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Mehanović E, Rosso G, Cuomo GL, Diecidue R, Maina G, Costa G, Vigna-Taglianti F. Risk factors for mortality after hospitalization for suicide attempt: results of 11-year follow-up study in Piedmont Region, Italy. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1039-1051. [PMID: 37552335 PMCID: PMC11116226 DOI: 10.1007/s00127-023-02544-7] [Citation(s) in RCA: 1] [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: 02/14/2023] [Accepted: 07/30/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Suicide attempters are at high risk of premature death, both for suicide and for non-suicidal causes. The aim of this study is to investigate risk factors and temporal span for mortality in a cohort of cases admitted to hospital for suicide attempt. METHODS The cohort included 1489 patients resident in Piedmont Region, North West of Italy, who had been admitted to hospital or emergency department for suicide attempt between 2010 and 2020. Cox regression models were used to identify risk factors for death. The final multivariate model included gender, age, area deprivation index, family composition, psychiatric disorders, malignant neoplasms, neurological disorders, diabetes mellitus, cardiovascular diseases, chronic obstructive pulmonary disease, and intracranial injury or skull fracture. RESULTS During the observation period, 7.3% of patients died. The highest mortality was observed within the first 12 months after suicide attempt, and remained elevated for many years afterwards. Male gender, older age, high deprivation index of the census area, single-parent family, mood disorders, malignant neoplasms, diabetes mellitus and intracranial injuries or skull fracture were independent predictors of death. Risk factors for natural and unnatural causes of death were also identified. CONCLUSIONS The mortality risk of suicide attempters is very high, both in the months immediately following the attempt and afterwards. The identification of high-risk groups can help to plan outpatient care following the hospital discharge. Our findings urge the need to design strategies for the assistance and care of these patients at long term in order to reduce the unfavourable outcomes.
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Affiliation(s)
- Emina Mehanović
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy.
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy.
| | - Gianluca Rosso
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Gian Luca Cuomo
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy
| | - Roberto Diecidue
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy
| | - Giuseppe Maina
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Giuseppe Costa
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy
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Batterham PJ, Gendi M, Christensen H, Calear AL, Shand F, Sunderland M, Borschmann R, Banfield M, O'Dea B, Larsen M, Heffernan C, Kazan D, Werner-Seidler A, Mackinnon AJ, Hielscher E, Han J, Boydell KM, Leach L, Farrer LM. Understanding suicidal transitions in Australian adults: protocol for the LifeTrack prospective longitudinal cohort study. BMC Psychiatry 2023; 23:821. [PMID: 37940886 PMCID: PMC10634090 DOI: 10.1186/s12888-023-05335-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/31/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND The factors that influence transition from suicidal ideation to a suicide attempt or remission of suicidal thoughts are poorly understood. Despite an abundance of research on risk factors for suicidal ideation, no large-scale longitudinal population-based studies have specifically recruited people with suicidal ideation to examine the mechanisms underlying critical transitions to either suicide attempt or recovery from suicidal ideation. Without longitudinal data on the psychological, behavioural, and social determinants of suicide attempt and the remission of suicidal ideation, we are unlikely to see major gains in the prevention of suicide. AIM The LifeTrack Project is a population-based longitudinal cohort study that aims to identify key modifiable risk and protective factors that predict the transition from suicidal ideation to suicide attempt or remission of suicidal ideation. We will assess theory-informed risk and protective factors using validated and efficient measures to identify distinct trajectories reflecting changes in severity of suicidal ideation and transition to suicide attempt over three years. METHODS A three-year prospective population-based longitudinal cohort study will be conducted with adults from the general Australian population who initially report suicidal ideation (n = 842). Eligibility criteria include recent suicidal ideation (past 30 days), aged 18 years or older, living in Australia and fluent in English. Those with a suicide attempt in past 30 days or who are unable to participate in a long-term study will be excluded. Participants will be asked to complete online assessments related to psychopathology, cognition, psychological factors, social factors, mental health treatment use, and environmental exposures at baseline and every six months during this three-year period. One week of daily measurement bursts (ecological momentary assessments) at yearly intervals will also capture short-term fluctuations in suicidal ideation, perceived burdensomeness, thwarted belongingness, capability for suicide, and distress. CONCLUSION This study is intended to identify potential targets for novel and tailored therapies for people experiencing suicidal ideation and improve targeting of suicide prevention programs. Even modest improvements in current treatments may lead to important reductions in suicide attempts and deaths. STUDY REGISTRATION Australian New Zealand Clinical Trials Registry identifier: ACTRN12623000433606.
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Affiliation(s)
- Philip J Batterham
- Centre for Mental Health Research, The Australian National University, 63 Eggleston Road, Canberra, ACT, 2601, Australia.
| | - Monica Gendi
- Centre for Mental Health Research, The Australian National University, 63 Eggleston Road, Canberra, ACT, 2601, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Alison L Calear
- Centre for Mental Health Research, The Australian National University, 63 Eggleston Road, Canberra, ACT, 2601, Australia
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental health and Substance use, University of Sydney, Sydney, Australia
| | - Rohan Borschmann
- Melbourne School of Population and Global Health, Centre for Mental Health, The University of Melbourne, Melbourne, Australia
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia
- School of Population Health, Curtin University, Perth, Australia
| | - Michelle Banfield
- Centre for Mental Health Research, The Australian National University, 63 Eggleston Road, Canberra, ACT, 2601, Australia
| | - Bridianne O'Dea
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Mark Larsen
- Black Dog Institute, University of New South Wales, Sydney, Australia
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Cassandra Heffernan
- Centre for Mental Health Research, The Australian National University, 63 Eggleston Road, Canberra, ACT, 2601, Australia
| | - Dominique Kazan
- Centre for Mental Health Research, The Australian National University, 63 Eggleston Road, Canberra, ACT, 2601, Australia
| | - Aliza Werner-Seidler
- Black Dog Institute, University of New South Wales, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | | | - Emily Hielscher
- The Council of the Queensland Institute of Medical Research, Brisbane, Australia
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Flourish Australia, Sydney, Australia
| | - Jin Han
- Center for Global Health Equity, New York University Shanghai, Shanghai, China
| | - Katherine M Boydell
- Melbourne School of Population and Global Health, Centre for Mental Health, The University of Melbourne, Melbourne, Australia
| | - Liana Leach
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Louise M Farrer
- Centre for Mental Health Research, The Australian National University, 63 Eggleston Road, Canberra, ACT, 2601, Australia
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Liang S, Liu X, Li D, Zhang J, Zhao G, Yu H, Zhao X, Sha S. Development and validation of a nomogram to predict suicidal behavior in female patients with mood disorder. Front Psychiatry 2023; 14:1212579. [PMID: 37484676 PMCID: PMC10360170 DOI: 10.3389/fpsyt.2023.1212579] [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: 05/03/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction This study aims to explore the risk factors associated with suicidal behavior and establish predictive models in female patients with mood disorders, specifically using a nomogram of the least absolute shrinkage and selection operator (LASSO) regression. Methods A cross-sectional survey was conducted among 396 female individuals diagnosed with mood disorders (F30-F39) according to the International Classification of Diseases and Related Health Problems 10th Revision (ICD-10). The study utilized the Chi-Squared Test, t-test, and the Wilcoxon Rank-Sum Test to assess differences in demographic information and clinical characteristics between the two groups. Logistic LASSO Regression Analyses were utilized to identify the risk factors associated with suicidal behavior. A nomogram was constructed to develop a prediction model. The accuracy of the prediction model was evaluated using a Receiver Operating Characteristic (ROC) curve. Result The LASSO regression analysis showed that psychotic symptoms at first-episode (β = 0.27), social dysfunction (β = 1.82), and somatic disease (β = 1.03) increased the risk of suicidal behavior. Conversely, BMI (β = -0.03), age of onset (β = -0.02), polarity at onset (β = -1.21), and number of hospitalizations (β = -0.18) decreased the risk of suicidal behavior. The area under ROC curve (AUC) of the nomogram predicting SB was 0.778 (95%CI: 0.730-0.827, p < 0.001). Conclusion The nomogram based on demographic and clinical characteristics can predict suicidal behavior risk in Chinese female patients with mood disorders.
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Affiliation(s)
- Sixiang Liang
- National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xinyu Liu
- National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Dan Li
- National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jinhe Zhang
- National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Guangwei Zhao
- National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Hongye Yu
- National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xixi Zhao
- National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Sha Sha
- National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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Sung C, Chung CH, Lin FH, Chien WC, Sun CA, Tsao CH, Weng CE, Ng DY. A Population-Based Cohort Study of the Association between Visual Loss and Risk of Suicide and Mental Illness in Taiwan. Healthcare (Basel) 2023; 11:healthcare11101462. [PMID: 37239748 DOI: 10.3390/healthcare11101462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 04/27/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
The psychosocial and health consequences of ocular conditions that cause visual impairment (VI) are extensive and include impaired daily activities, social isolation, cognitive impairment, impaired functional status and functional decline, increased reliance on others, increased risk of motor vehicle accidents, falls and fractures, poor self-rated health, and depression. We aimed to determine whether VI increases the likelihood of a poor prognosis, including mental illness, suicide, and mortality over time. In this large, location, population-based, nested, cohort study, we used data from 2000 to 2015 in the Taiwan National Health Insurance Research Database (NHIRD), which includes diagnoses of all the patients with VI. Baseline features, comorbidities, and prognostic variables were evaluated using a 1:4-matched cohort analysis. Furthermore, comparisons were performed using Cox regression and Bonferroni-correction (for multiple comparisons) to study the association between VI and poor prognosis (mental illness, suicide). The study outcome was the cumulative incidence of poor prognosis among the visually impaired and controls. A two-tailed Bonferroni-corrected p < 0.001 was considered statistically significant. Among the 1,949,101 patients enlisted in the NHIRD, 271 had been diagnosed with VI. Risk factors for poor prognosis and the crude hazard ratio was 3.004 (95% confidence interval 2.135-4.121, p < 0.001). Participants with VI had an increased risk of poor prognosis according to the sensitivity analysis, with a poor prognosis within the first year and first five years. VI was associated with suicide and mental health risks. This study revealed that patients with VI have a nearly 3-fold higher risk of psychiatric disorders, including anxiety, depression, bipolar, and sleep disorders, than the general population. Early detection through comprehensive examinations based on increased awareness in the clinical context may help maintain visual function and avoid additional complications.
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Affiliation(s)
- Chieh Sung
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Nursing, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei 11490, Taiwan
| | - Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei 11490, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City 24205, Taiwan
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City 24205, Taiwan
| | - Chang-Huei Tsao
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Microbiology and Immunology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Chih-Erh Weng
- Department of Nursing, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Daphne Yih Ng
- Department of Family Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
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Cause-specific mortality after hospital discharge for suicide attempt or suicidal ideation: A cohort study in Piedmont Region, Italy. J Psychiatr Res 2023; 161:19-26. [PMID: 36893667 DOI: 10.1016/j.jpsychires.2023.02.035] [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: 05/10/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Suicide attempters are at higher risk of death than the general population. The present study aims to investigate the excess of all-cause mortality and cause-specific mortality in a cohort of patients who have attempted suicide or had suicidal ideation compared with the general population. METHOD The cohort included 826 patients residing in the Piedmont Region of Northwest Italy who were admitted to a hospital or emergency department for suicide attempts or suicidal ideation between 2010 and 2016. Mortality excesses of the study population compared to the general population were estimated by applying indirect standardization. Standardized Mortality Ratios and 95% Confidence Intervals were calculated for all-cause, and cause-specific, natural, and unnatural causes of death by gender and age. RESULTS During the 7 years of follow-up, 8.2% of the study sample died. The mortality of suicide attempters and ideators was significantly higher than that of the general population. Mortality was about twice than expected from natural causes, and 30 times than expected from unnatural causes. The mortality due to suicide was 85 times higher than that of the general population, with an excess of 126 times for females. The SMRs for all-cause mortality decreased with increasing age. CONCLUSIONS Patients who access hospitals or emergency departments for suicide attempts or suicidal ideation are a frail group at high risk of dying from natural or unnatural causes. Clinicians should pay special attention to the care of these patients, and public health and prevention professionals should develop and implement appropriate interventions to timely identify individuals at higher risk for suicide attempts and suicidal ideation and provide standardized care and support services.
