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Ebulum GC, Eze JE, Ezeihuoma OP, Njoku C, Chukwuorji JC. Roles of Loneliness, Stress, and Religiosity in Suicide Ideation Among Nigerian Older Adults. Int J Aging Hum Dev 2024:914150241268006. [PMID: 39105289 DOI: 10.1177/00914150241268006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
Suicidal behavior in older adults is a fundamental public health problem globally and the highest suicide rates occur in low- and middle-income countries (LMICs). However, there is limited research on suicidality among older adults, especially in sub-Saharan Africa. We sought to find out whether loneliness, stress and religiosity would be associated with suicide ideation in a sample of sub-Saharan African older adults (N = 500; aged 51-70 years, Mage = 58.97, SD = 6.16; 45.6% women). They completed the Beck Suicidal Ideation Scale, the UCLA Loneliness Scale-version 3, Perceived Stress Scale, and Religiosity Scale. Regression results showed that whereas suicidal ideation could be increased by loneliness and stress, religious older adults were less likely to report suicidal ideation. Interventions aimed at managing and protecting the mental health of older adults during their transition to late adulthood should guard them against loneliness and buffer their resilience and coping strategies with the connectedness that religiosity offers.
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Affiliation(s)
- Genevieve Chimaoge Ebulum
- Department of Community Medicine, David Umahi Federal University of Health Sciences, Uburu, Ebonyi, Nigeria
| | - John E Eze
- Department of Psychology, University of Nigeria, Nsukka, Nigeria
| | | | - Crystal Njoku
- Department of Medicine, American University of Antigua College of Medicine, Osbourn, Antigua & Barbuda
| | - JohnBosco Chika Chukwuorji
- Department of Psychology, University of Nigeria, Nsukka, Nigeria
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA
- Promotion of Health and Innovation Lab, International Network for Well-being, Enugu, Nigeria
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Tu CY, Chiu MR, Wang YW, Hsu CY, Chen YY, Chang SS. Association of Body Mass Index and Cardiometabolic Factors With Elderly Suicide: A Cohort Study of 101,518 Older Taiwanese. Am J Geriatr Psychiatry 2023; 31:965-977. [PMID: 37258341 DOI: 10.1016/j.jagp.2023.05.002] [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: 01/20/2023] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Older people have the highest suicide rate across age groups in most countries. The prevalence of cardiometabolic risk factors also increases with age. We investigated the association between body mass index (BMI), cardiometabolic risk factors, and suicide in a large cohort of older people in Taiwan. METHODS We conducted a cohort study using data from an elderly health examination program in Taipei City, Taiwan (2005-2010), linked to the national cause-of-death data files. We used competing risk Cox regression models to investigate the associations of BMI (kg/m2) and cardiometabolic factors with suicide after adjusting for sex, age, socioeconomic variables, chronic diseases, psychological distress, and cognitive function. RESULTS Among 101,518 individuals aged ≥ 65 years, 92 died by suicide during an average follow-up of 3.9 years. Underweight (BMI<18.5) was associated with increased suicide risk (adjusted hazard ratio [aHR]=2.33, 95% confidence interval [CI] 1.20-4.52) (reference: normal weight). Low diastolic blood pressure was associated with increased suicide risk - aHR was 0.51 (95% CI 0.29-0.91) and 0.55 (95% CI 0.31-0.99) for the third and fourth quartiles of diastolic blood pressure (reference: the lowest quartile), respectively. Older people with a higher waist circumference (aHR per 1-standard-deviation increase=0.60 [95% CI 0.37-0.98]) and a higher number of metabolic syndrome criteria (aHR per 1-criterion increase=0.65 [95% 0.46-0.92]) had lower suicide risk. Systolic blood pressure, pulse rate, fasting blood glucose, and lipid profiles were not associated with suicide risk. CONCLUSIONS Underweight, low diastolic blood pressure, and low waist circumference may be markers of increased suicide risk in older people.
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Affiliation(s)
- Chao-Ying Tu
- Department of Psychiatry (C-YT), National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan; Department of Psychiatry (C-YT), College of Medicine, National Taiwan University, Taipei City, Taiwan; Institute of Health Policy and Management (C-YT), College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Meng-Rou Chiu
- Department of Occupational Therapy (M-RC), Yonghe Cardinal Tien Hospital, New Taipei City, Taiwan; Institute of Health Behaviors and Community Sciences (M-RC, S-SC), College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Yi-Wen Wang
- Department of Psychiatry, School of Medicine (Y-WW, C-YH), College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Chia-Yueh Hsu
- Department of Psychiatry, School of Medicine (Y-WW, C-YH), College of Medicine, Taipei Medical University, Taipei City, Taiwan; Department of Psychiatry, Wan Fang Hospital (C-YH), Taipei Medical University, Taipei City, Taiwan; Psychiatric Research Center, Wan Fang Hospital (C-YH, S-SC), Taipei Medical University, Taipei City, Taiwan
| | - Ying-Yeh Chen
- Taipei City Psychiatric Center (Y-YC), Taipei City Hospital, Taipei City, Taiwan; Institute of Public Health and Department of Public Health (Y-YC), National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences (M-RC, S-SC), College of Public Health, National Taiwan University, Taipei City, Taiwan; Psychiatric Research Center, Wan Fang Hospital (C-YH, S-SC), Taipei Medical University, Taipei City, Taiwan.
