157) versus 49% (217/447), fullness in the ear 47% (541/1157) versus 35% (155/447), and miosis/ptosis 85% (1124/1157) versus 75% (426/447) (all p values <0.001). Respondents with maximal pain also had other statistically significant findings: more frequent attacks (4.0 ± 2.0 attacks per day vs. 3.5 ± 2.0 attacks per day), higher Hopelessness Depression Symptom Questionnaire scores (24.5 ± 16.9 vs. 21.1 ± 15.2), decreased overall effectiveness from calcium channel blockers (on a 5-point Likert scale), and more likely female: 34% (389/1157) versus 24% (108/447) (all p values <0.001). Pain intensity was not associated with restlessness, headache duration, age of onset, episodic/chronic status, or the effectiveness of any acute or preventive medication other than calcium channel blockers. CONCLUSIONS Cluster headache is an intensely painful disorder, even in the context of other disorders considered intensely painful. Maximal pain intensity is associated with more cranial autonomic features, suggesting a graded response between pain and autonomic features. Maximal pain intensity is also associated with headache frequency but not duration, suggesting a relationship between pain intensity and mechanisms controlling headache onset, but not between pain intensity and mechanisms controlling headache offset.
Collapse
Affiliation(s)
- Mark J. Burish
- Department of NeurosurgeryUniversity of Texas Health Science Center at HoustonHoustonTXUSA
| | | | - Robert E. Shapiro
- Department of Neurological SciencesUniversity of VermontBurlingtonVTUSA
| | - Wei Zhang
- Department of Biostatistics and Data ScienceUTHealth School of Public HealthHoustonTXUSA
| | - Larry I. Schor
- Department of PsychologyUniversity of West GeorgiaCarrolltonGAUSA
| |
Collapse
|
11
|
Levi-Belz Y, Gavish-Marom T, Barzilay S, Apter A, Carli V, Hoven C, Sarchiapone M, Wasserman D. Psychosocial Factors Correlated with Undisclosed Suicide Attempts to Significant Others: Findings from the Adolescence SEYLE Study. Suicide Life Threat Behav 2019; 49:759-773. [PMID: 29851140 DOI: 10.1111/sltb.12475] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/06/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Suicide attempt (SA) is recognized as one of the risk factors for completed suicides. The concealment of this behavior often hinders detection and management of suicide risk. Thus, in this study, we sought to shed light on adolescents' psychosocial processes that could facilitate disclosure of SAs. Specifically, we sought to identify antecedents of adolescent SAs that had not been revealed to significant others. METHOD A high school sample) N = 990 (completed a self-report questionnaire tapping psychiatric, personal, and interpersonal characteristics, as well as suicidality, as part of the SEYLE project. Twenty-seven adolescents acknowledged having made an SA without disclosing it to parents or to other significant others. They were compared with 47 adolescents who made SAs that were communicated to others and with a control group of 916 adolescents having no history of suicidal behavior. RESULTS Compared with disclosures and controls, non-disclosing suicide attempters were characterized by higher levels of suicide ideation, distress, and victimization. Low levels of self-disclosure and parental support were significantly associated with undisclosed SAs. CONCLUSIONS Interpersonal difficulties may be related to loneliness and a thwarted sense of belongingness, which may explain the failure to disclose SAs. Implications related to assessment and prevention are discussed.