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Aguiar RA, Riffel RT, Acrani GO, Lindemann IL. Tentativa de suicídio: prevalência e fatores associados entre usuários da Atenção Primária à Saúde. JORNAL BRASILEIRO DE PSIQUIATRIA 2022. [DOI: 10.1590/0047-2085000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RESUMO Objetivo Estimar a prevalência de tentativa de suicídio entre usuários da Atenção Primária à Saúde (APS) e verificar fatores associados. Métodos Estudo transversal realizado com indivíduos de 18 anos ou mais, atendidos na rede urbana da APS de Passo Fundo, Rio Grande do Sul. Foi calculada a prevalência do desfecho, com intervalo de confiança de 95% (IC95), além das Razões de Prevalência (RPs) brutas e ajustadas para verificação dos fatores associados. Resultados Amostra de 1.443 indivíduos, prevalência da tentativa de suicídio de 9% (IC95 8%-11%), com maior probabilidade em mulheres (RP = 3,01; IC95 1,54-5,86), 18-59 anos (RP = 2,15; IC95 1,38-3,34), sem cônjuge (RP = 1,82; IC95 1,09-3,03), com duas ou mais doenças crônicas não transmissíveis (RP = 1,54; IC95 1,08-2,18), diagnóstico de HIV/AIDS (RP = 3,02; IC95 1,30-7,02), de depressão (RP = 2,69; IC95 1,83-3,96), história familiar de tentativa de suicídio (RP = 1,99; IC95 1,50-2,63) e insônia (RP = 1,46; IC95 1,05-2,02). Observou-se tendência linear inversamente proporcional em relação à escolaridade, com redução de 42% na probabilidade do desfecho entre os participantes com ensino superior (RP = 0,58; IC95 0,39-0,86). Conclusões Constataram-se alta prevalência de tentativa de suicídio, em comparação à média nacional, e associação com idade adulta, sexo feminino, menor escolaridade, ausência de cônjuge, diagnóstico de doenças crônicas, insônia e história familiar de suicídio.
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Karnick AT, Boska RL, Caulfield NM, Winchell R, Capron DW. Suicide and self-injury outcomes for patients with comorbid psychiatric and physical health conditions. Psychiatry Res 2022; 308:114345. [PMID: 34954501 DOI: 10.1016/j.psychres.2021.114345] [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: 07/16/2021] [Revised: 12/08/2021] [Accepted: 12/12/2021] [Indexed: 11/29/2022]
Abstract
Suicide is a transdiagnostic public health issue that affects nearly all psychiatric disorders, individuals without a mental health diagnosis, and individuals with physical health issues. We assessed the relationship between these variables and suicide outcomes using a novel epidemiological research paradigm. Data were collected from the National Trauma Data Bank. Participants included patients admitted to trauma units for suicide and self-injury (n = 13,422). Patients were classified to one of four comorbid condition groups: no comorbidity, comorbid physical condition, comorbid major psychiatric condition, or multimorbidity (comorbid physical and psychiatric conditions). Multivariable logistic regression measured associations between comorbid condition and mortality and multivariable linear regression measured associations between comorbidity and injury severity. Mortality in patients with physical health comorbidity was not significant, but patients with psychiatric comorbidity or multimorbidity had significantly lower mortality than patients without either. No association between injury severity and comorbidity was detected. There were no differences in suicide mortality for individuals with a physical health comorbidity, but mortality was lower for individuals with a comorbid major psychiatric illness or multimorbidity. Since physical health conditions and psychiatric illness are associated with eventual suicide mortality, prevention strategies could target these populations at trauma units for suicide and self-injury admissions.
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Affiliation(s)
- Aleksandr T Karnick
- Department of Psychology, The University of Southern Mississippi, 118 College Drive, #5025, Hattiesburg, MS, USA.
| | - Rachel L Boska
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort hill Avenue, Canandaigua, NY, 14424; Department of Psychiatry, University of Rochester School of Medicine & Dentistry, 300 Crittenden Blvd., Rochester, NY, 14642
| | - Nicole M Caulfield
- Department of Psychology, The University of Southern Mississippi, 118 College Drive, #5025, Hattiesburg, MS, USA
| | - Robert Winchell
- Department of Surgery, Weill Cornell Medicine, 525 E. 68th Street, New York, NY, USA
| | - Daniel W Capron
- Department of Psychology, The University of Southern Mississippi, 118 College Drive, #5025, Hattiesburg, MS, USA
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Au VYO, Rosic T, Sanger N, Hillmer A, Chawar C, Worster A, Marsh DC, Thabane L, Samaan Z. Factors associated with opioid overdose during medication-assisted treatment: How can we identify individuals at risk? Harm Reduct J 2021; 18:71. [PMID: 34238301 PMCID: PMC8265117 DOI: 10.1186/s12954-021-00521-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to the loss of tolerance to opioids during medication-assisted treatment (MAT), this period may represent a time of heightened risk for overdose. Identifying factors associated with increased risk of overdose during treatment is therefore paramount to improving outcomes. We aimed to determine the prevalence of opioid overdoses in patients receiving MAT. Additionally, we explored factors associated with opioid overdose during MAT and the association between length of time enrolled in MAT and overdose. METHODS Data were collected prospectively from 2360 participants receiving outpatient MAT in Ontario, Canada. Participants were divided into three groups by overdose status: no history of overdose, any lifetime history of overdose, and emergency department visit for opioid overdose in the last year. We used a multivariate multinomial regression model to assess demographic and clinical factors associated with overdose status. RESULTS Twenty-four percent of participants reported a lifetime history of overdose (n = 562), and 8% reported an emergency department (ED) visit for opioid overdose in the last year (n = 179). Individuals with a recent ED visit for opioid overdose were in treatment for shorter duration (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.87, 0.97, p = 0.001). Individuals with a lifetime or recent history of overdose were more likely to be younger in age (OR 0.93, 95% CI 0.89, 0.98, p = 0.007 and OR 0.84, 95% CI 0.77, 0.92, p < 0.001, respectively), report more physical symptoms (OR 1.02, 95% CI 1.01, 1.03, p = 0.005 and OR 1.03, 95% CI 1.01, 1.05, p = 0.005, respectively), and had higher rates of non-prescription benzodiazepine use (OR 1.87, 95% CI 1.32, 2.66, p < 0.001 and OR 2.34, 95% CI 1.43, 3.81, p = 0.001, respectively) compared to individuals with no history of overdose. CONCLUSIONS A considerable number of patients enrolled in MAT have experienced overdose. Our study highlights that there are identifiable factors associated with a patient's overdose status that may represent areas for intervention. In particular, longer duration in MAT is associated with a decreased risk of overdose.
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Affiliation(s)
- Vivian Y O Au
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Tea Rosic
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 100 West 5th St, Hamilton, ON, L8N 3K7, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Nitika Sanger
- Medical Sciences Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Alannah Hillmer
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Caroul Chawar
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Andrew Worster
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, Sudbury, ON, Canada
- Canadian Addiction Treatment Centres, Markham, ON, Canada
- ICES North, Sudbury, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Research Institute At St Joseph's Healthcare, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 100 West 5th St, Hamilton, ON, L8N 3K7, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
- Population Genomics Program, McMaster University, Hamilton, ON, Canada.
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Jordan JT, McNiel DE. Characteristics of persons who die on their first suicide attempt: results from the National Violent Death Reporting System. Psychol Med 2020; 50:1390-1397. [PMID: 31217042 DOI: 10.1017/s0033291719001375] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Much of suicide research focuses on suicide attempt (SA) survivors. Given that more than half of the suicide decedent population dies on their first attempt, this means a significant proportion of the population that dies by suicide is overlooked in research. Little is known about persons who die by suicide on their first attempt-and characterizing this understudied population may improve efforts to identify more individuals at risk for suicide. METHODS Data were derived from the National Violent Death Reporting System, from 2005 to 2013. Suicide cases were included if they were 18-89 years old, with a known circumstance leading to their death based on law enforcement and/or medical examiner reports. Decedents with and without a history of SA were compared on demographic, clinical, and suicide characteristics, and circumstances that contributed to their suicide. RESULTS A total of 73 490 cases met criteria, and 57 920 (79%) died on their first SA. First attempt decedents were more likely to be male, married, African-American, and over 64. Demographic-adjusted models showed that first attempt decedents were more likely to use highly lethal methods, less likely to have a known mental health problem or to have disclosed their intent to others, and more likely to die in the context of physical health or criminal/legal problem. CONCLUSIONS First attempt suicide decedents are demographically different from decedents with a history of SA, are more likely to use lethal methods and are more likely to die in the context of specific stressful life circumstances.
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Affiliation(s)
- Joshua T Jordan
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA94143, USA
| | - Dale E McNiel
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA94143, USA
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Abstract
Youth suicide is a national and global public health crisis. Pediatricians can use primary and secondary prevention strategies to intervene with youth before or after the onset of suicidal behaviors. Universal suicide risk screening programs can be used to identify youth in medical settings who may otherwise pass through the health care setting with undetected suicide risk. Pediatricians are uniquely positioned to help foster resilience in their young patients and equip families of at-risk youth with safety plans and lethal means safety counseling. Pediatricians on the frontlines of this critical public health crisis require education and training in detecting suicide risk, managing those who screen positive, and connecting their patients to much needed mental health interventions and treatments. Evidence-based suicide risk screening and assessment tools, paired with interventions, are feasible and potentially life-saving in the medical setting.
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Affiliation(s)
- Lisa Horowitz
- National Institute of Mental Health, Bethesda, Maryland
| | - Mary V Tipton
- National Institute of Mental Health, Bethesda, Maryland
| | - Maryland Pao
- National Institute of Mental Health, Bethesda, Maryland
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11
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Physical multimorbidity and suicidal behavior in the general population in the United States. J Affect Disord 2020; 260:604-609. [PMID: 31541971 DOI: 10.1016/j.jad.2019.09.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 08/01/2019] [Accepted: 09/08/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND As yet, there has been little research on the association between physical multimorbidity (the co-occurrence of two or more physical illnesses) and suicide, and results have been mixed. This study examined if physical multimorbidity is associated with suicidal behavior in the general population in the United States. METHOD Data were analyzed from 15,311 adults that were obtained from the Collaborative Psychiatric Epidemiology Surveys (CPES). Information was obtained on nine self-reported physical health conditions and lifetime suicidal behavior (suicidal ideation, plan, and attempts). Logistic regression analysis was used to examine associations. RESULTS An increasing number of physical health conditions was associated with higher odds for suicidal behavior. Compared to those with no physical conditions, individuals with ≥ 4 physical illnesses had 2.99, 4.82, and 4.39 times higher odds for reporting suicidal ideation, a suicide plan, and suicide attempts, respectively. An interaction analysis showed that for suicide attempts the association was stronger in younger rather than older adults. LIMITATIONS The data were cross-sectional and information on physical conditions and suicidal behavior was self-reported and may have been subject to reporting bias. CONCLUSIONS As multimorbidity has increased in recent decades in the United States, alerting medical practitioners to the increased risk of suicidal behavior in adults who have multiple medical conditions as well as screening for suicidality in this group may be important preventive measures to help reduce suicidal behavior in the general population.
