Family history of suicidal behavior predicts impulsive-aggressive behavior levels in psychiatric outpatients

Suicide attempts of friends and family during adolescence and long-term suicidal ideation and attempts: Findings from the 25-year Add Health study

BACKGROUND

Suicide is a significant global public health concern. However, previous studies have predominantly focused on individual-level risk factors. Against this backdrop, microsystem suicide propinquity, which encompasses suicidal thoughts and behaviors (STB) within families and peer groups, is significant in elucidating the development and perpetuation of STB in adolescents.

METHODS

This study utilized data from the National Longitudinal Study of Adolescent to Adult Health (Add Health, 1994-2018). Adolescents who reported instances of suicide attempts among their friends and family members during Wave 1 were selected (N = 4826). Generalized estimation equations (GEE) and structural equation models (SEM) were employed.

RESULTS

GEE analyses indicated that individuals with friends who had attempted suicide exhibited higher risks for suicidal ideation (OR [95 % CI] = 2.57 [2.13, 3.11]) and suicide attempts (OR [95 % CI] = 2.47 [1.78, 3.42]). Also, individuals with family members who had attempted suicide exhibited higher risks for suicidal ideation (OR [95 % CI] = 2.37 [1.62, 3.46]) and attempts (OR [95 % CI] = 2.27 [1.17, 4.41]). However, friends' and family members' suicide attempts failed to show significant interactive effect. Besides, SEM analyses indicated that friends' and family members' suicide attempts were associated with one's long-term suicidal ideation and attempts via depressive symptoms.

CONCLUSION

Suicide attempts of friends and family during adolescence were long-term risk factors for suicidal ideation and attempts from adolescence to young adulthood. Moreover, depressive symptoms served as long-term mechanisms in these associations.

Why Suicide? Suicide Propinquity and Adolescent Risk for Suicidal Thoughts and Behaviors

Suicide represents an international public health concern, and for adolescents aged 14 to 18 in the United States, is the third leading cause of death (Centers for Disease Control and Prevention. 2021 Youth Risk Behavior Survey Data. Available at: www.cdc.gov/yrbs . Accessed on August 30, 2023.). In response to this alarming rate, as well as the relative lack of meaningful progress in the prediction and prevention of suicidal thoughts and behaviors (STB) over the past decades (see Franklin et al., 2017), recent reviews of the suicide literature have advocated for the adoption of novel frameworks and theoretical reexamination of the processes that confer risk for suicide. Currently, the majority of suicide theories emphasize distal factors associated with suicide risk, but these factors also generalize to other types of psychopathology and do not answer the fundamental question of "why suicide?" vs. other maladaptive outcomes. In an effort to address this gap and build off existing theoretical and empirical science from various disciplines, the current theoretical paper will explore the concept of suicide propinquity, the degree of closeness and identification with STB, as a potential moderator of the link between psychological distress and suicide. Specifically, this paper: (1) provides context within the existing theories of suicide, highlighting gaps that might otherwise be explained by propinquity; (2) discusses historical and scientific evidence of suicide phenomena that support the existence of propinquity; (3) explores potential processes of how propinquity may confer risk for STB in adolescence; and (4) suggests future directions for research to examine adolescent suicide from a propinquity perspective.

Prevalence and determinants of aggressive behavior among adults with problematic substance use in Northwest Ethiopia: a cross-sectional survey

BACKGROUND

The recent WHO data reported that a high treatment gap for behavioral illnesses (70%) in low- and- middle-income countries and the mortality rate of aggressive behavior reaches up to 32.1 per 100,000 populations in the region. However, the magnitude of aggressive behavior is not well stated in resource-limited settings. Therefore, the aim of this study was to assess the prevalence and determinant factors of aggressive behavior among adults with problematic substance use in northwest Ethiopia.

METHODS

A community-based cross-sectional study was employed from January to March 2019. A multi-stage cluster sampling method was used to screen a total of 4028 adults for problematic substance use by using the Cutdown, Annoyed, Guilty, and Eye-opener questionnaire (CAGE AID). Finally, 838 participants were positive for problematic substance use and interviewed for aggressive behavior using a modified overt aggression scale. Multiple logistic regression analysis was used to show the adjusted odds ratios (AOR) and p-value < 0.05 considered statistically significant. A multilevel binary logistic regressions model was employed for the hierarchical structure of two-level data for the individual and woreda/district levels.

