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Lévy-Bencheton J, Chaste P, Sansen M. Link between neurodevelopmental disorders and suicidal risk in children. L'ENCEPHALE 2024:S0013-7006(24)00042-3. [PMID: 38523026 DOI: 10.1016/j.encep.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/27/2023] [Accepted: 12/13/2023] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Suicide represents a significant public health issue among children and adolescents. However, in this population, while the literature seems to support a link between suicidal risk and neurodevelopmental disorders, there are still few studies on the subject. The psychopathological description of children who have realized a suicide attempt with a high potential for lethality, which can be defined as "serious", appears to resemble that of children who have died by suicide. This study aimed to characterize the dimensional aspects of the neurodevelopmental profile of a population of children and adolescents hospitalized at Necker-Enfants-Malades Hospital for a serious suicide attempt. METHODS This is an observational, prospective, and single-center study. Questionnaires for collecting general information and dimensional scales of neurodevelopment (Autism-Tics, ADHD, and Other Comorbidities Inventory, Social Responsiveness Scale, and Conners-3 for parents) were used. This study included 21 patients aged 9 to 15 years at the time of their hospitalization. RESULTS The results supported the presence of at least one neurodevelopmental disorder (autistic traits, attention-deficit/hyperactivity disorder, learning disorder, or motor disorder) in 70% (n=14) of the subjects, and at least one behavioral disorder (oppositional defiant disorder, conduct disorder) in 65% (n=13) of these subjects. CONCLUSION The observed frequency of traits indicative of neurodevelopmental disorders in our population was higher than that observed in the general population, without the presented symptoms being eligible for categorical diagnosis. Considering the dimensional aspects of neurodevelopmental symptoms would therefore enable better identification of children at suicidal risk and more tailored interventions to contribute to the prevention of suicide in children.
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Affiliation(s)
- Julie Lévy-Bencheton
- Child psychiatry department, Necker-Enfants-Malades Hospital, 75015 Paris, France.
| | - Pauline Chaste
- Child psychiatry department, Necker-Enfants-Malades Hospital, 75015 Paris, France
| | - Mélisande Sansen
- Child psychiatry department, Necker-Enfants-Malades Hospital, 75015 Paris, France
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Rabbany JM, Ellis S, Metts A, Burke A, Brent DA, Melhem N, Marcott S, Mann JJ. Mood Disorders and Aggressive Traits Mediate Effects of Reported Childhood Adversity on Suicide Attempt Risk. Arch Suicide Res 2023; 27:1207-1230. [PMID: 36052407 DOI: 10.1080/13811118.2022.2112118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Childhood adversity (CA) is linked to suicidal behavior as well as to mood disorders and aggressive traits. This raises the possibility that depression and aggressive traits mediate the relationship of childhood adversity to suicide risk. Moreover, it is not known if they operate independently or interactively. AIMS To determine whether, and how, mood disorders and aggressive traits mediate the effects of reported physical and sexual abuse on future suicidal behavior. METHODS Five hundred and forty-eight subjects, offspring of parents with mood disorders, were interviewed at baseline and at yearly follow-ups with questionnaires assessing aggression, mood disorders, and suicidal behavior. The mediation analysis involved a three-step process, testing the relationships between (1) CA and attempt; (2) CA and putative mediators; and (3) putative mediators and suicide attempt, adjusting for CA. RESULTS Aggressive trait severity and mood disorder onset each mediated the relationship between CA and future suicide attempts. Greater aggression severity also raised the hazard of the development of a mood disorder. If aggressive trait severity was clearly elevated, then onset of mood disorder did not increase further the hazard of the suicide attempt. Including family as a random effect had a much bigger effect on attempt outcome for physical abuse compared with sexual abuse. CONCLUSIONS Amelioration of aggressive traits and treatment of mood disorders in CA-exposed offspring of a parent with a mood disorder may prevent future suicide attempts and may reduce the risk of mood disorder. Familial factors influence the impact of childhood physical abuse but not sexual abuse. HIGHLIGHTSChildhood Adversity (CA) predicted future mood disorder and aggression severity.Depression and aggression mediate the relationship between CA and suicide attempts.When one mediator is present, the presence of the other does not increase the hazard.Between family variation contributed much more to suicidal behavior outcomes relative to the effect of physical abuse, but sexual abuse contributed to suicidal outcomes more than family variation.
