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Yazıcı Çelebi G, Kaya F. The Association Between Personal, Affective, and Cognitive Factors and Suicide Risk Among Muslims in Turkey. JOURNAL OF RELIGION AND HEALTH 2023; 62:3780-3800. [PMID: 37946028 DOI: 10.1007/s10943-023-01945-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
This study was conducted to examine the association of various personal, affective, and cognitive factors with suicide risk. The study group consisted of a total of 423 individuals, including 341 (74%) females and 82 (26%) males, who lived in Turkey and declared that they were Muslims. The data of the study, in which a cross-sectional design was employed, were collected between October and December 2022. The mean age of the participants was 26.84 years (SD = 9.88, min-max = 18-64). The data collection measures included the Psychological Distress Scale, the Perception of God Scale, the Two-Dimensional Self-Esteem Scale, the Suicide Probability Scale, and a personal information form. Pearson correlation analysis and Hierarchical Multiple Linear Regression analysis were employed in the analysis of the data obtained from the research. In the study, it was found that gender, age, suicide attempt, communication with the mother, communication with the father, psychological distress, self-esteem, and perception of God explained 58% of the variance in suicide risk. Psychological distress had the strongest positive association with suicide risk (β = 0.136, p < 0.001), while self-esteem had the strongest negative relation (β = - 0.454, p < 0.001). In conclusion, it was determined that the female gender, suicide attempt, and psychological distress increased the risk of suicide, but that age, positive communication with parents, self-esteem, and positive perception of God decreased it. The findings of the research were discussed in light of the literature.
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Affiliation(s)
- Gülin Yazıcı Çelebi
- Faculty of Letters, Department of Psychology, Gumushane University, 29000, Gumushane, Turkey
| | - Feridun Kaya
- Faculty of Letters, Department of Psychology, Atatürk University, 25000, Erzurum, Turkey.
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Lee J, Man Chang S, Hahm BJ, Park JE, Seong SJ, Hong JP, Jeon HJ, An H, Kim BS. Prevalence of Loneliness and Its Association With Suicidality in the General Population: Results From a Nationwide Survey in Korea. J Korean Med Sci 2023; 38:e287. [PMID: 37698209 PMCID: PMC10497353 DOI: 10.3346/jkms.2023.38.e287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/09/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Although it is known that a substantial proportion of the population experience loneliness, the consequence of loneliness remains unclear by countries and ages. Accordingly, this study aimed to assess the association between loneliness and suicidality in the general population of Korea. METHOD A total of 5,511 Koreans aged 18-79 completed a tablet-assisted personal interview using the Korean version of the Composite International Diagnostic Interview and responded to questions about loneliness and lifetime suicidal ideation, plans, and attempts. A logistic regression analysis was used to examine the association between loneliness and suicidality. RESULTS Approximately one-third of the Korean general population reported loneliness. Being older, never married, widowed, separated, or divorced, unemployed, and having a part-time job were all significantly related to loneliness. After adjusting for sociodemographic factors, individuals with loneliness were significantly associated with increased suicidal ideation (adjusted odd ratio [aOR], 4.05; 95% confidence interval [CI], 3.36-4.88), suicidal plans (aOR, 4.91; 95% CI, 3.34-7.21), and suicidal attempts (aOR, 4.82; 95% CI, 3.03-7.66). Even after adjusting for sociodemographic factors and mental disorders, suicidality remained statistically significant. Moreover, frequent, moderate-to-severe, and long-term loneliness were all associated with increased ORs for suicidality, regardless of sociodemographic factors and mental disorders. CONCLUSION Loneliness was associated with suicidal ideation, plans, and attempts. This study lays the foundation for public health policymakers to establish early intervention and mental health care support for lonely people.
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Affiliation(s)
- Jimin Lee
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Korea
| | - Sung Man Chang
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Korea
| | - Bong-Jin Hahm
- Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Jee Eun Park
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Su Jeong Seong
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyonggin An
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Korea
| | - Byung-Soo Kim
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Psychiatry, Kyungpook National University Chilgok Hospital, Daegu, Korea.
