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Le GH, Wong S, Haikazian S, Johnson DE, Badulescu S, Kwan ATH, Gill H, Di Vincenzo JD, Rosenblat JD, Mansur R, Teopiz KM, Rhee TG, Ho R, Liao S, Cao B, Schweinfurth-Keck N, Vinberg M, Grande I, Phan L, d'Andrea G, McIntyre RS. Association between cognitive functioning, suicidal ideation and suicide attempts in major depressive disorder, bipolar disorder, schizophrenia and related disorders: A systematic review and meta-analysis. J Affect Disord 2024; 365:381-399. [PMID: 39168166 DOI: 10.1016/j.jad.2024.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/18/2024] [Accepted: 08/11/2024] [Indexed: 08/23/2024]
Abstract
INTRODUCTION Treatable mental disorders, such as psychotic, major depressive disorder (MDD), and bipolar disorder (BD), contribute to a substantial portion of suicide risk, often accompanied by neurocognitive deficits. We report the association between cognitive function and suicidal ideation/suicide attempts (SI/SA) in individuals with schizoaffective disorder, BD, and MDD. METHODS A systematic search was conducted on PubMed, Ovid and Scopus databases for primary studies published from inception to April 2024. Eligible articles that reported on the effect size of association between cognition and SI/SA were pooled using a random effects model. RESULTS A total of 41 studies were included for analysis. There was a negative association between executive functioning and SI/SA in schizoaffective disorder (SA: Corr = -0·78, 95 % CI [-1·00, 0·98]; SI: Corr = -0·06, 95 % CI [-0·85, 0·82]) and MDD (SA: Corr = -0·227, 95 % CI [-0·419, -0·017]; SI: Corr = -0·14, 95 % CI [-0·33, 0·06]). Results were mixed for BD, with a significant positive association between SA and global executive functioning (Corr = 0·08, 95 % CI [0·01, 0·15]) and negative association with emotion inhibition. Mixed results were observed for processing speed, attention, and learning and memory, transdiagnostically. LIMITATIONS There is heterogeneity across sample compositions and cognitive measures. We did not have detailed information on individuals with respect to demographics and comorbidities. CONCLUSIONS We observed a transdiagnostic association between measures of cognitive functions and aspects of suicidality. The interplay of cognitive disturbances, particularly in reward-based functioning, may underlie suicidality in individuals with mental disorders. Disturbances in impulse control, planning, and working memory may contribute to self-injurious behavior and suicide.
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Affiliation(s)
- Gia Han Le
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada.
| | - Sabrina Wong
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Canada.
| | - Sipan Haikazian
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Danica E Johnson
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Sebastian Badulescu
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada.
| | - Angela T H Kwan
- Brain and Cognition Discovery Foundation, Toronto, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada.
| | - Hartej Gill
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Joshua D Di Vincenzo
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, Canada.
| | - Joshua D Rosenblat
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Rodrigo Mansur
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, Canada.
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA.
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore.
| | - Sonya Liao
- Brain and Cognition Discovery Foundation, Toronto, Canada.
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing 400715, PR China.
| | - Nina Schweinfurth-Keck
- Center of Affective, Stress-related and Sleep Disorders (ZASS), University Medical Centers Basel (UPK), Basel, Switzerland; University of Basel, Department of Psychiatry, Basel, Switzerland.
