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Karnecki K, Gos T, Steiner J, Mańkowski D, Kaliszan M. Epidemiology of suicide in the Tri-City metropolitan area in Poland in 2010-2019. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01548-9. [PMID: 36583739 DOI: 10.1007/s00406-022-01548-9] [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: 10/18/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
The paper, which is a continuation of our previous epidemiological studies on the phenomenon of suicide in the Tri-City metropolitan area, presents the results of statistical analyses of suicides in the autopsy material of the Department of Forensic Medicine of the Medical University of Gdańsk in the years 2010-2019. The purpose of the study was to analyse in detail demographic data of suicides (age, sex, place of death), as well as to assess suicide methods and the impact of alcohol on suicides in the study area. During the 10-year study period, 8495 autopsies were performed, of which 1261 were suicides (14.8%). Statistical analyses were conducted using the statistical data analysis software system STATISTICA, version 13 (StatSoft, Tulsa, Oklahoma, USA). The results of the study indicate a continuing downward trend in the number of suicides since the beginning of the 21th century, with the number of suicides in rural areas increasing over the same period. In the analysed cohort, suicides were committed in particular by middle-aged men and the number of suicides among older people (65 +) increased at the same time. The increase in suicide occurred in late autumn and early spring. The most common method of suicide was hanging. There was a high percentage of inebriated victims (45%), and a comparison of the present studies with previous ones indicates the increasing impact of alcohol on suicide.
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Affiliation(s)
- Karol Karnecki
- Department of Forensic Medicine, Faculty of Medicine, Medical University of Gdańsk, 23 Dębowa St, 80-204, Gdańsk, Poland.
| | - Tomasz Gos
- Department of Forensic Medicine, Faculty of Medicine, Medical University of Gdańsk, 23 Dębowa St, 80-204, Gdańsk, Poland
| | - Johann Steiner
- Department of Psychiatry, Otto-Von-Guericke University, 44 Leipziger St, 39120, Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Otto-Von-Guericke University, Universitätsplatz 2, 39106, Magdeburg, Germany
| | - Dobrosław Mańkowski
- Institute of Sociology, Faculty of Social Sciences, University of Gdańsk, Gdańsk, Poland
| | - Michał Kaliszan
- Department of Forensic Medicine, Faculty of Medicine, Medical University of Gdańsk, 23 Dębowa St, 80-204, Gdańsk, Poland
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Quesada-Franco M, Braquehais MD, Valero S, Beneria A, Ramos-Quiroga JA, Baca-García E, Pintor-Pérez L. A comparison of medically serious suicide attempters admitted to intensive care units versus other medically serious suicide attempters. BMC Psychiatry 2022; 22:805. [PMID: 36536386 PMCID: PMC9762004 DOI: 10.1186/s12888-022-04427-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Medically serious suicide attempts (MSSA) represent a subgroup of clinically heterogeneous suicidal behaviours very close to deaths by suicide. A simple definition of an MSSA is a suicide attempt with life-threatening consequences, regardless of the severity of the attempter's mental disorder. Few studies have specifically analysed the heterogeneity of MSSA. Therefore, the aim of this study is to describe the profile of individuals who made a highly severe MSSA and to compare those admitted to Intensive Care Units (ICU) - including Burn Units- with other MSSA admitted to other medical and surgical units. METHODS The study sample consisted of 168 patients consecutively admitted to non-psychiatric wards from two public hospitals in Barcelona after an MSSA during a 3-year period. In order to select more severe MSSA, the minimum hospital stay was expanded from Beautrais' definition of ≥ 24 h to ≥ 48 h. Mean hospital stay was 23.68 (SD = 41.14) days. Patients needing ICU treatment (n = 99) were compared to other MSSArs (n = 69) that were admitted to other medical and surgical units, not requiring intensive care treatment, with an initial bivariant analysis followed by a logistic regression analysis using conditional entrance. RESULTS Medically serious suicide attempters (MSSArs) spent more time hospitalized, more frequently reported recent stressful life events, were more likely to have at least one prior suicide attempt (SA) and their current attempt was more frequently non-planned, compared to the profile of MSSArs reported in previous studies. The most frequent method was medication overdose (67.3%) and jumping from heights (23.2%). Among those who chose more than one method (37.6%), the most frequent combination was medication overdose and drug use. Affective disorders and personality disorders were the most frequent diagnoses. Higher educational level, history of previous mental disorders and prior lifetime suicide attempts were significantly more frequent among those admitted to ICU compared to other MSSArs. Patients needing admission to ICU less frequently used self-poisoning and cuts. CONCLUSIONS MSSA needing ICU admission can be regarded clinically as similar to attempts resulting in suicide. More research on this type of highly severe suicide behaviour is needed due to its serious implications both from a clinical and public health perspective.
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Affiliation(s)
- Marta Quesada-Franco
- Department of Psychiatry, Hospital Universitari, Vall d'Hebron, Barcelona, Spain. .,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Mª Dolores Braquehais
- grid.430994.30000 0004 1763 0287Psychiatry, Mental Health and Addictions Research Group, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain ,Integral Care Programme for Sick Health Professionals, Galatea Clinic, Barcelona, Spain ,grid.469673.90000 0004 5901 7501Biomedical Network Research Centre On Mental Health (CIBERSAM), Barcelona, Spain ,grid.410675.10000 0001 2325 3084School of Medicine, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Sergi Valero
- grid.410675.10000 0001 2325 3084Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Anna Beneria
- Department of Psychiatry, Hospital Universitari, Vall d’Hebron, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain ,grid.430994.30000 0004 1763 0287Psychiatry, Mental Health and Addictions Research Group, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
| | - J. A. Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari, Vall d’Hebron, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain ,grid.430994.30000 0004 1763 0287Psychiatry, Mental Health and Addictions Research Group, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain ,grid.469673.90000 0004 5901 7501Biomedical Network Research Centre On Mental Health (CIBERSAM), Barcelona, Spain
| | - Enrique Baca-García
- grid.419651.e0000 0000 9538 1950Department of Psychiatry, University Hospital Jimenez Diaz Foundation, Madrid, Spain ,grid.459654.fDepartment of Psychiatry, University Hospital Rey Juan Carlos, Mostoles, Spain ,Department of Psychiatry, General Hospital of Villalba, Madrid, Spain ,grid.411171.30000 0004 0425 3881Department of Psychiatry, University Hospital Infanta Elena, Valdemoro, Spain ,grid.5515.40000000119578126Department of Psychiatry, Madrid Autonomous University, Madrid, Spain ,grid.413448.e0000 0000 9314 1427CIBERSAM (Centro de Investigacion en Salud Mental), Carlos III Institute of Health, Madrid, Spain ,UniversidadCatolica del Maule, Talca, Chile ,grid.411165.60000 0004 0593 8241Department of Psychiatry, Centre Hospitalier Universitaire de Nîmes, Nimes, France
| | - Luis Pintor-Pérez
- grid.5841.80000 0004 1937 0247Department of Psychiatry, Hospital Clinic, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
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Chitty KM, Cvejic RC, Heintze T, Srasuebkul P, Morley K, Dawson A, Carter G, Dinh M, Buckley NA, Trollor JN. The Association Between Problematic Use of Alcohol and Drugs and Repeat Self-Harm and Suicidal Ideation. CRISIS 2022. [PMID: 36073254 DOI: 10.1027/0227-5910/a000880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Aims: We investigated the association between problematic use of alcohol and/or drugs (PUAD) and the incidence, urgency, and mode of discharge for a subsequent episode of self-harm (SH) or suicidal ideation (SI). Methods: This was a retrospective population-based cohort study of individuals admitted to hospital for an index episode of SH/SI (2010-2014) using linked data from hospital admissions and emergency department (ED) presentations. The outcome variables were (1) subsequent presentation to the ED for SH/SI, (2) triage category, and (3) mode of departure. Key predictors were PUAD. Results: In total, 23,007 individuals were admitted to hospital for an index SH/SI, of whom 8% had a subsequent presentation to an ED for SH/SI within a year. The odds of subsequent presentation was increased in those with problematic alcohol use (AOR 1.62, 95% CI 1.36, 1.92), drug use (AOR 1.28, 95% CI 1.07, 1.53), and mental health diagnoses (AOR 1.63, 95% CI 1.44, 1.85). Those with problematic alcohol use were more likely to be assigned to the most urgent triage categories (AOR 1.84, 95% CI 1.32, 2.56). Limitations: Defining SH and PUAD using administrative data is challenging, and the true prevalence is likely to be underestimated. Conclusion: The findings underscore the importance of drug health intervention as a key component of self-harm prevention.