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Lee J, Pak TY. Machine learning prediction of suicidal ideation, planning, and attempt among Korean adults: A population-based study. SSM Popul Health 2022; 19:101231. [PMID: 36263295 PMCID: PMC9573904 DOI: 10.1016/j.ssmph.2022.101231] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background Suicide remains the leading cause of premature death in South Korea. This study aims to develop machine learning algorithms for screening Korean adults at risk for suicidal ideation and suicide planning or attempt. Methods Two sets of balanced data for Korean adults aged 19–64 years were drawn from the 2012–2019 waves of the Korea Welfare Panel Study using the random down-sampling method (N = 3292 for the prediction of suicidal ideation, N = 488 for the prediction of suicide planning or attempt). Demographic, socioeconomic, and psychosocial characteristics were used to predict suicidal ideation and suicide planning or attempt. Four machine-learning classifiers (logistic regression, random forest, support vector machine, and extreme gradient boosting) were tuned and cross-validated. Results All four algorithms demonstrated satisfactory classification performance in predicting suicidal ideation (sensitivity 0.808–0.853, accuracy 0.843–0.863) and suicide planning or attempt (sensitivity 0.814–0.861, accuracy 0.864–0.884). Extreme gradient boosting was the best-performing algorithm for predicting both suicidal outcomes. The most important predictors were depressive symptoms, self-esteem, income, consumption, and life satisfaction. The algorithms trained with the top two predictors, depressive symptoms and self-esteem, showed comparable classification performance in predicting suicidal ideation (sensitivity 0.801–0.839, accuracy 0.841–0.846) and suicide planning or attempt (sensitivity 0.814–0.837, accuracy 0.874–0.884). Limitations Suicidal ideation and behaviors may be under-reported due to social desirability bias. Causality is not established. Discussion More than 80% of individuals at risk for suicidal ideation and suicide planning or attempt could be predicted by a number of mental and socioeconomic characteristics of respondents. This finding suggests the potential of developing a quick screening tool based on the known risk factors and applying it to primary care or community settings for early intervention. This study develops machine learning models to predict suicidal ideation and behaviors. Logistic regression, random forest, support vector machine, and extreme gradient boosting are used. The algorithms correctly identifyed 80–90% of suicidal cases. The algorithms with the top two predictors (depressive symptoms and self-esteem) could achieve comparable accuracy. Our findings can be used to design a quick screening tool for use in primary care or community settings.
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Affiliation(s)
- Jeongyoon Lee
- Convergence Program for Social Innovation, Sungkyunkwan University, Seoul, South Korea
| | - Tae-Young Pak
- Department of Consumer Science and Convergence Program for Social Innovation, Sungkyunkwan University, Seoul, South Korea
- Corresponding author.
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Kim E, Yi JS. Factors Related to Suicidal Ideation and Prediction of High-Risk Groups among Youngest-Old Adults in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10028. [PMID: 36011664 PMCID: PMC9408520 DOI: 10.3390/ijerph191610028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/06/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
(1) Background: The suicide of older adults shows different factors between the youngest-old adults and the old-old adults. This study aimed to identify factors predicting suicidal ideation among youngest-old adults (ages 65 to 74 years) and predict high-risk groups’ characteristics. (2) Methods: The subjects of this study were 970 youngest-old adults who participated in the Korean National Health and Nutrition Examination Survey (KNHANES VIII Year 1, 2019). Logistic regression analysis identified factors related to suicidal ideation, and decision tree analysis identified combined characteristics among high-risk groups. Data were analyzed using SPSS 27.0. (3) Results: Suicidal ideation became more common among those with relatively lower income levels (OR = 1.48, 95% CI = 1.04−2.12), those whom had experienced depression (OR = 9.28, 95% CI = 4.57−18.84), those with relatively higher stress levels (OR = 2.42, 95% CI = 1.11−5.28), and those reporting a relatively worse perceived health (OR = 1.88, 95% CI = 1.23−3.11). Complex characteristics that combined depression, low personal income level, and low perceived health predicted a high risk of suicidal ideation (64.6%, p < 0.05). (4) Conclusions: The findings indicate that this high-risk group should be prioritized when developing suicide prevention strategies.
