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Szücs A, Galfalvy H, Alessi MG, Kenneally LB, Valderas JM, Maier AB, Szanto K. Diligent for better or worse: Conscientiousness is associated with higher likelihood of suicidal behavior and more severe suicidal intent in later life. Compr Psychiatry 2024; 135:152523. [PMID: 39126760 DOI: 10.1016/j.comppsych.2024.152523] [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: 04/10/2024] [Revised: 07/18/2024] [Accepted: 08/04/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Contradictory findings link trait conscientiousness in mid- and late life to increased healthspan and lifespan, as well as to death by suicide. It remains unclear whether conscientiousness is associated with higher odds of attempting suicide or with more severe suicidal behavior among attempters, and whether its relationship to suicide risk varies with aging-related stressors, such as declining health. METHODS In this cross-sectional study comprising 313 depressed adults aged ≥40 years and participating in the Longitudinal Research Program in Late-Life Suicide (Pittsburgh, USA), we employed logistic and linear regression to test whether conscientiousness was associated with the presence of recent suicidal behavior (≤2 years) and with intent severity in recent attempters (n = 84). We further tested whether the above relationships varied based on mental, cognitive, and physical health status, measured as depression severity, cognitive functioning, and the presence/absence of severe physical illness. RESULTS Participants were 62.1 years old on average (SD = 7.6), 85% White, and 53% female. Recent attempters had a mean age of 61.8 years at their most recent attempt (SD = 8.5), had lower cognitive functioning and were more likely severely physically ill than comparisons. Conscientiousness was positively associated with a higher likelihood of recent suicidal behavior overall (adjusted OR = 1.44, 95% CI = 1.09, 1.90, p = .010), but not in case of co-occurring severe physical illness (interaction OR = 0.54, 95% CI = 0.30, 0.97, p = .039). Conscientiousness was also positively associated with suicidal intent at the most recent attempt (adjusted β = 1.60, SE = 0.62, p = .012), explaining 7% of its variance, although this association lost significance after adjusting for other personality dimensions. CONCLUSIONS Highly conscientious middle-aged and older adults may be at increased risk of resolute suicidal behavior, although conscientiousness may not confer additional suicide risk among those severely physically ill.
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Affiliation(s)
- Anna Szücs
- Vrije Universiteit Amsterdam, Faculty of Behavioural and Movement Sciences, The Netherlands; National University of Singapore, Yong Loo Lin School of Medicine, Department of Medicine, Singapore.
| | | | - Maria G Alessi
- University of North Carolina at Charlotte, Program in Health Psychology, USA
| | | | - Jose M Valderas
- National University of Singapore, Yong Loo Lin School of Medicine, Department of Medicine, Singapore
| | - Andrea B Maier
- Vrije Universiteit Amsterdam, Faculty of Behavioural and Movement Sciences, The Netherlands; National University of Singapore, Yong Loo Lin School of Medicine, Department of Medicine, Singapore
| | - Katalin Szanto
- University of Pittsburgh, School of Medicine, Department of Psychiatry, USA
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Nobile B, Jaussent I, Kahn JP, Leboyer M, Risch N, Olié E, Courtet P. Risk factors of suicide re-attempt: A two-year prospective study. J Affect Disord 2024; 356:535-544. [PMID: 38657762 DOI: 10.1016/j.jad.2024.04.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/09/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND History of suicide attempt (SA) is the strongest predictor of a new SA and suicide. It is primordial to identify additional risk factors of suicide re-attempt. The aim of this study was to identify risk factors of suicide re-attempt in patients with recent SA followed for 2 years. METHODS In this multicentric cohort of adult inpatients, the median of the index SA before inclusion was 10 days. Clinicians assessed a large panel of psychological dimensions using validated tools. Occurrence of a new SA or death by suicide during the follow-up was recorded. A cluster analysis was used to identify the dimensions that best characterized the population and a variable "number of personality traits" was created that included the three most representative traits: anxiety, anger, and anxious lability. Risk factors of re-attempt were assessed with adjusted Cox regression models. RESULTS Among the 379 patients included, 100 (26.4 %) re-attempted suicide and 6 (1.6 %) died by suicide. The two major risk factors of suicide re-attempt were no history of violent SA and presenting two or three personality traits among trait anxiety, anger and anxious lability. LIMITATIONS It was impossible to know if treatment change during follow-up occur before or after the re-attempt. DISCUSSION One of the most important predictors of re-attempt in suicide attempters with mood disorders, was the presence of three personality traits (anger, anxiety, and anxious lability). Clinicians should provide close monitoring to patients presenting these traits and proposed treatments specifically targeting these dimensions, especially anxiety.
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Affiliation(s)
- B Nobile
- Department of Emergency Psychiatry and Acute Care, CHU, Montpellier, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France; FondaMental Foundation, France.
| | - I Jaussent
- Institute for Neurosciences of Montpellier INM, INSERM Montpellier, University of Montpellier, Montpellier, France
| | - J P Kahn
- Université de Lorraine, Nancy, France; Clinique Soins-Etudes de Vitry le François, Fondation Sant'e des Etudiants de France (FSEF), Paris, France
| | - M Leboyer
- FondaMental Foundation, France; Univ Paris Est Créteil, INSERM U955, IMRB, Translational NeuroPsychiatry Laboratory, Créteil, France; AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - N Risch
- IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - E Olié
- Department of Emergency Psychiatry and Acute Care, CHU, Montpellier, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France; FondaMental Foundation, France
| | - Ph Courtet
- Department of Emergency Psychiatry and Acute Care, CHU, Montpellier, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France; FondaMental Foundation, France
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Mehanović E, Rosso G, Cuomo GL, Diecidue R, Maina G, Costa G, Vigna-Taglianti F. Risk factors for mortality after hospitalization for suicide attempt: results of 11-year follow-up study in Piedmont Region, Italy. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1039-1051. [PMID: 37552335 PMCID: PMC11116226 DOI: 10.1007/s00127-023-02544-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/30/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Suicide attempters are at high risk of premature death, both for suicide and for non-suicidal causes. The aim of this study is to investigate risk factors and temporal span for mortality in a cohort of cases admitted to hospital for suicide attempt. METHODS The cohort included 1489 patients resident in Piedmont Region, North West of Italy, who had been admitted to hospital or emergency department for suicide attempt between 2010 and 2020. Cox regression models were used to identify risk factors for death. The final multivariate model included gender, age, area deprivation index, family composition, psychiatric disorders, malignant neoplasms, neurological disorders, diabetes mellitus, cardiovascular diseases, chronic obstructive pulmonary disease, and intracranial injury or skull fracture. RESULTS During the observation period, 7.3% of patients died. The highest mortality was observed within the first 12 months after suicide attempt, and remained elevated for many years afterwards. Male gender, older age, high deprivation index of the census area, single-parent family, mood disorders, malignant neoplasms, diabetes mellitus and intracranial injuries or skull fracture were independent predictors of death. Risk factors for natural and unnatural causes of death were also identified. CONCLUSIONS The mortality risk of suicide attempters is very high, both in the months immediately following the attempt and afterwards. The identification of high-risk groups can help to plan outpatient care following the hospital discharge. Our findings urge the need to design strategies for the assistance and care of these patients at long term in order to reduce the unfavourable outcomes.
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Affiliation(s)
- Emina Mehanović
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy.
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy.
| | - Gianluca Rosso
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Gian Luca Cuomo
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy
| | - Roberto Diecidue
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy
| | - Giuseppe Maina
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Giuseppe Costa
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy
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Morikawa K, Nomura K, Onozawa D, Sasaki H, Morikawa Y. Sociodemographic and environmental characteristics associated with thoughts of death and suicidal ideation in community-dwelling residents of a rural town in Japan: analyses from a perspective of accompanying problems. BMC Public Health 2024; 24:1130. [PMID: 38654210 DOI: 10.1186/s12889-024-18538-2] [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: 10/06/2023] [Accepted: 04/07/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE Suicide prevention has been focused on primary prevention as a group rather than individuals. However, we aimed to identify sociodemographic and environmental characteristics of individuals with suicidal thoughts among rural residents in Japan. METHODS In 2015, a cross-sectional home visit survey was conducted in a rural town in Akita Prefecture. A total of 1,844 residents aged ≥ 20 years (response rate, 65%) answered a self-administered questionnaire about suicidal thoughts in the past one month. Multivariate logistic regression analyses were used to investigate sociodemographic and environmental characteristics associated with suicidal thoughts in models with accompanying problems for human relations problems (HRP), health problems (HP), and financial problems (FP), or with no accompanying problems. RESULTS In total, 218 (men 9.4%, women 13.8%) had suicidal thoughts with accompanying problems for HRP (n = 104), HP (n = 112), and FP (n = 72). The risk characteristics were Kessler Psychological Distress Scale scores ≥ 9 in models with HRP, HP, and FP or with no accompanying problems; being a woman and current smoking with no accompanying problems; absence of a person for help in a model of FP; and absence of family member for help in a model of HRP or with no accompanying problems. The mitigating factor were being optimistic (a domain of resilience skills identified by factor analysis) in models of HRP, HP, and FP or with no accompanying problems; being aged 70-79 and being aged ≥ 80 in a model of HRP. CONCLUSIONS Suicidal thoughts among rural residents in Japan were associated with multifactorial sociodemographic and environmental characteristics.
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Affiliation(s)
- Kozue Morikawa
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
- Department of Judo Physical Therapy, Teikyo Heisei University Faculty of Health Care and Medical Sports, Chiba, Japan
| | - Kyoko Nomura
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Daisuke Onozawa
- Department of Judo Physical Therapy, Teikyo Heisei University Faculty of Health Care and Medical Sports, Chiba, Japan
| | - Hisanaga Sasaki
- Department of Health Science and Nursing, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshiki Morikawa
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
- Department of Judo Physical Therapy, Teikyo Heisei University Faculty of Health Care and Medical Sports, Chiba, Japan
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Pemau A, Marin-Martin C, Diaz-Marsa M, de la Torre-Luque A, Ayad-Ahmed W, Gonzalez-Pinto A, Garrido-Torres N, Garrido-Sanchez L, Roberto N, Lopez-Peña P, Mar-Barrutia L, Grande I, Guinovart M, Hernandez-Calle D, Jimenez-Treviño L, Lopez-Sola C, Mediavilla R, Perez-Aranda A, Ruiz-Veguilla M, Seijo-Zazo E, Toll A, Elices M, Perez-Sola V, Ayuso-Mateos JL. Risk factors for suicide reattempt: a systematic review and meta-analysis. Psychol Med 2024:1-8. [PMID: 38623694 DOI: 10.1017/s0033291724000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Suicide is one of the main external causes of death worldwide. People who have already attempted suicide are at high risk of new suicidal behavior. However, there is a lack of information on the risk factors that facilitate the appearance of reattempts. The aim of this study was to calculate the risk of suicide reattempt in the presence of suicidal history and psychosocial risk factors and to estimate the effect of each individual risk factor. METHODS This systematic review and meta-analysis were conducted following the PRISMA-2020 guidelines. Studies on suicide reattempt that measured risk factors were searched from inception to 2022. The risk factors studied were those directly related to suicide history: history of suicide prior to the index attempt, and those that mediate the transition from suicidal ideation to attempt (alcohol or drug misuse, impulsivity, trauma, and non-suicidal self-injury). RESULTS The initial search resulted in 11 905 articles. Of these, 34 articles were selected for this meta-analysis, jointly presenting 52 different effect sizes. The pooled effect size across the risk factors was significant (OR 2.16). Reattempt risk may be increased in presence of any of the following risk factors: previous history, active suicidal ideation, trauma, alcohol misuse, and drug misuse. However, impulsivity, and non-suicidal self-injury did not show a significant effect on reattempt. CONCLUSION Most of the risk factors traditionally associated with suicide are also relevant when talking about suicide reattempts. Knowing the traits that define reattempters can help develop better preventive and intervention plans.