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Ingram M, Thorne E, Letourneau EJ, Nestadt PS. Self-Esteem, Perceived Social Support, and Suicidal Ideation and Behavior Among Adults Attracted to Children. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228221150304. [PMID: 36630479 DOI: 10.1177/00302228221150304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Introduction: People who are attracted to children may be at elevated risk for suicidal ideation and behavior compared to the general population. However, factors associated with suicidal ideation and behavior in this population represent a gap in the literature.Methods: The current study used multilinear regression to explore the impact of self-esteem and perceived social support on suicidal ideation and behavior in a sample of 154 adults attracted to children. Mediation analysis was conducted to investigate the role of lifetime major depressive disorder and hopelessness in these relationships.Results: Results showed high prevalence of past-year and lifetime suicidal ideation and behavior in the sample. Both self-esteem and perceived social support demonstrated significant, inverse relationships with suicidal ideation and behavior after adjustment for covariates. Mediation analyses provided support for the role of hopelessness, but not depression, in these relationships.Conclusion: Results demonstrate high rates of suicidal ideation and behavior among adults attracted to children and highlight important opportunities for prevention and intervention. Improving self-esteem, bolstering perceived social support, reducing hopelessness, and removing barriers to help-seeking may be targets for improving mental health and preventing suicidal ideation and behavior in this population.
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Affiliation(s)
- Maggie Ingram
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Evelyn Thorne
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth J Letourneau
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Paul S Nestadt
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Qaddoura N, Dardas LA, Pan W. Psychosocial determinants of adolescent suicide: A national survey. Arch Psychiatr Nurs 2022; 40:15-24. [PMID: 36064239 DOI: 10.1016/j.apnu.2022.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 04/05/2022] [Accepted: 04/09/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Suicide is a global health problem with considerable variability across countries in its prevalence and correlates. The aims of this study were to: (a) explore the prevalence and psychosocial determinants of adolescent suicidal ideation, and (b) explore the perceived stigma of suicide among adolescents. METHOD A nationally representative electronic survey was utilized to collect data from school adolescents. The Joanna Briggs Institute critical appraisal checklist for studies reporting prevalence data was used to design the survey. The study collected data on adolescents' suicidal ideation, depression, self-esteem, stigma of suicide, family functioning, educational stress, and anxiety levels. A representative sample of 647 Jordanian school adolescents was included. RESULTS The prevalence of suicidal ideation among school adolescents was 11%. Suicidal ideation was significantly higher among respondents who were boys and enrolled in public schools, had a mental health problem, a family history of suicidal attempt, a lower self-esteem, and higher depressive symptoms. The majority of school adolescents agreed with the descriptions of people who take their own lives as being "lost" (70%), "coward" (53%), "stupid" (51%), and "lonely" (49%). CONCLUSION There is no typical suicide victim, and there are no specific characteristics that can point out those who are suicidal. Suicide remains a complex phenomenon that is embedded in its sociocultural context. Collaborative efforts from Jordanian policy makers, healthcare providers, researchers, and educators are needed to develop culturally appropriate screening and prevention approaches to address suicide among adolescents. Nurses have a significant role in helping adolescents experiencing suicidal ideation and their families restore, maintain, and/or promote their mental health and wellbeing.
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Affiliation(s)
- Naheel Qaddoura
- School of Nursing, The University of Jordan, Amman 11942, Jordan.
| | | | - Wei Pan
- Duke University School of Nursing, Durham, USA.
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Hallard RI, Wells A, Aadahl V, Emsley R, Pratt D. Metacognition, rumination and suicidal ideation: An experience sampling test of the self-regulatory executive function model. Psychiatry Res 2021; 303:114083. [PMID: 34271370 DOI: 10.1016/j.psychres.2021.114083] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 06/23/2021] [Accepted: 06/26/2021] [Indexed: 11/30/2022]
Abstract
A relationship between rumination and suicidal ideation is well-evidenced. A role for thought suppression has also been suggested but under-explored. The present study assessed the relative contribution of rumination and a range of thought control strategies in the understanding of suicidal ideation, within the theoretical framework of the self-regulatory executive function (S-REF) model (Wells & Matthews, 2015). Twenty-four participants who had experienced suicidal ideation in the last two months completed trait-level measures of metacognitive beliefs and momentary sampling measures of thought control strategy use, rumination and suicidal ideation over six days. Maladaptive thought control strategy use (worry and punishment), alongside rumination, predicted suicidal ideation. Adaptive strategies (distraction, social control and reappraisal) emerged as negative predictors. Metacognitive beliefs about the need to control thoughts predicted the use of punishment- but not worry-based thought control strategies. Thought control strategy use is as important in the development of suicidal ideation as rumination. The S-REF model represents a promising new approach to understanding these processes in the development of suicidal ideation.