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12
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Wesson M, Boileau NR, Perlmutter JS, Paulsen JS, Barton SK, McCormack MK, Carlozzi NE. Suicidal Ideation Assessment in Individuals with Premanifest and Manifest Huntington Disease. J Huntingtons Dis 2019; 7:239-249. [PMID: 30056431 DOI: 10.3233/jhd-180299] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Huntington disease (HD) is associated with increased risk of suicide. OBJECTIVE This study compares suicide ideation in HD to the general population, assesses factors associated with increased prevalence of suicidal thoughts, and compares clinician-rated to self-reported assessments of suicidal ideation. METHODS We examined 496 participants with premanifest or manifest HD. Clinician-rated suicidal ideation was measured using the Problem Behaviors Assessment - short form. Self-reported ideation was measured using two items from the HDQLIFE Concern with Death and Dying item bank. Independent sample t-tests were conducted to compare the prevalence of suicidal thoughts between our HD sample and the U.S. POPULATION Logistic regression analyses were used to determine characteristics associated with higher odds of clinically significant suicidal ideation. Kappa agreement coefficients were calculated to evaluate concurrence between clinician-rated and self-reported assessments. RESULTS Our sample had a significantly higher occurrence of suicidal ideation (19.76%) and suicidal plans (2.1%) than the general population (p < 0.0001). Odds of clinically significant suicidal ideation were 6.8 times higher in females (p = 0.04) on the clinician measure, and Hispanic/Latinos had 10.9 times higher odds than non-Hispanics (p = 0.025) on the self-report measure. Clinician-rated assessment had fair agreement (k = 0.2-0.4) with self-reported assessments, except in early stage HD where there was no overlap in the identification of participants with clinically significant suicidal ideation. DISCUSSION Assessment for suicidal ideation and clinically significant suicidal thoughts in HD with a multimodal approach that includes clinician-rated and self-report measures is critical at all stages of the disease.
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Affiliation(s)
- Melissa Wesson
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, IN, USA
| | - Nicholas R Boileau
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Joel S Perlmutter
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA.,Radiology, Neuroscience, Physical Therapy, Occupational Therapy, Washington University in St. Louis, St. Louis, MO, USA
| | - Jane S Paulsen
- Neurology, Psychiatry, Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Stacey K Barton
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael K McCormack
- Department of Pathology, Rowan University School of Medicine, Glassboro, NJ, USA.,Department of Psychiatry, Rutgers-RWJMS, Piscataway Township, NJ, USA
| | - Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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13
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Chock MM, Lin JC, Athyal VP, Bostwick JM. Differences in Health Care Utilization in the Year Before Suicide Death: A Population-Based Case-Control Study. Mayo Clin Proc 2019; 94:1983-1993. [PMID: 31427140 DOI: 10.1016/j.mayocp.2019.04.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/05/2019] [Accepted: 04/03/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To compare health care usage between suicide decedents and living controls in the year before suicide in a large representative US population. PATIENTS AND METHODS Cases (n=1221) and controls (n=3663) belonged to an integrated health care system from January 1, 2009, through December 31, 2014. Cases and controls were matched for age and sex in a 1:3 ratio, with diagnostic and/or billing codes used to enumerate and classify health care visits in the year before the index suicide. Matched analysis via conditional logistic regression related odds of suicide to visit type. A generalized estimating equation model was used to compare timing and frequency of visits between cases and controls. RESULTS In the year before death, cases had an increased odds of both inpatient hospitalizations and emergency department nonmental health visits (odds ratio [OR], 1.55; 95% CI, 1.27-1.88; P<.001 and OR, 1.42; 95% CI, 1.26-1.60; P<.001) but not outpatient nonmental health visits (OR, 1.00; 95% CI, 0.99-1.01; P=.63). Decedents increased health care utilization closer to suicide death and had significantly more health care visits than did controls 3 months before suicide (6 vs 2; P=.01) but not 9 to 12 months before suicide (4 vs 2; P=.07). At all time points, cases used more mental health care services than did controls. CONCLUSION Compared with controls, suicide decedents had emergency department visits and more inpatient hospitalizations, both mental health and nonmental health related. As death approached, cases' frequency of health care usage increased. The only category in which cases and controls did not differ was in the frequency of outpatient nonmental health visits.
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Affiliation(s)
- Megan M Chock
- Family Medicine Residency Program, Kaiser Permanente, San Diego, CA.
| | - Jane C Lin
- Division of Biostatistics, Department of Research & Evaluation, Kaiser Permanente, Pasadena, CA
| | - Vidush P Athyal
- Southern California Permanente Medical Group, Kaiser Permanente, San Diego, CA
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Necho M, Mekonnen S, Haile K, Birkie M, Belete A. Suicidal plan, attempt, and associated factors among patients with diabetes in Felegehiwot referral hospital, Bahirdar, Ethiopia: cross-sectional study. BMC Psychiatry 2019; 19:258. [PMID: 31455263 PMCID: PMC6712698 DOI: 10.1186/s12888-019-2253-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/22/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Diabetes is a highly prevalent non-communicable disease which is prone to more psychiatric complications like suicide; however, research into this area is limited. Assessing suicidal plan and attempt as well as its determinants are therefore important. METHOD Institution based cross-sectional study was conducted from May 21 to June 21 at the diabetic outpatient clinic by recruiting 421 participants using systematic sampling. Suicide manual of the composite international diagnostic interview (CIDI) was used to assess suicidal plan and attempt. Chart review was used to obtain data regarding the co-morbidity of medical illness and complications of diabetes mellitus. Binary logistic regression was used to identify factors associated with suicidal attempt. Odds ratio with 95% CI was employed and variables with a p-value of< 0.05 in multivariable logistic regression were declared significant. RESULTS From 423 participants 421 participated in the study with 99.5% response rate. The mean age (±SD) of the respondents was 38.0((±13.9) years. The lifetime prevalence of Suicidal plan; an attempt was found to be 10.7 and 7.6% respectively. Being female (AOR = 2.14, 95%CI:1.10,5.65), poor social support (AOR = 3.21,95%CI:1.26,8.98), comorbid depression (AOR = 6.40,95%CI:2.56,15.46) and poor glycemic control (AOR = 4.38,95%CI:1.66,9.59) were factors associated with lifetime suicidal attempt. CONCLUSION The prevalence of suicidal attempt among Diabetes patients is high (7.6%). The suicidal attempt had a statistically significant association with female gender, comorbidity with depression, poor social support and poor glycemic control. Therefore the result of this study helps to do early screening, treatment, and referral of patients with suicidal attempt.
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Affiliation(s)
- Mogesie Necho
- Department of Psychiatry, Wollo University, College of Medicine and Health Sciences, Dessie, Ethiopia.
| | - Solomon Mekonnen
- 0000 0000 8539 4635grid.59547.3aDepartment of Public Health, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Kelemua Haile
- AmanuelMentalSpecialized Hospital, Addis Ababa, Ethiopia
| | - Mengesha Birkie
- 0000 0004 0515 5212grid.467130.7Department of Psychiatry, Wollo University, College of Medicine and Health Sciences, Dessie, Ethiopia
| | - Asmare Belete
- 0000 0004 0515 5212grid.467130.7Department of Psychiatry, Wollo University, College of Medicine and Health Sciences, Dessie, Ethiopia
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15
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Are non-psychiatric hospitalisations before self-harm associated with an increased risk for suicide among young people? J Psychosom Res 2019; 120:96-101. [PMID: 30929715 DOI: 10.1016/j.jpsychores.2019.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to investigate any increased risk for suicide in young people with admission for self-harm and if the risk is further increased due to somatic inpatient admissions before a first act of self-harm. METHODS This register study included 16,235 cases in the ages 16-24, with a first admission for self-harm, and 32,465 matched controls. All admissions and diagnoses were recorded from the year preceding cases first admission for self-harm. Subjects were followed until death or end of study, registering the cause of death for all deceased. Group differences were analysed using survival analysis with death by suicide as primary outcome. RESULTS In cases with a previous somatic admission, the risk for death by suicide during the study period was higher than in cases without a somatic admission (457 and 316 suicides per 100,000 people and year, respectively, p = 0.01). For cases with a somatic admission, the hazard ratio was 1.43 (95% confidence interval 1.04-1.98) compared with those without somatic admissions (controlled for age, sex and psychiatric admission). Survival of cases with a previous somatic admission compared with those without was 98.4% versus 99.2% after the first year, 97.8% versus 98.9% after the second year, and 95.5% versus 96.9% after the tenth year. CONCLUSIONS This study suggests that admission for physical illness before self-harm is associated with a higher risk for suicide among young people, and that their contact with healthcare due to physical problems could provide an opportunity to detect suicide risk.
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Jin S, Liu Y, Hennessy DA, Sun L, Zang Y, Si M, Zhang J. Physical Illnesses and Medically Serious Suicide Attempts in Rural China. CRISIS 2019; 41:15-23. [PMID: 30888227 DOI: 10.1027/0227-5910/a000597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background: Physical illness is a strong correlate of suicidal behavior. However, its impact on attempted suicide in rural China is under-studied. Aims: This study was designed to assess the influence of physical illness on risk of suicide attempts and to identify distinguishing characteristics among medically serious suicide attempters with physical illnesses from those without. Method: Participants were medically serious suicide attempters identified through hospital emergency rooms (n = 659) as well as age- and gender-matched community controls (n = 659) from Shandong Province, China. Face-to-face interviews with the respondents were conducted with a semistructured protocol that included sociodemographic and psychological measures. Results: Physical illness was a significant risk factor for medically serious suicide attempts (OR = 1.739, 95% CI = 1.182-2.560). Older age was a significant risk factor, while female gender, no religion, and non-peasant occupations were significant protective factors for suicide attempts with physical illness. Limitations: Samples from only one province may not completely represent all serious suicide attempters in China. Furthermore, we did not assess the severity and the degree to which their physical illness limited the functioning of the individual. Conclusion: Physical illness is an important risk factor for suicide attempts in rural China. More efforts are needed to specifically target older people, males, those with religious beliefs, and peasant workers with physical illness.
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Affiliation(s)
- Shenghua Jin
- Fuzhou University Institute of Psychological and Cognitive Sciences and Center for China Social Trust Research, Fuzhou, Fujian Province, China
| | - Yanzheng Liu
- Shandong University School of Public Health Center for Suicide Prevention Research, Jinan, Shandong Province, China
| | - Dwight A Hennessy
- Department of Psychology, State University of New York Buffalo State, New York, USA
| | - Long Sun
- Shandong University School of Public Health, Jinan, Shandong Province, China
| | - Yuli Zang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, China
| | - Min Si
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, China
| | - Jie Zhang
- Shandong University School of Public Health Center for Suicide Prevention Research, Jinan, Shandong Province, China.,Department of Sociology, State University of New York Buffalo State, New York, USA
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Abstract
After participating in this activity, learners should be better able to:• Assess epidemiologic evidence that increased altitude of residence is linked to increased risk of depression and suicide• Evaluate strategies to address hypoxia-related depression and suicidal ideation ABSTRACT: Suicide and major depressive disorder (MDD) are complex conditions that almost certainly arise from the influences of many interrelated factors. There are significant regional variations in the rates of MDD and suicide in the United States, suggesting that sociodemographic and environmental conditions contribute. Here, we review epidemiological evidence that increases in the altitude of residence are linked to the increased risk of depression and suicide. We consider the possibility that chronic hypobaric hypoxia (low blood oxygen related to low atmospheric pressure) contributes to suicide and depression, which is suggested by animal models, short-term studies in humans, and the effects of hypoxic medical conditions on suicide and depression. We argue that hypobaric hypoxia could promote suicide and depression by altering serotonin metabolism and brain bioenergetics; both of these pathways are implicated in depression, and both are affected by hypoxia. Finally, we briefly examine treatment strategies to address hypoxia-related depression and suicidal ideation that are suggested by these findings, including creatine monohydrate and the serotonin precursors tryptophan and 5-hydroxytryptophan.
