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Ludwig J, Barbek R, von dem Knesebeck O. Education and suicidal ideation in Europe: A systematic review and meta-analysis. J Affect Disord 2024; 349:509-524. [PMID: 38199415 DOI: 10.1016/j.jad.2024.01.040] [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: 07/13/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Understanding predictors of suicidal ideation (SI) is crucial for preventing suicides. Given Europe's high suicide rates and the complex nature of SI, it is essential to also examine social determinants like education as potential risk factors for SI in this region. This systematic review and meta-analysis investigates the association between formal/vocational education and SI in Europe. METHODS Electronic databases (PubMed, Web of Science, PsycINFO, PSYNDEX) were searched until November 2022. Included studies involved European populations examining associations between education and SI. Pooled Odds Ratios (OR) with 95 % confidence intervals (CI) were calculated using random-effects models. Heterogeneity was assessed with the heterogeneity variance τ2 and I2 statistic; subgroup analyses were performed based on study characteristics. Risk of bias was assessed using an adaption of the Newcastle-Ottawa Scale. RESULTS From 20,564 initial studies, 41 were included in the meta-analysis (outlier-adjusted, 96,809 study participants). A negative, insignificant association (OR = 0.86, 95 % CI: 0.75; 1.00) was observed between education and SI, with significant heterogeneity (τ2 = 0.09, I2 = 73 %). Subgroup analyses indicated that population type, age group, categorization of education, timeframe of SI assessment, and study quality significantly moderated the effect size. LIMITATIONS Heterogeneity across studies limits generalizability. The cross-sectional design precludes establishing causal relationships, and social desirability bias may have underestimated the association between education and SI. CONCLUSIONS This systematic review and meta-analysis suggests a trend towards a protective effect of education on the emergence of SI in Europe. Future research, preferably with longitudinal study design examining various covariates, should systematically consider educational inequalities in SI.
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Affiliation(s)
- Julia Ludwig
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rieke Barbek
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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2
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The Impact of Affective Temperaments on Suicidal Ideation and Behaviors: Results from an Observational Multicentric Study on Patients with Mood Disorders. Brain Sci 2023; 13:brainsci13010117. [PMID: 36672098 PMCID: PMC9856472 DOI: 10.3390/brainsci13010117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Suicide ideation and behaviors are major health issues in the field of mental health. Several psychological and psychosocial factors have been taken into account as possible predictors of suicidality. Only recently affective temperaments have been considered as possible factors linked to suicide. This study aims to investigate the relationship between affective temperaments and suicidality, including the lifetime onset of suicide ideation, lifetime presence of suicide attempts and the total number of lifetime suicide attempts. This is a naturalistic multicentric observational study, involving outpatient units of seven University sites in Italy. Patients were administered with the short version of TEMPS-M and the Columbia Suicide Severity Rating Scale. A total of 653 participants were recruited, with a diagnosis of bipolar (55.7%), unipolar (35.8%) and cyclothymic disorder (8.4%). Regression models showed that the presence of lifetime suicide behaviors was increased in patients presenting trait related impulsivity (p < 0.0001), poor free-interval functioning (p < 0.05), higher number of affective episodes (p < 0.01), higher number of hospitalizations (p < 0.0001), cyclothymic and irritable affective temperaments (p < 0.05 and p < 0.05, respectively). Conversely, the presence of hyperthymic affective disposition reduced the likelihood of having suicidal behaviors (p < 0.01). Lifetime suicidal ideation was associated with trait-related impulsivity (p < 0.001), poor free-interval functioning (p < 0.05), higher number of affective episodes (p < 0.001) and of hospitalizations (p < 0.001). Depressive temperaments increased the likelihood of presenting suicidal ideation (p < 0.05), along with irritable temperaments (p < 0.01), contrary to hyperthymic affective (p < 0.05). Results of the present study confirm that affective disposition has a significant impact on the onset of suicidal ideation and behaviors, and that affective dispositions should be assessed in clinical settings to identify people at risk of suicide. Moreover, a wider clinical evaluation, including different clinical psychopathological dimensions, should be taken into consideration to develop effective preventive interventions.
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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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Wong JCM, Chang CL, Shen L, Nyein N, Loh ASW, Yap NH, Kroneman LM, Feng L, Tan CH. Temperament, parenting, mental disorders, life stressors and help-seeking behavior of Asian adolescent suicide attempters: A case control study. Front Psychiatry 2022; 13:999089. [PMID: 36245865 PMCID: PMC9557074 DOI: 10.3389/fpsyt.2022.999089] [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] [Received: 07/20/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The need to elucidate risk factors for adolescent suicide is urgent, as suicide consistently ranks among the top causes of death globally. Understanding suicide risk factors could inform more effective interventions. Previous studies have identified certain risk factors associated with suicide, but there is a paucity of research among adolescent and multi-ethnic Asian populations. MATERIALS AND METHODS This case-control study sampled 13-to-19-year-old Asian adolescents who had attempted suicide (N = 60) and controls (N = 58) matched by age, ethnicity and gender at group-level (73.7% female). Life stressors, temperament, parenting style, mental health conditions and help-seeking behavior were examined. RESULTS All domains of life stress apart from emerging adult responsibility were higher among cases than controls, especially home life, peer pressure and romantic relationships. Suicide attempters tended to avoid new situations, be less adaptable to changes, have a negative outlook and irregular sleep-wake cycle. Additionally, they perceived their parents to be significantly more aggressive, neglecting, rejecting and cold, while parents' perceptions of their own parenting were only significantly different in the domain of parental neglect. Cases were more likely to exhibit disorders of disruptive behavior, eating, mood, anxiety, symptoms of schizophrenia and experience of disturbing events. Significant differences were also found for 10 out of 12 Axis II disorders, particularly borderline, depressive, and avoidant personality disorder traits. No significant case-control differences were found regarding overall rates of help-seeking. CONCLUSION Findings from this study may help in suicide prevention efforts through more tailored interventions.
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Affiliation(s)
- John Chee Meng Wong
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Psychological Medicine, National University Health System, Singapore, Singapore
| | - Christel Lynne Chang
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nyein Nyein
- Department of Psychological Medicine, National University Health System, Singapore, Singapore
| | - Adrian Seng Wei Loh
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Natalie Huijing Yap
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Leoniek Mirjam Kroneman
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lei Feng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Centre for Healthy Longevity, National University Health System, Singapore, Singapore
| | - Chay Hoon Tan
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Liu Q, Nestor BA, Cole DA. Differential associations of phasic and tonic irritability to suicidality among U.S. adults. J Affect Disord 2021; 292:391-397. [PMID: 34139413 DOI: 10.1016/j.jad.2021.05.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 05/23/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
Research on the relations between irritability and suicidality among adults has rarely compared or differentiated between tonic versus phasic irritability. The current cross-sectional study investigated the role of both tonic and phasic irritability in relation to lifetime suicidal ideation, plans, and attempts. The study included adult participants who completed the suicidality module from the National Comorbidity Survey - Replication (NCS-R) (N = 7683 for suicidal ideation and N = 1223 for suicidal plan and attempt). The NCS-R used lay-administered, standardized diagnostic interviews. Phasic and tonic irritability were assessed with individual screener items from the World Health Organization Composite International Diagnostic Interviews (CIDI). The current study used logistic regression, weighted Cox proportional hazard model, and multinomial logit regression, adjusting for sex, race/ethnicity, age, education, and marital status. Both types of irritability were included simultaneously in the models. Results indicated that both types of irritability were significantly associated with increased odds of suicidal ideation (phasic: Odds Ratio 2.72 [2.35,3.14]); tonic: OR 2.34 [2.04,2.68]), age of first-time suicidal ideation (phasic: Adjusted Hazard Ratio 2.87 [2.27, 3.63]; tonic: AHR 2.12 [1.76,2.54]), and suicide attempt (phasic: OR 1.53 [1.13,2.07]); tonic: OR 1.44 [1.11,1.89]). Only tonic but not phasic irritability was associated with suicide plans (OR 1.39 [1.08,1.79]). When suicide attempts were divided into those that were impulsive versus planned and compared them to no suicide attempt, both types of irritability were associated planned attempts, (phasic: OR 1.53 [1.13,2.07]); tonic: OR 1.44 [1.11,1.89]) but only phasic irritability was related to impulsive attempts (OR 1.70 [1.10,2.64]). Phasic and tonic irritability show differential relations to and can serve as differential markers for suicide-related outcomes in adults.