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Affiliation(s)
- Robert I Hallard
- Centre for New Treatments and Understanding in Mental Health (CeNTrUM), The Division of Psychology & Mental Health, The University of Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Trust Headquarters, Bury New Road, Prestwich, Manchester, M25 3BL, United Kingdom.
| | - Adrian Wells
- Centre for New Treatments and Understanding in Mental Health (CeNTrUM), The Division of Psychology & Mental Health, The University of Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Vikki Aadahl
- Centre for New Treatments and Understanding in Mental Health (CeNTrUM), The Division of Psychology & Mental Health, The University of Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Trust Headquarters, Bury New Road, Prestwich, Manchester, M25 3BL, United Kingdom
| | - Richard Emsley
- King's College London, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, United Kingdom
| | - Daniel Pratt
- Centre for New Treatments and Understanding in Mental Health (CeNTrUM), The Division of Psychology & Mental Health, The University of Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
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Folayan MO, Tantawi ME, Oginni O, Oziegbe E, Mapayi B, Arowolo O, Adeniyi AA, Sam-Agudu NA. Oral health practices and oral hygiene status as indicators of suicidal ideation among adolescents in Southwest Nigeria. PLoS One 2021; 16:e0247073. [PMID: 33630858 PMCID: PMC7906320 DOI: 10.1371/journal.pone.0247073] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background Oral health is a less-recognized correlate of overall and mental wellbeing. This study aimed to assess the relationship between suicidal behavior (ideation and attempt) and oral health practices and status, and to determine the effect of sex on these associations among Nigerian adolescents. Methods Household survey data were collected from 10 to 19-year-old adolescents in southwestern Nigeria. Dependent variables were daily tooth brushing, daily consumption of refined carbohydrates between meals, and oral hygiene status (measured by plaque index). The independent variable was lifetime suicidal ideation/attempt, dichotomized into ‘yes’ and ‘never’. ‘Daily tooth brushing’ and ‘daily consumption of refined carbohydrates between meals’ were included in two separate logistic regression models, and ‘oral hygiene status’ was included in a linear regression model. The models were adjusted for sex, age, and socioeconomic status. The linear regression model was also adjusted for frequency of daily tooth-brushing and of consumption of refined carbohydrates between meals. Interactions between sex and suicidal ideation/suicide attempt in association with dependent variables were assessed. Significance was set at 5%. Results We recruited 1,472 participants with mean age (standard deviation) of 14.6 (2.6) years. The mean plaque index was 0.84 (0.56), and 66 (4.5%) adolescents reported ever having suicidal ideation/attempt. Suicidal ideation/attempt was associated with significantly lower likelihood of tooth brushing (OR = 0.48, 95% CI: 0.26, 0.91), higher likelihood of consuming refined carbohydrates between meals (OR = 2.30, 95% CI: 1.29, 4.10), and having poor oral hygiene (B = 0.18, 95% CI: 0.05, 0.32). Among males, suicidal ideation/attempt was associated with less likelihood of eating refined carbohydrates between meals (OR = 0.96, 95% CI: 0.35, 2.61). Conversely, it was associated with a significantly higher likelihood of this outcome (OR = 4.85, 95% CI: 2.23, 10.55) among females. Conclusion The study findings suggest that poor tooth brushing habits and poor oral hygiene are indicators for risk of suicidal behavior for adolescents in Nigeria, while high sugar consumption may be an additional risk factor for adolescent females. These findings support the role of dental practitioners as members of healthcare teams responsible for screening, identifying and referring patients at risk for suicidal ideation/attempt.