Collapse
Affiliation(s)
- Yossi Levi-Belz
- Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel.,The Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Timor Gavish-Marom
- Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | - Shira Barzilay
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alan Apter
- The Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel.,The Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Cristina Hoven
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mario Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Dnuta Wasserman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| |
Collapse
|
12
|
Zhang D, Yang Y, Wu M, Zhao X, Sun Y, Xie H, Li H, Li Y, Wang K, Zhang J, Jia J, Su Y. The moderating effect of social support on the relationship between physical health and suicidal thoughts among Chinese rural elderly: A nursing home sample. Int J Ment Health Nurs 2018; 27:1371-1382. [PMID: 29359382 DOI: 10.1111/inm.12436] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2017] [Indexed: 12/25/2022]
Abstract
Suicide rate is relatively high among Chinese rural elderly. While there has been some exciting work on reporting and preventing suicide among community-dwelling elderly, only a few published studies have addressed the issues of rural nursing homes in China. This study aimed to investigate the relationship among perceived social support, physical health, and suicidal thoughts of the elderly living in Chinese rural nursing homes. It also examined the moderating effects of social support on the path from physical health to suicidal thoughts of the rural institutional elderly in China. This study investigated 205 participants aged 60 years and above in Chinese rural nursing homes. Participants' suicidal thoughts, perceived social support, and physical health were assessed. This study conducted descriptive analysis, Student's t-test, and Pearson's chi-square test to test how physical health and social support predicted suicidal thoughts, as well as the moderating effects of family's, friends', and others' social support on physical health and suicidal thoughts. Both physical health and perceived social support were significantly related to suicidal thoughts. Perceived social support from family, friends, and significant others moderated the relationship between physical health and suicidal thoughts. Findings of this study suggested that increasing social support and improving physical health would be effective in both suicide prevention and intervention for the residents in Chinese rural nursing homes.
Collapse
Affiliation(s)
- Dan Zhang
- School of Nursing, Shandong University, Jinan, Shandong, China
| | - Yang Yang
- School of Nursing, Shandong University, Jinan, Shandong, China
| | - Menglian Wu
- School of Nursing, Shandong University, Jinan, Shandong, China
| | - Xia Zhao
- School of Nursing, Shandong University, Jinan, Shandong, China
| | - Yaoyao Sun
- School of Nursing, Shandong University, Jinan, Shandong, China
| | - Hui Xie
- School of Nursing, Shandong University, Jinan, Shandong, China
| | - Hongkai Li
- School of Mathematics, Beijing University, Beijing, China
| | - Yuqin Li
- School of Philosophy and social development, Shandong University, Jinan, Shandong, China.,College of Humanities, Shandong Management University, Jinan, Shandong, China
| | - Kefang Wang
- School of Nursing, Shandong University, Jinan, Shandong, China
| | - Jie Zhang
- School of Public Health, Shandong University, Jinan, Shandong, China.,Department of Sociology, State University of New York Buffalo State, Buffalo, NY, USA
| | - Jihui Jia
- School of Nursing, Shandong University, Jinan, Shandong, China
| | - Yonggang Su
- School of Nursing, Shandong University, Jinan, Shandong, China.,School of Foreign Languages and Literature, Shandong University, Jinan, Shandong, China
| |
Collapse
|
13
|
Levi-Belz Y, Gvion Y, Grisaru S, Apter A. When the Pain Becomes Unbearable: Case-Control Study of Mental Pain Characteristics Among Medically Serious Suicide Attempters. Arch Suicide Res 2018; 22:380-393. [PMID: 28786756 DOI: 10.1080/13811118.2017.1355288] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The unbearable mental pain experience is recognized as a key antecedent of suicidal behavior. We aimed to examine the precise nature of the mental pain among medically serious suicide attempters (MSSAs), a population closely resembling those who died by suicide. We evaluated various factors of mental pain from the Orbach and Mikulincer Mental Pain Scale, as well as medical lethality and suicide intent. MSSAs were higher than non-MSSAs and psychiatric controls for Irreversibility of pain. Moreover, Emptiness predicted medical lethality, while Cognitive Confusion negatively predicted suicide intent level, controlling for hopelessness and depression. high sense of Irreversibility of pain as well as high Emptiness and low Cognitive Confusion are important risk factors for more severe suicidal behavior. Implications for identification of at-risk groups for suicide as well as for suicide prevention and treatment of suicidal individuals are discussed.
Collapse
|
14
|
Malhi GS, Outhred T, Das P, Morris G, Hamilton A, Mannie Z. Modeling suicide in bipolar disorders. Bipolar Disord 2018; 20:334-348. [PMID: 29457330 DOI: 10.1111/bdi.12622] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/17/2018] [Indexed: 12/17/2022]
Abstract
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.