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Affiliation(s)
- Kate M Chitty
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, The University of Sydney, NSW, Australia
| | - Rachael C Cvejic
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Teresa Heintze
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Preeyaporn Srasuebkul
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Kirsten Morley
- Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Andrew Dawson
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, The University of Sydney, NSW, Australia
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Gregory Carter
- Centre for Brain and Mental Health Research, Faculty of Health and Medicine, University of Newcastle, NSW, Australia
| | - Michael Dinh
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Nicholas A Buckley
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, The University of Sydney, NSW, Australia
| | - Julian N Trollor
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, NSW, Australia
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Sher L. The pathophysiology of high-lethality suicide attempts: a vital area of suicide research. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2022; 44:237-238. [PMID: 35239837 PMCID: PMC9169476 DOI: 10.1590/1516-4446-2021-2281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/18/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Leo Sher
- James J. Peters Veterans’ Administration Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Ball J, Crossin R, Boden J, Crengle S, Edwards R. Long-term trends in adolescent alcohol, tobacco and cannabis use and emerging substance use issues in Aotearoa New Zealand. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2060266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jude Ball
- Department of Public Health, University of Otago, Wellington
| | - Rose Crossin
- Department of Population Health, University of Otago, Christchurch
| | - Joseph Boden
- Department of Psychological Medicine, University of Otago, Christchurch
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington
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Marengo L, Douaihy A, Zhong Y, Krancevich K, Brummit B, Sakolsky D, Deal M, Zelazny J, Goodfriend E, Saul M, Murata S, Thoma B, Mansour H, Tew J, Ahmed N, Marsland A, Brent D, Melhem NM. Opioid use as a proximal risk factor for suicidal behavior in young adults. Suicide Life Threat Behav 2022; 52:199-213. [PMID: 34767271 PMCID: PMC10697688 DOI: 10.1111/sltb.12806] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 06/14/2021] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is a concomitant rise in suicide rates with the prevalence of opioids involved in overdose deaths, especially among adolescents and young adults. However, there are limited studies on whether opioid use prospectively predicts suicidal behavior in youth. METHODS Our sample included 183 psychiatric patients (18-30 years) admitted for a suicide attempt (SA), have current suicidal ideation (SI), and psychiatric controls without ideation or attempt (PC). Suicidal behavior was assessed using the Columbia Suicide Severity Rating Scale. We also recruited a healthy control group (HC; n = 40). Patients and controls were followed over a year. ANOVA, regression, and cox regression were used. RESULTS Suicide attempt (β = 0.87, CI [0.1-1.6], p = 0.02) and SI [(β = 0.75, CI [0.03-1.5], p = 0.04) were significantly more likely than HCs to have used opioids in the past year at baseline. Opioid use was associated with increased anxiety symptoms (β = 0.75, CI [0.001-1.5], p = 0.05), PTSD symptoms (β = 3.90, CI [1.1-6.7], p = 0.01), and aggression (β = 0.02, CI [0.01-0.04], p = 0.02). Opioid use in the month prior to hospitalization predicted SA at 6 months (OR = 1.87, CI [1.06-3.31], p = 0.032). CONCLUSIONS Opioid use is a proximal predictor for SA. These findings may help clinicians better identify patients at risk for suicidal behavior, allowing for more personalized treatment approaches.
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Affiliation(s)
- Laura Marengo
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Antoine Douaihy
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yongqi Zhong
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Katie Krancevich
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bradley Brummit
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Meredith Deal
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jamie Zelazny
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Eli Goodfriend
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Melissa Saul
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Stephen Murata
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Brian Thoma
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Hader Mansour
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jamie Tew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Nadeem Ahmed
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Anna Marsland
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Nadine M Melhem
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Kelly LM, Liu RT, Zajac K. Comorbid alcohol-related problems and suicidality disproportionately impact men and emerging adults among individuals with depressive symptoms. J Affect Disord 2021; 293:329-337. [PMID: 34229286 PMCID: PMC8352104 DOI: 10.1016/j.jad.2021.06.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 06/12/2021] [Accepted: 06/19/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Depressive disorders are common among adults with alcohol use disorder and with suicidality; however, demographic differences in comorbid alcohol use disorder, binge drinking, and suicidality are understudied. The objective of this study was to determine the extent to which comorbid suicidality and alcohol use disorders and comorbid suicidality and binge drinking differ by age and gender among adults with depressive symptoms. METHOD The sample included adults (unweighted N=29,460) in the United States who completed the 2015-2018 National Survey of Drug Use and Heath and screened positively for depression. Gender and age groups odds of alcohol use disorder only, suicidality only, and alcohol use disorder+suicidality were compared to neither problem. Similar analyses were conducted for binge drinking. RESULTS Men showed disproportional odds of alcohol use disorder only, all suicidality and alcohol use disorder comorbidities, and binge drinking+active suicidal ideation than women. Emerging adults showed higher odds of: passive and active suicidal ideation only and suicidality+alcohol use disorder than adults 35 and older; binge drinking only, binge drinking+passive suicidal ideation, and binge drinking+active suicidal ideation than all older adults; binge drinking+suicide planning and binge drinking+attempts than adults 50 and older. LIMITATIONS Because participants all reported depression symptoms either at the subclinical or clinical level, demographic differences in suicidality, alcohol use disorder, and binge drinking found in this study cannot be generalized to non-depressed samples. CONCLUSIONS Treatment providers should be aware of disproportionately higher odds of comorbid suicidality and alcohol use disorder, and suicidality and binge drinking among men and emerging adults.
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Affiliation(s)
- Lourah M. Kelly
- University of Connecticut School of Medicine, Farmington, CT, United States
| | - Richard T. Liu
- Massachusetts General Hospital, Boston, MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Kristyn Zajac
- University of Connecticut School of Medicine, Farmington, CT, United States.
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Choflet A, Davidson J, Lee KC, Ye G, Barnes A, Zisook S. A comparative analysis of the substance use and mental health characteristics of nurses who complete suicide. J Clin Nurs 2021; 30:1963-1972. [PMID: 33763857 DOI: 10.1111/jocn.15749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/02/2021] [Indexed: 12/11/2022]
Abstract
AIMS AND OBJECTIVES To describe the substance use and mental health characteristics of nurses who complete suicide compared to non-nurses. BACKGROUND Nurses are at higher risk of suicide than the general population. The relationship between substance use, mental health and suicide in a large sample of nurses in the USA has not been previously described. DESIGN Retrospective observational quantitative analysis. METHODS Suicide data were retrospectively analysed in the Centers for Disease Control and Prevention National Violent Death Reporting System from 2003 to 2017. Data were compared between nurses who died by suicide (n = 2,306) and non-nurses who died by suicide (n = 185,620) using odds ratios calculations and chi-square test of proportions to detect independent risk factors of suicide completion in nurses. This study followed the STROBE guidelines. RESULTS Significant differences between nurses and non-nurses were found. Among decedents for whom substances were implicated as a cause of death, nurses were far more likely to be positive at the time of death for almost all substance classifications. Both male and female nurses were more likely than non-nurses to have a mental health problem reported. Among both female and male nurses, job problems were more prevalent compared to non-nurses (12.8% and 19.9% versus 7.2% and 11.9%, respectively). Female nurses were more likely to have a physical health problem compared to female non-nurses, male nurses and male non-nurses (26.2% versus 21.3%, 22% and 20.4%). CONCLUSION Unique relationships between substance use and mental health exist among nurses who complete suicide which may offer specific opportunities for interventions to reduce suicide. RELEVANCE TO CLINICAL PRACTICE Efforts to address workplace stress, facilitate self-referral for risky substance use, encourage mental health treatment and reduce the stigma associated with seeking help all offer potential interventions to reduce nurse suicide.
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Affiliation(s)
| | - Judy Davidson
- University of California San Diego, San Diego, CA, USA
| | - Kelly C Lee
- University of California San Diego, San Diego, CA, USA
| | - Gordon Ye
- University of California San Diego, San Diego, CA, USA
| | | | - Sidney Zisook
- University of California San Diego, San Diego, CA, USA
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Bailey J, Kalk NJ, Andrews R, Yates S, Nahar L, Kelleher M, Paterson S. Alcohol and cocaine use prior to suspected suicide: Insights from toxicology. Drug Alcohol Rev 2021; 40:1195-1201. [PMID: 33715255 DOI: 10.1111/dar.13260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 12/28/2020] [Accepted: 01/24/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This study investigates whether there is a relationship between alcohol and cocaine use in deaths where suicide by self-injury is the suspected cause of death. METHODS Adults referred by coroners to the Imperial College London Toxicology Unit for toxicological analysis between 2012 and 2016 were reviewed for inclusion criteria. Those who died by self-injury reasoned to be deliberate were included in the analysis. Femoral blood alcohol concentration (BAC) and presence of cocaine or benzoylecognine (a metabolite of cocaine) in blood and/or urine were tabulated and odds ratios calculated. RESULTS A total of 1722 decedents met inclusion criteria. BAC was ≥50 mg/dL in 29% of decedents. Cocaine was detected in 8.4% of cases. The likelihood of testing positive for cocaine increased with BAC and was most frequent between 100 and 199 mg/dL, consistent with moderate to severe intoxication (odds ratio 5.88, 95% confidence interval 3.80, 9.09; P ≤ 0.001) compared to those with BAC <10 mg/dL. DISCUSSION AND CONCLUSIONS This study demonstrates a correlation between increasing BAC and likelihood of cocaine use prior to suspected suicide, up to a level consistent with severe intoxication. Cocaine use was found in a high proportion of cases relative to the general population reporting regular use. This pattern of drug and alcohol use has previously been given little attention in suicide prevention strategies and clinical prioritisation.
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Affiliation(s)
- James Bailey
- Department of Primary Care, King's College London, London, UK
| | - Nicola J Kalk
- Addictions Psychiatry Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Sarah Yates
- Addictions Psychiatry Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - Limon Nahar
- Toxicology Unit, Imperial College London, London, UK
| | - Michael Kelleher
- Addictions Psychiatry Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
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Rizk MM, Herzog S, Dugad S, Stanley B. Suicide Risk and Addiction: The Impact of Alcohol and Opioid Use Disorders. CURRENT ADDICTION REPORTS 2021; 8:194-207. [PMID: 33747710 PMCID: PMC7955902 DOI: 10.1007/s40429-021-00361-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 01/05/2023]
Abstract
Purpose of Review Suicide is a major public health concern and a leading cause of death in the US. Alcohol and opioid use disorders (AUD/OUD) significantly increase risk for suicidal ideation, attempts, and death, and are the two most frequently implicated substances in suicide risk. We provide a brief overview of shared risk factors and pathways in the pathogenesis of AUD/OUD and suicidal thoughts and behaviors. We also review clinical recommendations on inpatient care, pharmacotherapy, and psychotherapeutic interventions for people with AUD/OUD and co-occurring suicidal ideation and behavior. Recent Findings Among people with an underlying vulnerability to risk-taking and impulsive behaviors, chronic alcohol intoxication can increase maladaptive coping behaviors and hinder self-regulation, thereby increasing the risk of suicide. Additionally, chronic opioid use can result in neurobiological changes that lead to increases in negative affective states, jointly contributing to suicide risk and continued opioid use. Despite significantly elevated suicide risk in individuals with AUD/OUD, there is a dearth of research on pharmacological and psychosocial interventions for co-occurring AUD/OUD and suicidal ideation and behavior. Summary Further research is needed to understand the effects of alcohol and opioid use on suicide risk, as well as address notable gaps in the literature on psychosocial and pharmacological interventions to lower risk for suicide among individuals with AUD/OUD.