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Affiliation(s)
| | - Maha El Tantawi
- Faculty of Dentistry, Alexandria University, Alexandria, Alexandria Governorate, Egypt
| | - Olakunle Oginni
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Elizabeth Oziegbe
- Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Boladale Mapayi
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Olaniyi Arowolo
- Obafemi Awolowo University Teaching Hospitals’ Complex, Ile-Ife, Osun State, Nigeria
| | | | - Nadia A. Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
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Sobczak AM, Bohaterewicz B, Marek T, Fafrowicz M, Dudek D, Siwek M, Tereszko A, Krupa A, Bryll A, Chrobak AA. Altered Functional Connectivity Differences in Salience Network as a Neuromarker of Suicide Risk in Euthymic Bipolar Disorder Patients. Front Hum Neurosci 2020; 14:585766. [PMID: 33281585 PMCID: PMC7705642 DOI: 10.3389/fnhum.2020.585766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022] Open
Abstract
Objective The occurrence of death by suicide in patients diagnosed with bipolar disorder is as much as 60 times greater than in the general population. Even during the state of euthymia patients are characterized by suicide risk. The aim of the study is to investigate the baseline brain activity in euthymic bipolar disorder patients in regard to suicide risk. We hypothesized that patients compared to healthy control group will demonstrate altered functional connectivity among resting state networks which will be directly related to current suicide risk. Method 41 subjects were enrolled in the study consisting control group (n = 21) and euthymic bipolar disorder patients group (n = 20). Functional magnetic resonance imaging was used to evaluate resting state brain activity and ROI-ROI functional connectivity analysis was performed. Suicidal risk was estimated using The Suicide Behaviors Questionnaire-Revised. Results A two sample t-test revealed decreased functional connectivity between regions involved in the salience network in patients compared to the control group. This decrease was negatively correlated with current suicide risk. Conclusion Obtained results suggest the association between risk of suicide and activity of regions responsible for functions such as learning from mistakes, prospective thinking, and sensory integration.
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Affiliation(s)
- Anna Maria Sobczak
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| | - Bartosz Bohaterewicz
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland.,Department of Psychology of Individual Differences, Psychological Diagnosis, and Psychometrics, Institute of Psychology, University of Social Sciences and Humanities, Warsaw, Poland
| | - Tadeusz Marek
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| | - Magdalena Fafrowicz
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| | - Dominika Dudek
- Department of Adult Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Siwek
- Department of Affective Disorders, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Tereszko
- Chair of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Krupa
- Chair of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Amira Bryll
- Chair of Radiology, Jagiellonian University Medical College, Kraków, Poland
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Fan S, Lippard ET, Sankar A, Wallace A, Johnston JA, Wang F, Pittman B, Spencer L, Oquendo MA, Blumberg HP. Gray and white matter differences in adolescents and young adults with prior suicide attempts across bipolar and major depressive disorders. J Affect Disord 2019; 245:1089-1097. [PMID: 30699851 PMCID: PMC6903411 DOI: 10.1016/j.jad.2018.11.095] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/24/2018] [Accepted: 11/17/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Findings regarding brain circuitry abnormalities in suicide attempters (SAs) converge across bipolar disorder (BD) and major depressive disorder (MDD), the most common disorders observed in suicides. These abnormalities appear to be present during adolescence/young adulthood when suicide rates increase steeply, and suicide is a leading cause of death in this age group. Identification of brain circuitry common to adolescent/young adult SAs with BD and MDD is important for generating widely effective early prevention strategies. We examined brain circuitry in SAs in adolescents/young adults across these two disorders. METHODS Eighty-three participants (ages 14-25 years), 46 with BD (21 SAs) and 37 with MDD (19 SAs), underwent structural and diffusion-weighted magnetic resonance scanning. Whole-brain analyses compared gray matter (GM) volume and white matter (WM) fractional anisotropy (FA) between SAs and non-suicide attempters (NSAs) across and within BD and MDD (p < 0.005). RESULTS Across and within BD and MDD, SAs showed differences compared to NSAs in ventral prefrontal cortex (PFC) GM volume and fronto-limbic (including uncinate fasciculus (UF)) WM FA. Exploratory analyses showed additional within-disorder differences for BD SAs in dorsolateral PFC (dlPFC) and hippocampus GM volume and UF FA, and for MDD SAs dorsomedial and dlPFC GM and dorsal frontal WM. However, there was no significant interaction between suicide attempt status and diagnosis. LIMITATIONS Modest sample size. CONCLUSIONS Common fronto-limbic gray and white matter alterations in adolescent/young adult SAs are potential targets for suicide prevention strategies across mood disorders. Preliminary findings of disorder-specific regional findings could suggest diagnostic-specific optimal targets may exist.
