Can better recognition and treatment of depression reduce suicide rates? A brief review

Anxiety and suicidality in the college student population

Objective: This study examined symptoms of anxiety, depression and suicidality in a national sample of college students. Participants: Using national survey data from the Healthy Minds Study (HMS), a random sample from 184 U.S. campuses from fall 2016 to spring 2019 was analyzed (N = 119,875). Methods: Prevalence rates were examined with the Generalized Anxiety Disorder 7-Item scale, Patient Health Questionnaire-9 and suicidality questions. Relationships between anxiety, depression and suicidality were assessed through Spearman's correlations, the Kruskal-Wallis H test and logistic regressions. Results: Findings revealed that screening only for depression would pick up 23% of suicidal ideation, increasing to 35% when also screening for anxiety. Those with anxiety and no to minimal depression had the second highest likelihood of suicide attempt, following those with anxiety and depression. The symptom "feeling afraid something awful might happen" doubled the odds of suicidal ideation. Conclusions: College campuses may benefit from assessing particular anxiety symptoms in relation to suicide.

From Sarcopenia to Depressive Symptoms in Elderly: A Path Analysis

BACKGROUND

Sarcopenia is an age-related progressive, generalized skeletal muscle disorder involving the accelerated loss of muscle function and muscle mass. The aim of this study was to assess the complex relationship between sarcopenia, malnutrition, cognitive impairment, physical activity, and depression in the elderly, with the potential role of quality of life as a mediator in these associations.

METHODS

A cross-sectional study was conducted on a sample (n = 298) of elderly patients admitted to Special Hospital for Rehabilitation "Termal", Vrdnik, Serbia. Sarcopenia, the risk for malnutrition, cognitive impairment, physical activity, quality of life, and depressive symptoms were measured by standardized instruments. Additional data included sociodemographic characteristics. Simultaneous assessment of the direct and indirect relationships of all determinants was performed by path analysis.

RESULTS

A total of 40% (n = 120) of the elderly were diagnosed with sarcopenia, and 42.6% had depression symptoms. The risk of malnutrition was present in 23.5%, cognitive impairment in 5.4%, and a low level of physical activity was reported in 26.2% of elderly participants. The mean reported quality of life measured by Sarcopenia and Quality of Life Questionnaire was 60 (on the scale ranging from 0 to 100; where a higher score reflects a higher quality of life). The best-fitted model (χ2/DF = 1.885, NFI = 0.987, CFI = 0.993, GFI = 0.997, RMSEA = 0.055) highlighted the mediating effect of quality of life between sarcopenia, malnutrition, cognitive impairment, lower level of physical activities and depression. According to the model, quality of life was a direct negative predictor of depressive symptoms in the elderly, while malnutrition positively affected depression.

CONCLUSIONS

The presented path model may assist rehabilitation centers in developing strategies to screen for sarcopenia and risk of malnutrition, and promote physical activity in elderly, aiming to prevent their negative effects on mental health. For the elderly currently affected by sarcopenia, we consider regenerative medicine and stem cell therapy, which, in view of their etiology, could be a potential therapeutic strategy for sarcopenia.

Internet use and depression among Chinese older adults: The mediating effect of interpersonal relationship

The number of elderly Internet users has increased significantly in the past few years, and the Internet has greatly changed the way that older adults access information and communicate. Generally, those who regularly use the Internet may expand their range of interpersonal interactions, which has positive effects on their health. Depression is the leading cause of ill health, and is closely related to people's mental health. We sought to investigate whether internet use help reduce depression level among older adults. Using data from the 2020 China Family Panel Studies (CFPS), a total of 4,714 respondents were included to explore the effects of Internet use on the elderly's depression levels in China, along with the mediating role of interpersonal relationship in the above relationship. Regression results indicated that Internet use significantly reduced depression levels among the elderly. Further analysis showed that different Internet usage had different effects on depression among the elderly. Wechat chatting, video browsing, and online shopping were positively correlated with lower levels of depression. However, playing online games and online learning did not predict reduced levels of depression. Moreover, interpersonal relationship mediated the relationship between Internet use and depression levels. Internet use was associated with a higher level of interpersonal relationship, which in turn reduced depression levels in older adults. Regarding gender and regional differences, the coefficient of Internet use for urban older adults was significantly negative at 0.001 level, while it was not significant for rural older adults. A mediating effect of interpersonal relationship between Internet use and depression levels was only found for male elderly. To reduce the level of depression and promote mental health in the course of aging, Internet use and the improvement of interpersonal relationships merit special attention.

Trends in suicide methods in Switzerland from 1969 to 2018: an observational study

BACKGROUND

Suicide is a serious societal and health problem. We examined changes in rates of completed suicides in Switzerland between 1969-2018 with particular regard to different methods of suicide used in different subgroups of the resident population.

METHODS

We used data of the Swiss cause of death statistics and Poisson regression models to analyse annual incidence rates and calendar time trends of specific suicide methods used in population subgroups by sex (men vs women), age (10-29, 30-64, >64 years), and nationality (Swiss vs other citizenship).

RESULTS

There were 64,996 registered suicides between 1969 and 2018. Across these 5 decades, the overall suicide rate was higher in men than in women (incidence rate ratio [IRR] 2.62, 95% confidence interval [CI] 2.58-2.67), in Swiss citizens than in foreigners (IRR 2.02; 95% CI 1.97-2.07), and in older residents (>64 years) than in the age groups 30-64 years (IRR 1.35, 95% CI 1.32-1.37) and 10-29 years (IRR 2.37, 95% CI 2.32-2.43). After peaking in the 1980s, the overall suicide rate had declined in all of these population subgroups, with flattening trends over most recent years. The most common specific methods of suicide were hanging (accounting for 26.7% of all suicides) and firearms (23.6%). The rates of the specific suicide methods were usually higher in men, in Swiss citizens and in older residents, and they had typically declined over most recent decades in the population subgroups examined. However, some methods diverged from this general pattern, at least in some population subgroups. For instance, railway suicides most recently increased in younger and in male residents whereas suicides by gas and by drowning were only at a low level after rapid declines in the last millennium.

CONCLUSIONS

Restricting access to lethal means (e.g., detoxification of domestic gas), improvements in health care and media guidelines for responsible reporting of suicides are possible explanations for the generally declining suicide rates in Switzerland. Whereas some methods (e.g., poisoning by gases or drowning) had become rare, others continue to account for many suicides every year, at least in some population subgroups (e.g., firearms in older Swiss men or railway suicides in younger and in male residents). As different methods of suicide are chosen by different people or subgroups of the population, preventive efforts should include differentiated strategies and targeted measures to further reduce suicides in Switzerland and elsewhere.

Using intensive time sampling methods to capture daily suicidal ideation: A systematic review

INTRODUCTION

There has been an increased emphasis on understanding suicidal thoughts and behaviors as they occur in real-time, resulting in a proliferation of studies utilizing intensive time sampling methods. Given the continued growth in this area, there is a need to synthesize the feasibility of these methods in capturing suicidal ideation at the daily level, in addition to an examination of study factors that may impact suicidal ideation detection, to guide future research.

METHOD

Online databases (i.e., PsychINFO, ERIC, PubMed, MEDLINE) were systematically searched for articles published through December 2020 that assessed suicidal ideation at the daily level.