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Affiliation(s)
- Andres Pemau
- Universidad Complutense de Madrid, Madrid, Spain
| | | | - Marina Diaz-Marsa
- San Carlos University Clinic Hospital, Madrid, Spain
- Araba University Hospital, Vitoria, Spain
| | - Alejandro de la Torre-Luque
- Universidad Complutense de Madrid, Madrid, Spain
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | | | - Ana Gonzalez-Pinto
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Araba University Hospital, Vitoria, Spain
- University of the Basque Country, Bilbao, Spain
| | - Nathalia Garrido-Torres
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Virgen del Rocio University Hospital, Seville, Spain
- Seville Biomedical Research Institute (IBiS), Seville, Spain
| | | | - Natalia Roberto
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Purificación Lopez-Peña
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Araba University Hospital, Vitoria, Spain
- University of the Basque Country, Bilbao, Spain
- BIOARABA, Vitoria, Spain
| | - Lorea Mar-Barrutia
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Araba University Hospital, Vitoria, Spain
- University of the Basque Country, Bilbao, Spain
- BIOARABA, Vitoria, Spain
| | - Iria Grande
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Marti Guinovart
- Institut d'Investigacio i Innovacio ParcTauli (I3PT), Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Daniel Hernandez-Calle
- La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Luis Jimenez-Treviño
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
- Principado de Asturias Health Research Institute (ISPA), Oviedo, Spain
- University of Oviedo, Oviedo, Spain
- Principado de Asturias Neuroscience Research Institute (INEUROPA), Oviedo, Spain
| | - Clara Lopez-Sola
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Roberto Mediavilla
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Autonomous University of Madrid, Madrid, Spain
| | | | - Miguel Ruiz-Veguilla
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Virgen del Rocio University Hospital, Seville, Spain
- Seville Biomedical Research Institute (IBiS), Seville, Spain
- University of Seville, Seville, Spain
| | - Elisa Seijo-Zazo
- Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
- Principado de Asturias Health Research Institute (ISPA), Oviedo, Spain
- University of Oviedo, Oviedo, Spain
- Principado de Asturias Neuroscience Research Institute (INEUROPA), Oviedo, Spain
| | - Alba Toll
- Autonomous University of Barcelona, Barcelona, Spain
- Neurosciences Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Matilde Elices
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Autonomous University of Barcelona, Barcelona, Spain
- Neurosciences Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Victor Perez-Sola
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Neurosciences Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
- Hospital de Mar, Mental Health Institute, Barcelona, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Jose Luis Ayuso-Mateos
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Autonomous University of Madrid, Madrid, Spain
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Berardelli I, Aguglia A, Amerio A, Sarubbi S, Rogante E, Trocchia MA, Zelletta D, Longhini L, Erbuto D, Pastorino F, Lamis DA, Innamorati M, Serafini G, Pompili M. Characterization of Psychiatric Inpatients: The Role of Gender Differences in Clinical and Pharmacological Patterns. J Psychiatr Pract 2024; 30:2-12. [PMID: 38227722 DOI: 10.1097/pra.0000000000000756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Severe mental disorders that require hospitalization are disabling conditions that contribute to the burden of mental diseases. They pose increased clinical challenges and highlight the need to thoroughly explore variables emerging from daily clinical practice. In this study, we assessed to what extent gender differences may characterize a large population of psychiatric inpatients. METHODS We conducted a cross-sectional study in 2 Italian teaching medical centers, which included 2358 patients who were consecutively admitted to the psychiatric emergency units. We explored and characterized gender differences for variables such as prevalence of psychiatric diagnosis, presence of suicidal ideation, suicide attempts, age at onset of psychiatric illness, presence of substance or alcohol abuse, length of stay, number of hospitalizations, presence of involuntary admission, type of discharge from the hospital, and pharmacological treatment at discharge. RESULTS Female patients were primarily diagnosed with bipolar disorder or personality disorders. Female patients had a significantly higher prevalence of lifetime suicide attempts (23.1% vs. 16.5%, P<0.001) and a longer length of hospitalization (11.43±10.73 d vs. 10.52±10.37 d, t=-2.099, gl=2356, P=0.036) compared with male patients. Male patients had more involuntary admissions (25.1% vs. 19.7%, χ2=9.616, gl=1, P=0.002), more use of illicit substances (34.1% vs. 20.9%, χ2=51.084, gl=1, P<0.001), and higher rates of alcohol abuse (21.3% vs. 14.7%, χ2=17.182, gl=1, P<0.001) compared with female patients. Finally, antidepressants and lithium were prescribed more frequently to the female patients, whereas other mood stabilizers were more often prescribed to the male patients. CONCLUSIONS Our real-world results highlighted gender differences among patients with severe mental disorders admitted to psychiatric units, and suggest further investigations that may help in understanding trajectories accompanying disabling clinical conditions.
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Yeşiloğlu C, Tamam L, Demirkol ME, Namli Z, Karaytuğ MO, Şenbayram Güzelbaba Ş. The relationship of coping skills with psychache in patients with depressive disorder. Medicine (Baltimore) 2023; 102:e34339. [PMID: 37478252 PMCID: PMC10662877 DOI: 10.1097/md.0000000000034339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/23/2023] [Indexed: 07/23/2023] Open
Abstract
Suicide is a leading cause of death and disability worldwide. Psychache (psychological pain) and diminished tolerance of psychaches are important risk factors for suicide. People experiencing psychaches of similar severity may not demonstrate the same levels of tolerance because of various coping skills. This study aimed to determine the relationship between psychache, tolerance for psychache, and coping skills in individuals with depression and healthy controls. We included 73 patients with depressive disorders without comorbid mental disorders and 65 healthy controls. We applied beck depression inventory, beck hopelessness scale, beck suicidal ideation scale, psychache scale, tolerance for mental pain scale (TMPS), and coping attitudes evaluation scale (COPE) to all participants. People with depression had significantly higher COPE dysfunction scores than those in the control group did. Patients who had previously attempted suicide attempt(s) previously had significantly higher beck hopelessness scale, beck depression inventory, COPE dysfunction, and psychache scale scores, and lower TMPS-10 scores than those who did not attempt suicide. Mediation analyses revealed that dysfunctional coping skills played a partial mediating role in the relationship between psychache and the TMPS. The study revealed that dysfunctional coping skills were related to suicidal ideation and previous suicide attempts. These findings suggest that improving coping skills could help reduce the severity of suicidal ideation.
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Affiliation(s)
- Caner Yeşiloğlu
- Kirşehir Training and Research Hospital, Department of Psychiatry, Kirşehir, Turkey
| | - Lut Tamam
- Çukurova University School of Medicine, Department of Psychiatry, Adana, Turkey
| | | | - Zeynep Namli
- Çukurova University School of Medicine, Department of Psychiatry, Adana, Turkey
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Cause-specific mortality after hospital discharge for suicide attempt or suicidal ideation: A cohort study in Piedmont Region, Italy. J Psychiatr Res 2023; 161:19-26. [PMID: 36893667 DOI: 10.1016/j.jpsychires.2023.02.035] [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: 05/10/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Suicide attempters are at higher risk of death than the general population. The present study aims to investigate the excess of all-cause mortality and cause-specific mortality in a cohort of patients who have attempted suicide or had suicidal ideation compared with the general population. METHOD The cohort included 826 patients residing in the Piedmont Region of Northwest Italy who were admitted to a hospital or emergency department for suicide attempts or suicidal ideation between 2010 and 2016. Mortality excesses of the study population compared to the general population were estimated by applying indirect standardization. Standardized Mortality Ratios and 95% Confidence Intervals were calculated for all-cause, and cause-specific, natural, and unnatural causes of death by gender and age. RESULTS During the 7 years of follow-up, 8.2% of the study sample died. The mortality of suicide attempters and ideators was significantly higher than that of the general population. Mortality was about twice than expected from natural causes, and 30 times than expected from unnatural causes. The mortality due to suicide was 85 times higher than that of the general population, with an excess of 126 times for females. The SMRs for all-cause mortality decreased with increasing age. CONCLUSIONS Patients who access hospitals or emergency departments for suicide attempts or suicidal ideation are a frail group at high risk of dying from natural or unnatural causes. Clinicians should pay special attention to the care of these patients, and public health and prevention professionals should develop and implement appropriate interventions to timely identify individuals at higher risk for suicide attempts and suicidal ideation and provide standardized care and support services.
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Risk of suicide attempt repetition after an index attempt: A systematic review and meta-analysis. Gen Hosp Psychiatry 2023; 81:51-56. [PMID: 36805332 DOI: 10.1016/j.genhosppsych.2023.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To estimate the risk of suicide attempt repetition among individuals with an index attempt. It also aims to study the role of risk factors and prevention programme in repetition. METHODS This systematic review and meta-analysis was conducted in keeping with the PRISMA 2020 guidelines. Studies on attempt repetition (both cohort studies and intervention studies) were searched from inception to 2022. RESULTS A total of 110 studies comprising 248,829 attempters was reviewed. The overall repetition rate was 0.20 (0.17, 0.22). Repetition risk linearly increased over time. A higher risk of attempt repetition was associated with female sex and index attempts in which self-cutting methods were used. Moreover, a mental disorder diagnosis was associated with an increasing repetition risk (OR = 2.02, p < .01). The delivery of a preventive programme reduced the repetition risk, OR = 0.76, p < .05; however, this effect was significant for psychotherapy interventions, OR = 0.38, p < .01. CONCLUSION One in five suicide attempters will engage in a new suicide attempt. An elevated repetition risk is associated with being female, more severe index methods and psychiatric disorder diagnosis. Preventive programmes, particularly psychotherapy, may contribute to reducing repetition risk and eventually save lives.
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Moftakhar L, Azarbakhsh H, Piraee E, Rezaei F, Mirahmadizadeh A. Suicide attempts and deaths by self-immolation: A population-based study in Fars (Iran), 2011-2019. MEDICINE, SCIENCE, AND THE LAW 2023; 63:22-30. [PMID: 35607282 DOI: 10.1177/00258024221099351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: Self-immolation is a leading public health challenge with a relatively high mortality, especially in some low- and middle-income countries. This study aimed to investigate epidemiological factors of attempts and completed suicide by self-immolation during 2011-2019 in Fars province (Iran). Materials and methods: This retrospective cross-sectional study included 506 cases of attempted self-immolation suicide during 2011-2019 in Fars province (Iran). Demographic characteristics and suicide information were collected from the Fars Suicide Surveillance System. The first fatality rate and age-standardized mortality rates were calculated. Then, chi-square tests were performed to evaluate suicide trends and examine differences between qualitative variables and outcomes. Logistic regression was used to identify factors associated with self-immolation death. Result: The mean age of study participants was 32.11 ± 14.04 years. The highest age-standardized rates of attempt and completed self-immolation suicide were seen in the age group 25-34 years. The fatality rate of suicide by self-immolation was 61.89%, and the risk of death was around three times higher in people with a history of suicide attempts compared to those who had no history of suicide attempts. However, a family history of suicide attempts was shown to be a protective factor against completed self-immolation suicide. Conclusion: The rate of self-immolation is higher in women and young adults. The results of our study can assist health policy-makers to design comprehensive plans and determine the necessary strategies aimed at identifying vulnerable people, then preventing self-immolation suicide.
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Affiliation(s)
- Leila Moftakhar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Elahe Piraee
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fariba Rezaei
- Shiraz University of Medical Sciences, Mental Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Mirahmadizadeh
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Özlü-Erkilic Z, Diehm R, Wenzel T, Bingöl Ҫağlayan RH, Güneş H, Üneri ÖŞ, Winter S, Akkaya-Kalayci T. Transcultural differences in suicide attempts among children and adolescents with and without migration background, a multicentre study: in Vienna, Berlin, Istanbul. Eur Child Adolesc Psychiatry 2022; 31:1671-1683. [PMID: 34050830 PMCID: PMC9666344 DOI: 10.1007/s00787-021-01805-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Abstract
While suicide can occur throughout the lifespan, worldwide suicide is the second leading cause of death among young people aged between 15 and 29 years. The aim of this multicentre study, conducted in Austria, Germany and Turkey, is to investigate the transcultural differences of suicide attempts among children and adolescents with and without migration background. The present study is a retrospective analyses of the records of 247 young people, who were admitted after a suicide attempt to Emergency Outpatient Clinics of Departments of Child and Adolescent Psychiatry of the collaborating Universities including Medical University of Vienna, Charité University Medicine Berlin and Cerrahpaşa School of Medicine and Bakirkoy Training and Research Hospital for Mental Health in Istanbul over a 3-year period. The results of the present study show significant transcultural differences between minors with and without migration background in regard to triggering reasons, method of suicide attempts and psychiatric diagnosis. The trigger event "intra-familial conflicts" and the use of "low-risk methods" for their suicide attempt were more frequent among patients with migration background. Moreover among native parents living in Vienna and Berlin divorce of parents were more frequent compared to parents living in Istanbul and migrants in Vienna. These results can be partly explained by cultural differences between migrants and host society. Also disadvantages in socio-economic situations of migrants and their poorer access to the healthcare system can mostly lead to acute and delayed treatments. Larger longitudinal studies are needed to understand better the impact of migration on the suicidal behaviour of young people.