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Affiliation(s)
- Eungyung Kim
- Department of Nursing, Chungbuk National University, Cheongju 28644, Korea
| | - Jee-Seon Yi
- College of Nursing, Gyeongsang National University, Jinju 52727, Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju 52727, Korea
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Chiang A, Paynter J, Edlin R, Exeter DJ. Suicide preceded by health services contact - A whole-of-population study in New Zealand 2013-2015. PLoS One 2021; 16:e0261163. [PMID: 34928994 PMCID: PMC8687551 DOI: 10.1371/journal.pone.0261163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/27/2021] [Indexed: 01/20/2023] Open
Abstract
New Zealand’s rate of suicide persistently exceeds the global average. The burden of suicide in New Zealand is disproportionately borne by youth, males and Māori (NZ indigenous people). While the demographic characteristics of suicide decedents are established, there is a need to identify potential points of contact with health services where preventative action could take place. This paper aims to determine if suicide deaths in New Zealand were likely to be preceded by contact with health services, and the type and time frame in which these contacts took place. This study utilised a whole-of-population-cohort of all individuals age 15 years and over, who were alive on March 5th 2013, followed up to December 2015. Associations between the odds of suicide, demographic factors, area-based deprivation, and the timing of last contact with primary, secondary, and tertiary services were analysed using univariate and multivariate logistic regression. Contact with a health service in the 6 Months prior to death was associated with the highest odds of suicide. Over half of the suicide decedent population (59.4%) had contacted primary health services during this period. Large proportions of the suicide decedent population contacted secondary and tertiary services in the 6 Months prior to death, 46.5% and 30.4% respectively. Contact with primary, secondary and tertiary services in the prior 6 Months, were associated with an increased odds of suicide of 2.51 times [95% CI 2.19–2.88], 4.45 times [95% CI 3.69–4.66] and 6.57 times [95% CI 5.84–7.38], respectively, compared to those who had no health services contact.
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Affiliation(s)
- Annie Chiang
- Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
- * E-mail:
| | - Janine Paynter
- General Practice and Primary Healthcare, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Richard Edlin
- Health Systems, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Daniel J. Exeter
- Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
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Gujral S, Butters MA, Dombrovski AY, Szanto K. Late-Onset Suicide: A Dementia Prodrome? Am J Geriatr Psychiatry 2021; 29:709-713. [PMID: 33317918 PMCID: PMC8187470 DOI: 10.1016/j.jagp.2020.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/25/2020] [Accepted: 12/03/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This study examined whether late-onset (versus early-onset) suicidal behavior is associated with worse cognition. METHODS Participants included 278 adults aged 50+ years (56 nonpsychiatric comparison group; 67 nonsuicidal depressed older adults; 63 depressed suicide ideators; and 44 late-onset (55+ years) and 48 early-onset suicide attempters (<55 years). Using a case-control design, this study examined group differences in global cognition, episodic memory, information processing speed, and executive functioning, assessed using the Repeatable Battery of Neuropsychological Status and the Trail Making Test from the Delis-Kaplan Executive Function System. Linear regression was used for data analyses. RESULTS Both attempter groups displayed worse executive functioning than nonsuicidal depressed older adults. Late-onset attempters additionally displayed poorer global cognition and processing speed than nonsuicidal depressed older adults and poorer memory than early-onset attempters. CONCLUSIONS Late-onset suicidal behavior is associated with worse performance in a broad range of cognitive domains, possibly reflective of a dementia prodrome.
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Affiliation(s)
- Swathi Gujral
- VA VISN 4 Mental Illness Research, Education, and Clinical Center of Excellence (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA; University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA.
| | - Meryl A. Butters
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | | | - Katalin Szanto
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
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Corke M, Mullin K, Angel-Scott H, Xia S, Large M. Meta-analysis of the strength of exploratory suicide prediction models; from clinicians to computers. BJPsych Open 2021; 7:e26. [PMID: 33407984 PMCID: PMC8058929 DOI: 10.1192/bjo.2020.162] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Suicide prediction models have been formulated in a variety of ways and are heterogeneous in the strength of their predictions. Machine learning has been a proposed as a way of improving suicide predictions by incorporating more suicide risk factors. AIMS To determine whether machine learning and the number of suicide risk factors included in suicide prediction models are associated with the strength of the resulting predictions. METHOD Random-effect meta-analysis of exploratory suicide prediction models constructed by combining two or more suicide risk factors or using clinical judgement (Prospero Registration CRD42017059665). Studies were located by searching for papers indexed in PubMed before 15 August 2020 with the term suicid* in the title. RESULTS In total, 86 papers reported 102 suicide prediction models and included 20 210 411 people and 106 902 suicides. The pooled odds ratio was 7.7 (95% CI 6.7-8.8) with high between-study heterogeneity (I2 = 99.5). Machine learning was associated with a non-significantly higher odds ratio of 11.6 (95% CI 6.0-22.3) and clinical judgement with a non-significantly lower odds ratio of 4.7 (95% CI 2.1-10.9). Models including a larger number of suicide risk factors had a higher odds ratio when machine-learning studies were included (P = 0.02). Among non-machine-learning studies, suicide prediction models including fewer risk factors performed just as well as those including more risk factors. CONCLUSIONS Machine learning might have the potential to improve the performance of suicide prediction models by increasing the number of included suicide risk factors but its superiority over other methods is unproven.