| | - Maj Vinberg
- The Early Multimodular Prevention and Intervention Research Institution (EMPIRI), Mental Health Centre, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Iria Grande
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, (UB), c. Casanova, 143, 08036 Barcelona, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Lee Phan
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, Canada
| | - Giacomo d'Andrea
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, Chieti, Italy
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
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2
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Anmella G, De Prisco M, Joyce JB, Valenzuela-Pascual C, Mas-Musons A, Oliva V, Fico G, Chatzisofroniou G, Mishra S, Al-Soleiti M, Corponi F, Giménez-Palomo A, Montejo L, González-Campos M, Popovic D, Pacchiarotti I, Valentí M, Cavero M, Colomer L, Grande I, Benabarre A, Llach CD, Raduà J, McInnis M, Hidalgo-Mazzei D, Frye MA, Murru A, Vieta E. Automated Speech Analysis in Bipolar Disorder: The CALIBER Study Protocol and Preliminary Results. J Clin Med 2024; 13:4997. [PMID: 39274208 PMCID: PMC11396536 DOI: 10.3390/jcm13174997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/06/2024] [Accepted: 08/13/2024] [Indexed: 09/16/2024] Open
Abstract
Background: Bipolar disorder (BD) involves significant mood and energy shifts reflected in speech patterns. Detecting these patterns is crucial for diagnosis and monitoring, currently assessed subjectively. Advances in natural language processing offer opportunities to objectively analyze them. Aims: To (i) correlate speech features with manic-depressive symptom severity in BD, (ii) develop predictive models for diagnostic and treatment outcomes, and (iii) determine the most relevant speech features and tasks for these analyses. Methods: This naturalistic, observational study involved longitudinal audio recordings of BD patients at euthymia, during acute manic/depressive phases, and after-response. Patients participated in clinical evaluations, cognitive tasks, standard text readings, and storytelling. After automatic diarization and transcription, speech features, including acoustics, content, formal aspects, and emotionality, will be extracted. Statistical analyses will (i) correlate speech features with clinical scales, (ii) use lasso logistic regression to develop predictive models, and (iii) identify relevant speech features. Results: Audio recordings from 76 patients (24 manic, 21 depressed, 31 euthymic) were collected. The mean age was 46.0 ± 14.4 years, with 63.2% female. The mean YMRS score for manic patients was 22.9 ± 7.1, reducing to 5.3 ± 5.3 post-response. Depressed patients had a mean HDRS-17 score of 17.1 ± 4.4, decreasing to 3.3 ± 2.8 post-response. Euthymic patients had mean YMRS and HDRS-17 scores of 0.97 ± 1.4 and 3.9 ± 2.9, respectively. Following data pre-processing, including noise reduction and feature extraction, comprehensive statistical analyses will be conducted to explore correlations and develop predictive models. Conclusions: Automated speech analysis in BD could provide objective markers for psychopathological alterations, improving diagnosis, monitoring, and response prediction. This technology could identify subtle alterations, signaling early signs of relapse. Establishing standardized protocols is crucial for creating a global speech cohort, fostering collaboration, and advancing BD understanding.
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Affiliation(s)
- Gerard Anmella
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, 08036 Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
| | - Michele De Prisco
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, 08036 Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
| | - Jeremiah B Joyce
- School of Graduate Medical Education, Mayo Clinic, Rochester, MN 55902, USA
| | - Claudia Valenzuela-Pascual
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, 08036 Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
| | - Ariadna Mas-Musons
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, 08036 Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
| | - Vincenzo Oliva
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, 08036 Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
| | - Giovanna Fico
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, 08036 Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
| | | | - Sanjeev Mishra
- Alix School of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Majd Al-Soleiti
- School of Graduate Medical Education, Mayo Clinic, Rochester, MN 55902, USA
| | - Filippo Corponi
- School of Informatics, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Anna Giménez-Palomo
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, 08036 Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
| | - Laura Montejo
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, 08036 Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
| | - Meritxell González-Campos
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, 08036 Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
| | - Dina Popovic
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, 08036 Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
| | - Isabella Pacchiarotti
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, 08036 Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
| | - Marc Valentí
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, 08036 Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
| | - Myriam Cavero
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, 08036 Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
| | - Lluc Colomer
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, 08036 Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
| | - Iria Grande
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, 08036 Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
| | - Antoni Benabarre
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, 08036 Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
| | - Cristian-Daniel Llach
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON M5G 1M9, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Joaquim Raduà
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
| | - Melvin McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Diego Hidalgo-Mazzei
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, 08036 Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Andrea Murru
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, 08036 Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, 08036 Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
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Bagge CL, Himes KP, Cohen SM, Barbour EV, Comtois KA, Littlefield AK. Can profiles of behaviors occurring within 48 h of a suicide attempt predict future severity of suicidal thoughts and reattempt?: An examination of hospitalized patients 12 Months post-discharge. J Psychiatr Res 2024; 176:259-264. [PMID: 38901390 DOI: 10.1016/j.jpsychires.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
Behavioral warning signs (WS) are near-term changes within individuals, which aid in determining imminent risk for suicide attempts. However, those who attempt suicide differ in their engagement of WS, and it is unclear if these differences relate to future risk of suicidal behavior. Using a sample of 132 adults presenting to a hospital following a suicide attempt, the current study sought to determine if differences in engagement in WS for the index attempt prospectively predicted suicide attempt, frequency of ideation, and intensity of suicide ideation 12 months post discharge. Latent class analyses (LCAs) conducted on 6 behaviors (i.e., alcohol use, nightmares, interpersonal negative life events, suicide communication, risky behavior, low sleep, and high sleep) found a 5-class solution optimally fit the data. One identified class, characterized by engagement in risky behaviors the hours before an attempt differed from other identified classes in terms of risk for future suicidal ideation and behaviors. More specifically, participants in "High Risky Behavior" class had higher rates of 12-month suicide reattempt, significantly more frequent suicide ideation, and significantly worse intensity of suicide ideation during the 12 months following their index attempt compared to participants endorsing typical patterns of WS. These results held when adjusting for various traditional baseline covariates (e.g., depressive symptoms). The current study demonstrates that patterns of behavioral WS may be utilized as their own prognostic indicator of future suicidal ideation and behaviors among high-risk individuals reporting a recent suicide attempt, which can inform post-discharge clinical intervention and prevention efforts.