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Affiliation(s)
- Zeliha Özlü-Erkilic
- Department of Child and Adolescent Psychiatry, Outpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Robert Diehm
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Thomas Wenzel
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - R Hülya Bingöl Ҫağlayan
- Department of Child and Adolescents Psychiatry, Cerrahpaşa School of Medicine, İstanbul University-Cerrahpaşa, Kocamustafapasa Cd. No: 53, Fatih, Istanbul, Turkey
| | - Hatice Güneş
- Department of Psychology, İstanbul Gelisim University, Cihangir Mahallesi Şehit Jandarma Komando Er Hakan Oner Sk. No:1, Avcilar, Istanbul, Turkey
- Department of Child and Adolescent Psychiatry, Bakirkoy Training and Research Hospital for Mental Health and Neurological Disorders, Zuhuratbaba Mah. Dr Tevfik Sağlam Cad. No:25/2, Bakirköy, Istanbul, Turkey
| | - Özden Şükran Üneri
- Department of Child and Adolescents Psychiatry, Ankara City Hospital, AYBÜ Ankara Şehir Hastanesi Çocuk Hastanesi 06800 Bilkent, Ankara, Turkey
| | - Sibylle Winter
- Departement of Child and Adolescent Psychiatry, Psychsomatics and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Virchow, Augustenbruger Platz 1, 13353, Berlin, Germany
| | - Türkan Akkaya-Kalayci
- Department of Child and Adolescent Psychiatry, Outpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Postgraduate University Program Transcultural Medicine and Diversity Care, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
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Berardelli I, Rogante E, Sarubbi S, Erbuto D, Cifrodelli M, Concolato C, Pasquini M, Lester D, Innamorati M, Pompili M. Is Lethality Different between Males and Females? Clinical and Gender Differences in Inpatient Suicide Attempters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013309. [PMID: 36293891 PMCID: PMC9602518 DOI: 10.3390/ijerph192013309] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 05/09/2023]
Abstract
According to the gender paradox in suicidology, an important sex difference has been reported with a preponderance of females in nonfatal suicidal behavior and a preponderance of males in completed suicide. Furthermore, females and males present different risk factors for suicide. The present study explored possible clinical differences between male and female psychiatric inpatients who had recently attempted suicide. The study included 177 adult inpatients hospitalized following a suicide attempt at the University Psychiatric Clinic, Sant'Andrea Hospital, Sapienza University of Rome. Clinical features assessed included psychiatric diagnosis, method and lethality of suicide attempts using the Risk/Rescue Rating Scale, the history of suicide attempts, age at onset of psychiatric illness, the presence of substance or alcohol use, and the length of stay. The results found that males and females differed in the method used for the suicide attempt, the scores for risk and rescue, and the length of hospitalization post-suicide attempt. In conclusion, identifying gender characteristics of patients at higher risk of suicide is important for implementing specific suicide prevention strategies and reducing the risk of future suicidal behavior in psychiatric inpatients.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
- Correspondence: ; Tel.: +06-33-775-675
| | - Elena Rogante
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy
| | - Salvatore Sarubbi
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy
| | - Denise Erbuto
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Mariarosaria Cifrodelli
- Psychiatry Residency Training Program, Psychiatry Unit, Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Cristina Concolato
- Psychiatry Residency Training Program, Psychiatry Unit, Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy
| | - David Lester
- Psychology Program, Stockton University, Galloway, NJ 08205, USA
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163 Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
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Fuller-Thomson E, Baiden P, Mahoney IP, MacNeil A. A Bright Light at the End of the Tunnel: Factors Associated With Complete Mental Health After a Suicide Attempt. Arch Suicide Res 2022; 26:1911-1925. [PMID: 34313193 DOI: 10.1080/13811118.2021.1950088] [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: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to investigate factors associated with complete mental health (CMH) among a nationally representative sample of Canadians who had a history of suicide attempts. METHODS Data for this study came from the 2012 Canadian Community Health Survey-Mental Health. A subsample of 796 respondents who had ever attempted suicide was analyzed. The outcome variable investigated was CMH, which includes three elements: (a) absence of past-year suicidality or mental illness (measured by the World Health Organization version of the Composite International Diagnostic Interview); (b) happiness or satisfaction; and (c) social and psychological well-being. Bivariate analyses and binary logistic regression were conducted to identify factors associated with CMH among Canadians who had a history of suicide attempts. RESULTS Of the 796 respondents who had a history of suicide attempts, 28.4% were in CMH. In accordance with past research, positive factors associated with CMH were as follows: having a confidant, lacking chronic pain, absence of insomnia, being female, older age, higher income, and having no history of mental illness, including bipolar disorder, major depressive episode, or generalized anxiety disorder. Those with two suicide attempts were less likely to experience CMH than those with one suicide attempt. Surprisingly, medical attention after the attempt was positively associated with CMH. In total, these factors accounted for 29% of the variance in CMH. CONCLUSIONS Adults with a history of suicide attempts can achieve an excellent level of mental health. These findings suggest that interventions to promote social support and manage chronic pain and insomnia may be helpful. HIGHLIGHTSMore than one in four adults with a history of suicide attempts are in complete mental healthHaving a confidant was positively associated with having complete mental health after suicide attemptThose with a history of suicide attempts need ongoing mental health support.
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Bommersbach TJ, Rosenheck RA, Petrakis IL, Rhee TG. Why are women more likely to attempt suicide than men? Analysis of lifetime suicide attempts among US adults in a nationally representative sample. J Affect Disord 2022; 311:157-164. [PMID: 35598742 DOI: 10.1016/j.jad.2022.05.096] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/09/2022] [Accepted: 05/15/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE While it is well-known that women are more likely to attempt suicide than men, little is known about risk and protective factors underlying this difference. METHODS Using data from the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III), we compared women and men with and without self-reported lifetime suicide attempts to identify sociodemographic, clinical, and behavioral characteristics that were associated with suicide attempts for each gender. We then examined the interaction of gender and risk factors to identify specific factors that have a significantly different association with the risk of suicide attempts by gender. Multivariate analyses identified factors that were independently associated with a significant interaction of gender and risk of suicide attempt and the extent to which these interactions accounted for the greater risk of suicide attempts among women. RESULTS In unadjusted analysis, women had 1.78 greater odds of self-reported lifetime suicide attempts than men (95% confidence interval (CI), 1.61-1.96). While men and women shared similar risk and protective factors for suicide attempts, several factors were associated with significantly different risks for women than men. In multivariate analysis, these factors only partially accounted for the gender difference in lifetime risk of suicide attempt (adjusted odds ratio, 1.53; 95% CI, 1.12-2.08). CONCLUSIONS Several risk factors for suicide attempts appear to have significantly different magnitude of association among women and men; however, these differences only partially account for gender difference in risk for suicide attempts, suggesting that other factors, not measured in this study, are at play.
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Affiliation(s)
- Tanner J Bommersbach
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America
| | - Robert A Rosenheck
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America; VA New England Mental Illness, Research Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Ismene L Petrakis
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America; VA New England Mental Illness, Research Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America; VA New England Mental Illness, Research Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, CT, United States of America; Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, United States of America.
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15
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Pandey S, Bolstad I, Lien L, Walby FA, Myhre MØ, Bramness JG. Sex-specific factors associated with lifetime suicide attempt among patients with alcohol use disorders. BJPsych Open 2022; 8:e135. [PMID: 35848151 PMCID: PMC9346164 DOI: 10.1192/bjo.2022.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients with alcohol use disorder (AUD) are at high risk for suicide attempts. Mental health problems along with AUD-related factors may contribute to this increased risk. Studies have shown sex differences in rates and correlates of suicide attempts. AIMS The purpose of the study was to examine mental-health-related and AUD-related factors associated with suicide attempt separately in female and male AUD patients. METHOD We collected information about lifetime suicide attempt and mental-health- and AUD-related factors for AUD in-patients (n = 114; 32 females) receiving rehabilitative treatment. RESULTS The prevalence of lifetime suicide attempt was 27%, and the rate was similar in both sexes. Among females, current depressive symptoms and current post-traumatic stress disorder diagnosis were associated with suicide attempt. In male AUD patients, among the mental-health-related factors, lifetime major depression, panic disorder, social phobia, childhood sexual abuse and antisocial personality disorder were associated with suicide attempt. In addition, AUD-related factors including longer duration of drinking, history of delirium tremens, greater severity of AUD and lower levels of prolactin were associated with suicide attempt in males. CONCLUSIONS Our results indicate that suicide attempts in female AUD patients were more mental-health-related, whereas those in males were also related to the severity of AUD. This suggests that a suicide prevention programme for AUD patients would benefit from a sex-based understanding of the risk factors.
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Affiliation(s)
- Susmita Pandey
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway; and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingeborg Bolstad
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway; and Department of Health and Social Science, Innlandet University of Applied Science, Elverum, Norway
| | - Fredrik A Walby
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Martin Øverlien Myhre
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jørgen G Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway; Department of Clinical Medicine, UiT - Norway's Arctic University, Tromsø, Norway; and Norwegian Institute of Public Health, Oslo, Norway
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16
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Liu BP, Jia CX, Qin P, Zhang YY, Yu YK, Luo X, Li SX. Associating factors of suicide and repetition following self-harm: A systematic review and meta-analysis of longitudinal studies. EClinicalMedicine 2022; 49:101461. [PMID: 35747199 PMCID: PMC9126760 DOI: 10.1016/j.eclinm.2022.101461] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Longitudinal evidence for sociodemographic and clinic factors deviating risk for suicide and repetition following SH (self-harm) varied greatly. METHODS A comprehensive search of PubMed, Web of Science, EMBASE, and PsycINFO was conducted from January 1st, 2010 to April 5th, 2022. Longitudinal studies focusing on examining associating factors for suicide and repetition following SH were included. PROSPERO registration CRD42021248695. FINDINGS The present meta-analysis synthesized data from 62 studies published from Jan. 1st, 2010. The associating factors of SH repetition included female gender (RR, 95%CI: 1.11, 1.04-1.18, I2=82.8%), the elderly (compared with adolescents and young adults, RR, 95%CI: 0.67, 0.52-0.87, I2=86.3%), multiple episodes of SH (RR, 95%CI: 1.97, 1.51-2.57, I2=94.3%), diagnosis (RR, 95%CI: 1.60, 1.27-2.02, I2=92.7%) and treatment (RR, 95%CI: 1.59, 1.40-1.80, I2=93.3%) of psychiatric disorder. Male gender (RR, 95%CI: 2.03, 1.80-2.28, I2=83.8%), middle-aged adults (compared with adolescents and young adults, RR, 95%CI: 2.40, 1.87-3.08, I2=74.4%), the elderly (compared with adolescents and young adults, RR, 95%CI: 4.38, 2.98-6.44, I2=76.8%), physical illness (RR, 95%CI: 1.95, 1.56-2.43, I2=0), multiple episodes of SH (RR, 95%CI: 2.02, 1.58-2.58, I2=87.4%), diagnosis (RR, 95%CI: 2.13, 1.67-2.71, I2=90.9%) and treatment (RR, 95%CI: 1.36, 1.16-1.58, I2=58.6%) of psychiatric disorder were associated with increased risk of suicide following SH. INTERPRETATION Due to the substantial heterogeneity for clinic factors of suicide and repetition following SH, these results need to be interpreted with caution. Clinics should pay more attention to the cases with SH repetition, especially with poor physical and psychiatric conditions. FUNDING This work was supported by National Natural Science Foundation of China (NSFC) [No: 82103954; 30972527; 81573233].
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Affiliation(s)
- Bao-Peng Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
- Corresponding author at: Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine of University of Oslo, Oslo, Norway
| | - Ying-Ying Zhang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Yao-Kun Yu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Xiao Luo
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Shi-Xue Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Corresponding author at: Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Tachikawa H, Takahashi S, Nemoto K, Yonemoto N, Oda H, Miyake Y, Hirayasu Y, Arai T, Kawanishi C. Predictive factors for recurrent suicide attempts: Evidence from the ACTION-J study. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2022; 1:e7. [PMID: 38868638 PMCID: PMC11114385 DOI: 10.1002/pcn5.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/29/2022] [Accepted: 03/14/2022] [Indexed: 06/14/2024]
Abstract
Aim Risk factors for attempted suicide have been widely studied. However, there is limited evidence on predictive factors for suicide reattempts. We aimed to identify these in suicide attempters admitted to emergency departments. Methods This is the second analysis from a randomized controlled multicenter trial, ACTION-J. Patient characteristics were extracted from baseline demographic data and clinical data of participants. Predictive factors for a recurrent suicide attempt in each gender were examined using Cox proportional hazards regression analysis. Dependent variables were months from trial entry to the first reattempt. Independent variables were characteristics regarded as potential predictive factors. Results The study included 914 adults (400 men and 514 women). A visit to a psychiatrist within a month of the suicide attempt was significantly associated with reattempts in men (hazard ratio [HR] 2.49, 95% confidence interval [CI] 1.21-5.25). Substance-related disorders (HR 3.65, 95% CI 1.16-7.9.60), drinking alcohol less than once per month (HR 0.42, 95% CI 0.17-0.88), previous suicide attempts (HR 2.28, 95% CI 1.40-3.87), and taking a drug overdose for the first suicide attempt (HR 1.82, 95% CI 1.14-3.01) were significantly associated with reattempts in women. Conclusion Our data highlight the importance of visits to a psychiatrist a short time before the first suicide attempt in men and substance-related disorder, previous suicide attempts, and drug overdose in the first suicide attempt in women as predictive factors for future suicide reattempts.
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Affiliation(s)
- Hirokazu Tachikawa
- Department of Disaster and Community Psychiatry, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Sho Takahashi
- Department of Disaster and Community Psychiatry, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Kiyotaka Nemoto
- Department of Psychiatry, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Naohiro Yonemoto
- Department of Neuropsychopharmacology, National Institute of Mental HealthNational Center of Neurology and PsychiatryKodairaJapan
| | - Hiroyuki Oda
- Department of NeuropsychiatryKansai Medical UniversityHirakataJapan
| | - Yasufumi Miyake
- Department of Emergency MedicineTeikyo University HospitalItabashi‐kuJapan
| | | | - Tetsuaki Arai
- Department of Psychiatry, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Chiaki Kawanishi
- Department of NeuropsychiatrySapporo Medical University Graduate School of MedicineSapporoJapan
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Fossi LD, Debien C, Demarty AL, Vaiva G, Messiah A. Loss to follow-up in a population-wide brief contact intervention to prevent suicide attempts - The VigilanS program, France. PLoS One 2022; 17:e0263379. [PMID: 35231052 PMCID: PMC8887722 DOI: 10.1371/journal.pone.0263379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 01/18/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Brief Contact Interventions (BCIs) after a suicide attempt (SA) are an important element of prevention against SA and suicide. VigilanS generalizes to a whole French region a BCI combining resource cards, telephone calls and sending postcards, according to a predefined algorithm. However, a major obstacle to such real-life intervention is the loss of contact during follow-up. Here, we analyze the occurrence of loss of follow-up (LFU) and compare characteristics of patients LFU with follow-up completers. METHODS The study concerned patients included in VigilanS over the period from 1st January 2015 to 31 December 2018, with an end of follow-up on 1st July 2019. We performed a series of descriptive analysis and logistic regressions. The outcome was the loss to follow-up, relative to the 6th month call marking the end of the follow-up; the predictive variables were the characteristics of the patient at entry and during follow-up. Age and sex were considered as adjustment variables. RESULTS 11879 inclusions occurred during the study period, corresponding to 10666 different patients. The mean age was 40.6 ± 15 years. More than a third were non-first suicide attempters (46.6%) and the most frequent means of suicide was by voluntary drug intoxication (83.2%). 8335 patients were LFU. After simple and multiple regression, a significant relationship with loss to follow-up was identified among non-first suicide attempters, alcohol consumers, patients having no companion on arrival at the emergency room, patients who didn't make or receive any calls. An increased stay in hospital after a SA was a protective factor against loss of follow-up. CONCLUSION A majority of patients were lost to follow-up by the expected surveillance time of 6 months. Characteristics of lost patients will help focusing efforts to improve retention in the VigilanS program and might give insights for BCI implemented elsewhere.