RESULTS

The prevalence of aggressive behavior was found to be 37.9% (301/795, 95% CI: 34.5, 41.3). Stressful life events (AOR = 2.209, 95 CI; 1.423, 3.429), family history of mental illness (AOR = 4.038, 95 CI; 2.046, 7.971), comorbid physical illness (AOR = 2.01, 95 CI; 1.332, 3.032) and depressive symptoms (AOR = 2.342, 95 CI; 1.686, 3.253) were associated with aggressive behavior among individual with problem substance use.

CONCLUSION

Aggressive behavior was found to be high among problematic substance uses. An individual with problematic substance use is recommended to be screened by health extension workers for aggressive behavior at the community level.

'Omics' of suicidal behaviour: A path to personalised psychiatry

Psychiatric disorders, including suicide, are complex disorders that are affected by many different risk factors. It has been estimated that genetic factors contribute up to 50% to suicide risk. As the candidate gene approach has not identified a gene or set of genes that can be defined as biomarkers for suicidal behaviour, much is expected from cutting edge technological approaches that can interrogate several hundred, or even millions, of biomarkers at a time. These include the '-omic' approaches, such as genomics, transcriptomics, epigenomics, proteomics and metabolomics. Indeed, these have revealed new candidate biomarkers associated with suicidal behaviour. The most interesting of these have been implicated in inflammation and immune responses, which have been revealed through different study approaches, from genome-wide single nucleotide studies and the micro-RNA transcriptome, to the proteome and metabolome. However, the massive amounts of data that are generated by the '-omic' technologies demand the use of powerful computational analysis, and also specifically trained personnel. In this regard, machine learning approaches are beginning to pave the way towards personalized psychiatry.

Exposure to Early Life Adversity and Interpersonal Functioning in Attempted Suicide

BACKGROUND

Early life adversity (ELA) may lead to an increased risk for mental health problems including suicidal behavior. ELA alters biological stress systems that affect behavior and control within the individual that in turn will affect interpersonal behavior. Strained relations and interpersonal conflicts leading to rejection and isolation have been shown to be factors for suicidal behavior. Difficulties in interpersonal relationships are a common reason for seeking help in psychiatric care. In the present study, we examined relationship between different types of interpersonal problems and adverse childhood experiences in patients with a recent suicide attempt.

METHOD

The study included 181 recent suicide attempters. We assessed early life adversity and specific interpersonal problems by using the Karolinska Interpersonal Violence Scale and the Inventory of Interpersonal problems respectively.

RESULTS

Suicide attempters with high levels of early life adversity expressed a more socially avoidant, non-assertive, and exploitable personal style even after adjustment for comorbidities with personality disorder and substance use disorder.

CONCLUSIONS

Patients with a recent suicide attempt with high levels of early life adversity tend to isolate themselves, of being introvert, and having difficulties to open up and confide in others. They report low self-confidence and self-esteem and problems with feeling and expressing anger. These behaviors complicate interaction with others and make establishment of solid relationships more difficult. In regards to detection of suicidal communication and treatment of suicidal patients, this may lead to misinterpretations and difficulties to fully benefit from treatment given or for professionals to provide the appropriate treatment. Clinicians should closely investigate the presence of early life adversity in suicidal patients and pay attention to their personal style and their difficulties in interpersonal exchange.

Time, trauma, and the brain: How suicide came to have no significant precipitating event

In this article, we trace shifting narratives of trauma within psychiatric, neuroscience, and environmental epigenetics research. We argue that two contemporary narratives of trauma - each of which concerns questions of time and psychopathology, of the past invading the present - had to be stabilized in order for environmental epigenetics models of suicide risk to be posited. Through an examination of these narratives, we consider how early trauma came to be understood as playing an etiologically significant role in the development of suicide risk. Suicide, in these models, has come to be seen as a behavior that has no significant precipitating event, but rather an exceptional precipitating neurochemical state, whose origins are identified in experiences of early traumatic events. We suggest that this is a part of a broader move within contemporary neurosciences and biopsychiatry to see life as post: seeing life as specific form of post-traumatic subjectivity.

