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Law KC, O'Connell KL, Jacobson SV, Baer MM, Baker PM, Tull MT. Influences of sleep, cortisol reactivity, and risk/reward-based decision-making on suicide. J Behav Ther Exp Psychiatry 2024; 85:101975. [PMID: 38870548 DOI: 10.1016/j.jbtep.2024.101975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/03/2024] [Accepted: 05/25/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND AND OBJECTIVES Poor sleep quality is a known contributor to suicidal thoughts and behaviors. This study examines whether sleep quality modulates the effect of an individual's stress response and risk/reward-based decision making on suicide risk. METHODS Participants were 160 adults at a residential substance use treatment facility with lifetime exposure to trauma who completed a clinician-administered measure of suicide risk, the Iowa Gambling Task (IGT), and a self-report measure of sleep. Cortisol reactivity (i.e., changes in cortisol before and after a personalized trauma script) was used to measure stress response. We used quantile regression to examine the effects of sleep, cortisol, and risk/reward decision-making on suicide risk. RESULTS We found poor sleep quality to be increasingly salient in individuals at greater risk for suicide than those at lower risk for suicide. Furthermore, individuals with moderate to moderate-high levels of suicide risk seem to have greater cortisol reactivity. In the low-moderate quantile, we found suicide risk to be associated with both high stress reactivity and low-risk, high-reward decision-making, as well as low stress reactivity and high-risk/low-reward decision-making. LIMITATIONS These findings should be interpreted considering several methodological constraints, such as the use of a pre-determined sample and instruments not tailored for our hypotheses, the MINI 'Suicide' Module's limited differentiation between suicidal ideation and behavior, and variably timed cortisol sampling. CONCLUSIONS Despite these limitations, the findings from this study support the use of evidence-based interventions focused on improving sleep quality and managing emotional reactivity to decrease suicide risk.
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Affiliation(s)
- Keyne C Law
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA.
| | | | - Samantha V Jacobson
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA
| | - Margaret M Baer
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Phillip M Baker
- Department of Psychology, Seattle Pacific University, Seattle, WA, USA
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, OH, USA; Lyra Health Inc., Burlingame, CA, USA
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O'Donnell S, Egan T, Clarke N, Richardson N. Prevalence and associated risk factors for suicidal ideation, non-suicidal self-injury and suicide attempt among male construction workers in Ireland. BMC Public Health 2024; 24:1263. [PMID: 38720265 PMCID: PMC11077913 DOI: 10.1186/s12889-024-18483-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/28/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Suicide among male construction workers are reported to be disproportionally high compared to the working age population. However, there is minimal understanding of the prevalence and associated factors for suicidal ideation, non-suicidal self-injury, and suicide attempt among this occupational group globally. METHODS A cross-sectional study was conducted on a large sample of male construction workers in Ireland (n = 1,585). We investigated the prevalence of suicidal ideation, non-suicidal self-injury and suicide attempts and sociodemographic, occupational, and mental health factors associated with these three outcomes. Multivariable Poisson regression was performed to estimate the prevalence rate ratio of suicidal ideation (model 1 primary outcome), while multivariable logistic regression was used to estimate the odds ratio of non-suicidal self-injury (model 2 primary outcome), and suicide attempt (model 3 primary outcome). RESULTS The lifetime prevalence rate for suicidal ideation was 22%, 6% for non-suicidal self-injury, and 6% for suicide attempt. In univariate modelling, socio-demographic and occupation-specific factors associated with the three outcomes included younger age (suicidal ideation and non-suicidal self-injury), not being in a relationship (suicide attempt) and working 35-44 h per week (suicidal ideation and suicide attempt). The mental health factors generalized anxiety disorder, depression, and suicide bereavement were significantly associated with increased risk of the three outcomes. In fully adjusted multivariable models, increasing severity of generalized anxiety disorder and depression were associated with an increased prevalence rate ratio of suicidal ideation, and a higher odds ratio of non-suicidal self-injury and suicide attempt. CONCLUSION Suicidal ideation, non-suicidal self-injury and suicide attempt are significant issues for male construction workers that require specific attention. Findings highlight a need to support younger male construction workers and those bereaved by suicide. They also highlight the need for the early detection and treatment of generalized anxiety disorder and depression in order to intervene in, and potentially prevent, suicidality among male construction workers.
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Affiliation(s)
- Shane O'Donnell
- National Centre for Men's Health, South East Technological University (Carlow Campus), Kilkenny Road, Carlow, Ireland.
| | - Tom Egan
- School of Business, South East Technological University (Waterford Campus), Cork Road, Waterford, Ireland
| | - Nicholas Clarke
- RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin, Ireland
| | - Noel Richardson
- National Centre for Men's Health, South East Technological University (Carlow Campus), Kilkenny Road, Carlow, Ireland
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Gunn J, McGrain P, Ördög B, Guerin M. Their final words: An analysis of suicide notes from the United States. DEATH STUDIES 2024:1-11. [PMID: 38709641 DOI: 10.1080/07481187.2024.2348057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
The present study sought to explore motivations (affective, relationships, life events, injury/medical diagnosis) in suicide notes (N = 49) from the U.S. Authors ranged in age from 18 to 74 years and were majority male (73.5%). Four raters analyzed the notes and, through a series of meetings, came to a consensus on the motives behind each note writers' suicide in terms of the broader motivational themes and the narrower second-level themes. All notes were primarily affectional in nature, with some gender and age differences. For example, suicide notes from males frequently refer to financial hardships whereas suicide notes from females were more focused on lowered self-worth and notes written by younger persons focused more on affect and relationships, while notes written by older adults focused on life events and marriage difficulties and separation. Findings illuminate the varied nature of suicide motivations but also highlight important patterns across groups.
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Affiliation(s)
- John Gunn
- Gwynedd Mercy University, Gwynedd Valley, Pennsylvania, USA
| | | | - Brielle Ördög
- Gwynedd Mercy University, Gwynedd Valley, Pennsylvania, USA
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Lee CS, Sirin SR, Choi E, Sin EJ. Meta-Analysis of Acculturation and Suicide-Related Outcomes: A Test of the Immigrant Paradox. J Racial Ethn Health Disparities 2024; 11:913-927. [PMID: 36943654 DOI: 10.1007/s40615-023-01572-y] [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: 11/15/2022] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE This meta-analysis aimed to systematically test the relation between acculturation and suicide-related outcomes among immigrants, with attention to key methodological (i.e., measure of suicide-related outcome, measure of acculturation) and demographic (i.e., race, gender, age, geographic region, publication year) moderators. METHOD We conducted a meta-analysis of 72 independent samples from 50 studies (38 peer-reviewed articles, 12 dissertations) representing more than 1.4 million immigrants. Participants' age ranged from 11.20 to 74.70 years (M = 29.96, SD = 15.07). Random effects models were used for both main and moderation analyses. RESULTS We found significant positive associations between acculturation and suicidal ideation, but not suicide attempts and deaths. We also found a significant and positive effect of acculturation on suicide-related outcomes when acculturation was measured by psychological scales, but not by generation status, length of residence in the host country, and proficiency in the host country's language. More acculturated Latinx immigrants were at higher risk for suicide-related outcomes, whereas a reverse pattern was found among Asian immigrants. Meta-regressions revealed that the moderating effects of participants' age and publication year were also significant. CONCLUSION Our results show partial support for the immigrant paradox but suggest that the relation between acculturation and suicide-related outcomes is complex and multifaceted. We discuss the implications of our findings and recommendations for research and prevention.
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Affiliation(s)
- Christina Seowoo Lee
- Department of Applied Psychology, New York University, 246 Greene St, New York, NY, 10004, USA.
| | - Selcuk R Sirin
- Department of Applied Psychology, New York University, 246 Greene St, New York, NY, 10004, USA
| | - Elysia Choi
- Department of Applied Psychology, New York University, 246 Greene St, New York, NY, 10004, USA
| | - Esther J Sin
- Department of Applied Psychology, New York University, 246 Greene St, New York, NY, 10004, USA
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Bozzay ML, Bresin K, Brown ME, Mekawi Y, Verona E. Eyes of the beholders: Multi-method relationships between internalizing and externalizing symptom dimensions and aggression risk. Aggress Behav 2024; 50:e22141. [PMID: 38425222 DOI: 10.1002/ab.22141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
Although aggression occurs across a range of disorders, associations between dimensions of psychopathology and self- and other-directed aggression are not well understood. Investigating associations between psychopathology dimensions and aggression helps further understanding about the etiology of aggression, and ultimately, can inform intervention and prevention strategies. This study adopted a multi-method approach to examine associations between internalizing and externalizing dimensions of psychopathology and self- and other-directed aggression as a function of reporter (participant and informant) and modality of aggression measurement (subjective and objective). Participants were an unselected sample of 151 racially diverse adults recruited from the community. Dimensions of psychopathology were assessed using interview and questionnaire reports from participants and collateral informants, and forms of aggression were measured via subjective reports and an objective, laboratory aggression paradigm. Analyses of participant-reported psychological symptom data consistently linked externalizing symptoms to other-directed aggression, and internalizing symptoms to self-directed aggression. Results across informant and participant reporters replicated prior findings showing a significant interaction between internalizing and externalizing dimensions in predicting intimate partner violence. Most other effects in informant models were nonsignificant. The findings uncover consistency in and replicability of relationships between dimensions of psychopathology and certain manifestations of aggression and highlight the importance of examining multiple forms of aggression in etiological research. Examining aggression through a transdiagnostic lens can help us better understand and intervene upon processes implicated in devasting forms of self- and other-directed aggression.