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Affiliation(s)
- Mina M. Rizk
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
- Department of Psychiatry, Faculty of Medicine, Minia University, Egypt, Egypt
| | - Sarah Herzog
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
| | - Sanjana Dugad
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Barbara Stanley
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
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Bhoge N, Pawar S, Tagad P, Pawar A. Study on suicidal intent and its relationship with psychiatric morbidity in cases of deliberate self-harm. ARCHIVES OF MENTAL HEALTH 2021. [DOI: 10.4103/amh.amh_65_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Widom CS, Li X. The role of psychiatric symptoms and environmental vulnerability factors in explaining the relationship between child maltreatment and suicidality: A prospective investigation. J Affect Disord 2020; 276:720-731. [PMID: 32871705 PMCID: PMC9375955 DOI: 10.1016/j.jad.2020.06.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 05/06/2020] [Accepted: 06/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Childhood maltreatment has been associated with suicide thoughts and attempts; however, few longitudinal studies have assessed risk of suicidality into adulthood. Fewer have examined potential mediators (psychiatric symptoms and environmental vulnerability factors). METHODS Prospective cohort design. Children with documented cases of maltreatment (N = 495, ages 0-11) were matched with non-maltreated children (N = 395) and followed up into adulthood. Psychiatric symptoms (depression, anxiety, dysthymia, post-traumatic stress,antisocial personality,and substance use) and environmental vulnerability (social isolation, physical disability/illness, and homelessness) were assessed at mean age 29 and suicide thoughts and attempts at 39. Structural equation models tested for mediation, controlling for age, sex, race, and IQ. RESULTS Childhood maltreatment predicted suicide attempts (Beta = 0.44, p<0.001), but not suicide thoughts only.Individuals with only suicide thoughts differed significantly from those with suicide attempts in psychiatric symptoms, physical disability/ illness, and homelessness. There were significant paths from child maltreatment to suicide attempts through psychiatric symptoms (0.18, p<0.001), ASPD (0.13, p<0.001), substance use (0.07, p<0.01), and homelessness (0.10, p<0.05). LIMITATIONS Court cases of child maltreatment may not generalize to middle- or upper- class and non-reported cases.Effect sizes were small but significant. CONCLUSIONS Psychiatric risk factors for suicide are well recognized. These new results provide strong evidence that environmental vulnerability factors, particularly homelessness, are associated with increased risk for suicide attempts and warrant attention.Although many people report suicide thoughts, maltreated children with more psychiatric symptoms and experience homelessness are more likely to attempt suicide and warrant targeted interventions.
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Affiliation(s)
- Cathy Spatz Widom
- Psychology Department, John Jay College and City University of New York, New York City, NY, United States.
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13
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Boenisch S, Bramesfeld A, Mergl R, Havers I, Althaus D, Lehfeld H, Niklewski G, Hegerl U. The Role Of Alcohol Use Disorder And Alcohol Consumption In Suicide Attempts-A Secondary Analysis Of 1921 Suicide Attempts. Eur Psychiatry 2020; 25:414-20. [DOI: 10.1016/j.eurpsy.2009.11.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 11/09/2009] [Accepted: 11/09/2009] [Indexed: 10/19/2022] Open
Abstract
AbstractBackgroundIt is not known how characteristics of suicide attempts vary with different forms of alcohol involvement. The aim of this study is to clarify the role of alcohol use disorder and acute alcohol consumption in suicide attempts.MethodsData on 1921 suicide attempts was gathered in a major German city over a 5-year period. Suicide attempts were categorised according to a diagnosis of alcohol use disorder and acute alcohol consumption at the time of the attempt. Group comparisons and multinomial logistic regression were used for statistical analysis.ResultsIn 331 suicide attempts (17%) an alcohol use disorder was diagnosed. Six hundred and twenty-two suicide attempts (32%) were committed with acute alcohol consumption. Suicide attempts by individuals with alcohol use disorder were more often committed by men, older individuals and as a recurrent attempt, independently of alcohol consumption at the time of the attempt. When alcohol was consumed in suicide attempts by individuals with alcohol use disorder, low-risk methods were used most often.ConclusionsIndividuals with a diagnosis of alcohol use disorder are a high-risk group for multiple suicide attempts and should be a target group for suicide prevention. Screening for suicidality should be a regular part of the clinical assessment in individuals with alcohol use disorder.
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Perez J, Beale E, Overholser J, Athey A, Stockmeier C. Depression and alcohol use disorders as precursors to death by suicide. DEATH STUDIES 2020; 46:619-627. [PMID: 32238058 DOI: 10.1080/07481187.2020.1745954] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The combined presence of depression with alcohol abuse can increase suicide risk. We used psychological autopsy to evaluate 101 individuals who died by suicide, to understand relationships between stressful life events, alcohol abuse, and depression. As compared to suicidal adults with depression only, individuals meeting criteria for both a depressive disorder and alcohol use disorder tended to be younger and experienced higher rates of stressful life events during the six months prior to death. Alcohol abuse likely influences interpersonal conflict, financial distress, and legal problems. Interventions focusing on managing life problems may help to reduce suicide risk.
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Affiliation(s)
- Jalessa Perez
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Eleanor Beale
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - James Overholser
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alison Athey
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Craig Stockmeier
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Psychiatry and Human Behavior, Division of Neurobiology and Behavior Research, Translational Research Center (TR415), University of Mississippi Medical Center, Cleveland, Ohio, USA
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15
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16
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Kim DW, Cho SE, Kang JM, Woo SK, Kang SG, Yeon BK, Cho SJ. Risk Factors for Serious Suicide Attempts: Difference Between Older and Younger Attempters in the Emergency Department. Front Psychiatry 2020; 11:607811. [PMID: 33488429 PMCID: PMC7820120 DOI: 10.3389/fpsyt.2020.607811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/07/2020] [Indexed: 01/11/2023] Open
Abstract
Objective: Suicide attempts of the older adults are known to be more serious than that of the younger adults. Despite its major social impact in South Korea, the behavioral mechanism of serious suicide attempt (SSA) in old people remains to be elucidated. Thus, we investigated the risk factors for SSA in older and younger suicide attempters in the emergency department. Methods: Demographic data, clinical information, and the level of seriousness of suicide with Risk Rescue Rating Scale were compared between older (age ≥65) and younger (age <65) adults who visited the emergency department for a suicide attempt. Regression analyses were performed to identify the risk factors for SSA in these two groups. Results: Among 370 patients, 37 were older adults (10%; aged 74.41 ± 6.78), more likely to have another medical disease (p < 0.001), and a higher suicide completion rate (16.2 vs. 5.4%, p = 0.023). In the younger group, old age (B = 0.090, p < 0.001), male sex (B = -0.038, p = 0.019), and impression of schizophrenia (B = 0.074, p = 0.027) were associated with a higher risk-rescue ratio and interpersonal stress condition was associated with a lower risk-rescue ratio (B = -0.045, p = 0.006). In the older group, however, no variables were included significant in the regression model for the Risk Rescue Rating Scale. Conclusions: Demographic and clinical factors such as old age, male sex, interpersonal stress, and impression of schizophrenia were associated with lethality in the younger suicide attempters. However, no factors were associated with SSA in the older adult group. Different mechanisms may underly the lethality in old age suicide.
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Affiliation(s)
- Dong Wook Kim
- College of Medicine, Gachon University, Incheon, South Korea
| | - Seo Eun Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Jae Myeong Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Soo Kyun Woo
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Seung-Gul Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Byeong Kil Yeon
- Department of Psychiatry, Gyeonggi Provincial Medical Center Suwon Hospital, Suwon, South Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
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17
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Gauthier JM, Cole AB, Bagge CL. A preliminary examination of the association between drinking as a typical coping strategy and level of acute alcohol consumption prior to a suicide attempt. Psychiatry Res 2019; 282:112626. [PMID: 31685287 PMCID: PMC6923992 DOI: 10.1016/j.psychres.2019.112626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/17/2019] [Accepted: 10/19/2019] [Indexed: 01/02/2023]
Abstract
Drinking to cope is associated with suicide ideation and attempts. Event-based research shows drinking, particularly when alcohol is consumed in large quantities, increases the intensity of suicidal thoughts and immediate risk for attempt. Such findings suggest those who typically drink to cope may be especially likely to drink heavily in the hours preceding a suicide attempt. In the first examination of the association between regular use of alcohol as a coping strategy and acute alcohol consumption prior to a suicide attempt, participants included 130 patients hospitalized for a recent attempt. The number of drinks consumed in the acute period preceding the attempt, as well as past-year heavy drinking frequency, typical drinking motives, and depressive symptoms were assessed. The unique impacts of coping motives on odds of consuming any alcohol, and of using specific amounts of alcohol in the acute period, were determined through binary and multinomial logistic regressions. Results demonstrated that commonly drinking for coping motives increased the odds of heavy drinking - but not of using alcohol at low levels - during the acute period. Results held after adjusting for relevant covariates. Clinicians should assess drinking motives and prioritize prevention of drinking to cope to reduce risk of alcohol-related suicide attempts.
