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Sanz-Gómez S, Vera-Varela C, Alacreu-Crespo A, Perea-González MI, Guija JA, Giner L. Impulsivity in fatal suicide behaviour: A systematic review and meta-analysis of psychological autopsy studies. Psychiatry Res 2024; 337:115952. [PMID: 38723408 DOI: 10.1016/j.psychres.2024.115952] [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: 11/17/2023] [Revised: 05/03/2024] [Accepted: 05/04/2024] [Indexed: 06/18/2024]
Abstract
Our aim is to review and perform a meta-analysis on the role of impulsivity in fatal suicide behaviour. We included papers who used psychological autopsy methodology, assessed adult death by suicide, and included assessment of impulsivity. We excluded papers about assisted suicide, terrorist suicide, or other cause of death other than suicide or postmortem diagnosis made only from medical records or database. 97 articles were identified. 33 were included in the systematic review and nine in the meta-analysis. We found that people who die by suicide with high impulsivity are associated with younger age, substance abuse, and low intention to die, whereas those with low impulsivity were associated with older age, depression, schizophrenia, high intention to die and low social support. In the meta-analysis, suicide cases had higher impulsivity scores than living controls (Hedges' g = 0.59, 95 % CI [0.28, 0.89], p=.002). However, studies showed heterogeneity (Q = 90.86, p<.001, I2=89.0 %). Impulsivity-aggressiveness interaction was assessed through meta-regression (β=0.447, p=.045). Individuals with high impulsivity would be exposed to a higher risk of fatal suicide behaviour, aggressiveness would play a mediating role. People who die by suicide with high and low impulsivity display distinct characteristics, which may reflect different endophenotypes leading to suicide by different pathways.
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Affiliation(s)
| | | | | | | | - Julio Antonio Guija
- Servicio de Psiquiatría Forense, Instituto de Medicina Legal y Ciencias Forenses de Sevilla, Seville, Spain
| | - Lucas Giner
- Department of Psychiaty, Universidad de Sevilla, Seville, Spain
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Hersh RG. Treating Narcissistic Disorders in General Psychiatry: Practical Application of Transference-Focused Psychotherapy Principles. Psychodyn Psychiatry 2024; 52:150-172. [PMID: 38829230 DOI: 10.1521/pdps.2024.52.2.150] [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] [Indexed: 06/05/2024]
Abstract
Patients with primary or co-occurring narcissistic disorders are seen routinely in general psychiatry settings. Contemporary trends in training and practice have impacted psychiatrists' skills and confidence in identifying and treating these disorders, which can range from relatively benign to high-acuity presentations. The goal of this article is to introduce key principles derived from transference-focused psychotherapy (TFP) for use by clinicians in general practice in their work with patients with narcissistic disorders, even when those clinicians do not routinely provide individual psychotherapy. Practical application of TFP principles in work with patients with narcissistic disorders in general psychiatry are proposed, including in diagnostic evaluation, family engagement, prescribing, and safety assessment and risk management calculus. Many psychiatrists whose practices are focused primarily on psychopharmacology, or a "medical model," may not appreciate fully the impact of pathological narcissism in their work. Clinicians who may benefit from familiarity with TFP principles in work with patients with narcissistic disorders include the approximately one-half of U.S. psychiatrists who do not offer psychotherapy in their practice.
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Gabilondo A, Gonzalez-Pinto A, Garcia J, Del Valle D, Morentin B, Iruin A. Analysis of health services use and clinical profiles in the year prior to suicide between 2010 and 2018: An opportunity to improve its prevention. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2024:S2950-2853(24)00031-0. [PMID: 38768759 DOI: 10.1016/j.sjpmh.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 05/07/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Suicide is the first cause of external death in Spain. International studies show frequent and varied health contacts in the months prior to suicide. There are hardly any studies on that phenomenon in this country. OBJECTIVE To analyze health care use in the year prior to suicide between 2010 and 2018 in the Basque Country, as well as pharmacological prescriptions and psychiatric diagnoses received. METHODS Retrospective descriptive study with all suicides registered by the Basque Institute of Legal Medicine (BILM) between 2010 and 2018. The records of the BILM and the Basque Health Service (Osakidetza) were cross-checked. RESULTS 1526 suicides were analyzed. 74% had health contacts in the previous year. The use was higher in women (p<0.05) and in older ages (p<0001). Primary care was the most used specialty (58.8% the previous year and 7.1% the previous week), followed by Hospital Emergencies (50.3% and 10.2%) and Outpatient Medical Specialties (49% and 11.6%), especially Radiology. Outpatient psychiatry only contacted 29.6% that year, although it had the highest average number of visits (15.1 SD22.6). The most frequent diagnostic category among psychiatric patients was F30-39 (26.7%), with differences between sexes and ages. 49.7% received psychotropic drugs. CONCLUSIONS The results are aligned with international evidence, which they also extend, and reinforce the need to extend prevention beyond psychiatric services. It seems advisable to increase proactivity in the search for risk by sensitizing and training different professional profiles, but also to work from non-health settings to improve assistance to highly vulnerable profiles (young men) with low health links.
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Affiliation(s)
- Andrea Gabilondo
- Outpatient Mental Health Network of Gipuzkoa, Basque Health System (Osakidetza), San Sebastián, Spain; Biodonostia Health Research Institute, Basque Health System (Osakidetza), San Sebastián, Spain; CiberSam, Network Centre for Biomedical Research in Mental Health, Spain.
| | - Ana Gonzalez-Pinto
- CiberSam, Network Centre for Biomedical Research in Mental Health, Spain; University Hospital of Araba, Basque Health System (Osakidetza), Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Basque Health System (Osakidetza), Vitoria-Gasteiz, Spain
| | - Jon Garcia
- Outpatient Mental Health Network of Bizkaia, Basque Health System (Osakidetza), Bilbao, Spain; Biocruces Health Research Institute, Basque Health System (Osakidetza), Bilbao, Spain
| | - David Del Valle
- Basque Institute of Legal Medicine, San Sebastián, Bilbao, Vitoria-Gasteiz, Spain
| | - Benito Morentin
- Basque Institute of Legal Medicine, San Sebastián, Bilbao, Vitoria-Gasteiz, Spain
| | - Alvaro Iruin
- Outpatient Mental Health Network of Gipuzkoa, Basque Health System (Osakidetza), San Sebastián, Spain; Biodonostia Health Research Institute, Basque Health System (Osakidetza), San Sebastián, Spain
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Sprio V, Mirra L, Madeddu F, Lopez-Castroman J, Blasco-Fontecilla H, Di Pierro R, Calati R. Can clinical and subclinical forms of narcissism be considered risk factors for suicide-related outcomes? A systematic review. J Psychiatr Res 2024; 172:307-333. [PMID: 38437765 DOI: 10.1016/j.jpsychires.2024.02.017] [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: 09/11/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Clinical and subclinical forms of narcissism may increase suicide risk. However, little is known and there are controversies on this topic. This systematic review aims at providing an overview of studies investigating this association. METHODS We used PubMed, Scopus, and PsycInfo databases and followed PRISMA. We focused on cohort, case-control, cross-sectional and case series studies. We referred to both clinical (i.e., narcissistic personality disorder (NPD) and/or NPD criteria) and subclinical forms (i.e., grandiose and vulnerable narcissistic traits) of narcissism. Moreover, we considered: Suicidal Ideation (SI), Non-Suicidal Self-Injury(s) (NSSI), Deliberate Self-Harm (DSH), Suicide Attempt(s) (SA), Suicide Risk (SR), and Capability for Suicide. RESULTS We included 47 studies. Lack of association between NPD diagnosis/criteria and suicide-related outcomes (SI) or mixed results (SA) were found. Higher homogeneity emerged when considering narcissistic traits. Vulnerable narcissism was associated with SI, less impulsive NSSI, and DSH. Grandiose narcissism was associated with severe NSSI and multiple SA with high intent to die, but it was protective against SI and SR. Vulnerable narcissism seemed to be associated with suicide-related outcomes characterized by low intent to die, while grandiose narcissism seemed to be a risk factor for outcomes with high planning and severity. LIMITATIONS Between-study heterogeneity and lack of longitudinal studies. CONCLUSIONS Assessing suicide risk in subjects with clinical or subclinical forms of narcissism may be useful. Moreover, considering the most vulnerable form of narcissism, and not just the grandiose one, may contribute to a more nuanced risk stratification and to the identification of distinct therapeutic approaches.