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Affiliation(s)
- Melanie L Bozzay
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | - Konrad Bresin
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- Department of Counseling and Human Development, University of Louisville, Louisville, Kentucky, USA
| | - Meaghan E Brown
- Department of Psychology, University of South Florida, Tampa, Florida, USA
| | - Yara Mekawi
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Edelyn Verona
- Department of Psychology, University of South Florida, Tampa, Florida, USA
- Center for Justice Research and Policy, College of Arts and Sciences, University of South Florida, Tampa, Florida, USA
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Liu Q, László KD, Wei D, Yang F, Fall K, Valdimarsdóttir U, Feychting M, Li J, Fang F. Suicide attempt and death by suicide among parents of young individuals with cancer: A population-based study in Denmark and Sweden. PLoS Med 2024; 21:e1004322. [PMID: 38227561 PMCID: PMC10791002 DOI: 10.1371/journal.pmed.1004322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/14/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The psychological toll on parents of a child receiving a cancer diagnosis is known to be high, but there is a knowledge gap regarding suicidal behavior among these parents. The aim of this study was to investigate the risk of suicide attempt and death by suicide in relation to having a child with cancer. METHODS AND FINDINGS We performed a binational population-based and sibling-controlled cohort study, including all parents with a child diagnosed with cancer in Denmark (1978 to 2016) or Sweden (1973 to 2014), 10 matched unexposed parents per exposed parent (population comparison), and unaffected full siblings of the exposed parents (sibling comparison). Suicide attempt was identified through the Patient Register and the Psychiatric Central Register in Denmark and the Patient Register in Sweden, whereas death by suicide was identified through the Danish Causes of Death Register and the Swedish Causes of Death Register. In population comparison, we used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of suicide attempt and death by suicide associated with cancer diagnosis of a child, adjusting for sex, age, country of residence, calendar year, marital status, highest attained educational level, household income, history of cancer, history of psychiatric disorder, and family history of psychiatric disorder. The sibling comparison was performed to assess the role of familial confounding in the studied associations. The population comparison consisted of 106,005 exposed parents and 1,060,050 matched unexposed parents, with a median age of 56 at cohort entry and 46.9% male. During the median follow-up of 7.3 and 7.2 years, we observed 613 (incidence rate [IR], 58.8 per 100,000 person-years) and 5,888 (IR, 57.1 per 100,000 person-years) cases of first-onset suicide attempt among the exposed and unexposed parents, respectively. There was an increased risk of parental suicide attempt during the first years after a child's cancer diagnosis (HR, 1.15; 95% CI, [1.03, 1.28]; p = 0.01), particularly when the child was 18 or younger at diagnosis (HR, 1.25; 95% CI, [1.08, 1.46]; p = 0.004), when the child was diagnosed with a highly aggressive cancer (HR, 1.60; 95% CI, [1.05, 2.43]; p = 0.03), or when the child died due to cancer (HR, 1.63; 95% CI, [1.29, 2.06]; p < 0.001). The increased risk did not, however, maintain thereafter (HR, 0.86; 95% CI: [0.75, 0.98]; p = 0.03), and there was no altered risk of parental death by suicide any time after the child's cancer diagnosis. Sibling comparison corroborated these findings. The main limitation of the study is the potential residual confounding by factors not shared between full siblings. CONCLUSIONS In this study, we observed an increased risk of parental suicide attempt during the first years after a child's cancer diagnosis, especially when the child was diagnosed during childhood, or with an aggressive or fatal form of cancer. There was, however, no altered risk of parental death by suicide at any time after a child's cancer diagnosis. Our findings suggest extended clinical awareness of suicide attempt among parents of children with cancer, especially during the first few years after cancer diagnosis.
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Affiliation(s)
- Qianwei Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Krisztina D. László
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- The Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Dang Wei
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fen Yang
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Katja Fall
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Unnur Valdimarsdóttir
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center of Public Health Sciences, School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Maria Feychting
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jiong Li
- Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Gomez SH, Overholser J, McGovern C, Silva C, Stockmeier CA. The role of premeditation in suicide: Identifying factors associated with increased planning among suicide decedents. J Clin Psychol 2023; 79:2768-2780. [PMID: 37539866 PMCID: PMC10838361 DOI: 10.1002/jclp.23577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/28/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Suicide premeditation is a critical factor to consider when assessing suicide risk. Understanding which individuals are more or less likely to plan their suicidal behavior can shed light on how suicidal thoughts turn into actions. METHOD The present study used psychological autopsy data to identify factors associated with level of premeditation among 131 adults who died by suicide. RESULTS Logistic regression analyses indicated that suicide decedents with higher premeditation scores had higher odds of being diagnosed with a depressive disorder and choosing a violent suicide method, specifically a firearm. Individuals with lower premeditation scores had higher odds of being diagnosed with a polysubstance use disorder. CONCLUSION Suicide decedents exhibiting greater premeditation before their deaths were different in several ways from suicide decedents exhibiting less premeditation. A better understanding of suicide premeditation can ultimately aid in the development of improved risk assessments and targeted safety interventions for those struggling with suicidal thoughts.
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Affiliation(s)
- Stephanie H Gomez
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - James Overholser
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Christopher McGovern
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Christiana Silva
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Craig A Stockmeier
- Department of Psychiatry and Human Behavior, The University of Mississippi Medical Center, Jackson, Mississippi, USA
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Krvavac S, Bystad M, Wynn R, Bukholm IRK, Jansson B. Characteristics of Patients Who Complete Suicide and Suicide Attempts While Undergoing Treatment in Norway: Findings from Compensation Claims Records. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4083. [PMID: 36901092 PMCID: PMC10002346 DOI: 10.3390/ijerph20054083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/19/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
The aim of this study was to identify characteristics that differentiate patients who complete suicide (SC) from patients with suicide attempts (SA) while undergoing treatment in Norway. We examined data from the Norwegian System of Patient Injury Compensation (Norsk Pasientskade Erstatning-NPE). Data were extracted from NPE case records from a 10-year period (2009-2019) for 356 individuals who attempted (n = 78) or died by (n = 278) suicide. The two groups differed significantly in the types of medical errors identified by experts. Inadequate suicide risk assessment tended to be proportionally and significantly more prevalent among SC compared to SA. There was a weak but significant trend that SA had received medication only, whereas SC had received both medication and psychotherapy. There were no significant differences with respect to age group, gender, diagnostic category, number of previous suicide attempts, inpatient/outpatient status, or category of responsible clinic. We conclude that suicide attempters and suicide completers differed in terms of identified medical errors. Focusing on the prevention of these and other types of errors could help to reduce the number of suicides of patients in treatment.
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Affiliation(s)
- Sanja Krvavac
- Department of Psychiatry, Helgeland Hospital Trust, 8802 Sandnessjøen, Norway
- Department of Health and Care Sciences, UiT The Arctic University of Tromsø, 9037 Tromsø, Norway
| | - Martin Bystad
- Division of Substance Use and Mental Health, University Hospital of North Norway, 9019 Tromsø, Norway
| | - Rolf Wynn
- Department of Clinical Medicine, UiT The Arctic University of Tromsø, 9038 Tromsø, Norway
- Department of Education, ICT and Learning, Østfold University College, 1757 Halden, Norway
| | - Ida Rashida Khan Bukholm
- The Norwegian System of Patient Injury Compensation, 0130 Oslo, Norway
- Faculty of Landscape and Society, The Norwegian University of Life Sciences, 1430 Ås, Norway
| | - Billy Jansson
- Department of Psychology and Social Work, Mid Sweden University, 831 25 Ostersund, Sweden
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Borroni S, Franchini L, Brioschi S, Vassena G, Masci E, Franzoni C, Ruotolo G, Colombo C, Fossati A. The role of clinical and Personological features in predicting high lethality suicide attempts: A study among mood disorder patients. Personal Ment Health 2023; 17:99-106. [PMID: 35982533 DOI: 10.1002/pmh.1546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/31/2022] [Accepted: 04/21/2022] [Indexed: 11/06/2022]
Abstract
Suicidal attempts (SA) represent heterogeneous behaviours ranging in their seriousness from fatal and near-fatal (high-lethality) cases to those that do not require medical attention (low lethality). These considerations stress the need to identify high-risk individuals for high lethality SA in order to target suicide preventive interventions. The present study aims at evaluating the role of sociodemographic and clinical variables and examining personality pathological features in predicting high lethality SA. The sample was composed by 94 patients who were consecutively admitted to the Mood Disorders Unit of the San Raffaele Turro Hospital in Milan. The results of binary logistic regression analyses showed that previous SA and current suicide ideation play a role in predicting serious SA. Considering the DSM-5 personality dysfunctional domains assessed by the Personality Inventory for DSM-5, our logistic regression analyses suggested that high lethality SA was associated with Detachment PID-5 domain. Finally, binary hierarchical regression analysis showed that Detachment domain remained a significant predictor of serious SA over and above the effect of previous SA and suicide ideation. As a whole, our results highlight the importance of a multidimensional approach to develop adequate assessment, effective treatments and prevention of high lethality SA risk.
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Affiliation(s)
- Serena Borroni
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | | | - Elisabetta Masci
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Chiara Franzoni
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Giulia Ruotolo
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Cristina Colombo
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Fossati
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
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Shiwei L, Xiaojing Z, Yingli Z, Shengli C, Xiaoshan L, Ziyun X, Gangqiang H, Yingwei Q. Cortical hierarchy disorganization in major depressive disorder and its association with suicidality. Front Psychiatry 2023; 14:1140915. [PMID: 37168085 PMCID: PMC10165114 DOI: 10.3389/fpsyt.2023.1140915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/07/2023] [Indexed: 05/13/2023] Open
Abstract
Objectives To explore the suicide risk-specific disruption of cortical hierarchy in major depressive disorder (MDD) patients with diverse suicide risks. Methods Ninety-two MDD patients with diverse suicide risks and 38 matched controls underwent resting-state functional MRI. Connectome gradient analysis and stepwise functional connectivity (SFC) analysis were used to characterize the suicide risk-specific alterations of cortical hierarchy in MDD patients. Results Relative to controls, patients with suicide attempts (SA) had a prominent compression from the sensorimotor system; patients with suicide ideations (SI) had a prominent compression from the higher-level systems; non-suicide patients had a compression from both the sensorimotor system and higher-level systems, although it was less prominent relative to SA and SI patients. SFC analysis further validated this depolarization phenomenon. Conclusion This study revealed MDD patients had suicide risk-specific disruptions of cortical hierarchy, which advance our understanding of the neuromechanisms of suicidality in MDD patients.
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Affiliation(s)
- Lin Shiwei
- Department of Radiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Zhang Xiaojing
- Guangdong Provincial Key Laboratory of Genome Stability and Disease Prevention and Regional Immunity and Diseases, Department of Pathology, Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Zhang Yingli
- Department of Depressive Disorder, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, Guangdong, China
| | - Chen Shengli
- Department of Radiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Lin Xiaoshan
- Department of Radiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Xu Ziyun
- Department of Radiology, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Hou Gangqiang
- Department of Radiology, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
- *Correspondence: Hou Gangqiang,
| | - Qiu Yingwei
- Department of Radiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
- Qiu Yingwei,
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Wand AP, Browne R, Jessop T, Peisah C. A systematic review of evidence-based aftercare for older adults following self-harm. Aust N Z J Psychiatry 2022; 56:1398-1420. [PMID: 35021912 DOI: 10.1177/00048674211067165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Self-harm is closely associated with suicide in older adults and may provide opportunity to intervene to prevent suicide. This study aimed to systematically review recent evidence for three components of aftercare for older adults: (1) referral pathways, (2) assessment tools and safety planning approaches and (3) engagement and intervention strategies. METHODS Databases PubMed, Medline, PsychINFO, Embase and CINAHL were searched from January 2010 to 10 July 2021 by two reviewers. Empirical studies reporting aftercare interventions for older adults (aged 60+) following self-harm (including with suicidal intent) were included. Full text of articles with abstracts meeting inclusion criteria were obtained and independently reviewed by three authors to determine final studies for review. Two reviewers extracted data and assessed level of evidence (Oxford) and quality ratings (Alberta Heritage Foundation for Medical Research Standard Quality Assessment Criteria for quantitative and Attree and Milton checklist for qualitative studies), working independently. RESULTS Twenty studies were reviewed (15 quantitative; 5 qualitative). Levels of evidence were low (3, 4), and quality ratings of quantitative studies variable, although qualitative studies rated highly. Most studies of referral pathways were observational and demonstrated marked variation with no clear guidelines or imperatives for community psychiatric follow-up. Of four screening tools evaluated, three were suicide-specific and one screened for depression. An evidence-informed approach to safety planning was described using cases. Strategies for aftercare engagement and intervention included two multifaceted approaches, psychotherapy and qualitative insights from older people who self-harmed, carers and clinicians. The qualitative studies identified targets for improved aftercare engagement, focused on individual context, experiences and needs. CONCLUSION Dedicated older-adult aftercare interventions with a multifaceted, assertive follow-up approach accompanied by systemic change show promise but require further evaluation. Research is needed to explore the utility of needs assessment compared to screening and evaluate efficacy of safety planning and psychotherapeutic approaches.
