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Dennis BB, Roshanov PS, Bawor M, ElSheikh W, Garton S, DeJesus J, Rangarajan S, Vair J, Sholer H, Hutchinson N, Lordan E, Thabane L, Samaan Z. Re-examination of classic risk factors for suicidal behavior in the psychiatric population. CRISIS 2016; 36:231-40. [PMID: 26440619 PMCID: PMC4614877 DOI: 10.1027/0227-5910/a000342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract.Background: For decades we have understood the risk factors for
suicide in the general population but have fallen short in understanding what
distinguishes the risk for suicide among patients with serious psychiatric
conditions. Aims: This prompted us to investigate risk factors
for suicidal behavior among psychiatric inpatients. Method: We
reviewed all psychiatric hospital admissions (2008–2011) to a centralized
psychiatric hospital in Ontario, Canada. Using multivariable logistic regression
we evaluated the association between potential risk factors and lifetime history
of suicidal behavior, and constructed a model and clinical risk score to predict
a history of this behavior. Results: The final risk prediction
model for suicidal behavior among psychiatric patients (n =
2,597) included age (in three categories: 60–69 [OR = 0.74, 95%
CI = 0.73–0.76], 70–79 [OR = 0.45, 95% CI = 0.44–0.46], 80+
[OR = 0.31, 95% CI = 0.30–.31]), substance use disorder
(OR = 1.30, 95% CI = 1.27–1.32), mood disorder
(OR = 1.49, 95% CI = 1.47–1.52), personality disorder
(OR = 2.30, 95% CI = 2.25–2.36), psychiatric disorders due
to general medical condition (OR = 0.52, 95% CI = 0.50–0.55),
and schizophrenia (OR = 0.42, 95% CI = 0.41–0.43). The risk
score constructed from the risk prediction model ranges from −9 (lowest risk, 0%
predicted probability of suicidal behavior) to +5 (highest risk, 97% predicted
probability). Conclusion: Risk estimation may help guide
intensive screening and treatment efforts of psychiatric patients with high risk
of suicidal behavior.
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Affiliation(s)
- Brittany B Dennis
- 1 St. George's University of London, UK.,2 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Pavel S Roshanov
- 3 Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Monica Bawor
- 1 St. George's University of London, UK.,4 McMaster Integrative Neuroscience and Discovery Program, McMaster University, Hamilton, ON, Canada
| | - Wala ElSheikh
- 5 Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada
| | - Sue Garton
- 6 St. Joseph's Healthcare Hamilton, ON, Canada
| | - Jane DeJesus
- 5 Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- 5 Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada
| | - Judith Vair
- 6 St. Joseph's Healthcare Hamilton, ON, Canada
| | | | | | | | - Lehana Thabane
- 2 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Zainab Samaan
- 2 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,7 Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.,8 Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, ON, Canada
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Voss WD, Kaufman E, O'Connor SS, Comtois KA, Conner KR, Ries RK. Preventing addiction related suicide: a pilot study. J Subst Abuse Treat 2013; 44:565-9. [PMID: 23375569 DOI: 10.1016/j.jsat.2012.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 09/04/2012] [Accepted: 10/22/2012] [Indexed: 10/27/2022]
Abstract
Persons addicted to alcohol and drugs are at 5-10 times higher risk for suicide as compared to the general population. To address the need for improved suicide prevention strategies in this population, the Preventing Addiction Related Suicide (PARS) module was developed. Pilot testing of 78 patients demonstrated significant post-treatment changes in knowledge [t(66) = 12.07, p = .000] and attitudes [t(75) = 6.82, p = .000] toward suicide prevention issues. Significant gains were maintained at 1-month follow-up for changes in knowledge [t(55) = 6.33, p = .000] and attitudes [t(61) = 3.37, p = .0001], with changes in positive help seeking behaviors in dealing with suicidal issues in friends [χ(2)(1) = 10.49, p = .007], family [χ(2)(1) = 9.81, p = .015], and self [χ(2)(1) = 19.62, p = .008] also observed. The PARS was also highly rated by treatment staff as feasible within their standard clinical practice.