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Affiliation(s)
- Veronica Sprio
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Lucia Mirra
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Fabio Madeddu
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Jorge Lopez-Castroman
- Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France; Center of Biomedical Network Research on Mental Health (CIBERSAM), Carlos III Institute of Health, Madrid, Spain; PSNREC, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France
| | - Hilario Blasco-Fontecilla
- Center of Biomedical Network Research on Mental Health (CIBERSAM), Carlos III Institute of Health, Madrid, Spain; UNIR Health Sciences School and Medical Center, Universidad Internacional de La Rioja, Madrid, Spain
| | | | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Milan, Italy; Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France.
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Cailhol L, Marcoux M, Mathur A, Yrondi A, Birmes P. Predictors of prospective suicide attempts in a group at risk of personality disorder following self-poisoning. Front Psychiatry 2023; 14:1084730. [PMID: 37363177 PMCID: PMC10289019 DOI: 10.3389/fpsyt.2023.1084730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Abstract
Background Patients with personality disorder (PD) are at risk for suicidal behavior and are frequently admitted for this reason to emergency departments. In this context, researchers have tried to identify predictors of their suicidal acts, however, the studies have been mostly retrospective, and uncertainty remains. To prospectively explore factors associated with suicide attempts (SA) in individuals screened for PD from the ecological context of emergencies. Methods Patients were recruited from two emergency departments after a self-poisoning episode (n = 310). PDQ-4+ (risk of PD), TAS-20 (alexithymia), SIS (suicidal intent), H (hopelessness), BDI-13 (depression), AUDIT (alcohol consumption), and MINI (comorbidity) questionnaires were completed. SA over the subsequent two years were identified by mailed questionnaires and hospitals' active files. Logistic regression analyses were performed. Results Having a previous suicidal attempt was linked to a 2.7 times higher chance of recurrence after 6 months, whereas the TAS-20 showed a 1.1 times higher risk at 18 months (OR = 1.1) and the BDI at 24 months (OR = 1.2). Each one-unit increment in TAS-20 and BDI-13 scores increased the risk of SA by 9.8 and 20.4% at 18 and 24 months, respectively. Conclusion Some clinical features, such as alcohol dependence, suicide intent, and hopelessness, may not be reliable predictors of SA among PD patients. However, in the short term, previous SA and, in the long term, depression and alexithymia may be the most robust clinical predictors to consider in our sample of patients with self-poisoning SA.Clinical trial registration: [ClinicalTrials.gov], NCT00641498 24/03/2008 [#2006-A00450-51].
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Affiliation(s)
- Lionel Cailhol
- Department of Psychiatry, Institut Universitaire de Santé Mentale de Montréal, CIUSSS of East Montreal, University of Montreal, Montreal, QC, Canada
| | - Mariève Marcoux
- Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Anjali Mathur
- Department of Brief therapy, University Hospital Center of Toulouse (CHU Toulouse), Toulouse, Occitanie, France
| | - Antoine Yrondi
- Department of Psychiatry and Medical Psychology, University Hospital Center of Toulouse (CHU Toulouse), Expert Centre for Treatment-Resistant Depression FondaMental, ToNIC Toulouse NeuroImaging Centre, Toulouse University, Toulouse, Occitanie, France
| | - Philippe Birmes
- Department of Psychiatry, Psychotherapies and Art Therapy, University Hospital Center of Toulouse (CHU Toulouse), ToNIC Toulouse NeuroImaging Centre, Toulouse University, Toulouse, Occitanie, France
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Krvavac S, Bystad M, Wynn R, Bukholm IRK, Jansson B. Characteristics of Patients Who Complete Suicide and Suicide Attempts While Undergoing Treatment in Norway: Findings from Compensation Claims Records. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4083. [PMID: 36901092 PMCID: PMC10002346 DOI: 10.3390/ijerph20054083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/19/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
The aim of this study was to identify characteristics that differentiate patients who complete suicide (SC) from patients with suicide attempts (SA) while undergoing treatment in Norway. We examined data from the Norwegian System of Patient Injury Compensation (Norsk Pasientskade Erstatning-NPE). Data were extracted from NPE case records from a 10-year period (2009-2019) for 356 individuals who attempted (n = 78) or died by (n = 278) suicide. The two groups differed significantly in the types of medical errors identified by experts. Inadequate suicide risk assessment tended to be proportionally and significantly more prevalent among SC compared to SA. There was a weak but significant trend that SA had received medication only, whereas SC had received both medication and psychotherapy. There were no significant differences with respect to age group, gender, diagnostic category, number of previous suicide attempts, inpatient/outpatient status, or category of responsible clinic. We conclude that suicide attempters and suicide completers differed in terms of identified medical errors. Focusing on the prevention of these and other types of errors could help to reduce the number of suicides of patients in treatment.
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Affiliation(s)
- Sanja Krvavac
- Department of Psychiatry, Helgeland Hospital Trust, 8802 Sandnessjøen, Norway
- Department of Health and Care Sciences, UiT The Arctic University of Tromsø, 9037 Tromsø, Norway
| | - Martin Bystad
- Division of Substance Use and Mental Health, University Hospital of North Norway, 9019 Tromsø, Norway
| | - Rolf Wynn
- Department of Clinical Medicine, UiT The Arctic University of Tromsø, 9038 Tromsø, Norway
- Department of Education, ICT and Learning, Østfold University College, 1757 Halden, Norway
| | - Ida Rashida Khan Bukholm
- The Norwegian System of Patient Injury Compensation, 0130 Oslo, Norway
- Faculty of Landscape and Society, The Norwegian University of Life Sciences, 1430 Ås, Norway
| | - Billy Jansson
- Department of Psychology and Social Work, Mid Sweden University, 831 25 Ostersund, Sweden
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Borroni S, Franchini L, Brioschi S, Vassena G, Masci E, Franzoni C, Ruotolo G, Colombo C, Fossati A. The role of clinical and Personological features in predicting high lethality suicide attempts: A study among mood disorder patients. Personal Ment Health 2023; 17:99-106. [PMID: 35982533 DOI: 10.1002/pmh.1546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/31/2022] [Accepted: 04/21/2022] [Indexed: 11/06/2022]
Abstract
Suicidal attempts (SA) represent heterogeneous behaviours ranging in their seriousness from fatal and near-fatal (high-lethality) cases to those that do not require medical attention (low lethality). These considerations stress the need to identify high-risk individuals for high lethality SA in order to target suicide preventive interventions. The present study aims at evaluating the role of sociodemographic and clinical variables and examining personality pathological features in predicting high lethality SA. The sample was composed by 94 patients who were consecutively admitted to the Mood Disorders Unit of the San Raffaele Turro Hospital in Milan. The results of binary logistic regression analyses showed that previous SA and current suicide ideation play a role in predicting serious SA. Considering the DSM-5 personality dysfunctional domains assessed by the Personality Inventory for DSM-5, our logistic regression analyses suggested that high lethality SA was associated with Detachment PID-5 domain. Finally, binary hierarchical regression analysis showed that Detachment domain remained a significant predictor of serious SA over and above the effect of previous SA and suicide ideation. As a whole, our results highlight the importance of a multidimensional approach to develop adequate assessment, effective treatments and prevention of high lethality SA risk.