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Affiliation(s)
- Courtney L Bagge
- Department of Psychiatry, University of Michigan Medical Center, 4250 Plymouth Road, Ann Arbor, MI, 48109-2800, USA; VA Center for Clinical Management Research Ann Arbor Department of Veteran Affairs, 2800 Plymouth Rd., North Campus Research Center, B16, Ann Arbor, MI, 48109-2800, USA.
| | - Katie P Himes
- Texas Tech University, Department of Psychology, 2500 Broadway, Lubbock, TX, 79409, USA
| | - Sarah M Cohen
- Department of Psychiatry, University of Michigan Medical Center, 4250 Plymouth Road, Ann Arbor, MI, 48109-2800, USA; VA Center for Clinical Management Research Ann Arbor Department of Veteran Affairs, 2800 Plymouth Rd., North Campus Research Center, B16, Ann Arbor, MI, 48109-2800, USA
| | - Elizabeth V Barbour
- Department of Psychiatry, University of Michigan Medical Center, 4250 Plymouth Road, Ann Arbor, MI, 48109-2800, USA; VA Center for Clinical Management Research Ann Arbor Department of Veteran Affairs, 2800 Plymouth Rd., North Campus Research Center, B16, Ann Arbor, MI, 48109-2800, USA
| | - Katherine A Comtois
- University of Washington, Box 359911, Harborview Medical Center, Seattle, WA, 98195, USA
| | - Andrew K Littlefield
- Texas Tech University, Department of Psychology, 2500 Broadway, Lubbock, TX, 79409, USA
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4
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Pemau A, Marin-Martin C, Diaz-Marsa M, de la Torre-Luque A, Ayad-Ahmed W, Gonzalez-Pinto A, Garrido-Torres N, Garrido-Sanchez L, Roberto N, Lopez-Peña P, Mar-Barrutia L, Grande I, Guinovart M, Hernandez-Calle D, Jimenez-Treviño L, Lopez-Sola C, Mediavilla R, Perez-Aranda A, Ruiz-Veguilla M, Seijo-Zazo E, Toll A, Elices M, Perez-Sola V, Ayuso-Mateos JL. Risk factors for suicide reattempt: a systematic review and meta-analysis. Psychol Med 2024; 54:1897-1904. [PMID: 38623694 DOI: 10.1017/s0033291724000904] [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: 04/17/2024]
Abstract
BACKGROUND Suicide is one of the main external causes of death worldwide. People who have already attempted suicide are at high risk of new suicidal behavior. However, there is a lack of information on the risk factors that facilitate the appearance of reattempts. The aim of this study was to calculate the risk of suicide reattempt in the presence of suicidal history and psychosocial risk factors and to estimate the effect of each individual risk factor. METHODS This systematic review and meta-analysis were conducted following the PRISMA-2020 guidelines. Studies on suicide reattempt that measured risk factors were searched from inception to 2022. The risk factors studied were those directly related to suicide history: history of suicide prior to the index attempt, and those that mediate the transition from suicidal ideation to attempt (alcohol or drug misuse, impulsivity, trauma, and non-suicidal self-injury). RESULTS The initial search resulted in 11 905 articles. Of these, 34 articles were selected for this meta-analysis, jointly presenting 52 different effect sizes. The pooled effect size across the risk factors was significant (OR 2.16). Reattempt risk may be increased in presence of any of the following risk factors: previous history, active suicidal ideation, trauma, alcohol misuse, and drug misuse. However, impulsivity, and non-suicidal self-injury did not show a significant effect on reattempt. CONCLUSION Most of the risk factors traditionally associated with suicide are also relevant when talking about suicide reattempts. Knowing the traits that define reattempters can help develop better preventive and intervention plans.