Association of Religious Activity with Male Suicide Deaths

OBJECTIVE

To analyze the relationship between suicide in men and stratified measures of religiosity.

METHODS

We studied 192 suicides and 81 controls (nonsuicide, sudden, or accidental death). We employed the psychological autopsy method to compile diagnoses based on DSM-IV criteria. Overall, religiosity and participation in religious associations were determined using a Likert-type scale. Given the limited participation of women in the religious associations of southern Spain, only male subjects were included.

RESULTS

Religious participants had decreased risk of suicide compared to nonparticipants (OR = 0.148, 95% CI = 0.049-0.447). This lower risk was further associated with the degree of involvement in religious activity. Suicides accounted for 73.47% of subjects with no religious participation, 61.17% of those with some participation, and 56.52% of frequent participants (linear trend test Z = -2.0329, p = .042). Membership in a religious association was also associated with a lower rate of suicide compared to nonmembers (OR = 0.356, 95% CI = 0.172-0.736). This effect was similarly associated with the degree of involvement in the association. Suicides accounted for 74.67% of subjects who never participated in the activities of a religious association, 69.23% of those who sometimes participated, and 42.86% of frequent participants (linear trend test Z = -3.4082, p < .001).

CONCLUSIONS

Religiosity, either as general participation or through a religious association, was associated with protection against suicide proportional to the degree of involvement in religious activities.

Explaining suicide attempt with personality traits of aggression and impulsivity in a high risk tribal population of India

Introduction

Suicide is a spectrum of behavior including suicide ideation and suicidal attempt and is undoubtedly the outcome of the interaction of several factors. The role of two main constructs of human nature, aggression and impulsivity, has been discussed broadly in relation to suicide, as endophenotypes or traits of personality, in research and in clinical practice across diagnoses. The objective of our study was to assess impulsive and aggressive behaviors among primitive people of the Idu Mishmi tribe, who are known for high suicide completer and attempter rates.

Methods

The study group was comprised of 177 unrelated Idu Mishmi participants divided into two sets: 39 suicide attempters and 138 non-attempters. Data on demographic factors and details of suicide attempts were collected. Participants completed a set of instruments for assessment of aggression and impulsivity traits.

Results

In the Idu Mishimi population we screened (n = 177), 22.03% of the individuals had attempted suicide, a high percentage. The suicide attempters also showed a significant sex difference: 35.9% were male and 64.10% were female (p = .002*). The suicide attempters (A) scored significantly higher than non-attempters (NA) on aggression (A = 23.93,NA = 18.46) and impulsivity (A = 75.53,NA = 71.59, with p value = 0.05). The trait impulsiveness showed a significantly higher difference (F (1, 117) = 7.274) in comparison to aggression (F (1, 117) = 2.647), suggesting a profound role of impulsiveness in suicide attempts in the Idu Mishmi population. Analysis of sub-traits of aggression and impulsivity revealed significant correlations between them. Using different models, multivariate logistic regression implied roles of gender (OR = 1.079 (0.05)) and impulsiveness (OR = 3.355 (0.013)) in suicide attempts.

Conclusion

Results demonstrate that gender and impulsivity are strong risk factors for suicide attempts in the Idu Mishmi population.

Can Religious Beliefs be a Protective Factor for Suicidal Behavior? A Decision Tree Analysis in a Mid-Sized City in Iran, 2013

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.

Family history of suicide and interpersonal functioning in suicide attempters

Difficulties in interpersonal relationships are associated with a wide range of psychiatric diagnoses and have been reported as a trigger for suicidal behavior, too. The aim of this study was to examine the relationship between interpersonal problems and family history of suicide in suicide attempters and to describe relevant patterns of interpersonal problems in this patient group. The study involves 181 patients having their clinical follow-up after a suicide attempt. Family history of suicide was assessed by using the Karolinska Self Harm History Interview or retrieved in patient records. The Inventory of Interpersonal Problems was used to assess personal style in an interpersonal context. Suicide attempters with a family history of suicide had significantly more often an intrusive personal style. The results remained significant after adjustment for personality disorder. The specific interpersonal patterns associated with family history of suicide may interfere with the ability to create stable, long-lasting relationships. In regards to treatment, these personal qualities could cause difficulties in the alliance with health care personnel and make it harder for suicide attempters to accept or benefit from treatment. Attention to suicide attempters' interpersonal problems is of importance to lower their distress.