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Affiliation(s)
- Qimin Liu
- Department of Psychology and Human Development, Vanderbilt University, USA.
| | - Bridget A Nestor
- Department of Psychology and Human Development, Vanderbilt University, USA
| | - David A Cole
- Department of Psychology and Human Development, Vanderbilt University, USA
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Emotional Dysregulation, Temperament and Lifetime Suicidal Ideation among Youths with Mood Disorders. J Pers Med 2021; 11:jpm11090865. [PMID: 34575642 PMCID: PMC8471959 DOI: 10.3390/jpm11090865] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 02/07/2023] Open
Abstract
Background: Psychopathological dimensions contributing to suicidal ideation in young age are poorly understood. We aimed to investigate the involvement of emotional dysregulation and temperament in suicide risk in a sample of accurately selected young patients with mood disorders and a matched sample of healthy controls (HC). Methods: We assessed 50 young patients (aged 14–25 years) with DSM-5 bipolar or depressive disorders for clinical and psychopathological characteristics and 82 age and sex, educational level, and smoking habits-matched HC. Emotional dysregulation and temperament were assessed using the Difficulties in Emotion Regulation Scale (DERS) and the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire (TEMPS-A-39), respectively. We tested their associations with suicidal ideation, using standard univariate/bivariate methods, preceded by overall multivariate analysis. Results: In the group of patients, 24 (48%) reported lifetime suicide ideation (LSI). Patients with LSI scored higher on emotional dysregulation (p < 0.001) and cyclothymic (p < 0.001), irritable (p = 0.01), and hyperthymic temperaments (p = 0.003) than HC. Patients with LSI specifically presented with more emotional dysregulation (p < 0.001) and cyclothymic temperament (p = 0.001), than patients without LSI (N = 26). Conclusions: Temperamental features, in particular cyclothymic temperament, and emotion dysregulation may represent independent factors for increased vulnerability to lifetime suicidal ideation in young adults with mood disorders.
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7
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Perrini F, Matrone M, de Bartolomeis A, Montano A, Amici E, Callovini G, Cuomo I, de Persis S, Lombardozzi G, Battagliese G, Porrari R, Kotzalidis GD, De Filippis S. Developmental trajectories in psychiatric disorders: does substance/alcohol use moderate the effects of affective temperaments as moderators of age at onset? A study in post-acute, hospitalized patients with psychotic or DSM-5 bipolar or major depressive disorders. J Addict Dis 2021; 39:373-387. [PMID: 33587024 DOI: 10.1080/10550887.2021.1886568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Age-at-onset (AAO) affects psychiatric disorder outcome; substance (SUDs) or alcohol use disorders (AUDs) may influence their onset. Affective temperaments may affect early AAO and drug-use proneness. Objectives: To investigate whether SUD/AUD moderated temperamental effects in determining AAO of mental disorders. Methods: We included 300 post-acute inpatients with schizophrenia-spectrum and other psychotic (SSOPDs), major depressive (MDD) or bipolar (BD) disorders (168 men; mean age, 40.63 years ± 11.82 men, 43.21 years ± 12.69 women) with (N = 110) or without (N = 190) SUD/AUD. Patients completed cross-sectionally TEMPS-A. We carried moderation analysis with each regression-significant TEMPS temperament as independent variable, SUD/AUD presence/absence as dichotomous moderator, and AAO as dependent variable. Significance was set at p < 0.05. Results: AAO was lower in patients with SUD/AUD diagnosis than in patients without (23.74 ± 10.09 vs. 27.73 ± 10.35, respectively, p = 0.001, η2 = 0.034). SUD/AUD patients scored higher on the hyperthymic (10.22 ± 4.08, p < 0.001, η2 = 0.069) and irritable (8.26 ± 4.69, p < 0.01, η2 = 0.026) temperaments than nonSUD/AUD patients. Moderation analysis showed only direct effects of irritable (β = -0.55, p < 0.005) and hyperthymic (β = -0.95, p < 0.001) temperaments on AAO and no significant SUD/AUD and interaction effects. Limitations. Cross-sectional design. Conclusions: When irritable and hyperthymic traits prevail over other temperaments, AAO is earlier in SSOPDs, MDD, and BD. SUD/AUD presence/absence does not moderate the relationship between temperament and AAO.