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Affiliation(s)
- Michelle Corke
- School of Psychiatry, University of New South Wales, Australia
| | - Katherine Mullin
- South Eastern Sydney Local Health District and School of Medicine, University of Notre Dame, Australia
| | | | - Shelley Xia
- South Eastern Sydney Local Health District, Australia
| | - Matthew Large
- South Eastern Sydney Local Health District, Australia; and School of Medicine, University of Notre Dame, Australia
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Liu RT, Steele SJ, Hamilton JL, Do QBP, Furbish K, Burke TA, Martinez AP, Gerlus N. Sleep and suicide: A systematic review and meta-analysis of longitudinal studies. Clin Psychol Rev 2020; 81:101895. [PMID: 32801085 PMCID: PMC7731893 DOI: 10.1016/j.cpr.2020.101895] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 07/06/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022]
Abstract
The current review provides a quantitative synthesis of the empirical literature on sleep disturbance as a risk factor for suicidal thoughts and behaviors (STBs). A systematic search of PsycINFO, MEDLINE, and the references of prior reviews resulted in 41 eligible studies included in this meta-analysis. Sleep disturbance, including insomnia, prospectively predicted STBs, yielding small-to-medium to medium effect sizes for these associations. Complicating interpretation of these findings however, is that few studies of suicidal ideation and suicide attempts, as well as none of suicide deaths, assessed short-term risk (i.e., employed follow-up assessments of under a month). Such studies are needed to evaluate current conceptualizations of sleep dysregulation as being involved in acute risk for suicidal behavior. This want of short-term risk studies also suggests that current clinical recommendations to monitor sleep as a potential warning sign of suicide risk has a relatively modest empirical basis, being largely driven by cross-sectional or retrospective research. The current review ends with recommendations for generating future research on short-term risk and greater differentiation between acute and chronic aspects of sleep disturbance, and by providing a model of how sleep disturbance may confer risk for STBs through neuroinflammatory and stress processes and associated impairments in executive control.
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Affiliation(s)
- Richard T Liu
- Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America.
| | - Stephanie J Steele
- Department of Psychology, Williams College, Williamstown, MA, United States of America
| | - Jessica L Hamilton
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Quyen B P Do
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Kayla Furbish
- Department of Psychology, Boston University, Boston, MA, United States of America
| | - Taylor A Burke
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Ashley P Martinez
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Nimesha Gerlus
- Duke University School of Medicine, Durham, NC, United States of America
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Gallo JJ, Hwang S, Truong C, Reynolds CF, Spira AP. Role of persistent and worsening sleep disturbance in depression remission and suicidal ideation among older primary care patients: the PROSPECT study. Sleep 2020; 43:5814941. [PMID: 32239161 DOI: 10.1093/sleep/zsaa063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/31/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES We analyzed data from a practice-based randomized controlled trial within 20 primary care practices located in greater New York City, Philadelphia, and Pittsburgh to determine whether persistent or worsening sleep disturbance plays a role in the outcomes of depression and suicidal ideation at 1 year in older adults with depression. METHODS The study sample consisted of 599 adults aged 60 years and older meeting criteria for major depression or clinically significant minor depression. Longitudinal analysis via growth curve mixture modeling was carried out to classify patients as having worsening, persistent, or improving sleep over 1 year. RESULTS At 1-year follow-up, compared with patients with improving sleep, those with worsening sleep were more likely to have a diagnosis of major depression (adjusted odds ratio (aOR) = 28.60, 95% confidence interval (CI) 12.15 to 67.34), a diagnosis of clinically significant minor depression (aOR = 11.88, 95% CI 5.67 to 24.89), and suicidal ideation (aOR = 1.10, 1.005 to 1.199), and were half as likely to achieve remission (aOR = 0.52, 95% CI 0.46 to 0.57). Patients with persistent sleep disturbance showed similar but attenuated results. CONCLUSIONS Older primary care patients with depression who exhibit worsening or persistent sleep disturbance were at increased risk for persistent depression and suicidal ideation 1 year later. The pattern of sleep disturbance over time may be an important signal for exploration by primary care physicians of depression and suicidal ideation among older adults with depression. CLINICAL TRIAL REGISTRATION NCT00279682.
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Affiliation(s)
- Joseph J Gallo
- Department of Mental Health, Johns Hopkins University, Baltimore, MD.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.,Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, MD
| | - Seungyoung Hwang
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.,American Psychiatric Association, Washington, D.C
| | - Christine Truong
- Department of Mental Health, Johns Hopkins University, Baltimore, MD
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins University, Baltimore, MD.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.,Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, MD
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Harris LM, Huang X, Linthicum KP, Bryen CP, Ribeiro JD. Sleep disturbances as risk factors for suicidal thoughts and behaviours: a meta-analysis of longitudinal studies. Sci Rep 2020; 10:13888. [PMID: 32807889 PMCID: PMC7431543 DOI: 10.1038/s41598-020-70866-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/30/2020] [Indexed: 12/13/2022] Open
Abstract
In recent years, there has been a growing interest in understanding the relationship between sleep and suicide. Although sleep disturbances are commonly cited as critical risk factors for suicidal thoughts and behaviours, it is unclear to what degree sleep disturbances confer risk for suicide. The aim of this meta-analysis was to clarify the extent to which sleep disturbances serve as risk factors (i.e., longitudinal correlates) for suicidal thoughts and behaviours. Our analyses included 156 total effects drawn from 42 studies published between 1982 and 2019. We used a random effects model to analyse the overall effects of sleep disturbances on suicidal ideation, attempts, and death. We additionally explored potential moderators of these associations. Our results indicated that sleep disturbances are statistically significant, yet weak, risk factors for suicidal thoughts and behaviours. The strongest associations were found for insomnia, which significantly predicted suicide ideation (OR 2.10 [95% CI 1.83-2.41]), and nightmares, which significantly predicted suicide attempt (OR 1.81 [95% CI 1.12-2.92]). Given the low base rate of suicidal behaviours, our findings raise questions about the practicality of relying on sleep disturbances as warning signs for imminent suicide risk. Future research is necessary to uncover the causal mechanisms underlying the relationship between sleep disturbances and suicide.