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Affiliation(s)
- Jami M Gauthier
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States; Substance Abuse Treatment Program, Atlanta VA Medical Center, Atlanta, GA, United States.
| | - Ashley B Cole
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States; Department of Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Courtney L Bagge
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States; Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, MI, United States; Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, MI, United States
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18
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O'Brien S, Nicolas MD, Bhutiani N, Schucht JE, Stollo B, Miller KR, Benns MV, Nash NA, Franklin GA, Smith JW, Harbrecht BG, Bozeman MC. Self-Inflicted Stab Wounds: A Single-Center Experience from 2010 to 2016. Am Surg 2019. [DOI: 10.1177/000313481908500619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite low mortality rates, self-inflicted stab wounds (SISWs) can result in significant morbidity and often reflect underlying substance abuse and mental health disorders. This study aimed to characterize demographics, comorbidities, and outcomes seen in self-inflicted stabbings and compare these metrics to those seen in assault stabbings. A Level I trauma center registry was queried for patients with stab injuries between January 2010 and December 2015. Classification was based on whether injuries were SISWs or the result of assault stab wounds (ASWs). Demographic, injury, and outcome measures were recorded. Differences between genders, ethnicities, individuals with and without psychiatric comorbidities, and SISW and ASW patients were assessed. Within the SIWS cohort, no differences were found when comparing age, gender, or race, including need for operative intervention. However, patients with psychiatric histories were less likely to have a positive toxicology test on arrival than those without psychiatric histories (22% vs. 0%, P = 0.04). When compared with 460 ASW patients, SISW were older (41 vs. 35, P < 0.001), more likely to be white (92% vs. 64%, P < 0.001), more likely to have a psychiatric history (15% vs. 4%, P < 0.001), require operative intervention (65% vs. 50%, P = 0.008), and be discharged to a psychiatric facility (47% vs. 0.2%, P < 0.001). SISW patients have higher rates of psychiatric illness and an increased likelihood to require operative intervention as compared with ASW patients. This population demonstrates an acute need for both inpatient and outpatient psychiatric care with early involvement of multidisciplinary teams for treatment and discharge planning.
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Affiliation(s)
- Stephen O'Brien
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Mark D. Nicolas
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Neal Bhutiani
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Jessica E. Schucht
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Brian Stollo
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Keith R. Miller
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Matthew V. Benns
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Nicholas A. Nash
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Glen A. Franklin
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Jason W. Smith
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Brian G. Harbrecht
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Matthew C. Bozeman
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky
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Kalk NJ, Kelleher MJ, Curtis V, Morley KI. Addressing substance misuse: a missed opportunity in suicide prevention. Addiction 2019; 114:387-388. [PMID: 30307070 DOI: 10.1111/add.14463] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Nicola J Kalk
- South London and Maudsley NHS Foundation Trust/Clinical Lecturer, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael J Kelleher
- Lambeth Addictions Consortium, South London and Maudsley NHS Foundation Trust/Public Health England Adviser Alcohol and Tobacco, London, UK
| | - Vivienne Curtis
- Centralised Place of Safety, South London and Maudsley NHS Foundation Trust/Honorary Consultant Senior Lecturer, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, USA
| | - Katherine I Morley
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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20
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Sher L, Rutter SB, New AS, Siever LJ, Hazlett EA. Gender differences and similarities in aggression, suicidal behaviour, and psychiatric comorbidity in borderline personality disorder. Acta Psychiatr Scand 2019; 139:145-153. [PMID: 30353921 DOI: 10.1111/acps.12981] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We examined gender differences and similarities in aggression, impulsivity, suicidal behaviour, and psychiatric comorbidity in men and women with borderline personality disorder (BPD) compared with healthy controls. METHOD A community sample of 511 participants (healthy controls: 81 men and 82 women; BPD patients: 145 men and 203 women) were rigorously characterized using structured diagnostic interviews and symptom severity assessments. RESULTS In comparison with women with BPD, men were less educated, had higher total Barratt Impulsivity Scale (BIS), BIS-motoric impulsiveness and BIS-non-planning impulsiveness subscale, total Buss-Perry Aggression Questionnaire (BPAQ), and BPAQ-physical aggression subscale scores. Men with BPD were more likely to have comorbid narcissistic, antisocial, paranoid, and schizotypal personality disorders, alcohol and substance use disorders but less likely to have dependent and obsessive-compulsive personality disorders compared to women with BPD. There was a trend toward higher maximum lethality of suicide attempts in men suicide attempters compared with women suicide attempters but no difference between men and women with regard to the proportion of suicide attempters or the number of suicide attempts. CONCLUSION Men with BPD are more impaired and may be at higher risk of dying by suicide compared to women with BPD.
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Affiliation(s)
- L Sher
- James J. Peters Veterans' Administration Medical Center, Bronx, New York, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S B Rutter
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A S New
- James J. Peters Veterans' Administration Medical Center, Bronx, New York, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - L J Siever
- James J. Peters Veterans' Administration Medical Center, Bronx, New York, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - E A Hazlett
- James J. Peters Veterans' Administration Medical Center, Bronx, New York, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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21
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The role of substance use, smoking, and inflammation in risk for suicidal behavior. J Affect Disord 2019; 243:33-41. [PMID: 30223137 PMCID: PMC6241516 DOI: 10.1016/j.jad.2018.09.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/09/2018] [Accepted: 09/06/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Alcohol and substance use disorders are important predictors for suicidal behavior. However, the role of individual substances as proximal risk factors for suicidal behavior and the mechanisms through which substance use affect risk are not entirely clear. We examine whether the frequency of substance use and whether biological markers in the HPA axis and inflammatory pathways are associated with clinical risk factors of suicidal behavior of aggression, impulsivity, hopelessness, and poor sleep. METHODS The sample consisted of psychiatric inpatients, aged 15-30 years, admitted for suicide attempt (n = 38), suicidal ideation (n = 40); and healthy controls (n = 37). We measured hair cortisol concentrations, glucocorticoid receptor (GR) sensitivity, stimulated production of interleukin- or IL-6, C-reactive protein, and mRNA expression of GR, SKA2, FKBP5, TNF-α, and IL-1β. RESULTS Smoking was associated with increased aggression [β = 2.9, 95% CI (-0.03, 6), p = 0.05], impulsivity [β = 3.1, 95% CI (1.6, 4.6), p < 0.001], and poor sleep [β = 0.5, 95% CI (0.03, 0.95), p = 0.04] even after controlling for demographics and group. Similarly, TNF-α mRNA was associated with impulsivity [β = 0.07, 95% CI (0.01, 0.1), p = 0.02] and hopelessness [β = 0.03, 95% CI (0.004, 0.05), p = 0.03]. Smoking tobacco (r = 0.32, p < 0.001) was positively associated with TNF-α mRNA. LIMITATIONS Study limitations include the cross-sectional design, retrospective assessment, and relatively small sample size. CONCLUSIONS Future longitudinal studies are needed to test whether inflammatory markers mediate the relationships between smoking, clinical risk factors, and suicidal behavior; and to examine whether smoking cessation could reduce the risk for suicidal behavior in at-risk patients.
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22
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Factors Affecting Suicide Method Lethality Among Suicide Attempters in the Korea National Suicide Survey. J Nerv Ment Dis 2018; 206:202-210. [PMID: 28902068 DOI: 10.1097/nmd.0000000000000735] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This is the first national survey study in South Korea investigating the relationship between suicide lethality and the clinical information of suicide attempters. An interview questionnaire was used to assess their sociodemographic factors, medical and psychiatric information, and two suicide scales, the Columbia-Suicide Severity Rating Scale and the Suicide Intent Scale. Suicide methods were categorized as low and high lethality; low lethality covered drug overdose or self-cutting behavior, and high lethality covered all other methods. High and low lethality suicide method groups were significantly different in demographic, medical, and psychiatric factors. The two scale score distributions differed significantly across two groups, and the difference was also valid for the subcategory analyses of the Suicide Intent Scale. Multiple factors such as older age, male sex, no previous psychiatric history, and previous suicide attempt, as well as high suicide intent by means of suicide scale, affect selection of suicide method of high lethality.
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Borges G, Cherpitel CJ, Orozco R, Ye Y, Monteiro M, Hao W, Benegal V. A dose-response estimate for acute alcohol use and risk of suicide attempt. Addict Biol 2017; 22:1554-1561. [PMID: 27507572 DOI: 10.1111/adb.12439] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/14/2016] [Accepted: 07/22/2016] [Indexed: 11/27/2022]
Abstract
This study reports dose-response estimates for the relative risk and population attributable risk (PAR) between acute alcohol use and serious suicide attempt. Data were analyzed on 272 suicide attempters arriving at 38 emergency departments within 6 hours of the event in 17 countries. Case-crossover analysis, pair-matching the number of standard drinks consumed within the 6 hours prior to the suicide attempt with that consumed during the same 6-hour period of the previous week, was performed using fractional polynomial analysis for dose-response. Every drink increased the risk of a suicide attempt by 30 percent; even one-two drinks was associated with a sizable increase in the risk of a serious suicide attempt, and a dose-response was found for the relationship between drinking 6 hours prior and the risk of a suicide attempt up to 20 drinks. Acute use of alcohol was responsible for 35 percent PAR of all suicide attempts. While very high levels of drinking were associated with larger relative risk s of suicide attempt, the control and reduction of smaller quantities of acute alcohol use also had an impact on population levels of suicide attempt, as showed here for the first time with our PAR estimates. Interventions to stop drinking or at least decrease levels of consumption could reduce the risk of suicide attempt. Screening people more at risk to suffer these acute effects of ethanol and offering interventions that work to these high-risk groups are a matter of urgent new research in the area.