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Affiliation(s)
- Serena Borroni
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | | | - Elisabetta Masci
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Chiara Franzoni
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Giulia Ruotolo
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Cristina Colombo
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Fossati
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
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Moselli M, Casini MP, Frattini C, Williams R. Suicidality and Personality Pathology in Adolescence: A Systematic Review. Child Psychiatry Hum Dev 2023; 54:290-311. [PMID: 34524583 PMCID: PMC9977705 DOI: 10.1007/s10578-021-01239-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
This work presents a review of research papers examining the role of emerging personality pathology in suicidal ideation and behaviours in adolescence. Initially, 226 studies were selected in line with PRISMA guidelines, and 33 articles were finally included in this review. The data show percentages of any personality disorder diagnosis ranging from 19.5 to 22.8% in suicide attempters, while in autopsy studies, the rate of personality disorder diagnosis varied between 29.6 and 42.1%. The overwhelming majority of the studies focus on the role of borderline personality disorder (BPD) in suicidal behaviours, also highlighting its predictive role at a longitudinal level. Furthermore, the literature review shows that personality traits supposed to underlie BPD, such as affective instability, impulsivity and identity diffusion, have specific predictive links with suicidal conduct. Other personality pathology dimensions, such as aggressiveness, sadism and perfectionism that are associated with other personality disorders, namely, antisocial and narcissistic personality disorders, have also shown a significant mediating role for suicidal risk. Overall, these results seem to parallel the role of personality pathology in predicting suicide in adulthood and point to the relevance of assessing the presence of emerging patterns of personality disorders for the clinical management of suicidal risk in adolescence.
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Affiliation(s)
- Marta Moselli
- grid.7841.aDepartment of Clinical and Dynamic Psychology, Sapienza University of Rome, Rome, Italy
| | - Maria Pia Casini
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Camilla Frattini
- grid.7841.aDepartment of Clinical and Dynamic Psychology, Sapienza University of Rome, Rome, Italy
| | - Riccardo Williams
- Department of Clinical and Dynamic Psychology, Sapienza University of Rome, Rome, Italy.
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Vera-Varela C, Manrique Mirón PC, Barrigón ML, Álvarez-García R, Portillo P, Chamorro J, Baca-García E. Low Level of Agreement Between Self-Report and Clinical Assessment of Passive Suicidal Ideation. Arch Suicide Res 2022; 26:1895-1910. [PMID: 34223799 DOI: 10.1080/13811118.2021.1945984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Discrepancies between patient reports during clinical evaluations and self-reported suicide ideation are of vital importance. We study the agreement in passive suicidal ideation between reports made by clinicians and patients' self-reports. METHOD Wish of death in 648 outpatients was assessed by attending clinicians. Within 24 h after clinical evaluation, patients completed a self-report questionnaire in which they were asked whether they had no desire to live. We used cluster analysis to determine the clinical profile of a population of patients according to the concordance between reports made by clinicians and self-reported information. RESULTS A low level of agreement (kappa = 0.072) was found between clinicians and patients, as 56.4% (n = 366) of clinician reports classified as containing no death-related ideas although on self-report the patient did state that they had no desire to live. In this group containing discrepancies between the two reports, two clusters were found to have shared characteristics: female sex, middle age, cohabitation, active employment, no history of suicidal behavior, and diagnosis of neurotic, stress-related, and somatoform disorders. In a third, more severe cluster, patients self-reported sleep disturbances, less appetite, poor treatment adherence, and aggressiveness. CONCLUSIONS We found low agreement between self-reports and clinician assessments regarding the death wish. Self-reporting may be useful in assessing suicide risk. HIGHLIGHTSLow agreement was found between self-reports and clinician assessments regarding passive suicidal ideation.Most patients in whom the clinician underestimated the risk of suicide were women.Our results suggest that clinicians require adequate documentation of suicidal risk assessment to identify the high-risk population.
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Dewar C, Heggs DA, Davies J. Exploring the Relationship Between Domestic Violence Perpetration and Suicidal Behavior in Male Prisoners. Arch Suicide Res 2022; 26:1831-1846. [PMID: 34162317 DOI: 10.1080/13811118.2021.1939207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study is the first to explore the relationship between domestic violence perpetration and suicidal behavior in prisoners in England and Wales. The nature of this relationship is unclear, however, understanding and reducing suicide in prisons is a critical issue for frontline staff and policy makers. Eight participants with a history of suicide attempts and domestic violence perpetration were interviewed. Five key themes were identified through thematic analysis; "Trauma, victimization and life struggles," "Relationship ideals versus relationship reality", "Explaining domestic violence", "The impact of prison" and "Suicide as a coping strategy". This study shows that the relationship between domestic violence and suicide risk in prisoners may be better understood through a pathway of experiences rather than individual risk factors. Further research is needed to test the replicability of this pathway in other samples.
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Walker SA, Olderbak S, Gorodezki J, Zhang M, Ho C, MacCann C. Primary and secondary psychopathy relate to lower cognitive reappraisal: A meta-analysis of the Dark Triad and emotion regulation processes. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2021.111394] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Schechter M, Goldblatt MJ, Ronningstam E, Herbstman B. The Psychoanalytic Study of Suicide, Part I: An Integration of Contemporary Theory and Research. J Am Psychoanal Assoc 2022; 70:103-137. [PMID: 35451317 DOI: 10.1177/00030651221086622] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Psychodynamic psychotherapy has an important role in suicide prevention. The psychoanalytic study of suicide has taught us a great deal about the human experience and the process of suicidality. There is also much to be learned from other fields of study and from empirical research that can be integrated into psychoanalytic therapies. Central to the psychoanalytic approach to suicide has been understanding the patient's internal subjective experience of unbearable emotional or psychic pain and the urgent need for relief. Emotional pain can include intense affects such as shame, humiliation, self-hate, and rage. Factors that can increase vulnerability to suicidal states include problems with early attunement, dissociation and deficits in bodily love and protection, conscious and unconscious fantasy, and certain character traits and dynamics. Empirical research has confirmed many basic psychoanalytic concepts about suicide, including escape from unbearable pain as the primary driver of suicidal behavior, the role of dissociation in increasing risk of bodily attack, and the importance of unconscious processes. Further research into implicit processes and their role in the suicidal process holds potential to improve suicide risk assessment and to enhance psychotherapy by bringing otherwise inaccessible material into the treatment.
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The Road from Pathological Narcissism to Suicidality in Adolescence: An Empirical Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189761. [PMID: 34574681 PMCID: PMC8469779 DOI: 10.3390/ijerph18189761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022]
Abstract
Background: Clinical and empirical research evidenced a complex link between pathological narcissism and the suicidal process in adulthood. Given the relevance of suicidality and the peculiar narcissistic vicissitudes of adolescence, the proposed research investigated the relationship between pathological narcissism analyzed from the multi-dimensional perspective of the Diagnostic Interview for Narcissism (DIN) and suicidal ideation conducted in a sample of Italian Adolescents. Methods: One hundred and three Italian male and female adolescents between 12 and 18 were administered the DIN, SCIDII, CSSRS, and Kiddie-SADS with six months follow-up. Results: The correlation, t-test, multiple regression analyses evidenced the association of narcissistic affective states and mood with both suicidal ideation and lethality of conduct. The increase in the dimension of grandiosity is associated with the passage to potentially highly lethal suicidal gestures. Conclusions: Suicidal ideation and conduct seem to serve the function of restoring a sense of control and self-esteem in narcissistic individuals experiencing a state of affective dysregulation. Narcissistic pathological functioning seems to play an important role in the adolescent suicidal process, quite like adulthood. Assessing an adolescent’s narcissistic functioning may provide useful clinical information in understanding and managing the suicidal risk in this phase of life.
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Ponzoni S, Beomonte Zobel S, Rogier G, Velotti P. Emotion dysregulation acts in the relationship between vulnerable narcissism and suicidal ideation. Scand J Psychol 2021; 62:468-475. [PMID: 33956346 PMCID: PMC8360132 DOI: 10.1111/sjop.12730] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 03/17/2021] [Accepted: 04/04/2021] [Indexed: 12/23/2022]
Abstract
Suicide behaviors are peculiar aspects of several cluster B disorders, including Narcissistic Personality Disorder. To date, it is still unclear which facet of narcissism is more related to the desire to die and which other factors are involved in this relationship. This study aims to offer preliminary empirical evidences concerning the relationship between narcissism, emotion dysregulation and suicide ideation. We administered the Pathological Narcissism Inventory (PNI), Difficulties in Emotion Regulation Scale (DERS), PID‐5‐BF (Personality Inventory for DSM‐5‐Short Form) and Beck Scale for Suicide ideation (BSI) to a sample of individuals with suicide ideation (n = 70) and a sample of community participants (n = 154). Controlling for age, gender and Negative Affectivity, we found that BSI scores correlated significantly with the vulnerable dimension of narcissism, but not with the grandiose one, and with all DERS dimension, apart from Awareness. Nevertheless, emotion dysregulation moderates the relationship between vulnerable narcissism and suicide ideation. Suicide ideation seems to be deeply connected with the vulnerable dimension of pathological narcissism and the relationship between the constructs is totally mediated by emotion dysregulation. Future directions and clinical implications are discussed.