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Xu C, Wang F, Huang Q, Lyu D, Wu C, Cao T, Zhao J, Wang M, Zhou N, Yang W, Chen Y, Wei Z, Xie B, Hong W. Association between overt aggression and anhedonia in patients with major depressive disorder during the acute phase. J Psychiatr Res 2023; 165:41-47. [PMID: 37459777 DOI: 10.1016/j.jpsychires.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE To explore the factors influencing anhedonia at baseline and use them as confounding factors. To further investigate the correlation between overt aggression and anhedonia during the acute phase of major depressive disorder. METHODS In this eight-week prospective study, 384 major depressive disorder patients were recruited from the outpatient section of Shanghai Mental Health Center from May 1, 2017, to October 30, 2018. Standard treatments were performed with escitalopram or venlafaxine for participants. Depressive symptoms, overt aggression, and anhedonia were assessed using the 17-item Hamilton Rating Scale for Depression, Modified Overt Aggression Scale, and Snaith-Hamilton Pleasure Scale at baseline, and in the 4th and 8th weeks. RESULTS Obsessive-compulsive symptoms and the duration of untreated psychosis were positively associated with aggression (P < 0.05). Patients with aggressive behaviour had worse cognitive impairment and severe anhedonia of pleasurable sensory experiences (P < 0.05). For anhedonia, being female (tau_b = -0.23, P = 0.012) was a protective factor, while number of recurrent, melancholic features, current obsessions, previous combination drug therapies, depressive symptoms, and aggressive behaviour were risk factors (P < 0.05). Social anhedonia related to interests/pastimes, and pleasurable sensory experiences were more severe in major depressive disorder patients with aggressive behaviour in the acute phase (P < 0.05). CONCLUSIONS Anhedonia persisted in major depressive disorder patients with aggressive behaviour after standardized treatment during the acute phase. Being female protected the pleasures from social interaction and sensory experience. However, the number of depressive episodes, melancholic features, current obsessive symptoms, previous combination drug therapies, depressive symptoms, and aggressive behaviour was positively associated with anhedonia.
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Affiliation(s)
- Chuchen Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Fan Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China. beauty--
| | - Qinte Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Dongbin Lyu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Chenglin Wu
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, China.
| | - Tongdan Cao
- Shanghai Mental Health Center of Huangpu District, Shanghai, 200011, China.
| | - Jie Zhao
- Shanghai Mental Health Center of Huangpu District, Shanghai, 200011, China.
| | - Meiti Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Ni Zhou
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Weichieh Yang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Yiming Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Zheyi Wei
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Bin Xie
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 20030, China.
| | - Wu Hong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 20030, China.
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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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Peng C, Guo T, Cheng J, Wang M, Tan Y, Rong F, Kang C, Ding H, Wang Y, Yu Y. Association between childhood physical abuse and suicidal behaviors among Chinese adolescents: The mediation of aggression. J Affect Disord 2022; 318:338-346. [PMID: 36113686 DOI: 10.1016/j.jad.2022.09.021] [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] [Received: 09/14/2021] [Revised: 04/30/2022] [Accepted: 09/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although previous studies have examined many predictors of suicidal behaviors. However, little is known for childhood physical abuse (CPA) and aggression, which are prevalent among adolescents. This study aimed to explore association between CPA and suicidal behaviors, and the potential mediating role of aggression. METHOD A total of 16,111 students graded 7 to 12 were recruited using a stratified cluster sampling across five representative provinces in China. Conflict Tactics Scale-Parents to Child (CTS-PC) and Buss and Warren's Aggression Questionnaire (BWAQ) were used to measure CPA and aggression, respectively. RESULTS During the last year, 16.0 % of adolescents reported suicidal behaviors. Specifically, 7.9 % were suicide ideators, 4.6 % were planners, and 3.5 % were attempters. The prevalence of CPA in mild, moderate, and severe was 15.7 %, 26.9 %, and 4.4 %, respectively. Multinomial logistic regression indicated that moderate and severe CPA and overall aggression were associated with suicide ideators, planners, and attempters. In five sub-types of aggression, only hostility was significantly associated with all three suicidal behaviors. Structural equation modelling showed that aggression partially mediate the relationship between CPA and suicidal behaviors. The mediation proportion of overall aggression, physical aggression, verbal aggression, anger, hostility, and indirect aggression were 27.2 %, 22.4 %, 5.2 %, 14.2 %, 23.5 %, and 12.1 %, respectively. LIMITATIONS Cross-sectional design, self-reported questionnaire, and no other forms of childhood maltreatment. CONCLUSIONS CPA is a critical risk factor of suicidal behaviors among Chinese adolescents and aggression is a mediator between CPA and suicidal behaviors. Targeted suicide prevention should focus on those adolescents who report CPA and aggression, especially for hostility.