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Affiliation(s)
- Filippo Perrini
- Von Siebenthal Neuropsychiatric Hospital, Genzano di Roma, Italy.,Istituto A.T. Beck-Diagnostic Centre, Research and Training in Cognitive-Behavioral Psychotherapy, Rome, Italy
| | - Marta Matrone
- Von Siebenthal Neuropsychiatric Hospital, Genzano di Roma, Italy.,Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University, Naples, Italy
| | - Andrea de Bartolomeis
- Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University, Naples, Italy
| | - Antonella Montano
- Istituto A.T. Beck-Diagnostic Centre, Research and Training in Cognitive-Behavioral Psychotherapy, Rome, Italy
| | - Emanuela Amici
- Von Siebenthal Neuropsychiatric Hospital, Genzano di Roma, Italy
| | - Gemma Callovini
- Von Siebenthal Neuropsychiatric Hospital, Genzano di Roma, Italy.,Department of Mental Health, ASL Rieti, Rieti, Italy
| | - Ilaria Cuomo
- Von Siebenthal Neuropsychiatric Hospital, Genzano di Roma, Italy.,Istituto Penitenziario Regina Coeli, ASL RM1, Rome, Italy
| | | | | | - Gemma Battagliese
- Centro di Riferimento Alcologico della Regione Lazio, RM1, Rome, Italy
| | - Raffaella Porrari
- Von Siebenthal Neuropsychiatric Hospital, Genzano di Roma, Italy.,Centro di Riferimento Alcologico della Regione Lazio, RM1, Rome, Italy
| | - Georgios D Kotzalidis
- Von Siebenthal Neuropsychiatric Hospital, Genzano di Roma, Italy.,NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
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Carta MG, Colom F, Erfurth A, Fornaro M, Grunze H, Hantouche E, Nardi AE, Preti A, Vieta E, Karam E. In Memory of Hagop Akiskal. Clin Pract Epidemiol Ment Health 2021; 17:48-51. [PMID: 34249138 PMCID: PMC8227446 DOI: 10.2174/1745017902117010048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Mauro G. Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Address correspondence to this author at the Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; E-mail:
| | | | - Andreas Erfurth
- Department of Psychiatry and Psychotherapeutic Medicine, Klinik Hietzing, Vienna, Austria
| | - Michele Fornaro
- Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, School of Medicine, University "Federico II", Naples, Italy
| | - Heinz Grunze
- Center for Psychiatry Weinsberg, Klinikum am Weissenhof, Weinsberg, Germany
| | - Elie Hantouche
- Center for Anxiety and Mood Disorders, Anxiety & Mood Center, 117, Rue de Rennes, Paris 75006, France
| | - Antonio E. Nardi
- Institute of Psychiatry,Federal University of Rio de Janeiro,Rio de Janeiro, Brazil
| | - Antonio Preti
- Department of Neurosciences, University of Turin, 10124 Turin, Italy
| | - Eduard Vieta
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Elie Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
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Abstract
BACKGROUND Among risk factors for suicidal behavior, there is growing interest in associations with stable affective temperament types, particularly based on assessment with the TEMPS-A self-rating scale. AIM As research on this topic has not been reviewed systematically, we synthesized relevant, reported research findings. METHODS Systematic searching identified peer-reviewed reports pertaining to associations of suicidal behavior or ideation with affective temperament types evaluated with TEMPS-A. We summarized available findings and applied quantitative meta-analytic methods to compare scale scores in suicidal versus nonsuicidal subjects. RESULTS In 21 of 23 TEMPS-A studies meeting inclusion criteria, anxious, cyclothymic, depressive, or irritable temperament scores were significantly higher with previous or recent suicide attempts or ideation in both psychiatric and general population samples compared to nonsuicidal controls, whereas hyperthymic temperament scores were lower in 9 of 11 reports. These findings were synthesized by random-effects meta-analyses of standardized mean differences in TEMPS-A temperament scores in suicidal versus nonsuicidal subjects. Associations ranked: depressive ≥ irritable > cyclothymic > anxious > hyperthymic (negative). CONCLUSIONS Affective temperaments, especially depressive and irritable, were strongly associated with suicidal risk, whereas hyperthymic temperament appeared to be protective.
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10
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Orri M, Perret LC, Turecki G, Geoffroy MC. Association between irritability and suicide-related outcomes across the life-course. Systematic review of both community and clinical studies. J Affect Disord 2018; 239:220-233. [PMID: 30025311 DOI: 10.1016/j.jad.2018.07.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/25/2018] [Accepted: 07/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Irritability is gaining considerable attention as a risk factor for suicide-related outcomes (suicide mortality, attempt, and ideation). However, the evidence of this association is scant. We conducted a systematic review of the evidence regarding the associations between irritability and suicide-related outcomes across the life-course. METHODS We conducted a systematic search on Medline and PsycINFO (up to January 2018) for original articles published in English investigating the association between irritability and suicide-related outcomes. Two researchers independently screened the articles, assessed the quality of the evidence (New-Castle-Ottawa Scale) and extracted study characteristics. RESULTS Thirty-nine studies were retrieved, most were of low/medium quality. Twelve assessed irritability in childhood/adolescence (6 in community samples, 6 in clinical samples) and 27 in adulthood (7 in community samples, 20 in clinical samples). In both childhood/adolescence and adult samples, most community-based studies reported a positive association between irritability and suicidal ideation and/or attempt, while clinical studies reported mixed findings. More specifically, in clinical studies, the association of irritability with suicide-related outcomes (i) was not supported among adult depressed patients, (ii) findings were inconsistent in adult bipolar patients, (iii) for inpatients/outpatients with various psychiatric disorders/conditions, association was observed in adulthood but not in childhood/adolescence. LIMITATIONS Differences in methodology and definition/measurement of irritability limited the comparability of included studies. CONCLUSIONS Although irritability has been proposed as a promising transdiagnostic factor associated with suicide-related outcomes, the absence of consensus in the definition of irritability (vs anger or reactive/impulsive aggression), the poor methodological quality, and the lack of developmental considerations mitigate the conclusions.
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Affiliation(s)
- Massimiliano Orri
- McGill Group for Suicide Studies, Douglas Mental Health University Institute & Department of Psychiatry, McGill University, Montreal, Canada
| | - Lea C Perret
- McGill Group for Suicide Studies, Douglas Mental Health University Institute & Department of Psychiatry, McGill University, Montreal, Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute & Department of Psychiatry, McGill University, Montreal, Canada
| | - Marie-Claude Geoffroy
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada.
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11
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Pompili M, Baldessarini RJ, Innamorati M, Vázquez GH, Rihmer Z, Gonda X, Forte A, Lamis DA, Erbuto D, Serafini G, Fiorillo A, Amore M, Girardi P. Temperaments in psychotic and major affective disorders. J Affect Disord 2018; 225:195-200. [PMID: 28837953 DOI: 10.1016/j.jad.2017.08.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/06/2017] [Accepted: 08/10/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Assessment of affective temperaments with the extensively validated, 110-item TEMPS-A autoquestionnaire has been used to characterize patients with mood disorders, and its scores have been associated consistently with suicidal behavior. Much less has been reported about comparisons of characteristics of such assessments in psychotic and other psychiatric disorders. METHODS We analyzed results of TEMPS-A assessments in 1081 psychiatrically hospitalized patients in Rome and compared subscale scores (anxious [anx], cyclothymic [cyc], depressive [dep], irritable [irr], hyperthymic [hyp]) and a composite score (anx+cyc+dep+irr - hyp) among diagnoses and subjects with vs. without a suicide attempt. RESULTS TEMPS-A subscale scores differed significantly among diagnoses and were higher with major affective than psychotic or other disorders. Suicide attempts were 1.5-times more frequent among women than men and with affective versus nonaffective disorders, ranking: bipolar-II > major depression > bipolar-I > other disorders > psychotic disorders. TEMPS-A subscores were significantly higher among suicidal subjects (ranking: anx ≥ cyc ≥ dep > irr) except hyp (lower), but the composite score differed most (1.37-fold higher). Multivariable logistic regression modeling indicated that suicide attempt was significantly and independently associated with: TEMPS-A composite score > female sex > affective disorder > older age. CONCLUSIONS TEMPS-A scores, particularly a composite score (anx+cyc+dep+irr - hyp) may help effectively evaluate suicidal risk in association with nonaffective as well as affective disorders.