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Affiliation(s)
- Larissa Djembi Fossi
- INSERM, MOODS Research unit “Depression, Anxiety, Psychotraumatism and Suicide”, Centre de recherche en Epidémiologie et santé des populations (CESP), Université Paris-Saclay, Hôpital Paul-Brousse, Villejuif, France
- INSERM, Sorbonne University, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Social Epidemiology Team, Paris, France
| | - Christophe Debien
- Department of Psychiatry, University Hospital of Lille, Lille, France
- Univ. Lille, Inserm, CHU Lille, U1172—LilNCog (JPARC)—Lille Neurosciences & Cognition, Lille, France
- Centre National de Ressources et Résilience Pour Les Psychotraumas (Cn2r Lille Paris), Department of Psychiatry, University Hospital of Lille, Lille, France
| | | | - Guillaume Vaiva
- Department of Psychiatry, University Hospital of Lille, Lille, France
- Univ. Lille, Inserm, CHU Lille, U1172—LilNCog (JPARC)—Lille Neurosciences & Cognition, Lille, France
- Centre National de Ressources et Résilience Pour Les Psychotraumas (Cn2r Lille Paris), Department of Psychiatry, University Hospital of Lille, Lille, France
| | - Antoine Messiah
- INSERM, MOODS Research unit “Depression, Anxiety, Psychotraumatism and Suicide”, Centre de recherche en Epidémiologie et santé des populations (CESP), Université Paris-Saclay, Hôpital Paul-Brousse, Villejuif, France
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McQuaid RJ, Nikolitch K, Vandeloo KL, Burhunduli P, Phillips JL. Sex Differences in Determinants of Suicide Risk Preceding Psychiatric Admission: An Electronic Medical Record Study. Front Psychiatry 2022; 13:892225. [PMID: 35711595 PMCID: PMC9196272 DOI: 10.3389/fpsyt.2022.892225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/09/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Individuals requiring inpatient psychiatric care represent a group at higher risk of progressing toward suicide attempt. Using electronic medical record (EMR) data collected from psychiatric inpatient admissions, the objective of this study was to identify sex differences in risk factors for suicide plans and/or attempts within the 30 days preceding hospital admission. METHODS Resident Assessment Instrument for Mental Health (RAI-MH) intake data were obtained for patients admitted to a Canadian tertiary-care hospital deemed a "threat or danger to self" during a 10-year period (2008-2018). Data was extracted for individuals categorized into three groups: non-suicidal (N = 568), presence of suicide plan (N = 178), and presence of suspected suicide attempt (N = 124) in the 30 days prior to hospital admission. Multivariate logistic regression models were used to examine determinants of suicide risk. RESULTS Across all models, diagnosis of depression was the strongest predictor of suicide plan and/or attempt (OR = 5.54, 95% CI = 3.71-8.27, p < 0.001). Comparing clinical symptoms between suicidal and non-suicidal groups at the time of admission, the largest effect sizes were found for hopelessness (p < 0.001, η2 = 0.11), and guilt or shame (p < 0.001, η2 = 0.09). Female sex was identified as a significant factor for elevated suicidal risk (OR = 1.56, 95% CI = 1.01-2.21, p = 0.01), thus we stratified the regression model by sex to identify specific risk factors for suicide plan and/or attempt for males and females. Among males, having no confidant (OR = 2.13, 95% CI = 1.19-3.80, p = 0.01), presence of recent stressors (OR = 1.95, 95% CI = 1.16-3.29, p = 0.01), and participation in social activities (OR = 1.67, 95% CI = 1.02-2.71, p = 0.04) were important predictors, while among females, younger age (OR = 0.96, 95% CI = 0.94-0.97, p < 0.001) increased odds of suicide plan and/or attempt. CONCLUSION EMR-derived findings highlight different psychosocial and clinical determinants for males and females associated with suicide plan or attempt prior to psychiatric admission. Identifying precipitating factors that elevate imminent suicide risk may inform suicide prevention efforts for psychiatric inpatients.
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Affiliation(s)
- Robyn J McQuaid
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada.,Department of Neuroscience, Carleton University, Ottawa, ON, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Katerina Nikolitch
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Katie L Vandeloo
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Patricia Burhunduli
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer L Phillips
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada.,Department of Neuroscience, Carleton University, Ottawa, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
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20
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Wasserman D, Carli V, Iosue M, Javed A, Herrman H. Suicide prevention in psychiatric patients. Asia Pac Psychiatry 2021; 13:e12450. [PMID: 33605074 DOI: 10.1111/appy.12450] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/12/2021] [Accepted: 02/02/2021] [Indexed: 01/21/2023]
Abstract
An increased risk of suicide has been reported for psychiatric patients. In several world regions, an underlying psychiatric disorder is reported in up to 90% of people who die from suicide, though this rate seems to be considerably lower in low- and middle-income countries. Major psychiatric conditions associated with suicidality are mood disorders, alcohol and substance use disorders, borderline personality disorder, and schizophrenia. Comorbidity between different disorders is frequently associated with a higher suicide risk. A history of suicide attempts, feelings of hopelessness, impulsivity and aggression, adverse childhood experiences, severe psychopathology, and somatic disorders are common risk factors for suicide among psychiatric patients. Stressful life events and interpersonal problems, including interpersonal violence, are often triggers. A comprehensive and repeated suicide risk assessment represents the first step for effective suicide prevention. Particular attention should be paid during and after hospitalization, with the first days and weeks after discharge representing the most critical period. Pharmacological treatment of mood disorders and schizophrenia has been shown to have an anti-suicidal effect. A significant reduction of suicidal thoughts and behavior has been reported for cognitive behavioral therapy and dialectical behavior therapy. Brief interventions, including psychoeducation and follow-ups, are associated with a decrease in suicide deaths. Further development of suicide prevention in psychiatric patients will require a better understanding of additional risk and protective factors, such as the role of a person's decision-making capacity and social support, the role of spiritual and religious interventions, and the reduction of the treatment gap in mental health care.
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Affiliation(s)
- Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden.,World Psychiatric Association (WPA)-Section on Suicidology, Geneva, Switzerland
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden.,World Psychiatric Association (WPA)-Section on Suicidology, Geneva, Switzerland
| | - Miriam Iosue
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden.,World Psychiatric Association (WPA)-Section on Suicidology, Geneva, Switzerland
| | - Afzal Javed
- Coventry and Warwickshire Partnership NHS Trust, Nuneaton Coventry, Coventry, UK
| | - Helen Herrman
- Orygen, and Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
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21
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The Male Experience of Suicide Attempts and Recovery: An Interpretative Phenomenological Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105209. [PMID: 34068854 PMCID: PMC8153566 DOI: 10.3390/ijerph18105209] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/14/2022]
Abstract
Suicidal behaviour is a complex phenomenon—its aetiology spans biological, psychological, environmental, social and cultural facets. Men’s deaths by suicide outnumber women in every country in the world. This study explored the male experience of suicide attempts and recovery as well as factors which may be protective for men. Men (n = 12) participated in semi-structured face-to-face interviews which were subjected to Interpretative Phenomenological Analysis (IPA). Four master themes were identified: (1) “characteristics of attempt/volitional factors”, (2) “dealing with suicidal thoughts and negative emotions”, (3) “aftermath” and (4) “protective factors”. The theoretical and clinical implications of this study are discussed, including help seeking, emotional expression, the long-term impact of suicide attempt as well as the applied contribution to established theories.
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22
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Golay P, Ostertag L, Costanza A, Van der Vaeren B, Dorogi Y, Saillant S, Michaud L. Patients with first versus multiple episodes of self-harm: how do their profiles differ? Ann Gen Psychiatry 2021; 20:30. [PMID: 33985548 PMCID: PMC8120773 DOI: 10.1186/s12991-021-00351-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-harm (SH) is among the strongest predictors of further episodes of SH, suicide attempt, and death by suicide. People who repeteadly harm themselves are at even higher risk for suicide. Factors influencing the repetition are important to identify when assessing suicidal risk and thereafter to offer specific interventions. Therefore, this study aimed to compare first versus multiple episodes characteristics in a large sample of patients in french-speaking Switzerland. METHOD We used the database from the French-speaking Swiss program for monitoring SH. Data of the psychiatric assessment of all adults admitted for SH were collected in the emergency department of four Swiss city hospitals between December 2016 and October 2019. RESULTS 1730 episodes of SH were included. Several variables were significantly associated with multiple episodes, including diagnosis (over representation of personality disorders and under representation of anxiety disorders), professional activity (Invalidity insurance more frequent) and prior psychiatry care. CONCLUSIONS Patients suffering from a personality disorder and those with invalidity insurance are at risk for multiple episodes of SH and should be targeted with specific interventions.
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Affiliation(s)
- Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Psychology, Faculty of Social and Political Science, University of Lausanne, Lausanne, Switzerland
| | - Louise Ostertag
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
| | - Bénédicte Van der Vaeren
- Pole of Psychiatry and Psychotherapy, Liaison Psychiatry Service, Hospital Centre of Valais Romand, Sion, Switzerland
| | - Yves Dorogi
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stéphane Saillant
- Center for Psychiatric Emergencies and Liaison Psychiatry, Department of General and Liaison Psychiatry, Neuchâtel Psychiatry Center, Neuchâtel, Switzerland
| | - Laurent Michaud
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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23
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Richardson C, Robb KA, O'Connor RC. A systematic review of suicidal behaviour in men: A narrative synthesis of risk factors. Soc Sci Med 2021; 276:113831. [PMID: 33780831 DOI: 10.1016/j.socscimed.2021.113831] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/30/2020] [Accepted: 03/06/2021] [Indexed: 12/17/2022]
Abstract
RATIONALE Suicides by men outnumber those by women in every country of the world. To date, there has not been a comprehensive systematic review of risk factors for suicidal behaviour in men to better understand the excess deaths by suicide in men. OBJECTIVE The present systematic review seeks to determine the nature and extent of the risk factors to predict suicidal behaviour in men over time. METHODS A range of databases (CINAHL, PsycINFO, Web of Science Core Collection, Pubmed, Embase, and Psychology and Behavioural Sciences Collection) were searched from inception to January 2020 for eligible articles. The findings were collated through a narrative synthesis of the evidence. RESULTS An initial 601 studies were identified. Following the inclusion and exclusion criteria, there were 105 eligible studies (62 prospective and 43 retrospective) identified. Overall, the risk factors with the strongest evidence predicting suicidal behaviour in men were alcohol and/or drug use/dependence; being unmarried, single, divorced, or widowed; and having a diagnosis of depression. In the prospective studies, the most consistent evidence was for sociodemographic factors (19 risk factors), mental health/psychiatric illness (16 risk factors), physical health/illness (13 risk factors), and negative life events/trauma (11 risk factors). There were a small number of psychological factors (6 factors) and characteristics of suicidal behaviour (3 factors) identified. The findings from the retrospective studies provided further evidence for the risk factors identified in the prospective studies. CONCLUSIONS This systematic review has highlighted the wide range of risk factors for suicidal behaviour in men, in this review alone 68 different risk factors were identified. Many factors can interact and change in relevance throughout an individual's life. This review has identified extensive gaps in our knowledge as well as suggestions for future research.
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Affiliation(s)
- Cara Richardson
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
| | - Kathryn A Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
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24
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Bommersbach TJ, Rhee TG, Stefanovics EA, Rosenheck RA. Recovery from past suicide attempts: Correlates of time since the last attempt in a national sample of US adults. J Affect Disord 2021; 279:98-105. [PMID: 33045555 DOI: 10.1016/j.jad.2020.10.001] [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: 06/12/2020] [Revised: 09/09/2020] [Accepted: 10/01/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study takes a lifetime perspective on suicide attempts and examines correlates of years since the last attempt as a potential proxy for recovery from suicidality. METHODS Data from 36,309 adults in the National Epidemiologic Survey on Alcohol and Related Conditions-III were used to identify 1,924 respondents (5.3%) who reported a lifetime suicide attempt. Measures included socio-demographics, behavioral factors, and DSM-5 diagnoses, as well as the age at first attempt. Bivariate and multivariate analyses were used to adjust for potentially confounding effects of age and to identify independent factors associated with not attempting suicide for >1-5 years or >5 years. RESULTS Of those who reported a lifetime suicide attempt, 7.9% reported their most recent attempt in the past year, 18.6% within 1 to 5 years, and 73.5% in greater than 5 years. While absence of lifetime substance use disorder and past year psychiatric disorder prominently characterized those with no attempt in the past 1 to 5 years, many more sociodemographic advantages additionally characterized those whose last attempt was >5 years ago, including being older, married, employed, higher incomes, no recent homelessness or criminal justice involvement, more social contacts, as well as having less past year substance use or psychiatric disorders. LIMITATIONS The retrospective, self-report design introduces the possibility of recall bias. CONCLUSIONS Almost three-fourths of people with lifetime suicide attempts have not attempted for more than 5 years. Recovery involves not only psychiatric and substance use disorders but improvements in key socio-demographics and social connectedness over many years.