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Affiliation(s)
- Siyan Fan
- Departments of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Elizabeth T.C. Lippard
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA,Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Anjali Sankar
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Amanda Wallace
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Fei Wang
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Brian Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Linda Spencer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Maria A. Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania; Philadelphia, PA; USA
| | - Hilary P. Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA,Department of Child Study Center, Yale School of Medicine, New Haven, CT, USA
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Malhi GS, Outhred T, Das P, Morris G, Hamilton A, Mannie Z. Modeling suicide in bipolar disorders. Bipolar Disord 2018; 20:334-348. [PMID: 29457330 DOI: 10.1111/bdi.12622] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/17/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Suicide is a multicausal human behavior, with devastating and immensely distressing consequences. Its prevalence is estimated to be 20-30 times greater in patients with bipolar disorders than in the general population. The burden of suicide and its high prevalence in bipolar disorders make it imperative that our current understanding be improved to facilitate prediction of suicide and its prevention. In this review, we provide a new perspective on the process of suicide in bipolar disorder, in the form of a novel integrated model that is derived from extant knowledge and recent evidence. METHODS A literature search of articles on suicide in bipolar disorder was conducted in recognized databases such as Scopus, PubMed, and PsycINFO using the keywords "suicide", "suicide in bipolar disorders", "suicide process", "suicide risk", "neurobiology of suicide" and "suicide models". Bibliographies of identified articles were further scrutinized for papers and book chapters of relevance. RESULTS Risk factors for suicide in bipolar disorders are well described, and provide a basis for a framework of epigenetic mechanisms, moderated by neurobiological substrates, neurocognitive functioning, and social inferences within the environment. Relevant models and theories include the diathesis-stress model, the bipolar model of suicide and the ideation-to-action models, the interpersonal theory of suicide, the integrated motivational-volitional model, and the three-step theory. Together, these models provide a basis for the generation of an integrated model that illuminates the suicidal process, from ideation to action. CONCLUSION Suicide is complex, and it is evident that a multidimensional and integrated approach is required to reduce its prevalence. The proposed model exposes and provides access to components of the suicide process that are potentially measurable and may serve as novel and specific therapeutic targets for interventions in the context of bipolar disorder. Thus, this model is useful not only for research purposes, but also for future real-world clinical practice.
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Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Tim Outhred
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Pritha Das
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Grace Morris
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Amber Hamilton
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Zola Mannie
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
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Abstract
Suicide is a leading cause of global mortality. Suicide clusters have recently been identified among peer networks in high-income countries. This study investigates dynamics of suicide clustering within social networks of young Kenya men (n = 532; 18-34 years). We found a strong, statistically significant association between reported number of friends who previously attempted suicide and present suicide ideation (odds ratio = 1.9; 95% confidence interval (1.42, 2.54); p < 0.001). This association was mediated by lower collective self-esteem (23% of total effect). Meaning in life further mediated the association between collective self-esteem and suicide ideation. Survivors of peer suicide should be evaluated for suicide risk.
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11
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Yusufov M, Dalrymple K, Bernstein MH, Walsh E, Rosenstein L, Chelminski I, Zimmerman M. Body mass index, depression, and suicidality: The role of self-esteem in bariatric surgery candidates. J Affect Disord 2017; 208:238-247. [PMID: 27792969 DOI: 10.1016/j.jad.2016.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/28/2016] [Accepted: 10/16/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Previous research suggests a relationship between weight and depression/suicidality, although few studies have examined the mechanisms underlying this association. This study examined the mediating role of self-esteem in the relationship between BMI and depression/suicidality, as well as the moderating role of gender in the mediated pathways. METHODS As part of a screening process in consideration for bariatric surgery, 3,101 adults (81.4% female, 18.6% male) were assessed one time. Five univariate mediation and five univariate moderated-mediation models were hypothesized and analyzed. For the mediation models, we entered five outcome variables separately: 1) severity of depressed mood, 2) diagnosis of Major Depressive Disorder, 3) lifetime history of suicide attempts, 4) suicidal ideation at the time of evaluation, and 5) severity of suicidality, BMI as the independent variable, and self-esteem as the mediator. For the moderated-mediated models, gender was examined as a moderator to examine whether self-esteem was a stronger mediator for one gender, compared to the other. RESULTS Findings supported the mediating role of self-esteem across all five outcomes. Further, the mediated effect was moderated by gender, such that the mediation effect was stronger for males, compared to females. LIMITATIONS The majority of the sample consisted of White females, limiting broad applicability of findings. All variables were assessed simultaneously, at baseline, limiting the ability to make causal attributions. CONCLUSIONS Study findings suggest that self-esteem may help explain the relationship between BMI and depression/suicidality, particularly for men. Thus, interventions targeting self-esteem may be useful for improving psychological outcomes among those presenting for bariatric surgery.