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Affiliation(s)
- Anne Pf Wand
- Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Older Peoples Mental Health Service, Jara Ward, Concord Centre for Mental Health, Sydney Local Health District, Concord, Australia
| | - Roisin Browne
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,ForeFront Motor Neuron Disease & Frontotemporal Dementia Clinic, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
| | - Tiffany Jessop
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
| | - Carmelle Peisah
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
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Bjork JM, Sawyers CK, Straub LK, Garavito DMN, Westbrook A. Cognitive effort avoidance in veterans with suicide attempt histories. Acta Psychol (Amst) 2022; 231:103788. [PMID: 36335888 PMCID: PMC10292953 DOI: 10.1016/j.actpsy.2022.103788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Suicide attempts (SA) are increasing in the United States, especially in veterans. Discovering individual cognitive features of the subset of suicide ideators who attempt suicide is critical. Cognitive theories attribute SA to facile schema-based negative interpretations of environmental events. Over-general autobiographical memory and facile solutions in problem solving tasks in SA survivors suggest that aversion to expending cognitive effort may be a neurobehavioral marker of SA risk. In veterans receiving care for mood disorder, we compared cognitive effort discounting and evidence-gathering in a beads task between veterans with (SAHx+; n = 26) versus without (SAHx-; n = 22) a history of SA. Groups did not differ in depressed mood or in a proxy metric of premorbid intelligence. Compared to SAHx- participants, SAHx+ participants self-reported significantly more severe cognitive problems in most domains, and also eschewed choice to earn higher monetary reward if earning it required a slightly increased working memory (WM) demand relative to an easy WM task. There was no group difference, however, in extent of evidence-gathering before declaring a conclusion in a beads task. These preliminary data suggest that aversion to expenditure of cognitive effort, potentially as a component of cognitive difficulties, may be a marker for SA risk.
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Affiliation(s)
- James M Bjork
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, 203 E Cary St Room 202, Richmond, VA 23219, United States of America; Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond VA, United States of America.
| | - Chelsea K Sawyers
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, 203 E Cary St Room 202, Richmond, VA 23219, United States of America
| | - Lisa K Straub
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, 203 E Cary St Room 202, Richmond, VA 23219, United States of America
| | - David M N Garavito
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, 203 E Cary St Room 202, Richmond, VA 23219, United States of America
| | - Andrew Westbrook
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, 203 E Cary St Room 202, Richmond, VA 23219, United States of America; Department of Cognitive, Linguistic & Psychological Sciences, Brown University, Providence, RI, United States of America
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13
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Barker J, Oakes-Rogers S, Leddy A. What distinguishes high and low-lethality suicide attempts in older adults? A systematic review and meta-analysis. J Psychiatr Res 2022; 154:91-101. [PMID: 35933859 DOI: 10.1016/j.jpsychires.2022.07.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/30/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022]
Abstract
Those making suicide attempts with highly lethal medical consequences are arguably the best proxy for those who die by suicide and represent a qualitatively different population from those making lower lethality attempts. Different factors influence the likelihood of a suicide attempt occurring and the lethality of that attempt. Both are important dimensions of risk. Older adults represent a distinct group in suicide research with unique risk factors that influence the lethality of their suicide attempts. This systematic review and meta-analysis summarises factors distinguishing those making high and low-lethality suicide attempts in older adulthood. Databases PsycINFO, PubMed (MEDLINE), Embase and CINAHL were systematically searched with seven of 1182 unique records included. Random effects meta-analyses were conducted on 18 variables in addition to a narrative synthesis regarding executive function. Only increased suicidal intent and planning meaningfully distinguished high from low-lethality attempters in meta-analyses. A large effect size was additionally observed for white ethnicity. Diminished alcohol use disorder prevalence and depression severity, and greater cognitive impairment, may be associated with high lethality attempters but further research is needed. Age and gender were not associated with lethality, contrary to adult populations. A narrative synthesis of studies exploring differences in executive functioning suggested high-lethality attempters were less likely to impulsively act on suicidal urges, allowing them to better plan suicide attempts that are more lethal, and are less likely to alter suicidal plans. Key limitations were that meta-analyses were underpowered to detect small effect sizes, and samples were largely white and limited to the USA.
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14
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McDonnell S, Flynn S, Shaw J, Smith S, McGale B, Hunt I. Suicide bereavement in the UK: Descriptive findings from a national survey. Suicide Life Threat Behav 2022; 52:887-897. [PMID: 35611626 PMCID: PMC9790485 DOI: 10.1111/sltb.12874] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/12/2022] [Accepted: 05/05/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Those bereaved by suicide are a high-risk group of adverse health outcomes and suicidal behavior, yet little is known about the experiences and support needs of these individuals in the UK. METHODS We conducted a national cross-sectional study using an online survey and analyzed the experiences of 7158 participants who had been bereaved or affected by suicide. RESULTS Suicide had a major impact on 77% of participants, including those who had lost a friend and those exposed to suicide at a professional level. Mental and physical health problems linked to the suicide were reported in half. Adverse social outcomes and engaging in high-risk behaviors following the suicide were common. Over a third reported suicidal ideation and 8% had attempted suicide as a direct result of the suicide loss. Most had not accessed support services, with the majority viewing provision of local suicide bereavement support as inadequate. CONCLUSIONS Our results highlight the need for a multi-disciplinary approach in postvention and the provision of proactive outreach to support those bereaved by suicide. Postvention efforts need to acknowledge the death of a friend by suicide as a significant loss.
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Affiliation(s)
- Sharon McDonnell
- Faculty of Biology, Medicine and HealthCentre for Mental Health and SafetyUniversity of ManchesterManchesterUK,Suicide BereavementRamsbottomUK
| | - Sandra Flynn
- Faculty of Biology, Medicine and HealthCentre for Mental Health and SafetyUniversity of ManchesterManchesterUK
| | - Jenny Shaw
- Faculty of Biology, Medicine and HealthCentre for Mental Health and SafetyUniversity of ManchesterManchesterUK,Greater Manchester Mental Health NHS Foundation TrustManchesterUK,Independent Advisory Panel on Deaths in CustodyLondonUK
| | - Shirley Smith
- If U Care Share FoundationChesterUK,Support After Suicide PartnershipLondonUK
| | - Barry McGale
- Suicide BereavementRamsbottomUK,Support After Suicide PartnershipLondonUK
| | - Isabelle M. Hunt
- Faculty of Biology, Medicine and HealthCentre for Mental Health and SafetyUniversity of ManchesterManchesterUK
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15
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Dewar C, Heggs DA, Davies J. Exploring the Relationship Between Domestic Violence Perpetration and Suicidal Behavior in Male Prisoners. Arch Suicide Res 2022; 26:1831-1846. [PMID: 34162317 DOI: 10.1080/13811118.2021.1939207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study is the first to explore the relationship between domestic violence perpetration and suicidal behavior in prisoners in England and Wales. The nature of this relationship is unclear, however, understanding and reducing suicide in prisons is a critical issue for frontline staff and policy makers. Eight participants with a history of suicide attempts and domestic violence perpetration were interviewed. Five key themes were identified through thematic analysis; "Trauma, victimization and life struggles," "Relationship ideals versus relationship reality", "Explaining domestic violence", "The impact of prison" and "Suicide as a coping strategy". This study shows that the relationship between domestic violence and suicide risk in prisoners may be better understood through a pathway of experiences rather than individual risk factors. Further research is needed to test the replicability of this pathway in other samples.
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16
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Longitudinal big data needs to meet the individual to inform self-harm and suicide prevention in older adults. Int Psychogeriatr 2022; 34:767-769. [PMID: 34127164 DOI: 10.1017/s1041610220004147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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17
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Kaster TS, Blumberger DM, Gomes T, Sutradhar R, Wijeysundera DN, Vigod SN. Risk of suicide death following electroconvulsive therapy treatment for depression: a propensity score-weighted, retrospective cohort study in Canada. Lancet Psychiatry 2022; 9:435-446. [PMID: 35487236 DOI: 10.1016/s2215-0366(22)00077-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous studies examining the risk of suicide death after treatment with electroconvulsive therapy have been confounded and the resulting uncertainty around the risk-benefit profile of electroconvulsive therapy might contribute to its underuse. We aimed to compare the risk of death by suicide after psychiatric hospitalisation among individuals with depression who had been exposed to electroconvulsive therapy with those who had not. METHODS This was a propensity score-weighted, retrospective cohort study using linked population-level administrative health data for adults with depression who had been admitted to a designated psychiatric bed in Ontario, Canada for more than 3 days between April 1, 2007 and Dec 31, 2017. Electroconvulsive therapy exposure was defined as one or more physician billing procedure codes during hospitalisation. The primary outcome was death by suicide identified using administrative health records within 365 days following discharge. We used cause-specific Cox proportional hazards model to estimate the cause-specific hazard ratio (csHR) for electroconvulsive therapy-exposed and electroconvulsive therapy-unexposed individuals. Secondary outcomes were non-suicide death and all-cause mortality. FINDINGS In the analytic cohort, there were 67 327 psychiatric hospitalisation records (27 231 men and 40 096 women; mean age 45·1 years [SD 16·8; range 18-103]), of whom 4982 were exposed to electroconvulsive therapy and 62 345 were not exposed to electroconvulsive therapy. No ethnicity data were available. In propensity-score weighted analyses, electroconvulsive therapy was associated with a significantly reduced risk of suicide death (csHR 0·53 [95% CI 0·31-0·92]). Accounting for non-suicide death as a competing risk had no effect on the findings. Electroconvulsive therapy was also associated with a significantly reduced risk of all-cause mortality (0·75 [0·58-0·97]), but not non-suicide death (0·83 [0·61-1·12]). INTERPRETATION Among individuals admitted to hospital with depression, electroconvulsive therapy is associated with a significantly reduced risk of death by suicide in the year after discharge. This study reinforces the importance of electroconvulsive therapy, particularly for people with severe depression. FUNDING Norris Scholars Award, Department of Psychiatry, University of Toronto, and the Canadian Institutes for Health Research.
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Affiliation(s)
- Tyler S Kaster
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Tara Gomes
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; ICES, Toronto, ON, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada
| | - Duminda N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Department of Anesthesia, St Michael's Hospital, Toronto, ON, Canada
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada
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18
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Proteomic profiling of postmortem prefrontal cortex tissue of suicide completers. Transl Psychiatry 2022; 12:142. [PMID: 35383147 PMCID: PMC8983647 DOI: 10.1038/s41398-022-01896-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/05/2022] [Accepted: 03/11/2022] [Indexed: 11/30/2022] Open
Abstract
Suicide is a leading cause of death worldwide, presenting a serious public health problem. We aimed to investigate the biological basis of suicide completion using proteomics on postmortem brain tissue. Thirty-six postmortem brain samples (23 suicide completers and 13 controls) were collected. We evaluated the proteomic profile in the prefrontal cortex (Broadmann area 9, 10) using tandem mass tag-based quantification with liquid chromatography-tandem mass spectrometry. Bioinformatics tools were used to elucidate the biological mechanisms related to suicide. Subgroup analysis was conducted to identify common differentially expressed proteins among clinically different groups. Of 9801 proteins identified, 295 were differentially expressed between groups. Suicide completion samples were mostly enriched in the endocannabinoid and apoptotic pathways (CAPNS1, CSNK2B, PTP4A2). Among the differentially expressed proteins, GSTT1 was identified as a potential biomarker among suicide completers with psychiatric disorders. Our findings suggest that the previously under-recognized endocannabinoid system and apoptotic processes are highly involved in suicide.