RESULTS

Twenty-six articles presenting data from sixteen independent datasets met inclusion criteria. Across included articles, suicidal ideation detection ranged from approximately 1-92% of participant-completed surveys, with 18-100% of unique study participants reporting suicidal ideation during the study period. Assessment-based factors (i.e., number of daily assessments, duration of daily assessment period) did not appear to be meaningfully associated with suicidal ideation detection rates. Rather, participant characteristics (i.e., baseline suicide risk history, inclusion criteria) were better indicators of a study's ability to capture suicidal ideation at the daily level.

CONCLUSIONS

Findings highlights the impact of targeting participants with elevated suicide risk at study enrollment.

The Toxicity Potential of Antidepressants and Antipsychotics in Relation to Other Medication and Alcohol: A Naturalistic and Retrospective Study

QT interval prolongation and ventricular tachyarrhythmia are potential adverse effects of antidepressant (AD) and antipsychotic- (AP) agents, especially when overdosed. Since AD and AP agents are often prescribed to patients suffering from suicidal intentions, it is essential to estimate these risks in the context of intoxications. This retrospective and naturalistic one-year registry study included 105 patients treated for oral intoxication at the University Department of Emergency Medicine in Vienna, Austria. AD/AP intoxications were present in 26 patients, while in the control group (n = 79) non-AD/AP drugs (n = 54) and exclusively alcohol (n = 25) were the toxic agents. QT intervals, the necessity of intubation, the extent of conscious state, and the subsequent discharge management were compared. The mean age was 34.94 ± 14.6 years, 62 patients (59%) were female. There were no significant between-group differences regarding QT prolongation >470 ms using Bazett's correction (p = 0.178), or >440 ms using Fridericia's correction (p = 0.760). No significant group differences concerning the need for intubation were observed (p = 0.747). The AD/AP and the control group did not significantly differ regarding Glasgow Coma Scale scores (p = 0.439). Patients with AD/AP intoxication were significantly more often transferred to the psychiatric department, while discharge to home was more likely in the control group (p = 0.002). These results suggest that the risk of a potentially life-threatening outcome in cases of intoxication with AD/AP is not substantially higher than in other easily available toxic agents, in line with the advantageous risk/benefit ratio of newer ADs and APs.

Using natural language processing to extract self-harm and suicidality data from a clinical sample of patients with eating disorders: a retrospective cohort study

OBJECTIVES

The objective of this study was to determine risk factors for those diagnosed with eating disorders who report self-harm and suicidality.

DESIGN AND SETTING

This study was a retrospective cohort study within a secondary mental health service, South London and Maudsley National Health Service Trust.

PARTICIPANTS

All diagnosed with an F50 diagnosis of eating disorder from January 2009 to September 2019 were included.

INTERVENTION AND MEASURES

Electronic health records (EHRs) for these patients were extracted and two natural language processing tools were used to determine documentation of self-harm and suicidality in their clinical notes. These tools were validated manually for attribute agreement scores within this study.

RESULTS

The attribute agreements for precision of positive mentions of self-harm were 0.96 and for suicidality were 0.80; this demonstrates a 'near perfect' and 'strong' agreement and highlights the reliability of the tools in identifying the EHRs reporting self-harm or suicidality. There were 7434 patients with EHRs available and diagnosed with eating disorders included in the study from the dates January 2007 to September 2019. Of these, 4591 (61.8%) had a mention of self-harm within their records and 4764 (64.0%) had a mention of suicidality; 3899 (52.4%) had mentions of both. Patients reporting either self-harm or suicidality were more likely to have a diagnosis of anorexia nervosa (AN) (self-harm, AN OR=3.44, 95% CI 1.05 to 11.3, p=0.04; suicidality, AN OR=8.20, 95% CI 2.17 to 30.1; p=0.002). They were also more likely to have a diagnosis of borderline personality disorder (p≤0.001), bipolar disorder (p<0.001) or substance misuse disorder (p<0.001).

CONCLUSION

A high percentage of patients (>60%) diagnosed with eating disorders report either self-harm or suicidal thoughts. Relative to other eating disorders, those diagnosed with AN were more likely to report either self-harm or suicidal thoughts. Psychiatric comorbidity, in particular borderline personality disorder and substance misuse, was also associated with an increase risk in self-harm and suicidality. Therefore, risk assessment among patients diagnosed with eating disorders is crucial.

Adverse Social Relationships in Childhood: Are there Links with Depression, Obsessive-Compulsive Disorder and Suicidality in Adulthood?

This study aimed to (i) explore the association between perceptions of negative social relationships in childhood with significant others, including peers, guardians and teachers, symptoms of depression and OCD, and suicide behaviors, and (ii) examine whether depression and OCD severity meditated the association between these perceptions and suicide experiences. In total, 783 individuals from the community were invited to complete self-report measures. There were strong associations between perceptions of adverse social relationships in childhood, severity of depression and OCD, and suicide behaviors. Furthermore, depression and OCD partially mediated the association between perceptions of adverse social relationships, especially with peers, and suicide behaviors. These results provide strong evidence for the importance of developing clinical interventions that directly target negative experiences of social relationships in childhood, and for raising public and scientific awareness that everyday adverse social interactions with significant others can impact negatively on mental health including suicide behaviors.

Suicide Risk and Mood Disorders in Women in the Postpartum Period: a Longitudinal Study

Suicide associated with severe psychiatric illnesses is considered the leading cause of maternal deaths. We aimed to assess the suicide risk in women who experienced depressive or mixed episodes of mood change during the postpartum period and to determine which disorder is more related to suicide risk in the same period. We conducted a longitudinal study with 706 women whose children were born from April 2007 to May 2008 in a southern city in Brazil, and received prenatal care by the Brazilian National System of Public Health. The first assessment occurred during the prenatal period and the second within 30 to 60 days postpartum. The incidence of suicide risk was 10.9%. The odds of postpartum suicide risk were 6.50 (95% CI: 2.73; 15.48) higher in mothers with postpartum depression and 41.50 (95% CI: 12.11; 142.16) higher in those with mixed episodes than those who did not suffer from any mood disorder. Women with chronic episodes (who had depressive or mixed episodes during pregnancy and postpartum) were at increased odds of 4.94 (95% CI: 1.46; 16.69) of a postpartum suicide risk. The postpartum seems to be a critical period in the women's mental health. The impact of mental disorders in this period, especially mixed episodes, can increase the odds of a suicide risk onset. A good psychiatric evaluation and support during the prenatal and postpartum care may prevent the subsequent risk of suicide.

Relationship between suicide rate and antidepressant prescription: An ecological study in the People's Republic of China

OBJECTIVES

The objective of this study was to estimate the features of suicide rate and its association with antidepressant prescriptions during the past decade in China.

METHODS

Official data on suicides were obtained and stratified by four age groups, gender, urban/rural areas, and regions (East, Central, and West). The annual antidepressant prescriptions were expressed in pills per 100 persons calculated as the volume of prescriptions divided by the total population. Negative binomial regression was carried out to examine the association between suicide and other variables.

RESULTS

Suicide rates in each stratum typically decreased from 2008 to 2015, while annual antidepressant prescriptions were generally increased by the year. The suicide rate increased with age and was greater in adult males than in females; higher in the central area and greater in rural than in urban areas. Suicide rates are negatively associated with antidepressant prescriptions including selective serotonin reuptake inhibitors (Incidence rate ratio [IRR] 0.983, 95% confidence interval [CI] 0.983-0.983), serotonin-norepinephrine reuptake inhibitors (IRR 0.951, 95% CI 0.951-0.951), tricyclic antidepressant (IRR 0.925, 95% CI 0.925-0.925) and total antidepressants (IRR 0.990, 95% CI 0.990-0.990) during 2008-2012.