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Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA.
| | - Ross J Baldessarini
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Gustavo H Vázquez
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Zoltan Rihmer
- Department of Psychiatry and Psychotherapy, Kútvölgyi Clinical Center, Semmelweis University, Budapest, Hungary; Laboratory of Suicide Prevention and Research, National Institute for Psychiatry and Addictology, Department of Pharmacology and Pharmacotherapy, Semmelweis University, Hungary
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Kútvölgyi Clinical Center, Semmelweis University, Budapest, Hungary; Laboratory of Suicide Prevention and Research, National Institute for Psychiatry and Addictology, Department of Pharmacology and Pharmacotherapy, Semmelweis University, Hungary; MTA-SE Neurochemistry and Neuropsychopharmacology Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - Alberto Forte
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA
| | - Dorian A Lamis
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Denise Erbuto
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Gianluca Serafini
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics, and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics, and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Paolo Girardi
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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12
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Ziółkowski M, Czarnecki D, Chodkiewicz J, Gąsior K, Juczyński A, Biedrzycka A, Gruszczyńska E, Nowakowska-Domagała K. Suicidal thoughts in persons treated for alcohol dependence: The role of selected demographic and clinical factors. Psychiatry Res 2017; 258:501-505. [PMID: 28893411 DOI: 10.1016/j.psychres.2017.08.089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 06/16/2017] [Accepted: 08/24/2017] [Indexed: 11/26/2022]
Abstract
Greater knowledge is needed of potential predictive factors for suicide in cases of alcohol addiction. Therefore, the aim of the study was to identify the socio-demographic variables and clinical factors associated with alcohol dependence which may have an influence on the occurrence of suicidal thoughts in alcohol-dependent patients. A group of 510 patients (396 male and 114 female) diagnosed with alcohol dependence syndrome were interviewed during the third week of therapy according to the Beck Depression Inventory (BDI), the Penn Alcohol Craving Scale (PACS) and the Short Alcohol Dependence Data Questionnaire (SADD). Socio-demographic data was also collected. The results of a binary logistic regression with suicidal thoughts as a dependent variable show that 63 out of the 510 participants (12% of the sample) reported the presence of suicidal thoughts. Alcohol dependence and alcohol craving appear to increase the likelihood of suicidal thoughts, and participants presenting psychiatric disorders were twice as likely to demonstrate suicidal ideation as those who did not. Alcohol dependence, alcohol craving and psychiatric comorbidity may be regarded as risk factors for suicidal ideation in the studied sample, with the only protective factor being living in a relationship.
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Affiliation(s)
- Marcin Ziółkowski
- Department of Psychiatric Nursing, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Damian Czarnecki
- Department of Psychiatric Nursing, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Jan Chodkiewicz
- Department of Health Psychol ogy, Institute of Psychology, University of Lodz, Lodz, Poland
| | - Krzysztof Gąsior
- Świętokrzyski Prevention and Education Centre in Kielce, Kielce, Poland
| | - Artur Juczyński
- Municipal Centre of Addictions Prevention and Treatment in Lodz, Lodz, Poland
| | - Agata Biedrzycka
- Addictions Treatment Ward, Psychiatric Hospital in Radom, Radom, Poland
| | - Ewa Gruszczyńska
- Department of Health Psychology, Institute of Clinical Psychology, University of Social Sciences and Humanities, Warsaw, Poland
| | - Katarzyna Nowakowska-Domagała
- Department of Cognitive Science, Institute of Psychology, Faculty of Educational Sciences, University of Lodz, Lodz, Poland.
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13
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Association between suicide-related ideations and affective temperaments in the Japanese general adult population. PLoS One 2017. [PMID: 28640865 PMCID: PMC5481026 DOI: 10.1371/journal.pone.0179952] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Suicide rates are vastly higher in Japan than in many other countries, although the associations between affective temperaments and suicide-related ideations in the general adult population remain unclear. Therefore, we aimed to elucidate these associations in the present study. METHODS We analyzed data from 638 Japanese volunteers who completed both the Patient Health Questionnaire (PHQ-9) and the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A). Participants were then divided into three groups based on PHQ-9 summary scores and responses to the suicide-related ideation item: non-depressive control group (NC; N = 469), depressive symptoms without suicide-related ideations group (non-SI; N = 135), and depressive symptoms with suicide-related ideations group (SI; N = 34). The depressive symptoms were defined for PHQ-9 summary scores ≥5, and the suicide-related ideations were defined for PHQ-9 #9 score ≥1. We then compared TEMPS-A scores among the groups using Kruskal-Wallis tests. Then the 95% confidence intervals of differences in TEMPS-A subscale scores between the NC and non-SI groups, or between NC and SI groups, were calculated. RESULTS Participants of the SI group exhibited significantly higher scores on the depressive, irritable, and anxious temperament subscales than those of the non-SI group. Similarly, women of the SI group exhibited significantly higher scores of the depressive and irritable temperament subscales than women of the non-SI group, while men of the SI group exhibited significantly higher depressive temperament scores than those of the non-SI group. Among all participants and only men, cyclothymic subscale scores were higher in those of the SI group than the non-SI group (not significant), although the 95% confidence intervals did not overlap. LIMITATIONS The cross-sectional study design was the main limitation. CONCLUSIONS Depressive, irritable, and anxious temperaments are significant risk factors for suicide-related ideations in the Japanese general adult population. Furthermore, irritable temperament in women and depressive temperament in men are associated with suicide-related ideations.
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14
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Ardani AR, Hosseini FF, Asadpour Z, Hashemian AM, Dadpour B, Nahidi M. Affective temperaments, as measured by TEMPS-A, among self-poisoning nonlethal suicide attempters. Psychiatry Res 2017; 247:125-129. [PMID: 27888682 DOI: 10.1016/j.psychres.2016.10.086] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/26/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
Abstract
Suicidal behaviors are serious public health problems. The prominent association of mood disorders with suicide, along with the renaissance of the spectrum concept of psychiatric disorders in the recent decades, prioritizes the investigation of temperament variants in suicidal individuals. This study aimed to explore the relationship between affective temperaments and nonviolent suicide attempts. We administered Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Auto questionnaire (TEMPS-A) to 141 (27 males and 114 females) consecutive self-poisoning non-lethal suicide attempters at a Medical Toxicology Center and a sex and age matched group of healthy individuals (28 males, 112 females). Female suicide attempters scored significantly higher in depressive, cyclothymic, irritable, and anxious temperaments compared with female controls, whereas male cases' scores were significantly higher in depressive and anxious subscales compared with control males. Except for hyperthymic temperament which did not reveal any significant effects, depressive (OR: 11.5), cyclothymic (OR: 3.8), irritable (OR: 2.3), and anxious (OR: 8.8) temperaments were predictors for nonviolent suicide attempts. Therefore, this study replicated the evidence for the strong association of depressive temperament with suicide attempts. The hyperthymic temperament appeared to have neither protective nor predisposing influence. Further studies are needed to identify the role of this independent temperament.
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Affiliation(s)
- Amir Rezaei Ardani
- Psychiatry and Behavioural Sciences Research Centre, Mashhad University of Medical Sciences, Mashhad, Razavi Khorasan, Iran
| | - Farhad Farid Hosseini
- Psychiatry and Behavioural Sciences Research Centre, Mashhad University of Medical Sciences, Mashhad, Razavi Khorasan, Iran
| | - Zahra Asadpour
- Psychiatry and Behavioural Sciences Research Centre, Mashhad University of Medical Sciences, Mashhad, Razavi Khorasan, Iran
| | - Amir Masoud Hashemian
- Emergency Department, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bita Dadpour
- Medical Toxicology Research Centre, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahsa Nahidi
- Psychiatry and Behavioural Sciences Research Centre, Mashhad University of Medical Sciences, Mashhad, Razavi Khorasan, Iran.
