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Hartnett Y, Thekiso TB, Kowalska-Beda P, Maher T, McLoughlin DM, Kennedy N. Predictors of inpatient suicide in an Irish psychiatric service, a longitudinal case-control study. Suicide Life Threat Behav 2024. [PMID: 38517159 DOI: 10.1111/sltb.13073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 10/01/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Inpatient suicide remains difficult to predict. This study aimed to identify individual patient predictors to help identify those at greater risk. METHODS This case-control study was undertaken in an independent mental health service in Ireland. Cases were drawn from all admissions to the service between March 2004 and February 2019. Controls were matched for date of admission. Univariate and multivariate analyses were conducted. RESULTS Thirty-three cases of inpatient suicide were compared to 132 controls. The inpatient suicide rate was 76.2 per 100,000 admissions. The rate of inpatient suicide fell in line with national rates despite less restrictive practices being implemented in the service. Males accounted for 66% of cases. Hanging was the most common method of suicide overall and among male patients, and drowning was the most common among females. Male gender, tertiary referral, an adverse psychosocial event during admission, a period of absence without leave and expressing hopelessness were identified as independent risk factors for inpatient suicide. Substance use, involuntary detention, family history of suicide, and number of previous admissions were not significant. CONCLUSIONS While not highly sensitive, a period of absence without leave, tertiary referral and hopelessness are important predictors of inpatient suicide risk that treating teams should consider in care planning.
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Affiliation(s)
| | | | | | - Tom Maher
- St Patrick's University Hospital, Dublin, Ireland
| | - Declan M McLoughlin
- St Patrick's University Hospital, Dublin, Ireland
- Department of Psychiatry and Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Noel Kennedy
- St Patrick's University Hospital, Dublin, Ireland
- Highfield Healthcare, Dublin, Ireland
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2
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Etgen T, Stigloher M, Förstl H, Zwanzger P, Rentrop M. Systematic analysis of nonfatal suicide attempts and further diagnostic of secondary injury in strangulation survivors: A retrospective cross-sectional study. Health Sci Rep 2023; 6:e1572. [PMID: 37795312 PMCID: PMC10545888 DOI: 10.1002/hsr2.1572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/12/2023] [Accepted: 09/05/2023] [Indexed: 10/06/2023] Open
Abstract
Background and Aims Data on nonfatal suicide attempts in Germany are sparse. The study aimed to analyze data on nonfatal suicide attempts and consecutive diagnostic steps to identify secondary injuries after strangulation. Methods All admissions after nonfatal suicide attempt in a large Bavarian psychiatric hospital between 2014 and 2018 were reviewed and the methods were analyzed. Results A total of 2125 verified cases out of 2801 registered cases of nonfatal suicide attempts were included in further analysis. The most common methods were intoxication (n = 1101, 51.8%), cutting (n = 461, 21.7%), and strangulation (n = 183, 8.6%). Among survivors of strangulation with external neck compression (n = 99, 54.1%), no diagnostic steps were performed in 36 (36.4%) patients and insufficient imaging in 13 (20.6%) patients. Carotid artery dissection was detected in two (4.0%) of 50 patients with adequate neuroimaging. Conclusions This study provides details on nonfatal suicide attempts in Germany. Slightly more than half of the patients with strangulation underwent adequate diagnostic work-up, with 4.0% being diagnosed with dissection. Further studies with systematic screening for dissection after strangulation in psychiatric hospitals are recommended to reduce possible under-reporting.
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Affiliation(s)
- Thorleif Etgen
- Klinik und Poliklinik für Psychiatrie und PsychotherapieTechnische Universität MünchenMünchenGermany
- Klinik für Neurologie, KlinikumTraunsteinGermany
| | - Manuel Stigloher
- Klinik und Poliklinik für Psychiatrie und PsychotherapieTechnische Universität MünchenMünchenGermany
| | - Hans Förstl
- Institut für Geschichte und Ethik der MedizinTechnische Universität MünchenMünchenGermany
| | - Peter Zwanzger
- Department of PsychiatryLudwig Maximilian UniversityMünchenGermany
- kbo‐Inn‐Salzach‐Klinikum, Klinik für Psychiatrie, Psychotherapie und PsychosomatikWasserburg am InnGermany
| | - Michael Rentrop
- Klinik und Poliklinik für Psychiatrie und PsychotherapieTechnische Universität MünchenMünchenGermany
- kbo‐Inn‐Salzach‐Klinikum, Klinik für Psychiatrie, Psychotherapie und PsychosomatikWasserburg am InnGermany
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3
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Sparks S, Mitchell SM, LeDuc MK. Association between perceived social support and suicide ideation distress among psychiatric inpatients: The role of thwarted interpersonal needs. J Clin Psychol 2023; 79:1467-1479. [PMID: 36752510 PMCID: PMC10085832 DOI: 10.1002/jclp.23493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/02/2023] [Accepted: 01/26/2023] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The interpersonal theory of suicide posits that thwarted belongingness (TB) and perceived burdensomeness (PB) are proximal risk factors for suicide ideation; however, there are mixed results regarding this hypothesis among psychiatric inpatients. OBJECTIVE The current study examined the mediating role of TB and PB in the relationship between perceived social support (i.e., support from family, friends, a significant other, and total) and suicide ideation distress among psychiatric inpatients. METHODS Participants (short-term psychiatric inpatients; N = 139) were administered self-report assessments cross-sectionally. RESULTS Nonparametric mediation results indicated that the total (additive) indirect effects of TB and PB, in parallel, were significant in all models, yet there were only significant specific (unique) indirect effects of PB. CONCLUSION TB and PB, in combination, may be proximal risk factors for suicide ideation distress among psychiatric inpatients with lower perceived social support from family, friends, a significant other, and in total. These findings are congruent with the interpersonal theory of suicide's propositions that the combination of TB and PB increases the risk for suicide ideation. Clinicians may consider using interventions that target increasing perceived social support and decreasing TB and PB (i.e., cognitive behavioral therapy and social skills training) for this population.
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Affiliation(s)
- Sarah Sparks
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, United States
| | - Sean M. Mitchell
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, United States
| | - Michael K. LeDuc
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, United States
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4
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Castro Martínez JC, Santamaría-García H. Understanding mental health through computers: An introduction to computational psychiatry. Front Psychiatry 2023; 14:1092471. [PMID: 36824671 PMCID: PMC9941647 DOI: 10.3389/fpsyt.2023.1092471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023] Open
Abstract
Computational psychiatry recently established itself as a new tool in the study of mental disorders and problems. Integration of different levels of analysis is creating computational phenotypes with clinical and research values, and constructing a way to arrive at precision psychiatry are part of this new branch. It conceptualizes the brain as a computational organ that receives from the environment parameters to respond to challenges through calculations and algorithms in continuous feedback and feedforward loops with a permanent degree of uncertainty. Through this conception, one can seize an understanding of the cerebral and mental processes in the form of theories or hypotheses based on data. Using these approximations, a better understanding of the disorder and its different determinant factors facilitates the diagnostics and treatment by having an individual, ecologic, and holistic approach. It is a tool that can be used to homologate and integrate multiple sources of information given by several theoretical models. In conclusion, it helps psychiatry achieve precision and reproducibility, which can help the mental health field achieve significant advancement. This article is a narrative review of the basis of the functioning of computational psychiatry with a critical analysis of its concepts.
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Affiliation(s)
- Juan Camilo Castro Martínez
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Hernando Santamaría-García
- Ph.D. Programa de Neurociencias, Departamento de Psiquiatría y Salud Mental, Pontificia Universidad Javeriana, Bogotá, Colombia
- Centro de Memoria y Cognición Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia
- Global Brain Health Institute, University of California, San Francisco – Trinity College Dublin, San Francisco, CA, United States
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5
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Chammas F, Januel D, Bouaziz N. Inpatient suicide in psychiatric settings: Evaluation of current prevention measures. Front Psychiatry 2022; 13:997974. [PMID: 36386981 PMCID: PMC9650354 DOI: 10.3389/fpsyt.2022.997974] [Citation(s) in RCA: 2] [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: 07/19/2022] [Accepted: 10/05/2022] [Indexed: 12/01/2022] Open
Abstract
The risk of suicide in psychiatric hospitals is 50 times higher than in the general population, despite patient safety being a priority for any hospital. However, to date, due to the complexity of assessing suicide risk, there has been no consensus on the suicide prevention measures that should be in place in hospitals. The aim of this work is: To provide an overview of the progress that has been made in the field of inpatient suicide prevention in recent years; discuss the problems that remain; and suggest potential future developments. As new clinical dimensions (notably anhedonia, psychological pain and hopelessness) develop, they should become new therapeutic targets. Team training (like the Gatekeeper Training Program) and the latest advances in suicide risk assessment (such as the Collaborative Assessment and Management of Suicidality) should be implemented in psychiatric wards. Suicide prevention plans (e.g., ASSIP, SAFE-T, etc.) represent easy-to-administer, low-cost interventions. The Mental Health Environment of Care Checklist has been proven effective to reduce suicide risk at hospitals. Furthermore, the types of psychotherapy recommended to reduce suicide risk are cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). There are several pharmacological treatments for suicide risk, such as lithium and clozapine, which have been shown to be effective in the long term, as well as ketamine and esketamine, which are more effective in the short term. Following some encouraging recent results, buprenorphine may also be proposed to patients with a suicide risk. Triple chronotherapy rapidly improves depressive symptoms over 9 weeks. Regarding brain stimulation techniques, rTMS has proven to be effective in alleviating multiple dimensions of suicidality.
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Affiliation(s)
- Francesca Chammas
- Centre de Recherche Clinique, EPS Ville-Evrard, Neuilly-sur-Marne, France
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6
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Christl J, Schröder N, Mennicken R, Jänner M, Supprian T. Inpatient Suicides in Late Life: A Retrospective Analysis of a Hospital Group with Nine Psychiatric Clinics. Arch Suicide Res 2022; 26:1436-1446. [PMID: 34006203 DOI: 10.1080/13811118.2021.1922107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Inpatient suicides are rare incidents; however, the impacts of such events on associated families and hospital staff are severe. Therefore, preventive strategies need to focus on risk factors. Clinical management in a hospital setting must integrate the home environment and social life of patients. Nevertheless, home leaves require careful preparation. METHODS Suicides were reported systematically from all psychiatric departments of the Landschaftsverband Rheinland (an assembly of municipalities) using a structured form during two periods (1995-2004, 2005-2014). From these reports we extracted data on suicide methods and sociodemographic and clinical variables. Only patients 65 years and older were included. RESULTS From a total of 551 reports on suicides in the period of 1995-2014, 103 patients 65 years and older (60 women, 43 men) died by suicide. In contrast to the general trend in Germany during this period, no decline in overall suicide rates was found. Most patients were treated because of depression (73.8%); schizophrenic psychosis was diagnosed in 11.7%; and dementia was only diagnosed in 1.9%. The most frequent suicide method was hanging (40%). All suicides within the hospital were hangings. The majority of suicides occurred outside the hospital during approved home leaves. Only 7% of suicides occurred when patients left the hospital without permission. Almost half of the patients (n = 44) died by suicide during the first month of treatment. With longer duration of hospitalization, the risk of suicide decreased. There were no significant trends with regard to suicide methods between the two periods. CONCLUSIONS In the first weeks of hospitalizations the patients are most endangered to die by suicide. Therefore, home leaves need careful consideration.