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18
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Daray FM, Goldmann E, Gutierrez L, Ponzo J, Lanas F, Mores N, Calandrelli M, Poggio R, Watkins BX, Irazola V. Suicidal ideation is associated with cardiovascular disease in a large, urban cohort of adults in the Southern Cone of Latin America. Gen Hosp Psychiatry 2019; 57:34-40. [PMID: 30710890 DOI: 10.1016/j.genhosppsych.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/10/2018] [Accepted: 12/17/2018] [Indexed: 01/14/2023]
Abstract
INTRODUCTION To examine the relationship between suicidal ideation (SI) and cardiovascular disease (CVD) in the general adult population of four cities in the Southern Cone of Latin America (Argentina, Uruguay, Chile) and the role that depression, stressful life events (SLEs) and physical functional impairment may play in this association. METHODS A population-based cross-sectional study was conducted among 7524 adults between 35 and 74 years old, randomly selected. History of CVD included acute myocardial infarction, stroke and central or peripheral revascularization. SI in the past two weeks was measured using the last item of the Patient Health Questionnaire (PHQ-9), quality of life was assessed with the 12-item Short Form Survey (SF-12), and having experience of a SLE was determined by asking participants whether they had experienced at least one of a list of events in the past year. Multiple logistic regression was used to examine the association between SI and CVD overall and by sex. RESULTS The prevalence of SI was 8.3% (95% CI = 7.5, 9.0) and twice as high among women than men (11.1% vs. 5.1%). History of CVD was associated with almost twice the odds of SI (OR = 1.9, 95% CI = 1.5, 2.4). This association remained strong and significant after adjusting for potential confounders (OR = 1.8, 95% CI = 1.2, 2.7). Three additional models were tested to further adjust for depression severity, functional impairment, and SLEs separately. Adjustment for depression severity yielded no association between CVD and SI (OR = 1.1, 95% CI = 0.6, 1.7), adjustment for functional impairment yielded a marginal statistically significant association (OR = 1.5; 95% CI = 1.0, 2.4) and adjustment for SLE didn't modify either the magnitude or the statistical significance of the association. CONCLUSIONS There is a significant association between SI and CVD, particularly among women, which may be driven, at least in part, by depression and physical functional impairment.
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Affiliation(s)
- Federico M Daray
- University of Buenos Aires, School of Medicine, Institute of Pharmacology, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina
| | - Emily Goldmann
- College of Global Public Health, New York University, New York, NY, USA
| | - Laura Gutierrez
- South American Center of Excellence for Cardiovascular Health (CESCAS), Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Jaqueline Ponzo
- Facultad de Medicina, Universidad de la República, Centro Cívico Salvador Allende, Canelones, Uruguay
| | | | - Nora Mores
- Municipalidad de Marcos Paz, Buenos Aires, Argentina
| | - Matías Calandrelli
- South American Center of Excellence for Cardiovascular Health (CESCAS), Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Rosana Poggio
- South American Center of Excellence for Cardiovascular Health (CESCAS), Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | | | - Vilma Irazola
- South American Center of Excellence for Cardiovascular Health (CESCAS), Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.
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Pitts BL, Whealin JM, Kato J. Risk Factors for Suicidal Behavior Depend on Age for Veterans in the Pacific Islands. Suicide Life Threat Behav 2018; 48:642-651. [PMID: 28782133 DOI: 10.1111/sltb.12376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 05/22/2017] [Indexed: 12/01/2022]
Abstract
We examined whether risk factors for suicidal behavior depend on age among military veterans in the Pacific Islands (N = 29,595). For veterans under 54 years old, having a diagnosis of posttraumatic stress disorder, borderline personality disorder, a drug use disorder, and having a service-related disability predicted suicidal behavior. For veterans 54 years old or older, having a mood disorder predicted suicidal behavior. Having a history of suicidal behavior and a high number of VA health care visits were associated with suicidal behavior for both age groups. Our findings suggest that the predictive value of certain risk factors in veterans in the Pacific Islands may depend on age.
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Affiliation(s)
- Barbara L Pitts
- Clinical Informatics Service Department, Veterans Affairs (VA) Pacific Islands Health Care System, Honolulu, HI, USA
| | - Julia M Whealin
- Clinical Informatics Service Department, Veterans Affairs (VA) Pacific Islands Health Care System, Honolulu, HI, USA
| | - Jackson Kato
- Clinical Informatics Service Department, Veterans Affairs (VA) Pacific Islands Health Care System, Honolulu, HI, USA
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Riordan P, Briscoe J, Kamal AH, Jones CA, Webb JA. Top Ten Tips Palliative Care Clinicians Should Know About Mental Health and Serious Illness. J Palliat Med 2018; 21:1171-1176. [DOI: 10.1089/jpm.2018.0207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Paul Riordan
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Department of Psychiatry, and Duke University School of Medicine, Durham, North Carolina
| | - Joshua Briscoe
- Department of Section of Palliative Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Arif H. Kamal
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Department of Section of Palliative Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Cancer Institute, Duke University, Durham, North Carolina
- Duke Fuqua School of Business, Duke University, Durham, North Carolina
| | - Christopher A. Jones
- Perelman School of Medicine and Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason A. Webb
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Department of Psychiatry, and Duke University School of Medicine, Durham, North Carolina
- Department of Section of Palliative Medicine, Duke University School of Medicine, Durham, North Carolina
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Petkus AJ, Wetherell JL, Stein MB, Chavira DA, Craske MG, Sherbourne C, Sullivan G, Bystritsky A, Roy-Byrne P. Age Differences in Death and Suicidal Ideation in Anxious Primary Care Patients. Clin Gerontol 2018; 41:271-281. [PMID: 28960158 DOI: 10.1080/07317115.2017.1356893] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The objective of this study was to examine age differences in the likelihood of endorsing of death and suicidal ideation in primary care patients with anxiety disorders. METHOD Participants were drawn from the Coordinated Anxiety Learning and Management (CALM) Study, an effectiveness trial for primary care patients with panic disorder (PD), generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and/or social anxiety disorder (SAD). RESULTS Approximately one third of older adults with anxiety disorders reported feeling like they were better off dead. Older adults with PD and SAD were more likely to endorse suicidal ideation lasting at least more than half the prior week compared with younger adults with these disorders. Older adults with SAD endorsed higher rates of suicidal ideation compared with older adults with other anxiety disorders. Multivariate analyses revealed the importance of physical health, social support, and comorbid MDD in this association. CONCLUSIONS Suicidal ideation is common in anxious, older, primary care patients and is particularly prevalent in socially anxious older adults. Findings speak to the importance of physical health, social functioning, and MDD in this association. CLINICAL IMPLICATIONS When working with anxious older adults it is important to conduct a thorough suicide risk assessment and teach skills to cope with death and suicidal ideation-related thoughts.
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Affiliation(s)
- Andrew J Petkus
- a University of Southern California , Los Angeles , California , USA
| | - Julie Loebach Wetherell
- b VA San Diego Healthcare System , San Diego , California , USA.,c University of California, San Diego , San Diego , California , USA
| | - Murray B Stein
- c University of California, San Diego , San Diego , California , USA
| | - Denise A Chavira
- d University of California, Los Angeles , Los Angeles , California , USA
| | - Michelle G Craske
- d University of California, Los Angeles , Los Angeles , California , USA
| | | | - Greer Sullivan
- f University of California, Riverside , Riverside , California , USA
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Hawkins M, Schaffer A, Sinyor M, Nishikawa Y, Herrmann N, Lanctôt KL, Styra R, Pompili M, Huffman J. Suicide deaths by intentional self-poisoning in people with cardiovascular disease. Gen Hosp Psychiatry 2018; 52:41-47. [PMID: 29621659 DOI: 10.1016/j.genhosppsych.2018.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 03/13/2018] [Accepted: 03/21/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to characterize self-poisoning deaths in people with cardiovascular disease (CVD) and compare to other suicide decedent groups. METHODS Suicide deaths by self-poisoning in people with CVD (n = 151) were compared to suicide deaths by other methods in people with CVD (n = 260) and suicide deaths by self-poisoning in people without CVD (n = 509). Sub-analysis of the CVD self-poisoning group compared people with depression and without depression. Toxicology reports were compared between intentional self-poisoning groups. RESULTS A higher proportion of suicide deaths were due to self-poisoning in the CVD group compared to the non-CVD group. People with CVD were less likely to have any identified stressor (excluding medical stressor) prior to dying from self-poisoning compared to those without CVD. Female sex, past suicide attempts, living circumstances, and comorbid substance abuse were each significantly associated with self-poisoning as the method of suicide in people with CVD. Opioid, any antidepressants, benzodiazepines, and tricyclic antidepressants (TCAs) were commonly identified as lethal in people with CVD. Compared to people in the CVD self-poisoning without depression group, people in the CVD self-poisoning with depression group were more likely to have lethal levels of TCAs. CONCLUSIONS Our findings characterize suicide deaths in people with CVD, and identified notable differences based on method of death and presence of depression.
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Affiliation(s)
- Michael Hawkins
- Department of Psychiatry, University of Toronto, 27 King's College Circle, Toronto, Ontario M5S 1A1, Canada.
| | - Ayal Schaffer
- Mood & Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Yasunori Nishikawa
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada; Mood & Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nathan Herrmann
- Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Krista L Lanctôt
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada.
| | - Rima Styra
- Department of Psychiatry, Division of Consultation/Liaison Psychiatry, University Health Network, 200 Elizabeth Street, Toronto M5G 2C4, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Maurizio Pompili
- Psychiatry Residency Training Program, Department of Neurosciences, Mental Health and Sensory Organs, Sant'Andrea Hospital, Sapienza University of Rome, Italy; Sant'Andrea Hospital, Sapienza University of Rome, Italy; Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy.
| | - Jeffrey Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA; Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Hashemi R, Moustafa AA, Rahmati Kankat L, Valikhani A. Mindfulness and Suicide Ideation in Iranian Cardiovascular Patients: Testing the Mediating Role of Patience. Psychol Rep 2017; 121:1037-1052. [DOI: 10.1177/0033294117746990] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of the present study was to explore the mediating role of patience on the relationship between mindfulness and suicide ideation. To do so, 110 patients with cardiovascular diseases were recruited from the outpatient Clinic of Imam Reza in the city of Shiraz in Iran. These patients completed The Five Facets Mindfulness Questionnaire, Patience Scale, and Suicide Ideation Questionnaire. Data were analyzed using structural equation modeling. Results indicated a significant positive relationship between mindfulness and patience ( r = .32, p < .001). There was a significant negative relationship between patience and suicide ideation ( r = −.36, p < .001). The results of mediating model showed that patience functioned as a mediator in the relationship between mindfulness and suicide ideation among patients with cardiovascular diseases ( β = −.33, p = .005). According to these findings, it can be claimed that mindfulness affects patients’ suicidal thoughts negatively through patience.
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Affiliation(s)
- Razieh Hashemi
- Department of Clinical Psychology, School of Education and Psychology, Shiraz University, Shiraz, Iran
| | - Ahmed A. Moustafa
- School of Social Sciences and Psychology, Marcs Institute of Brain, Behaviour, and Development, Western Sydney University, Sydney, Australia
| | - Leila Rahmati Kankat
- Department of Clinical Psychology, Faculty of Humanities, Islamic Azad University of Arak, Arak, Iran
| | - Ahmad Valikhani
- Department of Clinical Psychology, School of Education and Psychology, Shiraz University, Shiraz, Iran
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Ferro MA, Rhodes AE, Kimber M, Duncan L, Boyle MH, Georgiades K, Gonzalez A, MacMillan HL. Suicidal Behaviour Among Adolescents and Young Adults with Self-Reported Chronic Illness. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:845-853. [PMID: 28814100 PMCID: PMC5714119 DOI: 10.1177/0706743717727242] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aims of this study were to estimate the: (1) 12-mo prevalence of suicidal thoughts, plans, and attempts in a population sample of adolescents and young adults with and without chronic illness; (2) associations among chronic illness and suicidal thoughts and behaviour (STB); and, (3) moderating roles of mood and substance use disorder on this association. METHOD Individuals were aged 15 to 30 y ( n = 5,248) from the Canadian Community Health Survey-Mental Health. Twelve-month STB and psychiatric disorder were measured using the World Health Organization Composite International Diagnostic Interview 3.0. Multinomial logistic regression examined associations between chronic illness and STB, adjusting for relevant sociodemographic and health characteristics. Product term interactions among chronic illness, mood, and substance use disorders were included in the regression models to examine potential moderating effects. RESULTS Prevalence of suicidal thoughts, plans, and attempts was higher in individuals with chronic illness ( P < 0.01 for all). After adjustment, chronic illness increased the odds for suicidal thoughts [OR = 1.28 (1.01 to 1.64)], plans [OR = 2.34 (1.22 to 4.39)], and attempts [OR = 4.63 (1.52 to 14.34)]. In the presence v. absence of a mood disorder, the odds for suicidal thoughts were higher among individuals with chronic illness [OR = 1.89 (1.06 to 5.28)]. CONCLUSIONS Suicidal thoughts and behaviours are common among adolescents and young adults with chronic illness, particularly among those with comorbid mood disorders. Health professionals should routinely ask about STB during assessments of their adolescent and young adult patients.