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Affiliation(s)
- Sara Ponzoni
- Department of Educational Sciences, University of Genoa, Italy
| | - Sara Beomonte Zobel
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Guyonne Rogier
- Department of Educational Sciences, University of Genoa, Italy
| | - Patrizia Velotti
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
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15
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de la Vega Sánchez D, Guija JA, Pérez-Moreno P, Kelly SA, Santos M, Oquendo MA, Courtet P, Giner J, Giner L. Association of Religious Activity with Male Suicide Deaths. Suicide Life Threat Behav 2020; 50:449-460. [PMID: 31724765 DOI: 10.1111/sltb.12600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 10/02/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the relationship between suicide in men and stratified measures of religiosity. METHODS We studied 192 suicides and 81 controls (nonsuicide, sudden, or accidental death). We employed the psychological autopsy method to compile diagnoses based on DSM-IV criteria. Overall, religiosity and participation in religious associations were determined using a Likert-type scale. Given the limited participation of women in the religious associations of southern Spain, only male subjects were included. RESULTS Religious participants had decreased risk of suicide compared to nonparticipants (OR = 0.148, 95% CI = 0.049-0.447). This lower risk was further associated with the degree of involvement in religious activity. Suicides accounted for 73.47% of subjects with no religious participation, 61.17% of those with some participation, and 56.52% of frequent participants (linear trend test Z = -2.0329, p = .042). Membership in a religious association was also associated with a lower rate of suicide compared to nonmembers (OR = 0.356, 95% CI = 0.172-0.736). This effect was similarly associated with the degree of involvement in the association. Suicides accounted for 74.67% of subjects who never participated in the activities of a religious association, 69.23% of those who sometimes participated, and 42.86% of frequent participants (linear trend test Z = -3.4082, p < .001). CONCLUSIONS Religiosity, either as general participation or through a religious association, was associated with protection against suicide proportional to the degree of involvement in religious activities.
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Affiliation(s)
| | - Julio A Guija
- Instituto de Medicina Legal de Sevilla, Sevilla, Spain
| | - Pedro Pérez-Moreno
- Departamento de Psicología Clínica y Experimental, Universidad de Huelva, Huelva, Spain
| | - Samuel A Kelly
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - María Santos
- Instituto de Medicina Legal de Sevilla, Sevilla, Spain
| | - María A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Philippe Courtet
- INSERM Unit 1061, CHRU Montpellier, University of Montpellier, Montpellier, France.,Fondamental Foundation, Créteil, France
| | - José Giner
- Departamento de Psiquiatría, Universidad de Sevilla, Sevilla, Spain
| | - Lucas Giner
- Departamento de Psiquiatría, Universidad de Sevilla, Sevilla, Spain
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Moselli M, Frattini C, Williams R, Ronningstam E. The Study of Motivation in the Suicidal Process: The Motivational Interview for Suicidality. Front Psychiatry 2020; 11:598866. [PMID: 33519549 PMCID: PMC7838538 DOI: 10.3389/fpsyt.2020.598866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/30/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction: Suicide is the outcome of a process starting with the experiences of an unbearable pain or hopelessness, passing from suicidal ideation and planning, to possible para-suicidal behaviors or actual attempts. Recent studies have evidenced the necessity to integrate approaches based on the identification of psychopathological diagnoses and other variables as possible predictors of suicidal conduct with a more clinically based approach. A clinical assessment is needed that focuses on the patients' mental state with respect to thoughts concerning death and suicide. In particular, a qualitative assessment of motivations underlying the suicidal process could represent an effective guide for clinicians engaged in the difficult field of preventing adolescents' suicidal gestures. Most instruments investigating the suicidal motivation are self-report measures, possibly resulting in a lack of sufficiently valid assessment of this area. In the present work, we present the Motivational Interview for Suicidality in Adolescence (MIS-A) aiming at identifying the motivational areas sustaining suicidal ideation and gestures in this phase of development. Materials and Methods: The identification of the different areas derives from a thorough review of the empirical literature subsequently vetted by expert clinicians who selected specific reasons behind suicidal ideation and gesture. Result: The MIS is a semi-structured clinician-report interview. The interview is composed of seven areas and 14 sub-areas, evaluated on a four-point Likert scale: illness motivated attempts area, chronic presence of internal pessimistic criticism area, sense of defeat and entrapment area, relational area, external motivated crisis area, extreme and unusual cases area, and lack of control area. Conclusions: The path followed in the creation of the MIS reflects both an empirically orientated and a clinically informed approach. Creating this MIS is the first step within a wider research project that will allow one to test the reliability of the instrument.
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Affiliation(s)
- Marta Moselli
- Department of Clinical and Dynamic Psychology, Medicine and Psychology Faculty, Sapienza University of Rome, Rome, Italy
| | - Camilla Frattini
- Department of Clinical and Dynamic Psychology, Medicine and Psychology Faculty, Sapienza University of Rome, Rome, Italy
| | - Riccardo Williams
- Department of Clinical and Dynamic Psychology, Medicine and Psychology Faculty, Sapienza University of Rome, Rome, Italy
| | - Elsa Ronningstam
- Harvard Medical School, McLean Hospital, Belmont, MA, United States
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Hersh RG, McCommon B, Golkin EG. Sharing a Diagnosis of Narcissistic Personality: a Challenging Decision with Associated Risks and Benefits. Curr Behav Neurosci Rep 2019. [DOI: 10.1007/s40473-019-00193-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Rawat S, Rajkumari S, Joshi PC, Khan MA, Saraswathy KN. Who dies and who survives? Investigating the difference between suicide decedents and suicide attempters. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2019. [DOI: 10.1186/s41935-019-0115-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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19
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Fanelli G, Serretti A. The influence of the serotonin transporter gene 5-HTTLPR polymorphism on suicidal behaviors: a meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2019; 88:375-387. [PMID: 30125622 DOI: 10.1016/j.pnpbp.2018.08.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/31/2018] [Accepted: 08/13/2018] [Indexed: 12/16/2022]
Abstract
Suicidal Behavior (SB) is the second leading cause of death among youths worldwide and the tenth among all age groups. Inherited genetic differences have a role in suicidality with heritability ranging from 30 to 55%. The SLC6A4 5-HTTLPR gene variant has been largely investigated for association with SB, with controversial results. In this work, we sought to determine whether the results of previous meta-analyses were confirmed or modified subsequent to the inclusion of more recent literature data. An electronic literature search was performed to identify relevant studies published until July 2018. Data were analysed through RevMan v5.3. Subgroup and sensitivity meta-analyses were performed considering different SB sub-phenotypes, ethnicity, gender and psychiatric diagnostic categories. Our literature search yielded 1186 articles; among these, we identified 45 pertinent case-control studies (15,341 subjects). No association was found between low-expressing alleles or genotypes (S + LG alleles or S' carrier genotypes) and SB in the primary analyses. However, low-expressing alleles (S + LG) were associated with an increased risk of Violent Suicide Attempt (OR = 1.44, C.I. 1.17-1.78, p = .0007). An effect of the same alleles on SB was found in a subpopulation of substance abusers, but this result was not confirmed after the exclusion of healthy subjects from the control group. The other sensitivity meta-analyses did not show any significant effect. Our findings contribute to clarify the conflicting previous evidence by suggesting an association between the 5-HTTLPR and Violent SB. Nonetheless, many other modulators, including environmental factors and epigenetic mechanisms may act to further increase the level of complexity.