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Brown SL, Marshall AJ, Mitchell SM, Roush JF, Mumma GH, Jahn DR, Ribeiro JD, Joiner TE, Cukrowicz KC. Suicide Ideation and Thwarted Interpersonal Needs among Psychiatric Inpatients: A Network Approach. Clin Psychol Sci 2022; 9:1080-1094. [PMID: 35070498 DOI: 10.1177/21677026211000670] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We aimed to demonstrate the utility of an item-level network analysis approach to suicide risk by testing the interpersonal psychological theory of suicide (IPTS) among 402 psychiatric inpatients. We hypothesized specific thwarted belongingness (TB) or perceived burdensomeness (PB; Interpersonal Needs Questionnaire items) facets would positively relate to passive or active suicide ideation, and these facets would positively relate to each other and form distinct clusters. We also tested TB and PB facets central to the networks as predictors of suicide ideation compared to the full TB and PB subscales. Face-valid items congruent with latent constructs proposed by the IPTS (i.e., feelings of burden on society, feeling that one does not belong) were the only two facets uniquely predictive of passive and active suicide ideation. Facets of TB and PB did not form distinct clusters. Item-level network analysis may have important conceptual, assessment, predictive, and clinical implications for understanding suicide risk.
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Affiliation(s)
- Sarah L Brown
- Department of Psychological Sciences, Mail Stop 2051, Texas Tech University, Lubbock, TX 79409-2051
| | - Andrew J Marshall
- Department of Psychological Sciences, Mail Stop 2051, Texas Tech University, Lubbock, TX 79409-2051.,Department of Family & Protective Services, State of Texas, 701 W 51st St, Austin, TX 78751
| | - Sean M Mitchell
- Department of Psychological Sciences, Mail Stop 2051, Texas Tech University, Lubbock, TX 79409-2051.,Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd., Box Psych, Rochester, NY 14642
| | - Jared F Roush
- Department of Psychological Sciences, Mail Stop 2051, Texas Tech University, Lubbock, TX 79409-2051
| | - Gregory H Mumma
- Department of Psychological Sciences, Mail Stop 2051, Texas Tech University, Lubbock, TX 79409-2051
| | - Danielle R Jahn
- Mental Health Center for Acute Recovery Empowerment, Orlando VA Medical Center, 13800 Veterans Way, Orlando, FL 32827
| | - Jessica D Ribeiro
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306
| | - Thomas E Joiner
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306
| | - Kelly C Cukrowicz
- Department of Psychological Sciences, Mail Stop 2051, Texas Tech University, Lubbock, TX 79409-2051
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8
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Ward-Ciesielski EF, Rizvi SL. The potential iatrogenic effects of psychiatric hospitalization for suicidal behavior: A critical review and recommendations for research. ACTA ACUST UNITED AC 2021. [DOI: 10.1111/cpsp.12332] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Corke M, Mullin K, Angel-Scott H, Xia S, Large M. Meta-analysis of the strength of exploratory suicide prediction models; from clinicians to computers. BJPsych Open 2021; 7:e26. [PMID: 33407984 PMCID: PMC8058929 DOI: 10.1192/bjo.2020.162] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Suicide prediction models have been formulated in a variety of ways and are heterogeneous in the strength of their predictions. Machine learning has been a proposed as a way of improving suicide predictions by incorporating more suicide risk factors. AIMS To determine whether machine learning and the number of suicide risk factors included in suicide prediction models are associated with the strength of the resulting predictions. METHOD Random-effect meta-analysis of exploratory suicide prediction models constructed by combining two or more suicide risk factors or using clinical judgement (Prospero Registration CRD42017059665). Studies were located by searching for papers indexed in PubMed before 15 August 2020 with the term suicid* in the title. RESULTS In total, 86 papers reported 102 suicide prediction models and included 20 210 411 people and 106 902 suicides. The pooled odds ratio was 7.7 (95% CI 6.7-8.8) with high between-study heterogeneity (I2 = 99.5). Machine learning was associated with a non-significantly higher odds ratio of 11.6 (95% CI 6.0-22.3) and clinical judgement with a non-significantly lower odds ratio of 4.7 (95% CI 2.1-10.9). Models including a larger number of suicide risk factors had a higher odds ratio when machine-learning studies were included (P = 0.02). Among non-machine-learning studies, suicide prediction models including fewer risk factors performed just as well as those including more risk factors. CONCLUSIONS Machine learning might have the potential to improve the performance of suicide prediction models by increasing the number of included suicide risk factors but its superiority over other methods is unproven.
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Affiliation(s)
- Michelle Corke
- School of Psychiatry, University of New South Wales, Australia
| | - Katherine Mullin
- South Eastern Sydney Local Health District and School of Medicine, University of Notre Dame, Australia
| | | | - Shelley Xia
- South Eastern Sydney Local Health District, Australia
| | - Matthew Large
- South Eastern Sydney Local Health District, Australia; and School of Medicine, University of Notre Dame, Australia
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10
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Mitchell SM, Brown SL, Scanlon F, Swogger MT, Delgado D, Ventura MI, Bolaños AD, Morgan RD. Lifetime History of Suicide Attempts among Not Guilty by Reason of Insanity State Hospital Inpatients: The Roles of past Harmful Substance Use and Current Social Support. INTERNATIONAL JOURNAL OF FORENSIC MENTAL HEALTH 2020; 19:341-353. [PMID: 33223964 PMCID: PMC7678914 DOI: 10.1080/14999013.2020.1775326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study tested current perceived social support (CPSS) as a moderator of the relation between previous substance use (PSU) and lifetime suicide attempt (SA) history among 200 NGRI inpatients. Results indicated no significant CPSS main effect. PSU was associated with greater odds of multiple prior lifetime SA. Moderation indicated those low in PSU but high in CPSS were least likely to report multiple prior lifetime SA. Conversely, NGRI inpatients with high CPSS and high PSU were most likely to report multiple lifetime SA. Our study suggests CPSS and PSU assessments may inform suicide risk assessments and interventions among NGRI inpatients.
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Affiliation(s)
- Sean M. Mitchell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, Newyork
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas
| | - Sarah L. Brown
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Faith Scanlon
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas
| | - Marc T. Swogger
- Department of Psychiatry, University of Rochester Medical Center, Rochester, Newyork
| | - Darci Delgado
- Division of Clinical Operations, California Department of State Hospitals, Sacramento, California
| | - Maria I. Ventura
- Division of Clinical Operations, California Department of State Hospitals, Sacramento, California
- Department of Psychiatry, University of California, Davis, Sacramento, California
| | - Angelea D. Bolaños
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas
| | - Robert D. Morgan
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas
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11
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Tseng MCM, Chang CH, Liao SC, Yeh YC. Length of stay in relation to the risk of inpatient and post-discharge suicides: A national health insurance claim data study. J Affect Disord 2020; 266:528-533. [PMID: 32056922 DOI: 10.1016/j.jad.2020.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/21/2020] [Accepted: 02/01/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study aimed to compare the predictors of suicides among psychiatric inpatients and recently discharged patients and to examine the association between the length of stay and suicides. METHODS Data from psychiatric inpatients were extracted from the National Health Insurance databank and merged with information from the Cause of Death data using unique identification numbers. Poisson regression analyses were used to estimate the incidence rate ratio for inpatient and post-discharge suicides, which included the variables of sex, age, psychiatric diagnosis, and number of admissions in the preceding year. The associations between length of stay and inpatient and post-discharge suicide were examined using multivariate Poisson regression analyses that were adjusted for these variables. RESULTS A diagnosis of affective disorders and a higher number of previous admissions increased both inpatient and post-discharge suicides. Patients older than 15-24 years had a significantly lower inpatient suicide risk but were more likely to die by suicide post-discharge. The risk of suicide both during the inpatient stay and post-discharge statistically significantly decreased when the length of stay was longer. LIMITATIONS As there were variations in societal, environmental, and facility-level factors that might have influenced the association between length of stay and suicide, the generalization of our findings to different settings may be impeded. CONCLUSIONS This study provides additional evidence that hospitalization helps to reduce the suicide risk. It suggests that medical professionals should be alert to inpatient suicide and that they should determine the optimal length of stay considering post-discharge suicide.
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Affiliation(s)
- Mei-Chih Meg Tseng
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan; Department of Psychiatry, National Taiwan University College of Medicine, Taipei 10051, Taiwan; Department of Nursing, Oriental Institute of Technology, New Taipei City 22061, Taiwan.
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei 10055, Taiwan
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University College of Medicine, Taipei 10051, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Yi-Chun Yeh
- Department of Medical Research, National Taiwan University Hospital, Taipei 10055, Taiwan
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12
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Shoja Shafti S, Memarie A, Rezaie M, Hamidi M. Suicides and Suicide Attempts Among Psychiatric Hospital Inpatients in Iran. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2019. [DOI: 10.2174/2666082215666190917163630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background:
Suicidal behavior is seen in the context of a variety of mental disorders.
While many believe that, in general, first-episode psychosis is a particularly high-risk period for
suicide, no general agreement regarding higher prevalence of suicide in first-episode psychosis is
achievable.
Objective:
In the present study, suicides and suicide attempts among psychiatric in-patients have
been evaluated to assess the general profile of suicidal behavior among native psychiatric inpatients
and any relationship between serum cholesterol level and suicidal behavior.
Methods:
Five acute academic wards, which have been specified for admission of first episode adult
psychiatric patients, and five acute non-academic wards, which have been specified for admission of
recurrent episode adult psychiatric patients, were selected for the current study. All inpatients with
suicidal behavior (successful suicide and attempted suicide, in total), during the last five years
(2013-2018), were included in the present investigation. Also, the assessment of serum lipids, including
triglyceride, cholesterol, low-density lipoprotein and high-density lipoprotein, was done ,
for comparing the suicidal subjects with non-suicidal ones.
Results:
Among 19160 psychiatric patients hospitalized in Razi psychiatric hospital during a sixtymonths
period, 63 suicidal behaviors, including one successful suicide and sixty-two suicide attempts,
were recorded by the safety board of hospital. The most frequent mental illness was bipolar
I disorder, which was significantly more prevalent in comparison with other mental disorders
(p<0.04, p<0.02, p<0.007, and p<0.003 in comparison with schizophrenia, depression, personality
disorders and substance abuse, respectively). Self-mutilation, self-poisoning and hanging were the
preferred methods of suicide among 61.11%, 19.44% and 19.44% of cases, respectively. In addition,
no significant difference was evident between the first admission and recurrent admission inpatients,
totally and separately, particularly with respect to psychotic disorders. Besides, with respect to different
components of serum lipids, no specific or significant pattern was evident.