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Affiliation(s)
- Lauren M Harris
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306-4301, USA.
| | - Xieyining Huang
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306-4301, USA
| | - Kathryn P Linthicum
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306-4301, USA
| | - Chloe P Bryen
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306-4301, USA
| | - Jessica D Ribeiro
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306-4301, USA
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Hu C, Zhao D, Gong F, Zhao Y, Li J, Sun Y. Risk factors for suicidal ideation among the older people living alone in rural region of China: A path analysis. Medicine (Baltimore) 2020; 99:e21330. [PMID: 32702929 PMCID: PMC7373625 DOI: 10.1097/md.0000000000021330] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In China, suicide accounts for twenty-six percent of all suicides worldwide; however, researches on the suicidal ideation among older people living alone in the rural region are few. We performed a cross-sectional study to explore the prevalence and influence factors of suicidal ideation, and provide a theoretical basis for suicide prevention among older people living alone in rural region.695 older people living alone in rural region were selected by using stratified cluster sampling. Chi-square for categorical variables, T-test for continuous variables, and path analysis were conducted to statistical analysis.The prevalence of suicidal ideation among the elderly living alone in rural China was 23.6%. Path analyses showed that depression had the most substantial influence on suicidal ideation among the elderly living alone, it was also as a mediator between physical, economic status, social support, anxiety, and suicidal ideation; anxiety and social support had both direct and indirect influence on suicidal ideation; physical status and economic status had indirection impact.The incidence of suicidal ideation among the elderly living alone was high in Dangtu county. Psychological disorders (anxiety and depression) had the strongest impact on suicidal ideation. Strategies and measures targeting these relevant factors (economic status, physical status, and social support) should be taken to reduce the burdens of suicidal ideation among the elderly living alone in China.
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Affiliation(s)
- Caiyun Hu
- Department of Scientific Research, The First Affiliated Hospital of Anhui Chinese Medical University, Heffei
| | - Dongdong Zhao
- The First Affiliated Hospital of Anhui Medical University, Hefei
| | - Fengfeng Gong
- Medical department, Fuyang Hospital of Anhui Medical University, Fuyang
| | - Yuanyuan Zhao
- The Fifth Sanatorium for Retired Cadres, Anhui Provincial Military Region, Hefei
| | - Jie Li
- School of Public Health, Anhui Medical University, Hefei
| | - Yehuan Sun
- School of Public Health, Anhui Medical University, Hefei
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Bae SM. The prediction model of suicidal thoughts in Korean adults using Decision Tree Analysis: A nationwide cross-sectional study. PLoS One 2019; 14:e0223220. [PMID: 31596870 PMCID: PMC6785128 DOI: 10.1371/journal.pone.0223220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/15/2019] [Indexed: 11/18/2022] Open
Abstract
The purpose of this retrospective decisional analysis study is to develop the prediction model of suicidal ideation. We used a Decision Tree Analysis using SPSS 23.0 program to explore predictors of suicide thoughts for 12,015 Korean adults aged 19–98 years. As a result, the most powerful predictor of suicidal ideation was the level of depression. Of people who suspected depression (CESD-11>16), 32.6% experienced suicidal ideation, which is 12 times higher than that of total subjects. The group with the highest rate of suicidal ideation was people who experienced financial difficulties in depression-suspected group and the rate of suicidal thoughts in this group was 56.7%, which was the highest rate. However, in the non-depressive group, the satisfaction of family relationship was the strongest predictor of suicidal ideation. In the non-depressive group, the rate of suicidal thoughts of people with high level of family relationship satisfaction and high level of health satisfaction was 0.6%, which was the lowest rate. The contribution of this study was that it provided the combination of variables to predict the risk groups of adult suicide. This study suggests that researchers and clinicians should consider comprehensively depressive symptoms, family relationships, economic difficulties, and health status to prevent the suicide of adults.