Clinical Correlates of Planned and Unplanned Suicide Attempts

Suicide attempters differ in the degree of planning for their suicide attempts. The purpose of this study was to identify differences between individuals who make planned (≥3 hours of planning) and unplanned (<3 hours of planning) suicide attempts. Depressed suicide attempters (n = 110) were compared based on degree of planning of their most recent suicide attempt on demographic and clinical variables. Participants who made planned suicide attempts were more likely to have family history of completed suicide, more severe and frequent suicidal ideation, greater trait impulsivity, and greater suicidal intent and more severe medical consequences for both their most recent and most serious suicide attempts. These results suggest clear clinical differences based on the degree of suicide attempt planning. Severe suicidal ideation, high suicide intent, family history of suicide completion, and high levels of motor impulsivity contribute to a phenotype that is at greater risk of planned, highly lethal suicide attempts.

On the role of impulsivity and decision-making in suicidal behavior

Suicide risk constitutes a complex set of interacting demographic, clinical, psychobiological and environmental variables. Impulsivity is a long-known risk factor for suicide attempts. However, research based on clearer conceptual refinement in this area is imperative. One emerging field of study is that of decision-making. Impulsivity involves a failure of higher-order control, including decision-making. Using standardized operational definitions that take into consideration relevant aspects of impulsivity, including state- and trait-components and a deeper understanding of the process of decision-making in the suicidal mind, we may come a step closer to understanding suicidality and winning the fight in this scourge of human suffering.

Increased severity of suicidal behavior in impulsive aggressive patients exposed to familial adversities

BACKGROUND

The mechanisms by which childhood abuse and family history of suicidal behavior (FHS) lead to an increased risk of suicidal behavior are still unknown. Impulsive aggression may play an intermediate role. We investigated whether greater scores for aggression and impulsivity might be associated with the effects of FHS and/or childhood abuse on the severity of suicidal behavior.

METHOD

We examined the scores of three scales measuring impulsive aggression in a sample of 696 suicide attempters. We compared the highest and lowest scores with regard to reports of childhood abuse and FHS using adjusted multinomial regression models. Genetic polymorphisms of the serotonergic system known to be associated with impulsive aggression were also analyzed.

RESULTS

Patients with high impulsive aggressive scores showed significant differences in sociodemographic, clinical and suicidal features compared with patients with low impulsive aggressive scores. Adjusted results showed that combinations of some types of childhood abuse and FHS, particularly emotional abuse and emotional neglect, are associated with high impulsivity and hostility scores. The SS genotype of the serotonin transporter gene (5-HTTLPR) was associated with high levels of impulsivity when the subjects reported emotional abuse [odds ratio (OR) 5.55, 95% confidence interval (CI) 1.75-17.5] or physical abuse (OR 5.03, 95% CI 1.50-16.9) in their childhood.

CONCLUSIONS

Our results support the role of impulsive aggression as one of the links that may connect childhood abuse and FHS with severity of suicidal behavior.

Trait-aggressiveness and impulsivity: role of psychological resilience and childhood trauma in a sample of male prisoners

BACKGROUND

One of the major challenges for research in the field of human aggression is the need to define the role of personality and trait-like dimensions, such as impulsivity and aggressiveness, in predisposing to violent behavior.

AIMS

1) To determine whether trait- aggressiveness and impulsivity may be associated with socio-demographic, clinical and crime history variables in a sample of male prisoners; 2) to detect any association of those traits with measures of early traumatic experiences and current resilience traits.