CONCLUSION

Suicide varied among different studied stratum. Suicide rates are negatively associated with antidepressant prescriptions.

Increased prevalence of depression in South Korea from 2002 to 2013

South Korea has one of the highest suicide rates among countries. However, the prevalence of depression in South Korea has been reported to be much lower than in other countries. The current study aims to estimate the prevalence of major depressive disorder using a large representative sample of the South Korean population. The prevalence of depression in a sampled population of one million individuals increased from 2.8% in 2002 to 5.3% in 2013; it was found to increase with the age of the population, and was higher in females than in males for most age groups. A Cox's proportional hazard model showed that suicide risk was significantly higher in people with depression (hazard ratio [HR] 3.79, 95% CI 3.14-4.58) than those without depression. It was also significantly higher in older people (HR 1.52, 95% CI 1.36-1.70) than in younger people, and in males (HR 2.45, 95% CI 2.02-2.96) than in females. Furthermore, higher income groups were at lower suicide risk as compared to lower income groups (HR 0.88, 95% CI 0.80-0.95). This study using the large representative sample data provided evidence that increased prevalence of depression contributed to the increased risk of suicide in South Korea during the recent decade.

Outdoor smoking in Nigeria: prevalence, correlates and predictors

BACKGROUND

There is a lack of data on smoking in outdoor-open bars in Nigeria that may translate into effective legislation on public smoking.

METHOD

This study determined the prevalence, demographic and clinical correlates as well as predictors of smoking among a community sample of 1119 patrons of open place bars in Ibadan, Nigeria. Data on current smoking was obtained using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), while smoking intensity was calculated using the Pack-Year. Prevalence of alcohol use was determined using the Alcohol Use Disorders Identification Test (AUDIT), while depression was diagnosed using the Mini International Neuropsychiatry Interview (MINI). Analysis was carried out by SPSS version 20.0 software using Chi square statistics, t test and ANOVA, and was set at 95% confidence interval.

RESULTS

Prevalence of current smoking was 63.8% and the mean pack years of smoking of all respondents was 19.38 ± 17.16 years. Predictors of outdoor smoking were depression OR = 1.41, 95% CI (1.09-1.83) and alcohol use OR = 2.12, 95% CI (1.44-3.13). Predictors of high pack years were depression OR = 1.47, 95% CI (1.08-2.01), being married, OR = 1.78, 95% CI (1.29-2.45), high income, OR = 1.95, 95% CI (1.42-2.68) and alcohol use OR = 2.82, 95% CI (1.51-5.27). There was no significant relationship between stage of readiness to quit smoking and mean pack years of smoking, F = 0.3, p = 0.5.

CONCLUSION

The high prevalence of outdoor smoking in the sample calls for urgent public health initiatives for intervention. Thus, outdoor bars are potential tobacco use intervention sites to minimize the health consequences of smoking.

Depression Screening from Voice Samples of Patients Affected by Parkinson's Disease

Depression is a common mental health problem leading to significant disability world wide. Depression is not only common but also commonly co-occurs with other mental and neurological illnesses. Parkinson's Disease gives rise to symptoms directly impairing a person's ability to function. Early diagnosis and detection of depression can aid treatment, but diagnosis typically requires an interview with a health provider or structured diagnostic questionnaire. Thus, unobtrusive measures to monitor depression symptoms in daily life could have great utility in screening depression for clinical treatment. Vocal biomarkers of depression are a potentially effective method of assessing depression symptoms in daily life, which is the focus of the current research. We have a database of 921 unique patients with Parkinson's disease and their self assessment of whether they felt depressed or not. Voice recordings from these patients were used to extract paralinguistic features, which served as inputs to machine-learning and deep learning techniques to predict depression. The results are presented here and the limitations are discussed given the nature of the recordings which lack language content. Our models achieved accuracies as high as 0.77 in classifying depressed and non-depressed subjects accurately using their voice features and PD severity. We found depression and severity of Parkinson's Disease had a correlation coefficient of 0.3936, providing a valuable feature when predicting depression from voice. Our results indicate a clear correlation between feeling depressed and the severity of the Parkinson's disease. Voice may be an effective digital biomarker to screen for depression among patients suffering from Parkinson's Disease.

Robustness and Findings of a Web-Based System for Depression Assessment in a University Work Context

Depression is associated with absenteeism and presentism, problems in workplace relationships and loss of productivity and quality. The present work describes the validation of a web-based system for the assessment of depression in the university work context. The basis of the system is the Spanish version of the Beck Depression Inventory (BDI-II). A total of 185 participants completed the BDI-II web-based assessment, including 88 males and 97 females, 70 faculty members and 115 staff members. A high level of internal consistency reliability was confirmed. Based on the results of our web-based BDI-II, no significant differences were found in depression severity between gender, age or workers’ groups. The main depression risk factors reported were: “Changes in sleep”, “Loss of energy”, “Tiredness or fatigue” and “Loss of interest”. However significant differences were found by gender in “Changes in appetite”, “Difficulty of concentration” and “Loss of interest in sex”; males expressed less loss of interest in sex than females with a statistically significant difference. Our results indicate that the data collected is coherent with previous BDI-II studies. We conclude that the web-based system based on the BDI-II is psychometrically robust and can be used to assess depression in the university working community.

Not wallowing in misery - retractions of negative misinformation are effective in depressive rumination

People often continue to rely on misinformation in their reasoning after they have acknowledged a retraction; this phenomenon is known as the continued-influence effect. Retractions can be particularly ineffective when the retracted misinformation is consistent with a pre-existing worldview. We investigated this effect in the context of depressive rumination. Given the prevalence of depressotypic worldviews in depressive rumination, we hypothesised that depressive rumination may affect the processing of retractions of valenced misinformation; specifically, we predicted that the retraction of negative misinformation might be less effective in depressive ruminators. In two experiments, we found evidence against this hypothesis: in depressive ruminators, retractions of negative misinformation were at least as effective as they were in control participants, and more effective than retractions of positive misinformation. Findings are interpreted in terms of an attentional bias that may enhance the salience of negative misinformation and may thus facilitate its updating in depressive rumination.

Does CBT for anxiety-related disorders alter suicidal ideation? Findings from a naturalistic sample

BACKGROUND

Anxiety disorders commonly co-occur with suicidal ideation (SI). To our knowledge, no studies have reported on the baseline prevalence of SI and the reduction in SI in a naturalistic sample receiving cognitive behavior therapy (CBT) for anxiety-related disorders.

METHODS

Participants (n = 355) recruited from an anxiety specialty clinic reported SI at pre-, mid-, and post-CBT. Multilevel mixed effects logistic regression models compared differences in SI endorsement over Time.

RESULTS

Posttraumatic stress disorder (PTSD) and social anxiety disorder (SAD) were associated with significantly elevated baseline SI relative to specific phobia. PTSD and unspecified anxiety-related disorders were associated with significant reductions in SI, whereas reductions in SAD, GAD, OCD, and panic disorder did not reach significance. Rates of new onset and exacerbation of SI were low.

DISCUSSION

CBT for anxiety disorders was associated with significant reductions in SI over time, with no evidence for exacerbation of suicide risk. Clinical implications are discussed, as well as future research directions to further understand the effect of anxiety disorder treatments on SI.