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Affiliation(s)
- Giuseppe Fanelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.
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20
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21
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Szücs A, Szanto K, Aubry JM, Dombrovski AY. Personality and Suicidal Behavior in Old Age: A Systematic Literature Review. Front Psychiatry 2018; 9:128. [PMID: 29867594 PMCID: PMC5949532 DOI: 10.3389/fpsyt.2018.00128] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/26/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Suicide rates generally peak in the second half of life and are particularly high in older men; however, little is known about the contribution of dispositional factors to late-life suicide. Maladaptive personality traits have been strongly implicated in suicide among younger adults, but the extent to which they continue to play a role in late-life suicidal behavior is unclear. We also do not know whether specific personality profiles interact with the stressors of aging to cause suicidal behavior. METHODS We sought to synthesize the data on personality pathology in late-life suicidal ideation and behavior via a systematic review using the PubMed, Google Scholar, PsycInfo, Scopus, Ovid, Web of Science, Embase, and Cochrane search engines. The included key words related to three descriptors: "personality," "suicide," and "elderly." Included articles evaluated personality based on the Five-Factor Model (FFM) or ICD/DSM diagnostic criteria in older samples with minimum age cutoffs of 50 years or older. Our original search identified 1,183 articles, of which 31 were retained. RESULTS Included studies were heterogeneous in their design and personality measurements. Studies of categorical personality disorders were particularly scarce and suggested a stronger association with late-life suicidal ideation than with death by suicide. Only obsessive-compulsive and avoidant personality traits were associated with death by suicide in old age, but only in studies that did not control for depression. All personality constructs were positively linked to suicidal ideation, except for histrionic personality, which emerged as a negative predictor. Studies employing the FFM also indicated that older adults who died by suicide were less likely to display a maladaptive personality profile than elderly suicide attempters and younger suicide victims, having both lower levels of neuroticism and higher levels of conscientiousness than these comparison groups. Nevertheless, older suicide victims displayed lower levels of openness to experience than younger victims in two samples. CONCLUSION Maladaptive personality manifests in milder, subthreshold, and more heterogeneous forms in late-life vs. early-life suicide. An inability to adapt to the changes occurring in late life may help explain the association between suicide in old age and higher conscientiousness as well as obsessive-compulsive and avoidant personality disorders.
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Affiliation(s)
- Anna Szücs
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Decision Neuroscience and Psychopathology Laboratory, Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Katalin Szanto
- Decision Neuroscience and Psychopathology Laboratory, Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jean-Michel Aubry
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alexandre Y. Dombrovski
- Decision Neuroscience and Psychopathology Laboratory, Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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22
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Abstract
Few studies have examined associations between pathological narcissism and self-harm, but those that do indicate that narcissistic vulnerability (not narcissistic grandiosity) relates to self-harm. The current study extends this literature by investigating how facets of pathological narcissism assessed by the Pathological Narcissism Inventory relate to specific nonsuicidal self-injury (NSSI) behaviors assessed by the Inventory of Statements About Self-Injury using statistical models appropriate for non-normally distributed count data. In a sample of 1,023 undergraduate students, results revealed that facets of both narcissistic vulnerability and narcissistic grandiosity were differentially related to the endorsement and frequency of specific NSSI behaviors and higher-order latent NSSI factors (repetitive and impulsive), even after accounting for levels of borderline pathology. The clinical implications of these results are discussed.
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Affiliation(s)
- Sindes Dawood
- Pennsylvania State University, University Park, Pennsylvania
| | | | | | - Aaron L Pincus
- Pennsylvania State University, University Park, Pennsylvania
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23
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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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Ludwig B, Roy B, Wang Q, Birur B, Dwivedi Y. The Life Span Model of Suicide and Its Neurobiological Foundation. Front Neurosci 2017; 11:74. [PMID: 28261051 PMCID: PMC5306400 DOI: 10.3389/fnins.2017.00074] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/31/2017] [Indexed: 01/19/2023] Open
Abstract
The very incomprehensibility of the suicidal act has been occupying the minds of researchers and health professionals for a long time. Several theories of suicide have been proposed since the beginning of the past century, and a myriad of neurobiological studies have been conducted over the past two decades in order to elucidate its pathophysiology. Both neurobiology and psychological theories tend to work in parallel lines that need behavioral and empirical data respectively, to confirm their hypotheses. In this review, we are proposing a "Life Span Model of Suicide" with an attempt to integrate the "Stress-Diathesis Model" and the "Interpersonal Model of Suicide" into a neurobiological narrative and support it by providing a thorough compilation of related genetic, epigenetic, and gene expression findings. This proposed model comprises three layers, forming the capability of suicide: genetic factors as the predisposing Diathesis on one side and Stress, characterized by epigenetic marks on the other side, and in between gene expression and gene function which are thought to be influenced by Diathesis and Stress components. The empirical evidence of this model is yet to be confirmed and further research, specifically epigenetic studies in particular, are needed to support the presence of a life-long, evolving capability of suicide and identify its neurobiological correlates.
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Affiliation(s)
| | | | | | | | - Yogesh Dwivedi
- UAB Mood Disorder Program, Department of Psychiatry and Behavioral Neurobiology, University of Alabama at BirminghamBirmingham, AL, USA
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25
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Coleman D, Lawrence R, Parekh A, Galfalvy H, Blasco-Fontecilla H, Brent DA, Mann JJ, Baca-Garcia E, Oquendo MA. Narcissistic Personality Disorder and suicidal behavior in mood disorders. J Psychiatr Res 2017; 85:24-28. [PMID: 27816770 PMCID: PMC5191918 DOI: 10.1016/j.jpsychires.2016.10.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 10/18/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
Abstract
The relationship of Narcissistic Personality Disorder (NPD) to suicidal behavior is understudied. The modest body of existing research suggests that NPD is protective against low-lethality suicide attempts, but is associated with high lethality attempts. Mood-disordered patients (N = 657) received structured interviews including Axis I and II diagnosis and standardized clinical measures. Following chi-square and t-tests, a logistical regression model was constructed to identify predictors of suicide attempt. While there was no bivariate relationship of NPD on suicide attempt, in the logistic regression patients with NPD were 2.4 times less likely to make a suicide attempt (OR = 0.41; 95% CI = 0.19 - 0.88; p < 0.05), compared with non-NPD patients and controlling for possible confounding variables. NPD was not associated with attempt lethality. NPD patients were more likely to be male, to have a substance use disorder, and to have high aggression and hostility scores. Limitations include that the sample consists of only mood-disordered patients, a modest sample size of NPD, and the data are cross-sectional. The multivariate protective effect of NPD on suicide attempt is consistent with most previous research. The lower impulsivity of NPD patients and less severe personality pathology relative to other personality disorders may contribute to this effect. No relationship of NPD to attempt lethality was found, contradicting other research, but perhaps reflecting differences between study samples. Future studies should oversample NPD patients and include suicide death as an outcome. Clinical implications include discussion of individualized suicide risk assessment with NPD patients.