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Affiliation(s)
- Guilherme Borges
- National Institute of Psychiatry Ramon de la Fuente; Mexico City Mexico
| | | | - Ricardo Orozco
- National Institute of Psychiatry Ramon de la Fuente; Mexico City Mexico
| | - Yu Ye
- Alcohol Research Group; Emeryville CA USA
| | | | - Wei Hao
- Central South University; Hunan China
| | - Vikram Benegal
- National Institute of Mental Health and Neurosciences; Bangalore India
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Sher L, Grunebaum MF, Burke AK, Chaudhury S, Mann JJ, Oquendo MA. Depressed Multiple-SuicideAttempters – A High-Risk Phenotype. CRISIS 2017; 38:367-375. [DOI: 10.1027/0227-5910/a000475] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abstract. Background: There is compelling evidence that suicide attempts are among the strongest predictors of suicide and future suicide attempts. Aim: This study aimed to examine psychopathology in multiple-suicide attempters. Method: We compared the demographic and clinical features of three groups: depressed patients without a history of suicide attempts (non-attempters), depressed patients with a history of one to three suicide attempts (attempters), and depressed patients with a history of four or more suicide attempts (multiple attempters). Results: We found that attempters and multiple attempters had higher levels of depression, hopelessness, aggression, hostility, and impulsivity and were more likely to have borderline personality disorder and family history of major depression or alcohol use disorder compared with non-attempters, but did not differ between each other on these measures. Multiple attempters had greater suicidal ideation at study entry and were more likely to have family history of suicide attempt compared with attempters. Importantly, multiple attempters had greater suicide intent at the time of the most medically serious suicide attempt and more serious medical consequences during their most medically serious suicide attempt compared with attempters. Limitations: The cross-sectional design of the study. Conclusion: Our data suggest that multiple-suicide attempters require careful evaluation as their behavior can have serious medical consequences.
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Affiliation(s)
- Leo Sher
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
- James J. Peters Veterans' Administration Medical Center and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael F. Grunebaum
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ainsley K. Burke
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Sadia Chaudhury
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - J. John Mann
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Maria A. Oquendo
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Larkin C, Griffin E, Corcoran P, McAuliffe C, Perry IJ, Arensman E. Alcohol Involvement in Suicide and Self-Harm. CRISIS 2017; 38:413-422. [DOI: 10.1027/0227-5910/a000488] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Abstract. Background: Alcohol misuse and alcohol consumption are significant risk factors for suicidal behavior. Aims: This study sought to identify factors associated with alcohol consumption in cases of suicide and nonfatal self-harm presentations. Method: Suicide cases in Cork, Ireland, from September 2008 to June 2012 were identified through the Suicide Support and Information System. Emergency department presentations of self-harm in the years 2007–2013 were obtained from the National Self-Harm Registry Ireland. Results: Alcohol consumption was detected in the toxicology of 44% out of 307 suicide cases. Only younger age was significantly associated with having consumed alcohol among suicides. Alcohol consumption was noted in the case notes in 21% out of 8,145 self-harm presentations. Logistic regression analyses indicated that variables associated with having consumed alcohol in a self-harm presentation included male gender, older age, overdose as a method, not being admitted to a psychiatric ward, and presenting out-of-hours. Limitations: Data was limited to routinely collected variables by the two different monitoring systems. Conclusion: Alcohol consumption commonly precedes suicidal behavior, and several factors differentiated alcohol-related suicidal acts. Self-harm cases, in particular, differ in profile when alcohol is consumed and may require a tailored clinical approach to minimize risk of further nonfatal or fatal self-harm.
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Affiliation(s)
| | - Eve Griffin
- National Suicide Research Foundation, Cork, Ireland
| | - Paul Corcoran
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University College Cork, Ireland
| | | | - Ivan J. Perry
- School of Public Health, University College Cork, Ireland
| | - Ella Arensman
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University College Cork, Ireland
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Hartnett D, Murphy E, Kehoe E, Agyapong V, McLoughlin DM, Farren C. Supportive text messages for patients with alcohol use disorder and a comorbid depression: a protocol for a single-blind randomised controlled aftercare trial. BMJ Open 2017; 7:e013587. [PMID: 28554910 PMCID: PMC5729994 DOI: 10.1136/bmjopen-2016-013587] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Alcohol use disorders (AUDs) and mood disorders commonly co-occur, and are associated with a range of negative outcomes for patients. Mobile phone technology has the potential to provide personalised support for such patients and potentially improve outcomes in this difficult-to-treat cohort. The aim of this study is to examine whether receiving supporting SMS text messages, following discharge from an inpatient dual diagnosis treatment programme, has a positive impact on mood and alcohol abstinence in patients with an AUD and a comorbid mood disorder. METHODS AND ANALYSIS The present study is a single-blind randomised controlled trial. Patients aged 18-70 years who meet the criteria for both alcohol dependency syndrome/alcohol abuse and either major depressive disorder or bipolar disorder according to the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV Axis I will be randomised to receive twice-daily supportive SMS text messages for 6 months plus treatment as usual, or treatment as usual alone, and will be followed-up at 3, 6, 9 and 12 months postdischarge. Primary outcome measures will include changes from baseline in cumulative abstinence duration, which will be expressed as the proportion of days abstinent from alcohol in the preceding 90 days, and changes from baseline in Beck Depression Inventory scores. ETHICS AND DISSEMINATION The trial has received full ethical approval from the St. Patrick's Hospital Research Ethics Committee (protocol 13/14). Results of the trial will be disseminated through peer-reviewed journal articles and at academic conferences. TRIAL REGISTRATION NUMBER NCT02404662; Pre-results.
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Affiliation(s)
- Dan Hartnett
- Discipline of Psychiatry, School of Medicine, University of Dublin Trinity College, Dublin, Ireland
| | - Edel Murphy
- Discipline of Psychiatry, School of Medicine, University of Dublin Trinity College, Dublin, Ireland
| | - Elizabeth Kehoe
- Discipline of Psychiatry, School of Medicine, University of Dublin Trinity College, Dublin, Ireland
| | - Vincent Agyapong
- Department of Psychiatry, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Declan M McLoughlin
- Discipline of Psychiatry, School of Medicine, University of Dublin Trinity College, Dublin, Ireland
| | - Conor Farren
- Discipline of Psychiatry, School of Medicine, University of Dublin Trinity College, Dublin, Ireland
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Park CHK, Yoo SH, Lee J, Cho SJ, Shin MS, Kim EY, Kim SH, Ham K, Ahn YM. Impact of acute alcohol consumption on lethality of suicide methods. Compr Psychiatry 2017; 75:27-34. [PMID: 28288368 DOI: 10.1016/j.comppsych.2017.02.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/26/2017] [Accepted: 02/26/2017] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The influence of acute alcohol consumption on the factors related to suicide remains understudied. Thus, the present study investigated the relationship between blood alcohol content (BAC) and the lethality of suicide methods. METHODS Autopsy data on 315 South Korean suicide completers with a positive BAC were collected from a nationwide pool between May 2015 and November 2015, and the methods were dichotomised as suicide methods of low lethality (SMLL; drug/chemical overdose and sharp objects, n=67) and suicide methods of high lethality (SMHL; everything else, n=243). BAC at the time of autopsy and various suicide-related factors of these two groups were compared with logistic regression analyses. RESULTS Compared to suicide completers with a BAC in the lowest range of 0.011-0.049%, suicide completers with a BAC in the range of 0.150-0.199% were more likely to use SMHL (odds ratio [OR]: 3.644, 95% confidence interval [CI]: 1.221-10.874). Additionally, the adoption of SMHL was significantly associated with the absence of a psychiatric illness (OR: 0.433, 95% CI: 0.222-0.843) and a younger age; the OR for high BAC among subjects in their 40s was 0.266 (95% CI: 0.083-0.856); in their 50s, 0.183 (95% CI: 0.055-0.615); and in their 60s, 0.057 (95% CI: 0.015-0.216). CONCLUSIONS The relationship between BAC and suicide method lethality was represented by a bell-shaped pattern in which suicide methods of high lethality were more likely to be used by suicide completers with mid-range BAC levels. The increased impulsivity and impairments in particular executive functions, including planning and organization, associated with acute alcohol use may influence the selection of a particular suicide method based on its lethality.