Suicide in a National Student Mental Health Patient Population, 1997–2012

Abstract. Background: Entering higher education is a time of transition that coincides with the typical age of onset of serious mental illness. Awareness of the distinguishing characteristics of students with mental illness who die by suicide may inform clinical management. Aim: We aimed to compare the characteristics of mental health patients who died by suicide as students with other young people who died by suicide. Method: UK data were analyzed for individuals aged 18–35 years in contact with mental health services who died by suicide from 1997 to 2012. Univariate analyses examined the sociodemographic, behavioral, and clinical features of those who died as students. Backward stepwise regression analysis identified factors independently associated with student deaths. Results: In all, 214 university students died by suicide within 12 months of mental health service contact. Factors associated with student deaths were: being younger, female, from an ethnic minority group, and a primary diagnosis of affective disorder. Medication nonadherence was less likely to be associated with student deaths. Conclusion: Deaths by suicide are split almost equally between male and female students, unlike the predominance of male suicide in the general population. There are clear differences in the characteristics of the student and nonstudent groups, although causation could not be established.

Rates and predictors of injury in a population-based cohort of people living with HIV

OBJECTIVES

Injuries are responsible for 10% of the global burden of disease; however, the epidemiology of injury among people living with HIV (PLHIV) has not been well elucidated. This study seeks to characterize rates and predictors of injury among PLHIV compared to the general population in British Columbia (BC), Canada.

DESIGN

A population-based dataset was created via linkage between the BC Centre for Excellence in HIV/AIDS and PopulationDataBC.

METHODS

PLHIV aged 20 years and older were compared to a random 10% sample of the adult general population. The International Classification of Diseases 9 and 10 codes were used to classify unintentional and intentional injuries based on the external cause of the injury from 1996 to 2013. Generalized estimating equation (GEE) Poisson regression models were fit to estimate the effect of HIV status on rates of unintentional and intentional injury, and to identify correlates of injury among PLHIV.

RESULTS

The crude incidence rate of unintentional injury was 18.56/1000 person-years [95% confidence interval (CI) 17.77-19.39] among PLHIV and 8.51/1000 person-years (95% CI 8.42-8.59) in the general population. Among PLHIV, 13.45% of deaths were due to injury, compared to 5.52% of deaths in the general population. In adjusted models, PLHIV were more likely to report unintentional (incidence rate ratio 1.42, 95% CI 1.32-1.52) and intentional injury (incidence rate ratio 1.93, 95% CI 1.70-2.18) compared to the general population.

CONCLUSIONS

We identified elevated rates of intentional and unintentional injury among PLHIV. Injuries are largely preventable; as such, targeted efforts are needed to decrease the burden of injury-related disability and death among PLHIV.

Effective Screening for Emotional Distress in Refugees: The Refugee Health Screener

Screening for emotional distress is important, but not widely available. This study assesses the utility of the Refugee Health Screener 15 (RHS-15) in a public health setting. Refugee Health Screener 15 and diagnostic proxy (DP) instruments assessing anxiety, depression, and posttraumatic stress disorder were administered to refugees from 3 countries at their public health examination. Properties of the RHS-15 and its components were evaluated utilizing appropriate methods. Scale Cronbach α was 0.95, and a factor analysis identified 1 factor accounting for 66% of scale variance. Refugee Health Screener 15 scores and cases discriminated between refugee groups similar to DPs. Refugee Health Screener 15 case sensitivity and specificity to DPs were acceptable (≥0.87/0.77). A shorter, 13-item component had acceptable metric properties. The RHS-15 appears to be a valid screener for emotional distress of refugees. The 13-item scale may be more efficient and as efficacious for case identification. The critical public health need and recommendations for implementation are discussed.

Systematical Approach for Detecting the Intention and Intensity of Feelings on Social Network

Online posts not only represent the records of people's lives but also reveal their satisfaction with life and relationships as well as potential mental illnesses. The detection of (strong or general) negative as well as (strong or general) positive feelings of people from online posts can keep us from carelessly missing their important moments, difficult or great, due to the overloaded information in the daily life and lead to a better society. Therefore, in this paper, we build a Feeling Distinguisher system based on supervised Latent Dirichlet Allocation (sLDA), Latent Dirichlet Allocation, and SentiWordNet methodologies for detecting a person's intention and intensity of feelings through the analysis of his/her online posts. Experimental results on posts collected from five social network websites demonstrate the effectiveness of FeD. The performance of FeD is about 1.08-1.18 folds that of SVM and sLDA.

Are Suicide Rates Related to the Psychiatrist Density? A Cross-National Study

Introduction

Most suicide victims have a diagnosable psychiatric disorder. Treatment of psychiatric disorders should reduce the number of suicides. Higher psychiatrist-per-­population ratio increases the opportunity for contact between the patient and psychiatrist. It is reasonable to hypothesize that the higher psychiatrist density (PD) is associated with lower suicide rates. The aim of this study is to examine the association between suicide rates and the PD in the European Union countries. These countries are economically and culturally connected and located on the same continent. This is an attempt to study a relatively homogenous sample.

Methods

Correlations were computed to examine relationships between age-­standardized suicide rates in women and men, the PD, and the gross national income (GNI) per capita. Partial correlations were used to examine the relation between the PD and age-standardized suicide rates in women and men controlling for the GNI per capita.

Results

Higher suicide rates in women correlated with the higher PD. Controlling for the GNI per capita, the PD positively correlated with suicide rates both in women and in men. There was a trend toward a negative correlation between the GNI per capita and suicide rates in men. The PD was positively associated with the GNI per capita.

Conclusion

Probably, higher suicide rates directly and/or indirectly affect the decisions made by policy- and lawmakers regarding mental health services and how many psychiatrists need to be trained. The results of this study should be treated with caution because many confounding variables are not taken into account.

Panic symptoms and elevated suicidal ideation and behaviors among trauma exposed individuals: Moderating effects of post-traumatic stress disorder

Panic attacks (PAs) are highly prevalent among trauma exposed individuals and have been associated with a number of adverse outcomes. Despite high suicide rates among trauma exposed individuals, research to date has not examined the potential relation between panic symptoms and suicidal ideation and behaviors among this high risk population. The current study tested the association of panic with suicidal ideation and behaviors among a large sample of trauma exposed smokers. Community participants (N=421) who reported a lifetime history of trauma exposure were assessed concurrently for current panic, suicidal ideation and behaviors, and psychiatric diagnoses. Those who met criteria for a current panic disorder diagnosis were removed from analyses to allow for the assessment of non-PD related panic in line with the recent addition of the PA specifier applicable to all DSM-5 disorders. Findings indicated that panic symptoms were significantly associated with suicidal ideation and behaviors beyond the effects of depression and number of trauma types experienced. Further, post-traumatic stress disorder (PTSD) diagnostic status significantly moderated this relationship, indicating that the relationship between panic and suicidal ideation and behaviors is potentiated among individuals with a current PTSD diagnosis. This investigation suggests that panic symptoms may be a valuable clinical target for the assessment and treatment of suicidal ideation and behaviors among trauma exposed individuals.

Personality characteristics in childhood and outcomes in adulthood: findings from a 30 year longitudinal study

OBJECTIVE

Personality has been associated with a variety of outcomes in adulthood. Most of the literature related to mental state disorder and personality is cross sectional.

METHODS

Data from more than 900 participants of the Christchurch Health and Development Study (CHDS) were examined. Extroversion and neuroticism were measured at 14 years old and social outcomes at age 30. The presence of mental state disorder between 18-30 years old was identified. Multiple potential confounders in childhood were included in the analysis.

RESULTS

Neuroticism at fourteen was significantly correlated with multiple environmental exposures whereas extroversion had relatively few associations. Regression analysis found that neuroticism at 14 predicted depression, anxiety, suicidality and overall mental health problems at 30 as well as poor self-esteem but not relationship quality or wellbeing. Extroversion at 14 predicted alcohol and drug dependence and overall mental health problems, but also predicted improved social wellbeing, self-esteem and relationship quality at 30.