Conclusion:
While in the present study, the suicidal behavior was significantly more evident in
bipolar disorder in comparison with other psychotic or no-psychotic disorders, no significant difference
was evident between the first admission and recurrent admission of psychiatric inpatients.
Moreover, no significant relationship between suicidal behavior and serum lipids was found .
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Affiliation(s)
- Saeed Shoja Shafti
- University of Social Welfare and Rehabilitation Sciences, (USWR), Razi Psychiatric Hospital, Postal Code: 18669- 58891, P.O. Box: 18735-569, Tehran, Iran
| | - Alireza Memarie
- University of Social Welfare and Rehabilitation Sciences, (USWR), Razi Psychiatric Hospital, Postal Code: 18669- 58891, P.O. Box: 18735-569, Tehran, Iran
| | - Masomeh Rezaie
- University of Social Welfare and Rehabilitation Sciences, (USWR), Razi Psychiatric Hospital, Postal Code: 18669- 58891, P.O. Box: 18735-569, Tehran, Iran
| | - Masomeh Hamidi
- University of Social Welfare and Rehabilitation Sciences, (USWR), Razi Psychiatric Hospital, Postal Code: 18669- 58891, P.O. Box: 18735-569, Tehran, Iran
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Lin CE, Chung CH, Chen LF, Chien WC. Does Compulsory Admission Prevent Inpatient Suicide Among Patients with Schizophrenia? A Nationwide Cohort Study in Taiwan. Suicide Life Threat Behav 2019; 49:966-979. [PMID: 30079449 DOI: 10.1111/sltb.12497] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 04/25/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the risk of inpatient suicide in patients with schizophrenia during 2007-2013 and to determine putative risk factors. METHODS We conducted a national population-based cohort study of 2,038 psychiatric inpatients in their first compulsory admission, matched with 8,152 controls who were voluntary inpatients. Only patients with schizophrenia were included in the study. We used data derived from the Taiwanese National Health Insurance Database 2005, comprising 1 million beneficiaries randomly selected from the entire population of Taiwan. RESULTS During the follow-up period, 23 and 75 inpatient suicides were observed in the compulsory and control groups, respectively. Kaplan-Meier curves showed that the cumulative incidence rate of inpatient suicide was not significantly different between compulsory and voluntary admissions (log-rank test, p = .206). CONCLUSIONS Our results suggest that compulsory admission has no protective effects on risk reduction of inpatient suicide for patients with schizophrenia who are compulsorily admitted compared with voluntarily admitted controls. Clinicians should be more alert for the prevention of inpatient suicide among patients with schizophrenia and consider the close monitoring of inpatient suicide risk in the first week of admission.
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Affiliation(s)
- Ching-En Lin
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan.,School of Public Health, National Defense Medical Centre, Taipei, Taiwan
| | - Li-Fen Chen
- School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Psychiatry, Tri-Service General Hospital, Penhu Branch, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan.,School of Public Health, National Defense Medical Centre, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Centre, Taipei, Taiwan
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Brown SL, Mitchell SM, Roush JF, La Rosa NL, Cukrowicz KC. Rejection sensitivity and suicide ideation among psychiatric inpatients: An integration of two theoretical models. Psychiatry Res 2019; 272:54-60. [PMID: 30579182 DOI: 10.1016/j.psychres.2018.12.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 10/13/2018] [Accepted: 12/02/2018] [Indexed: 11/30/2022]
Abstract
Rejection is a direct threat to an individual's need to belong that has serious consequences for mental health. Rejection sensitivity may explain why some individuals are more likely to perceive rejection in social situations and experience subsequent psychological distress. The current study examined suicide ideation among psychiatric inpatients (N = 103) through the lenses of the rejection sensitivity model and the interpersonal theory of suicide. We hypothesized that rejection sensitivity would be indirectly associated with suicide ideation (i.e., a cognitive-affective reaction to social rejection) through greater perceptions of rejection (i.e., thwarted belongingness and perceived burdensomeness, constructs from the interpersonal theory of suicide), in parallel. Results from bootstrapped parallel mediation regression procedures indicated that the relation between rejection sensitivity and suicide ideation was significantly indirectly associated through the additive effect of thwarted belongingness and perceived burdensomeness, such that greater rejection sensitivity was associated with greater thwarted belongingness and perceived burdensomeness and subsequently greater suicide ideation. Further, rejection sensitivity was significantly indirectly associated with suicide ideation independently through thwarted belongingness, but not perceived burdensomeness. These findings provide support for the rejection sensitivity model and the interpersonal theory of suicide in an effort to advance our conceptualization of suicide risk among psychiatric inpatients.
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Affiliation(s)
- Sarah L Brown
- Department of Psychological Sciences, Mail Stop 42051, Texas Tech University, Lubbock 79409-2051, TX, USA
| | - Sean M Mitchell
- Department of Psychological Sciences, Mail Stop 42051, Texas Tech University, Lubbock 79409-2051, TX, USA
| | - Jared F Roush
- Department of Psychological Sciences, Mail Stop 42051, Texas Tech University, Lubbock 79409-2051, TX, USA
| | - Nikki L La Rosa
- Department of Psychological Sciences, Mail Stop 42051, Texas Tech University, Lubbock 79409-2051, TX, USA
| | - Kelly C Cukrowicz
- Department of Psychological Sciences, Mail Stop 42051, Texas Tech University, Lubbock 79409-2051, TX, USA.
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15
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Bruer RA, Rodway-Norman M, Large M. Closer to the Truth: Admission to Multiple Psychiatric Facilities and an Inaccurate History of Hospitalization Are Strongly Associated with Inpatient Suicide. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:748-756. [PMID: 29685070 PMCID: PMC6299186 DOI: 10.1177/0706743718772519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate clinical associations within Canadian psychiatric inpatient suicides. METHOD We conducted a case-control study comparing 98 patients who died by suicide while in hospital and 196 similarly admitted living inpatient controls. All were admitted to an Ontario psychiatric bed between 2008 and 2015 inclusive and had data collected at admission using the Resident Assessment Instrument for Mental Health (RAI-MH). The data were analyzed with bivariate tests and logistic regression modeling. RESULTS The strongest associations with inpatient suicide were prior admission to any Ontario psychiatric bed within the previous 30 days (odds ratio [OR] = 6.13), self-harm assessed at prior admission to a psychiatric hospital other than the hospital of suicide (OR = 6.07), and prior admission to a psychiatric hospital other than the hospital of suicide in the previous year (OR = 5.38). A multivariate model using risk factors assessed at admission had an area under the curve (AUC) of 0.77. The model improved to (AUC) 0.81 using a retrospective search of all Ontario admissions to more accurately detect prior admissions. The risk model was optimized to (AUC) 0.83 when the model also included a "discrepancy" variable to denote records in which admission assessment data and retrospective search data did not agree regarding past month admissions. CONCLUSIONS In addition to the well-known risks of suicide associated with previous suicide attempts and depressive conditions, our data suggest a particular risk of inpatient suicide associated with inpatient care in more than one hospital, particularly when the treating clinicians were unaware of recent previous admissions.
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Affiliation(s)
- Robert A. Bruer
- Orillia Soldiers’ Memorial Hospital, Orillia, Ontario, Canada
| | | | - Matthew Large
- School of Psychiatry, University of NSW, New South Wales, Australia
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16
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Mitchell SM, Brown SL, Roush JF, Bolaños AD, Morgan RD, Cukrowicz KC. Do criminal associates impact psychiatric inpatients' social support and interpersonal needs? DEATH STUDIES 2018; 43:535-541. [PMID: 30285601 DOI: 10.1080/07481187.2018.1493003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 05/01/2018] [Accepted: 05/08/2018] [Indexed: 06/08/2023]
Abstract
Suicide risk is elevated among psychiatric inpatients; however, research has not examined moderators of the associations between perceived social support and thwarted belongingness (TB) and perceived burdensomeness (PB), such as involvement with criminal associates. Adult psychiatric inpatients (N = 142) completed assessments. Perceived social support was negatively associated with TB and PB; however, associates' criminal involvement did not moderate these associations. A significant interaction indicated a stronger negative association between perceived social support and TB when participants spent more time with associates. Therefore, time spent with associates, regardless of criminal involvement, may be a relevant interpersonal suicide risk factor.
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Affiliation(s)
- Sean M Mitchell
- Department of Psychological Sciences, Texas Tech University , Lubbock , Texas , USA
| | - Sarah L Brown
- Department of Psychological Sciences, Texas Tech University , Lubbock , Texas , USA
| | - Jared F Roush
- Department of Psychological Sciences, Texas Tech University , Lubbock , Texas , USA
| | - Angelea D Bolaños
- Department of Psychological Sciences, Texas Tech University , Lubbock , Texas , USA
| | - Robert D Morgan
- Department of Psychological Sciences, Texas Tech University , Lubbock , Texas , USA
| | - Kelly C Cukrowicz
- Department of Psychological Sciences, Texas Tech University , Lubbock , Texas , USA
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Bergfeld IO, Mantione M, Figee M, Schuurman PR, Lok A, Denys D. Treatment-resistant depression and suicidality. J Affect Disord 2018; 235:362-367. [PMID: 29665520 DOI: 10.1016/j.jad.2018.04.016] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/28/2018] [Accepted: 04/02/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Thirty percent of patients with treatment-resistant depression (TRD) attempt suicide at least once during their lifetime. However, it is unclear what the attempted and completed suicide incidences are in TRD patients after initiating a treatment, and whether specific treatments increase or decrease these incidences. METHODS We searched PubMed systematically for studies of depressed patients who failed at least two antidepressant therapies and were followed for at least three months after initiating a treatment. We estimated attempted and completed suicide incidences using a Poisson meta-analysis. Given the lack of controlled comparisons, we used a meta-regression to estimate whether these incidences differed between treatments. RESULTS We included 30 studies investigating suicidality in 32 TRD samples, undergoing deep brain stimulation (DBS, n = 9), vagal nerve stimulation (VNS, n = 9), electroconvulsive therapy (ECT, n = 5), treatment-as-usual (n = 3), capsulotomy (n = 2), cognitive behavioral therapy (n = 2), ketamine (n = 1), and epidural cortical stimulation (n = 1). The overall incidence of completed suicides was 0.47 per 100 patient years (95% CI: 0.22-1.00), and of attempted suicides 4.66 per 100 patient years (95% CI: 3.53-6.23). No differences were found in incidences following DBS, VNS or ECT. LIMITATIONS Suicidality is poorly recorded in many studies limiting the number of studies available. CONCLUSIONS The completed and attempted suicide incidences are high (0.47 and 4.66 per 100 patient years respectively), but these incidences did not differ between three end of the line treatments (DBS, VNS or ECT). Given the high suicide risk in TRD patients, clinical trials should consider suicidality as an explicit outcome measure.