Collapse
Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Tim Outhred
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Pritha Das
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Grace Morris
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Amber Hamilton
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Zola Mannie
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| |
Collapse
|
15
|
Abstract
BACKGROUND Increased inflammation is linked to suicide risk. However, it is unclear whether increased inflammation drives suicidal crises or is a trait associated with lifetime suicidal behavior. Limited data exist on the sources of increased inflammation observed in suicidal patients and on its downstream effects. AIMS To examine factors associated with inflammation and with suicidal ideation severity in acutely suicidal depressed patients. METHODS Fifty-two adult depressed patients of both sexes hospitalized for severe suicidal ideation were characterized for suicidality, depression, anxiety, medical comorbidity, psychological and physical pain, impulsivity, verbal fluency, C-reactive protein (CRP) and interleukin (IL) 6. Two generalized linear models were performed with either CRP or suicidal ideation severity as dependent variables. RESULTS CRP levels were positively associated with age, body mass index (BMI), IL6, current physical pain and number of lifetime suicide attempts. Suicidal ideation severity was not significantly correlated with either CRP or IL6. Suicidal ideation severity was positively associated with female sex, presence of an anxiety disorder, current physical pain, number of lifetime suicide attempts and with delay discounting for medium and large losses. CONCLUSIONS Increased inflammation is not associated with acute suicidal risk, but seems to represent a trait associated with lifetime suicidal behavior.
Collapse
Affiliation(s)
- Ricardo Cáceda
- Department of Psychiatry, Stony Brook University, New York, USA
| | - W Sue T Griffin
- Donald W. Reynolds Department of Geriatrics and Institute on Aging, University of Arkansas for Medical Sciences, Geriatric Research, Education and Clinical Center, VAMC/CAVHS, Little Rock, USA
| | - Pedro L Delgado
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, USA
| |
Collapse
|
16
|
Abstract
Suicide is one of the leading causes of death among medical students, second to car accidents. We investigated the prevalence and predictors of suicidal ideation (SI) among medical students in Brazil. This is a cross-sectional study with 475 medical students of a public university. The research protocol included data on sociodemographics and academic life, and structured instruments to assess social support and psychopathological symptoms, including the Beck Depression Inventory (BDI). The outcome was evaluated using the BDI suicide item. Bivariate analyses were followed by logistic regression. SI was present in 34 participants (7.2%). In the logistic regression, SI remained associated with living alone, thoughts of abandoning the course, moderate or severe depressive symptoms, and probable obsessive-compulsive disorder. SI is frequent among medical students and can be identified with a simple screening question. Special attention should be given to students living alone, with thoughts of abandoning the course, and relevant depressive or obsessive-compulsive symptoms.
Collapse
|
17
|
Gvion Y. Aggression, impulsivity, and their predictive value on medical lethality of suicide attempts: A follow-up study on hospitalized patients. J Affect Disord 2018; 227:840-846. [PMID: 29689698 DOI: 10.1016/j.jad.2017.11.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/27/2017] [Accepted: 11/08/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study examined the role of aggressive-impulsive variants, and suicide history in predicting the medical severity of follow-up suicide attempts. METHODS 97 consecutive psychiatric in-patients who participated in earlier study 2-5 years previously. Thirty-three had a history of a medically serious suicide attempt (MSSA), 29 had a history of a medically non-serious suicide attempt (MNSSA), and 35 had no history of suicide. Participants completed a battery of instruments measuring aggressive-impulsive variables, hopelessness and communication difficulties. Findings were analyzed in relation to follow-up suicide attempts and their severity. RESULTS 32 patients (33%) had attempted suicide: 9 (9.27%) (including one death) MSSSA. Of these, 7 patients were MSSAs in the index attempt and 2 were MNSSAs in the index attempt. 23 (23.7%) MNSSA: Of these, 6 were MSSAs in the index attempt; 13, MNSSAs in the index attempt and 4 from the non-suicidal psychiatric group. 65 patients (67%) did not attempt suicide during the period since the index studies. Anger-out, violence impulsivity and hopelessness had significant positive correlations with medical severity of follow-up suicide attempts. Similar correlations were found between anger-out, violence and the amount of follow-up suicide attempts. A hierarchical regression analysis was conducted to determine contribution of study variables to severity of future suicide attempts. Severity of index attempt, hopelessness aggressive-impulsive variants and two interactions (medical severity of index suicide attempt X impulsivity and self-disclosure X anger-in) accounted for 44.7% of the variance of the medical severity of follow-up suicide attempts. 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 The major findings of this paper are the predictive value of MSSA vs. MNSSA. The Lethality of future suicide attempt is closely linked to the lethality of former suicide attempt, impulsivity and hopelessness. Thus, patients who have made a suicide attempt should be assessed for medical severity of the attempt, impulsive-aggressive measures hopelessness, and communication difficulties, which are important factors in follow-up attempts.