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Affiliation(s)
- Chang Peng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tengyun Guo
- Department of Neurosurgery, Army Medical Center of PLA, Army Medical University, Chongqing, China
| | - Junhan Cheng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mengni Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yafei Tan
- Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fajuan Rong
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chun Kang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hongli Ding
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yan Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yizhen Yu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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The impulsiveness level influences the salivary cortisol response and social stress sensitivity in suicidal patients. J Psychiatr Res 2022; 156:159-167. [PMID: 36252345 DOI: 10.1016/j.jpsychires.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 08/06/2022] [Accepted: 10/03/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Suicide attempters (SA) are more vulnerable to social stress and show disturbed cortisol response in stressful conditions compared with psychiatric and healthy controls. Recent data suggest that this dysregulation might be related to impulsivity traits. However, little is known about the emotional consequences of social stress in SA exposed to stress. OBJECTIVES The aim of our study was to evaluate the cortisol and emotional responses to social stress in patients with depression with and without suicide attempt, by taking into account impulsivity traits and depression severity. METHODS 67 adult women (41 SA and 26 affective controls (AC,i.e. without suicide attempt history)) with lifetime history of major depressive episode were included. Patients performed the Trier Social Stress Test (TSST), a well-validated social stress task. Patients provided seven saliva samples, to measure the cortisol response, and filled in questionnaires to assess psychological pain, positive and negative mood, and anxiety at different time points (from 10 min before to 120 min after the TSST). Moderated regression models were used including suicide attempt history, depression severity, and impulsivity as independent variables and their interactions. RESULTS In patients with low depression and high impulsivity, salivary cortisol response during the TSST was higher in SA than in AC (p < .001). Psychological pain, negative mood, and anxiety were increased in all patients just after the TSST, followed by a decrease at 120 min. Positive mood recovery was slower in SA, and in patients with high impulsivity and low depression level (p < .001). CONCLUSIONS Impulsivity traits have an important role in suicidal vulnerability in stress conditions. Impulsivity traits might help to differentiate patients at risk of suicide who are highly sensitive to stress when depression level is low. Higher impulsiveness may increase the sensitivity to emotional distress that translates into inadequate physiological responses.
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Teng T, Fan L, Yan W, Li X, Zhang Y, Xiang Y, Jiang Y, Yuan K, Yin B, Shi L, Liu X, Yu Y, Zhou X, Lu L, Xie P. A diathesis-stress rat model induced suicide-implicated endophenotypes and prefrontal cortex abnormalities in the PKA and GABA receptor signaling pathways. Prog Neuropsychopharmacol Biol Psychiatry 2022; 116:110538. [PMID: 35189256 DOI: 10.1016/j.pnpbp.2022.110538] [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] [Received: 01/01/2022] [Accepted: 02/16/2022] [Indexed: 10/19/2022]
Abstract
Suicide is one of the leading causes of death and represents a significant public health problem worldwide; however, the underlying mechanism of suicide remains unclear, and there is no animal model with suicide-implicated endophenotypes for investigating the etiology, course and potential treatment targets of suicide. Thus, we generated a diathesis-stress rat model to simulate suicide-implicated endophenotypes. First, two hundred rats were screened in two rounds of learned helplessness (LH) tests and selected as learned helplessness-sensitive (LHS) rats (n = 37) and learned helplessness-resistant (LHR) rats (n = 39). Then, all LHS rats and half of the rats (randomly selected) in the LHR group were exposed to four weeks of social defeat stress (SDS) (LHS + SDS group, n = 37 and LHR + SDS group, n = 20, respectively). The remainder of the LHR rats were handled as controls (LHR + CON group, n = 19). The LHS + SDS group showed significantly more suicide-implicated endophenotypes than the LHR + CON group, including longer immobile times in the forced swim test (hopelessness), higher scores in the irritability test (irritability), shorter latencies to attack (impulsivity), longer total attack times in the resident-intruder test (aggression), and lower sucrose preference indices (anhedonia). Proteomic analyses revealed that the canonical pathways that were the most common between the LHS + SDS and LHR + CON groups were the PKA and GABA receptor pathways in the prefrontal cortex. A diathesis-stress paradigm would be a useful way to establish a rat model with suicide-implicated endophenotypes, providing novel perspectives for revealing the potential mechanism of suicide.
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Affiliation(s)
- Teng Teng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; NHC Key Laboratory of Diagnosis and Treatment on Brain Function and Disease, Chongqing Medical University, Chongqing, China
| | - Li Fan
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; NHC Key Laboratory of Diagnosis and Treatment on Brain Function and Disease, Chongqing Medical University, Chongqing, China
| | - Wei Yan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xuemei Li
- NHC Key Laboratory of Diagnosis and Treatment on Brain Function and Disease, Chongqing Medical University, Chongqing, China; Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuqing Zhang
- NHC Key Laboratory of Diagnosis and Treatment on Brain Function and Disease, Chongqing Medical University, Chongqing, China; Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yajie Xiang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; NHC Key Laboratory of Diagnosis and Treatment on Brain Function and Disease, Chongqing Medical University, Chongqing, China
| | - Yuanliang Jiang
- NHC Key Laboratory of Diagnosis and Treatment on Brain Function and Disease, Chongqing Medical University, Chongqing, China; Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kai Yuan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Bangmin Yin
- NHC Key Laboratory of Diagnosis and Treatment on Brain Function and Disease, Chongqing Medical University, Chongqing, China; Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Le Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xueer Liu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; NHC Key Laboratory of Diagnosis and Treatment on Brain Function and Disease, Chongqing Medical University, Chongqing, China
| | - Ying Yu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; NHC Key Laboratory of Diagnosis and Treatment on Brain Function and Disease, Chongqing Medical University, Chongqing, China
| | - Xinyu Zhou
- NHC Key Laboratory of Diagnosis and Treatment on Brain Function and Disease, Chongqing Medical University, Chongqing, China; Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; NHC Key Laboratory of Diagnosis and Treatment on Brain Function and Disease, Chongqing Medical University, Chongqing, China.