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Affiliation(s)
- Daniel Coleman
- Graduate School of Social Service, Fordham University, New York, NY, USA.
| | - Ryan Lawrence
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Amrita Parekh
- School of Social Work, Columbia University, New York, NY, USA
| | - Hanga Galfalvy
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Hilario Blasco-Fontecilla
- Department of Psychiatry, Puerta de Hierro University Hospital, Autonoma University, CIBERSAM, Madrid, Spain
| | - David A. Brent
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - J. John Mann
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Enrique Baca-Garcia
- Department of Psychiatry, Jimenez Diaz Foundation, Autonoma University, Madrid, Spain
| | - Maria A. Oquendo
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
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26
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Suicide risk and suicide method in patients with personality disorders. J Psychiatr Res 2016; 83:29-36. [PMID: 27552531 DOI: 10.1016/j.jpsychires.2016.08.008] [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: 03/11/2016] [Revised: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The influence of psychopathology on suicide method has revealed different distributions among different psychiatric disorders. However, evidence is still scarce. We hypothesized that having a diagnosis of personality disorder (PD) affect the suicide method, and that different PD clusters would influence the suicide method in different ways. In addition, we hypothesized that the presence of psychiatric and somatic co-morbidity also affects the suicide method. METHOD We examined 25,217 individuals aged 15-64 who had been hospitalized in Sweden with a main diagnosis of PD the years 1987-2013 (N = 25,217). The patients were followed from the date of first discharge until death or until the end of the follow-up period, i.e. December 31, 2013, for a total of 323,508.8 person-years, with a mean follow up time of 11.7 years. The SMR, i.e. the ratio between the observed number of suicides and the expected number of suicides, was used as a measure of risk. RESULTS Overall PD, different PD-clusters, and comorbidity influenced the suicide method. Hanging evidenced highest SMR in female PD patients (SMR 34.2 (95% CI: 29.3-39.8)), as compared to non-PD patients and jumping among male PD patients (SMR 24.8 (95% CI: 18.3-33.6)), as compared to non PD-patients. Furthermore, the elevated suicide risk was related to both psychiatric and somatic comorbidity. CONCLUSION The increased suicide risk was unevenly distributed with respect to suicide method and type of PD. However, these differences were only moderate and greatly overshadowed by the overall excess suicide risk in having PD. Any attempt from society to decrease the suicide rate in persons with PD must take these characteristics into account.
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Abstract
Suicide is one of the leading causes of violent death in many countries and its prevention is included in worldwide health objectives. Currently, the DSM-5 considers suicidal behavior as an entity that requires further study. Among the three validators required for considering a psychiatric disorder, there is one based on psychological correlates, biological markers, and patterns of comorbidity. This review includes the most important and recent studies on psychological factors: cognitive, emotional, temperament, and personality correlates (unrelated to diagnostic criteria). We included classic factors related to suicidal behavior such as cognitive, inflexibility, problem-solving, coping, rumination, thought suppression, decision-making, autobiographical memory, working memory, language fluency, burdensomeness, belongingness, fearless, pain insensitivity, impulsiveness, aggressiveness, and hopelessness. The personality correlates reported are mainly based on the personality theories of Cloninger, Costa and McCrae, and Eysenck. Moreover, it explores conceptual links to other new pathways in psychological factors, emptiness, and psychological pain as a possible origin and common end path for a portion of suicidal behaviors.
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28
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Liu BP, Liu X, Jia CX. Characteristics of suicide completers and attempters in rural Chinese population. Compr Psychiatry 2016; 70:134-40. [PMID: 27624433 DOI: 10.1016/j.comppsych.2016.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/20/2016] [Accepted: 07/10/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE This study aimed to compare the similarities and differences between suicide completers and attempters in rural China. METHODS Two paired case-control studies of completed suicide and suicide attempts were conducted in rural Shandong, China. This analysis included 409 suicide attempters (SA) with a mean age of 43.90 (SD=13.31), 117 suicide completers (SC) with a mean age of 50.38 (SD=13.02) and their controls matched by gender, age (within 3years), and residence. Logistic regression models were used to examine risk factors of suicide attempts and completed suicide and the differences between SA and SC. RESULTS Compared to their matched controls, suicide attempters and completers shared the following common risk factors: low levels of education (middle school or under) (OR, 95% CI: 2.79, 1.40-5.55 for SA and 16.98, 1.59-181.60 for SC), negative life events (OR, 95% CI: 7.37, 4.73-11.50 for SA and 21.08, 4.74-93.71 for SC), and mental disorders (OR, 95% CI: 7.52, 3.85-14.69 for SA and 22.39, 2.65-189.60 for SC). Compared to suicide attempts, completed suicide was associated with the following risk factors: male gender (OR, 95% CI: 1.75, 1.06-2.90), advancing age (OR, 95% CI: 1.02, 1.00-1.04), poor family economic status (OR, 95% CI: 6.74, 3.22-14.13), prior suicide attempts (OR, 95% CI: 2.43, 1.18-4.97), family suicide history (OR, 95% CI: 2.59, 1.33-5.06), high suicide intent (OR, 95% CI: 1.15, 1.05-1.27), and highly lethal methods (OR, 95% CI: 13.65, 6.51-28.59). CONCLUSIONS Although suicide completers and attempters share some common risk factors, suicide completers are more likely to have prior suicide attempts, family suicide history, and higher suicidal intent, and to use highly lethal methods in rural Chinese.
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Affiliation(s)
- Bao-Peng Liu
- Department of Epidemiology, Shandong University School of Public Health, Jinan 250012, China
| | - Xianchen Liu
- Department of Epidemiology, Shandong University School of Public Health, Jinan 250012, China; The University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Cun-Xian Jia
- Department of Epidemiology, Shandong University School of Public Health, Jinan 250012, China.
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29
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Tong Y, Phillips MR, Conner KR. DSM-IV Axis II personality disorders and suicide and attempted suicide in China. Br J Psychiatry 2016; 209:319-326. [PMID: 26585099 PMCID: PMC6173803 DOI: 10.1192/bjp.bp.114.151076] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 03/01/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are meagre data on Axis II personality disorders and suicidal behaviour in China. AIMS To describe the prevalence of Axis II personality disorders in suicides and suicide attempts in China and to estimate risk for these outcomes associated with personality disorders. METHOD People who died by suicide (n = 151), people who attempted suicide (n = 118) and living community controls (n = 140) were randomly sampled from four Chinese counties and studied using the Structured Clinical Interviews for DSM-IV-TR Axis I Disorders (SCID-I) and Axis II Personality Disorders (SCID-II). We also determined the prevalence of subthreshold versions of ten DSM-IV personality disorders. RESULTS Axis II personality disorders were present in 7% of the suicide group, 6% of the suicide attempt group and 1% of the control group. Threshold and subthreshold personality disorders had adjusted odds ratios (point estimates) in the range of 2.7-8.0 for suicide and for suicide attempts. CONCLUSIONS Axis II personality disorders may confer increased risk for suicidal behaviour in China, but their low prevalence in the community and among people with suicidal behaviour suggests that other personality constructs such as select dimensional traits may be a more fruitful avenue for understanding and preventing suicide in China.
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Affiliation(s)
- Yongsheng Tong
- Yongsheng Tong, MD, PhD, Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA; Michael R. Phillips, MD, MA, MPH, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China, Departments of Psychiatry and Public Health, Emory University, Atlanta Georgia, USA, and Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China; Kenneth R. Conner, PsyD, MPH, Department of Psychiatry, University of Rochester Medical Center, Rochester, New York and US Department of Veterans Affairs VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
| | - Michael R. Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China, Departments of Psychiatry and Public Health, Emory University, Atlanta Georgia, USA, and Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China
| | - Kenneth R. Conner
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NewYork and US Department of Veterans Affairs VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
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Skopp NA, Smolenski DJ, Sheppard SC, Bush NE, Luxton DD. Comparison of Suicide Attempters and Decedents in the U.S. Army: A Latent Class Analysis. Suicide Life Threat Behav 2016; 46:413-26. [PMID: 26749381 DOI: 10.1111/sltb.12227] [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: 12/18/2014] [Accepted: 09/03/2015] [Indexed: 11/29/2022]
Abstract
A clearer understanding of risk factors for suicidal behavior among soldiers is of principal importance to military suicide prevention. It is unclear whether soldiers who attempt suicide and those who die by suicide have different patterns of risk factors. As such, preventive efforts aimed toward reducing suicide attempts and suicides, respectively, may require different strategies. We conducted a latent class analysis (LCA) to examine classes of risk factors among suicide attempters (n = 1,433) and decedents (n = 424). Both groups were represented by three classes: (1) External/Antisocial Risk Factors, (2) Mental Health Risk Factors, and (3) No Pattern. These findings support the conceptualization that military suicide attempters and decedents represent a single population.
