Completed suicide and psychiatric diagnoses in young people: a critical examination of the evidence

Clinical utility of depression measures and symptoms: Implications for suicide risk assessment in high risk, resource limited youth populations

OBJECTIVE

Suicide risk for youth in resource- limited settings has been largely underrepresented in the literature and requires targeted examination of practical ways to address this growing public health concern. The present study focuses on the clinical utility of depression risk assessment tools addressing how and for whom suicide prevention intervention is most beneficial within a low-middle-income-country, high suicide risk youth sample.

METHODS

Youth who reported a previous suicide attempt versus those who did not were criterion to test the validity of depression and hopelessness symptom assessment tools. We used item analyses to identify depressive symptom endorsements that most informed youth suicide risk, which will better equip rural practitioners for targeted intervention and monitoring of youth with an already high risk for suicide.

RESULTS

Findings demonstrated that practitioners may target symptoms of social anhedonia, depressed mood, concentration disturbance, feelings of worthlessness, sleep disturbance, and fatigue for suicide prevention-intervention efforts among high-risk youth.

CONCLUSIONS

Study implications are for clinicians' use of the BDI-II and CES-D for depression symptom identification and suicide risk monitoring in settings with limited mental health infrastructure.

"I was very sad, but not depressed": phenomenological differences between adjustment disorder and a major depressive episode

Introduction

Adjustment disorder (AD) is a diagnosis that must be differentiated from major depressive episode (MDE) because of the therapeutic implications. The aim of this study is to understand the experience of patients who in their lifetime have been diagnosed with AD as well as MDE to establish the characteristics of each disorder.

Methods

A descriptive phenomenological approach was used with in-depth interviews to four patients and the method proposed by Colaizzi to understand the experiences and reach the description of both disorders.

Results

Three women and one man, with advanced schooling were interviewed. The participants emphasized the existence of differences that were grouped in: the attribution made by the individual, the theme of cognitions, the variability in the course, the possibility of mood modulation, the syndrome severity, the presence of hopelessness and the perceived course.

Conclusion

Phenomenological differences were found in the subjective experience of MDE and AD. The MDE would be described as an intense state of generalized shutdown of the subject's own life, with little response to events, and the AD, as a dynamic reaction attributed to a stressful event, with high variability in the course of symptoms due to the dependence on such event, with the preserved hope that it will end.

Alcohol Use Disorder Visits and Suicide Ideation Diagnosis: Racial/Ethnic Differences at Emergency Departments

INTRODUCTION

Nationally, suicide ideation prevalence is comparable among White, American Indian/Alaska Native, Black, and Hispanic adults experiencing alcohol use disorder. This study examines whether such comparability extends to the probability of receiving a suicide ideation diagnosis when presenting with alcohol use disorder at emergency departments. The probability of hospitalization following such diagnosis is examined as well.

METHODS

National Emergency Department Sample (2019) data were used. Logistic and multilevel logistic regression analyses were performed in 2022-2023 with suicide ideation diagnosis and subsequent hospitalization as the outcome variables. Control variables included demographics, payor, alcohol use disorder level, comorbidities, and emergency department facility. Adjusted probabilities were computed.

RESULTS

Age-adjusted probabilities of suicide ideation diagnoses for American Indian/Alaska Native, Black, and Hispanic patients with alcohol use disorder were 5.4%, 6.7%, and 4.9% (95% CIs=3.7, 7.1; 6.0, 7.4; 4.4, 5.4), respectively; all less than that for White counterparts (8.7%; 95% CI=8.2, 9.2). Among patients with alcohol use disorder plus suicide ideation diagnoses, the age-adjusted probability of hospitalization for American Indians/Alaska Natives (32.4%; 95% CI=20.9, 44.0) was less than that for Whites, Blacks, and Hispanics (49.8%, 52.3%, and 49.9%; 95% CIs=46.7, 52.8; 47.1, 57.5; and 43.9, 55.8, respectively). In regressions with multiple control variables, the racial/ethnic differences remained statistically significant (p<0.05).

CONCLUSIONS

Diagnosis of suicide ideation, a key step in emergency department suicide prevention care, occurred significantly less often for patients of color with alcohol use disorder than for White counterparts. American Indians/Alaska Natives, the racial/ethnic group known to have the nation's highest suicide rate, had the lowest probability of being hospitalized after a diagnosis of alcohol use disorder plus suicide ideation.