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Affiliation(s)
- Isidoor O Bergfeld
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, Amsterdam, The Netherlands.
| | - Mariska Mantione
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn Figee
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, Amsterdam, The Netherlands; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - P Richard Schuurman
- Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Anja Lok
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, Amsterdam, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, Amsterdam, The Netherlands; Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
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18
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DelPozo-Banos M, John A, Petkov N, Berridge DM, Southern K, LLoyd K, Jones C, Spencer S, Travieso CM. Using Neural Networks with Routine Health Records to Identify Suicide Risk: Feasibility Study. JMIR Ment Health 2018; 5:e10144. [PMID: 29934287 PMCID: PMC6035342 DOI: 10.2196/10144] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/10/2018] [Accepted: 04/29/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Each year, approximately 800,000 people die by suicide worldwide, accounting for 1-2 in every 100 deaths. It is always a tragic event with a huge impact on family, friends, the community and health professionals. Unfortunately, suicide prevention and the development of risk assessment tools have been hindered by the complexity of the underlying mechanisms and the dynamic nature of a person's motivation and intent. Many of those who die by suicide had contact with health services in the preceding year but identifying those most at risk remains a challenge. OBJECTIVE To explore the feasibility of using artificial neural networks with routinely collected electronic health records to support the identification of those at high risk of suicide when in contact with health services. METHODS Using the Secure Anonymised Information Linkage Databank UK, we extracted the data of those who died by suicide between 2001 and 2015 and paired controls. Looking at primary (general practice) and secondary (hospital admissions) electronic health records, we built a binary feature vector coding the presence of risk factors at different times prior to death. Risk factors included: general practice contact and hospital admission; diagnosis of mental health issues; injury and poisoning; substance misuse; maltreatment; sleep disorders; and the prescription of opiates and psychotropics. Basic artificial neural networks were trained to differentiate between the suicide cases and paired controls. We interpreted the output score as the estimated suicide risk. System performance was assessed with 10x10-fold repeated cross-validation, and its behavior was studied by representing the distribution of estimated risk across the cases and controls, and the distribution of factors across estimated risks. RESULTS We extracted a total of 2604 suicide cases and 20 paired controls per case. Our best system attained a mean error rate of 26.78% (SD 1.46; 64.57% of sensitivity and 81.86% of specificity). While the distribution of controls was concentrated around estimated risks < 0.5, cases were almost uniformly distributed between 0 and 1. Prescription of psychotropics, depression and anxiety, and self-harm increased the estimated risk by ~0.4. At least 95% of those presenting these factors were identified as suicide cases. CONCLUSIONS Despite the simplicity of the implemented system, the proposed methodology obtained an accuracy like other published methods based on specialized questionnaire generated data. Most of the errors came from the heterogeneity of patterns shown by suicide cases, some of which were identical to those of the paired controls. Prescription of psychotropics, depression and anxiety, and self-harm were strongly linked with higher estimated risk scores, followed by hospital admission and long-term drug and alcohol misuse. Other risk factors like sleep disorders and maltreatment had more complex effects.
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Affiliation(s)
| | - Ann John
- Swansea University, Swansea University Medical School, Swansea, United Kingdom
| | - Nicolai Petkov
- Division of Intelligent Systems, Department of Computer Science, Bernoulli Institute of Mathematics, Computer Science and Artificial Intelligence, Faculty of Science and Engineering, University of Groningen, Groningen, Netherlands
| | - Damon Mark Berridge
- Swansea University, Swansea University Medical School, Swansea, United Kingdom
| | - Kate Southern
- Cardiff Adult Self Injury Project, Cardiff, United Kingdom
| | - Keith LLoyd
- Swansea University, Swansea University Medical School, Swansea, United Kingdom
| | - Caroline Jones
- Hillary Rodham Clinton School of Law, Swansea University, Swansea, United Kingdom
| | - Sarah Spencer
- Princess of Wales Hospital, Bridgend, ABMU Health Board, Swansea, United Kingdom
| | - Carlos Manuel Travieso
- Signals and Communications Department, IDeTIC, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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19
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Large M, Myles N, Myles H, Corderoy A, Weiser M, Davidson M, Ryan CJ. Suicide risk assessment among psychiatric inpatients: a systematic review and meta-analysis of high-risk categories. Psychol Med 2018; 48:1119-1127. [PMID: 28874218 DOI: 10.1017/s0033291717002537] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The clinical care of psychiatric patients is often guided by perceptions of suicide risk. The aim of this study was to examine the methods and results of studies reporting high-risk models for inpatient suicide. METHODS We conducted a registered meta-analysis according to PRISMA guidelines. We searched for relevant peer-reviewed cohort and controlled studies indexed in Medline, EMBASE and PsychINFO. RESULTS The pooled odds ratio (OR) among 18 studies reporting high-risk models for inpatient suicide was 7.1 [95% confidence interval (CI) 4.2-12.2]. Between-study heterogeneity in ORs was very high (range 0-94.8, first quartile 3.4, median 8.8, third quartile 26.1, prediction interval 0.80-63.1, I2 = 88.1%). The meta-analytically derived sensitivity was 53.1% (95% CI 38.2-67.5%, I2 = 95.9%) and specificity was 84.2% (95% CI 71.6-91.9%, I2 = 99.9%) with an associated meta-analytic area under the curve of 0.83. The positive predictive value of risk categorization among six cohort studies was 0.43% (95% CI 0.014-1.3%, I2 = 95.9%). A history of suicidal behavior and depressive symptoms or affective disorder was included in the majority of high-risk models. CONCLUSIONS Despite the strength of the pooled association between high-risk categorization and suicide, the very high degree of observed heterogeneity indicates uncertainty about our ability to meaningfully distinguish inpatients according to suicide risk. The limited sensitivity and low positive predictive value of risk categorization suggest that suicide risk models are not a suitable basis for clinical decisions in inpatient settings.
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Affiliation(s)
- M Large
- School of Psychiatry,University of New South Wales,Randwick,Australia
| | - N Myles
- The Queen Elizabeth Hospital,Woodville South,Australia
| | - H Myles
- School of Psychiatry,Adelaide University,Adelaide,Australia
| | - A Corderoy
- University of Notre Dame Australia,School of Medicine,Sydney,Australia
| | - M Weiser
- Department of Psychiatry,Sackler School of Medicine,Tel Aviv University,Tel Aviv,Israel
| | - M Davidson
- University of Nicosia Medical School,Nicosia,Cyprus
| | - C J Ryan
- Discipline of Psychiatry and Sydney Health Ethics,University of Sydney,Sydney,Australia
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20
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Eskiyurt R, Ozkan B. The investigation of the relationship between probability of suicide and reasons for living in psychiatric inpatients. Indian J Psychiatry 2017; 59:435-441. [PMID: 29497185 PMCID: PMC5806322 DOI: 10.4103/psychiatry.indianjpsychiatry_31_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIM This study was carried out to determine the reasons of the suicide probability and reasons for living of the inpatients hospitalized at the psychiatry clinic and to analyze the relationship between them. MATERIALS AND METHODS The sample of the study consisted of 192 patients who were hospitalized in psychiatric clinics between February and May 2016 and who agreed to participate in the study. In collecting data, personal information form, suicide probability scale (SPS), reasons for living inventory (RFL), and Beck's depression inventory (BDI) were used. Stepwise regression method was used to determine the factors that predict suicide probability. RESULTS In the study, as a result of analyses made, the median score on the SPS was found 76.0, the median score on the RFL was found 137.0, the median score on the BDI of the patients was found 13.5, and it was found that patients with a high probability of suicide had less reasons for living and that their depression levels were very high. As a result of stepwise regression analysis, it was determined that suicidal ideation, reasons for living, maltreatment, education level, age, and income status were the predictors of suicide probability (F = 61.125; P < 0.001). DISCUSSION It was found that the patients who hospitalized in the psychiatric clinic have high suicide probability and the reasons of living are strong predictors of suicide probability in accordance with the literature.
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Affiliation(s)
- Reyhan Eskiyurt
- Department of Nursing, Mental Health Nursing, Faculty of Health Sciences, University of Ankara Yildirim Beyazit, Ankara, Turkey
| | - Birgul Ozkan
- Department of Nursing, Mental Health Nursing, Faculty of Health Sciences, University of Ankara Yildirim Beyazit, Ankara, Turkey
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21
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22
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Selenius H, Strand S. Experiences of self-injury and aggression among women admitted to forensic psychiatric care. Nord J Psychiatry 2017; 71:304-311. [PMID: 28152333 DOI: 10.1080/08039488.2017.1283443] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Self-injury and institutional violence are well-known characteristics of female forensic psychiatric patients, but research on patients' experiences of these behaviours is limited. AIM The aim of the study was to investigate how female forensic psychiatric patients describe their self-injury and aggression. METHODS The authors performed qualitative in-depth interviews with 13 female forensic psychiatric inpatients. The interviews were analysed using thematic analysis. RESULTS The analysis resulted in three themes describing the process of handling negative thoughts and emotions by using self-injury or aggression towards others and thereby experiencing satisfaction. Both self-injury and aggression were experienced as strategies for emotional regulation. The forensic psychiatric care was perceived as important for the women in developing less harmful strategies for coping with negative thoughts and emotions instead of injuring themselves or others. CONCLUSIONS Self-injury and aggression are often risk-assessed separately, but results from the present study suggest that these behaviours need a more holistic approach.
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Affiliation(s)
- Heidi Selenius
- a School of Law, Psychology and Social Work, Örebro University , Örebro , Sweden.,b Department of Special Education , Stockholm University , Stockholm , Sweden
| | - Susanne Strand
- a School of Law, Psychology and Social Work, Örebro University , Örebro , Sweden.,c Centre for Forensic Behavioural Science, Swinburne University of Technology , Melbourne , Australia
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23
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Mitchell SM, Brown SL, Roush JF, Bolaños AD, Littlefield AK, Marshall AJ, Jahn DR, Morgan RD, Cukrowicz KC. The clinical application of suicide risk assessment: A theory-driven approach. Clin Psychol Psychother 2017; 24:1406-1420. [PMID: 28421644 DOI: 10.1002/cpp.2086] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/08/2017] [Accepted: 03/15/2017] [Indexed: 01/09/2023]
Abstract
The interpersonal theory of suicide posits that thwarted belongingness (TB) and perceived burdensomeness (PB) increase suicide ideation; however, studies have found mixed results regarding this hypothesis among psychiatric inpatients. This study aimed to (a) demonstrate how assessing TB and PB using the Interpersonal Needs Questionnaire (INQ) can provide clinically useful information and (b) investigate how statistical methodology may impact the clinical application of the INQ. Participants were 139 (Sample 1) and 104 (Sample 2) psychiatric inpatients. In both samples, ordinal logistic regression results indicated TB and PB, separately, were significant predictors of suicide ideation-related outcomes; however, when examined as simultaneous predictors, TB was no longer a significant predictor. The interaction between TB and PB was not significant for either sample. Despite this, TB and PB scores provided clinically relevant information about suicide ideation-related outcomes. For example, the highest scores on TB and PB indicated a 93% and 95% chance of having some level of distress due to suicide ideation (Sample 1), a 91% and 92% chance of having some level of desire for death, and a 79% and 84% chance of having some level of desire for suicide, respectively (Sample 2). This study also proposes clinical cutoff scores for the INQ (for TB and PB, respectively, cutoff scores were 22 and 17 for distress due to suicide ideation, 33 and 17 for desire for death, and 31 and 22 for desire for suicide). Although these results indicate that multicollinearity between TB and PB may create interpretational ambiguity for clinicians, TB and PB may each be useful separate predictors of suicide ideation-related outcomes in psychiatric inpatient settings and should be incorporated into suicide risk assessment. KEY PRACTITIONER MESSAGE The 15-item Interpersonal Needs Questionnaire (an assessment of thwarted belongingness and perceived burdensomeness) should be incorporated into suicide risk assessment. Among psychiatric inpatients, greater thwarted belongingness and perceived burdensomeness, as separate predictors, were associated with increased levels of distress due to suicide ideation, desire for death, and desire for suicide. The highest scores on thwarted belongingness and perceived burdensomeness indicated a 79% to 95% chance of experiencing an elevated level of distress due to suicide ideation, desire for death, or desire for suicide. Recommended clinical cutoff scores were provided. For example, thwarted belongingness cutoff score of 31 and perceived burdensomeness cutoff score of 22 maximized the sensitivity and specificity of the INQ to detect some level of desire for suicide.