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Quesada-Franco M, Pintor-Pérez L, Daigre C, Baca-García E, Ramos-Quiroga JA, Braquehais MD. Medically Serious Suicide Attempts in Personality Disorders. J Clin Med 2021; 10:4186. [PMID: 34575302 PMCID: PMC8469317 DOI: 10.3390/jcm10184186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022] Open
Abstract
Medically serious suicide attempts (MSSA) represent a subgroup of clinically heterogeneous suicidal behaviors very close to suicides. Personality disorders (PD) are highly prevalent among them, together with affective and substance use disorders. However, few studies have specifically analyzed the role of PD in MSSA. These suicide attempts (SA) are usually followed by longer hospitalization periods and may result in severe physical and psychological consequences. The aim of this study is to compare the profile of MSSA patients with and without PD. MSSA were defined according to Beautrais 'criteria, but had to remain hospitalized ≥48 h. Overall, 168 patients from two public hospitals in Barcelona were evaluated during a three-year period. Mean hospital stay was 23.68 (standard deviation (SD) = 41.14) days. Patients with PD (n = 69) were more likely to be younger, female, make the first and the most serious SA at a younger age, reported recent stressful life-events and more frequently had previous suicide attempts compared to those without PD. However, no differences were found with regards to comorbid diagnoses, current clinical status, features of the attempt, or their impulsivity and hopelessness scores. Therefore, focusing on the subjective, qualitative experiences related to MSSA among PD patients may increase understanding of the reasons contributing to these attempts in order to improve prevention strategies in the future.
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Affiliation(s)
- Marta Quesada-Franco
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (C.D.); (J.A.R.-Q.)
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Luis Pintor-Pérez
- Department of Psychiatry, Hospital Clinic, Instituto de Investigaciones Biomédicas Augusto Pi I Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Constanza Daigre
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (C.D.); (J.A.R.-Q.)
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), 08035 Barcelona, Spain;
| | - Enrique Baca-García
- Department of Psychiatry, Madrid Autonomous University, 28017 Madrid, Spain;
- CIBERSAM (Centro de Investigacion en Salud Mental), Carlos III Institute of Health, 28040 Madrid, Spain
- Department of Psychiatry, Centre Hospitalier Universitaire de Nîmes, 30900 Nîmes, France
- Psychology Department, Universidad Católica de Maule, Talca 3605, Chile
- Department of Psychiatry, University Hospital Jimenez Diaz Foundation, 28020 Madrid, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (C.D.); (J.A.R.-Q.)
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), 08035 Barcelona, Spain;
- Psychiatry, Mental Health and Addictions Research Group, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - María Dolores Braquehais
- Biomedical Network Research Centre on Mental Health (CIBERSAM), 08035 Barcelona, Spain;
- Psychiatry, Mental Health and Addictions Research Group, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
- Integral Care Program for Sick Health Professionals, Galatea Clinic, 08017 Barcelona, Spain
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Shaker NM, Sultan M, Mohamed MY, Helal SA, Abd El Moneam MHED. Lipid Profile and Impulsivity in Suicidal Patients with Major Depressive Disorder. Arch Suicide Res 2021; 25:641-656. [PMID: 32252618 DOI: 10.1080/13811118.2020.1746456] [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] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Previous observational cohort studies showed an association between low serum lipid levels and suicide. This study was undertaken to examine the relationship between lipid parameters and impulsivity in suicidal patients with major depressive disorder (MDD). METHODS The current study included 100 patients with MDD distributed as 50 patients with recent suicidal attempts and 50 patients with no lifetime history of suicide. Participants were subjected to Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I) to confirm the diagnosis. The risk of suicide was assessed through the Suicide Probability Scale (SPS), while the intent and seriousness of suicide were assessed through Beck's Suicidal Intent Scale. assessment of impulsivity was carried out through Barratt Impulsivity Scale. Serum lipid levels were measured in mg/dL after an overnight fast. RESULTS Total cholesterol (TC) was found significantly lower in the suicidal group compared to the non-suicidal depressed group (p = 0.040). Low high-density lipoprotein (HDL) level was significantly correlated with suicidality and high suicide intent was correlated with hopelessness. Logistic regression for lipid profile in both groups revealed significant TC and low-density lipoprotein (LDL) as predictors for suicide. There was no significant correlation between impulsivity and characteristics of depression, suicide probability, suicide intent, and all elements of the lipid profile. CONCLUSIONS Low TC and LDL could predict suicidal behavior in patients with MDD. Impulsivity could not be a mediator or predictor of suicide risk in patients with MDD.