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Affiliation(s)
- Mark A Ferro
- 1 School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario
| | - Anne E Rhodes
- 2 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.,3 Department of Psychiatry, University of Toronto, Toronto, Ontario.,4 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Melissa Kimber
- 4 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Laura Duncan
- 4 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Michael H Boyle
- 4 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Katholiki Georgiades
- 4 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Andrea Gonzalez
- 4 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Harriet L MacMillan
- 4 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario.,5 Department of Pediatrics, McMaster University, Hamilton, Ontario
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Kye SY, Park K. Suicidal ideation and suicidal attempts among adults with chronic diseases: A cross-sectional study. Compr Psychiatry 2017; 73:160-167. [PMID: 27992846 DOI: 10.1016/j.comppsych.2016.12.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/28/2016] [Accepted: 12/09/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION About 14% of the global burden of disease has been attributed to neuropsychiatric disorders. The aim of this study was to show the general picture of suicidal ideation and behavior among Korean, and to test the hypothesis that there is a positive association between diseases and suicidality. METHOD A total of 19,599 individuals were asked if they had any chronic diseases, suicidal ideation and attempts. The data from the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V, 2010-2012) conducted by Korea Centers for Disease Control and Prevention (KCDC) were examined. RESULTS Stroke and osteoarthritis were associated with a 1.81 and 1.27 times increase in the odds of suicidal ideation, respectively (95% CI=1.24-2.65; 95% CI=1.09-1.48). Angina pectoris and osteoarthritis were associated with a 3.88 and 2.09 times increase in the odds of suicide attempts (95% CI=1.78-8.43; 95% CI=1.24-3.55). Having pulmonary tuberculosis increased the odds of a suicide attempt 12-fold (OR=12.47, 95% CI=1.12-138.66). Having renal failure was associated with a 4.92 times increase in the odds of suicide attempts (95% CI=1.25-19.30). Having lung cancer or cervical cancer increased the odds of suicide attempts more than 10-fold (OR=11.53, 95% CI=1.03-128.80; OR=17.66, 95% CI=1.58-197.01). CONCLUSIONS Various diseases were risk factors for suicidality. Physicians' communication skills for frank and clear discussions about suicidality should be developed through various training courses.
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Affiliation(s)
- Su-Yeon Kye
- Cancer Information and Education Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Keeho Park
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.
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Kavalidou K, Smith DJ, O'Connor RC. The role of physical and mental health multimorbidity in suicidal ideation. J Affect Disord 2017; 209:80-85. [PMID: 27888724 DOI: 10.1016/j.jad.2016.11.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/07/2016] [Accepted: 11/16/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous research has focused on the separate roles of mental illness and physical health conditions in suicide risk, with relatively few studies investigating the importance of physical and psychiatric disorder co-occurrence. We aimed to investigate whether suicidal ideation might be influenced by physical and mental ill-health multimorbidity. METHODS Data from the Adult Psychiatric Morbidity Survey of England were analysed. Participants who responded to the suicidal thoughts question were grouped into four distinct categories based on their health conditions (Common mental disorders (CMD) only, physical health conditions only, CMD/physical health multimorbidity and a control group with neither physical nor mental health conditions). Multinomial logistic regression analyses were conducted and odds ratios (OR) and 95% CIs are presented. RESULTS In the fully adjusted model, both the multimorbidity and CMD-only groups were associated with higher levels of suicidal ideation relative to the control group. LIMITATIONS Secondary analyses of cross-sectional data. CONCLUSIONS Although multimorbidity was associated with suicidal thoughts, it does not appear to elevate risk beyond the independent effects of common mental disorders or physical health problems. Primary care and mental health clinicians should consider assessment of suicidal ideation among patients with multimorbid physical/mental health conditions.
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Affiliation(s)
- Katerina Kavalidou
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, College of Medical, Veterinary, and Life Sciences, University of Glasgow, United Kingdom.
| | - Daniel J Smith
- Institute of Health & Wellbeing, College of Medical, Veterinary, and Life Sciences, University of Glasgow, United Kingdom
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, College of Medical, Veterinary, and Life Sciences, University of Glasgow, United Kingdom
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The impact of suicidality on health-related quality of life: A latent growth curve analysis of community-based data. J Affect Disord 2016; 203:14-21. [PMID: 27285722 DOI: 10.1016/j.jad.2016.05.067] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/10/2016] [Accepted: 05/28/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The subjective burden of suicidality on mental and physical health-related quality of life (HRQoL) remains to be examined. Eight-year trajectories of mental and physical components of HRQoL were compared for suicidal and non-suicidal participants at baseline. The effect of poor mental and/or physical HRQoL on subsequent suicidality was also investigated. METHOD Randomly-selected community data (W1=7485; W2=6715; W3=6133) were analysed with multivariate latent growth curve (LGC) and logistic regression models. RESULTS Adjusted LGC modelling identified that baseline ideation was associated with poorer mental, but better physical HRQoL at baseline (b=-3.93, 95% CI=-4.75 to -3.12; b=1.38, 95% CI=0.53-2.23, respectively). However, ideation was associated with a declining physical HRQoL trajectory over 8 subsequent years (b=-0.88, 95% CI=-1.42 to -0.35). Poorer mental HRQoL was associated with higher odds of ideation onset (OR=0.98, 95% CI=0.96-0.99). LIMITATIONS Frequency of data collection was four-yearly, while suicidality was reported for the previous 12-months; analyses did not control for physical health problems at baseline, baseline depression may have influenced physical QoL; suicidality was assessed with binary measures; and, prior analyses of attrition over time showed those with poorer health were less likely to continue participating in the study. CONCLUSIONS Suicidality has differential longitudinal effects on mental and physical HRQoL. Findings emphasise the considerable subjective HRQoL burden upon suicidal individuals. HRQoL may be useful to compare relative social and economical impacts.
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Idenfors H, Strömsten LMJ, Renberg ES. Non-psychiatric inpatient care preceding admission for self-harm in young people. J Psychosom Res 2016; 88:8-13. [PMID: 27521645 DOI: 10.1016/j.jpsychores.2016.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 06/28/2016] [Accepted: 06/28/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Many young people contact health services before they harm themselves intentionally. However, they often seek care for non-suicidal or non-psychiatric causes despite having suicidal thoughts. We investigated the non-psychiatric hospital diagnoses received by young people during the year before their first admission to hospital for self-harm. METHODS From a national register, we selected people who were hospitalised for an episode of self-harm during the period 1999-2009, at which time they were aged 16 to 24. We compared them with matched controls regarding the probability for having been admitted with different diagnoses during the year preceding the self-harm admission. RESULTS The study included 48,705 young people (16,235 cases and 32,470 controls). Those admitted for self-harm were more likely than controls to have been hospitalised for non-psychiatric reasons, which included symptomatic diagnoses such as abdominal pain, syncope/collapse, unspecified convulsions, and chest pain. Certain chronic somatic illnesses were also overrepresented, such as epilepsy, diabetes mellitus type 1, and asthma. CONCLUSION Symptomatic diagnoses were more common in those who had been admitted for self-harm. It is possible that psychiatric problems could have been the cause of the symptoms in some of these admissions where no underlying illness could be found, and if this was not uncovered it might lead to a delay in suicide risk assessment. For several chronic illnesses, when admitted to hospital, a psychiatric evaluation might be indicated.
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Affiliation(s)
- Hans Idenfors
- Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden.
| | - Lotta M J Strömsten
- Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
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Rukundo GZ, Kinyanda E, Mishara B. Clinical correlates of suicidality among individuals with HIV infection and AIDS disease in Mbarara, Uganda. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2016; 15:227-32. [PMID: 27681146 DOI: 10.2989/16085906.2016.1182035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The association between suicidality and HIV/AIDS has been demonstrated for three decades, but little is know about risk factors that can help understand this association and help identify who is most at risk. Few research studies have been conducted in sub-Saharan Africa, a region that accounts for more than 70% of the HIV global burden. This paper describes clinical risk factors for suicidality among individuals with HIV infection and AIDS disease in Mbarara, Uganda. In this study, suicidality includes both suicidal ideation and suicidal attempts. A cross-sectional survey was conducted with 543 HIV-positive individuals aged 15 years and above, recruited from 2 HIV specialised clinics in Mbarara. Using logistic regression analysis, factors significantly associated with suicidality at 95% confidence interval were identified. The rate of suicidality was 10% (n = 54; 95% CI: 5.00-15.00). Risk factors for suicidality were: perception of poor physical health (OR 2.22, 95% CI 1.23-3.99, p = 0.007), physical pain (OR 1.83, 95% CI 1.01-3.30, p = 0.049), reducing work due to illness (OR = 2.22, 95% CI 1.23-3.99, p = 0.004) and recent HIV diagnosis (OR 1.02, 95% CI 1.01-1.03, p = 0.001). These findings suggest that HIV/AIDS in south-western Uganda is associated with a considerable burden of suicidality. HIV is associated with several clinical factors that increase vulnerability to suicidality. There is need for more appropriate interventions targeting these clinical risk factors, systematic suicide risk assessment and management of suicidal ideation and behaviours in HIV care.
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Affiliation(s)
- Godfrey Zari Rukundo
- a Department of Psychiatry , Mbarara University of Science and Technology , Mbarara , Uganda
| | - Eugene Kinyanda
- b Department of Psychiatry , Makerere College of Health Sciences, and Medical Research Council , Entebbe , Uganda
| | - Brian Mishara
- c Centre for Research and Intervention on Suicide and Euthanasia and Psychology Department , Université du Québec , Montreal , Canada
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30
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Clark CB, Li Y, Cropsey KL. Family Dysfunction and Suicide Risk in a Community Corrections Sample. CRISIS 2016; 37:454-460. [PMID: 27445017 DOI: 10.1027/0227-5910/a000406] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND When comparted with the general population, the suicide rate in correctional populations is elevated. While predictors of suicide are well researched in jail and prison populations, much less work has been done to examine predictors of suicide in community corrections samples where 80% of the US correctional population is currently supervised. AIMS The goal of this study was to determine factors associated with suicide risk in a community corrections sample. METHOD Self-reported current ideation was examined in a sample of 512 individuals under supervision. RESULTS When univariate associations between current suicidal ideation and predictor variables were examined, current suicidal ideation was associated with being female, being White, reporting an increased level of stress, reporting an increased level of depression, meeting criteria for an anxiety disorder, an increased number of physical health complaints, and self-report of family dysfunction. In a multivariate analysis predicting suicide risk, only meeting criteria for an anxiety disorder, an increased number of physical health complaints, and self-report of family dysfunction were significant. CONCLUSION Mental and physical health complaints as well as self-report of family dysfunction are salient predictors of suicide risk in the community corrections population.