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Affiliation(s)
- Andres Pemau
- Universidad Complutense de Madrid, Madrid, Spain
| | | | - Marina Diaz-Marsa
- San Carlos University Clinic Hospital, Madrid, Spain
- Araba University Hospital, Vitoria, Spain
| | - Alejandro de la Torre-Luque
- Universidad Complutense de Madrid, Madrid, Spain
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | | | - Ana Gonzalez-Pinto
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Araba University Hospital, Vitoria, Spain
- University of the Basque Country, Bilbao, Spain
| | - Nathalia Garrido-Torres
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Virgen del Rocio University Hospital, Seville, Spain
- Seville Biomedical Research Institute (IBiS), Seville, Spain
| | | | - Natalia Roberto
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Purificación Lopez-Peña
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Araba University Hospital, Vitoria, Spain
- University of the Basque Country, Bilbao, Spain
- BIOARABA, Vitoria, Spain
| | - Lorea Mar-Barrutia
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Araba University Hospital, Vitoria, Spain
- University of the Basque Country, Bilbao, Spain
- BIOARABA, Vitoria, Spain
| | - Iria Grande
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Marti Guinovart
- Institut d'Investigacio i Innovacio ParcTauli (I3PT), Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Daniel Hernandez-Calle
- La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Luis Jimenez-Treviño
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
- Principado de Asturias Health Research Institute (ISPA), Oviedo, Spain
- University of Oviedo, Oviedo, Spain
- Principado de Asturias Neuroscience Research Institute (INEUROPA), Oviedo, Spain
| | - Clara Lopez-Sola
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Roberto Mediavilla
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Autonomous University of Madrid, Madrid, Spain
| | | | - Miguel Ruiz-Veguilla
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Virgen del Rocio University Hospital, Seville, Spain
- Seville Biomedical Research Institute (IBiS), Seville, Spain
- University of Seville, Seville, Spain
| | - Elisa Seijo-Zazo
- Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
- Principado de Asturias Health Research Institute (ISPA), Oviedo, Spain
- University of Oviedo, Oviedo, Spain
- Principado de Asturias Neuroscience Research Institute (INEUROPA), Oviedo, Spain
| | - Alba Toll
- Autonomous University of Barcelona, Barcelona, Spain
- Neurosciences Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Matilde Elices
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Autonomous University of Barcelona, Barcelona, Spain
- Neurosciences Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Victor Perez-Sola
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Neurosciences Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
- Hospital de Mar, Mental Health Institute, Barcelona, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Jose Luis Ayuso-Mateos
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Autonomous University of Madrid, Madrid, Spain
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Nobile B, Jaussent I, Kahn JP, Leboyer M, Risch N, Olié E, Courtet P. Risk factors of suicide re-attempt: A two-year prospective study. J Affect Disord 2024; 356:535-544. [PMID: 38657762 DOI: 10.1016/j.jad.2024.04.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/09/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND History of suicide attempt (SA) is the strongest predictor of a new SA and suicide. It is primordial to identify additional risk factors of suicide re-attempt. The aim of this study was to identify risk factors of suicide re-attempt in patients with recent SA followed for 2 years. METHODS In this multicentric cohort of adult inpatients, the median of the index SA before inclusion was 10 days. Clinicians assessed a large panel of psychological dimensions using validated tools. Occurrence of a new SA or death by suicide during the follow-up was recorded. A cluster analysis was used to identify the dimensions that best characterized the population and a variable "number of personality traits" was created that included the three most representative traits: anxiety, anger, and anxious lability. Risk factors of re-attempt were assessed with adjusted Cox regression models. RESULTS Among the 379 patients included, 100 (26.4 %) re-attempted suicide and 6 (1.6 %) died by suicide. The two major risk factors of suicide re-attempt were no history of violent SA and presenting two or three personality traits among trait anxiety, anger and anxious lability. LIMITATIONS It was impossible to know if treatment change during follow-up occur before or after the re-attempt. DISCUSSION One of the most important predictors of re-attempt in suicide attempters with mood disorders, was the presence of three personality traits (anger, anxiety, and anxious lability). Clinicians should provide close monitoring to patients presenting these traits and proposed treatments specifically targeting these dimensions, especially anxiety.