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Affiliation(s)
- Tanner J Bommersbach
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, USA; Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Elina A Stefanovics
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, USA
| | - Robert A Rosenheck
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, USA
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25
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Bergmans Y, Guimond T, Lambert C, McInerney S, O'Brien K. Alexithymia in People With Recurrent Suicide Attempts. CRISIS 2020; 42:425-433. [PMID: 33241742 DOI: 10.1027/0227-5910/a000738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Alexithymia, an inability to identify or describe emotions, is associated with suicidality yet the correlation with single or repeated suicide attempts is less clear. Aims: We aimed to assess the modifiability of alexithymia following a group psychosocial intervention focused on improving emotional literacy in those with a history of recurrent suicide attempts (RSA). Method: A total of 169 participants with self-reported RSA completed pre- and postgroup assessments of a 20-week group therapy intervention. Questionnaires assessed alexithymia, depression, impulsivity, and hopelessness; the Toronto Alexithymia Scale (TAS-20) was the primary outcome. Data were analyzed using multiple imputation. Results: Participants had on average 7.8 lifetime suicide attempts, 73% were female, and 16.6% had a >13-point reduction in TAS-20 scores after 20 weeks. Directed acyclic graph (DAG) analysis demonstrated significant relationships between alexithymia, depression, hopelessness, problem-solving, and satisfaction with life. Age of onset of suicidality was the only factor predictive of postintervention TAS-20 score in univariate linear regression. Limitations: The study limitations were its sample size, insufficient resources, and missing data. Conclusion: A change in TAS scores indicated that alexithymia can be a modifiable treatment target. Being able to identify and describe feelings may lead to improvement in depression, hopelessness, problem-solving, and satisfaction with life in this population.
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Affiliation(s)
- Yvonne Bergmans
- Arthur Sommer Rotenberg Chair in Suicide and Depression Studies, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, ON, Canada
| | - Tim Guimond
- Department of Psychiatry, University of Toronto, ON, Canada
| | - Clare Lambert
- Arthur Sommer Rotenberg Chair in Suicide and Depression Studies, St. Michael's Hospital, Toronto, ON, Canada.,Royal College of Surgeons, Dublin, Ireland
| | - Shane McInerney
- Arthur Sommer Rotenberg Chair in Suicide and Depression Studies, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, ON, Canada.,Department of Psychiatry, University Hospital Galway, Ireland
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26
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Özlü-Erkilic Z, Wenzel T, Kothgassner OD, Akkaya-Kalayci T. Transcultural Differences in Risk Factors and in Triggering Reasons of Suicidal and Self-Harming Behaviour in Young People with and without a Migration Background. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186498. [PMID: 32906614 PMCID: PMC7557370 DOI: 10.3390/ijerph17186498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/28/2020] [Accepted: 09/03/2020] [Indexed: 01/20/2023]
Abstract
Minors with and without migration background can have different risk factors and triggering reasons for self-harming and suicidal behaviour. We retrospectively analysed the data of 192 children and adolescents to investigate the transcultural differences in self-harming, as well as suicidal behaviour in Austrian, Turkish, and Bosnian/Croatian/Serbian (BCS)-speaking patients, who were treated in an emergency out-patient clinic in Vienna. Our results showed transcultural differences in both behaviours. In all groups, females had higher rates of suicide attempts and self-harming behaviour than males. While Turkish-speaking patients received treatment more often, after attempted suicide, Austrians and BCS-speaking patients needed treatment more often for acute stress disorder. Suicide attempts and self-harming behaviours were triggered most frequently by intrafamilial problems, but more frequently in migrant patients. Turkish-speaking patients were at a more than 2 times (OR = 2.21, 95%CI: 1.408–3.477) higher risk for suicide attempts, and were triggered almost 3 times (OR = 2.94, 95%CI: 1.632–5.304) more often by interfamilial conflicts. The suicide attempts of BCS-speaking minors were more often caused by relationship and separation crises (OR = 2.56, 95%CI: 1.148–5.705). These transcultural differences in suicidal and self-harming behaviour of minors, demand an increase of transcultural competence to provide optimal treatment of migrant children.
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Affiliation(s)
- Zeliha Özlü-Erkilic
- Outpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria;
- Postgraduate University Program Transcultural Medicine and Diversity Care, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas Wenzel
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria;
| | - Oswald D. Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria;
| | - Türkan Akkaya-Kalayci
- Outpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria;
- Postgraduate University Program Transcultural Medicine and Diversity Care, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence:
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27
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Suárez-Pinilla P, Pérez-Herrera M, Suárez-Pinilla M, Medina-Blanco R, López-García E, Artal-Simón JÁ, de Santiago-Díaz AI. Recurrence of suicidal thoughts and behaviors during one year of follow-up: An exploratory study. Psychiatry Res 2020; 288:112988. [PMID: 32387919 DOI: 10.1016/j.psychres.2020.112988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 11/28/2022]
Abstract
Suicidal thoughts and behaviors (STB) include suicidal ideation (SI), suicide attempt (SA) and completed suicide. We aimed to identify recurrence predictors of any type of STB, and separately for SA and SI, and to analyze the time until event. A 108-subject cohort presenting at Emergencies with STB was followed during one year. Recurrence risk factors were investigated by multiple Cox survival regressions. Within one year, 31.5%, 23.1% and 9.3% patients recurred with any STB, SA, and SI respectively. Most recurrences (~70%) occurred within the first 6 months. Seeking emergency psychiatric assistance for problems other than STB during follow-up was a common predictor for recurrence of any STB, and SA and SI specifically. Previous SA history and contact with psychiatry outpatient units during follow-up predicted both STB in general and SA in particular. A specific predictor for SA was hospitalization at index, while SI recurrence was associated to SI at index. These results highlight the importance of early intervention and multidisciplinary follow-up considering concurrent psychosocial or adaptive problems. A careful exploration at Emergencies is needed to target potential predictors.
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Affiliation(s)
- Paula Suárez-Pinilla
- Department of Psychiatry, University Hospital Marqués de Valdecilla IDIVAL, Santander, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Santander, Spain.
| | - Marina Pérez-Herrera
- Department of Psychiatry, University Hospital Marqués de Valdecilla IDIVAL, Santander, Spain
| | - Marta Suárez-Pinilla
- Department of Neurodegenertive Diseases UCL Queen Square, Institute of Neurology, London, UK
| | - Raquel Medina-Blanco
- Department of Psychiatry, University Hospital Marqués de Valdecilla IDIVAL, Santander, Spain
| | - Enrique López-García
- Department of Psychiatry, University Hospital Marqués de Valdecilla IDIVAL, Santander, Spain
| | - Jesús Ángel Artal-Simón
- Department of Psychiatry, University Hospital Marqués de Valdecilla IDIVAL, Santander, Spain
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28
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Depression and suicidal ideation: association of physical, mental, social, and spiritual health status. Qual Life Res 2020; 29:2807-2814. [PMID: 32468404 DOI: 10.1007/s11136-020-02538-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE The aim of this study was to determine if multidimensional (physical, mental, social, spiritual) health status could predict the presence of depressive symptoms and suicidal ideation in the general population. METHODS We administered a population-based, cross-sectional survey to 1200 participants from the general Korean population. The survey included the 5 Health Status Questionnaire (5HSQ) for self-rated health status, Patient Health Questionnaire-9 (PHQ-9) for depression, and a question from the PHQ-9 for suicidal ideation. Multiple logistic regression was performed to estimate the association of significant socio-demographic factors and self-rated health status with depression and suicidal ideation. RESULTS Physical health status was associated with depression in both men and women (men: adjusted odds ratio [aOR], 4.69; 95% confidence interval [CI] 2.44-9.00; women: aOR, 2.05; 95% CI 1.13-3.72) while spiritual health status only affected men (aOR, 5.50; 95% CI 2.59-11.65) and mental health status only women (aOR, 3.92; 95% CI 2.03-7.54). Social health status was associated with suicidal ideation in men (aOR, 4.87; 95% CI 2.74-19.99) while mental health status was associated with suicidal ideation in women (aOR, 4.31; 95% CI 1.90-9.76). CONCLUSION Physical, mental, social, and spiritual self-rated health statuses were all found to be associated with an individual's predisposition to depression and suicidal ideation with notable differences between men and women.
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29
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Taron M, Nunes C, Maia T. Suicide and suicide attempts in adults: exploring suicide risk 24 months after a psychiatric emergency room visit. ACTA ACUST UNITED AC 2020; 42:367-371. [PMID: 32491023 PMCID: PMC7430398 DOI: 10.1590/1516-4446-2019-0583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 12/20/2019] [Indexed: 11/22/2022]
Abstract
Objective: Suicide risk (including attempted and completed suicide) should be measured over short periods of time after contacting health services. The objective of this study was to identify the patterns of attempted and completed suicides within 24-months of a psychiatric emergency department visit, as well as to investigate predictive risk factors, including sociodemographic and clinical variables, previous suicidal behavior, and service utilization. Method: A convenience sample (n=147), recruited at a general hospital’s psychiatric emergency room, included patients with suicidal ideation, suicidal plans or previous suicide attempts. These patients were followed for 24 months, focusing on two main outcomes: attempted and completed suicides. Results: After six months there were no completed suicides and 36 suicide attempts, while after 24 months there were seven completed suicides and 69 suicide attempts. A final logistic regression model for suicide attempts at 24 months identified somatic pathology and the number of previous psychiatric hospitalizations as predictive factors, with a good area under the receiver operating characteristic curve. Conclusions: The findings showed distinct patterns of attempted and completed suicides over time, indicating the importance of a systematic multidisciplinary suicide risk evaluation in psychiatric emergency rooms.
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Affiliation(s)
- Marisa Taron
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Carla Nunes
- Departamento de Estatística, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Teresa Maia
- Departamento de Saúde Mental, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
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30
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Hodé Y, Dubreucq J, Valladier E, Guillard Bouhet N, Lemestré S, Attal J, Canceil O, Biotteau M, Laffond P, Raynaud A, Chéreau-Boudet I, Montagne Larmurier A, Giordana JY, Saingery B, d'Amato T, Willard D. [Suicidal risk prevention in schizophrenia: Importance of family psychoeducation]. Encephale 2020; 46:450-454. [PMID: 32317163 DOI: 10.1016/j.encep.2020.02.002] [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: 06/15/2019] [Revised: 02/03/2020] [Accepted: 02/07/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Although mortality by suicide in schizophrenia seems to have decreased in some countries over the last 30 years, it remains much higher than in the general population. Studies have shown this risk to impact around 5% of patients, corresponding to a risk almost 2.5 times higher than in the general population. Family psychoeducation in schizophrenia has been demonstrated to lead to symptom reductions and to an improvement of the quality of life, two factors that should contribute to decreasing the suicidal risk. Therefore, if families attend an efficient psychoeducation program, we can expect a decrease in the patient suicidal risk. Attending a family psychoeducation program at the beginning of the disease would also be associated with a stronger preventive effect on suicidal mortality. The objective of this study is to describe the suicide attempt rate of patients who suffer from schizophrenia before and one year after one of their relatives participated to the family psychoeducation program Profamille. METHOD We performed a retrospective study on 1209 people who attended the Profamille (V3.2 version) Family Psychoeducation Program. This program has 2 modules: an initial training module of 14 weekly or fortnightly sessions, and a consolidation module of 4 sessions over 2 years. Sessions last 4 hours and follow a precise and structured course. Data were collected from 40 different centers in France, Belgium and Switzerland and were based on participants assessed at the beginning and one year after the first module. Self-assessment from the relatives participating in the program provided the measure of patients' suicide attempts. An assessment at T0 explored the attempts over the 12 months before the beginning of the program while the assessment at T1 analyzed those during the 12 months following the end of the Program. The Chi2 test was used to compare the suicide attempt rates for each period, using a significance threshold of 0.05. Since the risk of suicide is greater in the first years of the illness, rates of attempts are also calculated according to the age of disorder. The analysis was carried out with the statistical software R. RESULTS The number of participants reporting that their relative had attempted suicide in the previous 12 months decreased from 41 to 21. The annual attempts rate was evaluated at 6.4 % before the Profamille program and decreased to 2.4 % a year after the end of the program (P=0.0003). The reduction of the attempt rate was observed even for patients with schizophrenia for more than 10 years. CONCLUSION This study shows the positive impact of Profamille on reducing the rate of suicide attempts in patients with schizophrenia. It has been shown that the risk is highest at the beginning of the disorder. Therefore, based on our results, it would seem appropriate to propose the Profamille program at an early stage.