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Affiliation(s)
- C Brendan Clark
- 1 Wichita State University, Department of Psychology, Wichita, KS, USA
| | - Ye Li
- 2 University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Birmingham, AL, USA
| | - Karen L Cropsey
- 2 University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Birmingham, AL, USA
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31
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Fuller-Thomson E, Ramzan N, Baird SL. Arthritis and suicide attempts: findings from a large nationally representative Canadian survey. Rheumatol Int 2016; 36:1237-48. [DOI: 10.1007/s00296-016-3498-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
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Major depressive disorder and suicidal behavior among urban dwelling Ethiopian adult outpatients at a general hospital. J Affect Disord 2016; 197:58-65. [PMID: 26971124 PMCID: PMC4964269 DOI: 10.1016/j.jad.2016.02.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/07/2016] [Accepted: 02/25/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND We sought to evaluate the prevalence and correlates of major depressive disorder (MDD) and suicidal behavior among urban dwelling Ethiopian adults. METHODS This was a cross-sectional study of 1097 outpatient adults (≥18 years of age) in a major hospital in Addis Ababa, Ethiopia. Sociodemographic and lifestyle characteristics were collected via structured interviews. MDD and suicidal behavior were assessed using the Composite International Diagnostic Interview (CIDI) among all study participants. Multivariable logistic regression models were fitted to estimate odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS Prevalence estimates for lifetime and 12-month MDD were 18.0% and 6.7%, respectively. The prevalence of suicidal behavior during the previous year (i.e., suicidal ideation, plan or attempt) was 15.2% with approximately 4% having reported attempts. Overall, women were more likely to report suicidal behavior (17.8%) than men (11.3%). MDD odds were 1.53-fold higher among women as compared with men (aOR=1.53, 95% CI 1.05-2.23). Lifetime MDD was significantly associated with age, sex, marital status, and self-reported physical health. Participants reporting poor mental health had approximately 3-fold increased odds of MDD (OR=2.93; 95%CI: 1.05-2.23); those between 35 and 44 years old (aOR=1.92; 95%CI: 1.06-3.49) and those older than 55 years (aOR=2.54; 95%CI: 1.16-5.57) had higher odds of MDD. Similarly suicidal behavior was significantly associated with sex, marital status, and self-reported physical and mental health. LIMITATIONS This cross-sectional study utilized self-reported data from outpatients. Causality cannot be inferred, and results may not be fully generalizable. CONCLUSIONS Overall results show that MDD and suicidal behavior are highly prevalent among urban-dwelling Ethiopian adults. Women and middle-age adults constitute a high-risk group and may therefore benefit from targeted interventions.
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Sohn J, Kang DR, Kim HC, Cho J, Choi YJ, Kim C, Suh I. Elevation of Serum Aminotransferase Levels and Future Risk of Death from External Causes: A Prospective Cohort Study in Korea. Yonsei Med J 2015; 56:1582-9. [PMID: 26446640 PMCID: PMC4630046 DOI: 10.3349/ymj.2015.56.6.1582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/29/2015] [Accepted: 09/08/2015] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The association between liver enzymes and death from external causes has not been examined. We investigated the association between serum aminotransferase levels and external-cause mortality in a large prospective cohort study. MATERIALS AND METHODS A total of 142,322 subjects of 35-59 years of age who completed baseline examinations in 1990 and 1992 were enrolled. Mortalities were identified using death certificates. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were categorized into quintiles. Sub-distribution hazards ratios and 95% confidence intervals (CIs) were estimated using a competing risks regression model in which deaths from other causes were treated as competing risks. RESULTS Of 8,808 deaths, 1,111 (12.6%) were due to external causes. Injury accounted for 256 deaths, and suicide accounted for 255. After adjusting for covariates, elevated ALT and AST were significantly associated with an increased risk of all external-cause mortalities, as well as suicide and injury. Sub-distribution hazards ratios (95% CIs) of the highest versus the lowest quintiles of serum ALT and AST were, respectively, 1.57 (1.26-1.95) and 1.45 (1.20-1.76) for all external causes, 2.73 (1.68-4.46) and 1.75 (1.15-2.66) for suicide, and 1.79 (1.10-2.90) and 1.85 (1.21-2.82) for injury. The risk of external-cause mortality was also significantly higher in the fourth quintile of ALT (21.6-27.5 IU/L) than in its first quintile. CONCLUSION Elevated aminotransferase levels, even within the normal range, were significantly associated with increased risk of all external-cause mortalities, including suicide, and injury.
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Affiliation(s)
- Jungwoo Sohn
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Ryong Kang
- Department of Humanities and Social Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jaelim Cho
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Jung Choi
- Health Insurance Review & Assessment Service, Seoul, Korea
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
| | - Il Suh
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
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Colman I, Kingsbury M, Sareen J, Bolton J, van Walraven C. Migraine headache and risk of self-harm and suicide: A population-based study in Ontario, Canada. Headache 2015; 56:132-40. [PMID: 26518353 DOI: 10.1111/head.12710] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Migraine has been associated with mental illness, and may also be associated with increased risk of suicidal behavior. OBJECTIVE The aim of this article was to examine the association between migraine headache and self-harm and suicide mortality using population-based health administrative data from Ontario, Canada. METHODS The sample included 101,114 participants in a population-based health survey in the province of Ontario, Canada, who responded to the survey in 2003, 2005, or 2007, and provided health card numbers for linkage to population-based health administrative data. Participants self-reported a physician diagnosis of migraine headache. Heath administrative data were used to calculate (1) Follow-up time until first presentation to the emergency department for intentional self-harm; (2) Follow-up time until death by suicide. Proportional subdistribution hazards regression was used to compare time until death among those with and without history of migraine, after accounting for competing risks of death and adjusting for confounders. RESULTS Physician diagnosis of migraine was reported by 11.2% of the sample (11,314 individuals). Mean follow-up time was 7.3 years. Emergency department visits for self-harm during the follow-up period were almost 50% more likely in those with migraine (76.4 vs 35.7 per 100,000 person years; adjusted hazard ratio = 1.48; 95%CI: 1.11,1.96). Death by suicide was rare with only 55 suicides in the follow-up period (7.45 per 100,000 person-years). Risk of suicide was similar for both those with and without history of migraine headache (adjusted hazard ratio=0.60; 95%CI: 0.22,1.65). CONCLUSIONS Physician diagnosis of migraine headache was found to be prospectively associated with increased risk of deliberate self-harm, but there was no evidence linking it to suicide mortality. Definitively linking migraine to death by suicide may require very large samples. Health care professionals should consider monitoring suicidal risk in individuals with migraine headache.
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Affiliation(s)
- Ian Colman
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Mila Kingsbury
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
| | - Carl van Walraven
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada
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Le Strat Y, Le Foll B, Dubertret C. Major depression and suicide attempts in patients with liver disease in the United States. Liver Int 2015; 35:1910-6. [PMID: 24905236 DOI: 10.1111/liv.12612] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 05/18/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Depression is common in patients with liver disease. Moreover, alcohol use is intricately linked with both major depression and liver disease, and has also been linked with suicidal behaviours, suggesting that the alcohol use may have an intermediate role in the relationship between liver disease and major depression or suicidal behaviours. This study presents nationally representative data on the prevalence of major depression in patients with liver disease in the United States and its association with suicide attempts. METHODS Data were drawn from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The NESARC is a survey of 43 093 adults aged 18 years and older in the United States. Medically recognized liver diseases were self-reported, and diagnoses of major depression were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version. RESULT The prevalence of liver disease was estimated at 0.7%. Respondents with a liver disease reported 12-month rates of major depression (17.2%) that were significantly higher than among respondents without liver disease (7.0%; Adjusted OR:2.2; CI: 1.2-4.1). Lifetime rates of suicide attempts among participants with a major depression were also higher in participants with a liver disease (33.2%) than among respondents without liver disease (13.7%; OR: 3.1; CI: 1.3-7.6). CONCLUSIONS Liver diseases are associated with major depression and suicide attempts among adults in the community. Adjustment for the amount of alcohol used or sociodemographical factors did not explain the observed association of liver disease with both major depression and suicide attempts.
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Affiliation(s)
- Yann Le Strat
- Department of Psychiatry, Louis Mourier Hospital, AP-HP, Colombes, France.,Centre for Psychiatry and Neurosciences, INSERM U894, Team 1, 2 ter rue d'Alesia, Paris, 75014, France.,Sorbonne Paris Cité, Faculty of medicine, Univ Paris Diderot, France.,Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Addiction Program, Centre for Addiction and Mental Health, Toronto, Canada.,Departments of Family and Community Medicine, Psychiatry, Pharmacology and Toxicology, Institutes of Medical Sciences, University of Toronto, Toronto, Canada
| | - Caroline Dubertret
- Department of Psychiatry, Louis Mourier Hospital, AP-HP, Colombes, France.,Centre for Psychiatry and Neurosciences, INSERM U894, Team 1, 2 ter rue d'Alesia, Paris, 75014, France.,Sorbonne Paris Cité, Faculty of medicine, Univ Paris Diderot, France
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36
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Suicidal ideation among individuals with dysvascular lower extremity amputation. Arch Phys Med Rehabil 2015; 96:1404-10. [PMID: 25883037 DOI: 10.1016/j.apmr.2015.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/30/2015] [Accepted: 04/01/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the estimated prevalence and correlates of suicidal ideation (SI) among individuals 1 year after a first lower extremity amputation (LEA). DESIGN Cohort survey. SETTING Four medical centers. PARTICIPANTS A referred sample of patients (N=239), primarily men, undergoing their first LEA because of complications of diabetes mellitus or peripheral arterial disease, were screened for participation between 2005 and 2008. Of these patients, 136 (57%) met study criteria and 87 (64%) enrolled; 70 (80.5%) of the enrolled patients had complete data regarding SI at 12-month follow-up. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES SI, demographic/health information, depressive symptoms, mobility, independence in activities of daily living (ADL), satisfaction with mobility and ADL, medical comorbidities, social support, self-efficacy. RESULTS At 12 months postamputation, 11 subjects (15.71%) reported SI; of these, 3 (27.3%) screened negative for depression. Lower mobility, lower satisfaction with mobility, greater impairment in ADL, lower satisfaction with ADL, lower self-efficacy, and depressive symptoms were all correlated with the presence of SI at a univariate level; of these, only depressive symptoms remained significantly associated with SI in a multivariable model. CONCLUSIONS SI was common among those with recent LEA. Several aspects of an amputee's clinical presentation, such as physical functioning, satisfaction with functioning, and self-efficacy, were associated with SI, although depression severity was the best risk marker. A subset of the sample endorsed SI in the absence of a positive depression screen. Brief screening for depression that includes assessment of SI is recommended.
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Bolton JM, Walld R, Chateau D, Finlayson G, Sareen J. Risk of suicide and suicide attempts associated with physical disorders: a population-based, balancing score-matched analysis. Psychol Med 2015; 45:495-504. [PMID: 25032807 DOI: 10.1017/s0033291714001639] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The association between physical disorders and suicide remains unclear. The aim of this study was to examine the relationship between physical disorders and suicide after accounting for the effects of mental disorders. METHOD Individuals who died by suicide (n = 2100) between 1996 and 2009 were matched 3:1 by balancing score to general population controls (n = 6300). Multivariate conditional logistic regression compared the two groups across physician-diagnosed physical disorders [asthma, chronic obstructive pulmonary disease (COPD), ischemic heart disease, hypertension, diabetes, cancer, multiple sclerosis and inflammatory bowel disease], adjusting for mental disorders and co-morbidity. Secondary analyses examined the risk of suicide according to time since first diagnosis of each physical disorder (1-90, 91-364, ⩾ 365 days). Similar analyses also compared individuals with suicide attempts (n = 8641) to matched controls (n = 25 923). RESULTS Cancer was associated with increased risk of suicide [adjusted odds ratio (AOR) 1.40, 95% confidence interval (CI) 1.03-1.91, p < 0.05] even after adjusting for all mental disorders. The risk of suicide with cancer was particularly high in the first 90 days after initial diagnosis (AOR 4.10, 95% CI 1.71-9.82, p < 0.01) and decreased to non-significance after 1 year. Women with respiratory diseases had elevated risk of suicide whereas men did not. COPD, hypertension and diabetes were each associated with increased odds of suicide attempts in adjusted models (AORs ranged from 1.20 to 1.73). CONCLUSIONS People diagnosed with cancer are at increased risk of suicide, especially in the 3 months following initial diagnosis. Increased support and psychiatric involvement should be considered for the first year after cancer diagnosis.