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Uğur K, Demirkol ME, Tamam L. The Mediating Roles of Psychological Pain and Dream Anxiety in the Relationship between Sleep Disturbance and Suicide. Arch Suicide Res 2021; 25:512-528. [PMID: 32191162 DOI: 10.1080/13811118.2020.1740124] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ABSRTACTSuicide is a significant public health problem worldwide, and sleep disturbances have negative effects on mental health and suicidality. Several psychological concepts may mediate the relationship between sleep disturbances and suicide. We aimed to investigate the mediating roles of psychological pain and dream anxiety in this relationship. This cross-sectional study included 150 depressive patients with or without recent suicide attempts and 91 healthy controls. The Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), Psychache Scale (PS), and Van Dream Anxiety Scale (VDAS) were used to assess sleep quality, depression severity, psychological pain, and dream anxiety, respectively. Depression group's mean depression, dream anxiety, psychache, and median sleep quality scores were higher than those of the control group. The ROC analyses indicated no relationship between the violence status of the suicides and the mean dream anxiety, sleep quality or psychache scores. Multivariate regression analysis demonstrated that only the depression score predicted suicide attempts. Mediation analyses revealed that both psychache and dream anxiety have full mediator roles in the relationship between sleep disturbance and suicide attempts. Psychotherapeutic approaches to relieve dream anxiety and psychache may help prevent suicide attempts of at-risk individuals.
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Characteristics of depressed suicide attempters with remitted substance use disorders. J Psychiatr Res 2021; 137:572-578. [PMID: 33158553 PMCID: PMC8084874 DOI: 10.1016/j.jpsychires.2020.10.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/06/2020] [Accepted: 10/28/2020] [Indexed: 01/26/2023]
Abstract
Substance use disorder (SUD) comorbidity in mood disorders increases suicide risk. Suicide attempters with active SUD appear to have distinct characteristics but little is known whether these characteristics persist during remission and if they are related to different aspects of suicidal behavior. In this study, suicide attempters with a DSM mood disorder and remitted SUD (AT+SUD) (N = 135) were compared to those without lifetime SUD (AT-SUD) (N = 219) in terms of demographic, clinical and suicidal behavioral characteristics. Factor analyses were conducted to generate subjective distress and impulsivity/aggression factors - previously identified by our group to predict suicide risk in mood disorders. Associations between these traits and SUD history and suicidal behavior characteristics were then tested. Compared with AT-SUD, AT+SUD were more likely to be male, less educated and to have a Cluster B personality disorder. AT+SUD individuals had greater impulsivity/aggression factor scores, but comparable subjective distress scores. AT+SUD made a greater number of suicide attempts, with higher lethality, despite comparable suicide intent and degree of planning with AT-SUD. Impulsivity/aggression was higher in multiple versus single attempters, but did not correlate with suicide attempt lethality. Among suicide attempters with mood disorders, a history of lifetime SUD was associated with more frequent and more lethal suicide attempts. Among other correlates of lifetime SUD in this sample, impulsive/aggressive traits may explain greater frequency of suicide attempts. The results underscore that persons with mood disorders and lifetime SUD are at particularly high risk of frequent and lethal suicide attempts where more intensive prevention efforts are warranted.
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12
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Persett PS, Ekeberg Ø, Jacobsen D, Bjornaas MA, Myhren H. Higher Suicide Intent in Patients Attempting Suicide With Violent Methods Versus Self-Poisoning. CRISIS 2021; 43:220-227. [PMID: 33890826 PMCID: PMC9102881 DOI: 10.1027/0227-5910/a000773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Suicidal intent for patients attempting suicide using violent methods (VMs) is assumed to be higher than for those using self-poisoning (SP), which may explain the higher mortality observed in follow-up studies. However, this has not been studied prospectively. Aims: We aimed to compare patients attempting suicide using VMs with those using SP regarding suicidal intent, suicidal ideation, depression, and hopelessness during hospital stay and after 1 year. Methods: Patients hospitalized after suicide attempt by VMs (n = 80) or SP (n = 81) completed the Beck scales for Suicide Intent, Suicide Ideation, Depression Inventory, and Hopelessness on admission and at the 12-month follow-up. Results: On admission, those using VMs had higher suicidal intent than those using SP (M = 16.2 vs. 13.3, p < .001), but lower depression scores (M = 22.2 vs. 26.8, p < .05). No significant differences were found in suicidal ideation (M = 20.1 vs. 23.1) or hopelessness (M = 10.1 vs. 11.9). At 12-month follow-up, depression scores decreased significantly for both groups, while hopelessness decreased only for the SP group. Limitations: The statistical power achieved was lower than intended. Conclusion: The higher levels of suicidal intent, but lower levels of depression, may indicate more impulsivity among people attempting suicide using VMs. Suicidal ideation was relatively stable.