Collapse
Affiliation(s)
- Yari Gvion
- Bar Ilan University, Psychology Department, Israel.
| |
Collapse
|
18
|
Stein JY, Itzhaky L, Levi-Belz Y, Solomon Z. Traumatization, Loneliness, and Suicidal Ideation among Former Prisoners of War: A Longitudinally Assessed Sequential Mediation Model. Front Psychiatry 2017; 8:281. [PMID: 29312015 PMCID: PMC5732953 DOI: 10.3389/fpsyt.2017.00281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/29/2017] [Indexed: 01/12/2023] Open
Abstract
Although highly researched among veterans, the underlying mechanisms of suicidal ideation (SI) among former prisoners of war (ex-POWs), especially in the long-term, have rarely been investigated. Furthermore, while posttraumatic stress symptoms (PTSS) and loneliness have been individually associated with veteran SI, and both may be differentially implicated by captivity versus war traumas, the interplay between them has yet to be examined. Filling this gap, the current longitudinal study examined a hypothetical sequential model wherein war captivity, compared with combat-induced trauma, is implicated in worse PTSS, which is then implicated in worse loneliness and PTSS, which together may explain subsequent SI. Two groups of Israeli veterans of the 1973 Yom Kippur War, 163 ex-POWs and 185 matched non-captive veterans were assessed 18 (T1) and 30 (T2) years after the war. Analyses indicated that compared with war, captivity was implicated in worse PTSS, which was implicated in worse loneliness, and these worked in tandem to implicate SI. Loneliness, however, was not directly affected by the type of trauma, nor was its relation to SI linked to its implication in subsequent PTSS. These results may inform future research and clinical practice as the study underscores the importance of both PTSS and loneliness in ex-POWs' long-term SI.
Collapse
Affiliation(s)
- Jacob Y. Stein
- I-CORE Research Center for Mass Trauma, Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Liat Itzhaky
- I-CORE Research Center for Mass Trauma, Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Levi-Belz
- Department of Behavioral Sciences, Ruppin Academic Center, Emek-Hefer, Israel
| | - Zahava Solomon
- I-CORE Research Center for Mass Trauma, Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
19
|
Ziółkowski M, Czarnecki D, Chodkiewicz J, Gąsior K, Juczyński A, Biedrzycka A, Gruszczyńska E, Nowakowska-Domagała K. Suicidal thoughts in persons treated for alcohol dependence: The role of selected demographic and clinical factors. Psychiatry Res 2017; 258:501-505. [PMID: 28893411 DOI: 10.1016/j.psychres.2017.08.089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 06/16/2017] [Accepted: 08/24/2017] [Indexed: 11/26/2022]
Abstract
Greater knowledge is needed of potential predictive factors for suicide in cases of alcohol addiction. Therefore, the aim of the study was to identify the socio-demographic variables and clinical factors associated with alcohol dependence which may have an influence on the occurrence of suicidal thoughts in alcohol-dependent patients. A group of 510 patients (396 male and 114 female) diagnosed with alcohol dependence syndrome were interviewed during the third week of therapy according to the Beck Depression Inventory (BDI), the Penn Alcohol Craving Scale (PACS) and the Short Alcohol Dependence Data Questionnaire (SADD). Socio-demographic data was also collected. The results of a binary logistic regression with suicidal thoughts as a dependent variable show that 63 out of the 510 participants (12% of the sample) reported the presence of suicidal thoughts. Alcohol dependence and alcohol craving appear to increase the likelihood of suicidal thoughts, and participants presenting psychiatric disorders were twice as likely to demonstrate suicidal ideation as those who did not. Alcohol dependence, alcohol craving and psychiatric comorbidity may be regarded as risk factors for suicidal ideation in the studied sample, with the only protective factor being living in a relationship.