CONCLUSIONS

In this analysis extroversion interacts with significantly fewer environmental factors than neuroticism in predicting adult outcomes. Neuroticism at 14 years predicts poorer mental health outcomes in adulthood. Extroversion in childhood may be a protective factor in the development of mental disorder other than alcohol use disorders. Extroverted adolescents have more positive social outcomes at 30 years.

Cognitive behaviour therapy via the internet for depression: a useful strategy to reduce suicidal ideation

BACKGROUND

Depression is a major risk factor for suicide. Given the strong association between depression and suicide, treatment for depression should be a fundamental component of suicide prevention. Currently it is not. This study aims to demonstrate the usefulness of internet-delivered cognitive behavioural therapy (iCBT) for depression as a means of reducing suicide ideation.

METHODS

The sample comprised 484 patients who were prescribed iCBT for depression by their primary care physician. The outcomes of interest were major depression, as indexed by the PHQ-8, and suicidal ideation as measured by question 9 of the PHQ-9. Marginal models were used to appropriately analyse available data without biasing parameter estimates.

RESULTS

Following iCBT for depression, suicidal ideation and depression decreased in parallel over time. The prevalence of suicidal ideation reduced from 50% at baseline to 27% after treatment, whilst the prevalence of major depression reduced from 70% to 30%. Depression scores and suicidal ideation decreased after treatment regardless of demographic or clinical variables of interest.

LIMITATIONS

This is a naturalistic study; randomisation and scientific control were not possible.

CONCLUSIONS

The current study demonstrates the usefulness of iCBT for depression as a means of reducing suicidal ideation which can be implemented on a large scale without enacting major structural change at the societal level. These findings need to be replicated in randomised controlled trials.

Factors associated with hospitalization after suicide spectrum behaviors: results from a multicenter study in Spain

The objective of this study was to identify factors associated with hospital admission after suicide spectrum behaviors. Patients' characteristics, the nature of the suicidal behavior, admission rates between centers, and factors associated with admission have been examined in suicide spectrum presentations to emergency departments in 3 Spanish cities. The intent of the suicidal behavior had the greatest impact on hospitalization. Older age, living alone, self-harm method not involving drug overdose, previous history of suicide spectrum behaviors, and psychiatric diagnosis of schizophrenia, mood, or personality disorder were independently associated with being admitted. There was a 3-fold between-center difference in the rate of hospitalization. Widespread differences in the rate of hospitalization were primarily accounted for by characteristics of the individual patients and their suicidal behavior.

Incidence and predictors of suicide attempts among primary-care patients with depressive disorders: a 5-year prospective study

BACKGROUND

No previous study has prospectively investigated incidence and risk factors for suicide attempts among primary care patients with depression.

METHOD

In the Vantaa Primary Care Depression Study, a stratified random sample of 1119 patients was screened for depression, and Structured Clinical Interviews for DSM-IV used to diagnose Axis I and II disorders. A total of 137 patients were diagnosed with a DSM-IV depressive disorder. Altogether, 82% of patients completed the 5-year follow-up. Information on timing of suicide attempts, plus major depressive episodes (MDEs) and partial or full remission, or periods of substance abuse were examined with life charts. Incidence of suicide attempts and their stable and time-varying risk factors (phases of depression/substance abuse) were investigated using Cox proportional hazard and Poisson regression models.

RESULTS

During the follow-up there were 22 discrete suicide attempts by 14/134 (10.4%) patients. The incidence rates were 0, 5.8 and 107 during full or partial remission or MDEs, or 22.2 and 142 per 1000 patient-years during no or active substance abuse, respectively. In Cox models, current MDE (hazard ratio 33.5, 95% confidence interval 3.6-309.7) was the only significant independent risk factor. Primary care doctors were rarely aware of the suicide attempts.

CONCLUSIONS

Of the primary care patients with depressive disorders, one-tenth attempted suicide in 5 years. However, risk of suicidal acts was almost exclusively confined to MDEs, with or without concurrent active substance abuse. Suicide prevention among primary care patients with depression should focus on active treatment of major depressive disorder and co-morbid substance use, and awareness of suicide risk.

Incidental treatment effects of CBT on suicidal ideation and hopelessness

BACKGROUND

Depression and alcohol misuse are among the most prevalent diagnoses in suicide fatalities. The risk posed by these disorders is exacerbated when they co-occur. Limited research has evaluated the effectiveness of common depression and alcohol treatments for the reduction of suicide vulnerability in individuals experiencing comorbidity.

METHODS

Participants with depressive symptoms and hazardous alcohol use were selected from two randomised controlled trials. They had received either a brief (1 session) intervention, or depression-focused cognitive behaviour therapy (CBT), alcohol-focused CBT, therapist-delivered integrated CBT, computer-delivered integrated CBT or person-centred therapy (PCT) over a 10-week period. Suicidal ideation, hopelessness, depression severity and alcohol consumption were assessed at baseline and 12-month follow-up.

RESULTS

Three hundred three participants were assessed at baseline and 12 months. Both suicidal ideation and hopelessness were associated with higher severity of depressive symptoms, but not with alcohol consumption. Suicidal ideation did not improve significantly at follow-up, with no differences between treatment conditions. Improvements in hopelessness differed between treatment conditions; hopelessness improved more in the CBT conditions compared to PCT and in single-focused CBT compared to integrated CBT.

LIMITATIONS

Low retention rates may have impacted on the reliability of our findings. Combining data from two studies may have resulted in heterogeneity of samples between conditions.

CONCLUSIONS

CBT appears to be associated with reductions in hopelessness in people with co-occurring depression and alcohol misuse, even when it is not the focus of treatment. Less consistent results were observed for suicidal ideation. Establishing specific procedures or therapeutic content for clinicians to monitor these outcomes may result in better management of individuals with higher vulnerability for suicide.

Why has the continuous decline in German suicide rates stopped in 2007?

Background

Whereas German suicide rates had a clear decreasing tendency between 1991 and 2006, they increased from 2007 to 2010. Deeper analyses of suicide data might help to understand better this change. The aim of this study was to analyze 1) whether recent trends can be related to changes in specific suicide methods and diverge by gender and age; 2) whether the decrease of suicide rates before 2007 as well as the increase from 2007 to 2010 are driven by the same suicide method.

Methods

Analyses were based on suicide data from the Federal Statistical Office of Germany. For 1998–2010, 136.583 suicide cases of men and women with known age and suicide method could be identified. These data were analyzed by joinpoint regression analysis, allowing identification of the best fitting point in time (“joinpoint”) at which the suicide rate significantly changes in magnitude or direction.

Results

The national downward trend between 1998 and 2007 was mainly due to corresponding changes in self-poisoning by other means than drugs (e.g., pesticides) (annual percentage change (APC) ≤ −4.33), drowning (APC ≤ −2.73), hanging (APC ≤ −2.69) and suicides by firearms (APC ≤ −1.46) in both genders. Regarding the overall increase of age-adjusted suicide rates in Germany 2007–2010, mainly the increase of self-poisoning (e.g., by drugs) and “being overrun” (APC ≥ 1.50) contributed to this trend.

Limitations

The true suicide rates might have been underestimated because of errors in the official death certificates.