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Affiliation(s)
| | - Øivind Ekeberg
- Divisions of Mental Health and Addiction, Oslo University Hospital, Norway.,Department of Behavioral Sciences in Medicine, University of Oslo, Norway
| | - Dag Jacobsen
- Department of Acute Medicine, Oslo University Hospital, Norway.,Institute of Clinical Sciences, University of Oslo, Norway
| | | | - Hilde Myhren
- Department of Acute Medicine, Oslo University Hospital, Norway
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13
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Levi-Belz Y, Gvion Y, Apter A. The Serious Suicide Attempts Approach for Understanding Suicide: Review of the Psychological Evidence. OMEGA-JOURNAL OF DEATH AND DYING 2020; 86:591-608. [PMID: 33327864 DOI: 10.1177/0030222820981235] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The study of survivors of a serious suicide attempt (SSA)--an attempt that would have been fatal had it not been for the provision of rapid and effective emergency treatment--can help researchers understand the suicidal mind. Serious suicide attempters are epidemiologically very similar to those who died by suicide, and thus can serve as valid proxies for studying suicides. In this paper, our objective was to briefly review the main risk factors that may facilitate more dangerous suicide behavior with high levels of intent. Our review highlights several dimensions of risk factors for SSAs, including psychopathology, mental pain, communication difficulties, decision-making impulsivity, and aggression. Several studies have indicated that the interaction between some of these dimensions, especially between mental pain and interpersonal difficulties, may serve as major catalysts for SSAs. Suicidal risk assessment should incorporate a designated evaluation of these risk factors as part of suicide prevention models.
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Affiliation(s)
- Yossi Levi-Belz
- Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel.,The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Yari Gvion
- Department of Child Clinical Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Alan Apter
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel.,Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
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14
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Martin RL, Smith NS, Caulfield NM, Capron DW. The Pathways of Aggression - Differential Indirect Associations Between Anxiety Sensitivity Cognitive Concerns and Suicidality. CRISIS 2020; 42:335-342. [PMID: 33151097 DOI: 10.1027/0227-5910/a000725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: Suicide prevention efforts have focused on risk factors that help identify people with an increased risk for suicide. One risk factor related to suicide risk is anxiety sensitivity cognitive concerns (ASCC), which is the "fear of going crazy." The association between ASCC and suicidal ideation is hypothesized to result from the depression-distress amplification model, which postulates that ASCC exacerbates feelings of depression and concurrent distress. Furthermore, there is evidence for associations between ASCC/dysregulated anger and dysregulated anger/suicidal ideation. We hypothesized that aggression may provide pathways from ASCC to suicidality. The current study examined how facets of aggression (described as elevated agitation) meditated the association between ASCC and suicidality. Aims: The current study aimed to extend prior research by examining how different facets of aggression mediate the association between ASCC and suicidality. Method: Participants were 440 adults recruited online, 32.7% of whom endorsed experiencing lifetime suicidal ideation. Results: Our hypotheses were partially supported with two significant indirect effects. Results indicated that physical aggression and hostility provided significant indirect effects; however, verbal aggression and anger did not. Limitations: The study was cross-sectional in nature, limiting causal interpretations about the indirect effects. The sample included primarily White participants. Conclusion: Specific facets of aggression provide pathways through which ASCC is associated with suicidality. Aggression may be a catalyst for individuals to progress to suicidality. The current study provides foundational research for continued examination of physical aggression as a catalyst for suicide attempts.
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Affiliation(s)
- Rachel L Martin
- Department of Psychology, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Nicole S Smith
- Department of Psychology, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Nicole M Caulfield
- Department of Psychology, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Daniel W Capron
- Department of Psychology, The University of Southern Mississippi, Hattiesburg, MS, USA
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15
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Vargas-Medrano J, Diaz-Pacheco V, Castaneda C, Miranda-Arango M, Longhurst MO, Martin SL, Ghumman U, Mangadu T, Chheda S, Thompson PM, Gadad BS. Psychological and neurobiological aspects of suicide in adolescents: Current outlooks. Brain Behav Immun Health 2020; 7:100124. [PMID: 32835300 PMCID: PMC7405877 DOI: 10.1016/j.bbih.2020.100124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 01/10/2023] Open
Abstract
Suicidality is one of the leading causes of death among young adults in the United States and represents a significant health problem worldwide. The suicide rate among adolescents in the United States has increased dramatically in the latest years and has been accompanied by considerable changes in youth suicide, especially among young girls. Henceforth, we need a good understanding of the risk factors contributing to suicidal behavior in youth. An explanatory model for suicidal behavior that links clinical and psychological risk factors to the underlying neurobiological, neuropsychological abnormalities related to suicidal behavior might predict to help identify treatment options and have empirical value. Our explanatory model proposes that developmental, biological factors (genetics, proteomics, epigenetics, immunological) and psychological or clinical (childhood adversities) may have causal relevance to the changes associated with suicidal behavior. In this way, our model integrates findings from several perspectives in suicidality and attempts to explain the relationship between various neurobiological, genetic, and clinical observations in suicide research, offering a comprehensive hypothesis to facilitate understanding of this complex outcome. Unraveling the knowledge of the complex interplay of psychological, biological, sociobiological, and clinical risk factors is highly essential, concerning the development of effective prevention strategy plans for suicidal ideation and suicide.