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Affiliation(s)
- B Nobile
- Department of Emergency Psychiatry and Acute Care, CHU, Montpellier, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France; FondaMental Foundation, France.
| | - I Jaussent
- Institute for Neurosciences of Montpellier INM, INSERM Montpellier, University of Montpellier, Montpellier, France
| | - J P Kahn
- Université de Lorraine, Nancy, France; Clinique Soins-Etudes de Vitry le François, Fondation Sant'e des Etudiants de France (FSEF), Paris, France
| | - M Leboyer
- FondaMental Foundation, France; Univ Paris Est Créteil, INSERM U955, IMRB, Translational NeuroPsychiatry Laboratory, Créteil, France; AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - N Risch
- IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - E Olié
- Department of Emergency Psychiatry and Acute Care, CHU, Montpellier, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France; FondaMental Foundation, France
| | - Ph Courtet
- Department of Emergency Psychiatry and Acute Care, CHU, Montpellier, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France; FondaMental Foundation, France
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6
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Oliva V, Roberto N, Andreo-Jover J, Bobes T, Canal Rivero M, Cebriá A, Crespo-Facorro B, de la Torre-Luque A, Díaz-Marsá M, Elices M, Fernández-Rodrigues V, Gonzalez-Pinto A, Palao Tarrero A, Pérez-Diez I, Rodríguez-Vega B, Ruiz-Veguilla M, Saiz PA, Seijo-Zazo E, Toll-Privat A, McIntyre RS, Vieta E, Grande I, Pérez-Solà V. Anxious and depressive symptoms and health-related quality of life in a cohort of people who recently attempted suicide: A network analysis. J Affect Disord 2024; 355:210-219. [PMID: 38548208 DOI: 10.1016/j.jad.2024.03.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Suicide is an international health concern with immeasurable impact from the perspective of human and social suffering. Prior suicide attempts, anxious and depressive symptoms, and relatively lower health-related quality of life (HRQoL) are among the most replicated risk factors for suicide. Our goal was to visualize the distribution of these features and their interconnections with use of a network analysis approach in individuals who recently attempted suicide. METHODS Individuals with a recent suicide attempt were recruited from nine University Hospitals across Spain as part of the SURVIVE cohort study. Anxious and depressive symptoms, and perceived HRQoL were included in the network analysis. Network structures were estimated with the EBICglasso model. Centrality measures and bridge symptoms connecting communities were explored. Subnetworks comparing younger and older individuals, and women and men were analyzed. RESULTS A total of 1106 individuals with a recent suicide attempt were included. Depressed mood was the symptom with the greatest influence in the overall network, followed by anxiety symptoms such as feeling nervous, worrying, restless, and having difficulties to relax. Perceived general health was associated with increased suicidal ideation in the whole sample. Older people showed a specific connection between perceived general health and depressed mood. LIMITATIONS The cross-sectional design does not allow determination of established causality. CONCLUSIONS Depressed mood was the core network's symptom and, therefore, an important target in the management and prevention of suicide. HRQoL had more influence on the network of older populations, in which it should be a primary focus.
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Affiliation(s)
- Vincenzo Oliva
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Natalia Roberto
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Jorge Andreo-Jover
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid 2, Spain; Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Teresa Bobes
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, University of Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain; Instituto de Neurociencias del Principado de Asturias (INEUROPA), Spain; Mental Health Services of the Principality of Asturias (SESPA), Oviedo, Spain
| | - Manuel Canal Rivero
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Hospital Virgen del Rocio de Sevilla, Spain; IBIS, Universidad de Sevilla, Spain
| | - Anabel Cebriá
- Mental Health Department, Parc Taulí Hospital Universitari, Neuroscience and Mental Health Research Area, Institut d'Investigació I Innovació ParcTaulí (I3PT), Sabadell, Spain
| | - Benedicto Crespo-Facorro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Hospital Virgen del Rocio de Sevilla, Spain; IBIS, Universidad de Sevilla, Spain
| | - Alejandro de la Torre-Luque
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - Marina Díaz-Marsá
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain; Hospital Clínico San Carlos, Madrid, Spain
| | - Matilde Elices
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Hospital del Mar Medical Research Institute, IMIM, Barcelona, Spain
| | | | - Ana Gonzalez-Pinto
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Hospital Universitario Araba-Santiago, Instituto de Investigación Sanitaria Bioaraba, Universidad del País Vasco, Spain
| | - Angela Palao Tarrero
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid 2, Spain; Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Iván Pérez-Diez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Beatriz Rodríguez-Vega
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid 2, Spain; Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Miguel Ruiz-Veguilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Hospital Virgen del Rocio de Sevilla, Spain; IBIS, Universidad de Sevilla, Spain
| | - Pilar A Saiz