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Huemer J, Riegler A, Völkl-Kernstock S, Wascher A, Lesch OM, Walter H, Skala K. The influence of reported ADHD and substance abuse on suicidal ideation in a non-clinical sample of young men. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2016; 30:131-137. [PMID: 27714599 PMCID: PMC5063908 DOI: 10.1007/s40211-016-0198-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 09/12/2016] [Indexed: 01/09/2023]
Abstract
This study intended to determine whether former and current ADHD symptomatology is associated with suicidal ideation in a non-clinical sample of 18 year old males. We performed a cross sectional descriptive study of 3280 men during the examination for military service. The investigation included a screening for substance abuse, past (WURS) and current (ADHD symptom checklist) ADHD symptomatology and an interview about suicidal ideations. We found a correlation of suicidal ideations with a history of ADHD symptomatology. ADHD symptoms were strongly consistent over time. These results indicate that a history of (diagnosed or undiagnosed) ADHD could be a predictor for suicidal ideations. Surveying a history of ADHD in primary care might help identify subjects at risk for suicidal tendencies.
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Affiliation(s)
- Julia Huemer
- Dept. of Child and Adolescent Psychiatry, University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Anita Riegler
- Dept. of Psychiatry, University of Vienna, Vienna, Austria
| | - Sabine Völkl-Kernstock
- Dept. of Child and Adolescent Psychiatry, University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | | - Otto M Lesch
- Dept. of Psychiatry, University of Vienna, Vienna, Austria
| | | | - Katrin Skala
- Dept. of Child and Adolescent Psychiatry, University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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16
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Eskin M, Sun JM, Abuidhail J, Yoshimasu K, Kujan O, Janghorbani M, Flood C, Carta MG, Tran US, Mechri A, Hamdan M, Poyrazli S, Aidoudi K, Bakhshi S, Harlak H, Moro MF, Nawafleh H, Phillips L, Shaheen A, Taifour S, Tsuno K, Voracek M. Suicidal Behavior and Psychological Distress in University Students: A 12-nation Study. Arch Suicide Res 2016; 20:369-88. [PMID: 26954847 DOI: 10.1080/13811118.2015.1054055] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study investigated the prevalence of suicidal behavior and psychological distress in university students across 12 nations. A total of 5,572 university students from 12 countries were surveyed about suicide ideation, suicide attempts, and psychological distress by means of a self-administered questionnaire. Almost 29% of the samples reported having contemplated suicide and 7% reported attempting suicide. Of the total sample, 51.1% scored above the General Health Questionnaire-12 ≥ 3 cut-off points, 41.6% above the GHQ-12 ≥ 4 cut-off points, and 33.8% scored above the GHQ-12 ≥ 5 cut-off points. While odds of suicide ideation were elevated in Austria and the UK, reduced ORs were detected for China, Italy, Saudi Arabia, Tunisia, and Turkey. Similarly, while odds of suicide attempt were high in Jordan, Palestine, Saudi Arabia, and to some extent in Turkey, reduced ORs were observed for Austria, China, Italy, Japan and the United States. Elevated ORs for psychological distress were seen in Japan, Jordan, Palestine, Saudi Arabia, Tunisia, and Turkey but reduced ORs were noted in Austria, China, Iran, Italy, and the United States. Psychological distress was strongly associated with reports of suicide ideation and attempts. Suicide ideation, suicide attempt, and psychological distress are common in university students but their rates vary depending on the sociocultural context. Due attention should be devoted to the mental health needs of young adults enrolled in higher educational institutions and more cross-cultural research is warranted to better understand the etiology of the observed intersocietal variations in suicidal behavior and psychological distress.
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17
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Baldessarini RJ, Vázquez GH, Tondo L. Affective temperaments and suicidal ideation and behavior in mood and anxiety disorder patients. J Affect Disord 2016; 198:78-82. [PMID: 27011363 DOI: 10.1016/j.jad.2016.03.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/29/2016] [Accepted: 03/05/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Clinical characteristics proposed to be associated with suicidal risk include affective temperament types. We tested this proposal with two methods in a large sample of subjects with mood and anxiety disorders. METHODS We assessed consecutive, consenting subjects clinically for affective temperament types and by TEMPS-A self-ratings for associations of temperament with suicidal ideation and acts, using standard bivariate methods, and multivariate logistic regression models. RESULTS Among 2561 subjects (major depressive, 1171; bipolar, 919, anxiety disorders, 471), temperament-types and TEMPS-A (39-item Italian version) subscale scores differed by risk of suicidal acts or ideation. Suicidal acts and ideation were most associated with cyclothymic and dysthymic, and less with hyperthymic temperaments. These associations were sustained by multivariate modeling that included diagnosis, age, sex, and diagnosis. LIMITATIONS Not all subjects completed TEMPS-A self-ratings; clinical assessments of temperaments were not standardized, and long-term stability of temperament assessments was not tested. CONCLUSIONS The findings support and extend associations of cyclothymic-dysthymic temperaments with suicidal acts and ideation, whereas hyperthymic temperament may be protective.
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Affiliation(s)
- Ross J Baldessarini
- The International Consortium for Psychotic & Mood Disorders Research, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Gustavo H Vázquez
- The International Consortium for Psychotic & Mood Disorders Research, McLean Hospital, Belmont, MA, United States; Department of Neuroscience, Palermo University, Buenos Aires, Argentina
| | - Leonardo Tondo
- The International Consortium for Psychotic & Mood Disorders Research, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Lucio Bini Mood Disorders Centers, Cagliari, Rome, Italy.
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18
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Skala K, Riegler A, Erfurth A, Völkl-Kernstock S, Lesch OM, Walter H. The connection of temperament with ADHD occurrence and persistence into adulthood - An investigation in 18 year old males. J Affect Disord 2016; 198:72-7. [PMID: 27011362 DOI: 10.1016/j.jad.2016.03.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/22/2016] [Accepted: 03/11/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND This study intended to determine whether certain traits of temperament are associated with former and current ADHD symptomatology in a non-clinical sample of 18 year old males. METHODS We performed a cross sectional descriptive study of 3280 men during the examination for military service. The investigation included a socio-demographic questionnaire, screening for substance abuse, temperament (TEMPS-M), past (WURS) and current (ADHD symptom checklist) ADHD symptomatology. RESULTS We found a correlation of cyclothymic (p<.001), irritable (p<.001) and anxious (p<.05) temperament with occurrence and severity of past and present ADHD symptomatology. No significant correlation has been detected for hyperthymic and depressive temperament. Judged retrospectively, ADHD symptoms were strongly consistent over time. LIMITATIONS The sample consists of men only. These had to be fit enough to be enlisted for military service; men with severe mental or physical disorders were thus excluded. Furthermore, the cross-sectional study design does not allow making conclusions about the temporal relationships between ADHD symptoms and substance misuse. CONCLUSIONS These results indicate that a temperament based approach towards those affected by ADHD might be useful. Subtyping ADHD by integrating temperament profiles in diagnosis and treatment of the disorder could help explain some of the heterogeneity of the disease.