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Affiliation(s)
- Y Hodé
- Institut de psychiatrie GDR 3557 Paris, 1, rue Cabanis, 75014 Paris, France.
| | - J Dubreucq
- C3r CH Alpes-Isère, 3, rue de la Gare, 38120 Saint-Égrève, France
| | - E Valladier
- Service hospitalo-universitaire-S14, centre référent en remédiation cognitive et réhabilitation psychosociale (C3RP), centre hospitalier Sainte-Anne, 75014 Paris, France
| | - N Guillard Bouhet
- CREATIV, centre hospitalier H. Laborit, Poitiers, 370, avenue Jacques-Cœur, 86021 Poitiers, France
| | - S Lemestré
- ASBL Similes Wallonie, rue Lairesse, 15, 4020 Liège, Belgique
| | - J Attal
- Service universitaire de psychiatrie adulte, hôpital la Colombière, CHRU Montpellier, 191, avenue du Doyen Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - O Canceil
- Pôle Paris 12 - Secteur 75G10/11 hôpitaux de Saint-Maurice, 12-4, rue du Val d'Osne, 94410 Saint-Maurice, France
| | - M Biotteau
- Département de psychiatrie, CHU de Tours, 37044 Tours cedex 9, France
| | - P Laffond
- Hôpital de Malévoz, route de Morgins, 10, 1870 Monthey, Suisse
| | - A Raynaud
- Filière ambulatoire, centre hospitalier Esquirol, 15, rue Doct Raymond-Marcland, 87000 Limoges, France
| | - I Chéreau-Boudet
- Service de psychiatrie de l'adulte, CHU de Clermont-Ferrand, rue Montalembert, BP 69, 63003 Clermont-Ferrand, France
| | - A Montagne Larmurier
- Service de psychiatrie adulte, CHU de Caen, avenue de la Côte de Nacre CS 30001, 14033 Caen cedex 9, France
| | - J-Y Giordana
- CHS Sainte-Marie, 87, avenue Joseph-Raybaud, 06200 Nice, France
| | - B Saingery
- EPSM des Ardennes CHS Bélair, 1, rue Pierre-Hallali, 08000 Charleville-Mézières, France
| | - T d'Amato
- SHU pôle est, centre hospitalier Le-Vinatier, BP 30039 - 95, boulevard Pinel, 69678 Bron, France
| | - D Willard
- C3R-P/CJAAD, service hospitalo-universitaire, GHU Paris psychiatrie et neurosciences, 1, rue Cabanis, 75014 Paris, France
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Psychiatric diagnosis, gender, aggression, and mode of attempt in patients with single versus repeated suicide attempts. Psychiatry Res 2020; 284:112747. [PMID: 31927168 DOI: 10.1016/j.psychres.2020.112747] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 12/01/2019] [Accepted: 01/01/2020] [Indexed: 12/31/2022]
Abstract
There is evidence that patients with multiple suicide attempts in their history are at greater risk to repeat attempt and eventually die by suicide compared to those with a single attempt. This cross-sectional study aimed to explore possible differences in clinical characteristics between patients with a single attempt and patients with repeated attempts. Two hundred thirty one patients hospitalised in psychiatric department after suicide attempt were studied. Comparisons were made in relation to age, gender, psychiatric diagnosis, aggression, depression severity, suicide intent and mode of attempt. Highest frequencies of patients with repeated attempts were found for bipolar disorder (69%) and lowest for adjustment/personality disorders (39%). In patients with repeated attempts, female gender was associated with non-violent attempt mode. Depressive symptomatology was higher in patients with repeated attempts among females. In patients with depression those with repeated attempts were younger than patients with single attempt. In patients with mood disorders, total aggression and hostility scores were higher in females with repeated attempts but not in males. Psychiatric diagnosis, gender and attempt mode are features that differentiate patients with single and repeated attempts and should be considered to identify patients at increased risk to repeat attempt and design effective prevention interventions.
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Abstract
PURPOSE OF REVIEW To review and discuss recent advances in evidence-based interventions (EBIs) for youth suicide risk. RECENT FINDINGS There is a growing body of research on the effectiveness of interventions targeting suicidal ideation and behavior among adolescents. Dialectical Behavioral Therapy-Adolescent has shown effectiveness across two independent randomized controlled trials (RCTs). Several other interventions have shown effectiveness in only one trial and are in need of replication. New interventions are also being developed that incorporate developments in technology and adaptive intervention designs. It is recommended that future research focus on strategies for engaging underserved youth with interventions, consider the broader needs of youth living in poverty, and further tailor interventions to subgroups with distinct risk profiles. Limited EBIs exist for preadolescents, despite evidence for an increasing rate of suicidal behavior for these youth. Several interventions for youth suicide risk are highly promising, but further investigation is necessary. EBIs that are effective for preadolescents are needed, and greater efforts to tailor interventions for distinct subgroups of youth at risk are recommended.
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Fehling KB, Selby EA. Suicide in DSM-5: Current Evidence for the Proposed Suicide Behavior Disorder and Other Possible Improvements. Front Psychiatry 2020; 11:499980. [PMID: 33613330 PMCID: PMC7891495 DOI: 10.3389/fpsyt.2020.499980] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/29/2020] [Indexed: 02/06/2023] Open
Abstract
Suicide continues to be one of the greatest challenges faced by mental health clinicians and researchers, an issue made worse by increasing trends in the global suicide rate. Suicide behavior disorder (SBD) was introduced in DSM-5 as a disorder for further consideration and potential acceptance into the diagnostic system. There are numerous positive developments that would arise from the addition of a suicide-related diagnosis. Utilizing the 2009 guidelines established by Kendler and colleagues, the present review examines the evidence for SBD's validity and discusses the diagnosis' potential clinical benefits and limitations. Altogether, growing evidence indicates that SBD has preliminary validity and benefit. SBD presents with several significant limitations, however, and possible alternative additions to future DSMs are highlighted.
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Affiliation(s)
| | - Edward A Selby
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
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Huang WC, Yen TH, Lin L, Lin C, Juang YY, Wang BH, Lee SH. Clinical Characteristics of Pesticide Self-Harm as Associated with Suicide Attempt Repetition Status. Neuropsychiatr Dis Treat 2020; 16:1717-1726. [PMID: 32764947 PMCID: PMC7371433 DOI: 10.2147/ndt.s258475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/28/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Previous suicide behavior predicts future suicide risk. Studies of suicide repetition are important for suicide prevention. This study examined the clinical characteristics and psychiatric comorbidities of pesticide self-harm as associated with suicide attempt repetition status. PATIENTS AND METHODS This retrospective, observational study included patients admitted to a medical center in northern Taiwan between 2000 and 2015 following suicide attempts by pesticide. Diagnoses were made by a consultation-liaison psychiatry team based on the DSM IV-TR criteria. Independent samples t-test was used to analyze the quantitative variables and Pearson's Chi-squared test with a Bonferroni adjustment for categorical variables. Univariate binary logistic regression analysis was conducted to determine the predictors for repeated suicide attempt and multivariate binary logistic regression analysis to identify significant associated factors. RESULTS Among 151 patients, organophosphate pesticides were the most used (80.8%). The average age was 52.9±17.2 years. Most patients were married males from rural areas, with depressive disorder most often diagnosed (40.4%). Nearly one-third of them were suicide repeaters (n=43, 28.5%); these patients were less likely to be married (53.5%, p=0.001), had previously used psychiatric services (72.1%, p<0.001) and chose complex suicide (46.5%, p=0.014) more often compared to nonrepeaters. No significant differences were found between repeaters and nonrepeaters regarding psychiatric comorbidities. Multivariate logistic regression analysis revealed that marital status (odds ratio: 2.916, 95% confidence interval: 1.234-6.891, p=0.015) and previous psychiatric services usage (odds ratio: 6.897, 95% confidence interval: 3.012-15.625, p<0.001) were significant risk factors associated with suicide repetition. CONCLUSION Pesticide suicide repeaters were characterized by less likely to be married and more likely to use psychiatric services before suicide attempts. These features help ensuring that the needs of people who have made a suicide attempt are addressed, and it reduces the likelihood of repetition.
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Affiliation(s)
- Wei-Chen Huang
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Long Lin
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chemin Lin
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yeong-Yuh Juang
- Department of Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Bi-Hwa Wang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shwu-Hua Lee
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Guzmán EM, Cha CB, Ribeiro JD, Franklin JC. Suicide risk around the world: a meta-analysis of longitudinal studies. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1459-1470. [PMID: 31485691 DOI: 10.1007/s00127-019-01759-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/20/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE Suicidal thoughts and behaviors (STBs) have been a persistent problem worldwide. Identifying risk factors for STBs across distinct areas of the world may help predict who or where requires the greatest attention. However, risk factors for STBs are infrequently explored cross-nationally. The present study examined whether psychopathology prospectively predicts STBs across different areas of the world, and whether certain country-level factors moderate the degree of risk conferred. METHODS We conducted a meta-analysis of 71 longitudinal studies from 30 different countries that featured psychopathology-related variables predicting STB outcomes. Meta-regression was used to evaluate whether the following country-level factors modified risk: geographic region, income level, and degree of mental health structural stigma. RESULTS Over 90% of studies had been conducted in North America and Europe. When assessed by country income level, it was found that only one longitudinal study on psychopathology and STB was conducted outside of a high-income country. Moreover, less than 10% of studies were conducted in high structural stigma contexts. Meta-regression findings revealed that the variation in risk effect sizes across studies was not explained by models including country-level factors. CONCLUSIONS Our findings show critical underrepresentation of low- and middle-income countries, which account for a large proportion of global suicide deaths. This reveals a need to broaden the scope of longitudinal research on STB risk, such that countries across more regions, income levels, and degrees of structural stigma are fully accounted for. Such lines of research will improve generalizability of findings, and more precisely inform prevention efforts worldwide.
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Affiliation(s)
- E M Guzmán
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 West 120th Street, Box 102, New York, NY, 10027, USA
| | - C B Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 West 120th Street, Box 102, New York, NY, 10027, USA.
| | - J D Ribeiro
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahasee, FL, 32306, USA
| | - J C Franklin
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahasee, FL, 32306, USA
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Icick R, Melle I, Etain B, Ringen PA, Aminoff SR, Leboyer M, Aas M, Henry C, Bjella TD, Andreassen OA, Bellivier F, Lagerberg TV. Tobacco smoking and other substance use disorders associated with recurrent suicide attempts in bipolar disorder. J Affect Disord 2019; 256:348-357. [PMID: 31202989 DOI: 10.1016/j.jad.2019.05.075] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 04/08/2019] [Accepted: 05/30/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Suicide attempts (SA) are more frequent in bipolar disorder (BD) than in most other mental disorders. Prevention strategies would benefit from identifying the risk factors of SA recurrence in BD. Substance use disorders (SUD) (including tobacco-related) are strongly associated with both BD and SA, however, their specific role for the recurrence of SA in BD remains inadequately investigated. Thus, we tested if tobacco smoking - with or without other SUDs - was independently associated with recurrent SA in BD. METHODS 916 patients from France and Norway with ascertained diagnoses of BD and reliable data about SA and SUD were classified as having no, single, or recurrent (≥2) SA. Five SUD groups were built according to the presence/absence/combination of tobacco, alcohol (AUD) and cannabis use disorders. Multinomial logistic regression was used to identify the correlates of SA recurrence. RESULTS 338 (37%) individuals reported at least one SA, half of whom (173, 51%) reported recurrence. SUD comorbidity was: tobacco smoking only, 397 (43%), tobacco smoking with at least another SUD, 179 (20%). Regression analysis showed that tobacco smoking, both alone and comorbid with AUD, depressive polarity of BD onset and female gender were independently associated with recurrent SA. LIMITATIONS Lack of data regarding the relative courses of SA and SUD and cross-national differences in main variables. CONCLUSION Tobacco smoking with- or without additional SUD can be important risk factors of SA recurrence in BD, which is likely to inform both research and prevention strategies.
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Affiliation(s)
- R Icick
- Inserm, U1144, Paris F-75006, France; Paris Diderot University, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Saint-Louis - Lariboisière - F. Widal, Departement of Psychiatry and Addiction Medicine, Paris F-75010, France; FondaMental Foundation, Créteil F-94000, France.
| | - I Melle
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - B Etain
- Inserm, U1144, Paris F-75006, France; Paris Diderot University, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Saint-Louis - Lariboisière - F. Widal, Departement of Psychiatry and Addiction Medicine, Paris F-75010, France; FondaMental Foundation, Créteil F-94000, France
| | - P A Ringen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - S R Aminoff
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M Leboyer
- FondaMental Foundation, Créteil F-94000, France; Inserm U955, Psychiatric Genetics Team, Créteil F-94000, France; Paris Est University, Faculty of medicine, Créteil F-94000, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Henri Mondor, DHU PePsy, Psychiatry Center, Créteil F-94000, France
| | - M Aas
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - C Henry
- FondaMental Foundation, Créteil F-94000, France; Paris Est University, Faculty of medicine, Créteil F-94000, France
| | - T D Bjella
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - O A Andreassen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - F Bellivier
- Inserm, U1144, Paris F-75006, France; Paris Diderot University, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Saint-Louis - Lariboisière - F. Widal, Departement of Psychiatry and Addiction Medicine, Paris F-75010, France; FondaMental Foundation, Créteil F-94000, France
| | - T V Lagerberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Tsirigotis K. Gender Differentiation of Indirect Self-Destructiveness in Drug Addicted Individuals (Indirect Self-Destructiveness in Addicted Women and Men). Psychiatr Q 2019; 90:371-383. [PMID: 30835014 PMCID: PMC6522439 DOI: 10.1007/s11126-019-09629-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The use of psychoactive substances is considered to be a typical self-destructive behaviour with addiction itself regarded as one of the self-destructiveness forms. The aim of this work was to explore the gender differentiation of the indirect self-destructiveness syndrome (and its particular categories) in drug addicted individuals treated in drug addiction treatment centres. 172 drug addicted individuals (116 men and 56 women, M age = 23,5), ranged from 19 to 28 years, was recruited. In order to examine indirect self-destructiveness and its manifestations, the Polish version of the "Chronic Self-Destructiveness Scale" by Kelley (CS-DS) was administered. The statistical processing of scores used the Mann-Whitney U significance test. Women treated for drug addiction achieved significantly higher scores on indirect self-destructiveness: general score (p = 0.001), subscales of Transgression and Risk (p = 0.001), Personal and Social Neglects (p = 0.02), and Lack of Planfulness (p < 0.001). They scored lower on Poor Health Maintenance (p < 0.002) and Helplessness (p < 0.001). There is a need for specific, gender-adjusted manners of intervention and treatment in addicted women. Optimistically, after an addiction treatment, women cope and feel better psychologically and socially. They also care more about their health.