Conclusions

Increase in suicide rates in Germany since 2007 went along with corresponding changes for “being overrun” and “self-poisoning”. Copycat suicides following the railway suicide of the goalkeeper Robert Enke partly contributed to the results. Thus, prevention of Werther effects and limitation of the availability of high pack sizes for drugs are of special relevance for the reversal of this trend.

Longitudinal risk profiling for suicidal thoughts and behaviours in a community cohort using decision trees

BACKGROUND

While associations between specific risk factors and subsequent suicidal thoughts or behaviours have been widely examined, there is limited understanding of the interplay between risk factors in the development of suicide risk. This study used a decision tree approach to develop individual models of suicide risk and identify the risk factors for suicidality that are important for different subpopulations.

METHODS

In a population cohort of 6656 Australian adults, the study examined whether measures of mental health, physical health, personality, substance use, social support, social stressors and background characteristics were associated with suicidal ideation and suicidal behaviours after four-year follow-up.

RESULTS

Previous suicidality, anxiety symptoms, depression symptoms, neuroticism and rumination were the strongest predictors of suicidal ideation and behaviour after four years. However, divergent factors were predictive of suicidal thoughts and behaviours across the spectrum of mental health. In particular, substance use was only associated with suicidal thoughts and behaviours in those with moderate levels of anxiety or depression.

LIMITATIONS

Most of the measurements were based on self-report. Further research is required to assess whether changes in risk factors lead to changes in suicidality.

CONCLUSIONS

Examining suicide risk factors using decision trees is a promising approach for developing individualised assessments of suicide risk and tailored intervention programs.

[Suicide risk and health risk behavior among youth between the ages of 18 and 24 years: a descriptive study]

The aim of this study was to assess suicide risk and risk behavior in young people. A cross-sectional study in the urban area of Pelotas, Rio Grande do Sul State, Brazil was performed using systematic sampling with young people between the ages of 18 to 24 years. We measured the risk of suicide (MINI), behavior (YRBSS), abuse/substance dependence (ASSIST) and socioeconomic status (ABEP). Data was analyzed using SPSS software. The sample consisted of 1,560 young people and the prevalence of suicide risk was 8.6%. Suicide risk was associated with: having suffered an accident that required a visit to the emergency room (p = 0.011), fighting (p = 0.016), carrying a weapon (p = 0.001) and carrying a firearm (p ≤ 0.001), substance abuse/dependence (p ≤ 0.001), not having used a condom during the last sexual relationship (p = 0.025), not having a steady partner (p ≤ 0.001) and having sex with five or more people (p = 0.018). Young people that present risk behavior also represent a suicide risk.

Mental disorders in primary care

Current estimates indicate that 50% of the population experience at least one mental disorder in their lifetime and that at least 25% have suffered a mental disorder in the past year. recognition, diagnosis, treatment, and referral depend overwhelmingly on general practitioners, at least one third of whose consultations have a direct and explicit psychological component. Yet despite this intensive familiarization with the presentation of mental pathology, and the appropriateness of the primary care setting to its management, even the most recent surveys indicate that performance is best described by the rule of diminishing halves: only half the patients with a thresh-old disorder are recognized; only half of those recognized are treated; and only half of those treated are effectively treated. There is no single solution to this problem, only multiple solutions, which must be aimed, consistently and simultaneously, at the patient, practitioner, practice, and research levels.

Trends in suicide case fatality in Italy, 1983-2007

The proportion of suicide attempts ending up in the death of the attempter was used in past studies as an index of suicide lethality, or case fatality. This study aimed at investigating whether case fatality of suicide has decreased in Italy over the latest 25 ears using available data, as an alternative hypothesis to the proposed general decrease in suicidal behavior resulting from better identification and treatment of people with mental disorders. The official data on completed and attempted suicides by males and females in Italy, from 1983 to 2007, were analyzed with joinpoint regression analysis, to identify the points (i.e., "joinpoints") where linear trends changed significantly in direction or magnitude. It should be noted that only the most severe suicide attempts are recorded in Italian official statistics. Suicide rates decreased in both sexes, particularly from 1990 onward. Attempted suicide rates increased progressively in males, while in females they reached their peak in 1996-1998 and then decreased. In both sexes suicide case fatalities significantly decreased from 1990 onward. Improved survival after a suicide act is probably the main reason behind this favorable trend. The spreading of emergency services may prevent suicide.

Role of anxiety sensitivity subfactors in suicidal ideation and suicide attempt history

BACKGROUND

Anxiety along with anxiety-related risk factors has been increasingly implicated in suicidal ideation and suicide attempts. One such risk factor, anxiety sensitivity (AS), refers to fear of anxiety-related sensations. Subfactors of AS, notably physical and cognitive concerns, seem to be relevant to acquired capability, a risk factor for death by suicide from Joiner's (2005) Interpersonal-Psychological Theory of Suicide.

METHODS

This study examined the effect of Anxiety Sensitivity Index (ASI) total score and subfactor scores on suicidal ideation and suicide attempt history in a very large, moderately severe outpatient sample (N = 1,378).

RESULTS

Analyses were consistent with our a priori predictions about ASI cognitive concern and suicidal ideation. In contrast, ASI physical concerns did not predict previous suicide attempt as well as ASI cognitive or social concerns. However, ASI physical concerns did moderate the relationship between ASI social concerns and previous suicide attempt.

CONCLUSIONS

These findings suggest that suicide potential may be related to cognitive risk factors for anxiety.

Risk of suicide and mixed episode in men in the postpartum period

OBJECTIVES

To assess suicide risk in men with mood disorders at the postpartum period.

METHODS

We conduct a longitudinal study with 650 men whose child has born from April 2007 to May 2008 at maternity hospital. The first assessment was in the antenatal period and the second within 30 to 60days postpartum. Suicide risk, anxiety disorders, hypomanic, manic and mixed episodes were assessed by the Mini International Neuropsychiatric Interview (MINI).

RESULTS

The prevalence of suicide risk in fathers in postpartum was of 4.8%. Fathers with postpartum depression were 20.97 (CI: 5.74; 76.53) more likely to present suicide risk and those with mixed episodes showed a chance of 46.50 (CI: 10.52; 205.53) times higher than those who did not suffer from any mood disorder.

CONCLUSION

Mixed episodes are common in fathers at postpartum, posing a higher suicide risk than depressive and manic/hypomanic episodes. Therefore, in order to reduce the suicide risk, clinicians should address and treat adequately mixed affective states in this specific population.

Tobacco consumption and antidepressant use are associated with the rate of completed suicide in Hungary: an ecological study

The suicide rate of Hungary is the highest in the world averaged over the last century but it has shown a very pronounced decrease since 1987. To explore the background of this decrease we investigated the associations between some known suicide-related factors (i.e. tobacco use, antidepressant use and alcohol consumption at the population level) and the suicide rate between 1985 and 2008. The total number of man-hours worked per year by psychiatrists in the outpatient service system and real GDP growth were also monitored in our study. A time series analysis model was constructed to investigate the associations between the above variables and the suicide rate. In the unadjusted model annual tobacco consumption was significantly associated with the suicide rate in a positive manner, while antidepressant use and man-hours were significantly associated with the suicide rate in a negative manner. After adjustment, the associations remained significant only for tobacco consumption and antidepressant use. Neither alcohol consumption nor real GDP growth was associated with the suicide rate in any models. Our results from group-level data confirmed the role of smoking in suicidal behavior previously suggested mainly by studies using individual-level data and also corroborated the results of previous ecological studies concerning the inverse association between antidepressant use and suicide rate. These findings and the results of previous studies - investigating the relationship between smoking and the risk of suicidal behavior at the individual-level - may suggest that programs to prevent tobacco use or to address the widespread recognition and treatment of depression may also prevent suicidality.