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Affiliation(s)
- Javier Vargas-Medrano
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
- Southwest Brain Bank, Texas Tech University Health Science Center, El Paso, TX, 79905, University of Texas, El Paso, USA
| | - Valeria Diaz-Pacheco
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
- Southwest Brain Bank, Texas Tech University Health Science Center, El Paso, TX, 79905, University of Texas, El Paso, USA
| | - Christopher Castaneda
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
| | - Manuel Miranda-Arango
- Department of Biological Sciences, Border Biomedical Research Center, The University of Texas at El Paso, TX, 79968, USA
| | - Melanie O Longhurst
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
| | - Sarah L. Martin
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
| | - Usman Ghumman
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
| | - Thenral Mangadu
- Minority AIDS Research Center, Department of Health Sciences, The University of Texas at El Paso, TX, 79968, USA
| | - Sadhana Chheda
- Department of Pediatrics, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
| | - Peter M. Thompson
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
- Southwest Brain Bank, Texas Tech University Health Science Center, El Paso, TX, 79905, University of Texas, El Paso, USA
| | - Bharathi S. Gadad
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
- Southwest Brain Bank, Texas Tech University Health Science Center, El Paso, TX, 79905, University of Texas, El Paso, USA
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16
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Yin H, Galfalvy H, Zhang B, Tang W, Xin Q, Li E, Xue X, Li Q, Ye J, Yan N, Mann JJ. Interactions of the GABRG2 polymorphisms and childhood trauma on suicide attempt and related traits in depressed patients. J Affect Disord 2020; 266:447-455. [PMID: 32056912 DOI: 10.1016/j.jad.2020.01.126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/28/2019] [Accepted: 01/20/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previously, we reported that the longest variant of the GABA A receptor γ2 subunit (GABRG2) was associated with suicidal behavior. The present study therefore aimed to determine whether polymorphisms near the alternatively spliced exon of GABRG2 are associated with suicide attempt (SA) and its related traits, and how these variants might interact with reported childhood trauma (CT) in their association with suicidal behavior. METHODS We examined 5 single nucleotide polymorphisms (SNPs) of GABRG2. Subjects were suicide Attempters (N = 94), non-suicide attempters (N = 168) with MDD or Bipolar depression, and healthy volunteers (N = 100). Data on demographics, depression severity and suicide attempts were collected. Participants also completed a set of instruments assessing CT, and lifetime aggression and impulsivity.. GABRG2 polymorphisms were genotyped using Sanger sequencing. RESULTS Allele A of rs211034 was a protective factor for SA (OR = 0.50 (0.32, 0.80), p = 0.003), and had an interaction effect with emotional neglect (OR = 0.89 (0.82, 0.97), p = 0.006) on depression. One haploblock (consisting of rs211035 and rs211034) was identified within these SNPs, and subjects with haplotype GA (frequency = 7.3%), had lower rate of SA (OR=0.26(0.10, 0.67), p = 0.006). Cognitive impulsivity (OR=1.38)1.24,1.55), p < 0.001), non-planning impulsivity (OR = 1.18 (1.10,1.25), p < 0.001), anger (OR = 1.13 (1.07,1.19), p < 0.001), impulsivity total score (OR = 1.10(1.06,1.15), p < 0.001), hostility (OR = 1.10 (1.04, 1.15), p < 0.001), aggression total score (OR = 1.05 (1.03,1.07), p < 0.001) were associated with depression, meanwhile, hopelessness (OR = 2.18 (1.56, 3.04), p < 0.001) and impulsivity total score (OR = 1.05 (1.02,1.08), p < 0.001) were associated with the risk of SA, adjusted by age and gender. There was no mediation effect in the relationship among CT, gene polymorphisms and SA or depression through increased impulsivity or aggression. LIMITATIONS The main limitation of this study is its modest sample size. More genetic variants as well as epigenetic markers should be examined in future studies. CONCLUSIONS These findings add to evidence for the involvement of GABRG2 and impulsivity and hopelessness in SA independent from their association with depression. More research is needed on possible mediators of the relationship between GABA-related gene and SA.
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Affiliation(s)
- Honglei Yin
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China.
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University, New York, NY
| | - Bin Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Weiwei Tang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Qianqian Xin
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Enze Li
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Xiang Xue
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Qiyang Li
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Junping Ye
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Na Yan
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - J John Mann
- Department of Psychiatry, Columbia University, New York, NY; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York.
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17
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Deisenhammer EA, Behrndt-Bauer EM, Kemmler G, Haring C, Miller C. Suicide in Psychiatric Inpatients- A Case-Control Study. Front Psychiatry 2020; 11:591460. [PMID: 33408654 PMCID: PMC7779474 DOI: 10.3389/fpsyt.2020.591460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Psychiatric inpatients constitute a population at considerably increased risk for suicide. Identifying those at imminent risk is still a challenging task for hospital staff. This retrospective case-control study focused on clinical risk factors related to the course of the hospital stay. Method: Inpatient suicide cases were identified by linking the Tyrol Suicide Register with the registers of three psychiatric hospitals in the state. Control subjects were patients who had also been hospitalized in the respective psychiatric unit but had not died by suicide. Matching variables included sex, age, hospital, diagnosis, and admission date. The study period comprised 7 years. Data were analyzed by the appropriate two-sample tests and by logistic regression. Results: A total of 30 inpatient suicide cases and 54 control patients were included. A number of factors differentiated cases from controls; after correction for multiple testing, the following retained significance: history of aborted suicide, history of attempted suicide, history of any suicidal behavior/threats, suicidal ideation continuing during hospitalization, no development of prospective plans, no improvement of mood during the hospital stay, and leaving ward without giving notice. Logistic regression identified the latter three variables and history of attempted suicide as highly significant predictors of inpatient suicide. Conclusions: Preventive measures during hospitalization include thorough assessment of suicidal features, an emphasis on the development of future perspectives, and a review of hospital regulations for patients who want to leave the ward.