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Affiliation(s)
- K Skala
- University of Vienna, Department of Child and Adolescent Psychiatry, Austria.
| | - A Riegler
- Otto Wagner Spital, Department of Psychiatry IV, Austria
| | - A Erfurth
- Otto Wagner Spital, Department of Psychiatry IV, Austria
| | - S Völkl-Kernstock
- University of Vienna, Department of Child and Adolescent Psychiatry, Austria
| | - O M Lesch
- University of Vienna, Department of Psychiatry, Austria
| | - H Walter
- University of Vienna, Department of Psychiatry, Austria
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19
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Tanabe S, Terao T, Shiotsuki I, Kanehisa M, Ishii K, Shigemitsu O, Fujiki M, Hoaki N. Anxious temperament as a risk factor of suicide attempt. Compr Psychiatry 2016; 68:72-7. [PMID: 27234186 DOI: 10.1016/j.comppsych.2016.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/02/2016] [Accepted: 04/01/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Suicide has been reported to be associated with cyclothymic, irritable, depressive and anxious temperaments. In contrast, hyperthymic temperament has been reported to be protective against suicide. In the present study, we hypothesized that Japanese patients with suicide attempt may have higher scores of cyclothymic, irritable, depressive, and anxious temperaments but lower scores of hyperthymic temperament than non-suicidal patients. In order to examine this hypothesis, we investigated Japanese patients of a university emergency center. METHODS The association of temperament and suicide attempt was investigated in 116 patients referred to a university emergency center for intoxication or injury. Of them, 35 patients of suspected suicide attempt were categorized as 18 patients who intended to die with attempted suicide and suffered from self-inflicted but not fatal injury (Suicide Attempt II), 4 patients whose intention to die were undetermined although they suffered from self-inflicted injury (Undetermined Suicide-Related Behavior II), and 13 patients who had no intention to die although they suffered from self-inflicted injury (Self-Harm II). Logistic regression analyses and multiple regression analyses were used to identify factors associated with the present suicide attempt and the number of suicide attempts, respectively. RESULTS Anxious temperament scores were significantly and directly associated with Suicide Attempt II group whereas irritable temperament scores were associated with Self-Harm II group. CONCLUSION The present findings suggest that those with anxious temperament may have more suicide attempts than those with other temperaments, indicating anxious temperament as a risk factor of suicide attempt.
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Affiliation(s)
- Sanshi Tanabe
- Advanced Trauma, Emergency and Critical Care Center, Oita University Faculty of Medicine
| | - Takeshi Terao
- Department of Neuropsychiatry, Oita University Faculty of Medicine.
| | - Ippei Shiotsuki
- Advanced Trauma, Emergency and Critical Care Center, Oita University Faculty of Medicine; Department of Neuropsychiatry, Oita University Faculty of Medicine
| | - Masayuki Kanehisa
- Advanced Trauma, Emergency and Critical Care Center, Oita University Faculty of Medicine; Department of Neuropsychiatry, Oita University Faculty of Medicine
| | - Keisuke Ishii
- Advanced Trauma, Emergency and Critical Care Center, Oita University Faculty of Medicine
| | - Osamu Shigemitsu
- Advanced Trauma, Emergency and Critical Care Center, Oita University Faculty of Medicine
| | - Minoru Fujiki
- Department of Neurosurgery, Oita University Faculty of Medicine, Yufu, Japan
| | - Nobuhiko Hoaki
- Department of Neuropsychiatry, Oita University Faculty of Medicine; Hoaki hospital, Oita, Japan
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20
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Baker AW, Goetter EM, Bui E, Shah R, Charney ME, Mauro C, Shear MK, Simon NM. The Influence of Anxiety Sensitivity on a Wish to Die in Complicated Grief. J Nerv Ment Dis 2016; 204:314-6. [PMID: 27015394 PMCID: PMC4808517 DOI: 10.1097/nmd.0000000000000465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Individuals with complicated grief are at elevated risk of suicidal thoughts. Anxiety sensitivity has recently emerged as a risk factor of suicide. This study aimed to investigate a possible association between anxiety sensitivity and a wish to die in individuals with complicated grief. Participants were evaluated for participation in a treatment study and completed an ancillary questionnaire-based study. Participants were 51 bereaved adults evaluated (age: mean, 54 [SD, 13.6] years; 78% [n = 40] women). Logistic regression was used to examine the relationship between anxiety sensitivity and a wish to die. Overall, anxiety sensitivity was associated with a wish to die at the level of a medium effect size, although it did not reach statistical significance. The anxiety sensitivity social concerns subscale was significantly associated with a wish to die. These findings add to a growing literature implicating anxiety sensitivity in reporting a wish to die.
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21
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Pompili M, Innamorati M, Milelli M, Battuello M, Erbuto D, Lester D, Gonda X, Rihmer Z, Amore M, Girardi P. Temperaments in completed suicides: Are they different from those in suicide attempters and controls? Compr Psychiatry 2016; 65:98-102. [PMID: 26773996 DOI: 10.1016/j.comppsych.2015.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/25/2015] [Accepted: 11/07/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Temperaments in completed suicides have never been assessed whereas there is substantial research on temperaments in attempted suicides and psychiatric patients. METHODS The significant others of 18 completed suicides participated in this study in order to provide an assessment of temperaments, hopelessness, depression and the suicide risk of their loved ones. The data were compared with data from 244 psychiatric patients of whom 83 had attempted suicide in the previous month. The following instruments were used: the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-auto questionnaire (TEMPS-A), the Beck Hopelessness Scale (BHS), the Gotland Scale for Male Depression (GSMD), and the Mini International Neuropsychiatric Interview (MINI) module for assessing suicide risk. RESULTS Individuals who died by suicide more frequently had scores of 9 or higher on the BHS and higher MINI suicide risk scores compared with patients with mood disorders who had not attempted suicide in the previous month. Completed suicides also had lower scores on the TEMPS-A Cyclothymia and Anxiety scales and on the MINI suicide risk scale than mood disorder patients with a recent suicide attempt. LIMITATIONS Proxy assessment of variables through survivors can result in underestimation of psychiatric morbidity and other parameters investigated, and limits the generalization of our results CONCLUSIONS Our study adds information about temperamental subtypes and other variables in completed suicides and points to their difference from attempted suicides and non-suicidal psychiatric patients.