Failure to fill electronically prescribed antidepressant medications: a retrospective study

OBJECTIVE

Nonadherence to antidepressants has been reported to range widely from 10% to 60%. Most adherence studies focus on persistence of use and do not include prescriptions that are not picked up by the patient. The objectives of this study were to determine the rate of unfilled antidepressant prescriptions as well as to identify factors associated with failure to fill these prescriptions.

METHOD

This retrospective study used administrative and pharmacy data from a mid-Atlantic managed care organization serving 3.3 million medical members and 1.2 million pharmacy members. Electronic prescriptions for citalopram, duloxetine, sertraline, and venlafaxine sent to pharmacies from July 1, 2007, to June 30, 2009, were matched to pharmacy claims to determine the rate of unfilled antidepressant prescriptions. Patients were ≥18 years of age and had continuous pharmacy coverage from July 1, 2006, to July 31, 2009. Logistic regression was used to assess whether clinical and demographic factors were associated with unfilled electronic prescriptions.

RESULTS

There were 557 electronically prescribed antidepressants for 267 patients. The rate of unfilled electronic prescriptions was 13.1%, which affected 19.9% of patients. Electronic prescriptions for new users of the antidepressant were 5 times more likely to be unfilled (odds ratio [OR]=5.13; 95% CI, 2.66-9.91; P<.001) than those for previous users. Antidepressant prescriptions for patients aged 18-34 years were most likely to be unfilled (OR=3.72; 95% CI, 1.81-7.67; P<.001).

CONCLUSIONS

Nonadherence to antidepressants is a significant problem with one-fifth of patients never receiving their electronically prescribed antidepressant. Prescriptions for patients without a previous antidepressant claim and aged 18-34 years were least likely to be filled. Interventions targeting patients who fail to fill their antidepressant prescription are needed.

Antidepressants and Suicide Risk: A Comprehensive Overview

The annual worldwide suicide rate currently averages approximately 13 per 100,000 individuals per year (0.013% per year), with higher average rates for men than for women in all but a few countries, very low rates in children, and relatively high rates in elderly men. Suicide rates vary markedly between countries, reflecting in part differences in case-identification and reporting procedures. Rates of attempted suicide in the general population average 20-30 times higher than rates of completed suicide, but are probably under-reported. Research on the relationship between pharmacotherapy and suicidal behavior was rare until a decade ago. Most ecological studies and large clinical studies have found that a general reduction in suicide rates is significantly correlated with higher rates of prescribing modern antidepressants. However, ecological, cohort and case-control studies and data from brief, randomized, controlled trials in patients with acute affective disorders have found increases, particularly in young patients and particularly for the risk of suicide attempts, as well as increases in suicidal ideation in young patients. whether antidepressants are associated with specific aspects of suicidality (e.g., higher rates of completed suicide, attempted suicide and suicidal ideation) in younger patients with major affective disorders remains a highly controversial question. In light of this gap this paper analyzes research on the relationship between suicidality and antidepressant treatment.

Suicidal ideation among young French adults: association with occupation, family, sexual activity, personal background and drug use

BACKGROUND

To assess associations among young adults between suicidal ideation in the previous year and adverse childhood events, occupation, education, tobacco use, alcohol abuse, cannabis use in the previous month, illicit drug use, sexual orientation and activity, depression, physical violence in the previous year, and lifetime forced sexual intercourse.

METHODS

A subsample of 4075 French adults aged 18-30 years was drawn from a random national telephone survey in 2005. Major depressive episode and alcohol abuse were assessed using CIDI-SF and AUDIT-C (score above 4). Data were analysed with logistic regressions.

RESULTS

Suicidal ideation affected 5.7% of men and 4.9% of women. Among men depression had the highest adjusted odds ratio (ORa=8.06, 5.07-12.79), followed by homosexual intercourse (3.37, 1.62-7.04), absence of sexual activity (2.83, 1.80-4.44); ORa between 1.6 and 2.0 were observed for living alone, daily tobacco smoking, being unemployed, serious health event concerning the father, age 26-30 and bad relationships between parents. Among women, depression had the highest ORa (7.60, 4.70-12.29), followed by lifetime experience of forced sexual intercourse (5.37, 2.89-9.96), having consumed illicit drugs other than cannabis (4.01, 1.48-10.89); ORa between 1.7 and 2.5 were observed for living alone, being unemployed, bad relationship between parents and age 26-30.

LIMITATIONS

Cross-sectional survey, sexual orientation inferred from sexual activity.

CONCLUSION

Suicide prevention should integrate the fact that besides depression, unemployment, family history, age, and sexual activity and orientation are specific risk factors among men, whereas illicit drug use, violence and forced sexual intercourse are more important among women.

Suicide, big five personality factors, and depression at the American state level

The research determined the relation of the 2004-2005 American state suicide rates to state means on neuroticism, agreeableness, extraversion, openness, and conscientiousness as assessed by Rentfrow, Gosling, and Potter (2008). Multiple regression strategies were used to analyze relations between state suicide rates and state personality means with state socioeconomic status, White population percent, urban population percent, and depression rates controlled. Multiple regression analysis showed that neuroticism accounted for 32.0% and agreeableness another 16.3% of the variance in suicide rates when demographics and depression were controlled. Lower neuroticism and lower agreeableness were associated with higher suicide rates. Lower neuroticism and lower agreeableness may be important risk factors for completed suicide but not suicidal ideation or attempted suicide.

Suicide trends diverge by method: Swiss suicide rates 1969-2005

We examined the change in Swiss suicide rates since 1969, breaking down the rates according to the method used. The descriptive analyses of the main suicide methods are presented. The suicide rates reached a peak in the late 1970s/early 1980s and declined in more recent years. Firearm suicides and suicides by falls were the exception and sustained their upwards trend until the 1990s. Suicide by vehicle exhaust asphyxiation showed a rapid decline following the introduction of catalytic converters in motor vehicles. No substantial method substitution was observed. Suicide by poisoning declined in the 1990s but rose again following an increase in assisted suicide in somatically incurable patients. Suicide is too often regarded as a homogeneous phenomenon. With regard to the method they choose, suicide victims are a heterogeneous population and it is evident that different suicide methods are chosen by different people. A better understanding of the varying patterns of change over time in the different suicide methods used may lead to differentiated preventive strategies.

A stubborn behaviour: The failure of antidepressants to reduce suicide rates

Over the past decades the rate of completed suicide has remained quite stable, that of suicide attempts even seems to have increased (to the extent it has been studied in defined regions). These are puzzling observations, since depression is the major suicide precursor and since antidepressants over the years have been increasingly used in the treatment of depression. These observations have not attracted sufficient attention, possibly because they do not accord with consensus opinions about depression treatment in psychiatry today. In this paper a number of possible explanations are discussed. They not only deserve but are definitely in need of systematic investigation.

Anxiety disorders and suicidality in the National Comorbidity Survey-Replication

OBJECTIVE

The current study sought to examine the unique associations between anxiety disorders and suicidality using a large nationally representative sample and controlling for a number of established risk factors for suicide.

METHOD

Data from the National Comorbidity Survey-Replication were used for analyses. Lifetime diagnostic history and demographics were obtained in this survey through a structured interview. Lifetime suicidal ideation and attempts were also assessed.