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Affiliation(s)
- J M Bolton
- Department of Psychiatry,University of Manitoba,Winnipeg, Manitoba,Canada
| | - R Walld
- Manitoba Centre for Health Policy,Winnipeg, Manitoba,Canada
| | - D Chateau
- Manitoba Centre for Health Policy,Winnipeg, Manitoba,Canada
| | - G Finlayson
- Manitoba Centre for Health Policy,Winnipeg, Manitoba,Canada
| | - J Sareen
- Department of Psychiatry,University of Manitoba,Winnipeg, Manitoba,Canada
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Yoon DH, Kim SJ, Lee JH, Kim PM, Park DH, Ryu SH, Yu J, Ha JH. The Relationship between Type D Personality and Suicidality in Low-Income, Middle-Aged Adults. Psychiatry Investig 2015; 12:16-22. [PMID: 25670941 PMCID: PMC4310916 DOI: 10.4306/pi.2015.12.1.16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/17/2014] [Accepted: 03/11/2014] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Low-income adults are considered to be a group at high risk for suicide. We sought to examine the effect of type D personality and other socio-demographic factors on suicidality in low-income, middle-aged Koreans. METHODS In total, 306 low-income, middle-aged Koreans [age: 49.16±5.24 (40-59) years, 156 males, 150 females] were enrolled from the Korean National Basic Livelihood Security System. Socio-demographic data, including employment status, income, health, marital status, and educational attainment, were gathered. Beck's 19-item Scale for Suicidal Ideation (SSI) was applied to evaluate suicidality, and the DS14 was used to assess type D personality. RESULTS Unemployment (p<0.01) and absence of spouse (p=0.03) predicted higher SSI scores independent of other socioeconomic factors. All type D personality scores [i.e., negative affectivity (NA), social inhibition (SI), and total score] predicted higher SSI scores independent of all socioeconomic factors (all, p<0.001). Subjects with type D personality had higher SSI scores (p<0.001), and the association between suicidality and socio-demographic factors (employment or physical health) could be found only in subjects without type D personality. CONCLUSION Type D personality was a risk factor for suicide in low-income Koreans, independently from socio-economic factors. In addition, the socio-demographic factors were less prominently associated with suicidality in those with type D personality.
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Affiliation(s)
- Dae Hyun Yoon
- Department of Psychiatry, Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seog Ju Kim
- Department of Medicine, School of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jong-Ha Lee
- Department of Social Welfare, Induk University, Seoul, Republic of Korea
| | - Pyo-Min Kim
- Department of Social Welfare, Soongsil University, Seoul, Republic of Korea
| | - Doo-Heum Park
- Department of Psychiatry, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Seung Ho Ryu
- Department of Psychiatry, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Jaehak Yu
- Department of Psychiatry, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Jee Hyun Ha
- Department of Psychiatry, School of Medicine, Konkuk University, Seoul, Republic of Korea
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Asthma and self-harm: a population-based cohort study in Taiwan. J Psychosom Res 2014; 77:462-7. [PMID: 25224126 DOI: 10.1016/j.jpsychores.2014.08.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/26/2014] [Accepted: 08/28/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Few studies have investigated the relationship between asthma and suicidality-related outcomes in the world. We sought to investigate the association between asthma and risk of non-fatal self-harm in a large national sample. METHODS Cases aged 10years and over were identified from Taiwan's National Health Insurance Research Database with a new primary diagnosis of asthma (ICD-9:493) between 2000 and 2008. Case status required the presence of any inpatient diagnosis of asthma and/or at least two recorded diagnoses and 1year duration of asthma in outpatient services. These 27,781 cases were compared to 138,905 sex- and age-matched controls and both groups were followed until end of 2008 for instances of self-harm, defined as ICD-9 codes E950-E959 (self-harm causes) and E980-E989 (undetermined causes). Competing risk adjusted Cox regression analyses were applied, adjusting for sex, age, residence (urban/rural), insurance premium, episode of psychiatric disease, montelukast, Charlson comorbidity index and mortality. RESULTS Of the 166,686 subjects, 445 carried out self-harm during a mean (SD) follow-up period of 5.84 (2.35) years. Asthma (hazard ratio=1.70, 95% CI: 1.35-2.14), age, residence, episode of psychiatric disease and Charlson comorbidity index were independent risks on self-harm in the fully adjusted model. CONCLUSIONS Asthma was associated with increased risk of self-harm in this population, independent of a number of potential confounding factors including montelukast use. This reinforces the need to consider mental health in routine asthma care, and to consider asthma as a potentially important stressor in people with comorbid mental disorder.
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Strid JMC, Christiansen CF, Olsen M, Qin P. Hospitalisation for chronic obstructive pulmonary disease and risk of suicide: a population-based case-control study. BMJ Open 2014; 4:e006363. [PMID: 25421339 PMCID: PMC4244413 DOI: 10.1136/bmjopen-2014-006363] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To examine risk of suicide among individuals with hospitalised chronic obstructive pulmonary disease (COPD) and to profile differences according to sex, age, psychiatric history, and recency and frequency of COPD hospitalisations. DESIGN Nested case-control study. SETTING Data were retrieved from Danish national registries. PARTICIPANTS All suicide cases aged 40-95 years deceased between 1981 and 2006 in Denmark (n=19,869) and up to 20 live population controls per case matched on sex and date of birth (n=321,867 controls). MAIN OUTCOME MEASURES The relative risk of suicide associated with COPD was computed using conditional logistic regression and adjusted for effects of psychiatric history and important sociodemographic factors. RESULTS In our study population, 3% of suicide cases had been hospitalised for COPD compared with 1% of matched population controls. Thus, a hospitalised COPD was associated with a significantly increased risk for suicide (OR 2.6; 95% CI 2.3 to 2.8). The increased risk remained significant after adjustment for psychiatric history and sociodemographic variables (OR 2.0; 95% CI 1.8 to 2.2), and increased progressively with frequency and recency of COPD hospitalisation. At the same time, suicide risk associated with COPD differed significantly by sex, age and psychiatric status. The relative risk was more pronounced in women, in individuals older than 60 years and in persons with no history of psychiatric illness. CONCLUSIONS COPD confers an important risk factor for suicide completion. Risk assessment and prevention efforts should take patients' sex, age and psychiatric history into consideration.
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Affiliation(s)
- Jennie Maria Christin Strid
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus C, Denmark
| | | | - Morten Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Ping Qin
- National Centre for Register-based Research, Aarhus University, Aarhus C, Denmark
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Chung JH, Han CH, Park SC, Kim CJ. Suicidal ideation and suicide attempts in chronic obstructive pulmonary disease: the Korea National Health and Nutrition Examination Survey (KNHANES IV, V) from 2007-2012. NPJ Prim Care Respir Med 2014; 24:14094. [PMID: 25356541 PMCID: PMC4373505 DOI: 10.1038/npjpcrm.2014.94] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/26/2014] [Accepted: 09/15/2014] [Indexed: 01/19/2023] Open
Abstract
Background: There is good evidence for an association between chronic obstructive pulmonary disease (COPD) and depression, but there are few studies on the relationship between COPD and suicidal ideation/suicidal attempts. Aims: To evaluate the mental health of patients with COPD in Korea and to compare it with that of the general population. Methods: We analysed data of 15,718 subjects (age ⩾40 years) who participated in the 2007–2012 Korea National Health and Nutrition Examination Survey. COPD was defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for people aged ⩾40 years. We compared the mental health outcomes of 2,506 patients with COPD (2,355 GOLD stages I and II; 151 GOLD stages III and IV) with those of 13,212 controls. Results: Suicidal thoughts were reported by 16.0% of patients in stages I and II, by 23.8% of those in stages III and IV and by 15.7% of controls (P=0.023). Suicidal attempts were reported by 0.6% of patients in stages I and II, by 2.6% of those in stages III and IV and by 1.0% of controls (P=0.019). The crude odds ratio (OR) for suicidal ideation in those in stages III and IV was 1.68 (95% confidence interval (CI), 1.16–2.46), and the OR for suicidal attempts in stages III and IV was 2.83 (95% CI, 1.03–7.75). In multivariate analysis, the OR for suicidal ideation in stages III and IV was 1.67 (95% CI, 1.12–2.49) and that for suicidal attempts was 2.94 (95% CI, 1.03–8.31). Conclusions: GOLD stages III and IV COPD were associated with a marked increase in suicidal behaviour.
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Affiliation(s)
- Jae Ho Chung
- Division of Pulmonology, Department of Internal Medicine, International St. Mary`s Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Chang Hoon Han
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Koyang, Republic of Korea
| | - Seon Cheol Park
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Koyang, Republic of Korea
| | - Cheong Ju Kim
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Koyang, Republic of Korea
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Jia CX, Wang LL, Xu AQ, Dai AY, Qin P. Physical Illness and Suicide Risk in Rural Residents of Contemporary China. CRISIS 2014; 35:330-7. [DOI: 10.1027/0227-5910/a000271] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Physical illness is linked with an increased risk of suicide; however, evidence from China is limited. Aims: To assess the influence of physical illness on risk of suicide among rural residents of China, and to examine the differences in the characteristics of people completing suicide with physical illness from those without physical illness. Method: In all, 200 suicide cases and 200 control subjects, 1:1 pair-matched on sex and age, were included from 25 townships of three randomly selected counties in Shandong Province, China. One informant for each suicide or control subject was interviewed to collect data on the physical health condition and psychological and sociodemographic status. Results: The prevalence of physical illness in suicide cases (63.0%) was significantly higher than that in paired controls (41.0%; χ2 = 19.39, p < .001). Compared with suicide cases without physical illness, people who were physically ill and completed suicide were generally older, less educated, had lower family income, and reported a mental disorder less often. Physical illness denoted a significant risk factor for suicide with an associated odds ratio of 3.23 (95% CI: 1.85–5.62) after adjusted for important covariates. The elevated risk of suicide increased progressively with the number of comorbid illnesses. Cancer, stroke, and a group of illnesses comprising dementia, hemiplegia, and encephalatrophy had a particularly strong effect among the commonly reported diagnoses in this study population. Conclusion: Physical illness is an important risk factor for suicide in rural residents of China. Efforts for suicide prevention are needed and should be integrated with national strategies of health care in rural China.
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Affiliation(s)
- Cun-Xian Jia
- School of Public Health, Shandong University, Jinan, China
- Center for Suicide Prevention and Research, Shandong University, Jinan, China
| | - Lin-Lin Wang
- School of Public Health, Shandong University, Jinan, China
| | - Ai-Qiang Xu
- Shandong Center for Disease Control and Prevention, Jinan, China
| | | | - Ping Qin
- Center for Suicide Prevention and Research, Shandong University, Jinan, China
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway
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Goodwin RD, Taha F. Global health benefits of being raised in a rural setting: results from the National Comorbidity Survey. Psychiatry Clin Neurosci 2014; 68:395-403. [PMID: 24641788 DOI: 10.1111/pcn.12144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/25/2013] [Accepted: 12/01/2013] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to examine the association between being raised in a rural setting and physical and mental health among adults in the USA. METHODS Data were drawn from the National Comorbidity Survey (n = 8098), a household probability sample representative of adults aged 15-54 years in the USA. Multiple logistic regression analyses were used to determine the association between being raised in a rural area and the likelihood of mental disorders, physical disorders, suicide behavior, and parental mental health. Odds ratios (OR) with 95% confidence intervals were calculated, adjusting for differences in demographic characteristics. RESULTS Being raised in a rural setting was associated with decreased odds of ulcer (OR = 0.56 [0.34, 0.91]). Mental disorders (any lifetime) (OR = 0.74 [0.64, 0.85]), any anxiety disorder (OR = 0.75 [0.6, 0.92]) and any substance use disorder (OR = 0.79 [0.65, 0.94]) were significantly less likely among adults who were raised in a rural setting. Maternal psychopathology and exposure to trauma were significantly lower among those raised in a rural setting, compared with those who were not. These relations were not explained by sociodemographic differences. CONCLUSIONS These data provide preliminary evidence that being raised in a rural environment lowers the risk of mental and physical health problems in adulthood. Being raised in a rural community also appears to be associated with significantly lower likelihood of exposure to trauma and maternal psychopathology. Future studies that can identify potential protective factors and mechanisms underlying these pathways are needed next.