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Affiliation(s)
- Sung-Man Bae
- Department of Psychology and Psychotherapy, College of Health Science, Dankook University, Cheonan, Chungnam, Republic of Korea
- * E-mail: ,
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Tseng TJ, Wu YS, Tang JH, Chiu YH, Lee YT, Fan IC, Chan TC. Association between health behaviors and mood disorders among the elderly: a community-based cohort study. BMC Geriatr 2019; 19:60. [PMID: 30819099 PMCID: PMC6394040 DOI: 10.1186/s12877-019-1079-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/19/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND According to a WHO report, nearly 15% of adults aged 60 and over suffer from a mental disorder, constituting 6.6% of the total disability for this age group. Taipei City faces rapid transformation towards an aging society, with the proportion of elderly in the total population rising from 12% in 2008 to 16% in 2016. The aim of this study is to identify the prevalence of mental disorders among the elderly in Taipei City and to elucidate risk factors contributing to mental disorders. METHODS The elderly health examination database was obtained from the Department of Health, Taipei City government, from 2005 to 2012. A total of 86,061 people underwent publicly funded health examinations, with 348,067 visits. Each year, there are around 43,000 elderly persons in Taipei City using this service. We used a mental health questionnaire including five questions to estimated relative risks among potential risk factors with the generalized estimating equations (GEE) model to measure the mental health status of the elderly. Mood disorders were measured with the Brief Symptom Rating Scale (BSRS-5) questionnaire. Age, education level, gender, marital status, living alone, drinking milk, eating vegetables and fruits, long-term medication, smoking status, frequency of alcohol consumption, frequency of physical activity, BMI, and number of chronic diseases were included as covariates. RESULTS The results show that being male (odds ratio (OR) 0.57; 95% CI = 0.56, 0.59), higher education (OR 0.88; 95% CI = 0.82, 0.95), no long-term medication (OR 0.57; 95% CI = 0.56, 0.58), and exercising three or more times per week (OR 0.94; 95% CI = 0.91, 0.98) were all positively correlated with better emotional status. However, being divorced (OR = 1.22, 95% CI = 1.09, 1.36), not drinking milk (OR = 1.12, 95% CI = 1.09, 1.14), not eating enough vegetables and fruits every day (OR = 1.78, 95% CI = 1.73, 1.83), daily smoking (OR = 1.15, 95% CI = 1.01, 1.32), and having more chronic diseases (OR = 1.02, 95% CI = 1.01, 1.03) were all correlated with poor mental status among the elderly. CONCLUSIONS The findings of this research can both estimate the prevalence of mood disorders at the community level, and identify risk factors of mood disorders at the personal level.
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Affiliation(s)
- Tzu-Jung Tseng
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
| | - Yi-Syuan Wu
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Jia-Hong Tang
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Yen-Hui Chiu
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Yu-Ting Lee
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
| | - I-Chun Fan
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
- Institute of History and Philology, Academia Sinica, Taipei, Taiwan
| | - Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Exploring the use of telephone helpline pertaining to older adult suicide prevention: A Hong Kong experience. J Affect Disord 2018; 236:75-79. [PMID: 29723765 DOI: 10.1016/j.jad.2018.04.093] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/15/2018] [Accepted: 04/08/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Older adults usually have a higher suicide rate than the general population. There are helpline services provided to older adults but limited studies have examined the suicidal risks among the users, and how those services could be used as a platform to engage older adults in suicide prevention. METHODS In regard to elderly suicide prevention, this study explored the potential usefulness and relevance of a telephone helpline service in Hong Kong, which had 106,583 users during 2012-2015. An estimation on the suicide rates of the users was made and compared with the general older adult population in Hong Kong. The users' suicide risks and their associated factors were assessed by survival analyses and an estimation system on the users' suicide mortality likelihood was also tested. RESULTS The suicide rates of both male and female users were more than two times higher than the general older adult population in Hong Kong. The users' risks of suicides were greater at the early period of using the service; men, living alone, and having a history of mental illnesses were also associated with increased risks. Based on the identified factors, an estimation system was developed with a sensitivity of 0.73 and specificity of 0.54. LIMITATIONS A secondary data analysis. CONCLUSIONS By identifying a suicide risk profile and distinct telephone calling pattern among the users, early detection and a warning system should be implemented to allow timely intervention to reduce the number of older adult suicides in the community.
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Sousa GSD, Perrelli JGA, Botelho ES. Nursing diagnosis for Risk of Suicide in elderly: integrative review. Rev Gaucha Enferm 2018; 39:e20170120. [PMID: 30088601 DOI: 10.1590/1983-1447.2018.2017-0120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 10/06/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the specialized literature regarding the risk factors in nursing diagnosis for suicide risks in elderly. METHOD This is an integrative literature review carried out during June 2015 in the following databases with no time limit: MEDLINE, PsycINFO and CINAHL. RESULTS A total of 80 full papers were analyzed. It was suggested the inclusion of 23 risk factors in NANDA-I taxonomy: apathy; unrest; low self esteem; carelessness with medication; Inability to ask for help; Inability to express feelings; suicidal plan; rigidity; functional disability; visual problems; sadness; hostility; anxiety; failure; frustration; unhappiness; dishonor; frequent visits to a physician with unclear symptoms; social deprivation; social devaluation; psychological violence; Interfamilial violence; and financial violence. CONCLUSION The risks for suicide presented in NANDA-I taxonomy need to be refined and adapted to the elderly reality. Furthermore, a review is also recommended for the risk factors not included in this classification.