Collapse
Affiliation(s)
- Marcin Ziółkowski
- Department of Psychiatric Nursing, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Damian Czarnecki
- Department of Psychiatric Nursing, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Jan Chodkiewicz
- Department of Health Psychol ogy, Institute of Psychology, University of Lodz, Lodz, Poland
| | - Krzysztof Gąsior
- Świętokrzyski Prevention and Education Centre in Kielce, Kielce, Poland
| | - Artur Juczyński
- Municipal Centre of Addictions Prevention and Treatment in Lodz, Lodz, Poland
| | - Agata Biedrzycka
- Addictions Treatment Ward, Psychiatric Hospital in Radom, Radom, Poland
| | - Ewa Gruszczyńska
- Department of Health Psychology, Institute of Clinical Psychology, University of Social Sciences and Humanities, Warsaw, Poland
| | - Katarzyna Nowakowska-Domagała
- Department of Cognitive Science, Institute of Psychology, Faculty of Educational Sciences, University of Lodz, Lodz, Poland.
| |
Collapse
|
20
|
Santos HGBD, Marcon SR, Espinosa MM, Baptista MN, Paulo PMCD. Factors associated with suicidal ideation among university students. Rev Lat Am Enfermagem 2017; 25:e2878. [PMID: 28513765 PMCID: PMC5465973 DOI: 10.1590/1518-8345.1592.2878] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 02/13/2017] [Indexed: 11/22/2022] Open
Abstract
Objective to analyze the factors associated with suicidal ideation in a representative sample of university students. Methods cross-sectional study, carried out with 637 students of the Federal University of Mato Grosso. The presence of suicidal ideation, demographic and socioeconomic variables, use of alcohol through the Alcohol, Smoking and Substance Involvement Screening Test, and depressive symptoms (Major Depression Inventory) were investigated. Bivariate analysis was performed with the Chi-square test and multivariate analysis using the Poisson regression model. Results it was found that 9.9% of the students had suicidal thoughts in the previous 30 days and, in the bivariate analysis, the variables economic class, sexual orientation, religious practice, suicide attempts in the family and among friends, alcohol consumption and depressive symptoms were associated with suicidal ideation. In the multivariate analysis sexual orientation, suicide attempts in the family and the presence of depressive symptoms remained as associated factors. Conclusion these findings constitute a situational diagnosis that enables the formulation of academic policies and preventive actions to confront this situation on the university campus.
Collapse
Affiliation(s)
| | - Samira Reschetti Marcon
- PhD, Adjunct Professor, Faculdade de Enfermagem, Universidade Federal de Mato Grosso, Cuiabá, MT, Brazil
| | - Mariano Martínez Espinosa
- PhD, Adjunct Professor, Departamento de Estatística, Universidade Federal de Mato Grosso, Cuiabá, MT, Brazil
| | - Makilin Nunes Baptista
- PhD, Professor, Departamento de Psicologia, Universidade São Francisco, Itatiba, SP, Brazil
| | - Paula Mirianh Cabral de Paulo
- Undergraduate student in Nursing, Universidade Federal de Mato Grosso, Cuiabá, MT, Brazil. Scholarship holder at Conselho Nacional de Desenvolvimento Cientifico e Tecnológico (CNPq), Brazil
| |
Collapse
|
21
|
Laglaoui Bakhiyi C, Jaussent I, Beziat S, Cohen R, Genty C, Kahn JP, Leboyer M, Le Vaou P, Guillaume S, Courtet P. Positive and negative life events and reasons for living modulate suicidal ideation in a sample of patients with history of suicide attempts. J Psychiatr Res 2017; 88:64-71. [PMID: 28088052 DOI: 10.1016/j.jpsychires.2016.12.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 12/30/2016] [Accepted: 12/31/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The influence of life events on suicidal behavior remains inconclusive, while reasons for living (RFL) may be protective. OBJECTIVES To analyze the association between positive and negative life events and suicidal ideation (SI) and the interaction between life events and RFL on SI. METHOD Patients with history of suicide attempts (n = 338) underwent a comprehensive clinical evaluation, including SI (Beck's Suicidal Ideation scale), RFL (Reasons for Living Inventory, RFLI) and life events (family, school, student or professional, social, health