METHODS

A sample of male prisoners (n = 1356) underwent the Brown-Goodwin Assessment for Lifetime History of Aggression (BGLHA) and the Barratt Impulsivity Scale (BIS). Axis I psychiatric disorders were also assessed. Early traumatic experiences and psychological resilience were detected respectively by the Childhood Trauma Questionnaire (CTQ) and the Connor-Davidson Resilience Scale (CD-RISC). Two non-linear logistic regression models were performed to test for the best predictors of trait-aggressiveness and impulsivity.

RESULTS

Subjects with a history of substance use disorders and self-mutilation reported both higher BGLHA and BIS scores. Axis I disorders and suicide attempts were associated with aggressiveness, but not to impulsivity. A consistent correlation was found between BGLHA scores and early traumatic experiences. Resilience was positively correlated to impulsivity but not to aggressiveness scores.

CONCLUSIONS

Our results support the view that aggressiveness and impulsivity are two different, albeit related trait-like dimensions of personality, having a different relationship with resilience, and, inferentially, a different impact over the development of psychiatric disorders.

Family history of suicide and exposure to interpersonal violence in childhood predict suicide in male suicide attempters

BACKGROUND

Family studies, including twin and adoption designs, have shown familial transmission of suicidal behaviors. Early environmental risk factors have an important role in the etiology of suicidal behavior. The aim of the present study was to assess the impact of family history of suicide and childhood trauma on suicide risk and on severity of suicide attempt in suicide attempters.

METHODS

A total of 181 suicide attempters were included. Family history of suicide was assessed with the Karolinska Suicide History Interview or through patient records. Childhood trauma was assessed with the Karolinska Interpersonal Violence Scale (KIVS) measuring exposure to violence and expressed violent behavior in childhood (between 6 and 14 years of age) and during adult life (15 years or older). Suicide intent was measured with the Freeman scale.

RESULTS

Male suicide attempters with a positive family history of suicide made more serious and well planned suicide attempts and had a significantly higher suicide risk. In logistic regression, family history of suicide and exposure to interpersonal violence as a child were independent predictors of suicide in male suicide attempters.

LIMITATIONS

The information about family history of suicide and exposure to interpersonal violence as a child derives from the patients only. In the first part of the inclusion period the information was collected from patient records.

CONCLUSIONS

The results of this study imply that suicides among those at biological risk might be prevented with the early recognition of environmental risks.

Suicidal phenotypes associated with family history of suicidal behavior and early traumatic experiences

BACKGROUND

Family history of suicidal behavior and personal history of childhood trauma are risk factors for suicidal behaviors. We hypothesize that subjects with any of these risk factors will show differential features and that subjects with both of them will display more severe phenotypes.

METHODS

This study compares three groups of suicide attempters (n=878): subjects with a family history of suicidal behavior and a personal history of early traumatic experiences, subjects with a family history of suicidal behavior or a personal history of early traumatic experiences, and subjects with neither of these two risk factors, with regards to psychopathology, personality traits and suicidal behavior.

RESULTS

Subjects with a family history of suicidal behavior and childhood trauma were younger at their first suicide attempt and made more frequent, severe and violent attempts when compared with the other groups. Differences in number and precocity of attempts remained after adjustments in a multinomial regression model. Finally, personality profiles were also substantially different in the group with higher impulsiveness, novelty seeking, affective lability and hopelessness.

LIMITATIONS

The information provided by subjects regarding childhood abuse and family history of suicidal behavior was not confirmed by other sources.

CONCLUSIONS

Suicide attempters with a family history of suicidal behavior and childhood trauma show specific characteristics that might be used to prevent future suicidal behaviors in this population. Both risk factors should be routinely investigated when assessing the suicidal risk of a patient.

Personal and family history of suicidal behaviour is associated with lower peripheral cortisol in depressed outpatients

BACKGROUND

Suicidal behaviour aggregates in families and HPA-axis dysregulation may help explain part of this familial aggregation. Nevertheless, exogenous manipulation of the HPA-axis has yielded mixed results. Naturalistic and non-pharmacological inductions of the HPA-axis do not suggest hyper-responsiveness, yet suggest greater cognitive consequences of stress in individuals at risk for suicide. In this study, we aimed to characterize the relationship between plasma cortisol and an increased risk for suicide, as defined by family history.