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, University of Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain; Instituto de Neurociencias del Principado de Asturias (INEUROPA), Spain; Mental Health Services of the Principality of Asturias (SESPA), Oviedo, Spain
| | - Elisa Seijo-Zazo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, University of Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain; Instituto de Neurociencias del Principado de Asturias (INEUROPA), Spain; Mental Health Services of the Principality of Asturias (SESPA), Oviedo, Spain
| | - Alba Toll-Privat
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Hospital del Mar Medical Research Institute, IMIM, Barcelona, Spain
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON M5T 2S8, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada; Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada; Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Eduard Vieta
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Iria Grande
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Víctor Pérez-Solà
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques, (IMIM), Parc de Salut Mar, Barcelona, Spain
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7
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Zainal NH. Is combined antidepressant medication (ADM) and psychotherapy better than either monotherapy at preventing suicide attempts and other psychiatric serious adverse events for depressed patients? A rare events meta-analysis. Psychol Med 2024; 54:457-472. [PMID: 37964436 DOI: 10.1017/s0033291723003306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Antidepressant medication (ADM)-only, psychotherapy-only, and their combination are the first-line treatment options for major depressive disorder (MDD). Previous meta-analyses of randomized controlled trials (RCTs) established that psychotherapy and combined treatment were superior to ADM-only for MDD treatment remission or response. The current meta-analysis extended previous ones by determining the comparative efficacy of ADM-only, psychotherapy-only, and combined treatment on suicide attempts and other serious psychiatric adverse events (i.e. psychiatric emergency department [ED] visit, psychiatric hospitalization, and/or suicide death; SAEs). Peto odds ratios (ORs) and their 95% confidence intervals were computed from the present random-effects meta-analysis. Thirty-four relevant RCTs were included. Psychotherapy-only was stronger than combined treatment (1.9% v. 3.7%; OR 1.96 [1.20-3.20], p = 0.012) and ADM-only (3.0% v. 5.6%; OR 0.45 [0.30-0.67], p = 0.001) in decreasing the likelihood of SAEs in the primary and trim-and-fill sensitivity analyses. Combined treatment was better than ADM-only in reducing the probability of SAEs (6.0% v. 8.7%; OR 0.74 [0.56-0.96], p = 0.029), but this comparative efficacy finding was non-significant in the sensitivity analyses. Subgroup analyses revealed the advantage of psychotherapy-only over combined treatment and ADM-only for reducing SAE risk among children and adolescents and the benefit of combined treatment over ADM-only among adults. Overall, psychotherapy and combined treatment outperformed ADM-only in reducing the likelihood of SAEs, perhaps by conferring strategies to enhance reasons for living. Plausibly, psychotherapy should be prioritized for high-risk youths and combined treatment for high-risk adults with MDD.
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Affiliation(s)
- Nur Hani Zainal
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Department of Psychology, National University of Singapore, Singapore
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8
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Pedrola-Pons A, Sanchez-Carro Y, Pemau A, Garcia-Ramos A, De la Torre-Luque A. Efficiency of psychological interventions in the prevention of suicidal behavior and self-injury in penitentiary population: A systematic review. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2024; 92:101948. [PMID: 38219472 DOI: 10.1016/j.ijlp.2023.101948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Suicidal behavior is an important public health problem, with a high prevalence in penitentiary context. Nowadays, there is a wide variety of specific treatment programs, aimed to prevent suicidal and self-injurious behavior in incarcerated people. These programs show relative efficiency depending on the model of the psychological intervention applied. This systematic review evaluates the efficiency of suicidal and self-injurious behavior prevention programs in prisons. METHOD Empirical studies, evaluating prevention programs for suicidal and self-injurious behavior in penitentiary context were considered for inclusion. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) directives were followed. Studies from 1990 to 2022 were reviewed, based on the review developed by Winicov (2019) that covered the time lapse between 1990 and 2015. Articles from 2015 to 2022 were located by database research (EBSCOHost, ScienceDirect, PubMed & ProQuest). RESULTS 44,050 potential studies were identified. Eighteen were included in this systematic review (9 studies by Winicov, 2019). 14 studies showed efficacy of intervention programs on self-injury behavior. The use of Cognitive Behavioral Therapy (CBT) reduced suicidal ideation. In addition, positive results were observed in 3 studies using third-generation therapies as an intervention. CONCLUSIONS Suicidal and self-injurious behavior in prison shows lower levels of incidence when specific treatment programs are applied. It's crucial to increase the evaluation in relation to the implementation of new treatment models (i.e., Dialectical Behavior Therapy - DBT, Acceptance and Commitment Therapy - ACT, Mindfulness, Functional Analytic Psychotherapy - FAP) as to better orientate prevention strategies. Further research is needed in gender sensitive interventions.