and religion-related and other life events) during the last twelve months. RESULTS The only negative life events associated with SI were health-related events (OR = 2.01 95%CI[1.04;3.92]). Family-related positive life events and RFL were negatively associated with SI (OR = 0.73 95%CI[0.58;0.91] and OR = 0.98 95%CI[0.97;0.98], respectively). No significant interaction between the number of positive life events and RFLI total score with current SI (p = 0.57) was detected. Family-related positive life events and RFL did not have any additive effect on SI. Positive life events did not moderate the association between health-related negative life events and SI. LIMITATIONS This was a retrospective study, the presence of axis II disorders was not investigated and results cannot be generalized due to the sample choice (only suicide attempters). CONCLUSIONS Patients with history of suicide attempts could be less sensitive to negative life events, except for those related to health. Clinicians should pay more attention to somatic problems in patients at risk of suicide. Family support, positive psychology and therapies that strengthen RFL should be developed to prevent suicide.
Collapse
Affiliation(s)
- Camélia Laglaoui Bakhiyi
- Department of Emergency Psychiatry & Acute Care, CHU Montpellier, Montpellier, France; Psychiatric Unit, CHU Casablanca, Hassan II University, Casablanca, Morocco; Inserm U1061, La Colombière Hospital, University of Montpellier, France.
| | - Isabelle Jaussent
- Inserm U1061, La Colombière Hospital, University of Montpellier, France.
| | - Séverine Beziat
- Inserm U1061, La Colombière Hospital, University of Montpellier, France.
| | - Renaud Cohen
- FondaMental Foundation, France; University of Lorraine, Psychotherapeutic Centre of Nancy-Laxou, France.
| | - Catherine Genty
- Department of Emergency Psychiatry & Acute Care, CHU Montpellier, Montpellier, France; Inserm U1061, La Colombière Hospital, University of Montpellier, France; FondaMental Foundation, France.
| | - Jean-Pierre Kahn
- FondaMental Foundation, France; University of Lorraine, Psychotherapeutic Centre of Nancy-Laxou, France.
| | - Marion Leboyer
- FondaMental Foundation, France; Department of Psychiatry and Addictology, Créteil, France.
| | - Pascal Le Vaou
- Emergency and Liaison Psychiatry Department, CHR Metz-Thionville, France.
| | - Sébastien Guillaume
- Department of Emergency Psychiatry & Acute Care, CHU Montpellier, Montpellier, France; Inserm U1061, La Colombière Hospital, University of Montpellier, France; FondaMental Foundation, France.
| | - Philippe Courtet
- Department of Emergency Psychiatry & Acute Care, CHU Montpellier, Montpellier, France; Inserm U1061, La Colombière Hospital, University of Montpellier, France; FondaMental Foundation, France.
| |
Collapse
|
22
|
Zhang D, Yang Y, Sun Y, Wu M, Xie H, Wang K, Zhang J, Jia J, Su Y. Characteristics of the Chinese rural elderly living in nursing homes who have suicidal ideation: A multiple regression model. Geriatr Nurs 2017; 38:423-430. [PMID: 28347559 DOI: 10.1016/j.gerinurse.2017.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 02/09/2017] [Accepted: 02/13/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Chinese rural elderly are at higher risk of committing suicide. However, little is known about the suicidal ideation (SI) of institutional elderly residents in rural China. METHODS 250 participants aged 60 or above living in Chinese rural nursing homes were recruited. Data were collected on subjects' SI, social-demographic characters, physical illness and psychological factors. Univariate comparisons and path analysis were conducted then. RESULTS 19.5% (40/205) of the participants reported a current SI. Hopelessness and depression had significant direct impacts on SI, and self-esteem and loneliness can impact SI through the mediating of depression and hopelessness. Visiting frequency of children, number of physical illnesses and social activities can also affect SI through the mediating of loneliness or self-esteem. CONCLUSION As the first study on path analysis of SI of rural institutional elderly, the findings are significant. All these factors in our model should be considered when interventions are being conducted.