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19
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Affiliation(s)
- Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
| | | | - Sheikh Shoib
- Dept. of Psychiatry, Jawahar Lal Nehru Memorial Hospital, Srinagar, Kashmir, India
| | - Arpit Parmar
- Dept. of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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20
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Dominguez-Rodriguez A, Herdoiza-Arroyo PE, Martínez Arriaga RJ, Bautista Valerio E, Mateu Mollá J, de la Rosa-Gómez A, Farfallini L, Hernández Jiménez MJ, Esquivel Santoveña EE, Ramírez-Martínez FR, Castellanos Vargas RO, Arzola-Sánchez CA, Arenas-Landgrave P, Martínez-Luna SC. Prevalence of Anxiety Symptoms and Associated Clinical and Sociodemographic Factors in Mexican Adults Seeking Psychological Support for Grief During the COVID-19 Pandemic: A Cross-Sectional Study. Front Psychiatry 2022; 13:749236. [PMID: 35370841 PMCID: PMC8964437 DOI: 10.3389/fpsyt.2022.749236] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/31/2022] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic is one of the greatest challenges in modern history, with more than four million confirmed deaths worldwide. To date, evidence regarding the psychological impact of the COVID-19 pandemic on grievers is scarce for developing countries such as Mexico. This study aimed to assess the levels of anxiety and associated concerns in a sample of Mexican adults bereaved during the COVID-19 outbreak. A cross-sectional study was conducted through the Duelo COVID (COVID Grief) platform, which is a self-guided online treatment. A total of 5,224 participants reported their anxiety, depression, sleep quality, avoidance, and arousal, prolonged grief symptoms, and medication consumption. Independent sample Mann-Whitney U-tests, chi-square tests, and Kruskal-Wallis tests, as well as multinomial logistic regression, were conducted. Results indicated that 90.4% of the participants reported clinical levels of anxiety, depression, and sleep affectations. The people who lost someone during the last 5 months scored higher in normal grief symptoms compared to the people whose loss was 6 months ago or more, and 9.8% of individuals reported the use of prescription medication, with anxiolytics and antidepressants being the most common. Females, younger respondents, unemployed people with a lower educational level, and participants who disclosed a recent suicide attempt were among those who reported medication consumption. Sleep problems were more frequent in older participants.
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Affiliation(s)
| | | | - Reyna Jazmin Martínez Arriaga
- Departamento de Clínicas de Salud Mental, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Eduardo Bautista Valerio
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Anabel de la Rosa-Gómez
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Luis Farfallini
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
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21
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Persons JE, Lodder P, Coryell WH, Nurnberger JI, Fiedorowicz JG. Symptoms of mania and anxiety do not contribute to suicidal ideation or behavior in the presence of bipolar depression. Psychiatry Res 2022; 307:114296. [PMID: 34852976 PMCID: PMC8724399 DOI: 10.1016/j.psychres.2021.114296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 01/03/2023]
Abstract
Bipolar disorder is typified by episodes of manic/hypomanic and depressive symptoms, either distinctly or concurrently as mixed symptoms. While depressive symptoms are the major driver of risk, it is unclear whether specific combinations of manic and anxiety symptoms contribute differentially to suicidal ideation and behavior in individuals with bipolar disorder during a depressive state. This study uses a quantitative application of Rothman's theoretical framework of causation, or 'causal pies' model. Data were obtained from the National Network of Depression Centers Mood Outcomes Program for 1028 visits from 626 individuals with bipolar disorder with current moderate-to-severe depressive symptoms, operationalized as a Patient Health Questionnaire-8 (PHQ-8) score ≥10. Mania symptoms were captured using the Altman Self-Rating Mania scale (ASRM) and anxiety symptoms were captured using the Generalized Anxiety Disorder-7 scale (GAD-7). The outcome of suicidal ideation or behavior was captured using the Columbia Suicide Severity Rating Scale (C-SSRS). In this cohort of individuals with bipolar disorder and at least moderate depressive symptoms, we found no increased risk of suicidal ideation or behavior attributable to manic and anxiety symptom clusters in individuals with bipolar disorder during depressive state. A small amount (4%) of risk was attributable to having severe depressive symptoms. These findings, however, may be influenced by limitations in sample size and measurement instruments. Future studies would benefit from larger samples and more rigorous assessments, including clinician-rated measures.
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Affiliation(s)
- Jane E Persons
- Department of Pathology, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, IA, USA.
| | - Paul Lodder
- Department of Methodology and Statistics, School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherland
| | - William H Coryell
- Departments of Psychiatry and Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, IA USA
| | - John I Nurnberger
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jess G Fiedorowicz
- The Ottawa Hospital, Ottawa Hospital Research Institute, and University of Ottawa, Ottawa, Ontario, Canada
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22
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Coci C, Invernizzi R, Capone L, Casini E, Orlandi M, Galli P, Rossi I, Martinelli O, Borgatti R, Mensi MM. Psychological and behavioral characterization of suicide ideators and suicide attempters in adolescence. Front Psychiatry 2022; 13:1009460. [PMID: 36299537 PMCID: PMC9589341 DOI: 10.3389/fpsyt.2022.1009460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Suicide is a global cause of death, a chronic disability, and a significant public health problem. Recent works emphasize the importance of differentiating people with suicide ideation (SI) and people with suicidal attempts (SA), so we conducted a clinical cross-sectional study to better characterize the features most associated with SA. We enrolled 88 adolescents (77 females) from 12 to 18 years of age (M = 15.21, SD = 1.63) admitted to Northern Italian Child Neurology and Psychiatry Service who presented SI and/or SA. We conducted an assessment using the Columbia-Suicide Severity Rating Scale, and divided participants into two groups: adolescents with SA, and adolescents with thoughts about killing themselves which may include a plan but no suicidal attempts (SI). We found that the SA group showed greater severity of SI [t (86) = -3.485, p < 0.001], higher levels of subjective depression [t (70) = -2.65, p = 0.01)], and a higher prevalence of personality disorders [ χ ( 3 ) 2 = 8.775, p = 0.032] than the SI group. Both groups presented a prevalence of internalizing problems compared to the externalizing ones in the Youth Self-Report (YSR). Higher scores on YSR internalizing problems correlate positively with the "Repulsion by Life" subscale of the Multi-Attitude Suicide Tendency (MAST) Scale in both SA and SI groups (p = 0.41 and p = 0.67, respectively), while low levels of the MAST "Attraction to Life" subscale appear more often in the SA one (p = -0.71). In conclusion, results showed that some features (e.g., prevalence of personality disorders, SI intensity, and subjective depression) might help clinicians distinguish between patients with SI and those with SA and support the importance of carefully pursuing this distinction in research.
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Affiliation(s)
- Chiara Coci
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Roberta Invernizzi
- Child Neurology and Psychiatry Unit, ASST Lecco, Lecco, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Luca Capone
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Erica Casini
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Marika Orlandi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Paola Galli
- Child Neurology and Psychiatry Unit, ASST Lecco, Lecco, Italy
| | - Ilaria Rossi
- Child Neurology and Psychiatry Unit, ASST Lecco, Lecco, Italy
| | | | - Renato Borgatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Martina Maria Mensi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
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23
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Britton PC, Crasta D, Bohnert KM, Kane C, Klein J, Pigeon WR. Shorter and longer-term risk for non-fatal suicide attempts among male U.S. military veterans after discharge from psychiatric hospitalization. J Psychiatr Res 2021; 143:9-15. [PMID: 34438203 DOI: 10.1016/j.jpsychires.2021.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022]
Abstract
Although there are key differences in shorter-term (days 1-90) and longer-term (days 91-365) risk factors for suicide after discharge from inpatient psychiatry, there are no comparable data on non-fatal suicide attempts. Risk factors for non-fatal attempts in the first 90 days after discharge were compared with those over the remainder of the year to identify temporal changes in risk. Records were extracted from 208,554 male veterans discharged from Veterans Health Administration acute psychiatric inpatient units from 2008 through 2013. Proportional hazard regression models identified correlates of non-fatal attempts for 1-90 days and 91-365 days; adjusted piecewise proportional hazards regression compared risk between these time frames. 5010 (2.4%) veterans made a non-fatal attempt, 1261 (0.60%) on days 1-90 and 3749 (1.78%) on days 91-365. Risk across both time frames was highest among younger veterans ages 18-59, and those hospitalized with a suicide attempt or suicidal ideation. It was lowest among those with a dementia diagnosis. Risk estimates were generally stable over time but increased among those with substance use disorders and decreased among those with sleep disturbance and discharged against medical advice. Estimates of some risk factors for non-fatal attempts change over time in the year after discharge and differ from those that change for suicide. Different preventive approaches may be needed to reduce shorter and longer-term risk for non-fatal attempts and suicide in the year after discharge.
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Affiliation(s)
- Peter C Britton
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Dev Crasta
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Kipling M Bohnert
- Department of Public Health, Michigan State University, Lansing, MI, USA; Department of Veteran Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Cathleen Kane
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA
| | - John Klein
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA
| | - Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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24
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Mishara BL, Weisstub DN. Genetic testing for suicide risk assessment: Theoretical premises, research challenges and ethical concerns. Prev Med 2021; 152:106685. [PMID: 34119595 DOI: 10.1016/j.ypmed.2021.106685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 12/21/2022]
Abstract
We explore ethical premises and practical implications of using genetic testing to predict suicide risk. Twin studies indicate heritable components of suicide risk, intertwined with the heritability of mental disorders, and possibly other traits. Current genetics research has abandoned searching for single gene Mendelian determinants, in favour of complex probabilistic epigenetic models. Genome-Wide Association Studies (GWAS) might identify thousands of single nucleotide polymorphisms (SNPs), each contributing very little to the variance associated with behavioral phenotypes. However, suicide is a behavioral outcome rather than a phenotype, with so many different causal aetiologies, that it is impossible to predict the behaviors of individuals. We analyse practical and ethical issues that would arise if future research were to identify genetic information that will accurately predict suicide. Applying ACCE guidelines that specify when genetic tests should and should not be used, we examine the Analytic Validity, Clinical Validity, Clinical Utility and Ethical, Legal, and Social Implications. Low sensitivity and specificity for predicting suicide diminish potential advantages and exacerbate risks. Key considerations include the likelihood that testing will result in effective preventive interventions, which are not currently available, and unreliable positive results increasing hopelessness, stigma, and psychosocial risks. If the unregulated direct-to-consumer genetic testing services include suicide risk assessments, their use risks negative impacts. In the future, if genetic testing could accurately identify suicide risk in individuals, its use would be contraindicated if we cannot provide effective preventive interventions and mitigate the negative impacts of informing people about their risk level.