METHOD

Patients (N=148) with depressive disorders underwent psychopathological assessment, including structured investigation of past suicidal behaviour and underwent laboratory blood testing of cortisol. They also completed a family history interview investigating family psychopathology and suicidal behaviour, representing data on 848 first degree relatives. The relationship between plasma cortisol, past suicidal behaviour and suicidal behaviour among first degree relatives was examined.

RESULTS

Lower levels of plasma cortisol were associated with a personal and family history of suicidal behaviour, as well as a family history of depression among first degree relatives. Multivariate analyses controlling for significant psychopathology replicated the association between lower levels of plasma cortisol, a family history of suicidal behaviour and personal history of suicide attempts, but not a family history of depression. Controlling for personal history of suicide attempts revealed an independent association between plasma cortisol and family history of suicidal behaviour, with an additional contribution by family history of depression in predicting the latter.

CONCLUSIONS

Lower plasma cortisol is associated with a family history of suicide among depressed outpatients, independent of psychopathology and previous suicide attempts.

Developmental course of impulsivity and capability from age 10 to age 25 as related to trajectory of suicide attempt in a community cohort

Hierarchical linear models were used to examine trajectories of impulsivity and capability between ages 10 and 25 in relation to suicide attempt in 770 youths followed longitudinally: intercepts were set at age 17. The impulsivity measure assessed features of urgency (e.g., poor control, quick provocation, and disregard for external constraints); the capability measure assessed aspects of self-esteem and mastery. Compared to nonattempters, attempters reported significantly higher impulsivity levels with less age-related decline, and significantly lower capability levels with less age-related increase. Independent of other risks, suicide attempt was related significantly to higher impulsivity between ages 10 and 25, especially during the younger years, and lower capability. Implications of those findings for further suicidal behavior and preventive/intervention efforts are discussed.

Combination of family history of suicidal behavior and childhood trauma may represent correlate of increased suicide risk

BACKGROUND

There is a need to try to identify patients at highest risk for suicidal behavior. A family history of suicidal behavior (FHS) and childhood trauma are two important risk factors for suicidal behavior. It was therefore decided to combine them and examine if the combination would identify patients at even increased risk for suicidal behavior.

METHODS

Two hundred and eighty one substance dependent patients with a FHS completed the Childhood Trauma Questionnaire (CTQ) and were interviewed about their lifetime history of suicidal behavior. Patients with the combination of a FHS and CTQ score above the mean were examined and compared with FHS patients with a CTQ score below the mean.

RESULTS

One hundred and two of the 129 (79.1%) FHS patients with a CTQ score above the mean had attempted suicide. Thirty five of the 40 female (87.5%) FHS patients with a CTQ score above the mean had attempted suicide .Patients with a CTQ score above the mean were found significantly more among FHS patients who had attempted suicide than among FHS patients who had never attempted. FHS attempters with a CTQ score above the mean had a significantly earlier age of first attempting and had made more attempts than FHS attempters with a CTQ score below the mean.

LIMITATIONS

Childhood trauma data derived from self-report questionnaire. No consistent collateral information about FHS.

CONCLUSION

The combination of a FHS and childhood trauma may represent a correlate of increased risk of attempting suicide, attempting earlier, and making more attempts.

The base rates and factors associated with reported access to firearms in psychiatric inpatients

OBJECTIVE

The aim of this study was to define whether specific patient demographic groups, diagnoses or other factors are associated with psychiatric inpatients reporting firearms access.

METHODS

A retrospective medical records review study was conducted using information on access to firearms from electronic medical records for all patients 16 years and older admitted between July 2007 and May 2008 at the Mayo Clinic Psychiatric Hospital in Rochester, MN. Data were obtained only on patients providing authorization for record review. Data were analyzed using univariate and multivariate logistic regression analyses accounting for gender, diagnostic groups, comorbid substance use, history of suicide attempts and family history of suicide/suicide attempts.