Collapse
Affiliation(s)
- Dan Zhang
- School of Nursing, Shandong University, Jinan, 250012, Shandong, China
| | - Yang Yang
- School of Nursing, Shandong University, Jinan, 250012, Shandong, China
| | - Yaoyao Sun
- School of Nursing, Shandong University, Jinan, 250012, Shandong, China
| | - Menglian Wu
- School of Nursing, Shandong University, Jinan, 250012, Shandong, China
| | - Hui Xie
- School of Nursing, Shandong University, Jinan, 250012, Shandong, China
| | - Kefang Wang
- School of Nursing, Shandong University, Jinan, 250012, Shandong, China
| | - Jie Zhang
- School of Public Health, Shandong University, Jinan, 250012, Shandong, China; Department of Sociology, State University of New York Buffalo State, Buffalo, NY, 14222, USA
| | - Jihui Jia
- School of Nursing, Shandong University, Jinan, 250012, Shandong, China
| | - Yonggang Su
- School of Foreign Languages and Literature, Shandong University, Jinan, 250100, Shandong, China; School of Nursing, Shandong University, Jinan, 250012, Shandong, China.
| |
Collapse
|
23
|
Shelef L, Ayzen E, Yavnai N, Fruchter E, Sarid O. The contribution of the socio-demographic characteristics on suicidal ideation among Israeli soldiers. DISASTER AND MILITARY MEDICINE 2017; 2:5. [PMID: 28265439 PMCID: PMC5330142 DOI: 10.1186/s40696-016-0014-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/27/2016] [Indexed: 11/30/2022]
Abstract
Background Suicidal ideation is a risk factor for suicide attempt. The aim of the present study is to compare suicidal ideation of different groups with different distress. Methods 100 soldiers, aged 18–21, divided into four research cohorts: soldiers who had carried out a suicide attempt (n = 40); soldiers with a psychiatric diagnosis (n = 20); soldiers having high severity adjustment difficulties (n = 20); and a control group of soldiers, having neither a history of mental health diagnosis, nor adjustment difficulties (n = 20). All completed the suicide ideation scale. Results Half of the attempters had a psychiatric diagnosis (depression or anxiety) on the day of their enlistment and 37.5 % of them had a specified personality disturbance. The attempters were characterized by previously-attempted suicide (p < .01). The lowest mean values (M = 1.95, SD = .67) were among the attempter (F = 3.173, df = 3, p = .02) in motivation for military service. The variable expressing low motivation for military service was the sole predictor of suicide ideation (p = .032). Conclusions Early diagnosis facilitated better monitoring by military mental health officers.
Collapse
Affiliation(s)
- Leah Shelef
- Psychology Branch, Israel Air Force, Ramat-Gan, Israel.,Mental Health Department, Israel Defense Forces Medical Corps, Ramat-Gan, Israel
| | - Evyatar Ayzen
- Mental Health Department, Israel Defense Forces Medical Corps, Ramat-Gan, Israel
| | - Nirit Yavnai
- IDF Medical Corps, Israel Defense Forces, Ramat-Gan, Israel
| | - Eyal Fruchter
- Mental Health Department, Israel Defense Forces Medical Corps, Ramat-Gan, Israel
| | - Orly Sarid
- Department of Social Work, Faculty of Humanities & Social Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
24
|
Nature and determinants of suicidal ideation among U.S. veterans: Results from the national health and resilience in veterans study. J Affect Disord 2016; 197:66-73. [PMID: 26970267 DOI: 10.1016/j.jad.2016.02.069] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 02/25/2016] [Accepted: 02/28/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Suicidal thoughts and behaviors among U.S. military veterans are a major public health concern. To date, however, scarce data are available regarding the nature and correlates of suicidal ideation (SI) among U.S. veterans. This study evaluated the prevalence and correlates of suicidal ideation in a contemporary, nationally representative, 2-year prospective cohort study. METHOD Data were analysed from a total of 2157 U.S. veterans who participated in the National Health and Resilience Veterans Study (NHRVS; Wave 1 conducted in 2011; Wave 2 in 2013). Veterans completed measures assessing SI, sociodemographic characteristics, and potential risk and protective correlates. RESULTS The majority of veterans (86.3%) denied