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Affiliation(s)
- C Hyung Keun Park
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Seong Ho Yoo
- Institute of Forensic Medicine and Department of Forensic Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Jaewon Lee
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Sung Joon Cho
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Min-Sup Shin
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Eun Young Kim
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Mental Health Center, Seoul National University Health Care Center, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
| | - Se Hyun Kim
- Department of Neuropsychiatry, Dongguk University International Hospital, Dongguk University Medical School, 27 Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 10326, Republic of Korea.
| | - Keunsoo Ham
- Psychological Forensics Division, National Forensic Service, 10 Ipchun-ro, Wonju-si, Gangwon-do 26460, Republic of Korea.
| | - Yong Min Ahn
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
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Kiraly DD, Sher L. Suicidal behavior in a medical professional with comorbid depression and substance use disorder: an educational case report. Int J Adolesc Med Health 2016; 27:231-3. [PMID: 25411994 DOI: 10.1515/ijamh-2015-5017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 08/21/2014] [Indexed: 11/15/2022]
Abstract
Here, we publish a report of a previously practicing nurse practitioner who presented to a community hospital with severely depressed mood and neurovegetative symptoms in the context of recent relapse to alcohol and cocaine abuse. This patient had a long history of depression and polysubstance abuse. Additionally, the patient had a history of multiple previous suicide attempts with a high possibility for lethality. All of his attempts occurred in the setting of depression, escalating substance use, and interpersonal difficulties. Due to his chronic struggles with mental health and substance abuse issues, the patient lost his marriage, many close friends, and, eventually, his license to practice medicine. In this report, we highlight the increased risk of suicidal behavior or completed suicide in patients with co-occurring depressive and substance abuse disorders. We also look to highlight the often unmet need of mental health and substance abuse treatment for healthcare professionals. Studies suggest that healthcare providers experience increasing rates of burnout, mood and anxiety disorders, and substance use disorders, but available treatment resources remain scarce. This is a serious public health issue that will require increased vigilance by the community at large to ensure the safety and wellbeing of both patients and their providers.
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Mergl R, Koburger N, Heinrichs K, Székely A, Tóth MD, Coyne J, Quintão S, Arensman E, Coffey C, Maxwell M, Värnik A, van Audenhove C, McDaid D, Sarchiapone M, Schmidtke A, Genz A, Gusmão R, Hegerl U. What Are Reasons for the Large Gender Differences in the Lethality of Suicidal Acts? An Epidemiological Analysis in Four European Countries. PLoS One 2015; 10:e0129062. [PMID: 26147965 PMCID: PMC4492725 DOI: 10.1371/journal.pone.0129062] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 05/04/2015] [Indexed: 11/18/2022] Open
Abstract
Background In Europe, men have lower rates of attempted suicide compared to women and at the same time a higher rate of completed suicides, indicating major gender differences in lethality of suicidal behaviour. The aim of this study was to analyse the extent to which these gender differences in lethality can be explained by factors such as choice of more lethal methods or lethality differences within the same suicide method or age. In addition, we explored gender differences in the intentionality of suicide attempts. Methods and Findings Methods. Design: Epidemiological study using a combination of self-report and official data. Setting: Mental health care services in four European countries: Germany, Hungary, Ireland, and Portugal. Data basis: Completed suicides derived from official statistics for each country (767 acts, 74.4% male) and assessed suicide attempts excluding habitual intentional self-harm (8,175 acts, 43.2% male). Main Outcome Measures and Data Analysis. We collected data on suicidal acts in eight regions of four European countries participating in the EU-funded “OSPI-Europe”-project (www.ospi-europe.com). We calculated method-specific lethality using the number of completed suicides per method * 100 / (number of completed suicides per method + number of attempted suicides per method). We tested gender differences in the distribution of suicidal acts for significance by using the χ2-test for two-by-two tables. We assessed the effect sizes with phi coefficients (φ). We identified predictors of lethality with a binary logistic regression analysis. Poisson regression analysis examined the contribution of choice of methods and method-specific lethality to gender differences in the lethality of suicidal acts. Findings Main Results Suicidal acts (fatal and non-fatal) were 3.4 times more lethal in men than in women (lethality 13.91% (regarding 4106 suicidal acts) versus 4.05% (regarding 4836 suicidal acts)), the difference being significant for the methods hanging, jumping, moving objects, sharp objects and poisoning by substances other than drugs. Median age at time of suicidal behaviour (35–44 years) did not differ between males and females. The overall gender difference in lethality of suicidal behaviour was explained by males choosing more lethal suicide methods (odds ratio (OR) = 2.03; 95% CI = 1.65 to 2.50; p < 0.000001) and additionally, but to a lesser degree, by a higher lethality of suicidal acts for males even within the same method (OR = 1.64; 95% CI = 1.32 to 2.02; p = 0.000005). Results of a regression analysis revealed neither age nor country differences were significant predictors for gender differences in the lethality of suicidal acts. The proportion of serious suicide attempts among all non-fatal suicidal acts with known intentionality (NFSAi) was significantly higher in men (57.1%; 1,207 of 2,115 NFSAi) than in women (48.6%; 1,508 of 3,100 NFSAi) (χ2 = 35.74; p < 0.000001). Main limitations of the study Due to restrictive data security regulations to ensure anonymity in Ireland, specific ages could not be provided because of the relatively low absolute numbers of suicide in the Irish intervention and control region. Therefore, analyses of the interaction between gender and age could only be conducted for three of the four countries. Attempted suicides were assessed for patients presenting to emergency departments or treated in hospitals. An unknown rate of attempted suicides remained undetected. This may have caused an overestimation of the lethality of certain methods. Moreover, the detection of attempted suicides and the registration of completed suicides might have differed across the four countries. Some suicides might be hidden and misclassified as undetermined deaths. Conclusions Men more often used highly lethal methods in suicidal behaviour, but there was also a higher method-specific lethality which together explained the large gender differences in the lethality of suicidal acts. Gender differences in the lethality of suicidal acts were fairly consistent across all four European countries examined. Males and females did not differ in age at time of suicidal behaviour. Suicide attempts by males were rated as being more serious independent of the method used, with the exceptions of attempted hanging, suggesting gender differences in intentionality associated with suicidal behaviour. These findings contribute to understanding of the spectrum of reasons for gender differences in the lethality of suicidal behaviour and should inform the development of gender specific strategies for suicide prevention.
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Affiliation(s)
- Roland Mergl
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Saxonia, Germany
| | - Nicole Koburger
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Saxonia, Germany
| | - Katherina Heinrichs
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Saxonia, Germany
| | - András Székely
- Institute of Behavioral Sciences, Semmelweis University Budapest, Budapest, Hungary
| | - Mónika Ditta Tóth
- Institute of Behavioral Sciences, Semmelweis University Budapest, Budapest, Hungary
| | - James Coyne
- Department of Health Psychology, University Medical Center, Groningen, the Netherlands
| | - Sónia Quintão
- CEDOC, Department of Psychiatry and Mental Health, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ella Arensman
- National Suicide Research Foundation and Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Claire Coffey
- National Suicide Research Foundation and Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, Scotland, United Kingdom
| | - Airi Värnik
- Estonian-Swedish Mental Health and Suicidology Institute and Tallinn University, Tallinn, Estonia
| | - Chantal van Audenhove
- LUCAS Center for care research and consultancy at Katholieke Universiteit Leuven, University of Leuven, Leuven, Belgium
| | - David McDaid
- London School of Economics, London, United Kingdom
| | - Marco Sarchiapone
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy, National Institute for Health, Migration and Poverty, Rome, Italy & University “Gabriele d’Annunzio” Foundation, Chieti, Italy
| | - Armin Schmidtke
- Department of Psychiatry, Psychosomatics and Psychotherapy, Universität Würzburg, Würzburg, Germany
| | - Axel Genz
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Ricardo Gusmão
- Department of Psychiatry and Mental Health, CEDOC, Universidade Nova de Lisboa & ISPUP, Institute of Public Health, University of Porto, Porto, Portugal
| | - Ulrich Hegerl
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Saxonia, Germany
- * E-mail:
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Jiménez-Treviño L, Saiz PA, Corcoran P, Burón P, García-Portilla MP, Chinea ER, Navio M, Fernández V, Jimenez-Arriero MA, Gracia R, Bobes J. Factors associated with hospitalization after suicide spectrum behaviors: results from a multicenter study in Spain. Arch Suicide Res 2015; 19:17-34. [PMID: 24810383 DOI: 10.1080/13811118.2013.824841] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective of this study was to identify factors associated with hospital admission after suicide spectrum behaviors. Patients' characteristics, the nature of the suicidal behavior, admission rates between centers, and factors associated with admission have been examined in suicide spectrum presentations to emergency departments in 3 Spanish cities. The intent of the suicidal behavior had the greatest impact on hospitalization. Older age, living alone, self-harm method not involving drug overdose, previous history of suicide spectrum behaviors, and psychiatric diagnosis of schizophrenia, mood, or personality disorder were independently associated with being admitted. There was a 3-fold between-center difference in the rate of hospitalization. Widespread differences in the rate of hospitalization were primarily accounted for by characteristics of the individual patients and their suicidal behavior.
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Dissociation et passage à l’acte violent : une revue de littérature. EVOLUTION PSYCHIATRIQUE 2015. [DOI: 10.1016/j.evopsy.2014.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Developing an integrated, Internet-based self-help programme for young people with depression and alcohol use problems. Internet Interv 2014. [DOI: 10.1016/j.invent.2014.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Deady M, Teesson M, Kay-Lambkin F, Mills KL. Evaluating a brief, internet-based intervention for co-occurring depression and problematic alcohol use in young people: protocol for a randomized controlled trial. JMIR Res Protoc 2014; 3:e6. [PMID: 24583824 PMCID: PMC3961749 DOI: 10.2196/resprot.3192] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/16/2014] [Accepted: 01/19/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Depression and alcohol misuse represent two of the major causes of disease burden in young adults. These conditions frequently co-occur and this co-occurrence is associated with increased risks and poorer outcomes than either disorder in isolation. Integrated treatments have been shown to be effective, however, there remains a significant gap between those in need of treatment and those receiving it, particularly in young people. The increased availability of Internet-based programs to complement health care presents a unique opportunity in the treatment of these conditions. OBJECTIVE The objective of our study was to evaluate whether a brief, Internet-based, self-help intervention (the DEAL [DEpression-ALcohol] Project) can be effective in treating co-occurring depression and problematic alcohol use in young people (18-25 years old). METHODS The evaluation will take the form of a randomized controlled trial (RCT), comparing the DEAL Project with an attention-control condition (HealthWatch). The RCT will consist of a four-week intervention phase and a 24-week follow-up. It will be entirely Internet-based and open Australia-wide to young people 18 to 25 years old. The primary outcomes will be change in depression symptoms and alcohol use at 5, 12, and 24 weeks post baseline. Secondary outcomes include change in general functioning and quality of life, anxiety/stress symptomatology, and a number of other depression/alcohol related outcomes. Process analysis will also measure engagement across the conditions. RESULTS This study is currently ongoing with preliminary results expected in late 2014. CONCLUSIONS This study, to our knowledge, will be the first RCT of a Internet-based treatment for comorbid depression and problematic alcohol use in any age group. If successful, the program represents a novel and innovative approach to addressing the significant harms associated with these conditions and will be an invaluable resource to those not receiving help elsewhere. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry; ACTRN12613000033741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363461 (Archived by WebCite at http://www.webcitation.org/6Mrg9VFX4).