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Affiliation(s)
- Girliani Silva de Sousa
- Universidade Federal de Pernambuco (UFPE), Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento. Recife, Pernambuco, Brasil
| | | | - Everton Sougey Botelho
- Universidade Federal de Pernambuco (UFPE), Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento. Recife, Pernambuco, Brasil
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17
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Abstract
Sleep disturbances are associated with suicide-related thoughts and behaviors, and the incidence of sleep concerns and suicide has increased recently in the US. Most published research exploring the sleep-suicidality relation is focused on select sleep disorders, with few reviews offering a comprehensive overview of the sleep-suicidality literature. This narrative review broadly investigates the growing research literature on sleep disorders and suicidality, noting the prevalence of suicide ideation and nonfatal and fatal suicide attempts, the impact of several sleep disorders on suicide risk, and potential sleep-disorder management strategies for mitigating suicide risk. Aside from insomnia symptoms and nightmares, there exist opportunities to learn more about suicide risk across many sleep conditions, including whether sleep disorders are associated with suicide risk independently of other psychiatric conditions or symptoms. Generally, there is a lack of randomized controlled trials examining the modification of suicide risk via evidence-based sleep interventions for individuals with sleep disorders.
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Affiliation(s)
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Mississippi State, MS, USA
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Tu CY, Tseng MCM, Chang CH, Lin CC. Comparative validity of the Internet and paper-and-pencil versions of the Night Eating Questionnaire. Compr Psychiatry 2017; 75:53-61. [PMID: 28314121 DOI: 10.1016/j.comppsych.2017.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE This study examined the psychometric properties of the Internet and paper-and-pencil versions of the Mandarin Chinese version of the Night Eating Questionnaire (C-NEQ) and compared these measures' validity. METHOD The C-NEQ was evaluated through two different media: 626 participants completed the C-NEQ on the Internet and 160 participants completed the paper-form C-NEQ at the psychiatric outpatient clinics. A subgroup completed both versions of the C-NEQ (n=50). The Night Eating Syndrome History and Inventory was used to identify individuals with night eating syndrome (NES). RESULTS The paper-and-pencil and Internet versions of the C-NEQ both showed good internal consistency, reliability, and concurrent validity. Reliability between the Internet and the paper-and-pencil versions of the C-NEQ was excellent (ICC=.96). Diagnostic analysis of the C-NEQ's performance using the Receiver Operation Curve method showed excellent results in both versions; the area under the curve did not differ significantly between the versions. Regarding detecting NES, the Internet version had a higher optimal cutoff point than the paper-and-pencil version (23 and 22, respectively). CONCLUSIONS The Internet and paper-and-pencil versions of the C-NEQ both showed strong reliability and validity; however the two versions appear to differ marginally regarding usage in NES detection.
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Affiliation(s)
- Chao-Ying Tu
- Department of Psychiatry, National Taiwan University Hospital, Yunlin Branch, Yunlin, 64041.
| | - Mei-Chih Meg Tseng
- Department of Psychiatry, National Taiwan University Hospital, Taipei, 10002, Taiwan; Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan; Department of Nursing, Oriental Institute of Technology, New Taipei City 22061, Taiwan.
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei, 10055, Taiwan.
| | - Chao-Cheng Lin
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan; Yujie Clinic, Taipei, 10611, Taiwan.
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Zhang D, Yang Y, Sun Y, Wu M, Xie H, Wang K, Zhang J, Jia J, Su Y. Characteristics of the Chinese rural elderly living in nursing homes who have suicidal ideation: A multiple regression model. Geriatr Nurs 2017; 38:423-430. [PMID: 28347559 DOI: 10.1016/j.gerinurse.2017.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 02/09/2017] [Accepted: 02/13/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Chinese rural elderly are at higher risk of committing suicide. However, little is known about the suicidal ideation (SI) of institutional elderly residents in rural China. METHODS 250 participants aged 60 or above living in Chinese rural nursing homes were recruited. Data were collected on subjects' SI, social-demographic characters, physical illness and psychological factors. Univariate comparisons and path analysis were conducted then. RESULTS 19.5% (40/205) of the participants reported a current SI. Hopelessness and depression had significant direct impacts on SI, and self-esteem and loneliness can impact SI through the mediating of depression and hopelessness. Visiting frequency of children, number of physical illnesses and social activities can also affect SI through the mediating of loneliness or self-esteem. CONCLUSION As the first study on path analysis of SI of rural institutional elderly, the findings are significant. All these factors in our model should be considered when interventions are being conducted.
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Affiliation(s)
- Dan Zhang
- School of Nursing, Shandong University, Jinan, 250012, Shandong, China
| | - Yang Yang
- School of Nursing, Shandong University, Jinan, 250012, Shandong, China
| | - Yaoyao Sun
- School of Nursing, Shandong University, Jinan, 250012, Shandong, China
| | - Menglian Wu
- School of Nursing, Shandong University, Jinan, 250012, Shandong, China
| | - Hui Xie
- School of Nursing, Shandong University, Jinan, 250012, Shandong, China
| | - Kefang Wang
- School of Nursing, Shandong University, Jinan, 250012, Shandong, China
| | - Jie Zhang
- School of Public Health, Shandong University, Jinan, 250012, Shandong, China; Department of Sociology, State University of New York Buffalo State, Buffalo, NY, 14222, USA
| | - Jihui Jia
- School of Nursing, Shandong University, Jinan, 250012, Shandong, China
| | - Yonggang Su
- School of Foreign Languages and Literature, Shandong University, Jinan, 250100, Shandong, China; School of Nursing, Shandong University, Jinan, 250012, Shandong, China.