The Recovery from Attempting Suicide

A positive trajectory of life after an attempted suicide is extremely limited in research despite its advantage of aiding salutary outcomes. A systematic review of the qualitative research was conducted to explore the impact the attempt of taking your own life has had on your life and your work, to discover what changes participants have made to move toward a life worth living, and to understand how people can help better support individuals from attempted suicide attempts. A comprehensive search of online articles identified thirteen eligible studies. Three themes emerged: (1) rediscovering a life of meaning (2) contextual factors that facilitate a life worth living (3) internal changes. Limitations were discussed along with recommendations for future research.

Prevalence and factors associated with suicidal ideation among students taking university entrance tests: revisited and a study based on Geographic Information System data

BACKGROUND

A previous study identified students taking Bangladeshi university entrance tests as a vulnerable group at a higher risk of suicidal behaviours before the COVID-19 pandemic. However, the impact of the pandemic on the magnitude of these behaviours among this population remains unexplored.

AIMS

This study aimed to investigate the prevalence of suicidal ideation and associated factors among Bangladeshi university entrance test takers following the pandemic. In addition, an approach based on Geographic Information System (GIS) data was used to visualise the distribution of suicidal ideation across the country.

METHODS

A cross-sectional approach was used to collect data among participants taking the entrance test at Jahangirnagar University in September 2022. Using SPSS, data were analysed with chi-squared tests and binary regression, and ArcGIS was used to map the results across the nation.

RESULTS

The study revealed a prevalence of 14.4% for past-year suicidal ideation, with 7.4% and 7.2% reporting suicide plans and attempts, respectively. Notably, repeat test-takers exhibited a higher prevalence of suicidal behaviours. Significant risk factors for suicidal ideation included urban residence, smoking, drug use, COVID-19 infection and deaths among close relations, depression, anxiety and burnout. The GIS-based distribution indicated significant variation in the prevalence of suicidal ideation across different districts, with higher rates observed in economically and infrastructurally deprived areas.

CONCLUSIONS

Urgent measures are needed to address the high prevalence of suicidal behaviours among students taking university entrance tests students in Bangladesh, particularly in light of the COVID-19 pandemic. Enhanced mental health support, targeted prevention efforts and improved resources in economically disadvantaged regions are crucial to safeguard the well-being of these students.

Healthcare utilization, psychiatric disorders, and physical illnesses shortly before suicide mortality in adolescents in Taiwan

BACKGROUND

This study examined the pattern of medical utilization and the distribution of comorbidities shortly before death among adolescents who died from suicide and compared these data with those of living controls.

METHODS

From Taiwan's National Health Insurance Research Database, this study identified adolescents aged 10-19 years who died from suicide (n = 935) between 1 January 2000, and 31 December 2016, by linking each patient with the national mortality database. The researchers conducted a nested case-control study through risk set sampling, and for each case, 20 age- and sex-matched controls (n = 18 700) were selected from the general population. The researchers applied conditional logistic regression to investigate differences in medical utilization and physical and psychiatric comorbidities between cases and controls.

RESULTS

Cases had a higher proportion of contact with the psychiatric department but a similar proportion of contact with any non-psychiatric medical department within 1 year before suicide compared with controls. There were 18.6% of adolescent suicide victims who only had contacted with a psychiatric department 3 months before suicide. Moreover, cases had a higher proportion of contact with non-psychiatric services within 3 months before suicide, particularly with emergency, surgery, and internal medicine departments. Cases had higher risks of several psychiatric disorders and physical illnesses, including heart diseases, pneumonia, and ulcer disease, than did controls.

CONCLUSIONS

The findings of increased medical utilization and higher risks of physical and psychiatric comorbidities in adolescent suicide victims are crucial for developing specific interventions to prevent suicide in this population.

Exploring adverse childhood experiences (ACEs) among Ugandan university students: its associations with academic performance, depression, and suicidal ideations

BACKGROUND

Adverse childhood experiences (ACEs) among university students have been linked to a variety of factors and have been shown to have a dose-response relationship with adult health and behavior.

OBJECTIVE

To investigate the effect of exposure to ACEs on academic performance, depression, and suicidal ideations among university students.