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Affiliation(s)
- Mark Deady
- National Drug and Alcohol Research Centre, University of New South Wales (UNSW), Sydney, Australia.
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Cheung YTD, Wong PWC, Lee AM, Lam TH, Fan YSS, Yip PSF. Non-suicidal self-injury and suicidal behavior: prevalence, co-occurrence, and correlates of suicide among adolescents in Hong Kong. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1133-44. [PMID: 23262815 DOI: 10.1007/s00127-012-0640-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 12/05/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite increasing concern over the prevalence of non-suicidal self-injury (NSSI) among adolescents, there is debate about its classification as a stand-alone psychiatric diagnosis. This study investigated the patterns, co-occurrence, and correlates of NSSI and other suicidal behaviors among a representative community sample of in-school adolescents. METHODS A cross-sectional survey of 2,317 adolescents was conducted. Participants were asked to self-report NSSI, suicidal ideation, suicide attempt, and psychosocial conditions over the past 12 months. Logistic regression and cumulative logit modeling analyses were conducted to investigate the different and similar correlates among these self-harm behaviors. RESULTS The age-standardized prevalence rates of NSSI among male and female adolescents were estimated to be 13.4 and 19.7 %, respectively, compared with 11.1 and 10.1 % for male and female suicide attempt. Only a small proportion engaged in NSSI exclusively in the past year. NSSI by burning or reckless and risky behaviors, frequent drinking, and sexual experience were associated with increasing severity level of suicidal behaviors among individuals with NSSI. CONCLUSIONS NSSI is prevalent among in-school adolescents in Hong Kong. However, it co-occurs with suicidal ideation and suicide attempt. High lethality of NSSI, frequent drinking habit, and lifetime sexual experience are suggested to be indicators for screening potential suicide attempters among those having NSSI.
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Affiliation(s)
- Yee Tak Derek Cheung
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
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Bantjes J, Kagee A. Epidemiology of suicide in South Africa: Setting an agenda for future research. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2013. [DOI: 10.1177/0081246313482627] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article offers a synthesis and critical overview of published studies on the prevalence and correlates of completed suicide in South Africa. It examines the evidence that suicide is a serious public health problem and highlights what remains unknown about suicide in South Africa. Reflections are offered on the implications of these studies for subsequent research. Focus areas are suggested for future research in order to provide the information needed to inform public health efforts to reduce the morbidity and mortality associated with suicidal behaviour. This article is of interest to scholars who seek to plan suicide research in South Africa, public health officials who wish to design suicide prevention programmes, and others who wish to gain an overview of the prevalence and correlates of completed suicide in the country.
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Caetano R, Kaplan MS, Huguet N, McFarland BH, Conner K, Giesbrecht N, Nolte KB. Acute alcohol intoxication and suicide among United States ethnic/racial groups: findings from the national violent death reporting system. Alcohol Clin Exp Res 2013; 37:839-46. [PMID: 23384174 DOI: 10.1111/acer.12038] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 09/18/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND To assess the prevalence and sociodemographic correlates of suicide involving acute alcohol intoxication among U.S. ethnic minorities. METHODS Data were derived from the restricted 2003 to 2009 National Violent Death Reporting System. The study focused on the sociodemographic and toxicological information of 59,384 male and female suicide decedents for 16 states of the United States. Acute alcohol intoxication was defined as having a blood alcohol content (BAC) ≥0.08 g/dl. Overall, 76% of decedents were tested for the presence of alcohol. RESULTS The proportion of suicide decedents with a positive BAC ranged from 47% among American Indians/Alaska Natives (AIs/ANs) to 23% among Asians/Pacific Islanders (PIs). Average BAC was highest among AIs/ANs. Among those who were tested for BAC, the proportion of decedents legally intoxicated prior to suicide was as follows: Blacks, 15%; AIs/ANs, 36%; Asians/PIs, 13%; and Hispanics, 28%. Bivariate associations showed that most suicide decedents who were legally intoxicated were male, younger than 30 years of age, with a high school education, not married, nonveterans, lived in metropolitan areas, and used a firearm to complete suicide. However, with the exception of Whites, most of these associations became not statistically significant in multivariate analysis. CONCLUSIONS Alcohol use and legal intoxication prior to completing suicide are common among U.S. ethnic groups, especially among men and those who are younger than 30 years of age. The AI/AN group had the highest mean BAC, the highest rate of legal intoxication and decedents who were particularly young. Suicide prevention strategies should address alcohol use as a risk factor. Alcohol problems prevention strategies should focus on suicide as a consequence of alcohol use, especially among AI/AN youth and young adults.
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Affiliation(s)
- Raul Caetano
- University of Texas School of Public Health, Dallas, TX 75390-9128, USA.
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Morin J, Wiktorsson S, Marlow T, Olesen PJ, Skoog I, Waern M. Alcohol use disorder in elderly suicide attempters: a comparison study. Am J Geriatr Psychiatry 2013; 21:196-203. [PMID: 23343493 DOI: 10.1016/j.jagp.2012.10.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 09/27/2011] [Accepted: 10/20/2011] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To compare lifetime prevalence of alcohol use disorder (AUD) in older adults who were hospitalized in connection with a suicide attempt and in a population comparison group, as well as to compare previous suicidal behavior in attempters with and without AUD. DESIGN Case-comparison. SETTING Five hospitals in Western Sweden. PARTICIPANTS Persons 70 years or older, who were treated in a hospital because of a suicide attempt during 2003-2006 were recruited. Of 133 eligible participants, 103 participants were enrolled (47 men, 56 women, mean age 80 years, response rate 77%). Four comparison subjects per case were randomly selected among participants in our late-life population studies. MEASUREMENTS Lifetime history of AUD in accordance with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, was discerned on the basis of interview data, case record review, and the hospital discharge register. Depression symptoms were rated using the Montgomery-Åsberg Rating Scale. RESULTS AUD was observed in 26% of the cases and in 4% of the comparison group (odds ratio [OR]: 10.5; 95% confidence interval [CI]: 4.9-22.5). Associations were noted in men (OR: 9.5; 95% CI: 4.0-22.8) and women (OR: 12.0; 95% CI: 2.4-59.5). More than half of the cases with AUD and a third of those without AUD had made at least one prior suicide attempt. In these, AUD was associated with a longer interval between the first attempt and the index attempt. CONCLUSIONS A strong association between AUD and hospital-treated suicide attempts was noted in both sexes in this northern European setting. Given the high rates of suicide worldwide in this fast-growing and vulnerable group, comparison studies in other settings are needed.
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Affiliation(s)
- Johanna Morin
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
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Badger JM, Gregg SC, Adams CA. Non-fatal suicide attempt by intentional stab wound: Clinical management, psychiatric assessment, and multidisciplinary considerations. J Emerg Trauma Shock 2012; 5:228-32. [PMID: 22988400 PMCID: PMC3440888 DOI: 10.4103/0974-2700.99688] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 01/17/2012] [Indexed: 11/17/2022] Open
Abstract
Background: Suicide by means of self-inflicted stab wounds is relatively uncommon and little is known about this population and their management. Materials and Methods: Retrospective review of adult trauma patients admitted to our Level-1 trauma center between January 2005 and October 2009 for management of non-fatal, self-inflicted stab wounds. Results: Fifty-eight patients were evaluated with self-inflicted stab wounds. Four patients died due to their injuries (mortality, 7%). Of the non-fatal stab wounds, 78% were male ranging in age from 19-82 (mean: 45 years). The most common injury sites were the abdomen (46%), neck (33%), and chest (20%). In terms of operative interventions, 56% of abdominal operations were therapeutic, whereas 100% of neck and chest operations were therapeutic. When assessing for suicidal ideation, 44 patients (81%) admitted to suicidal intentions whereas 10 patients (19%) described accidental circumstances. Following psychiatric evaluation, 8 of the 10 patients with “accidental injuries” were found to be suicidal. Overall, 54 patients (98%) met criteria for a formal psychiatric diagnosis with 48 patients (89%) necessitating inpatient or outpatient psychiatric assistance at discharge. Conclusions: Compared to previous reports of stab wounds among trauma patients, patients with self- inflicted stab wounds may have a higher incidence of operative interventions and significant injuries depending on the stab location. When circumstances surrounding a self-inflicted stabbing are suspicious, additional interviews by psychiatric care providers may uncover a suicidal basis to the event. Given the increased incidence of psychiatric illness in this population, it is imperative to approach the suicidal patient in a multidisciplinary fashion.