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Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | | | - Mariantonietta Milelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Michele Battuello
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Denise Erbuto
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Xenia Gonda
- Department of Clinical and Theoretical Mental Health, Kútvölgyi Clinical Center, Semmelweis University, Budapest, Hungary; Laboratory of Suicide Prevention and Research, National Institute for Psychiatry and Addictology, Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary; MTA-SE Neurochemistry Research Group, Budapest, Hungary
| | - Zoltan Rihmer
- Department of Clinical and Theoretical Mental Health, Kútvölgyi Clinical Center, Semmelweis University, Budapest, Hungary
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genova, Genova, Italy
| | - Paolo Girardi
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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22
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Naderer A, Keller F, Plener P, Unseld M, Lesch OM, Walter H, Erfurth A, Kapusta ND. The brief TEMPS-M temperament questionnaire: A psychometric evaluation in an Austrian sample. J Affect Disord 2015; 188:43-6. [PMID: 26342887 DOI: 10.1016/j.jad.2015.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/20/2015] [Accepted: 08/04/2015] [Indexed: 01/14/2023]
Affiliation(s)
- A Naderer
- Medical University of Vienna, Department of Psychoanalysis and Psychotherapy, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - F Keller
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
| | - P Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
| | - M Unseld
- Medical University of Vienna, Department of Internal Medicine I, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - O M Lesch
- Medical University of Vienna, Department of Psychiatry and Psychotherapy, Clinical Division for Social Psychiatry, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - H Walter
- Medical University of Vienna, Department of Psychiatry and Psychotherapy, Clinical Division for Social Psychiatry, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - A Erfurth
- Social Medical Center Baumgartner Höhe, Otto-Wagner Hospital, 6th Psychiatric Ward, Baumgartner Höhe 1, 1140 Vienna, Austria
| | - N D Kapusta
- Medical University of Vienna, Department of Psychoanalysis and Psychotherapy, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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23
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Rahme E, Low NCP, Lamarre S, Turecki G, Bonin JP, Diane Daneau RN, Habel Y, Yung ECC, Morin S, Szkrumelak N, Singh S, Renaud J, Lesage A. Attempted Suicide Among Students and Young Adults in Montreal, Quebec, Canada: A Retrospective Cross-Sectional Study of Hospitalized and Nonhospitalized Suicide Attempts Based on Chart Review. Prim Care Companion CNS Disord 2015; 17:15m01806. [PMID: 26835175 DOI: 10.4088/pcc.15m01806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 07/17/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE We conducted a chart review to identify postsecondary students and nonstudents in the same age range who presented to the emergency department following a suicide attempt to (1) compare demographic characteristics and suicide risk factors and (2) determine factors associated with more serious attempts requiring hospitalizations. METHOD The study was conducted in 1 tertiary trauma hospital and 1 community hospital affiliated with McGill University, Montreal, Quebec, Canada, between January 1, 2009, and March 31, 2010. Charts of patients with potential suicide attempts were identified from medical records using ICD-10 codes that indicated traumatic injury, intentional self-harm, poisoning, and psychiatric or perception/cognition disorders and from the emergency department triage file using keywords that indicated suicidality or self-harm at presentation. RESULTS In multivariable logistic regression models (odds ratio, 95% CI), students were younger (per 5-year increase: 0.22, 0.12-0.41), less likely to be born in Canada (0.17, 0.06-0.44), and more likely to use less violent methods (laceration, poisoning, other, multiple methods) versus more violent methods (collision, jump, fire burns, firearm, hanging) in their attempt. Fewer students had a history of substance abuse (0.12, 0.02-0.94) but were not different from nonstudents on history of other mental disorders. Less students attempted suicide in the winter/spring (January-April) versus fall (September-December) semester (0.32, 0.11-0.91). Students who attempted suicide were more likely to have family/social support. Those who attempted suicide in the previous year were more likely to require hospitalization for their current suicide attempt. CONCLUSIONS Knowledge of specific factors associated with suicide attempts in young people can help inform and guide suicide prevention efforts in both academic and community settings. Specific to the findings of this study regarding the method of suicide attempt used, for example, limiting access to dangerous substances or large quantities of medications may help prevent or reduce suicide attempts in this population.
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Affiliation(s)
- Elham Rahme
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Nancy C P Low
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Psychiatry, McGill University Health Centre, Montreal, Quebec, Canada; Mental Health Service, Services for Students, McGill University, Montreal, Quebec, Canada
| | - Suzanne Lamarre
- Department of Psychiatry, St-Mary's Hospital, Montreal, Quebec, Canada
| | - Gustavo Turecki
- Department of Psychiatry, McGill University Health Centre, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Jean-Pierre Bonin
- Institut universitaire en santé mentale de Montréal, Quebec, Canada; Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - R N Diane Daneau
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Youssef Habel
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Emily C C Yung
- Mental Health Service, Services for Students, McGill University, Montreal, Quebec, Canada
| | - Suzanne Morin
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Nadia Szkrumelak
- Department of Psychiatry, McGill University Health Centre, Montreal, Quebec, Canada
| | - Santokh Singh
- Department of Psychiatry, St-Mary's Hospital, Montreal, Quebec, Canada
| | - Johanne Renaud
- Douglas Mental Health University Institute, Montreal, Quebec, Canada; Manulife Centre for Breakthroughs in Teen Depression and Suicide Prevention, Montreal, Quebec, Canada
| | - Alain Lesage
- Institut universitaire en santé mentale de Montréal, Quebec, Canada; Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
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Karam EG, Itani L, Fayyad J, Hantouche E, Karam A, Mneimneh Z, Akiskal H, Rihmer Z. Temperament and suicide: A national study. J Affect Disord 2015; 184:123-8. [PMID: 26080077 DOI: 10.1016/j.jad.2015.05.047] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Several studies have shown temperament variants in suicidality. Yet, to our knowledge, the association between temperaments and suicide attempts has not been studied on a nationally representative level nor systematically in subjects with no mental disorders. Also, although hyperthymic temperament is recognized as protective of most mental disorders, its role in the protection from self-harm remains inconclusive. METHODS The study is based on nationally representative data of all Lebanese adults. Mental disorders were assessed using the Composite International Diagnostic Interview, whereas the five affective temperaments were assessed using the TEMPS-A. RESULTS Anxious temperament is a solid and strong risk factor for suicide attempts in subjects with (OR: 10.1) and without (OR: 9.0) mental disorders. Depressive (OR: 4.3) and irritable (OR: 5.1) temperaments are risk factors for suicide attempt among subjects with mental disorders. Hyperthymic temperament plays a dual role in females with mental disorders: while the hyperthymic trait "having self-confidence" is strongly protective of suicide attempts, "liking to be the boss", "getting into heated arguments", and "the right and privilege to do as I please" are hyperthymic risk traits for suicide attempts reflecting the "dark side" of the hyperthymic temperament. Interestingly, these three hyperthymic risk traits--in the absence of "having self-confidence"--are a universal risk for suicide attempt in females with mental disorder. LIMITATIONS Social desirability could have led to the under-reporting of suicide attempts and mental disorders. CONCLUSIONS The anxious temperament plays a strong role in predicting suicide attempts in the community, in the presence and absence of diagnosable mental disorders. The irritable and the depressive temperaments are additional risks in subjects with mental disorders. The dual role of the hyperthymic temperament is quite interesting: while it is protective of suicidal behavior, it also has a dark side in subjects with mental disorders.