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Affiliation(s)
- Renee D Goodwin
- Department of Psychology, Queens College and The Graduate Center, City University of New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
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Qin P, Hawton K, Mortensen PB, Webb R. Combined effects of physical illness and comorbid psychiatric disorder on risk of suicide in a national population study. Br J Psychiatry 2014; 204:430-5. [PMID: 24578445 DOI: 10.1192/bjp.bp.113.128785] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND People with physical illness often have psychiatric disorder and this comorbidity may have a specific influence on their risk of suicide. AIMS To examine how physical illness and psychiatric comorbidity interact to influence risk of suicide, with particular focus on relative timing of onset of the two types of illness. METHOD Based on the national population of Denmark, individual-level data were retrieved from five national registers on 27 262 suicide cases and 468 007 gender- and birth-date matched living controls. Data were analysed using conditional logistic regression. RESULTS Both suicides and controls with physical illness more often had comorbid psychiatric disorder than their physically healthy counterparts. Although both physical and psychiatric illnesses constituted significant risk factors for suicide, their relative timing of onset in individuals with comorbidity significantly differentiated the associated risk of suicide. While suicide risk was highly elevated when onsets of both physical and psychiatric illness occurred close in time to each other, regardless which came first, psychiatric comorbidity developed some time after onset of physical illness exacerbated the risk of suicide substantially. CONCLUSIONS Suicide risk in physically ill people varies substantially by presence of psychiatric comorbidity, particularly the relative timing of onset of the two types of illness. Closer collaboration between general and mental health services should be an essential component of suicide prevention strategies.
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Affiliation(s)
- Ping Qin
- Ping Qin, MD, PhD, National Centre for Register-based Research, Aarhus University, Denmark, and National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway; Keith Hawton, DSc, DM, Centre for Suicide Study, Department of Psychiatry, Oxford University, UK; Preben Bo Mortensen, MD, DrMedSc, National Centre for Register-based Research, Aarhus University, Denmark; Roger Webb, MSc, PhD, Centre for Mental Health and Risk, University of Manchester, UK
| | - Keith Hawton
- Ping Qin, MD, PhD, National Centre for Register-based Research, Aarhus University, Denmark, and National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway; Keith Hawton, DSc, DM, Centre for Suicide Study, Department of Psychiatry, Oxford University, UK; Preben Bo Mortensen, MD, DrMedSc, National Centre for Register-based Research, Aarhus University, Denmark; Roger Webb, MSc, PhD, Centre for Mental Health and Risk, University of Manchester, UK
| | - Preben Bo Mortensen
- Ping Qin, MD, PhD, National Centre for Register-based Research, Aarhus University, Denmark, and National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway; Keith Hawton, DSc, DM, Centre for Suicide Study, Department of Psychiatry, Oxford University, UK; Preben Bo Mortensen, MD, DrMedSc, National Centre for Register-based Research, Aarhus University, Denmark; Roger Webb, MSc, PhD, Centre for Mental Health and Risk, University of Manchester, UK
| | - Roger Webb
- Ping Qin, MD, PhD, National Centre for Register-based Research, Aarhus University, Denmark, and National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway; Keith Hawton, DSc, DM, Centre for Suicide Study, Department of Psychiatry, Oxford University, UK; Preben Bo Mortensen, MD, DrMedSc, National Centre for Register-based Research, Aarhus University, Denmark; Roger Webb, MSc, PhD, Centre for Mental Health and Risk, University of Manchester, UK
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Pompili M, Venturini P, Montebovi F, Forte A, Palermo M, Lamis DA, Serafini G, Amore M, Girardi P. Suicide risk in dialysis: review of current literature. Int J Psychiatry Med 2014; 46:85-108. [PMID: 24547611 DOI: 10.2190/pm.46.1.f] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Studies have shown that patients with end-stage kidney disease (ESKD) are at risk of experiencing suicidal ideation and suicide attempt. STUDY DESIGN The aim of the present review was to investigate whether there was a relationship between dialysis and suicide. A careful systematic review of the literature was conducted to determine the potential association between dialysis and suicide. SELECTION CRITERIA FOR STUDIES Abstracts that did not explicitly mention suicide and dialysis were excluded. We identified as specific fields of interest in the analysis of dialysis or ESRD and suicidal behavior. RESULTS A total of 26 articles from peer-reviewed journals were considered and the most relevant articles (N = 13) were selected for this review. OUTCOMES It has been posited that suicidal ideation, occurring in dialysis, may arise from co-morbid depression and psychiatric symptoms are frequent in patients who underwent dialysis. LIMITATIONS The present review should be considered in the light of some limitations. We did not carry out a meta-analysis because data from most of the studies did not permit it. Samples included different measurements and different outcomes, and they assessed patients at different time points. CONCLUSIONS The available data suggest that the risk of self-harm may be higher than expected in dialysis patients especially in those who suffer by depression and anxiety. Moreover, although the majority of deaths among dialysis patients is preceded by withdrawal from treatment, suicide remains a separate phenomenon.
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Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs-Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy.
| | | | | | | | | | - Dorian A Lamis
- Emory University School of Medicine, Atlanta, Georgia, USA
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Myers AK, Grannemann BD, Lingvay I, Trivedi MH. Brief report: depression and history of suicide attempts in adults with new-onset Type 2 Diabetes. Psychoneuroendocrinology 2013; 38:2810-4. [PMID: 23978666 DOI: 10.1016/j.psyneuen.2013.06.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 06/07/2013] [Accepted: 06/07/2013] [Indexed: 11/24/2022]
Abstract
AIM To assess past suicide attempts in a cohort of adults with Type 2 Diabetes diagnosed within the prior 24 months. METHODS Outpatients were recruited from diabetes education classes or diabetes shared medical appointment. Participants aged 18 or over with a self-reported diagnosis of Type 2 Diabetes (T2DM) in the prior 24 months completed questionnaires about medical (including diabetes), psychiatric, and social history. Participants also completed two screening questionnaires for depression: Patient Health Questionnaire 9 and the Questionnaire Inventory for Depressive Symptoms-Self Report. Those who screened positive for depression had confirmatory testing with a clinician administered Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) checklist. RESULTS In this convenience sample of 145 patients with Type 2 Diabetes, 9.7% of patients had history of a suicide attempt and 38.2% met diagnosis for major depressive disorder (MDD). Patients with MDD were more likely to have a history of suicide attempts than those without MDD (p=0.0002). Of the patients with prior suicide attempts, 50% screened positive for MDD at the time of the survey. CONCLUSION In patients with newly-diagnosed Type 2 Diabetes the rate of past suicide attempts was nearly 10%, which is twice the rate seen in the general population. The rate of past suicide attempts in currently depressed patients with diabetes is 21.8%. These findings suggest the need for monitoring patients with diabetes and depression for future suicide risk.
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Affiliation(s)
- Alyson K Myers
- Department of Psychiatry, University of Texas at Southwestern Medical Center, Dallas, TX, United States; Division of Endocrinology, University of Texas at Southwestern Medical Center, Dallas, TX, United States.
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Young SN. Elevated incidence of suicide in people living at altitude, smokers and patients with chronic obstructive pulmonary disease and asthma: possible role of hypoxia causing decreased serotonin synthesis. J Psychiatry Neurosci 2013; 38:423-6. [PMID: 24148847 PMCID: PMC3819157 DOI: 10.1503/jpn.130002] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Recent research indicates that suicide rates are elevated in those living at higher altitudes in both the United States and South Korea. A possible mechanism that was proposed is metabolic stress associated with hypoxia. This commentary discusses these results, and also the association between elevated suicide rates and other conditions associated with hypoxia (smoking, chronic obstructive pulmonary disease and asthma). Tryptophan hydroxylase may not normally be saturated with oxygen, so mild hypoxia would decrease serotonin synthesis. Low brain serotonin is known to be associated with suicide. Thus, the commentary proposes and discusses the hypothesis that decreased brain serotonin synthesis associated with hypoxia is a mechanism that may contribute to suicide in conditions causing hypoxia. Finally the commentary proposes various studies that could test aspects of this hypothesis.
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Affiliation(s)
- Simon N. Young
- Correspondence to: S.N. Young, Department of Psychiatry, McGill University, 1033 Pine Ave. W, Montréal QC H3A 1A1;
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Bomyea J, Lang AJ, Craske MG, Chavira D, Sherbourne CD, Rose RD, Golinelli D, Campbell-Sills L, Welch SS, Sullivan G, Bystritsky A, Roy-Byrne P, Stein MB. Suicidal ideation and risk factors in primary care patients with anxiety disorders. Psychiatry Res 2013; 209:60-5. [PMID: 23608160 PMCID: PMC3745797 DOI: 10.1016/j.psychres.2013.03.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 03/12/2013] [Accepted: 03/18/2013] [Indexed: 11/18/2022]
Abstract
The presence of an anxiety disorder is associated with greater frequency of suicidal thoughts and behaviors. Given the high personal and societal costs of suicidal behaviors, suicide prevention is a priority. Understanding factors present within individuals with anxiety disorders that increase suicide risk may inform prevention efforts. The aims of the present study were to examine the prevalence of suicidal ideation and behaviors, as well as factors associated with suicide risk in patients with anxiety disorders in primary care. Data from a large scale randomized controlled study were analyzed to assess prevalence of suicidal thoughts and behaviors, as well as factors associated with suicide risk. Results revealed that suicidal ideation and behaviors were relatively common in this group. When examining mental and physical health factors jointly, presence of depression, mental health-related impairment, and social support each uniquely accounted for variance in suicide risk score. Methodological limitations include cross-sectional data collection and lack of information on comorbid personality disorders. Moreover, patients included were from a clinical trial with exclusion criteria that may limit generalizability. Results highlight the complex determinants of suicidal behavior and the need for more nuanced suicide assessment in this population, including evaluation of comorbidity and general functioning.
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Affiliation(s)
- Jessica Bomyea
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA 92037, USA.
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Abstract
Suicide accounts for about 1,000,000 deaths worldwide every year and is among the leading causes of death in young adults. Reports of high prevalence of suicidal ideation and increased suicide risk in several skin diseases raised concerns about deliberate self-harm in dermatological patients. The literature consistently points to an increased suicide risk in patients with psoriasis, atopic dermatitis, and acne, with higher risk in patients in whom the skin condition is associated with clinically significant emotional distress, changes in body image, difficulties in close relationships, and impaired daily activities. Other risk factors for suicide include a history of suicide attempts, severe mental or physical disorders, alcoholism, unemployment, bereavement or divorce, and access to firearms or other lethal means. Dermatologists may play an important role in recognizing suicidal ideation and preventing fatal self-harm in their patients. Increasing dermatologists' awareness of the issue of suicide and developing mental health consultation-liaison services within dermatology settings would be instrumental in contributing to suicide prevention in this population.
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50
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Gordon-Elliott JS, Muskin PR. Managing the patient with psychiatric issues in dermatologic practice. Clin Dermatol 2013; 31:3-10. [PMID: 23245968 DOI: 10.1016/j.clindermatol.2011.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Patients often communicate emotions through their bodies and physical symptoms; the skin commonly serves as a means of expression in the patient-doctor relationship. It is important for the dermatologist to be able to indentify psychological issues that manifest in the skin and the interplay between psychiatric and dermatologic conditions. Delusional parasitosis, dermatitis artefacta, trichotillomania, and somatoform disorders all represent dermatologic conditions with underlying emotional causes. Many chronic dermatoses, such as psoriasis, atopic dermatitis, and acne, modulate and are influenced by psychosocial factors. Special issues, including significant medication interactions and the treatment of the "difficult" patient, are reviewed.
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