RESULTS

Multivariate analyses covarying for psychiatric comorbidity and demographic variables found social anxiety disorder (SAD), posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and panic disorder (PD) to be unique predictors of suicidal ideation, while only SAD, PTSD, and GAD were predictive of suicide attempts. Analyses by gender indicated that each of these four disorders were predictive of suicidal ideation or suicide attempts among women, while only PTSD and PD acted as risk factors among men.

CONCLUSIONS

Findings provide further evidence of the negative impact of anxiety disorders, suggest efforts should be made towards their early detection and treatment, and emphasize the importance of suicide risk assessment in treating individuals with anxiety disorders.

Do SSRIs or antidepressants in general increase suicidality? WPA Section on Pharmacopsychiatry: consensus statement

In the past few years several papers have reported critically on the risk of suicidal thoughts and behaviour associated with antidepressants, primarily SSRIs. The risk-benefit ratio of antidepressant (AD) treatment has been questioned especially in children and adolescents. The critical publications led to warnings being issued by regulatory authorities such as the FDA, MHRA and EMEA and stimulated new research activity in this field. However, potential harmful effects of antidepressants on suicidality are difficult to investigate in empirical studies because these have several methodological limitations. Randomised controlled trials (RCTs) are the most reliable way to test the hypothesis that AD have such side effects. In addition to meta-analyses of RCTs, complementary research methods should be applied to obtain the most comprehensive information. We undertook a comprehensive review of publications related to the topics ADs, suicide, suicidality, suicidal behaviour and aggression. Based on this comprehensive review we conclude that ADs, including SSRIs, carry a small risk of inducing suicidal thoughts and suicide attempts, in age groups below 25 years, the risk reducing further at the age of about 30-40 years. This risk has to be balanced against the well-known beneficial effects of ADs on depressive and other symptoms (anxiety, panic, obsessive-compulsive symptoms), including suicidality and suicidal behaviour. According to the principles of good clinical practice, decision making should consider carefully the beneficial effects of AD treatment as well as potentially harmful effects and attempt to keep the potential risks of AD treatment to a minimum. It is the major problem facing efforts to identify the possible 'suicidal effects' of antidepressants.

Changes in the seasonality of suicides over time in Slovenia, 1971 to 2002. Amplitude is only positively related to suicide rates among females

BACKGROUND

Changes in the suicide rate within one region over time had been hypothesised to correspond to changes in suicide seasonality: a recent investigation from Italy confirmed such an assumption. Data from Slovenia were investigated to further evaluate the links between suicide rates and seasonal amplitude.

METHODS

A total of 14325 male suicides and 4350 female suicides occurring in Slovenia from 1971 to 2002 were investigated with harmonic spectral analysis to extract their monthly seasonal dispersion by eight-year intervals. Changes in rate over time were analysed with a test for trend based on regression analysis.

RESULTS

The suicide rates of both males and females increased over time, with an evident peak in the 1987-1994 period and a decrease thereafter. Seasonality decreased across time in both sexes; however, no change of the peak was observed over time. The amplitude of the major 12-month cycle was slightly positively related to suicide rates, but the correlation was only statistically significant among females (P=0.0053; males: P=0.22).

LIMITATIONS

Data could not be analysed according to age, the method of suicide, or the diagnosis attributable to the deceased, since this information was not available.

CONCLUSION

The study confirmed that the seasonal effect on mortality by suicide is positively related to suicide rates, so much so that changes in suicide rates over time correspond to changes in suicide seasonality, but in Slovenia this effect was only evident among females, further pointing towards differences by sex in the mechanics leading to suicide.

Global warming possibly linked to an enhanced risk of suicide: data from Italy, 1974-2003

BACKGROUND

The global increase in surface temperature (known as global warming) was found to impact on mortality through ill health, particularly among the elderly and in summer. This study sets out to explore the impact of global warming on suicide mortality, using data from Italy.

METHODS

Monthly data on suicide mortality and temperature were obtained for a 30-year period (from January 1974 to December 2003), and the relation between them was investigated using the Gaussian low-pass filter, linear correlation analysis and rank analysis.

RESULTS

For males, increasing anomalies in monthly average temperatures associated to a higher monthly suicide mean from May to August and, to a lower extent, in November and December. In January, on the other hand, increasing anomalies in monthly average temperatures appeared to be coupled to a lower number of suicides. For females, the links between temperature and suicides are less consistent than for males, and sometimes have a reverse sign, too.

LIMITATIONS

Data could not be analyzed according to age, since this information was not available across the whole time interval. The use of monthly data, instead of daily data (unavailable), is another major limitation of this study.

CONCLUSIONS

An improvement in the ability of communities to adjust to temperature changes by implementing public health interventions may play an important part in preserving the wellness of the general population, and also in limiting the worst consequences of suicidal behaviour.

Association of suicide and antidepressant prescription rates in Japan, 1999-2003

OBJECTIVE

We examined the relationship of increasing prescription volume of newer antidepressants, introduced in Japan in 1999, to national rates of suicide.

METHOD

The relationship between annual changes in rates of suicide (obtained from the Japanese Ministry of Health, Labor, and Welfare Vital Statistics Database) and prescription volume of the newer antidepressants paroxetine, fluvoxamine, and milnacipran (obtained from the database of IMS Japan K.K.), stratified by gender and age groups, was modeled statistically for the years 1999 through 2003. Effects of unemployment and alcohol consumption and the interaction of gender and age with antidepressant prescribing were assessed.

RESULTS

From 1999 through 2003 in Japan, total antidepressant prescriptions increased 57% among males and 50% among females. Approximately 80% of this increase involved the selective serotonin reuptake inhibitors (SSRIs). To reduce a limitation of ecological analysis, we compared annual change in prescription and suicide rates, which eliminates the effect of long-term (secular) linear trends. We found an inverse association between year-to-year changes in the suicide rate and prescription volume of newer antidepressants (fluvoxamine, paroxetine, and milnacipran) (beta = -1.34, p = .008) and SSRIs specifically (fluvoxamine, paroxetine) (beta = -1.41, p = .019). An increase of 1 defined daily dose of SSRI use/1000 population/day was associated with a 6% decrease in suicide rate. Exploratory analysis suggested a stronger association in males, who experienced a greater increase in antidepressant use. Changes in unemployment and alcohol consumption rates did not explain the association.

CONCLUSION

In Japan during 1999 through 2003, absent long-term linear trend effects, annual increases in prescribing of newer antidepressant medications, mainly SSRIs, were associated with annual decreases in suicide rates, particularly among males.

Seasonality and suicide in Italy: amplitude is positively related to suicide rates

BACKGROUND

Recent studies have reported changes in the time patterns of suicide, with conflicting findings regarding the direction of these changes: data from Italy were investigated to evaluate the influence of recent social and medicine-related changes on the seasonality of suicides in the country.

METHODS

A total of 71,227 male suicides and 26,466 female suicides occurring in Italy from 1974 to 2003 were investigated with harmonic spectral analysis to extract their monthly seasonal dispersion by five-year intervals.

RESULTS

The suicide rates of both males and females showed a rising trend, with an evident peak in the 1987-1994 period and a decrease thereafter. Seasonality of suicides, with a clear peak in spring as against the other seasons, accounted for a statistically significant proportion of total variance: around 40% among males and 39% among females. Seasonality did not change across time in a relevant way; however, an anticipation of the peak was observed in both males and females over time, with amplitude increasing or decreasing as a function of yearly suicide rates.

LIMITATIONS

Data could not be analysed according to age or to the method of suicide, since this information was not available across the whole time interval.

CONCLUSION

The seasonal effect on mortality by suicide is positively related to suicide rates, so much that changes in suicide rates over time correspond to changes in suicide seasonality.