RESULTS

Seventy-four percent (1169/1580) of patients provided research authorization. The ratio of men to women was identical in both research and nonresearch authorization groups. There were 14.6% of inpatients who reported firearms access. In univariate analysis, men were more likely (P<.0001) to report access than women, and a history of previous suicide attempt(s) was associated with decreased access (P=.02). Multiple logistic regression analyses controlling for other factors found females and patients with history of previous suicide attempt(s) less likely to report access, while patients with a family history of suicide or suicide attempts reported increased firearms access. Diagnostic groups were not associated with access on univariate or multiple logistic regression analyses.

CONCLUSIONS

Men and inpatients with a family history of suicide/suicide attempts were more likely to report firearms access. Clinicians should develop standardized systems of identification of firearms access and provide guidance on removal.

The prefrontal-limbic network in depression: Modulation by hypothalamus, basal ganglia and midbrain

The anterior cingulate cortex, amygdala and hippocampus form part of an interconnected prefrontal neocortical and limbic archicortical network that is dysregulated in major depressive disorders (MDD). Modulation of this prefrontal-limbic network (PLN) is principally through the hypothalamus, basal ganglia and midbrain. Here the likely mechanisms by which these modulations are affected are described and the implications of their failure for depression associated with suicidal diathesis, late-life and psychoses discussed.

Aggression, impulsivity, and suicide behavior: a review of the literature

This article reviews the literature on the association between impulsivity aggression and suicide. The key words impulsivity, aggression, and suicide were entered into the pubmed, psychlit, and proqest databases. Significant articles were scrutinized for relevant information. Impulsivity and aggression are highly correlated with suicidal behavior across psychiatric samples, nosological borders, and non-psychiatric populations. Impulsivity and aggression are related but the nature of this relationship remains unclear. The literature is confusing and contradictory. This is probably due to the difficulty in defining and separating out these concepts and the fact that there is much overlap between them. Future research should aim at clarifying and refining these concepts as well as their link to all the different forms of suicidal behavior.

Dysregulation of the sympathetic nervous system, hypothalamic-pituitary-adrenal axis and executive function in individuals at risk for suicide

BACKGROUND

Suicidal behaviour aggregates in families, and the hypothalamic-pituitary-adrenal (HPA) axis and noradrenergic dysregulation may play a role in suicide risk. It is unclear whether stress dysregulation is a heritable trait of suicide or how it might increase risk. We investigated stress reactivity of the autonomic nervous system and the HPA axis in suicide predisposition and characterized the effect of this dysregulation on neuropsychologic function.

METHODS

In this family-based study of first-degree relatives (n = 14) of suicide completers and matched controls with no family or personal history of suicidal behaviour (n = 14), participants underwent the Trier Social Stress Test (TSST). We used salivary α-amylase and cortisol levels to characterize stress reactivity and diurnal variation. We administered a series of neuropsychologic and executive function tests before and after the TSST.

RESULTS

Despite normal diurnal variation, relatives of suicide completers exhibited blunted cortisol and α-amylase TSST reactivity. Although there were no baseline differences in conceptual reasoning, sustained attention or executive function, the relatives of suicide completers did not improve on measures of inhibition upon repeated testing after TSST. Secondary analyses suggested that these effects were related to suicide vulnerability independent of major depression.

LIMITATIONS

The sample size was small, and the design prevents us from disentangling our findings from the possible traumatic consequences of losing a relative by suicide.

CONCLUSIONS

Blunted stress response may be a trait of suicide risk, and impairment of stress-induced executive function may contribute to suicide vulnerability.

The role of impulsivity in self-mutilators, suicide ideators and suicide attempters - a study of 1265 male incarcerated individuals

OBJECTIVE

We explored differences between high and low-impulsive incarcerated individuals in the context of lifetime self-mutilation, suicide ideation and suicide attempt.

METHODS

A total of 1265 males detained in Italian penitentiary institutions were studied between January 2006 and December 2008. The study raters were specifically trained to discriminate between suicide attempters, ideators and self-mutilators. Participants completed the Barratt Impulsivity Scale, Childhood Trauma Questionnaire (CTQ), Eysenck Personality Questionnaire (EPQ), Connor-Davidson Resilience Scale (CD-RISC), Brown-Goodwin Assessment for Lifetime History of Aggression (BGLHA) and Buss and Durkee Hostility Inventory (BDHI). Based on BIS 7 total score distribution, two extreme quarters - high-impulsive group (n=306) and low-impulsive group (n=285) - were compared.