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Affiliation(s)
- Sean M Mitchell
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Sarah L Brown
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Jared F Roush
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Angelea D Bolaños
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | | | - Andrew J Marshall
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | | | - Robert D Morgan
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Kelly C Cukrowicz
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
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24
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Baneshi MR, Haghdoost AA, Zolala F, Nakhaee N, Jalali M, Tabrizi R, Akbari M. Can Religious Beliefs be a Protective Factor for Suicidal Behavior? A Decision Tree Analysis in a Mid-Sized City in Iran, 2013. JOURNAL OF RELIGION AND HEALTH 2017; 56:428-436. [PMID: 26923839 DOI: 10.1007/s10943-016-0215-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study aimed to assess using tree-based models the impact of different dimensions of religion and other risk factors on suicide attempts in the Islamic Republic of Iran. Three hundred patients who attempted suicide and 300 age- and sex-matched patient attendants with other types of disease who referred to Kerman Afzalipour Hospital were recruited for this study following a convenience sampling. Religiosity was assessed by the Duke University Religion Index. A tree-based model was constructed using the Gini Index as the homogeneity criterion. A complementary discrimination analysis was also applied. Variables contributing to the construction of the tree were stressful life events, mental disorder, family support, and religious belief. Strong religious belief was a protective factor for those with a low number of stressful life events and those with a high mental disorder score; 72 % of those who formed these two groups had not attempted suicide. Moreover, 63 % of those with a high number of stressful life events, strong family support, strong problem-solving skills, and a low mental disorder score were less likely to attempt suicide. The significance of four other variables, GHQ, problem-coping skills, friend support, and neuroticism, was revealed in the discrimination analysis. Religious beliefs seem to be an independent factor that can predict risk for suicidal behavior. Based on the decision tree, religious beliefs among people with a high number of stressful life events might not be a dissuading factor. Such subjects need more family support and problem-solving skills.
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Affiliation(s)
- Mohammad Reza Baneshi
- Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoost
- Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Farzaneh Zolala
- Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nouzar Nakhaee
- Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Jalali
- Department of Biostatistics, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Tabrizi
- Health Policy Research Center (HPRC), School of Medicine, Shiraz University of Medical Science, Building No 2, Eighth Floor, Zand Avenue, Shiraz, 71348-53185, Iran
| | - Maryam Akbari
- Health Policy Research Center (HPRC), School of Medicine, Shiraz University of Medical Science, Building No 2, Eighth Floor, Zand Avenue, Shiraz, 71348-53185, Iran.
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25
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Madsen T, Erlangsen A, Nordentoft M. Risk Estimates and Risk Factors Related to Psychiatric Inpatient Suicide-An Overview. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030253. [PMID: 28257103 PMCID: PMC5369089 DOI: 10.3390/ijerph14030253] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 02/22/2017] [Indexed: 12/24/2022]
Abstract
People with mental illness have an increased risk of suicide. The aim of this paper is to provide an overview of suicide risk estimates among psychiatric inpatients based on the body of evidence found in scientific peer-reviewed literature; primarily focusing on the relative risks, rates, time trends, and socio-demographic and clinical risk factors of suicide in psychiatric inpatients. Psychiatric inpatients have a very high risk of suicide relative to the background population, but it remains challenging for clinicians to identify those patients that are most likely to die from suicide during admission. Most studies are based on low power, thus compromising quality and generalisability. The few studies with sufficient statistical power mainly identified non-modifiable risk predictors such as male gender, diagnosis, or recent deliberate self-harm. Also, the predictive value of these predictors is low. It would be of great benefit if future studies would be based on large samples while focusing on modifiable predictors over the course of an admission, such as hopelessness, depressive symptoms, and family/social situations. This would improve our chances of developing better risk assessment tools.
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Affiliation(s)
- Trine Madsen
- Danish Research Institute for Suicide Prevention, Copenhagen Mental Health center, 2900 Hellerup, Denmark.
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Copenhagen Mental Health center, 2900 Hellerup, Denmark.
- Department of Mental Health, Bloomberg Johns Hopkins School of Public Health, Baltimore, MD 21205, USA.
- Institute of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark.
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Copenhagen Mental Health center, 2900 Hellerup, Denmark.
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26
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Wolfersdorf M, Vogel R, Vogl R, Grebner M, Keller F, Purucker M, Wurst FM. [Suicide in psychiatric hospitals : Results, risk factors and therapeutic measures]. DER NERVENARZT 2017; 87:474-82. [PMID: 27090898 DOI: 10.1007/s00115-016-0111-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Suicide prevention is a core responsibility of psychiatry and psychotherapy. Periods of change in psychiatric inpatient treatment concepts are usually also accompanied by an increase in psychopathological behavior and with increased suicide rates in psychiatric hospitals, as seen in the 1970s and 1980s in Germany. That this represented a real increase of inpatient suicides during those years was confirmed and subsequently the number and rate of inpatient suicides has decreased from approximately 280 out of 100,000 admissions of patients in 1980 to approximately 50 in 2014. Death can also occur in psychiatric hospitals and an absolute prevention is not possible even under optimal conditions of therapy and nursing, communication and security. The suicide rate has clearly decreased over the last two decades in relation to admissions. The group of young male schizophrenic patients newly identified as having a high clinical suicide risk has decreased among the suicide victims whereas the percentage of severely depressed patients with delusions has increased. This reduction could be associated with the comprehensive improvements in educational and training programs in the field of suicide and suicide prevention, objectification of coping methods, development of diagnostic and therapeutic strategies, improvements in therapy and relationship possibilities and a general reduction in the number of suicides in Germany.
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Affiliation(s)
- M Wolfersdorf
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Bayreuth, Akademisches Lehrkrankenhaus der Universität Erlangen-Nürnberg, Nordring 2, 95445, Bayreuth, Deutschland.
| | - R Vogel
- Klinik für Forensische Psychiatrie und Psychotherapie, Abteilung Psychiatrie II der Universität Ulm, Bezirkskrankenhaus Günzburg, Günzburg, Deutschland
| | - R Vogl
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Christophsbad Göppingen, Göppingen, Deutschland
| | - M Grebner
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Christophsbad Göppingen, Göppingen, Deutschland
| | - F Keller
- Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Universität Ulm, Ulm, Deutschland
| | - M Purucker
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Bayreuth, Akademisches Lehrkrankenhaus der Universität Erlangen-Nürnberg, Nordring 2, 95445, Bayreuth, Deutschland
| | - F M Wurst
- Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich
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Large M, Kaneson M, Myles N, Myles H, Gunaratne P, Ryan C. Meta-Analysis of Longitudinal Cohort Studies of Suicide Risk Assessment among Psychiatric Patients: Heterogeneity in Results and Lack of Improvement over Time. PLoS One 2016; 11:e0156322. [PMID: 27285387 PMCID: PMC4902221 DOI: 10.1371/journal.pone.0156322] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 05/12/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE It is widely assumed that the clinical care of psychiatric patients can be guided by estimates of suicide risk and by using patient characteristics to define a group of high-risk patients. However, the statistical strength and reliability of suicide risk categorization is unknown. Our objective was to investigate the odds of suicide in high-risk compared to lower-risk categories and the suicide rates in high-risk and lower-risk groups. METHOD We located longitudinal cohort studies where psychiatric patients or people who had made suicide attempts were stratified into high-risk and lower-risk groups for suicide with suicide mortality as the outcome by searching for peer reviewed publications indexed in PubMed or PsychINFO. Electronic searches were supplemented by hand searching of included studies and relevant review articles. Two authors independently extracted data regarding effect size, study population and study design from 53 samples of risk-assessed patients reported in 37 studies. RESULTS The pooled odds of suicide among high-risk patients compared to lower-risk patients calculated by random effects meta-analysis was of 4.84 (95% Confidence Interval (CI) 3.79-6.20). Between-study heterogeneity was very high (I2 = 93.3). There was no evidence that more recent studies had greater statistical strength than older studies. Over an average follow up period of 63 months the proportion of suicides among the high-risk patients was 5.5% and was 0.9% among lower-risk patients. The meta-analytically derived sensitivity and specificity of a high-risk categorization were 56% and 79% respectively. There was evidence of publication bias in favour of studies that inflated the pooled odds of suicide in high-risk patients. CONCLUSIONS The strength of suicide risk categorizations based on the presence of multiple risk factors does not greatly exceed the association between individual suicide risk factors and suicide. A statistically strong and reliable method to usefully distinguish patients with a high-risk of suicide remains elusive.
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Affiliation(s)
- Matthew Large
- School of Psychiatry, University of New South Wales, Randwick, Australia
- Prince of Wales Hospital, Randwick, Australia
- * E-mail:
| | - Muthusamy Kaneson
- Faculty of Medicine, University of New South Wales, Randwick, Australia
| | - Nicholas Myles
- The Queen Elizabeth Hospital, Woodville South, Australia
| | - Hannah Myles
- Discipline of Psychiatry, School of Medicine, The University of Adelaide, SA, Australia
- Country Health SA Mental Health, SA, Australia
| | | | - Christopher Ryan
- Discipline of Psychiatry and Centre for Values Ethics and the Law in Medicine, University of Sydney, Sydney, Australia
- Department of Psychiatry, Westmead Hospital, Westmead, NSW, Australia
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Bose S, Khanra S, Umesh S, Khess CRJ, Ram D. Inpatient suicide in a psychiatric hospital: Fourteen years' observation. Asian J Psychiatr 2016; 19:56-8. [PMID: 26957339 DOI: 10.1016/j.ajp.2015.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 12/06/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Swarnali Bose
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi 834006, India.
| | - Sourav Khanra
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi 834006, India.
| | - Shreekantiah Umesh
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi 834006, India.
| | - Christoday R J Khess
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi 834006, India.
| | - Daya Ram
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi 834006, India.