SI at either time point, 5.0% had SI onset (no SI at Wave 1, SI at Wave 2), 4.9% chronic SI (SI at Waves 1 and 2), and 3.8% had remitted SI (SI at Wave 1, no SI Wave 2). Greater Wave 1 psychiatric distress was associated with increased likelihood of chronic SI (relative risk ratio [RRR]=3.72), remitted SI (RRR=3.38), SI onset (RRR=1.48); greater Wave 1 physical health difficulties were additionally associated with chronic SI (RRR=1.64) and SI onset (RRR=1.47); and Wave 1 substance abuse history was associated with chronic SI (RRR 1.57). Greater protective psychosocial characteristics (e.g., resilience, gratitude) at Wave 1 were negatively related to SI onset (RRR=0.57); and greater social connectedness at Wave 1, specifically perceived social support and secure attachment style, was negatively associated with SI onset (RRR=0.75) and remitted SI (RRR=0.44), respectively. LIMITATIONS Suicidal ideation was assessed using a past two-week timeframe, and the limited duration of follow-up precludes conclusions regarding more dynamic changes in SI over time. CONCLUSIONS These results indicate that a significant minority (13.7%) of U.S. veterans has chronic, onset, or remitted SI. Prevention and treatment efforts designed to mitigate psychiatric and physical health difficulties, and bolster social connectedness and protective psychosocial characteristics may help mitigate risk for SI.
Collapse
|
25
|
Verrocchio MC, Carrozzino D, Marchetti D, Andreasson K, Fulcheri M, Bech P. Mental Pain and Suicide: A Systematic Review of the Literature. Front Psychiatry 2016; 7:108. [PMID: 27378956 PMCID: PMC4913233 DOI: 10.3389/fpsyt.2016.00108] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 06/06/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mental pain, defined as a subjective experience characterized by perception of strong negative feelings and changes in the self and its function, is no less real than other types of grief. Mental pain has been considered to be a distinct entity from depression. We have performed a systematic review analyzing the relationship between mental pain and suicide by providing a qualitative data synthesis of the studies. METHODS We have conducted, in accordance with PRISMA guidelines, a systematic search for the literature in PubMed, Web Of Science, and Scopus. Search terms were "mental pain" "OR" "psychological pain" OR "psychache" combined with the Boolean "AND" operator with "suicid*." In addition, a manual search of the literature, only including the term "psychache," was performed on Google Scholar for further studies not yet identified. RESULTS Initial search identified 1450 citations. A total of 42 research reports met the predefined inclusion criteria and were analyzed. Mental pain was found to be a significant predictive factor of suicide risk, even in the absence of a diagnosed mental disorder. Specifically, mental pain is a stronger factor of vulnerability of suicidal ideation than depression. CONCLUSION Mental pain is a core clinical factor for understanding suicide, both in the context of mood disorders and independently from depression. Health care professionals need to be aware of the higher suicidal risk in patients reporting mental pain. In this regard, psychological assessment should include a clinimetric evaluation of mental pain in order to further detect its contribution to suicidal tendency.
Collapse
Affiliation(s)
- Maria Cristina Verrocchio
- Department of Psychological, Health, and Territorial Sciences, G. d'Annunzio University , Chieti , Italy
| | - Danilo Carrozzino
- Department of Psychological, Health, and Territorial Sciences, G. d'Annunzio University, Chieti, Italy; Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Daniela Marchetti
- Department of Psychological, Health, and Territorial Sciences, G. d'Annunzio University , Chieti , Italy
| | - Kate Andreasson
- Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University Hospital , Hillerød , Denmark
| | - Mario Fulcheri
- Department of Psychological, Health, and Territorial Sciences, G. d'Annunzio University , Chieti , Italy
| | - Per Bech
- Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University Hospital , Hillerød , Denmark
| |
Collapse
|