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Affiliation(s)
- James M Badger
- Department of Psychiatry, Warren Alpert School of Medicine, Rhode Island Hospital, USA
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Lamis DA, Malone PS. Alcohol Use and Suicidal Behaviors among Adults: A Synthesis and Theoretical Model. SUICIDOLOGY ONLINE 2012; 3:4-23. [PMID: 23243500 PMCID: PMC3519287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Suicidal behavior and alcohol use are major public health concerns in the United States; however the association between these behaviors has received relatively little empirical attention. The relative lack of research in this area may be due in part to the absence of theory explaining the alcohol use-suicidality link in the general adult population. The present article expands upon Conner, McCloskey, and Duberstein's (2008) model of suicide in individuals with alcoholism and proposes a theoretical framework that can be used to explain why a range of adult alcohol users may engage in suicidal behaviors. Guided by this model, we review and evaluate the evidence on the associations among several constructs that may contribute to suicidal behaviors in adult alcohol consumers. The current framework should inform future research and facilitate further empirical analyses on the interactive effects among risk factors that may contribute to suicidal behaviors. Once the nature of these associations is better understood among alcohol using adults, more effective suicide prevention programs may be designed and implemented.
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Klimkiewicz A, Ilgen MA, Bohnert ASB, Jakubczyk A, Wojnar M, Brower KJ. Suicide attempts during heavy drinking episodes among individuals entering alcohol treatment in Warsaw, Poland. Alcohol Alcohol 2012; 47:571-6. [PMID: 22691386 DOI: 10.1093/alcalc/ags069] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Acute alcohol intoxication itself may act as a trigger for suicidal thoughts and attempts among individuals at risk and may influence the potential lethality of the suicide attempt. This study in alcohol-dependent patients compared the correlates of suicide attempts during a heavy drinking episode with those of suicide attempts during relative sobriety. METHODS In two outpatient and two residential alcohol treatment programs in Warsaw, Poland, 113 patients who reported a suicide attempt during their lifetime were interviewed. The analyses focused on the patients' most serious suicide attempts and on whether these occurred during a heavy drinking episode. RESULTS Over two-thirds of the patients reported that their most serious suicide attempt occurred during a period of heavy drinking. A multivariable logistic model indicated that the following factors significantly distinguished those patients whose most serious suicide attempt occurred during a heavy drinking episode: male gender, younger current age, greater severity of alcohol dependence and the attempt being unplanned. CONCLUSION Among the patients in treatment for alcohol dependence who made a suicide attempt, the most serious attempt was likely to have been unplanned and committed by men when it occurred during a heavy drinking episode.
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Affiliation(s)
- Anna Klimkiewicz
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
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Grucza RA, Hipp PR, Norberg KE, Rundell L, Evanoff A, Cavazos-Rehg P, Bierut LJ. The legacy of minimum legal drinking age law changes: long-term effects on suicide and homicide deaths among women. Alcohol Clin Exp Res 2012; 36:377-84. [PMID: 22085045 PMCID: PMC3587149 DOI: 10.1111/j.1530-0277.2011.01608.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Prior to the establishment of the uniform drinking age of 21 in the United States, many states permitted legal purchase of alcohol at younger ages. Lower drinking ages were associated with several adverse outcomes, including elevated rates of suicide and homicide among youth. The objective of this study is to examine whether individuals who were legally permitted to drink prior to age 21 remained at elevated risk in adulthood. METHODS Analysis of data from the U.S. Multiple Cause of Death files, 1990 to 2004, combined with data on the living population from the U.S. Census and American Community Survey. The assembled data contained records on over 200,000 suicides and 130,000 homicides for individuals born between 1949 and 1972, the years during which the drinking age was in flux. Logistic regression models were used to evaluate whether adults who were legally permitted to drink prior to age 21 were at elevated risk for death by these causes. A quasi-experimental analytical approach was employed, which incorporated state and birth-year fixed effects to account for unobserved covariates associated with policy exposure. RESULTS In the population as a whole, we found no association between minimum drinking age and homicide or suicide. However, significant policy-by-sex interactions were observed for both outcomes, such that women exposed to permissive drinking age laws were at higher risk for both suicide (OR = 1.12, 95% CI: 1.05, 1.18, p = 0.0003) and homicide (OR = 1.15, 95% CI: 1.04, 1.25, p = 0.0028). Effect sizes were stronger for the portion of the cohort born after 1960, whereas no significant effects were observed for women born prior to 1960. CONCLUSIONS Lower drinking ages may result in persistent elevated risk for suicide and homicide among women born after 1960. The national drinking age of 21 may be preventing about 600 suicides and 600 homicides annually.
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Affiliation(s)
- Richard A Grucza
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Arias AJ, Chan G, Gelernter J, Farrer L, Kranzler HR. Variation in OPRM1 and risk of suicidal behavior in drug-dependent individuals. Am J Addict 2011; 21:5-10. [PMID: 22211341 DOI: 10.1111/j.1521-0391.2011.00195.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Completed suicide and nonfatal suicide-related outcomes (SROs), such as suicidal ideation and attempts, are heritable. A recent genetic association study in a sample of suicide victims reported a protective effect of the G allele of Asn40Asp (rs1799971) on risk for completed suicide. We examined the association of three OPRM1 single nucleotide polymorphisms (SNPs) (rs1799971, rs609148, and rs648893) with SRO in 426 European Americans, using GEE logistic regression analysis to examine the association of a lifetime history of SRO. There was no allelic association with the SRO phenotypes. A larger sample may be needed to identify risk variants that convey SRO risk. OPRM1 may not be important in the risk of SRO.
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Affiliation(s)
- Albert J Arias
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
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Differences in suicide risk according to living arrangements in Japanese men and women--the Japan Public Health Center-based (JPHC) prospective study. J Affect Disord 2011; 131:113-9. [PMID: 21168916 DOI: 10.1016/j.jad.2010.11.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 10/27/2010] [Accepted: 11/24/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Living alone has been suggested as a risk factor for suicide. However, the effect on suicide risk of living together with spouse, child(ren) and parent(s) is unclear. This study aims to examine the association between living arrangements with spouse, child(ren), and parent(s) and suicide in a Japanese men and women. METHODS Altogether 104, 528 participants aged 40-69 years, who completed baseline questionnaire (1990-1994), were followed for death through December 2005. We used Cox proportional hazards regression model to estimate the hazard ratio (HR) and 95% confidence intervals (95% CI) for suicide according to living arrangements. RESULTS During an average 13.2-year follow up, 406 suicidal deaths were recorded. Men living without a spouse and women living with a parent(s) only were at increased risk of suicide than those living with a spouse only. The multivariate HR (95% CI) in men were as follows: "living with a parent(s) only", 1.86 (1.03-3.36); "living with a child(ren) only", 2.20 (1.32-3.66); "living with a parent(s) and child(ren)", 1.95 (1.02-3.72); and "living alone", 1.80 (0.99-3.25); and in women was as follow "living with a parent(s) only", 3.80 (1.90-7.61). Suicide risk was significantly decreased among women living with a spouse and child(ren) as compared with women living with a spouse only (HR 0.58, 95%CI 0.34 to 0.98). CONCLUSIONS Men living without a spouse and women living with a parent(s) only were at increased risk of suicide. Women living together with a spouse and child(ren) were at decreased risk of suicide.
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Skopp NA, Luxton DD, Bush N, Sirotin A. Childhood Adversity and Suicidal Ideation in a Clinical Military Sample: Military Unit Cohesion and Intimate Relationships as Protective Factors. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2011. [DOI: 10.1521/jscp.2011.30.4.361] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Austin AE, van den Heuval C, Byard R. Suicide in forensic practice – an Australian perspective. AUST J FORENSIC SCI 2011. [DOI: 10.1080/00450618.2010.506197] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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González A, Betancur ÁR, Aristizábal A, Valencia JG, Palacio C, Jaramillo CL. Suicidio y género en Antioquia (Colombia): estudio de autopsia psicológica. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s0034-7450(14)60250-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hishimoto A, Fukutake M, Mouri K, Nagasaki Y, Asano M, Ueno Y, Nishiguchi N, Shirakawa O. Alcohol and aldehyde dehydrogenase polymorphisms and risk for suicide: a preliminary observation in the Japanese male population. GENES BRAIN AND BEHAVIOR 2010; 9:498-502. [PMID: 20180859 DOI: 10.1111/j.1601-183x.2010.00577.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Epidemiological studies have shown that excessive alcohol consumption is a potent risk factor to develop suicidal behavior. Genetic factors for suicidal behavior have been observed in family, twin, and adoption studies. Because alcohol dehydrogenase (ADH1B) His47Arg and mitochondrial aldehyde dehydrogenase (ALDH2) Glu487Lys single nucleotide polymorphisms (SNPs), which affect alcohol metabolism, have been reported to exert significant impacts on alcohol consumption and on the risk for alcoholism in East Asia populations, we explored associations of the two functional SNPs with suicide using a case-control study of 283 completed suicides and 319 control subjects in the Japanese population. We found that the inactive ALDH2 allele (487Lys) was significantly less frequent in the completed suicides (19.3%) than in the controls (29.3%), especially in males, whereas this was not the case in females. The males bearing alcoholism-susceptible homozygotes at both loci (inactive ADH1B Arg/Arg and active ALDH2 Glu/Glu genotypes) have a 10 times greater risk for suicide compared with the males bearing alcoholism-protective homozygotes at both loci. Our data show the genetic impact of the two polymorphisms on suicidal behavior in the Japanese population, especially in males. Because we did not verify the daily alcohol consumption, the association of these SNPs with suicide might be due to alcoholism itself. Further studies using case-control subjects, which verifies the details of current and past alcohol consumption and diagnosis for alcoholism, are required to confirm these findings.
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Affiliation(s)
- A Hishimoto
- Department of Psychiatry, Faculty of Medical Sciences, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan.
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