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Affiliation(s)
- Konstantinos Tsirigotis
- Department of Psychology, The Jan Kochanowski University in Kielce, Piotrków Trybunalski Branch, 114/118 Słowackiego St, 97-300, Piotrków Trybunalski, Poland.
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Vijayakumar L, Lamech N. Suicide and Suicidal Behavior in Women. MENTAL HEALTH AND ILLNESS OF WOMEN 2019. [DOI: 10.1007/978-981-10-0371-4_3-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Icick R, Vorspan F, Karsinti E, Ksouda K, Lépine JP, Brousse G, Mouly S, Bellivier F, Bloch V. Gender-specific study of recurrent suicide attempts in outpatients with multiple substance use disorders. J Affect Disord 2018; 241:546-553. [PMID: 30153638 DOI: 10.1016/j.jad.2018.08.076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/06/2018] [Accepted: 08/12/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND people suffering from substance use disorders (SUD) often die by suicide, so that the prevention of suicide attempts (SA) remains a top priority in this population. SA recurrence is common and is associated with suicide death, but this phenotype has been overlooked in SUD populations. Thus, we aimed at identifying the risk factors of SA recurrence in SUD, controlling for both gender and levels of exposure to addictive substances, including tobacco. METHODS we consecutively recruited 433 treatment-seeking outpatients with either opiate or cocaine use disorder and assessed their lifetime history of addictive and suicidal symptoms by standardized questionnaires. They were reliably classified as never, single or recurrent (≥ 2) suicide attempters, whose characteristics were identified by multinomial regression, stratified by gender; and compared to our previous work on serious SA in order to identify common or different risk profiles. RESULTS 86/140 (61%) suicide attempters reported recurrence. The mean number of SA was 3.1. Recurrence was independently associated with psychiatric hospitalization in both genders, with nicotine dependence in men and with sedative use disorders in women. LIMITATIONS psychiatric diagnoses were derived from the current medication regimen. CONCLUSION specific and possibly avoidable/treatable risk factors for the recurrence of SA in SUD have been identified for the first time, opening new avenues for research and prevention in this high-risk population. Apart from nicotine dependence, these risk factors were very similar to those of serious SA. Although this comparison is indirect for now, it suggests a common liability towards suicidal behavior.
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Affiliation(s)
- R Icick
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Psychiatry and Addiction Medicine, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France; INSERM U1144, Paris F-75006, France; Inserm UMR-S1144, Paris Descartes University, Paris F-75006, France; Sorbonne Paris Cité, Inserm UMR-S1144, Paris Diderot University, Paris F-75013, France.
| | - F Vorspan
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Psychiatry and Addiction Medicine, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France; INSERM U1144, Paris F-75006, France; Inserm UMR-S1144, Paris Descartes University, Paris F-75006, France; Sorbonne Paris Cité, Inserm UMR-S1144, Paris Diderot University, Paris F-75013, France
| | - E Karsinti
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Psychiatry and Addiction Medicine, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France; INSERM U1144, Paris F-75006, France; ED139, Paris Nanterre University, Nanterre F-92001, France
| | - K Ksouda
- Pharmacology Laboratory, Faculty of Medicine, Sfax, Tunisia
| | - J-P Lépine
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Psychiatry and Addiction Medicine, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France; INSERM U1144, Paris F-75006, France; Inserm UMR-S1144, Paris Descartes University, Paris F-75006, France; Sorbonne Paris Cité, Inserm UMR-S1144, Paris Diderot University, Paris F-75013, France
| | - G Brousse
- Psychiatry B-Department of Addiction Psychiatry, Faculty of Medicine, EA7280 and CHU Clermont-Ferrand, Clermont 1 University, Clermont-Ferrand F-63003, France
| | - S Mouly
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Psychiatry and Addiction Medicine, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France; INSERM U1144, Paris F-75006, France; Inserm UMR-S1144, Paris Descartes University, Paris F-75006, France; Sorbonne Paris Cité, Inserm UMR-S1144, Paris Diderot University, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Internal Medicine, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France
| | - F Bellivier
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Psychiatry and Addiction Medicine, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France; INSERM U1144, Paris F-75006, France; Inserm UMR-S1144, Paris Descartes University, Paris F-75006, France; Sorbonne Paris Cité, Inserm UMR-S1144, Paris Diderot University, Paris F-75013, France
| | - V Bloch
- INSERM U1144, Paris F-75006, France; Inserm UMR-S1144, Paris Descartes University, Paris F-75006, France; Sorbonne Paris Cité, Inserm UMR-S1144, Paris Diderot University, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Hospital Pharmacy, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France
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López-Goñi JJ, Goñi-Sarriés A, Azcárate-Jiménez L, Sabater-Maestro P. Suicidal behaviour recurrence in psychiatric emergency departments of patients without a prior suicide attempt, index and reattempters: A prospective study. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2018; 13:192-201. [PMID: 30473478 DOI: 10.1016/j.rpsm.2018.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There has been little change in the incidence of suicidal behaviour and reattempts in recent years. Evidence is needed on the incidence of suicidal behaviour in the psychiatric population and its follow-up. MATERIAL AND METHOD A prospective multi-centre case-control study. The sample covered the cases of 440 patients seen as psychiatric emergencies. For this purpose, we used the Vital Adverse Event Scale by Brugha and screening with the Columbia Scale. The sample was divided into three groups: patients without prior suicide attempts, patients with an index attempt and patients with more than one attempt. At two years, the clinical histories of these patients were reviewed, assessing for suicidal behaviour. RESULTS A total of 49.1% (n=216) of the patients required urgent psychiatric care during the follow-up period, and 2.7% eventually committed suicide. The data shows a differential profile between the three groups analysed. Among them, the group of reattempters required the highest number of interventions regarding suicide behaviour (11.0%; χ2=30.3; d.f.=2; P<.001). Eventually, 6.1% of the patients without prior suicide attempts tried to commit suicide for the first time, and 21.7% (n=60) of the remaining sample repeated their prior attempts. The highest risk of attempt was in the thirty days following the urgent intervention. After this period, risk distribution varied for each group. Three items from the Columbia Scale predict suicide behaviour. CONCLUSIONS The results show the need for assessing suicidal behaviour for all patients who receive psychiatric urgent care, including during the follow-up period. A more thorough control should be performed during the first months for patients without prior suicide attempts, and longer periods for those patients who have already tried to commit suicide.
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Affiliation(s)
| | - Adriana Goñi-Sarriés
- Red de Salud Mental de Navarra, Servicio Navarro de Salud - Osasunbidea, Pamplona, España
| | - Leire Azcárate-Jiménez
- Red de Salud Mental de Navarra, Servicio Navarro de Salud - Osasunbidea, Pamplona, España
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Salles J, Calonge J, Franchitto N, Bougon E, Schmitt L. Factors associated with hospitalization after self-poisoning in France: special focus on the impact of alcohol use disorder. BMC Psychiatry 2018; 18:287. [PMID: 30189841 PMCID: PMC6127999 DOI: 10.1186/s12888-018-1854-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/16/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Previous studies have identified factors associated with admission to hospital after suicide spectrum behaviors. In this study, we aim to identify specific factors associated with psychiatric hospitalization after self-poisoning. Given earlier findings suggesting that alcohol use disorder is not associated with hospital admission, we also aim to consider its impact, as well as blood alcohol concentrations, on hospitalization decisions after a suicide attempt. METHODS We studied the association between demographic features, suicide intent, psychiatric characteristics and admission to hospital in self-poisoning patients in an emergency department in France. RESULTS Suicide intent, a past history of suicide attempts, bipolar disorder and depression were associated with psychiatric hospital admissions. Despite alcohol use disorder being known to be associated with a suicide risk, it was not linked with psychiatric hospitalization. A positive blood alcohol concentration in the emergency department likewise had no association with admission to a psychiatric ward for inpatient care. CONCLUSIONS Our findings were similar to those reported for other suicide spectrum behaviors. Alcohol use disorder was not associated with admission for inpatient psychiatric care, whereas depression clearly was. The cause of this discrepancy must be determined in future research.
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Affiliation(s)
- Juliette Salles
- Université de Toulouse III, F-31000 Toulouse, France
- CHU Toulouse, Service de Psychiatrie eSt Psychologie, Psychiatrie, F-31000 Toulouse, France
- CHU Toulouse, Service d’addictologie clinique, urgences réanimation médecine, F-31000 Toulouse, France
| | - Julie Calonge
- Université de Toulouse III, F-31000 Toulouse, France
| | - Nicolas Franchitto
- Université de Toulouse III, F-31000 Toulouse, France
- CHU Toulouse, Service d’addictologie clinique, urgences réanimation médecine, F-31000 Toulouse, France
| | - Emmanuelle Bougon
- Université de Toulouse III, F-31000 Toulouse, France
- CHU Toulouse, Service de Psychiatrie eSt Psychologie, Psychiatrie, F-31000 Toulouse, France
| | - Laurent Schmitt
- Université de Toulouse III, F-31000 Toulouse, France
- CHU Toulouse, Service de Psychiatrie eSt Psychologie, Psychiatrie, F-31000 Toulouse, France
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Akkaya-Kalayci T, Kapusta ND, Winkler D, Kothgassner OD, Popow C, Özlü-Erkilic Z. Triggers for attempted suicide in Istanbul youth, with special reference to their socio-demographic background. Int J Psychiatry Clin Pract 2018; 22:95-100. [PMID: 28899223 DOI: 10.1080/13651501.2017.1376100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Suicidal behavior of young people is a topic of utmost importance because suicide is irreversible, and should be prevented. Knowing about the psychosocial background and the triggering events could help in preventing suicidal behavior. We therefore aimed at identifying psychosocial factors that may trigger suicidal behavior in youth. METHODS We analyzed retrospectively the standardized records of 2232 youths aged ≤25 years, who were treated after a suicide attempt at emergency units of public hospitals in Istanbul, Turkey during a period of 1 year. We describe this population according to sex and socio-economic conditions, like educational, occupational, relationship status and link them with their reported reasons for suicide attempts. RESULTS The majority of patients were female (81.6%, N = 1822 females, 18.4%, N = 410 males). Independent of their educational and occupational background, patients indicated most frequently intra-familial problems (females 45.8%, males 30.5%), intrapersonal problems (females 19.9%, males 18.5%), and relationship problems (females 11.3%, males 23.9%) as triggering reasons. CONCLUSIONS Because intra-familial problems were the most frequently reported triggers of suicide attempts, preventive measures should focus on handling intra-familial conflicts. As sex differences were observed for the second-most common trigger-reasons, prevention should also focus on differentially handling intrapersonal and relationship conflicts better.
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Affiliation(s)
- Türkan Akkaya-Kalayci
- a Outpatient Clinic of Transcultural Psychiatry and Migration-Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry , Medical University of Vienna , Vienna , Austria
| | - Nestor D Kapusta
- b Department of Psychoanalysis and Psychotherapy , Medical University of Vienna , Vienna , Austria
| | - Dietmar Winkler
- c Department for Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry , Medical University of Vienna , Vienna , Austria
| | - Oswald D Kothgassner
- d Division of Clinical Psychology , Medical Directorate of the Vienna General Hospital - Medical University Campus , Vienna , Austria.,e Department of Child and Adolescent Psychiatry , Medical University of Vienna , Vienna , Austria
| | - Christian Popow
- e Department of Child and Adolescent Psychiatry , Medical University of Vienna , Vienna , Austria
| | - Zeliha Özlü-Erkilic
- a Outpatient Clinic of Transcultural Psychiatry and Migration-Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry , Medical University of Vienna , Vienna , Austria
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Pennel L, Quesada JL, Dematteis M. Neuroticism and anxious attachment as potential vulnerability factors of repeat suicide attempts. Psychiatry Res 2018; 264:46-53. [PMID: 29626831 DOI: 10.1016/j.psychres.2018.03.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 11/30/2022]
Abstract
The recurrence risk of suicide attempts can reach 50% in the first year, each attempt increasing suicide-risk by 32%. No screening tool efficiently identifies potential repeat suicide attempters who are too often regarded as borderline personality. Our aim was to identify individual and interpersonal psychopathological dimensions that could represent a vulnerability to repeat suicide attempts. Sixty first-time and repeat suicide attempters consecutively admitted in emergency rooms were compared for fundamental dimensions of personality, patterns of attachment, personality and mental disorders using standardized questionnaires. Confounding and significantly different factors were evaluated using univariate and multivariate logistic regressions. Repeat suicide attempters differed from first-attempters by higher neuroticism and anxious attachment. Combined in an 11-item measure, these two parameters identified a 3.99 times higher risk of repeat suicide attempt. These traits associated with the other two best predictors (non-suicidal self-injury history, current psychotropic drugs) provide a vulnerability model with better screening performance compared to each factor individually. Repeat suicide attempters have more psychological features impairing emotional stability and social interactions than first attempters. Cross-sectional study design, sample size, lack of independent sample and of fearful-avoidant attachment evaluation are the main limitations. The model needs to be validated in a prospective and controlled study.
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Affiliation(s)
- Lucie Pennel
- Univ. Grenoble Alpes, F-38042 Grenoble, France; CHU Grenoble Alpes, Department of Addiction Medicine, F-38043 Grenoble, France
| | - Jean-Louis Quesada
- CHU Grenoble Alpes, Clinical Investigation Center 1406, F-38043 Grenoble, France
| | - Maurice Dematteis
- Univ. Grenoble Alpes, F-38042 Grenoble, France; CHU Grenoble Alpes, Department of Addiction Medicine, F-38043 Grenoble, France.