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Affiliation(s)
- Nancy A Skopp
- National Center for Telehealth & Technology (T2), Defense Centers of Excellence for Psychological Health & Traumatic Brain Injury, Joint Base Lewis McChord, Tacoma, WA, USA
| | - Derek J Smolenski
- National Center for Telehealth & Technology (T2), Defense Centers of Excellence for Psychological Health & Traumatic Brain Injury, Joint Base Lewis McChord, Tacoma, WA, USA
| | - Sean C Sheppard
- 17/555 Embedded Behavioral Health Clinic OIC, 17th Fires Brigade, 7th Infantry Division, Joint Base Lewis McChord, Tacoma, WA, USA
| | - Nigel E Bush
- National Center for Telehealth & Technology (T2), Defense Centers of Excellence for Psychological Health & Traumatic Brain Injury, Joint Base Lewis McChord, Tacoma, WA, USA
| | - David D Luxton
- National Center for Telehealth & Technology (T2), Defense Centers of Excellence for Psychological Health & Traumatic Brain Injury, Joint Base Lewis McChord, Tacoma, WA, USA
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Lim M, Lee S, Park JI. Differences between Impulsive and Non-Impulsive Suicide Attempts among Individuals Treated in Emergency Rooms of South Korea. Psychiatry Investig 2016; 13:389-96. [PMID: 27482239 PMCID: PMC4965648 DOI: 10.4306/pi.2016.13.4.389] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/19/2015] [Accepted: 11/08/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE A considerable proportion of suicide attempts are the result of sudden desires. Understanding such impulsive suicide attempts is necessary for effective interventions. We evaluated the impulsivity of suicide attempters treated in emergency rooms. The aim of the study was to identify the characteristics of impulsive suicide attempts by comparing these individuals to those who attempted to commit suicide in a non-impulsive manner. METHODS This study analyzed suicide attempters who visited the emergency departments of seven selected university hospitals. A total of 269 medical records in which impulsivity of suicide attempt were confirmed were subject to be analyzed. The impulsivity of the suicide attempt was examined using a summative score of items 6 and 15 on the Suicide Intent Scale. RESULTS A total of 48.0% of the participants were impelled by sudden inclinations to attempt suicide. Impulsive attempters were younger, unmarried and less physical illness than non-impulsive attempters, whereas no significant differences were found on psychiatric history and previous suicide history. Impulsive suicide attempters had suicide ideations that were not as severe (χ(2)=55.33, p<0.001) or intense (t=-8.38, p<0.001) as their counterparts'. Furthermore, medical results of impulsive suicide attempts were better than non-impulsive suicide attempts (t=-3.77, p<0.001). CONCLUSION The results suggested that a considerable proportion of suicide attempts were the result of sudden inclinations. Impulsive attempts were made in relatively earlier stages of suicide ideation; consequently, they have less intent than non-impulsive attempts.
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Affiliation(s)
- Meerae Lim
- St. Andrea Neuropsychiatric Hospital, Icheon, Republic of Korea
| | - Soojung Lee
- Korea Suicide Prevention Center, Seoul, Republic of Korea
| | - Jong-Ik Park
- Korea Suicide Prevention Center, Seoul, Republic of Korea
- Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
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Coimbra DG, Pereira E Silva AC, de Sousa-Rodrigues CF, Barbosa FT, de Siqueira Figueredo D, Araújo Santos JL, Barbosa MR, de Medeiros Alves V, Nardi AE, de Andrade TG. Do suicide attempts occur more frequently in the spring too? A systematic review and rhythmic analysis. J Affect Disord 2016; 196:125-37. [PMID: 26921865 DOI: 10.1016/j.jad.2016.02.036] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 01/25/2016] [Accepted: 02/06/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Seasonal variations in suicides have been reported worldwide, however, there may be a different seasonal pattern in suicide attempts. The aim of this study was to perform a systematic review on seasonality of suicide attempts considering potential interfering variables, and a statistical analysis for seasonality with the collected data. METHOD Observational epidemiological studies about seasonality in suicide attempts were searched in PubMed, Web of Science, LILACS and Cochrane Library databases with terms attempted suicide, attempt and season. Monthly or seasonal data available were evaluated by rhythmic analysis softwares. RESULTS Twenty-nine articles from 16 different countries were included in the final review. It was observed different patterns of seasonality, however, suicide attempts in spring and summer were the most frequent seasons reported. Eight studies indicated differences in sex and three in the method used for suicide attempts. Three articles did not find a seasonal pattern in suicide attempts. Cosinor analysis identified an overall pattern of seasonal variation with a suggested peak in spring, considering articles individually or grouped and independent of sex and method used. A restricted analysis with self-poisoning in hospital samples demonstrated the same profile. LIMITATIONS Grouping diverse populations and potential analytical bias due to lack of information are the main limitations. CONCLUSIONS The identification of a seasonal profile suggests the influence of an important environmental modulator that can reverberate to suicide prevention strategies. Further studies controlling interfering variables and investigating the biological substrate for this phenomenon would be helpful to confirm our conclusion.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Antonio Egidio Nardi
- Panic & Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, National Institute for Translational Medicine (INCT-TM), Rio de Janeiro, Brazil
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Suicidal ideation, suicide attempt, and occupations among employed adults aged 18-64years in the United States. Compr Psychiatry 2016; 66:176-86. [PMID: 26995251 PMCID: PMC4959536 DOI: 10.1016/j.comppsych.2016.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 01/04/2016] [Accepted: 02/01/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Approximately 70% of all US suicides are among working-age adults. This study was to determine whether and how 12-month suicidal ideation and suicide attempt were associated with specific occupations among currently employed adults aged 18-64 in the U.S. METHODS Data were from 184,300 currently employed adults who participated in the 2008-2013 National Surveys on Drug Use and Health (NSDUH). NSDUH provides nationally representative data on suicidal ideation and suicide attempt. Descriptive analyses and multivariable logistic regressions were conducted. RESULTS Among currently employed adults aged 18-64 in the U.S., 3.5% had suicidal ideation in the past 12months (3.1% had suicidal ideation only, and 0.4% had suicidal ideation and attempted suicide). Compared with adults in farming, fishing, and forestry occupations (model adjusted prevalence (MAP)=1.6%), adults in the following occupations were 3.0-3.6 times more likely to have suicidal ideation in the past year (model adjusted relative risks (MARRs)=3.0-3.6): lawyers, judges, and legal support workers (MAP=4.8%), social scientists and related workers (MAP=5.4%), and media and communication workers (MAP=5.8%). CONCLUSIONS Among employed adults aged 18-64 in the U.S., the 12-month prevalence of suicidal ideation varies by occupations. Adults in occupations that are at elevated risk for suicidal ideation may warrant focused suicide prevention.
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de Leon J, Baca-García E, Blasco-Fontecilla H. From the serotonin model of suicide to a mental pain model of suicide. PSYCHOTHERAPY AND PSYCHOSOMATICS 2016; 84:323-9. [PMID: 26398763 DOI: 10.1159/000438510] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 07/08/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Jose de Leon
- Mental Health Research Center, Eastern State Hospital, Lexington, Ky., USA
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Joo SH, Wang SM, Kim TW, Seo HJ, Jeong JH, Han JH, Hong SC. Factors associated with suicide completion: A comparison between suicide attempters and completers. Asia Pac Psychiatry 2016; 8:80-6. [PMID: 26477349 DOI: 10.1111/appy.12216] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/11/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The objective of this study was to compare the sociodemographic and clinical variables of suicide attempters and completers and to identify risk and protective factors for suicide completion. METHODS Subjects (n = 320) visiting to the emergency room were classified into two groups: suicide attempters (n = 222) and suicide completers (n = 98). Univariate analyses and logistic regression models were used to explore the differences between suicide attempters and completers and to identify risk factors for suicide completion. RESULTS The results showed that compared with suicide attempters, suicide completers were older, male, having alcohol use disorders, having comorbid health problems, having severe suicide ideation, and using severe suicide methods such as hanging and jumping from a height. Using multiple logistic regression model, risk factors predicting suicide completion were comorbid medical illness, and intense suicide ideation. Factor that served as protective factors against suicide completion was female. DISCUSSION This study demonstrated that suicide completers have more severe clinical profile than suicide attempters. Decreasing intensity of suicide ideation and treating comorbid medical illness of suicide attempters might be important in preventing them from suicide completion. It is important that the implementation of suicide preventive programs focused on alcoholism is useful in decreasing suicide rates further. Moreover, suicide completers used highly lethal methods, our results indicate that our country should make greater efforts to decrease hanging and jumping from a height.