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Affiliation(s)
- Brian L Mishara
- Centre for Research and Intervention on Suicide, Ethical Issues and End of Life Practices, Université du Québec à Montréal, Montreal, Quebec, Canada; Psychology Department, Université du Québec à Montréal, Montreal, Quebec, Canada.
| | - David N Weisstub
- Centre for Research and Intervention on Suicide, Ethical Issues and End of Life Practices, Université du Québec à Montréal, Montreal, Quebec, Canada; International Academy of Law and Mental Health, Montreal, Quebec, Canada; International Academy of Ethics, Medicine and Public Health, Paris, France
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DiBlasi E, Kang J, Docherty AR. Genetic contributions to suicidal thoughts and behaviors. Psychol Med 2021; 51:2148-2155. [PMID: 34030748 PMCID: PMC8477225 DOI: 10.1017/s0033291721001720] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/28/2021] [Accepted: 04/19/2021] [Indexed: 12/27/2022]
Abstract
Suicidal ideation, suicide attempt (SA) and suicide are significantly heritable phenotypes. However, the extent to which these phenotypes share genetic architecture is unclear. This question is of great relevance to determining key risk factors for suicide, and to alleviate the societal burden of suicidal thoughts and behaviors (STBs). To help address the question of heterogeneity, consortia efforts have recently shifted from a focus on suicide within the context of major psychopathology (e.g. major depressive disorder, schizophrenia) to suicide as an independent entity. Recent molecular studies of suicide risk by members of the Psychiatric Genomics Consortium and the International Suicide Genetics Consortium have identified genome-wide significant loci associated with SA and with suicide death, and have examined these phenotypes within and outside of the context of major psychopathology. This review summarizes important insights from epidemiological and biometrical research on suicide, and discusses key empirical findings from molecular genetic examinations of STBs. Polygenic risk scores for these phenotypes have been observed to be associated with case-control status and other risk phenotypes. In addition, estimated shared genetic covariance with other phenotypes suggests specific medical and psychiatric risks beyond major depressive disorder. Broadly, molecular studies suggest a complexity of suicide etiology that cannot simply be accounted for by depression. Discussion of the state of suicide genetics, a growing field, also includes important ethical and clinical implications of studying the genetic risk of suicide.
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Affiliation(s)
- Emily DiBlasi
- Department of Psychiatry & the Center for Genomic Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, Salt Lake City, UT, USA
| | - Jooeun Kang
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anna R. Docherty
- Department of Psychiatry & the Center for Genomic Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, Salt Lake City, UT, USA
- Virginia Institute for Psychiatric & Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Siau CS, Wee LH, Wahab S, Visvalingam U, Yeoh SH, Halim NAA, Ibrahim N. The influence of religious/spiritual beliefs on Malaysian hospital healthcare workers’ attitudes towards suicide and suicidal patients: a qualitative study. J Res Nurs 2021; 26:723-740. [DOI: 10.1177/17449871211008520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background There has been mixed findings on whether a healthcare workers’ religious beliefs contribute positively or negatively to their attitudes towards suicidal patients. Aims This study aims to explore qualitatively the influence of religious/spiritual beliefs on healthcare workers’ attitudes towards suicide and suicidal patients in the culturally heterogeneous Malaysian population. Methods Thirty-one healthcare workers from diverse religious backgrounds, professions and medical disciplines were interviewed. Thematic analysis revealed the centrality of religion in determining healthcare workers’ acceptability of suicide, specific religious beliefs that influenced their views on the right-to-die issue, perceptions of the suicidal patient’s religiousness/spirituality, and the aspects and extent of religious relevance in professional philosophy and practice. Results Healthcare workers who could perceive the multifactorial nature of suicide causation had a more empathetic response. There were high levels of paternalism in the care of suicidal patients, involving unsolicited religious/spiritual advice practised as a form of suicide deterrent and social support. Conclusions The formal integration of religious/spiritual practices into the professional care of suicidal patients was indicated.
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Affiliation(s)
- Ching Sin Siau
- Senior Lecturer, Center for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Malaysia
| | - Lei-Hum Wee
- Professor, Center for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Malaysia
| | - Suzaily Wahab
- Associate Professor, Department of Psychiatry, UKM Medical Centre, Malaysia
| | - Uma Visvalingam
- Consultant Psychiatrist, Department of Psychiatry and Mental Health, Putrajaya Hospital, Malaysia
| | - Seen Heng Yeoh
- Assistant Professor, Faculty of Medicine, Universiti Tunku Abdul Rahman, Malaysia
| | - Nur Atikah Abdul Halim
- Health Education PhD Candidate, Health Education Programme, Universiti Kebangsaan Malaysia, Malaysia
| | - Norhayati Ibrahim
- Associate Professor, Faculty of Health Sciences, Center for Healthy Ageing and Wellness, Universiti Kebangsaan Malaysia, Malaysia
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Mills PD, Watts BV, Hemphill RR. Suicide and Suicide Attempts on Hospital Grounds and Clinic Areas. J Patient Saf 2021; 17:e423-e428. [PMID: 28230577 DOI: 10.1097/pts.0000000000000356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The goal of this study was to describe suicide and suicide attempts that occurred while the patient was on hospital grounds, common spaces, and clinic areas using root cause analysis (RCA) reports of these events in a national health care organization in the United States. METHOD This is an observational review of all RCA reports of suicide and suicide attempts on hospital grounds, common spaces, and clinic areas in our system between December 1, 1999, and December 31, 2014. Each RCA report was coded for the location of the event, method of self-harm, if the event resulted in a death by suicide, and root causes. RESULTS We found 47 RCA reports of suicide and suicide attempts occurring on hospital grounds, common spaces, or clinic areas. The most common methods were gunshot, overdose, cutting, and jumping, and we have seen an increase in these events since 2011. The primary root causes were breakdowns in communication, the need for improved psychiatric and medical treatment of suicidal patients, and problems with the physical environment. CONCLUSIONS Hospital staff should evaluate the environment for suicide hazards, consider prohibiting firearms, assist patients with no appointments, and promote good communication about high-risk patients.
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Affiliation(s)
| | | | - Robin R Hemphill
- From the VA National Center for Patient Safety, White River Junction, VT
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28
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Blomdahl C, Guregård S, Rusner M, Wijk H. Recovery From Depression—A 6-Month Follow-up of a Randomized Controlled Study of Manual-Based Phenomenological Art Therapy for Persons With Depression. ART THERAPY 2021. [DOI: 10.1080/07421656.2021.1922328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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29
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Lin C, Huang CM, Karim HT, Liu HL, Lee TMC, Wu CW, Toh CH, Tsai YF, Yen TH, Lee SH. Greater white matter hyperintensities and the association with executive function in suicide attempters with late-life depression. Neurobiol Aging 2021; 103:60-67. [PMID: 33845397 DOI: 10.1016/j.neurobiolaging.2020.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/27/2020] [Accepted: 12/15/2020] [Indexed: 10/21/2022]
Abstract
Late-life depression (LLD) is associated with greater risk of suicide and white matter hyperintensities (WMH), which are also found in suicide attempters regardless of age. Greater periventricular WMH are related to worse cognitive function. We investigated the spatial distribution of WMH in suicide attempters with LLD and its association with cognitive function. We recruited 114 participants with LLD (34 with history of suicide attempt and 80 without) and 47 older adult controls (individuals without LLD or history of suicide attempt). WMH were quantified by an automated segmentation algorithm and were classified into different regions. Suicide attempters with LLD had significantly higher global WMH (F3, 150 = 2.856, p = 0.039) and periventricular WMH (F3, 150 = 3.635, p = 0.014) compared to other groups. Suicide attempters with high WMH had significantly lower executive function, which could be an underlying mechanism for cognitive decline in older adults with suicidality.
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Affiliation(s)
- Chemin Lin
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Mao Huang
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ho-Ling Liu
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tatia Mei-Chun Lee
- Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong; State Key Laboratory of Brain and Cognitive Science, The University of Hong Kong, Hong Kong
| | - Changwei W Wu
- Brain and Consciousness Research Center, Shuang-Ho Hospital, New Taipei, Taiwan; Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
| | - Cheng Hong Toh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taoyuan County, Taiwan
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan City, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan City, Taiwan
| | - Tzung-Hai Yen
- College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shwu-Hua Lee
- College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Department of Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan County, Taiwan.
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30
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Theoretical models of suicidal behaviour: A systematic review and narrative synthesis. THE EUROPEAN JOURNAL OF PSYCHIATRY 2021. [DOI: 10.1016/j.ejpsy.2021.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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31
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Lerman SF, Sylvester S, Hultman CS, Caffrey JA. Suicidality After Burn Injuries: A Systematic Review. J Burn Care Res 2021; 42:357-364. [PMID: 33482003 DOI: 10.1093/jbcr/irab014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Burn survivors may be at increased risk for suicide due to the nature of their injury and psychiatric comorbidities. The purpose of this review is to assess the evidence as to the prevalence of suicidal ideations and behaviors (attempts and completed suicides) in burn survivors as well as evaluate risk and protective factors. PubMed, EMBASE, CINAHL, Cochrane, PsycINFO, and Web Science databases were searched using search terms regarding suicide, suicidality, and burn. Fourteen full-text manuscripts and two published abstracts were included in the review. Overall, burn survivors demonstrate elevated suicidal ideations and a higher lifetime prevalence of suicide attempts compared to the general population. There is mixed evidence as to rates of completed suicide postburn injury, though rates appear to be relatively low. Risk factors include pain at discharge, perceived level of disfigurement, premorbid psychiatric comorbidities, and past suicide attempts. Results of this systematic review shed light on the scarcity of data on rates of suicidality among burn survivors, which is surprising given the multiple risk factors burn survivors possess including chronic pain, sleep disturbances, history of substance abuse, posttraumatic stress disorder, social isolation, and depression which are linked to suicidality in the general population. Suicide risk screening should be included as an integral part of burn survivors' care, and more research is needed to better understand the magnitude of this phenomenon and offer targeted interventions to vulnerable individuals.
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Affiliation(s)
- Sheera F Lerman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Scott Sylvester
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, Division of Burn Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Julie A Caffrey
- Department of Plastic and Reconstructive Surgery, Division of Burn Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Living alone, loneliness and lack of emotional support as predictors of suicide and self-harm: A nine-year follow up of the UK Biobank cohort. J Affect Disord 2021; 279:316-323. [PMID: 33096330 PMCID: PMC7758739 DOI: 10.1016/j.jad.2020.10.026] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/27/2020] [Accepted: 10/11/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The association between loneliness and suicide is poorly understood. We investigated how living alone, loneliness and emotional support were related to suicide and self-harm in a longitudinal design. METHODS Between 2006 and 2010 UK Biobank recruited and assessed in detail over 0.5 million people in middle age. Data were linked to prospective hospital admission and mortality records. Adjusted Cox regression models were used to investigate relationships between living arrangements, loneliness and emotional support, and both suicide and self-harm as outcomes. RESULTS For men, both living alone (Hazard Ratio (HR) 2.16, 95%CI 1.51-3.09) and living with non-partners (HR 1.80, 95%CI 1.08-3.00) were associated with death by suicide, independently of loneliness, which had a modest relationship with suicide (HR 1.43, 95%CI 0.1.01-2.03). For women, there was no evidence that living arrangements, loneliness or emotional support were associated with death by suicide. Associations between living alone and self-harm were explained by health for women, and by health, loneliness and emotional support for men. In fully adjusted models, loneliness was associated with hospital admissions for self-harm in both women (HR 1.89, 95%CI 1.57-2.28) and men (HR 1.74, 95%CI 1.40-2.16). LIMITATIONS Loneliness and emotional support were operationalized using single item measures. CONCLUSIONS For men - but not for women - living alone or living with a non-partner increased the risk of suicide, a finding not explained by subjective loneliness. Overall, loneliness may be more important as a risk factor for self-harm than for suicide. Loneliness also appears to lessen the protective associations of cohabitation.