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Abstract
The aim of this work was to review results of research into direct and indirect self-destructiveness in women. Studied projects covered two populations: individuals who attempted suicide and individuals who did not attempt suicide. The Chronic Self-Destructiveness Scale and Bem Sex Role Inventory were used. Intensity of indirect self-destructiveness is lower in women. A probable explanation of the gender paradox in suicides may be the hypothesis that suicides attempted by men more often end in death as men display stronger indirect self-destructiveness. Masculinity and male sex are factors that predispose to indirect self-destructiveness, while femininity and female sex are factors protecting against it. Gender schema opposite to biological sex is significant to intensity of indirect self-destructiveness.
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Affiliation(s)
- Konstantinos Tsirigotis
- Department of Psychology, Jan Kochanowski University, Piotrków Trybunalski Branch, Słowackiego 114/118 str, 97-300, Piotrków Trybunalski, Poland.
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Suicide Risk Screening in Healthcare Settings: Identifying Males and Females at Risk. J Clin Psychol Med Settings 2018; 24:8-20. [PMID: 28251427 DOI: 10.1007/s10880-017-9486-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Suicide is the tenth leading cause of death in the United States, accounting for more than 42,000 deaths in 2014. Although this tragedy cuts across groups defined by age, gender, race/ethnicity, and geographic location, it is striking that nearly four times as many males as females die by suicide in the U.S. We describe the current regulations and recommendations for suicide risk screening in healthcare systems and also describe the aspirational goal of "Zero Suicide," put forth by the National Action Alliance for Suicide Prevention. We then provide information about suicide risk screening tools and steps to take when a patient screens positive for suicide risk. Given the substantially higher suicide rate among males than females, we argue that it is important to consider how we could optimize suicide risk screening strategies to identify males at risk and females at risk. Further research is needed to accomplish this goal. It is recommended that we consider multi-factorial suicide risk screens that incorporate risk factors known to be particularly important for males as well as computerized, adaptive screens that are tailored for the specific risk considerations of the individual patient, male or female. These strategies are not mutually exclusive. Finally, universal suicide risk screening in healthcare settings, especially primary care, specialty medical care, and emergency department settings, is recommended.
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Bergmans Y, Gordon E, Eynan R. Surviving moment to moment: The experience of living in a state of ambivalence for those with recurrent suicide attempts. Psychol Psychother 2017; 90:633-648. [PMID: 28497887 DOI: 10.1111/papt.12130] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 02/25/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This qualitative study aimed to capture the experience of living in the ambivalent space between life and death for adults with recurrent suicide attempts (RSA). It sought to expand upon an earlier study that explored the processes involved in transitioning away from RSA among adults, which revealed that occupying this ambivalent space is a crucial part of this process. DESIGN Interpretive phenomenological analysis (IPA) was used. This methodology was designed to explore the lived experiences and meaning making and enabled interpretation of the multidimensional subjective experiences of RSA participants. METHODS In-depth semi-structured interviews were conducted with eight adult women with a history of RSA who had participated in a therapeutic intervention at the research site (Skills for Safer Living: A Psychosocial/Psychoeducational Intervention for People with Recurrent Suicide Attempts [SfSL/PISA]). The six stages of IPA were followed to analyse the interview data. RESULTS Analysis revealed the superordinate theme, 'surviving moment to moment', which refers to a precarious state of making decisions about one's life and destiny on a moment-to-moment basis without clear commitment to either life or death. Two subordinate themes were identified: 'deciding not to die in the moment' when the participants were more invested in dying than living and 'deciding to live in the moment' when they were more invested in living than dying. CONCLUSION The study illuminated the complex process of making decisions about ones' destiny on a moment-to-moment basis. It revealed the torment experienced when occupying this state, while paradoxically, also revealing how indecision about life and death provided a lifeline opportunity for those with RSA. Clinicians who recognize the subtle distinctions associated with this in-between state can tailor their interventions accordingly. PRACTITIONER POINTS Surviving moment to moment is characterized by a state of emotional flux and uncertainty about one's destiny, where the person has not fully committed to either life or death. Within this state, there are two interlinked subprocesses, whereby the person is leaning more towards death or life. A critical feature in working with this client group is to recognize their ambiguity and the fragility and temporality of their decisions about their destiny. The practitioner has an opportunity to be a catalyst in the momentum towards life by demonstrating understanding of this survival struggle and tailoring intervention to fit with the nuanced processes within this state.
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Affiliation(s)
- Yvonne Bergmans
- Arthur Sommer Rotenberg Chair in Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada.,University of Toronto, Ontario, Canada
| | | | - Rahel Eynan
- Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Akkaya-Kalayci T, Kapusta ND, Waldhör T, Blüml V, Poustka L, Özlü-Erkilic Z. The association of monthly, diurnal and circadian variations with suicide attempts by young people. Child Adolesc Psychiatry Ment Health 2017; 11:35. [PMID: 28781609 PMCID: PMC5537930 DOI: 10.1186/s13034-017-0171-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 06/18/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Different psychosocial factors might have an impact on suicidal behaviour and evidence shows that there may be an association between monthly, diurnal and circadian changes and suicidal behaviours. METHODS In the present study we analysed retrospectively records of 2232 youth, who were treated in emergency units of state hospitals in Istanbul/Turkey after attempting suicide. RESULTS The majority of the suicide attempters were females (81.6%). In both sexes, suicide attempts most frequently occurred at the beginning of the calendar week and between evening and midnight. CONCLUSIONS This study shows that suicide attempts in youth follow diurnal and circadian changes. As suicide attempts of youth most frequently occurred at the beginning of the calendar week and between evening and midnight, health services such as specialized counselling for youth should especially be available during this time.
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Affiliation(s)
- Türkan Akkaya-Kalayci
- 0000 0000 9259 8492grid.22937.3dOutpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Nestor D. Kapusta
- 0000 0000 9259 8492grid.22937.3dDepartment for Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Thomas Waldhör
- 0000 0000 9259 8492grid.22937.3dDepartment for Epidemiology, Medical University of Vienna, Kinderspitalgasse 15/I, 1090 Vienna, Austria
| | - Victor Blüml
- 0000 0000 9259 8492grid.22937.3dDepartment for Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Luise Poustka
- 0000 0000 9259 8492grid.22937.3dDepartment of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Zeliha Özlü-Erkilic
- 0000 0000 9259 8492grid.22937.3dOutpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Perquier F, Duroy D, Oudinet C, Maamar A, Choquet C, Casalino E, Lejoyeux M. Suicide attempters examined in a Parisian Emergency Department: Contrasting characteristics associated with multiple suicide attempts or with the motive to die. Psychiatry Res 2017; 253:142-149. [PMID: 28365537 DOI: 10.1016/j.psychres.2017.03.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 02/28/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
Abstract
Among patients examined after a suicide attempt in a Parisian emergency department, we aimed to compare individual characteristics of i) first time and multiple suicide attempters, ii) attempters whose principal motive was "to die" and attempters who had any other motive. Information regarding sociodemographics, clinical characteristics, prior mental health care and outgoing referral was collected in 168 suicide attempters using a standardized form. Associations of these variables with suicide attempt repetition (yes or no) and with the motive underlying the attempt (to die or not) were examined using descriptive statistics and multivariable logistic regression models. Multiple attempters were more likely to have no occupation and to report previous mental health care: mental health follow-up, psychiatric medication or psychiatric hospitalization. The motive to die was not associated with the risk of multiple suicide attempts but related to past suicidal ideation and to some specific precipitating factors, including psychiatric disorder. Patients who intended to die were also more likely to be referred to inpatient than to outpatient psychiatric care. Multiple attempters and attempters who desire to die might represent two distinct high-risk groups regarding clinical characteristics and care pathways. They would probably not benefit from the same intervention strategies.
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Affiliation(s)
- Florence Perquier
- Department of Epidemiology, Paris Hospital Group - Psychiatry & Neurosciences, 1 rue Cabanis, 75014 Paris, France.
| | - David Duroy
- Department of Psychiatry and Addictive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France; Paris Diderot University - Paris VII, 5 Rue Thomas Mann, 75013 Paris, France
| | - Camille Oudinet
- Department of Psychiatry and Addictive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France; Paris Diderot University - Paris VII, 5 Rue Thomas Mann, 75013 Paris, France
| | - Alya Maamar
- Department of Epidemiology, Paris Hospital Group - Psychiatry & Neurosciences, 1 rue Cabanis, 75014 Paris, France
| | - Christophe Choquet
- Emergency Department, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France
| | - Enrique Casalino
- Paris Diderot University - Paris VII, 5 Rue Thomas Mann, 75013 Paris, France; Emergency Department, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France
| | - Michel Lejoyeux
- Department of Epidemiology, Paris Hospital Group - Psychiatry & Neurosciences, 1 rue Cabanis, 75014 Paris, France; Department of Psychiatry and Addictive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France; Paris Diderot University - Paris VII, 5 Rue Thomas Mann, 75013 Paris, France
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Parra-Uribe I, Blasco-Fontecilla H, Garcia-Parés G, Martínez-Naval L, Valero-Coppin O, Cebrià-Meca A, Oquendo MA, Palao-Vidal D. Risk of re-attempts and suicide death after a suicide attempt: A survival analysis. BMC Psychiatry 2017; 17:163. [PMID: 28472923 PMCID: PMC5415954 DOI: 10.1186/s12888-017-1317-z] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 04/20/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Suicide is the primary cause of unnatural death in Spain, and suicide re-attempts a major economic burden worldwide. The risk factors for re-attempt and suicide after an index suicide attempt are different. This study aims to investigate risk factors for re-attempt and suicide after an index suicide attempt. METHODS This observational study is part of a one-year telephone management program. We included all first-time suicide attempters evaluated in the emergency department at Parc Taulí-University Hospital (n = 1241) recruited over a five-year period (January 2008 to December 2012). Suicide attempters were evaluated at baseline using standardized instruments. Bivariate logistic regression models were used to identify risk factors. Kaplan-Meier curves were used to compare the time to re-attempt between categorical variables. Comparisons were performed using Log-Rank and Wilcoxon tests. Variables with a p-value lower than 0.2 were included in a multivariate Cox regression model. Bivariate logistic regression models were considered to identify risk factors for suicide. The significance level was set to 0.05. RESULTS Suicide re-attempters were more likely diagnosed with cluster B personality disorders (36.8% vs. 16.6%; p < 0.001), and alcohol use disorders (19.8 vs. 13.9; p = 0.02). Several [1.2% (15/1241)] of them died by suicide. Attempters who suicide were more likely alcohol users (33.3% vs. 17.2%; p = 0.047), and older (50.9 ± 11.9 vs. 40.7 ± 16.0; p = 0.004). CONCLUSIONS Alcohol use, personality disorders and younger age are risk factors for re-attempting. Older age is a risk factor for suicide among suicide attempters. Current prevention programs of suicidal behaviour should be tailored to the specific profile of each group.
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Affiliation(s)
- Isabel Parra-Uribe
- Department of Mental Health, Parc Tauli-University Hospital, Parc Taulí 1, 08208 Sabadell, Barcelone Spain ,grid.7080.fDepartment of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelone, Spain ,0000 0004 1762 4012grid.418264.dCIBERSAM, Madrid, Spain
| | - Hilario Blasco-Fontecilla
- Department of Psychiatry, IDIPHIM-Puerta de Hierro University Hospital, Autonoma University of Madrid, Avenida Manuel de Falla s/n, Madrid, Spain. .,CIBERSAM, Madrid, Spain.
| | - Gemma Garcia-Parés
- Department of Mental Health, Meritxell Hospital, Andorra la Vella, Andorra
| | | | - Oliver Valero-Coppin
- grid.7080.fStatistical Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Annabel Cebrià-Meca
- Department of Mental Health, Parc Tauli-University Hospital, Parc Taulí 1, 08208 Sabadell, Barcelone Spain ,0000 0004 1762 4012grid.418264.dCIBERSAM, Madrid, Spain
| | - Maria A. Oquendo
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, USA
| | - Diego Palao-Vidal
- Department of Mental Health, Parc Tauli-University Hospital, Parc Taulí 1, 08208, Sabadell, Barcelone, Spain. .,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelone, Spain. .,CIBERSAM, Madrid, Spain.
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Krysinska K, Batterham PJ, Christensen H. Differences in the Effectiveness of Psychosocial Interventions for Suicidal Ideation and Behaviour in Women and Men: A Systematic Review of Randomised Controlled Trials. Arch Suicide Res 2017; 21:12-32. [PMID: 26983580 DOI: 10.1080/13811118.2016.1162246] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The objective of this study was to explore outcomes of preventive programs and psychosocial treatments for suicidal ideation and behaviour in gender sub-groups in mixed gender studies and in studies limited to one gender. The method used was a systematic review of randomized controlled trials (RCTs) which included women or men only, or reported and/or examined outcomes of psychosocial interventions in mixed gender samples. A total of 27 (18%) of RCTs reported or examined differences in intervention outcomes. Of the mixed gender RCTs, 5 (33%) reported greater effectiveness for females than males. The review identified promising interventions in female-only samples. None of the trials reported greater effectiveness of the intervention in men. The majority of reviewed studies looking at treatment outcomes in gender sub-groups showed no differences between women and men or indicated that some psychosocial interventions are effective for women. There is a need for studies which look at gender effects and development of interventions more effective and appealing for men at risk of suicide.
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