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Affiliation(s)
- Elie G Karam
- Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon; Department of Psychiatry & Clinical Psychology, Saint George Hospital University Medical Center, Balamand University, Faculty of Medicine, Beirut, Lebanon.
| | - Lynn Itani
- Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon
| | - John Fayyad
- Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon; Department of Psychiatry & Clinical Psychology, Saint George Hospital University Medical Center, Balamand University, Faculty of Medicine, Beirut, Lebanon
| | - Elie Hantouche
- Centre des Troubles Anxieux et de l'Humeur (CTAH), Paris, France
| | - Aimee Karam
- Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon; Department of Psychiatry & Clinical Psychology, Saint George Hospital University Medical Center, Balamand University, Faculty of Medicine, Beirut, Lebanon
| | - Zeina Mneimneh
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Hagop Akiskal
- International Mood Center, University of California at San Diego, La Jolla, CA, USA
| | - Zoltán Rihmer
- Department of Clinical and Theoretical Mental Health, Semmelweis University and National Institute of Psychiatry and Addictions, Budapest, Hungary
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Evren C, Evren B, Bozkurt M. Tobacco use among 10th grade students in Istanbul and related variables. Asian J Psychiatr 2014; 8:69-75. [PMID: 24655632 DOI: 10.1016/j.ajp.2013.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 08/24/2013] [Accepted: 11/23/2013] [Indexed: 12/21/2022]
Abstract
Aim of this study was to determine prevalence of cigarette smoking and hookah use among 10th grade students in Istanbul, Turkey, and to compare sociodemographic, psychological and behavioral variables according to frequency of tobacco use. Cross-sectional online self-report survey conducted in 45 schools from the 15 districts in Istanbul/Turkey. The questionnaire included sections about demographic data, family characteristics, school life, psychological symptoms and use of substances including tobacco, hookah, alcohol, marijuana, volatiles, heroin, cocaine, non-prescribed legal tranquillizers (benzodiazepines, alprazolam etc.) and illegal tranquillizers (flunitrazepam). The analyses were conducted based on the 4957 subjects. Trial at least once in life is observed as 45.4% for hookah use and as 24.4% for cigarette use. Risk of hookah and cigarette use was significantly higher in male students than in female students. Frequency of tobacco use is related with various sociodemographic, psychological and behavioral variables. Our data also shows that using tobacco and alcohol increases the risk of all the other substances use and these effects are interrelated. The data suggest that there is a link between tobacco use and substance use, psychological, behavioral and social factors. There is also a strong association between tobacco use and suicidal behavior as well as self-mutilative, impulsive, hyperactive, delinquent, aggressive and behavioral problems. The illumination of these relationships may be relevant in prevention and management of tobacco use as well as important problems, such as substance use, impulsivity, hyperactivity, delinquent, aggressive self-mutilative and suicidal behavior among 10th grade students in Istanbul.
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Affiliation(s)
- Cuneyt Evren
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy State Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey.
| | - Bilge Evren
- Baltalimani State Hospital for Muskuloskeletal Disorders, Department of Psychiatry, Istanbul, Turkey
| | - Muge Bozkurt
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy State Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
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Pombo S, Figueira ML, da Costa NF, Ismail F, Yang G, Akiskal K, Akiskal H. The burden of cyclothymia on alcohol dependence. J Affect Disord 2013; 151:1090-6. [PMID: 24091304 DOI: 10.1016/j.jad.2013.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/03/2013] [Accepted: 09/03/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The relationship between cyclothymic temperament and alcoholism remains insufficiently explored. METHODS A sample of 125 alcohol-dependent patients diagnosed according to DSM-IV-TR criteria (APA, 2000) was recruited from a clinical setting. Cyclothymic temperament was diagnosed according to the Portuguese version of the Akiskal and Akiskal (2005) temperament scale. RESULTS Alcohol dependent patients who score positive (above mean) for CT present to some extent a more severe profile of alcohol-related problems. LIMITATIONS Correlational study CONCLUSIONS CT traits in alcohol dependents seems to influence whether subjects engage earlier in pathological alcohol use and present particular alcohol-related problems, in particular Cloninger type II alcoholism phenotype.
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Affiliation(s)
- Samuel Pombo
- Psychiatric Service and Medical Psychology from Santa Maria Universitary Hospital of Lisbon, Portugal.
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Guerreiro DF, Sampaio D, Rihmer Z, Gonda X, Figueira ML. Affective temperaments and self-harm in adolescents: a cross-sectional study from a community sample. J Affect Disord 2013; 151:891-8. [PMID: 24035491 DOI: 10.1016/j.jad.2013.07.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 07/29/2013] [Accepted: 07/31/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adolescent self-harm (SH) is a major health problem potentially associated with poor outcomes including reduced life expectancy and risk of completed suicide in adulthood. Several studies point to the role of possible constitutional vulnerabilities that could predispose to this behavior. This study sets out to assess the relationship between SH and affective temperaments (AT) in adolescents. METHODS A cross-sectional sample of public school students (n=1713), with age limits between 12 and 20, was examined using anonymously completed self-report instruments including 'The Lifestyle & Coping Questionnaire' and the 'Temperament Evaluation of Memphis, Pisa, Paris and San Diego-auto-questionnaire' (TEMPS-A). SH was defined according to strict criteria through a two-stage procedure. Statistical significance of associations with SH for categorical variables was assessed in bivariate analysis. AT predictors of lifetime SH were examined in multivariate logistic regression analyses. RESULTS Lifetime SH was reported by 7.3%, being about three times more frequent in females. SH was associated, in both genders, with a significant deviation on depressive, cyclothymic and irritable dimensions of TEMPS-A. After multivariate logistic regression adjusted to family typology, smoking status, alcohol and drug consumption, only depressive temperament remained significantly associated as a predictor of SH in both genders. LIMITATIONS The use of self-rating instruments and the cross-sectional nature of the study limit our results. CONCLUSIONS Cyclothymic, irritable and especially depressive temperament might represent an important marker of vulnerability to SH in both male and female adolescents.
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Affective temperament, history of suicide attempt and family history of suicide in general practice patients. J Affect Disord 2013; 149:350-4. [PMID: 23477849 DOI: 10.1016/j.jad.2013.02.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 02/08/2013] [Accepted: 02/10/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Untreated major affective disorders are strongly associated with suicidal behaviour; however, clinical, psychological and psycho-social risk factors also play a contributory role. Personal history and family history of suicide are also important predictors of suicidal behaviours, and are also a powerful marker of current major depressive episode in general practice patients. Affective temperaments, which can be considered the subaffective manifestations of major mood disorders also show a specific pattern of association with suicidal behaviour. In the present study our aim was to investigate the association between affective temperaments, personal history of suicide attempts and family history of completed suicide in primary practice patients. METHODS Five hundred and nine patients from 6 primary care practices completed the TEMPS-A, and were assessed concerning self-reported history of personal or family suicide. RESULTS We found that among those answering questions concerning suicide, 9.1% reported a family history of suicide in first and second degree relatives and 4.8% had at least one prior suicide attempt. Among those giving a positive answer to both questions, those who had a positive family history had significantly more frequent suicide attempts (15.4% vs. 4.0%). Patients with prior suicide attempts had a significantly higher score on the cyclothymic and depressive, and those with positive family history of suicide had on cyclothymic and anxious subscales. LIMITATIONS In the present study, personal and family history of suicide was assessed retrospectively and in a self-report way. The cross-sectional nature of this study and the facts that no current psychiatric morbidity has been investigated and only the documented history of depressive and anxiety disorders have been detected limit the generalisability of this study. DISCUSSION We found a significant relationship between depressive and cyclothymic affective temperament and personal history of suicide attempts, and between cyclothymic and anxious temperament and family history of completed suicide in first and second degree relatives. This is in line with previous findings showing a strong relationship between these affective temperaments and major mood episodes and that these temperaments are overrepresented among suicide attempters. Our findings also suggest that the presence of cyclothymic (and to lesser extent depressive) affective temperament in a patient with family history of completed suicide indicates a very high risk of suicidal behaviour.
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