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Hu DY, Huang D, Xiong Y, Lu CH, Han YH, Ding XP, Wang SJ, Liu YL. Risk factors and precautions of inpatient suicide from the perspective of nurses: A qualitative study. ACTA ACUST UNITED AC 2015; 35:295-301. [DOI: 10.1007/s11596-015-1427-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 03/02/2015] [Indexed: 10/23/2022]
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Walsh G, Sara G, Ryan CJ, Large M. Meta-analysis of suicide rates among psychiatric in-patients. Acta Psychiatr Scand 2015; 131:174-84. [PMID: 25559375 DOI: 10.1111/acps.12383] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine factors associated with the number of psychiatric admissions per in-patient suicide and the suicide rate per 100,000 in-patient years in psychiatric hospitals. METHOD Random-effects meta-analysis was used to calculate pooled estimates, and meta-regression was used to examine between-sample heterogeneity. RESULTS Forty-four studies published between 1945 and 2013 reported a total of 7552 in-patient suicides. The pooled estimate of the number of admissions per suicide calculated using 39 studies reporting 150 independent samples was 676 (95% CI: 604-755). Recent studies tended to report higher numbers of admissions per suicide than earlier studies. The pooled estimate of suicide rates per 100,000 in-patient years calculated using 27 studies reporting 95 independent samples was 147 (95% CI: 138-156). Rates of suicide per 100,000 in-patient years tended to be higher in more recent samples, in samples from regions with a higher whole of population suicide rate, in samples from settings with a shorter average length of hospital stay and in studies using coronial records to define suicide. CONCLUSION Rates of in-patient suicide in psychiatric hospitals vary remarkably and are disturbingly high. Further research might clarify the extent to which patient factors and the characteristics of in-patient facilities contribute to the unacceptable mortality in psychiatric hospitals.
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Affiliation(s)
- G Walsh
- Mental Health Services, The Prince of Wales Hospital, Sydney, NSW, Australia
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Lukaschek K, Baumert J, Krawitz M, Erazo N, Förstl H, Ladwig KH. Determinants of completed railway suicides by psychiatric in-patients: case-control study. Br J Psychiatry 2014; 205:398-406. [PMID: 25257065 DOI: 10.1192/bjp.bp.113.139352] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Suicide prediction during psychiatric in-patient treatment remains an unresolved challenge. AIMS To identify determinants of railway suicides in individuals receiving in-patient psychiatric treatment. METHOD The study population was drawn from patients admitted to six psychiatric hospitals in Germany during a 10-year period (1997-2006). Data from 101 railway suicide cases were compared with a control group of 101 discharged patients matched for age, gender and diagnosis. RESULTS Predictors of suicide were change of therapist (OR = 22.86, P = 0.004), suicidal ideation (OR = 7.92, P<0.001), negative or unchanged therapeutic course (OR = 7.73, P<0.001), need of polypharmaceutical treatment (OR = 2.81, P = 0.04) and unemployment (OR = 2.72, P = 0.04). Neither restlessness nor impulsivity predicted in-patient suicide. CONCLUSIONS Suicidal ideation, unfavourable clinical course and the use of multiple psychotropic substances (reflecting the severity of illness) were strong determinants of railway suicides. The most salient finding was the vital impact of a change of therapist. These findings deserve integration into the clinical management of patients with serious mental disease.
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Affiliation(s)
- Karoline Lukaschek
- Karoline Lukaschek, PhD, Jens Baumert, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg; Marion Krawitz, MD, Natalia Erazo, PhD, Department for Psychosomatic Medicine and Psychotherapy, Hans Förstl, MD, Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich; Karl-Heinz Ladwig, PhD, MD habil, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, and Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jens Baumert
- Karoline Lukaschek, PhD, Jens Baumert, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg; Marion Krawitz, MD, Natalia Erazo, PhD, Department for Psychosomatic Medicine and Psychotherapy, Hans Förstl, MD, Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich; Karl-Heinz Ladwig, PhD, MD habil, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, and Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Marion Krawitz
- Karoline Lukaschek, PhD, Jens Baumert, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg; Marion Krawitz, MD, Natalia Erazo, PhD, Department for Psychosomatic Medicine and Psychotherapy, Hans Förstl, MD, Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich; Karl-Heinz Ladwig, PhD, MD habil, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, and Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Natalia Erazo
- Karoline Lukaschek, PhD, Jens Baumert, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg; Marion Krawitz, MD, Natalia Erazo, PhD, Department for Psychosomatic Medicine and Psychotherapy, Hans Förstl, MD, Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich; Karl-Heinz Ladwig, PhD, MD habil, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, and Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Hans Förstl
- Karoline Lukaschek, PhD, Jens Baumert, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg; Marion Krawitz, MD, Natalia Erazo, PhD, Department for Psychosomatic Medicine and Psychotherapy, Hans Förstl, MD, Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich; Karl-Heinz Ladwig, PhD, MD habil, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, and Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Karl-Heinz Ladwig
- Karoline Lukaschek, PhD, Jens Baumert, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg; Marion Krawitz, MD, Natalia Erazo, PhD, Department for Psychosomatic Medicine and Psychotherapy, Hans Förstl, MD, Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich; Karl-Heinz Ladwig, PhD, MD habil, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, and Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Influence of differentially expressed genes from suicide post-mortem study on personality traits as endophenotypes on healthy subjects and suicide attempters. Eur Arch Psychiatry Clin Neurosci 2014; 264:423-32. [PMID: 24241531 DOI: 10.1007/s00406-013-0469-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 10/29/2013] [Indexed: 12/17/2022]
Abstract
Although a genetic contribution to the complex aetiology of suicidal behaviour has been suggested since many years, the attempt to identify specific genes related to suicide has led to contrasting results. In a post-mortem study on suicide, we previously detected several differentially expressed genes which, however, have not been subsequently associated with suicidal behaviour, or only nominally. Therefore, personality traits may represent good intermediate endophenotypes. Our primary aim was to investigate the potential modulation of several single-nucleotide polymorphisms (SNPs) of the same previously investigated genes (S100A13, EFEMP1, PCDHB5, PDGFRB, CDCA7L, SCN2B, PTPRR, MLC1 and ZFP36) on personality traits, as measured with the Temperament and Character Inventory (TCI), in a German sample composed of 287 healthy subjects (males: 123, 42.9 %; mean age: 45.2 ± 14.9 years) and in 111 psychiatric patients who attempted suicide (males: 43, 38.6 %; mean age: 39.2 ± 13.6 years). Multivariate analysis of covariance was used to test possible influence of single SNPs on TCI scores. Genotypic, allelic and haplotypic analyses have been performed. Controlling for sex, age and educational level, genotypic analyses showed a modulation of EFEMP1 rs960993 and rs2903838 polymorphisms on both harm avoidance and self-directedness in healthy subjects. Interestingly, we could replicate these associations in haploblocks within controls (p < 0.0001) and in the independent sample of suicide attempters for harm avoidance (p < 0.00001), a phenotype highly associated with suicidal behaviour. This study suggests that EFEMP1 SNPs, never investigated in association with suicidal behaviour and related personality, could be involved in its modulation in healthy subjects as well as in suicide attempters.
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Abstract
OBJECTIVE AND METHOD To consider the possibility that adverse aspects of psychiatric hospitalisation may precipitate suicide contributing significantly to the increased rate of suicide among inpatients, given little has been published about this. RESULTS AND CONCLUSIONS It is likely that psychiatric hospitalisation itself contributes to some inpatient suicides. This has significant implications for the delivery of inpatient psychiatric care.
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Affiliation(s)
- Matthew Large
- Mental Health Services, The Prince of Wales Hospital, Randwick, NSW, and; School of Psychiatry, University of New South Wales, Kensington, NSW, Australia
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Sakinofsky I. Preventing suicide among inpatients. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:131-40. [PMID: 24881161 PMCID: PMC4079240 DOI: 10.1177/070674371405900304] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Inpatient suicide comprises a proportionately small but clinically important fraction of suicide. This study is intended as a qualitative analysis of the comprehensive English literature, highlighting what is known and what can be done to prevent inpatient suicide. METHOD A systematic search was conducted on the Cochrane Library, PubMed, Embase, Web of Knowledge, and a personal database for articles on cohort series, preferably controlled, of inpatient suicide (not deliberate self-harm or attempted suicide, unless they also dealt specifically with suicide data). RESULTS A qualitative discussion is presented, based on the findings of the literature searched. CONCLUSIONS The bulk of inpatient suicides actually occur not on the ward but off premises, when the patient was on leave or had absconded. Peaks occur shortly after admission and discharge. It is possible to reduce suicide risk on the ward by having a safe environment, optimizing patient visibility, supervising patients appropriately, careful assessment, awareness of and respect for suicide risk, good teamwork and communication, and adequate clinical treatment.
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Molero P, Grunebaum MF, Galfalvy HC, Bongiovi MA, Lowenthal D, Almeida MG, Burke AK, Stevenson E, Mann JJ, Oquendo MA. Past suicide attempts in depressed inpatients: clinical versus research assessment. Arch Suicide Res 2014; 18:50-7. [PMID: 24350632 PMCID: PMC3988802 DOI: 10.1080/13811118.2013.803446] [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] [Indexed: 10/25/2022]
Abstract
The objective of this study was to compare structured clinical assessment versus research measurement of suicidal risk among inpatients with major depression. Fifty depressed inpatients underwent a structured clinical and an independent research assessment of suicidal risk. Agreement between both assessments and its impact upon time to first readmission was tested. A false negative rate of 25% in the clinical screening of past suicide attempts was associated with older age, concealment, and reported lower frequency of suicidal thoughts. Mean times to first readmission (2.5 years follow-up) were 74 weeks (discordant responders) and 118 weeks (concordant responders). A failure to detect 25% of patients with past suicide attempt history in the clinical assessment was associated with older age and concealment of suicidal thoughts.
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Löfman S, Hakko H, Mainio A, Timonen M, Räsänen P. Characteristics of suicide among diabetes patients: a population based study of suicide victims in Northern Finland. J Psychosom Res 2012; 73:268-71. [PMID: 22980531 DOI: 10.1016/j.jpsychores.2012.08.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 08/05/2012] [Accepted: 08/07/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Recent case reports of insulin suicides have raised the need to study in detail the suicides among diabetes patients. METHODS The data consisted of 2489 suicides (2030 men, 459 women) in Northern Finland during 1988 to 2010. The suicide victims with hospital-treated type 1 (n=27) or type 2 diabetes (n=51) were compared with those without diabetes (n=2411). RESULTS Of all suicide victims, 3.1% had diabetes (34.6% type 1 and 65.4% type 2 diabetes). 24.0% of victims with type 2 diabetes were under the influence of alcohol when they died from suicide, while the proportion was 44.4% in type 1 diabetes and 46.6% in victims without diabetes (P=0.007). Compared to those with type 2 diabetes or without diabetes, victims with type 1 diabetes had suffered more commonly from depression (44.4%, 23.5%, 19.9%, respectively) (P=0.006) and chosen self-poisoning as suicide method (48.1%, 31.4%, and 18.0%) (P<0.001). In victims with type 1 diabetes insulin as a suicide method covered half of the self-poisoning cases, while the proportion in type 2 diabetes was 13%. CONCLUSION We suggest that physicians who treat diabetes patients should evaluate co-occurring depression and substance abuse, both of which are major risk factors of suicide.