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Park CHK, Lee JW, Lee SY, Moon J, Jeon DW, Shim SH, Cho SJ, Kim SG, Lee J, Paik JW, Kim MH, You S, Jeon HJ, Rhee SJ, Kim MJ, Kim J, Ahn YM. Suicide risk factors across suicidal ideators, single suicide attempters, and multiple suicide attempters. J Psychiatr Res 2020; 131:1-8. [PMID: 32891923 DOI: 10.1016/j.jpsychires.2020.08.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/14/2020] [Accepted: 08/14/2020] [Indexed: 01/02/2023]
Abstract
Few studies have compared the three suicidality groups-suicidal ideators (SIs), single suicide attempters (SSAs), and multiple suicide attempters (MSAs)-in relation to the suicidal process. This cross-sectional study investigated trends and differences in suicide risk factors across suicidality groups. Using the baseline data of the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior, we analyzed trends (Jonckheere-Terpstra or Mantel-Haenszel χ2 test) and differences (analysis of covariance or logistic regression) in sociodemographic and clinical factors, psychiatric diagnoses, as well as clinical rating scores on psychopathology (suicidal ideation, depressive symptoms, anxiety symptoms, and problem drinking), trait impulsiveness, and stress across suicidality groups. Across suicidality groups comprising 193 SIs, 207 SSAs, and 376 MSAs, we observed a decreasing trend in age and increasing trends in history of early trauma, familial histories of suicide attempts and suicide, most diagnoses and psychopathologies (suicidal ideation, anxiety symptoms, and problem drinking), trait impulsiveness, and stress-with MSAs more likely to have histories of early trauma and familial suicide, almost uniformly higher proportions of diagnoses, and higher psychopathology rating scores. Overall, increasing trends in suicide risk factors were found across all suicidality groups. Notably, MSAs presented greater proportions of most psychiatric diagnoses and higher degrees of most psychopathologies, motor impulsiveness, and stress, indicating they were at more severe clinical states and were closer to suicide. Mental health professionals should ascertain the number of suicide attempts to identify MSAs, implement more thorough evaluations, and employ additional measures for reducing motor impulsiveness.
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Affiliation(s)
- C Hyung Keun Park
- Department of Psychiatry, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Jae Won Lee
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Republic of Korea.
| | - Sang Yeol Lee
- Department of Psychiatry, Wonkwang University Hospital, 895 Muwangno, Iksan, Jeollabuk-do, 54538, Republic of Korea.
| | - Jungjoon Moon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea.
| | - Dong-Wook Jeon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea.
| | - Se-Hoon Shim
- Department of Psychiatry, Soon Chun Hyang University Cheonan Hospital, Soon Chun Hyang University, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do, 31151, Republic of Korea.
| | - Seong-Jin Cho
- Department of Psychiatry, Gachon University Gil Medical Center, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea.
| | - Shin Gyeom Kim
- Department of Neuropsychiatry, Soon Chun Hyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, Gyeonggi-do, 14584, Republic of Korea.
| | - Jeewon Lee
- Department of Neuropsychiatry, Soon Chun Hyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, Gyeonggi-do, 14584, Republic of Korea.
| | - Jong-Woo Paik
- Department of Psychiatry, Kyung Hee University Medical Center, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
| | - Min-Hyuk Kim
- Department of Psychiatry, Wonju Severance Christian Hospital, 20 Ilsan-ro, Wonju, Gangwon-do, 26426, Republic of Korea.
| | - Sungeun You
- Department of Psychology, College of Social Sciences, Chungbuk National University, 1 Chungdae-ro, Seowon-gu, Cheongju, Chungcheongbuk-do, 28644, Republic of Korea.
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Sang Jin Rhee
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Min Ji Kim
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Junghyun Kim
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Yong Min Ahn
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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González-Rodríguez A, Seeman MV. Two Case Studies of Delusions Leading to Suicide, a Selective Review. Psychiatr Q 2020; 91:1061-1073. [PMID: 32761556 DOI: 10.1007/s11126-020-09802-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Many questions pertaining to delusional disorder (DD) remain unanswered. It is unclear what syndromes to include under this category of psychotic illness and when to treat with antidepressants, cognitive therapy, or antipsychotic medication. DD is associated with psychiatric comorbidity, especially depression, and rates of suicidal behavior are high when the two conditions co-exist. In this selective review, we present two instances of suicide in the context of DD, one illustrating risks for the somatic subtype and the second, risks for the persecutory subtype. The frequency of suicidal behaviour in these two subtypes of DD is estimated at 8-21%. The literature suggests a prominent role for social emotions (shame, humiliation) in the pathway leading to suicide. In addition, risk factors found in our two patients point to factors such as poverty, living alone, vulnerable risk periods, stigma, and lack of trust in mental health services. Building trust may be the most effective preventive measure.
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Affiliation(s)
- Alexandre González-Rodríguez
- Department of Mental Health, Parc Tauli University Hospital. I3PT. Autonomous University of Barcelona (UAB), Sabadell, Barcelona, Spain
| | - Mary V Seeman
- Department of Psychiatry, University of Toronto, 260 Heath Street West, Suite #605, Toronto, ON, M5P 3L6, Canada.
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35
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Abou El-Magd RM, Urichuk L, Surood S, Li D, Greenshaw A, Grunau M, MacNeil L, Challborn I, Grauwiler D, Olson R, Agyapong VIO. Family Members' Perspectives on Family and Social Support Available to Suicidal Patients, and Health Systems' Interactions and Responses to Suicide Cases in Alberta: Protocol for a Quantitative Research Study. JMIR Res Protoc 2020; 9:e19112. [PMID: 33231553 PMCID: PMC7723743 DOI: 10.2196/19112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/02/2020] [Accepted: 08/18/2020] [Indexed: 11/15/2022] Open
Abstract
Background Suicide is a major cause of preventable death globally and a leading cause of death by injury in Canada. To support people who experience suicidal thoughts and behaviors and to ultimately prevent people from dying by suicide, it is important to understand individual and familial experiences with the health care system. Objective We present the protocol for a study, the objective of which is to explore how people who died by suicide, and their family members, interacted with the health care system. Methods This is a quantitative research study. Data will be collected through a self-administered paper-based or online survey of the family member of patients who died by suicide. The sample size was calculated to be 385 (margin of error ±3%). Results Data collection will start in October 2020 and results will be available by March 2021. We expect the results to shed light on the experiences of individuals who died by suicide and their family members with the health care system. The study has received ethical clearance from the Health Ethics Research Board of the University of Alberta (Pro00096342). Conclusions Our study may inform practice, policy, and future research. The findings may shape how members of the health care system respond to people who are at risk of suicide and their families. International Registered Report Identifier (IRRID) PRR1-10.2196/19112
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Affiliation(s)
- Rabab M Abou El-Magd
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Liana Urichuk
- Addiction & Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Shireen Surood
- Addiction & Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Daniel Li
- Addiction & Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Andrew Greenshaw
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Mara Grunau
- Centre for Suicide Prevention, Calgary, AB, Canada
| | | | - Ione Challborn
- Canadian Mental Health Association, Edmonton, AB, Canada
| | | | - Robert Olson
- Centre for Suicide Prevention, Calgary, AB, Canada
| | - Vincent Israel Opoku Agyapong
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB, Canada.,Addiction & Mental Health, Alberta Health Services, Edmonton, AB, Canada
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Stewart JG, Shields GS, Esposito EC, Cosby EA, Allen NB, Slavich GM, Auerbach RP. Life Stress and Suicide in Adolescents. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:1707-1722. [PMID: 31028559 DOI: 10.1007/s10802-019-00534-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Stress exposure is central to theories of suicide. To advance understanding of the relation between stress and suicide, we examined whether specific, theoretically-pertinent life stressors were differentially related to suicidal thinking versus suicidal behaviors among hospitalized adolescents. Participants were 197 (144 female) adolescents aged 13 to 19 years old (M = 15.61, SD = 1.48) recruited from an acute residential psychiatric treatment program. Participants were categorized into mutually exclusive groups: psychiatric controls (n = 38) with no lifetime history of suicide ideation or suicide attempts, suicide ideators (n = 99) with current ideation and no lifetime attempts, and suicide attempters (n = 60) with a lifetime history of suicide ideation and at least one attempt in the past month. Adolescents completed the Stress and Adversity Inventory for Adolescents (Adolescent STRAIN), which assessed life events and chronic difficulties occurring in five social-psychological categories: Interpersonal Loss, Physical Danger, Humiliation, Entrapment, and Role Change/Disruption. Additionally, they completed a structured interview and symptom questionnaires to capture concurrent psychopathology. Controlling for demographic and clinical covariates, only Interpersonal Loss events distinguished attempters from psychiatric controls (OR = 2.27) and ideators (OR = 1.49); no events or difficulties differentiated ideators from controls. These effects persisted when analyses were restricted to single attempters and when events following the most recent attempt were excluded. The findings elucidate potential social-environmental triggers of suicide. Ultimately, this may improve the identification of ideators most likely to make an attempt, enabling the deployment of targeted early interventions.
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Affiliation(s)
- Jeremy G Stewart
- Department of Psychology, Queen's University, 62 Arch Street, Kingston, Ontario, K7L 3N6, Canada.
| | - Grant S Shields
- Department of Psychology, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, USA
| | - Erika C Esposito
- Department of Clinical and Social Sciences in Psychology, University of Rochester, P.O. Box 270266, Rochester, NY, 14627-0266, USA
| | - Elizabeth A Cosby
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA, 02215, USA.,McLean Hospital, 115 Mill Street, Belmont, MA, 02478-9106, USA
| | - Nicholas B Allen
- Department of Psychology, University of Oregon, 1227 University Street, Eugene, OR, 97403, USA
| | - George M Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, UCLA Medical Plaza 300, Room 3156, Los Angeles, CA, 90095-7076, USA
| | - Randy P Auerbach
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA.,Division of Clinical Developmental Neuroscience, Sackler Institute, 1051 Riverside Drive, New York, NY, 10032, USA
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37
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Glenn JJ, Nobles AL, Barnes LE, Teachman BA. Can Text Messages Identify Suicide Risk in Real Time? A Within-Subjects Pilot Examination of Temporally Sensitive Markers of Suicide Risk. Clin Psychol Sci 2020; 8:704-722. [PMID: 35692890 PMCID: PMC9186807 DOI: 10.1177/2167702620906146] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Objective tools to assess suicide risk are needed to determine when someone is at imminent risk. This pilot laboratory investigation utilized a within-subjects design to identify patterns in text messaging (SMS) unique to high-risk periods preceding suicide attempts. Individuals reporting a history of suicide attempt (N=33) retrospectively identified past attempts and periods of lower risk (e.g., suicide ideation). Language analysis software scored 189,478 text messages to capture three psychological constructs: self-focus, sentiment, and social engagement. Mixed-effects models tested whether these constructs differed in general (means) and over time (slopes) two weeks before a suicide attempt, relative to lower-risk periods. Regarding mean differences, no language features uniquely differentiated suicide attempts from other episodes. However, when examining patterns over time, anger increased and positive emotion decreased to a greater extent as one approached a suicide attempt. Results suggest private electronic communication has the potential to provide real-time digital markers of suicide risk.