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Affiliation(s)
- Eberhard A Deisenhammer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisa-Marie Behrndt-Bauer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria.,Department of Psychiatry and Psychotherapy, Center for Health Services Research in Medicine, Erlangen, Germany
| | - Georg Kemmler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Haring
- Department of Psychiatry and Psychotherapy B, State Hospital Hall in Tirol, Hall in Tirol, Austria
| | - Carl Miller
- Department of Psychiatry, County Hospital Kufstein, Kufstein, Austria
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Kim J, Kim J, Park S. Military hazing and suicidal ideation among active duty military personnel: Serial mediation effects of anger and depressive symptoms. J Affect Disord 2019; 256:79-85. [PMID: 31158719 DOI: 10.1016/j.jad.2019.05.060] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/09/2019] [Accepted: 05/27/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Military hazing is one of most serious problems affecting suicidal ideation (SI) among active duty personnel, but has received limited research attention. Studies on hazing and SI indicate anger and depressive symptoms as mediators for SI. METHODS A sample of active duty military personnel (N = 944) completed an offline survey, consisting of the revised Conflict Tactics Scale-2, Composite International Diagnostic Interview Screening Scale, and revised Columbia Suicide Severity Rating Scale. Frequency, bivariate correlation, and serial mediation analyses were conducted to assess the serial effects of military hazing on SI, mediated via anger and depressive symptoms. RESULTS Military hazing, anger, depressive symptoms, and SI were positively related to each other in bivariate analyses. In serial mediation analyses, hazing was found to be a significant predictor of higher levels of anger, consequently triggering depressive symptoms, which, in turn, were associated with greater SI. LIMITATIONS Study limitations included the use of cross-sectional data with the use of retrospective self-report. CONCLUSION Hazing in the military is prevalent (17.6%), and SI is associated with serial effects of hazing, anger, and depressive symptoms with full mediation path. Findings suggest that policies that address reducing hazing and implementing clinical interventions specifically focused on symptoms of anger and depression may be important for decreasing SI in military personnel.
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Affiliation(s)
- JaeYop Kim
- School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - JoonBeom Kim
- Interdisciplinary Graduate Program in Social Welfare Policy, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - SooKyung Park
- School of Social Welfare, Yonsei University, Seoul, Republic of Korea
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Gvion Y, Levi-Belz Y. Serious Suicide Attempts: Systematic Review of Psychological Risk Factors. Front Psychiatry 2018; 9:56. [PMID: 29563886 PMCID: PMC5845877 DOI: 10.3389/fpsyt.2018.00056] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/08/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND One of the main obstacles in studying suicide risk factors is the difference between cases in which the individual died by suicide and those in which the individual engaged in suicidal behavior. A promising strategy that overcomes this obstacle is the study of survivors of serious suicide attempt (SSA), i.e., an attempt that would have been lethal had it not been for the provision of rapid and effective emergency treatment. Serious suicide attempters are epidemiologically very much like those who died by suicide, and thus may serve as valid proxies for studying suicides. This paper aims to define the specific risk factors for SSAs by conducting a qualitative data synthesis of existing studies. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic search of the literature in PubMed, ProQuest, and Psychlit electronic research-literature databases. Search terms were "serious" "OR" "near lethal," combined with the Boolean "AND" operator with "suicide*." In addition, we performed a manual search on Google Scholar for further studies not yet identified. RESULTS The preliminary search identified 683 citations. A total of 39 research reports that met the predefined criteria were analyzed. Mental pain, communication difficulties, decision-making impulsivity, and aggression, as well as several demographic variables, were found to be major risk factors for SSAs. LIMITATIONS We found a variability of definitions for SSA that hamper the ability to draw a model for the risk factors and processes that facilitate it. Moreover, the role of suicide intent and planning in SSA is still unclear. Further studies should aim to clarify and refine the concepts and measures of SSA, thereby enabling more specific and concrete modeling of the psychological element in its formation. CONCLUSION SSA is a distinguishable phenomenon that needs to be addressed specifically within the scope of suicidal behavior. Interpersonal problems, as well as impulsivity and aggression, seem to facilitate SSA when mental pain serves as a secondary factor. Healthcare professionals should be aware of SSA, and familiar with its specific risk factors. Moreover, psychological and suicidal risk assessment should include a designated evaluation of these risk factors as part of intervention and prevention models for SSA.
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