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Affiliation(s)
- Sanna Löfman
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Oulu, Finland.
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Bouhlel S, M'solly M, Benhawala S, Jones Y, El-Hechmi Z. [Factors related to suicide attempts in a Tunisian sample of patients with schizophrenia]. Encephale 2012; 39:6-12. [PMID: 23095582 DOI: 10.1016/j.encep.2012.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 03/06/2012] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The mortality rate in schizophrenia is 4.5 times higher than in the general population. Suicide is one of the main causes of premature death in this affection. Life time prevalence of this behavior ranges from 10 to 15%, which represents a risk 20 to 50 times higher than in the general population. In addition, 40 to 93% of patients who committed suicide had attempted suicide previously. Thus, assessment of correlated variables with suicide attempts is a fundamental issue for developing preventive and therapeutic strategies in suicidal behavior. To the best of our knowledge, no systematic study has yet investigated suicide attempts in an Arabic Muslim population with schizophrenia, although many authors have demonstrated cultural differences in socio-demographic and clinical variables related to suicide attempts within many geographic areas around the world. OBJECTIVES The objectives of this study were to assess the frequency and characteristics of lifetime suicide attempts in Tunisian schizophrenic outpatients and to determine the correlated socio-demographic, clinical and therapeutic variables. METHODS A total of 134 patients with a DSM-IV diagnosis of schizophrenia who attended the outpatient department of the university psychiatric hospital of Tunis were included. The main demographic and lifetime clinical variables considered were: gender, marital status, family history of psychiatric disorders and suicide attempts, age at time of recruitment, age at onset of illness, duration of untreated psychosis defined as the interval between the onset of the illness and the first antipsychotic treatment, the type and dose of current treatment, dose of antipsychotic drugs converted to chlorpromazine equivalents, extrapyramidal side effects assessed with the Simpson Angus rating scale, number of hospitalizations, comorbid substance abuse, cigarette smoking, severity of psychopathology measured with the Positive And Negative Syndrome Scale (PANSS), and history of at least one suicide attempt. A suicide attempt was defined as a self-destructive act carried out with at least some intent to end one's life. We also assessed the number, the used methods and the causes of suicide attempts. We subdivided the sample into two sub samples according to the presence or absence of suicidal attempts. We analyzed and compared the demographic, clinical and therapeutic variables. RESULTS Out of the 134 patients, 45 (32%) had attempted suicide at least once. Half of them (49%) had attempted suicide more than once. The number of suicide attempts varied from one to five with an average of 1.8. The most used methods were medication overdose (n=18, 23.4%), followed by organophosphate poisoning (n=11, 14.3%), defenestration (n=9, 11.7%) and hanging or using sharp objects (n=7, 9.1% for each of them). The main reported reasons of suicide attempts were depressive symptoms (n=46, 60%) including depressed mood and hopelessness, stressful life events (bereavement, divorce, separation) (n=35, 46%) and presence of delusions and/or auditory hallucinations (n=25, 32.5%). No differences were found between the two groups regarding the different socio-demographic variables. Significant differences were found with respect to a duration of untreated psychosis equal to or more than one year (P<0.001), smoking in men (P=0.03), positive symptoms score on the PANSS (P<0.001), scores of Simpson-Angus scale (P=0.029) and poor medication compliance (P=0.02). CONCLUSION Demographic variables as suggested by other studies are less valuable predictors of suicide attempts in patients with schizophrenia. Interventions for reducing such behavior should focus on clinical variables and integrate an early diagnosis of the disease, reduce positive psychotic symptoms and tobacco consumption, correct extrapyramidal signs and improve medication compliance.
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Bauer R, Spiessl H, Schmidt T. Are there associations between caregiver information and suicidal behavior in psychiatric inpatients? Int J Psychiatry Clin Pract 2012; 16:238-42. [PMID: 22759193 DOI: 10.3109/13651501.2012.687453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The study aimed at exploring associations between inpatient suicides/attempted suicides in a psychiatric hospital and involvement of family caregivers in treatment. METHODS Based on the German psychiatric basic documentation systems (DGPPN-BADO), we analyzed a total sample of 49,257 cases of inpatient care (1998-2007) from a large psychiatric tertiary care university hospital and as a subsample all cases of schizophrenia, depression, acute stress/adjustment disorders and personality disorders (n = 22,880). Involvement of family caregivers was evaluated according to the following variables: admission to hospital due to recommendation of caregiver, conversation between therapist and caregiver, psychoeducation of caregiver as well as psychopharmacological and/or psychotherapeutic non-compliance of patient. Descriptive and bivariate analyses were performed. RESULTS Of the 22,880 cases in the subsample, 31 inpatient suicides and 198 attempted inpatient suicides were recorded. We could not find any significant associations of caregiver involvement variables with inpatient suicide. In contrast, for the total sample (n = 49,257), attempted suicide was associated with more conversation between therapists and caregivers (χ(2) = 3.863, df = 1, p = 0.049) and with psychopharmacological (χ(2) = 4.822, df = 1, p = 0.028) and psychotherapeutic (χ(2) = 13.041, df = 1, p = 0.000) non-compliance of the patients. CONCLUSION Further research is needed regarding the influence of caregivers on suicidal behavior of mentally ill inpatients.
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Affiliation(s)
- Rita Bauer
- Department of Psychiatry and Psychotherapy, University Regensburg, Germany.
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Lee JL, Ma WF, Yen WJ, Huang XY, Chiang LC. Predicting the likelihood of suicide attempts for rural outpatients with schizophrenia. J Clin Nurs 2012; 21:2896-904. [PMID: 22861353 DOI: 10.1111/j.1365-2702.2012.04206.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore suicide predictors in rural outpatients with schizophrenia. Background. Suicide is a major cause of mortality in patients with schizophrenia. Evidence indicates that patients in rural areas are at high risk for inadequate health care services. However, information is limited on suicide risk in outpatients with schizophrenia in rural areas. DESIGN Cross-sectional survey. METHODS Data were collected on individuals enrolled in the 2007 Taiwan National Health Insurance program as diagnosed with schizophrenia, ≥ 18 years, and living in a rural county. Eligible individuals (n=1655) were assessed by 12 community-based nurses at 12 public health centres. Participants' personal information was retrieved from National Health Insurance records using a personal data sheet, and treatment experiences were obtained by interviewing patients with a 10-item risk-assessment inventory. Data were collected over 18 months (2007-2008) and analysed by descriptive statistics and regression analyses. RESULTS Risk of suicide attempt in the previous year had four significant predictors: number of self-harm incidents during the previous year, violent incidents towards others during the previous year, number of follow-ups by mental health clinics and number of involuntary hospitalisations during the previous year (R(2) = 0.337, adjusted R(2) = 0.334, F=133.19, p=0.000). CONCLUSION Health care providers should assess rural outpatients with schizophrenia for suicidal thoughts by asking simple questions to evaluate for a history of self-harm and violence and by comparing this information with health system data on follow-ups by mental health clinics and involuntary hospitalisations. RELEVANCE TO CLINICAL PRACTICE Community-based health providers may use these results to prioritise assessments when they have a high case load of patients with schizophrenia. Community-based nurses need to be trained to recognise these four predictors to increase their sensitivity to suicidality among patients with schizophrenia.
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Affiliation(s)
- Jwo-Leun Lee
- Department of Senior Citizen Service Management, National Taichung University of Science & Technology, Taichung, Taiwan
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James K, Stewart D, Bowers L. Self-harm and attempted suicide within inpatient psychiatric services: a review of the literature. Int J Ment Health Nurs 2012; 21:301-9. [PMID: 22340085 DOI: 10.1111/j.1447-0349.2011.00794.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Self harm is a major public health concern, yet there are considerable challenges in providing support for those who self harm within psychiatric inpatient services. This paper presents the first review of research into self harm within inpatient settings. Searches of the main electronic databases were conducted using key words for self harm and inpatient care. There was substantial variation in the rates of self-harm and attempted suicide between studies, but rates were highest on forensic wards. There was no evidence of differences in prevalence of self-harm between men and women; women, however, were at increased risk of attempting suicide. People were more likely to self-harm in private areas of the ward and in the evening hours, and often self-harmed in response to psychological distress, or elements of nursing care that restricted their freedom. Wards used a variety of strategies to prevent self-harm; however, there is little research into their effectiveness.
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Affiliation(s)
- Karen James
- Institute of Psychiatry, Kings College London, London, UK.
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Stewart D, Ross J, Watson C, James K, Bowers L. Patient characteristics and behaviours associated with self-harm and attempted suicide in acute psychiatric wards. J Clin Nurs 2012; 21:1004-13. [PMID: 22512008 DOI: 10.1111/j.1365-2702.2011.03832.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES The study examined events before and after incidents of self-harm and attempted suicide and the characteristics of patients who engage in these behaviours. BACKGROUND Psychiatric inpatient populations have an elevated risk of self-harm and suicide, but relatively little is known about the circumstances of these events during an admission. DESIGN Retrospective case note analysis. METHOD Data were collected on conflict (aggression, rule breaking, etc.) and containment (coerced medication, restraint, etc.) during the first two weeks of admission for a sample of 522 acute psychiatric inpatients. RESULTS One in 10 patients self-harmed, and 4% attempted suicide. Aggression, attempting to leave the ward without permission and medication refusal were frequent precursors to incidents. Pro re nata medication and de-escalation were the most frequent interventions to follow an incident. Self-harm and attempted suicides during the current admission were significantly associated with younger age and a history of self-harm. CONCLUSIONS A minority of the sample were involved in these behaviours, but incidents occurred soon after admission and sometimes repeatedly during the course of a day. Assessment of risk should be completed as early as possible. RELEVANCE TO CLINICAL PRACTICE At-risk patients should be monitored for signs of withdrawal from ward activity, wanting to leave the ward without permission or non-compliance with medication to enable early intervention.
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Affiliation(s)
- Duncan Stewart
- Health Service and Population Research, Institute of Psychiatry, Kings College London, London, UK.
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42
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Large M, Smith G, Sharma S, Nielssen O, Singh SP. Systematic review and meta-analysis of the clinical factors associated with the suicide of psychiatric in-patients. Acta Psychiatr Scand 2011; 124:18-29. [PMID: 21261599 DOI: 10.1111/j.1600-0447.2010.01672.x] [Citation(s) in RCA: 157] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To estimate the strength of the associations between the suicide of psychiatric in-patients and demographic, historical, symptomatic, diagnostic and treatment factors. METHOD A systematic review and meta-analysis of controlled studies of the suicide of psychiatric in-patients including suicides while on approved or unapproved leave. RESULTS Factors that were significantly associated with in-patient suicide included a history of deliberate self-harm, hopelessness, feelings of guilt or inadequacy, depressed mood, suicidal ideas and a family history of suicide. Patients suffering from both schizophrenia and depressed mood appeared to be at particular risk. The association between suicidal ideas and in-patient suicide was weak and did not reach statistical significance after a quantitative correction for publication bias. A high-risk categorization as defined by a combination of retrospectively determined individual risk factors was strongly statistically associated with in-patient suicide (OR=10.9), with a sensitivity of 64% and a specificity of 85%. CONCLUSION Despite the apparently strong association between high-risk categorization and subsequent suicide, the low base rate of in-patient suicide means that predictive value of a high-risk categorization is below 2%. The development of safer hospital environments and improved systems of care are more likely to reduce the suicide of psychiatric in-patients than risk assessment.