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Affiliation(s)
- Jeffrey J. Glenn
- University of Virginia
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC)
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38
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Dai Q, Wang D, Wang J, Xu H, Andriescue EC, Wu HE, Xiu M, Chen D, Zhang X. Suicide attempts in Chinese Han patients with schizophrenia: cognitive, demographic, and clinical variables. BRAZILIAN JOURNAL OF PSYCHIATRY 2020; 43:29-34. [PMID: 32401875 PMCID: PMC7861187 DOI: 10.1590/1516-4446-2020-0900] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/13/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the lifetime suicide attempt rate, clinical characteristics and cognitive function of Chinese patients with chronic schizophrenia who had attempted suicide. METHODS We collected data from 908 schizophrenia inpatients about suicide attempts through interviews with the patients and their families, as well as through medical records. All patients were assessed with the Positive and Negative Syndrome Scale, the Rating Scale for Extrapyramidal Side Effects, the Abnormal Involuntary Movement Scale, and the Repeated Battery for the Assessment of Neuropsychological Status. RESULTS Of this sample, 97 (10.68%) had attempted suicide. Patients who had attempted suicide were younger, had longer illness duration, and more severe general psychopathology and depressive symptoms than those who had not. Logistic regression analysis confirmed that suicide attempts were correlated with age, smoking, and depression. No cognitive performance differences were observed between patients who had and had not attempted suicide. CONCLUSIONS In China, patients with chronic schizophrenia may have a higher prevalence of lifetime suicide attempts than the general population. Some demographic and clinical variables were related to suicide attempts in patients with chronic schizophrenia.
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Affiliation(s)
- Qilong Dai
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Jiesi Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Huang Xu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Elena C Andriescue
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hanjing E Wu
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Meihong Xiu
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Dachun Chen
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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39
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Exploring the psychiatric and social risk factors contributing to suicidal behaviors in religious young adults. Psychiatry Res 2020; 287:112449. [PMID: 31229309 DOI: 10.1016/j.psychres.2019.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/14/2019] [Accepted: 06/16/2019] [Indexed: 11/22/2022]
Abstract
The religion-suicide relationship is complex, and evidence of the role of religion in suicidal behaviors is inconsistent. This cross-sectional study aims to explore suicidal ideation and attempts among Modern Orthodox Jews and to examine the risk factors for suicidality in the presence of religious practice and affiliation, help-seeking behaviors, and social support. 321 young adults aged 18 to 36 completed self-report questionnaires assessing religious commitment and perception of religion as important, suicidal risk, depression, somatic symptoms, alcohol misuse, social support, and help-seeking patterns. The past 12-month suicide ideation prevalence was 8.7%. 14% of the sample were at risk for suicide. Those at a higher risk for suicide were less involved in religious practices and perceived religion as less important. In addition, depressive symptoms and alcohol misuse at a younger age presented the highest correlation with suicidal risk. The high rate of suicidal ideation among Modern Orthodox young adults highlights their vulnerability in the face of a lack of social support and mental health resources. Due to the limitations inherent in a convenience sampling, i.e., limited generalizability, this study may represent an underestimation of a risk for suicide amongst Modern Orthodox adults.
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40
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Zheng L, Wang O, Hao S, Ye C, Liu M, Xia M, Sabo AN, Markovic L, Stearns F, Kanov L, Sylvester KG, Widen E, McElhinney DB, Zhang W, Liao J, Ling XB. Development of an early-warning system for high-risk patients for suicide attempt using deep learning and electronic health records. Transl Psychiatry 2020; 10:72. [PMID: 32080165 PMCID: PMC7033212 DOI: 10.1038/s41398-020-0684-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 11/12/2019] [Accepted: 11/22/2019] [Indexed: 02/05/2023] Open
Abstract
Suicide is the tenth leading cause of death in the United States (US). An early-warning system (EWS) for suicide attempt could prove valuable for identifying those at risk of suicide attempts, and analyzing the contribution of repeated attempts to the risk of eventual death by suicide. In this study we sought to develop an EWS for high-risk suicide attempt patients through the development of a population-based risk stratification surveillance system. Advanced machine-learning algorithms and deep neural networks were utilized to build models with the data from electronic health records (EHRs). A final risk score was calculated for each individual and calibrated to indicate the probability of a suicide attempt in the following 1-year time period. Risk scores were subjected to individual-level analysis in order to aid in the interpretation of the results for health-care providers managing the at-risk cohorts. The 1-year suicide attempt risk model attained an area under the curve (AUC ROC) of 0.792 and 0.769 in the retrospective and prospective cohorts, respectively. The suicide attempt rate in the "very high risk" category was 60 times greater than the population baseline when tested in the prospective cohorts. Mental health disorders including depression, bipolar disorders and anxiety, along with substance abuse, impulse control disorders, clinical utilization indicators, and socioeconomic determinants were recognized as significant features associated with incident suicide attempt.
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Affiliation(s)
- Le Zheng
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
- Clinical and Translational Research Program, Betty Irene Moore Children's Heart Center, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | | | - Shiying Hao
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
- Clinical and Translational Research Program, Betty Irene Moore Children's Heart Center, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Chengyin Ye
- Department of Health Management, Hangzhou Normal University, Hangzhou, China
| | - Modi Liu
- HBI Solutions Inc, Palo Alto, CA, USA
| | | | - Alex N Sabo
- Department of Psychiatry and Behavioral Sciences, Berkshire Medical Center, Pittsfield, MA, USA
- Department of Psychiatry and Behavioral Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Liliana Markovic
- Department of Psychiatry and Behavioral Sciences, Berkshire Medical Center, Pittsfield, MA, USA
- Department of Psychiatry and Behavioral Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | | | | | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
- Clinical and Translational Research Program, Betty Irene Moore Children's Heart Center, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Wei Zhang
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, China
| | - Jiayu Liao
- Department of Bioengineering, Bourns College of Engineering, University of California at Riverside, Riverside, CA, USA
- West China-California Center for Predictive Intervention Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xuefeng B Ling
- Clinical and Translational Research Program, Betty Irene Moore Children's Heart Center, Lucile Packard Children's Hospital, Palo Alto, CA, USA.
- Department of Surgery, Stanford University, Stanford, CA, USA.
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41
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Abstract
Suicide ideation expressed in social media has an impact on language usage. Many at-risk individuals use social forum platforms to discuss their problems or get access to information on similar tasks. The key objective of our study is to present ongoing work on automatic recognition of suicidal posts. We address the early detection of suicide ideation through deep learning and machine learning-based classification approaches applied to Reddit social media. For such purpose, we employ an LSTM-CNN combined model to evaluate and compare to other classification models. Our experiment shows the combined neural network architecture with word embedding techniques can achieve the best relevance classification results. Additionally, our results support the strength and ability of deep learning architectures to build an effective model for a suicide risk assessment in various text classification tasks.
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42
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Mejías-Martín Y, Luna del Castillo JDD, Rodríguez-Mejías C, Martí-García C, Valencia-Quintero JP, García-Caro MP. Factors Associated with Suicide Attempts and Suicides in the General Population of Andalusia (Spain). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4496. [PMID: 31739626 PMCID: PMC6888127 DOI: 10.3390/ijerph16224496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 12/16/2022]
Abstract
Discrepant results have been published by studies comparing deaths by suicide with attempted suicides. This study aimed to determine factors associated with suicides and attempted suicides in Andalusia (Spain) between 2007 and 2013, comparing sex, age, year, and suicide method between these populations. A retrospective study was conducted of data on deaths by suicide and attempted suicides over a seven-year period, calculating the sex and age rates for each behavior. Adjusted Poisson regression was used to analyze the association with study variables, and incidence rate ratios were estimated. During the seven-year study period, 20,254 attempted suicides and 5202 deaths by suicide were recorded. The prevalence of attempted suicide did not differ between the sexes, whereas the prevalence of deaths by suicide was three-fold higher among males than among females and increased with higher age. The most frequently used method was the same in males and females for suicide attempts, but differed between the sexes for suicides. The combined influence of sex and age was greater in the model for death by suicide than in the model for attempted suicide. The key differentiating factor was the method used, while the finding of greatest concern was the suicide behavior among the elderly. Preventive strategies should take these differences into account.
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Affiliation(s)
- Yolanda Mejías-Martín
- Department of Mental Health, General University Hospital Virgen de las Nieves, 18014 Granada, Spain;
| | | | - Candela Rodríguez-Mejías
- Department of Intensive Care, General University Hospital Virgen de las Nieves, 18014 Granada, Spain; (C.R.-M.); (J.P.V.-Q.)
| | - Celia Martí-García
- Department of Nursing, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
| | - Juan Pablo Valencia-Quintero
- Department of Intensive Care, General University Hospital Virgen de las Nieves, 18014 Granada, Spain; (C.R.-M.); (J.P.V.-Q.)
| | - María Paz García-Caro
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain;
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43
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Pawsey SC, Wilson CG, Gunther WM, Fantaskey AP. Suicide by Close-Range Gunshot Wound to the Bridge of the Nose. J Forensic Sci 2019; 65:984-986. [PMID: 31651989 DOI: 10.1111/1556-4029.14221] [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: 08/22/2019] [Revised: 09/30/2019] [Accepted: 10/09/2019] [Indexed: 11/28/2022]
Abstract
Suicidal gunshot wounds to the nasal bridge are rare, particularly at close range (defined as muzzle of the weapon not touching the skin surface, but near enough to deposit soot and stippling). Previously reported suicidal gunshot wounds to the nose have been through the left nostril (Forensic Sci Int 1995;71(1):25-31; J Forensic Radiol Imag 2013;1(2):63-7). The death of a 26-year-old man with a close-range gunshot wound to the bridge of the nose was deemed suicide due to history, scene, and autopsy findings. These findings included previous suicidal ideation, texted and written notes, the decedent's cross-legged position seated on the floor, the trajectory of the bullet through his head and into the ceiling fan and roof above him, and acute alcohol intoxication. This decedent may have been intending a hard contact forehead location but inadvertently fired the gun into the bridge of his nose while bending forward, prior to contact.