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Affiliation(s)
- Miryam Yusufov
- Rhode Island Hospital, Department of Psychiatry, 146 West River Street, Providence, RI 02904, USA.
| | - Kristy Dalrymple
- Rhode Island Hospital, Department of Psychiatry, 146 West River Street, Providence, RI 02904, USA; Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Michael H Bernstein
- Department of Psychology, University of Rhode Island, Kingston, RI 02881, USA
| | - Emily Walsh
- Rhode Island Hospital, Department of Psychiatry, 146 West River Street, Providence, RI 02904, USA
| | - Lia Rosenstein
- Rhode Island Hospital, Department of Psychiatry, 146 West River Street, Providence, RI 02904, USA
| | - Iwona Chelminski
- Rhode Island Hospital, Department of Psychiatry, 146 West River Street, Providence, RI 02904, USA; Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Mark Zimmerman
- Rhode Island Hospital, Department of Psychiatry, 146 West River Street, Providence, RI 02904, USA; Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
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Perrot C, Vera L, Gorwood P. [Poor self-esteem is correlated with suicide intent, independently from the severity of depression]. Encephale 2016; 44:122-127. [PMID: 27908442 DOI: 10.1016/j.encep.2016.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 10/11/2016] [Accepted: 10/14/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Suicide is a major Public Health concern, and low self-esteem might represent a major risk factor. Our main objective was to assess the correlation between self-esteem and suicide intent. More specifically, we aimed to examine the relationship between the different dimensions of self-esteem (total, general, familial, professional and social) and suicide intent. We also sought the role of depression in the relationship of self-esteem to suicide intent. METHOD This retrospective cross-sectional study was conducted at a suicide prevention department at the CMME (Sainte-Anne Hospital, Paris, France). We included patients aged 15 and older and admitted for suicide attempt over a 3-year period from January 2008 to December 2010. Self-esteem was assessed with the Coopersmith's Self-Esteem Inventory (SEI) scale that takes into account several domains of self-esteem. Subjects scoring over 5 points on the lie scale were excluded. Our primary endpoint was the correlation between self-esteem and suicide intent. Our secondary endpoint was the same correlation adjusted for depression severity (using the Hamilton scale). Suicide intent was estimated using Beck's Suicide Intentionality Scale (SIS). We examined the Pearson's correlation coefficients between self-esteem and suicide intent. These analyses were adjusted for the severity of depressive symptoms assessed with the Hamilton Depression Rating Scale (17 items). RESULTS Overall, 132 patients were included. Suicide intent was correlated with total self-esteem (r=-0.227, P=0.009), social self-esteem (r=-0.331, P<0.001) and familial self-esteem (r=-0.260, P=0.003). These results remained significant after adjusting for the level of depression for total score (r=-0.181, P=0.038), and the social (r=-0.282, P=0.001) and familial (r=-0.237, P=0.006) dimensions. CONCLUSION Self-esteem (and especially social and familial dimensions) is likely to be associated with suicide intent, at least in part independently of the severity of depression, in a population of subjects hospitalized for suicide attempt. This correlation was strongest with social self-esteem. The main limitation of this monocentric study is the lack of representative sample. Nevertheless, this result paves the way for future strategies of suicide prevention, especially those dealing with poor self-esteem.