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Affiliation(s)
- Soo-Hyun Joo
- Department of Psychiatry, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sheng-Min Wang
- Department of Psychiatry, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Tae-Won Kim
- Department of Psychiatry, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Ho-Jun Seo
- Department of Psychiatry, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jin-Hee Han
- Department of Psychiatry, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Seung-Chul Hong
- Department of Psychiatry, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
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Risk of completed suicide in 89,049 young males assessed by a mental health professional. Eur Neuropsychopharmacol 2016; 26:341-349. [PMID: 26712325 DOI: 10.1016/j.euroneuro.2015.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 11/11/2015] [Accepted: 12/04/2015] [Indexed: 11/24/2022]
Abstract
In an individual who seeks help or is referred to a mental health professional it is common sense and clinical practice to assume that suicidal thoughts and previous attempts constitute risk factors for imminent suicide. However, this assumption has not been supported by large, population-based longitudinal studies. The current study investigated whether reports of current suicidal ideation and a history of suicide attempts indeed increase risk for later completed suicide in a historical prospective study design. Sequential records on 89,049 young males assessed by mental health professionals were screened for suicidal ideation and a history of suicide attempts. The data were linked with death records from the Israeli Central Bureau of Statistics. Over a follow-up period ranging from 2 months to 9.8 years, 54 individuals died by suicide, constituting an average suicide rate of 6.48 per 100,000 person-years. Overall, neither reporting current suicidal ideation (without a history of suicide attempts; HR=1.29, 95% CI=0.57-2.90) nor reporting a history of suicide attempts (with or without current suicidal ideation; HR=1.67, 95% CI=0.71-3.97) were significantly associated with increased risk for later completed suicide. However, young males with a previously diagnosed psychiatric disorder who reported current suicidal ideation (HR=4.52, 95% CI=1.08-18.91) or a history of suicide attempts (HR=6.43, 95% CI=1.54-26.90) were at increased risk of death by suicide. These findings indicate that in this particular population reports of current suicidal ideation or of a history of suicide attempts are helpful in predicting future suicide only among those with a previous diagnosis of a psychiatric disorder.
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Gómez-Durán EL, Forti-Buratti MA, Gutiérrez-López B, Belmonte-Ibáñez A, Martin-Fumadó C. Trastornos psiquiátricos en los casos de suicidio consumado en un área hospitalaria entre 2007-2010. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2016; 9:31-8. [DOI: 10.1016/j.rpsm.2014.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 02/10/2014] [Accepted: 02/17/2014] [Indexed: 01/23/2023]
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Bakian AV, Huber RS, Coon H, Gray D, Wilson P, McMahon WM, Renshaw PF. Acute air pollution exposure and risk of suicide completion. Am J Epidemiol 2015; 181:295-303. [PMID: 25673816 DOI: 10.1093/aje/kwu341] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Research into environmental factors associated with suicide has historically focused on meteorological variables. Recently, a heightened risk of suicide related to short-term exposure to airborne particulate matter was reported. Here, we examined the associations between short-term exposure to nitrogen dioxide, particulate matter, and sulfur dioxide and completed suicide in Salt Lake County, Utah (n = 1,546) from 2000 to 2010. We used a time-stratified case-crossover design to estimate adjusted odds ratios for the relationship between suicide and exposure to air pollutants on the day of the suicide and during the days preceding the suicide. We observed maximum heightened odds of suicide associated with interquartile-range increases in nitrogen dioxide during cumulative lag 3 (average of the 3 days preceding suicide; odds ratio (OR) = 1.20, 95% confidence interval (CI): 1.04, 1.39) and fine particulate matter (diameter ≤2.5 μm) on lag day 2 (day 2 before suicide; OR = 1.05, 95% CI: 1.01, 1.10). Following stratification by season, an increased suicide risk was associated with exposure to nitrogen dioxide during the spring/fall transition period (OR = 1.35, 95% CI: 1.09, 1.66) and fine particulate matter in the spring (OR = 1.28, 95% CI: 1.01, 1.61) during cumulative lag 3. Findings of positive associations between air pollution and suicide appear to be consistent across study locations with vastly different meteorological, geographical, and cultural characteristics.
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Bakian AV, Huber RS, Coon H, Gray D, Wilson P, McMahon WM, Renshaw PF. Bakian et al. respond to "Assessing air pollution and suicide risk". Am J Epidemiol 2015; 181:309-10. [PMID: 25673815 DOI: 10.1093/aje/kwu343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Younes N, Melchior M, Turbelin C, Blanchon T, Hanslik T, Chee CC. Attempted and completed suicide in primary care: not what we expected? J Affect Disord 2015; 170:150-4. [PMID: 25240842 DOI: 10.1016/j.jad.2014.08.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND General Practitioners (GPs) play a central role in suicide prevention. This study aims to compare the characteristics of individuals who attempt suicide to those who complete suicide in a same primary care setting. METHODS We compared the characteristics and GP's management of all patients with attempted (N=498, SA) or completed suicide (N=141, SC) reported to the GPs'French Sentinelles surveillance system (2009-2013). RESULTS Compared to patients who attempted suicide, those who completed suicide were more likely to be male, older and to have used a more lethal method; for men they were less likely to have a history of previous suicide attempt and prior contacts with their GP. In terms of GPs' management, we found no differences between the SA and SC groups in the identification of psychological difficulties and in the care, but GPs were more likely to provide psychological support to the SA group. During the last consultation, the SC group expressed suicidal ideas more frequently than the SA group (26.7% vs. 14.8%, p<0.01), only for women. LIMITATIONS The network may have missed cases and selected more serious SA. CONCLUSIONS Individuals who commit suicide differ from those who attempt suicide in terms of demographic characteristics and by sex, of history of suicide attempt, previous contact and expressed suicidal ideas. We show that GPs do not act more intensively with patients who will commit suicide, as if they do not foresee them. Current prevention programs particularly in primary care should be tailored.
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Affiliation(s)
- N Younes
- EA 40-47 Université Versailles Saint-Quentin-en-Yvelines, F-78047 Guyancourt, France; Academic Unit of Psychiatry, Versailles Hospital, 177 Rue de Versailles, F-78157 Le Chesnay, France.
| | - M Melchior
- INSERM, UMR_S 1136, Pierre Louis Institute for Epidemiology and Public Health, Department of Social Epidemiology, F-75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louise Institute of Epidemiology and Public Health, F-75013 Paris, France
| | - C Turbelin
- INSERM, U707, F-75012, Paris, France; UPMC University Paris 06, UMR-S U707, F-75012, Paris, France
| | - T Blanchon
- INSERM, U707, F-75012, Paris, France; UPMC University Paris 06, UMR-S U707, F-75012, Paris, France
| | - T Hanslik
- INSERM, U707, F-75012, Paris, France; UPMC University Paris 06, UMR-S U707, F-75012, Paris, France; Université Versailles Saint Quentin en Yvelines, F-78000, Versailles, France
| | - C Chan Chee
- French Institute for Public Health Surveillance, Saint Maurice, France
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Artieda-Urrutia P, Parra Uribe I, Garcia-Pares G, Palao D, de Leon J, Blasco-Fontecilla H. Management of suicidal behaviour: is the world upside down? Aust N Z J Psychiatry 2014; 48:399-401. [PMID: 24589981 DOI: 10.1177/0004867414525847] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Paula Artieda-Urrutia
- 1Department of Psychiatry, Villalba MHC, IDIPHIM-Puerta de Hierro University Hospital, Madrid, Spain
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Predicting suicidal behavior: are we really that far along? Comment on "Discovery and validation of blood biomarkers for suicidality". Curr Psychiatry Rep 2013; 15:424. [PMID: 24254200 PMCID: PMC3967238 DOI: 10.1007/s11920-013-0424-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A recent publication focused on biomarkers of future suicidal behaviors identifies several genes expressed in high-risk states among four samples. We discuss the implications of this study as well as the current state of research regarding biomarkers of suicidal behavior.
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