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Affiliation(s)
- M Large
- The Euroa Centre, Prince of Wales Hospital, Barker Street, Randwick, Sydney, NSW 2031, Australia.
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Proctor LJ, Van Dusen Randazzo K, Litrownik AJ, Newton RR, Davis IP, Villodas M. Factors associated with caregiver stability in permanent placements: a classification tree approach. CHILD ABUSE & NEGLECT 2011; 35:425-436. [PMID: 21645922 PMCID: PMC3740351 DOI: 10.1016/j.chiabu.2011.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 02/16/2011] [Accepted: 02/18/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Identify individual and environmental variables associated with caregiver stability and instability for children in diverse permanent placement types (i.e., reunification, adoption, and long-term foster care/guardianship with relatives or non-relatives), following 5 or more months in out-of-home care prior to age 4 due to substantiated maltreatment. METHODS Participants were 285 children from the Southwestern site of Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Caregiver instability was defined as a change in primary caregiver between ages 6 and 8 years. Classification and regression tree (CART) analysis was used to identify the strongest predictors of instability from multiple variables assessed at age 6 with caregiver and child reports within the domains of neighborhood/community characteristics, caregiving environment, caregiver characteristics, and child characteristics. RESULTS One out of 7, or 14% of the 285 children experienced caregiver instability in their permanent placement between ages 6 and 8. The strongest predictor of stability was whether the child had been placed in adoptive care. However, for children who were not adopted, a number of contextual factors (e.g., father involvement, expressiveness within the family) and child characteristics (e.g., intellectual functioning, externalizing problem behaviors) predicted stability and instability of permanent placements. CONCLUSIONS Current findings suggest that a number of factors should be considered, in addition to placement type, if we are to understand what predicts caregiver stability and find stable permanent placements for children who have entered foster care. These factors include involvement of a father figure, family functioning, and child functioning. PRACTICE IMPLICATIONS Adoption was supported as a desired permanent placement in terms of stability, but results suggest that other placement types can also lead to stability. In fact, with attention to providing biological parents, relative, and non-relative caregivers with support and resources (e.g., emotional, financial, and optimizing father involvement or providing a stable adult figure) the likelihood that a child will have a stable caregiver may be increased.
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Affiliation(s)
- Laura J Proctor
- Department of Psychology, San Diego State University, San Diego, CA 92183, USA
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Neuner T, Hübner-Liebermann B, Hausner H, Hajak G, Wolfersdorf M, Spiessl H. Revisiting the association of aggression and suicidal behavior in schizophrenic inpatients. Suicide Life Threat Behav 2011; 41:171-9. [PMID: 21342219 DOI: 10.1111/j.1943-278x.2011.00018.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Our study investigated the association of aggression and suicidal behavior in schizophrenic inpatients. Eight thousand nine hundred one admissions for schizophrenia (1998-2007) to a psychiatric university hospital were included. Schizophrenic suicides (n = 7)/suicide attempters (n = 40) were compared to suicides (n = 30)/suicide attempters (n = 186) with other diagnoses and to schizophrenic non-attempters regarding aggression. Logistic regression analysis was performed to explore risk factors for attempted suicide. Schizophrenic suicides/suicide attempters did not differ from other suicides/suicide attempters or from schizophrenic non-attempters with regard to aggression. Risk of inpatient suicide attempt was increased for patients with attempted suicide at admission, high school graduation, and disorganized subtype. Aggression could not be found to be a predictor of attempted suicide. Aggression seems to have a minor role for suicidal behavior in schizophrenia.
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Affiliation(s)
- Tanja Neuner
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
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Neuner T, Hübner-Liebermann B, Wolfersdorf M, Felber W, Hajak G, Spiessl H. Time patterns of inpatient suicides. Int J Psychiatry Clin Pract 2010; 14:95-101. [PMID: 24922468 DOI: 10.3109/13651500903506466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract Objective. Time patterns of suicides have been investigated in many population-based studies, but there are no studies exploring time patterns of suicides during psychiatric inpatient stay up to now. Methods. All inpatient suicides (1998-2007) of a psychiatric university hospital were identified by the German psychiatric basic documentation system (DGPPNBADO). Descriptive and univariate analyses were performed to analyse time patterns of inpatient suicides. Results. No significant differences could be found for the occurrence of the 37 inpatient suicides due to season (χ(2)=1.595, P=0.696), month (χ(2)=4.838, P=0.958) or weekday (χ(2)=5.189, P=0.550) of suicide. Furthermore, we could not find an unequal distribution of suicides due to month of birth (χ(2)=12.622, P=0.337). 78.4% of inpatient suicides occurred within 50 days after admission. Fourteen inpatients committed suicide around public holidays, two around their birthday. Conclusions. Apart from a notably enhanced risk of suicide in the period after admission, we could not find any time patterns to be of high relevance to inpatient suicides. There may be more relevant risk factors than cyclic or temporal variations.
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Affiliation(s)
- Tanja Neuner
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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Giegling I, Olgiati P, Hartmann AM, Calati R, Möller HJ, Rujescu D, Serretti A. Personality and attempted suicide. Analysis of anger, aggression and impulsivity. J Psychiatr Res 2009; 43:1262-71. [PMID: 19481222 DOI: 10.1016/j.jpsychires.2009.04.013] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 04/28/2009] [Accepted: 04/29/2009] [Indexed: 11/29/2022]
Abstract
Suicide is one of the leading causes of death worldwide, mortality from suicide being approximately 2%. Attempted suicide appears to be a major risk factor for suicide completion. Anger, aggression and impulsivity are personality traits associated with suicide attempt. In this study we analysed a part of a previously reported sample in order to test anger, impulsivity and temperament/character scales as predictors of aggression and self-aggression in suicide attempters and to compare anger- and aggression-related traits between impulsive and premeditated suicide attempts as well as between violent and non-violent suicide methods. One-hundred-eleven consecutively admitted inpatients with a lifetime history of attempted suicide were assessed for anger (State-Trait Anger Expression Inventory, STAXI), aggression (Questionnaire for Measuring Factors of Aggression, FAF) and temperament/character (Temperament and Character Inventory, TCI). Higher aggression scores, as measured by FAF, were predicted by being male, meeting criteria for borderline personality disorder and having higher angry temperament scores as assessed by STAXI; low cooperativeness was also associated with aggression but not after controlling for STAXI scales. TCI dimensions associated with self-aggression were high harm avoidance, high impulsivity and low self-directedness; state anger, inwardly directed anger and inhibition of aggression were also predictors of self-aggression. In conclusion, impulsivity and harm avoidance have emerged as temperament dimensions independently associated with self-aggressive tendencies in personality. Such interactions could explain the correlation between temperament and suicidality but further research is needed. Anger and self-directedness appear to have some effects on suicide attempt.
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Affiliation(s)
- Ina Giegling
- Molecular and Clinical Neurobiology, Department of Psychiatry, Ludwig-Maximilians-University, Nussbaumstr. 7, D-80336 Munich, Germany
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Abstract
The goal of the present study was to test the hypothesis that suicide attempts have a cathartic effect. We retrospectively investigated sociodemographic and clinical characteristics of suicide attempters admitted to the emergency department of a university hospital who were referred for a psychiatric assessment. The participants were 158 consecutive patients admitted to the emergency department because of a suicide attempt between January, 2006, and February, 2007; controls were 360 consecutive psychiatric referrals who did not report suicidal behavior. More than 70% of suicide attempters were coded on the triage classification system as critical/urgent. Loglinear analysis indicated that the risk of suicidal ideation was 9 times higher (p <0.001) and the risk of depressive mood was twice as high (p <0.001) among the attempters as in the control group of nonattempters, while their risk of anxiety (p <0.05) and agitation (p <0.05) was approximately half that of the nonattempters. The attempters also had a 5 times greater risk of being diagnosed with bipolar disorder (p <0.001) than the nonattempters. However, despite the fact that bipolar disorders were overrepresented in the group of attempters, suicidal ideation in the few hours after a suicide attempt was associated only with depressive mood. Based on these findings, it is recommended that psychiatric evaluation of suicide attempters in the emergency department should ideally include the use of psychometric instruments evaluating suicide ideation and suicide risk.
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Abstract
OBJECTIVE To describe the suicide rates of psychiatric in-patients in the canton of Zurich for the period 1992-2004, and to determine putative risk factors. METHOD The data were derived from the psychiatric case register of the canton Zurich. The analyses were based on person-years calculations and standardised mortality ratios. Additional information was assessed via case records. RESULTS During the 13-year period the standardised mortality ratio was 48.9. The risk of suicide was particularly high in patients with personality and affective disorders. Most suicides occurred during regular leave periods, despite the fact that clinical assessment had indicated there was no suicide risk for the patient. CONCLUSION The suicide risk of in-patients is distinctly higher than in the general population. A better assessment of suicide risk before regular leave periods could lead to a decrease of suicides in in-patient settings, as well as a more rigorous treatment of borderline cases, and of affective and psychotic symptoms.
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Affiliation(s)
- V Ajdacic-Gross
- Psychiatric University Hospital Zurich, Zurich, Switzerland.
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Mikell CB, McKhann GM, Segal S, McGovern RA, Wallenstein MB, Moore H. The hippocampus and nucleus accumbens as potential therapeutic targets for neurosurgical intervention in schizophrenia. Stereotact Funct Neurosurg 2009; 87:256-65. [PMID: 19556835 PMCID: PMC2836942 DOI: 10.1159/000225979] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Schizophrenia is a chronic and disabling psychiatric illness that is often refractory to treatment. Psychotic symptoms (e.g. hallucinations and delusions) in schizophrenia are reliably correlated with excess dopamine levels in the striatum, and have more recently been related to excess metabolic activity in the hippocampus. Multiple lines of evidence suggest that aberrantly high hippocampal activity may, via hippocampal connections with the limbic basal ganglia, drive excessive dopamine release into the striatum. In the present paper, we hypothesize that inhibition or stabilization of neural activity with high-frequency electrical stimulation of the hippocampus or nucleus accumbens, through different mechanisms, would treat the positive symptoms of schizophrenia. Thus, we suggest a direction for further experimentation aimed at developing neurosurgical therapeutic approaches for this devastating disease.
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Affiliation(s)
| | | | | | | | | | - Holly Moore
- Department of Neurological Surgery, Columbia University, New York, N.Y., USA
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