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Affiliation(s)
- C Perrot
- Clinique des maladies mentales et de l'encéphale (CMME), hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France.
| | - L Vera
- Clinique des maladies mentales et de l'encéphale (CMME), hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - P Gorwood
- Clinique des maladies mentales et de l'encéphale (CMME), hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Centre de psychiatrie et neuroscience, Inserm UMR894, 2, ter rue d'Alésia, 75014 Paris, France; Université Paris-Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France
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Stickley A, Koyanagi A. Loneliness, common mental disorders and suicidal behavior: Findings from a general population survey. J Affect Disord 2016; 197:81-7. [PMID: 26971125 DOI: 10.1016/j.jad.2016.02.054] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 01/11/2016] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Loneliness has been linked to an increased risk of engaging in suicidal behavior. To date, however, there has been comparatively little research on this in the general adult population, or on the role of common mental disorders (CMDs) in this association. The current study examined these associations using nationally representative data from England. METHODS Data came from the Adult Psychiatric Morbidity Survey 2007. Information was obtained from 7403 household residents aged ≥16 years on perceived loneliness and lifetime and past 12-month suicide ideation and attempts. The Clinical Interview Schedule Revised (CIS-R) was used to assess six forms of CMD. Logistic regression analysis was used to examine these associations. RESULTS Loneliness was associated with suicidal behavior. Although adjusting for CMDs attenuated associations, higher levels of loneliness were still significantly associated with suicidal ideation and suicide attempts with odds ratios (OR) for those in the most severe loneliness category ranging from 3.45 (lifetime suicide attempt) to 17.37 (past 12-month suicide attempt). Further analyses showed that ORs for suicidal behavior were similar for individuals who were lonely without CMDs, and for those respondents with CMDs who were not lonely. Lonely individuals with CMDs had especially elevated odds for suicidal ideation. LIMITATIONS This study used cross-sectional data and a single-item measure to obtain information on loneliness. CONCLUSION Loneliness is associated with suicidal behavior in the general adult population. This highlights the importance of efforts to reduce loneliness in order to mitigate its harmful effects on health and well-being.
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Affiliation(s)
- Andrew Stickley
- The Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge 141 89, Sweden; Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, 28029 Madrid, Spain
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Rasmussen ML, Dyregrov K, Haavind H, Leenaars AA, Dieserud G. The Role of Self-Esteem in Suicides Among Young Men. OMEGA-JOURNAL OF DEATH AND DYING 2015; 77:217-239. [PMID: 29940831 DOI: 10.1177/0030222815601514] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study explores self-esteem in suicide among young males with no earlier history of suicide attempt(s) or treatment in mental health services. The data come from an ongoing psychological autopsy study; 10 cases of young men aged 18 to 30, were selected to generate a phenomenologically based understanding of the psychological mechanisms and processes involved in the suicidal process. The analyses are based on in-depth interviews with 61 closely connected individuals, as well as suicide notes. We used Interpretative Phenomenological Analysis. For these young men, the transition to young adulthood, a period of major life challenges, seemed to be associated with personal defeats. According to their significant others, the deceased seemed to have experienced intolerable discrepancies between their actual performances and their ideal self standards. Four themes emerged from the analysis: (a) striving to find a viable path to life as an adult man; (b) experiencing a sense of failure according to own standards; (c) emotional self-restriction in relationships; and (d) strong feelings of loneliness and rejection of self. Improved understanding of suicides outside the mental illness paradigm may have important implications for preventive strategies.