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Affiliation(s)
- Anna Pedrola-Pons
- Valencian International University, Spain; Institute of Social Work and Social Services (INTRESS), Spain
| | - Yolanda Sanchez-Carro
- Center for Biomedical Research in Mental Health (CIBERSAM), Carlos III Health Institute, Spain
| | | | | | - Alejandro De la Torre-Luque
- Complutense University of Madrid, Spain; Center for Biomedical Research in Mental Health (CIBERSAM), Carlos III Health Institute, Spain
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9
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Brill J, Zacay G, Raviv G, Tsamir J, Heymann AD. Continuity of care after attempted suicide: the primary care physicians' role. Fam Pract 2023; 40:776-781. [PMID: 37053085 DOI: 10.1093/fampra/cmad045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Suicide prevention is an important public health concern, and primary care physicians (PCPs) often serve as the first point of contact for individuals at risk. Few interventions in the primary care setting have been linked to reduced suicide attempt (SA) rates. The Continuity of Care (COC) protocol was developed to improve the primary care treatment of high-risk suicidal patients. OBJECTIVES This study examined PCPs' awareness of the COC protocol, its perceived effectiveness, and PCPs' attitudes towards post-SA-discharge visits. METHODS A survey was administered to 64 PCPs who had a recent office visit with a patient who had attempted suicide. Data were collected between May and July 2021 and analyzed anonymously. RESULTS Thirty of the 64 PCPs answered the questionnaires, giving a response rate of 47%. Most were unaware of the COC protocol. Seventeen physicians (57%) felt that the visit strengthened their physician-patient relationship, and while nearly half of the physicians (47%, n = 14) agreed they had the knowledge and tools to manage a post-SA-discharge visit, 43% of them (n = 13) preferred that the visit would have been handled by a mental health professional rather than a PCP. Analysis of open-ended questions uncovered three themes: knowledge gap, system limitation, and the PCP's role in maintaining the COC. CONCLUSION The findings of this study highlighted the important role PCPs can play to prevent future SAs, as well as exposed gaps in the knowledge and system constraints that impede them from carrying out this role as effectively as possible.
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Affiliation(s)
- Jonathan Brill
- Department of Family Medicine, Meuhedet Health Maintenance Organization, Tel Aviv, Israel
| | - Galia Zacay
- Department of Family Medicine, Meuhedet Health Maintenance Organization, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Raviv
- Directorate of Mental Health, Meuhedet Health Maintenance Organization, Tel Aviv, Israel
| | - Judith Tsamir
- Meuhedet Health Maintenance Organization, Tel Aviv, Israel
| | - Anthony D Heymann
- Department of Family Medicine, Meuhedet Health Maintenance Organization, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Abascal-Peiró S, Alacreu-Crespo A, Peñuelas-Calvo I, López-Castromán J, Porras-Segovia A. Characteristics of Single vs. Multiple Suicide Attempters Among Adult Population: A Systematic Review and Meta-Analysis. Curr Psychiatry Rep 2023; 25:769-791. [PMID: 37740850 DOI: 10.1007/s11920-023-01461-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE OF REVIEW We aimed to examine the factors that differentiate single and multiple suicide attempters in adult population. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to conduct this review and meta-analysis. The review protocol was registered in PROSPERO. We carried out a systematic literature search in three databases to identify original studies that explored the differences between single and multiple suicide attempters among adult population. RECENT FINDINGS There might be meaningful differences between those individuals that attempt suicide once in their lifespan and those who make multiple attempts in terms of sociodemographic and clinical characteristics. There are no previous meta-analysis addressing this topic in the adult population. A total of 75 studies were included in the review and 69 were included in the meta-analysis. Multiple attempters were more likely to present certain disorders such as mood and psychotic disorders, as well as personality or substance use disorders. Higher suicide ideation and suicide intent scores also characterized this group. Childhood trauma experiences, stressful life events, and higher rates of hopelessness were statistically significant in multiple attempters. Identifying the factors predicting multiple suicide attempts helps to delineate a high-risk suicidal profile that should be taken into account in the clinical and suicide prevention scenario.