RESULTS

Over 42% of participants had lifetime suicide ideation, 13% attempted suicide and 17% were self-mutilators. High-impulsive subjects were younger, more often single and with more prominent psychoticism, extraversion, aggression, hostility and resilience capacity. They were more frequently diagnosed with substance use disorders and engaged in self-mutilating behaviour. There was no difference in the rate of suicide attempts between the two groups.

CONCLUSION

Although high-impulsive subjects were more prone to suicidal behaviour, it was not predicted by higher impulsivity when other psychological variables were accounted for.

What family studies teach us about suicidal behavior: implications for research, treatment, and prevention

Suicidal behavior is transmitted within families, above and beyond the transmission of psychiatric disorder. The familial phenotype of suicidal behavior includes suicide completion and attempts, but not suicidal ideation, the latter of which is transmitted along with depression. The familial transmission of early-onset suicidal behavior is co-transmitted with, and appears to be mediated by the transmission of impulsive aggression. Additionally, the familial transmission of suicidal behavior is, in part, mediated by the familial transmission of abuse. Moreover, high family loading for mood disorder and suicidal behavior are related to multi-generational abuse, impulsive aggression, and early-onset of mood disorder and of suicidal behavior.

[Which are the recent clinical findings regarding the association between depression and suicide?]

OBJECTIVE

Suicide is one of the leading causes of mortality worldwide, especially among young subjects. Suicide is considered the outcome of a multidimensional and complex phenomenon, which is a result of the interaction between several factors. The association between psychopathology and suicide has been extensively investigated. Major depression plays an important role among the psychiatric diagnoses associated with suicide. This finding seems to be confirmed by different study designs, and in distinct populations. The present paper aims to briefly review the recent findings regarding the suicide-related clinical features of depression. Moreover, strategies for suicide prevention were also reviewed.

REVIEW

Recent references were identified and grouped in order to illustrate the main contributions about depression and suicide. Briefly, the literature review stresses the high prevalence of major depression among subjects presenting suicide behaviors. Psychopathological traits, such as aggression and impulsivity play a relevant role in triggering suicidal behaviors. Strategies for suicide prevention were also reviewed in Brazil and internationally. In general, detection and treatment are effective in reducing suicide rates.

CONCLUSION

Studies regarding suicide behaviors have had a pragmatic approach, and generated a large body of evidence about correlates of suicide. However, these studies have not been able to provide a consistent theoretical explanation for this phenomenon. The recent adoption of modern strategies represents a possibility of enhancing the research capability of such studies. In order to be clinically useful, findings should make it possible to deepen the understanding over the experience of a suicidal person, as well as to design specific strategies for prevention and treatment in population subgroups.

Characteristics of suicide attempters with family history of suicide attempt: a retrospective chart review

BACKGROUND

Family history of suicide attempt is one of the risks of suicide. We aimed at exploring the characteristics of Japanese suicide attempters with and without a family history of suicide attempt.

METHODS

Suicide attempters admitted to an urban emergency department from 2003 to 2008 were interviewed by two attending psychiatrists on items concerning family history of suicide attempt and other sociodemographic and clinical information. Subjects were divided into two groups based on the presence or absence of a family history of suicide attempt, and differences between the two groups were subsequently analyzed.

RESULTS

Out of the 469 suicide attempters, 70 (14.9%) had a family history of suicide attempt. A significantly higher rate of suicide motive connected with family relations (odds ratio 2.21, confidence interval 1.18-4.17, p < .05) as well as a significantly higher rate of deliberate self-harm (odds ratio 2.51, confidence interval 1.38-4.57, p < .05) were observed in patients with a family history of suicide compared to those without such history. No significant differences were observed in other items investigated.

CONCLUSION

The present study has revealed the characteristics of suicide attempters with a family history of suicide attempt. Further understanding of the situation of such individuals is expected to lead to better treatment provision and outcomes, and family function might be a suitable focus in their treatment.