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Kaplan MS, McFarland BH, Huguet N, Valenstein M. Suicide risk and precipitating circumstances among young, middle-aged, and older male veterans. Am J Public Health 2012; 102 Suppl 1:S131-7. [PMID: 22390587 PMCID: PMC3496453 DOI: 10.2105/ajph.2011.300445] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2011] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the risk of suicide among veteran men relative to nonveteran men by age and to examine the prevalence of suicide circumstances among male veterans in different age groups (18-34, 35-44, 45-64, and ≥ 65 years). METHODS Data from the National Violent Death Reporting System (2003-2008) were used to calculate age-specific suicide rates for veterans (n = 8440) and nonveterans (n = 21,668) and to calculate the age-stratified mortality ratio for veterans. Multiple logistic regression was used to compare health status, stressful life events preceding suicide, and means of death among young, middle-aged, and older veterans. RESULTS Veterans were at higher risk for suicide compared with nonveterans in all age groups except the oldest. Mental health, substance abuse, and financial and relationship problems were more common in younger than in older veteran suicide decedents, whereas health problems were more prevalent in the older veterans. Most male veterans used firearms for suicide, and nearly all elderly veterans did so. CONCLUSIONS Our study highlighted heightened risk of suicide in male veterans compared with nonveterans. Within the veteran population, suicide might be influenced by different precipitating factors at various stages of life.
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Katz IR, McCarthy JF, Ignacio RV, Kemp J. Suicide among veterans in 16 states, 2005 to 2008: comparisons between utilizers and nonutilizers of Veterans Health Administration (VHA) services based on data from the National Death Index, the National Violent Death Reporting System, and VHA administrative records. Am J Public Health 2012; 102 Suppl 1:S105-10. [PMID: 22390582 DOI: 10.2105/ajph.2011.300503] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to compare suicide rates among veterans utilizing Veterans Health Administration (VHA) services versus those who did not. METHODS Suicide rates from 2005 to 2008 were estimated for veterans in the 16 states that fully participated in the National Violent Death Reporting System (NVDRS), using data from the National Death Index, NVDRS, and VHA records. RESULTS Between 2005 and 2008, veteran suicide rates differed by age and VHA utilization status. Among men aged 30 years and older, suicide rates were consistently higher among VHA utilizers. However, among men younger than 30 years, rates declined significantly among VHA utilizers while increasing among nonutilizers. Over these years, an increasing proportion of male veterans younger than 30 years received VHA services, and these individuals had a rising prevalence of diagnosed mental health conditions. CONCLUSIONS The higher rates of suicide for utilizers of VHA among veteran men aged 30 and older were consistent with previous reports about which veterans utilize VHA services. The increasing rates of mental health conditions in utilizers younger than 30 years suggested that the decreasing relative rates in this group were related to the care provided, rather than to selective enrollment of those at lower risk for suicide.
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Affiliation(s)
- Ira R Katz
- US Department of Veterans Affairs, Washington, DC, USA
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5
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Mrnak-Meyer J, Tate SR, Tripp JC, Worley MJ, Jajodia A, McQuaid JR. Predictors of suicide-related hospitalization among U.S. veterans receiving treatment for comorbid depression and substance dependence: who is the riskiest of the risky? Suicide Life Threat Behav 2011; 41:532-42. [PMID: 21815915 PMCID: PMC3821394 DOI: 10.1111/j.1943-278x.2011.00051.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined whether widely accepted suicide risk factors are useful in predicting suicide-related hospitalization, beyond history of a suicide attempt, in high-risk treatment-seeking veterans with depression and substance dependence. Negative mood regulation expectancies were the only significant predictor of hospitalization during 6-months of outpatient treatment. History of a suicide attempt was the only significant predictor of hospitalization during the one-year follow-up period. Results suggest that within high-risk populations, standard suicide risk factors may not identify individuals who will engage in suicidal behaviors resulting in hospitalization. Assessing negative mood regulation expectations may assist in identifying those most at risk.
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Affiliation(s)
| | - Susan R. Tate
- VA San Diego Healthcare System and University of California, San Diego 3350 La Jolla Village Dr., San Diego, CA 92161
| | - Jessica C. Tripp
- VA San Diego Healthcare System 3350 La Jolla Village Dr., San Diego, CA 92161
| | - Matthew J. Worley
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology 3350 La Jolla Village Dr., San Diego, CA 92161
| | - Archana Jajodia
- VA San Diego Healthcare System and University of California, San Diego 3350 La Jolla Village Dr., San Diego, CA 92161
| | - John R. McQuaid
- San Francisco VA Medical Center and University of California, San Francisco 4150 Clement St., San Francisco, CA 94121
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Thompson R, Kane V, Cook JM, Greenstein R, Walker P, Woody G. Suicidal Ideation in Veterans Receiving Treatment for Opiate Dependence. J Psychoactive Drugs 2006; 38:149-56. [PMID: 16903454 DOI: 10.1080/02791072.2006.10399839] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Persons with opiate use disorders, especially veterans, have a number of both chronic and acute indicators of risk for suicide, but are not typically screened for suicidal ideation on a routine basis, beyond initial evaluations. One hundred one veterans receiving treatment for opiate dependence at an urban VA medical center were screened for suicidal ideation. Over 24% reported some suicidal ideation. Current ideation was associated with severe chronic pain, ongoing problems with street drugs, firearm ownership, and with having recently enrolled in treatment. It was also associated with a variety of recent negative life events and mental health issues, especially depression, recurring troubling thoughts, hallucinations, loss of jobs, and conflicts with family members. Two veterans endorsing suicidal ideation required immediate hospitalization. The implications of these findings are discussed, and frequent screening for suicidal ideation among patients receiving treatment for opiate dependence is recommended.