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Predictive validity of a specific questionnaire for psychiatric morbidity and suicidal ideation. J Formos Med Assoc 2016; 115:1019-1020. [DOI: 10.1016/j.jfma.2016.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/05/2016] [Accepted: 09/07/2016] [Indexed: 11/24/2022] Open
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Shao Y, Zhu C, Zhang Y, Yu H, Peng H, Jin Y, Shi G, Wang N, Chen Z, Chen Y, Jiang Q. Epidemiology and temporal trend of suicide mortality in the elderly in Jiading, Shanghai, 2003-2013: a descriptive, observational study. BMJ Open 2016; 6:e012227. [PMID: 27543591 PMCID: PMC5013362 DOI: 10.1136/bmjopen-2016-012227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To investigate and describe the epidemiological characteristics of suicide in the elderly in Jiading, Shanghai, for the period 2003-2013. DESIGN Retrospective, observational, epidemiological study using routinely collected data. SETTING Jiading District, Shanghai. METHODS Suicide data were retrieved from the Shanghai Vital Registry database for the period 2003-2013. Crude and age-standardised mortality rates were calculated for various groups according to sex and age. Joinpoint regression was performed to estimate the percentage change (PC) and annual percentage change (APC) for suicide mortality. RESULT A total of 956 deaths due to suicide occurred among people aged ≥65 years during the study period, accounting for 76.7% (956/1247) of all suicide decedents. Among the 956 people with suicide deaths, 88.7% (848/956) had a history of a psychiatric condition. The age-standardised mortality rates for suicide without and with a psychotic history in people aged ≥65 years were much higher than those for people aged <65 years in both genders. Suicide mortality in the elderly showed a declining trend, with a PC of -51.5% for men and -47.5% for women. The APC was -29.1 in 2003-2005, 4.6 in 2005-2008 and -9.7 in 2008-2013 for aged men, and -12.2 in 2003-2006 and -5.2 in 2006-2013 for aged women, respectively. Women living in Jiading had a higher risk of suicide death than men, especially among the elderly. The mortality rate for suicide increased with age in the elderly, and was more marked for those with a psychiatric history than for those without. CONCLUSIONS Suicide mortality declined in Jiading during the study period 2003-2013 overall, but remained high in the elderly, especially those with a psychiatric history.
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Affiliation(s)
- Yueqin Shao
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Chenghua Zhu
- Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai, China
| | - Yiying Zhang
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Hongjie Yu
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Hui Peng
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Yaqing Jin
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Guozheng Shi
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Na Wang
- Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai, China
| | - Zheng Chen
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Yue Chen
- Faculty of Medicine, School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Qingwu Jiang
- Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai, China
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Wu CY, Lee JI, Lee MB, Liao SC, Chang CM, Chen HC, Lung FW. Predictive validity of a five-item symptom checklist to screen psychiatric morbidity and suicide ideation in general population and psychiatric settings. J Formos Med Assoc 2016; 115:395-403. [DOI: 10.1016/j.jfma.2015.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 05/08/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022] Open
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Bentley KH, Franklin JC, Ribeiro JD, Kleiman EM, Fox KR, Nock MK. Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: A meta-analytic review. Clin Psychol Rev 2015; 43:30-46. [PMID: 26688478 DOI: 10.1016/j.cpr.2015.11.008] [Citation(s) in RCA: 212] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/18/2015] [Accepted: 11/24/2015] [Indexed: 02/08/2023]
Abstract
Suicidal thoughts and behaviors are highly prevalent public health problems with devastating consequences. There is an urgent need to improve our understanding of risk factors for suicide to identify effective intervention targets. The aim of this meta-analysis was to examine the magnitude and clinical utility of anxiety and its disorders as risk factors for suicide ideation, attempts, and deaths. We conducted a literature search through December 2014; of the 65 articles meeting our inclusion criteria, we extracted 180 cases in which an anxiety-specific variable was used to longitudinally predict a suicide-related outcome. Results indicated that anxiety is a statistically significant, yet weak, predictor of suicide ideation (OR=1.49, 95% CI: 1.18, 1.88) and attempts (OR=1.64, 95% CI: 1.47, 1.83), but not deaths (OR=1.01, 95% CI: 0.87, 1.18). The strongest associations were observed for PTSD. Estimates were reduced after accounting for publication bias, and diagnostic accuracy analyses indicated acceptable specificity but poor sensitivity. Overall, the extant literature suggests that anxiety and its disorders, at least when these constructs are measured in isolation and as trait-like constructs, are relatively weak predictors of suicidal thoughts and behaviors over long follow-up periods. Implications for future research priorities are discussed.
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Affiliation(s)
- Kate H Bentley
- Center for Anxiety and Related Disorders, Boston University, USA.
| | | | - Jessica D Ribeiro
- Department of Psychology, Harvard University, USA; Military Suicide Research Consortium, USA
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