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Affiliation(s)
- Sydney C Pawsey
- Physician Assistant Program, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA, 23501
| | - Catherine G Wilson
- Doctor of Medicine Program, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA, 23501
| | - Wendy M Gunther
- Tidewater District, Commonwealth of Virginia, Office of the Chief Medical Examiner, 830 Southampton Avenue, Ste. 100, Norfolk, VA, 23510
| | - Amy P Fantaskey
- Physician Assistant Program, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA, 23501
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44
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Bryksa E, Shalaby R, Friesen L, Klingle K, Gaine G, Urichuk L, Surood S, Agyapong V. Family Members' Perspectives of Health Care System Interactions With Suicidal Patients and Responses to Suicides: Protocol for a Qualitative Research Study. JMIR Res Protoc 2019; 8:e13797. [PMID: 31400108 PMCID: PMC6709894 DOI: 10.2196/13797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 12/16/2022] Open
Abstract
Background Suicide is a major cause of preventable death globally and a leading cause of death by injury in Canada. To support people who experience suicidal thoughts and behaviors and ultimately prevent people from dying by suicide, it is important to understand the individual and familial experiences with the health care system. Objective This study aims to explore how suicide victims, and their family members, interacted with the health care system. Methods We will invite family members of 6 to 8 suicide victims to participate in the study by sharing their perspectives on both their relative’s as well as their own interactions with the health care system. Interviews will take place in-person and will be audio recorded, transcribed, and analyzed thematically. Results The results of the study are expected to be available in 12 months. We expect the results to shed light on the experiences of suicide victims and their family members with the health care system. Conclusions Our study results may inform practice, policy, and further research. They may shape how members of the health care system respond to people who are at risk of suicide and their families. International Registered Report Identifier (IRRID) PRR1-10.2196/13797
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Affiliation(s)
- Erin Bryksa
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Laura Friesen
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Kirsten Klingle
- Department of Educational Psychology, Faculty of Education, University of Alberta, Edmonton, AB, Canada
| | - Graham Gaine
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Liana Urichuk
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Shireen Surood
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Vincent Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
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45
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Rethinking suicides as mental accidents: Towards a new paradigm. J Affect Disord 2019; 252:141-151. [PMID: 30981951 DOI: 10.1016/j.jad.2019.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/27/2019] [Accepted: 04/07/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Since its beginnings, suicide research has made great progress in terms of empirical findings. However, in contrast to empirical knowledge, the theoretical understanding of suicides has shown only minimal progress. Missing interdisciplinary bridges and the lack of a unifying paradigm have been major obstacles. This paper examines the starting points for a rethink. METHODS In the first step, we identified major challenges in suicide research, which have been obstructing a better understanding. In the second step, we determined a new concept of suicide that is highly compatible with epidemiological results and meets the requirements of interdisciplinary usability. In the third step, the implications of this paradigm were explored by relating it to two process typologies, the one characterizing the temporal dynamics of suicide processes, and the other representing risk mechanisms / factors occurring at different stages of suicide processes. RESULTS Since suicides are rare events and often appear to be "rash acts", they can be conceived of as mental accidents or, more precisely, as failures to withstand temporary suicide impulses. This paradigm is suitable for synchronously implementing different personal, psychopathological, societal and situational perspectives. It applies to a high proportion of suicides and works well when being exposed to different typologies of suicide processes. CONCLUSIONS The mental accident paradigm provides an interdisciplinary starting point in suicidology that offers new perspectives in research, prediction and prevention.
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46
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Fuller-Thomson E, Kotchapaw LD. Remission From Suicidal Ideation Among Those in Chronic Pain: What Factors Are Associated With Resilience? THE JOURNAL OF PAIN 2019; 20:1048-1056. [PMID: 30979638 DOI: 10.1016/j.jpain.2019.02.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 01/27/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
Abstract
Although there have been many studies on the link between chronic pain and suicidality, surprisingly little research has focused on resilience and recovery among those in chronic and disabling pain who have had suicidal thoughts. The objectives of this study were to identify the prevalence and correlates of recovery from suicidal thoughts among those in chronic pain. A secondary analysis of a nationally representative sample of Canadians in chronic and disabling pain who had ever had serious suicidal thoughts (N = 635) was conducted to identify the prevalence and characteristics of those who are no longer considering suicide. Data were drawn from the Canadian Community Health Survey-Mental Health. Three in five Canadians in chronic pain (63%) who had seriously considered suicide at some point in their life had been free of these thoughts in the past year. Those free of suicidal ideation were significantly more likely to be older, women, white, better educated, with a confidant, and to use spirituality to cope, but less likely to have low household incomes, difficulties meeting basic expenses, and a history of depression and anxiety disorders. PERSPECTIVE: Almost two-thirds of formerly suicidal Canadians with chronic pain were free from suicidal thoughts in the past year. These findings provide a hopeful message of resilience and recovery in the context of disabling pain and help to improve targeted outreach to those most at risk for unremitting suicidality.
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Affiliation(s)
- Esme Fuller-Thomson
- Institute for Life Course & Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
| | - Lyndsey D Kotchapaw
- Institute for Life Course & Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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47
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Jongkind M, van den Brink B, Schaap-Jonker H, van der Velde N, Braam AW. Dimensions of Religion Associated with Suicide Attempt and Suicide Ideation in Depressed, Religiously Affiliated Patients. Suicide Life Threat Behav 2019; 49:505-519. [PMID: 29676507 DOI: 10.1111/sltb.12456] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/20/2017] [Indexed: 11/29/2022]
Abstract
There is substantial evidence to support the claim that religion can protect against suicide ideation, suicide attempts, and completed suicide. There is also evidence that religion does not always protect against suicidality. More insight is needed into the relationship between suicidal parameters and dimensions of religion. A total of 155 in- and outpatients with major depression from a Christian Mental Health Care institution were included. The following religious factors were assessed: religious service attendance, frequency of prayer, religious salience, type of God representation, and moral objections to suicide (MOS). Multiple regression analyses were computed. MOS have a unique and prominent (negative) association with suicide ideation and the lifetime history of suicide attempts, even after controlling for demographic features and severity of depression. The type of God representation is an independent statistical predictor of the severity of suicide ideation. A positive-supportive God representation is negatively correlated with suicide ideation. A passive-distressing God representation has a positive correlation with suicide ideation. High MOS and a positive-supportive God representation in Christian patients with depression are negatively correlated with suicide ideation. Both are likely to be important markers for assessment and further development of therapeutic strategies.
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Affiliation(s)
- Matthias Jongkind
- Eleos - Christian Centre for Mental Health Care, Amersfoort, The Netherlands.,KICG-Centre for Research and Innovation in Christian Mental Health Care, Amersfoort, The Netherlands
| | - Bart van den Brink
- Eleos - Christian Centre for Mental Health Care, Amersfoort, The Netherlands.,KICG-Centre for Research and Innovation in Christian Mental Health Care, Amersfoort, The Netherlands
| | - Hanneke Schaap-Jonker
- Eleos - Christian Centre for Mental Health Care, Amersfoort, The Netherlands.,KICG-Centre for Research and Innovation in Christian Mental Health Care, Amersfoort, The Netherlands
| | - Nathan van der Velde
- Eleos - Christian Centre for Mental Health Care, Amersfoort, The Netherlands.,KICG-Centre for Research and Innovation in Christian Mental Health Care, Amersfoort, The Netherlands
| | - Arjan W Braam
- Department of Emergency Psychiatry and Department of Specialist Training, Altrecht Mental Health Care, Utrecht, The Netherlands.,Department of Humanist Counseling, University for Humanistic Studies, Utrecht, The Netherlands
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48
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Rawat S, Rajkumari S, Joshi PC, Khan MA, Saraswathy KN. Who dies and who survives? Investigating the difference between suicide decedents and suicide attempters. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2019. [DOI: 10.1186/s41935-019-0115-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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49
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Fanelli G, Serretti A. The influence of the serotonin transporter gene 5-HTTLPR polymorphism on suicidal behaviors: a meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2019; 88:375-387. [PMID: 30125622 DOI: 10.1016/j.pnpbp.2018.08.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/31/2018] [Accepted: 08/13/2018] [Indexed: 12/16/2022]
Abstract
Suicidal Behavior (SB) is the second leading cause of death among youths worldwide and the tenth among all age groups. Inherited genetic differences have a role in suicidality with heritability ranging from 30 to 55%. The SLC6A4 5-HTTLPR gene variant has been largely investigated for association with SB, with controversial results. In this work, we sought to determine whether the results of previous meta-analyses were confirmed or modified subsequent to the inclusion of more recent literature data. An electronic literature search was performed to identify relevant studies published until July 2018. Data were analysed through RevMan v5.3. Subgroup and sensitivity meta-analyses were performed considering different SB sub-phenotypes, ethnicity, gender and psychiatric diagnostic categories. Our literature search yielded 1186 articles; among these, we identified 45 pertinent case-control studies (15,341 subjects). No association was found between low-expressing alleles or genotypes (S + LG alleles or S' carrier genotypes) and SB in the primary analyses. However, low-expressing alleles (S + LG) were associated with an increased risk of Violent Suicide Attempt (OR = 1.44, C.I. 1.17-1.78, p = .0007). An effect of the same alleles on SB was found in a subpopulation of substance abusers, but this result was not confirmed after the exclusion of healthy subjects from the control group. The other sensitivity meta-analyses did not show any significant effect. Our findings contribute to clarify the conflicting previous evidence by suggesting an association between the 5-HTTLPR and Violent SB. Nonetheless, many other modulators, including environmental factors and epigenetic mechanisms may act to further increase the level of complexity.
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Affiliation(s)
- Giuseppe Fanelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.
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50
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Athey A, Overholser J, Bagge C, Dieter L, Vallender E, Stockmeier CA. Risk-taking behaviors and stressors differentially predict suicidal preparation, non-fatal suicide attempts, and suicide deaths. Psychiatry Res 2018; 270:160-167. [PMID: 30253320 PMCID: PMC6292776 DOI: 10.1016/j.psychres.2018.09.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 09/10/2018] [Accepted: 09/15/2018] [Indexed: 10/28/2022]
Abstract
Negative life events are elevated in suicidal populations. Diathesis-stress and kindling effects models suggest different mechanisms by which negative life events increase suicide risk. Different forms of negative life events - risk-taking behaviors and stressors - may have different effects on non-fatal suicide attempts and suicide. We assessed the effects of risk-taking behaviors and stressors on suicide, history of non-fatal suicide attempts, and active preparation for suicide in a sample of adults who died by suicide or other causes (N = 377). Psychological autopsy procedures using family member interviews and collateral record review were used to complete a risk-taking behaviors composite measure from the Structured Interview for DSM-IV Personality Disorders, the Modified Life Experiences Scale, and the planning subscale of the Suicide Intent Scale. Stressors were significantly associated with death by suicide, even when accounting for demographic and diagnostic characteristics. Risk-taking behaviors were significantly associated with non-fatal suicide attempts, even when accounting for demographic and diagnostic characteristics. Suicide decedents who did not actively prepare for suicide showed significantly higher risk-taking scores than suicide decedents who actively planned for suicide. Our results suggest that risk-taking behaviors and stressors impact suicide risk through separate mechanisms. Risk-taking behaviors may represent a longstanding vulnerability to act impulsively on suicidal thoughts. Stressors may impact risk for fatal suicidal behaviors in mood disordered populations.
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Affiliation(s)
- Alison Athey
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road Cleveland, OH 44106-7123, USA.
| | - James Overholser
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road Cleveland, OH 44106-7123, USA.
| | - Courtney Bagge
- Department of Psychiatry and Human Behavior, Center for Psychiatric Neuroscience, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS 39216, USA.
| | - Lesa Dieter
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road Cleveland, OH 44106-7123, USA.
| | - Eric Vallender
- Department of Psychiatry and Human Behavior, Center for Psychiatric Neuroscience, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS 39216, USA.
| | - Craig A. Stockmeier
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road Cleveland, OH 44106-7123, USA,Department of Psychiatry and Human Behavior, Center for Psychiatric Neuroscience, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS 39216, USA
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