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Affiliation(s)
- Sofía Abascal-Peiró
- Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
| | - Adrián Alacreu-Crespo
- Department of Psychology and Sociology, Area of Personality, Assessment and Psychological Treatment, Universidad of Zaragoza, Teruel, Spain
| | - Inmaculada Peñuelas-Calvo
- Department of Child and Adolescent Psychiatry, Hospital 12 de Octubre, Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain
| | - Jorge López-Castromán
- Department of Psychiatry, CNRS-INSERM, University of Montpellier, CHU Nîmes & IGF, Montpellier, France
| | - Alejandro Porras-Segovia
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
- Division of Psychiatry, Imperial College, London, UK
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McClelland H, Cleare S, O'Connor RC. Suicide Risk in Personality Disorders: A Systematic Review. Curr Psychiatry Rep 2023; 25:405-417. [PMID: 37642809 PMCID: PMC10506938 DOI: 10.1007/s11920-023-01440-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW This systematic review aimed to distil recent literature investigating psychosocial factors which may account for the association between personality disorder (PD) and suicide attempt or suicide death. RECENT FINDINGS Suicide risk is particularly elevated in people with PD compared to those with no, or many other, mental health diagnoses. Despite this, suicide prevention strategies for PD populations have not progressed markedly in recent years. It is critical, therefore, to identify additional factors associated with suicide in PD populations. Of the 34 studies included in this review, most identified a relationship between personality disorder and suicide attempt and/or death. Historical interpersonal factors (e.g., childhood trauma), drug and alcohol use, and ideation-to-enaction factors were commonly associated with suicide-related outcomes. Interventions that provide interpersonal support may reduce suicide attempts. Limitations of the review include the heterogeneity of studies and small sample sizes.
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Affiliation(s)
- Heather McClelland
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland.
| | - Seonaid Cleare
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
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12
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Tanji F, Miyamoto S, Iwasawa A, Ohta H, Ono K. Association Between History of Psychiatric Disorder and Degree of Physical Injury Among Suicide Attempters: Secondary Data Analysis in a Japanese Rural Area. J Prim Care Community Health 2023; 14:21501319231212317. [PMID: 37981733 PMCID: PMC10658764 DOI: 10.1177/21501319231212317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/21/2023] Open
Abstract
INTRODUCTION While there may be differences in the choice of suicide methods between attempters with and those without a history of psychiatric disorders, it is not clear whether these differences predict the actual degree of physical injury. The present study aimed to investigate the association between the history of psychiatric disorder and the degree of physical injury among suicide attempters in a Japanese rural area. METHODS We conducted a cross-sectional study analyzing secondary data of 806 suicide attempters from April 2012 to March 2022 obtained from a Japanese rural city. The exposure variable was a history of psychiatric disorders. The primary outcome was the degree of physical injury of suicide attempters: moderate and severe. We conducted a multivariate Poisson regression analysis to estimate the prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS Among 806 suicide attempters, a significant negative association between the history of psychiatric disorder and the degree of physical injury was observed (PR = 0.40; 95% CI, 0.28-0.59). Those with and without psychiatric disorders were more likely to choose low- and severe-lethality suicide methods such as drug or psychotropic overdoses and hanging or deep wrist injuries, respectively (P < .001). CONCLUSIONS The present study highlights the importance of considering suicide attempters, both with and without psychiatric disorders, while formulating targeted suicide prevention strategies.
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Affiliation(s)
- Fumiya Tanji
- Akita University Graduate School of Health Sciences, Akita, Japan
- Akita University Suicide Prevention Research Center, Akita, Japan
| | - Syohei Miyamoto
- Akita University Suicide Prevention Research Center, Akita, Japan
| | - Atsushi Iwasawa
- Akita University Suicide Prevention Research Center, Akita, Japan
| | - Hidenobu Ohta
- Akita University Graduate School of Health Sciences, Akita, Japan
- Akita University Suicide Prevention Research Center, Akita, Japan
| | - Kyoichi Ono
- Akita University Suicide Prevention Research Center, Akita, Japan
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