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Affiliation(s)
- Richard Thompson
- Juvenile Protective Association, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60622, USA
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7
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Reith DM, Whyte I, Carter G, McPherson M, Carter N. Risk factors for suicide and other deaths following hospital treated self-poisoning in Australia. Aust N Z J Psychiatry 2004; 38:520-5. [PMID: 15255824 DOI: 10.1080/j.1440-1614.2004.01405.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To analyze the risk factors for suicide, premature death and all-cause death in a representative population of hospital-treated deliberate self-poisoning patients. METHOD A prospective cohort study using data-linkage between the Hunter Area Toxicology Service Database and the National Death Index of the Australian Institute of Health and Welfare, from January 1991 to December 2000. RESULTS There were 4105 subjects, of whom 228 (5.6%) died, 122 (2.9%) by premature death and 58 (1.4%) by suicide. The probability of suicide after 10 years follow-up was 2%. The adjusted hazard ratios (95% CI) for suicide were: 'disorders usually diagnosed in infancy, childhood and adolescence', 5.28 (95% CI = 2.04-13.65): male gender, 4.25 (95% CI = 2.21-8.14); discharge to involuntary psychiatric hospital admission, 3.20 (95% CI = 1.78-5.76); and increasing age, 1.02 (95% CI = 1.01-1.04). Men and women showed different patterns of multivariate risks, although increased risk with increasing age and discharge to an involuntary psychiatric admission was true for both. The standardized all-cause mortality ratio (95% CI) was: for men, 6.42 (95% CI = 5.44-7.57), and for women 4.39 (95% CI = 3.56-5.41). The standardized suicide mortality ratio (95% CI) was: for men, 20.55 (95% CI = 15.24-27.73), and for women 22.95 (95% CI = 13.82-38.11). CONCLUSIONS Men and women have different risk factors for subsequent suicide after self-poisoning. Hospital-treated self-poisoning patients have increased risk of subsequent suicide, premature and all-cause death. Psychiatric assessment, leading to discharge decisions, is worthwhile in identifying patients at long-term risk of suicide, premature and all-cause death.
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Affiliation(s)
- David M Reith
- Discipline Of Paediatrics, University of Otago and Children's Pavilion, Dunedin Public Hospital, Great King St, Dunedin, New Zealand.
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Dlugacz YD, Restifo A, Scanlon KA, Nelson K, Fried AM, Hirsch B, Delman M, Zenn RD, Selzer J, Greenwood A. Safety Strategies to Prevent Suicide in Multiple Health Care Environments. ACTA ACUST UNITED AC 2003; 29:267-78. [PMID: 14564745 DOI: 10.1016/s1549-3741(03)29031-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patient suicide is one of the primary sentinel events reported throughout the United States. North Shore-Long Island Jewish Health System undertook a series of performance improvement efforts to identify suicide risk factors and develop a series of strategies and tools to maximize the safety of all vulnerable patients. METHODOLOGY A multidisciplinary task force conducted root cause analyses of 17 attempted and completed suicides and targeted inadequate patient assessment, poor communication, and knowledge deficits. A protocol was designed to ensure appropriate assessment, monitoring, and treatment of patients at risk for alcohol withdrawal and suicide. Poor communication as patients moved throughout the continuum of care was addressed through targeted education, a centralized intake model, and an inter-institutional transfer summary form. A continuous suicide risk assessment tool was incorporated into the inpatient behavioral health rounds. SUMMARY AND CONCLUSIONS The new tools have raised awareness, improved accountability, and encouraged best practices throughout the health system.
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Affiliation(s)
- Yosef D Dlugacz
- North Shore-Long Island Jewish Health System, Great Neck, New York, USA
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