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Affiliation(s)
| | - Kari Dyregrov
- 1 Norwegian Institute of Public Health, Division of Mental Health, Oslo, Norway.,2 Center for Crisis Psychology, Bergen, Norway
| | - Hanne Haavind
- 3 Department of Psychology, University of Oslo, Norway
| | - Antoon A Leenaars
- 1 Norwegian Institute of Public Health, Division of Mental Health, Oslo, Norway
| | - Gudrun Dieserud
- 1 Norwegian Institute of Public Health, Division of Mental Health, Oslo, Norway
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Preti A, Sheehan DV, Coric V, Distinto M, Pitanti M, Vacca I, Siddi A, Masala C, Petretto DR. Sheehan Suicidality Tracking Scale (S-STS): reliability, convergent and discriminative validity in young Italian adults. Compr Psychiatry 2013; 54:842-9. [PMID: 23618606 DOI: 10.1016/j.comppsych.2013.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 02/12/2013] [Accepted: 03/04/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE The Sheehan Suicidality Tracking Scale (S-STS) is a patient self-report or clinician-administered rating scale that tracks spontaneous and treatment-emergent suicidal ideation and behaviors. This study set out to evaluate the reliability, convergent and divergent validity of the S-STS in a sample of college students, a population with a high risk of completed and attempted suicide. METHODS Cross-sectional, survey design. Participants (303 undergraduate students; males: 42%) completed several measures assessing psychological distress (General Health Questionnaire; GHQ); self-esteem (Rosenberg Self Esteem Scale; RSES); social support (Modified Social Support Survey; MOSSS); and suicidal behavior, including ideation and attempts (S-STS). RESULTS Both internal consistency and test-retest stability were excellent for the S-STS-global score. The S-STS subscale on suicide ideation also showed good reliability, while the subscale on suicidal behavior showed some inconsistency at retest. Convergent and divergent validity of S-STS was confirmed. All S-STS items loaded on a single factor, which had an excellent fit for the unidimensional model, thus justifying the use of the S-STS as a screening tool. In a mediation model, self-esteem and social support explained 45% of the effects of psychological distress on suicide ideation and behavior as measured by the S-STS-global score. CONCLUSIONS This study provided promising evidence on the convergent, divergent, internal consistency and test-retest stability of the Sheehan Suicidality Tracking Scale. The cross-sectional design and lack of measures of hopelessness and helplessness prevent any conclusion about the links of suicidal behavior with self-esteem and social support.
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Affiliation(s)
- Antonio Preti
- Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy; Genneruxi Medical Center, Cagliari, Italy.
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The suicidal process: age of onset and severity of suicidal behaviour. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1263-9. [PMID: 21935695 DOI: 10.1007/s00127-011-0434-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 09/05/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE The concept of the suicidal process implies a progression from behaviour of relatively low intent to completed suicide. Evidence from the literature has given rise to the speculation that the age of onset of an early form of the suicidal process may be associated with the ultimate seriousness of suicidal behaviour. This study was designed to test the hypothesis that early onset of the first stage of the suicidal process, a wish to die, is associated with increases in the ultimate position along the suicidal process dimension. METHODS Questions on the appearance and timing of suicidal process components (a death wish, ideation, plan, or attempt) were embedded in a telephone survey on mental health and addictions in the workforce. Records of those that had experienced suicidal behaviour were examined for the effects on the age of onset of the first death wish as a function of the level of severity of suicidal behaviour, gender, and depression. RESULTS The findings showed that increases in suicidal intent were associated with lowered age of the first death wish. This pattern held true for depressed and non-depressed persons alike. CONCLUSIONS The results support the notion that the early onset of a supposed precursor of suicidal behaviour, a death wish in this case, adds to its ability to portend more serious problem levels in later stages of life. Furthermore, mood operates independently in its association with the timing of such suicidal behaviour, suggesting that the effect of a relatively youthful appearance of a wish to die cannot be explained by early onset depression.
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Self-referential thinking, suicide, and function of the cortical midline structures and striatum in mood disorders: possible implications for treatment studies of mindfulness-based interventions for bipolar depression. DEPRESSION RESEARCH AND TREATMENT 2012; 2012:246725. [PMID: 21961061 PMCID: PMC3180071 DOI: 10.1155/2012/246725] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Revised: 07/28/2011] [Accepted: 07/29/2011] [Indexed: 12/30/2022]
Abstract
Bipolar depression is often refractory to treatment and is frequently associated with anxiety symptoms and elevated suicide risk. There is a great need for adjunctive psychotherapeutic interventions. Treatments with effectiveness for depressive and anxiety symptoms as well as suicide-related thoughts and behaviors would be particularly beneficial. Mindfulness-based interventions hold promise, and studies of these approaches for bipolar disorder are warranted. The aim of this paper is to provide a conceptual background for such studies by reviewing key findings from diverse lines of investigation. Results of that review indicate that cortical midline structures (CMS) appear to link abnormal self-referential thinking to emotional dysregulation in mood disorders. Furthermore, CMS and striatal dysfunction may play a role in the neuropathology underlying suicide-related thoughts and behaviors. Thus, combining studies of mindfulness interventions targeting abnormal self-referential thinking with functional imaging of CMS and striatal function may help delineate the neurobiological mechanisms of action of these treatments.
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