METHODS

A cross-sectional survey among university students at a public university in southwestern Uganda was conducted in 2021, integrating the Adverse Childhood Experiences International Questionnaire for assessing ACEs, the Patient Health Questionnaire for assessing depression symptoms and suicidal ideations, and questions assessing the family structure and academic performance as adopted from similar studies. Regression analysis was performed, and 3 models were generated to answer the study hypotheses.

RESULTS

A total of 653 undergraduate university students with a mean age of 22.80 (± 3.16) years were recruited. Almost all students (99.8%) experienced one or more ACEs, with physical abuse being the common ACE reported. The average depression symptom severity was statistically higher among individuals who experienced any form of ACEs. No relationship was observed between the ACEs experienced and self-rated academic performance. Similarly, on regression analysis, the cumulative number of ACEs was not associated with self-rated academic performance (β =  - 0.007; 95% CI - 0.031 to 0.016; p = 0.558). However, the cumulative number of ACEs was positively associated with depression symptom severity (β = 0.684; 95% CI 0.531-0.837; p < 0.001), as well as increased the likelihood of suicidal ideations (aOR = 1.264; 95% CI 01.090-1.465; p < 0.001).

CONCLUSIONS

The burden of ACEs is exceedingly high among Ugandan university students, highlighting the urgency in strengthening effective child protection strategies to protect Uganda's rapidly growing population from mental ill-health and avoid future psychological disability, a burden to the healthcare system. The study's findings will also be useful to practitioners/policymakers working to prevent/limit child maltreatment globally.

Prevalence and associated factors of suicidal behaviors among Bangladeshi rural community people: Findings from the 'BD ComMen Study'

BACKGROUND

Suicide is considered as one of the major public health concerns, which can be prevented with cost-effective and timely intervention. In Bangladesh, very few studies assessed the suicidal behavior of rural community people. Thus, this Bangladesh Community Mental Health Study (BD ComMen Study) attempted to understand the current situation of suicidality in Bangladeshi rural community people considering three-time frames: lifetime, past year, and past month.

METHODS

A cross-sectional study was conducted in a rural community in Bangladesh between May 17 and 31, 2022, using a cluster sampling technique. Information on socio-demographics, COVID-19-related factors, depression, anxiety, insomnia, and suicidal behaviors was collected. The Chi-square test or Fisher's exact test and logistic regression were used to analyze the data.

RESULTS

During their lifetime, 33.1% of the rural community people had suicidal thoughts, whereas 5.5% made a plan for suicide and 1.8% attempted suicide. The prevalence of past-year suicidal ideation was 3.9%, whereas 1.4% had a suicide plan. In addition, 0.6% had past-month suicidal thoughts, although none of them had planned or attempted suicide. The factors associated with suicidal behaviors included males, lower age, lower educational grade, low-earning jobs, living in a government-provided house, family history of mental health and suicide, and suffering from anxiety and insomnia.

CONCLUSIONS

Suicidal behaviors among the rural community people are of great concern as most of the rural people in Bangladesh do not have enough mental health literacy for treatment-seeking due to a high level of mental health-related stigma. Thus, this study would likely help to initiate further studies and stimulate suicide prevention programs, because most suicide can be prevented.

Suicidal ideation among people with disabilities during the COVID-19 pandemic in Bangladesh: prevalence and associated factors

BACKGROUND

Evidence from pandemic and pre-pandemic studies conducted globally indicates that people with disabilities (PWDs) have a higher risk for suicidality. However, none of these studies has assessed suicidality among PWDs in Bangladesh.

AIMS

The purpose of this study was to determine the prevalence of and factors associated with suicidal ideation among PWDs during the COVID-19 pandemic in Bangladesh.

METHOD

Using a snowball sampling technique, a cross-sectional survey was conducted from February to April 2021 among PWDs from six districts in the northern region of Bangladesh. Information related to sociodemographic factors, clinical characteristics, behavioural factors and suicidal ideation was collected. Chi-squared test and logistic regression were used to describe the data and explain the relationship of factors associated with suicidal ideation.

RESULTS

The prevalence of COVID-19-related past-year suicidal ideation was 23.9%. The factors associated with suicidal ideation included: age above 35 years, being female, acquiring a disability later in life, lack of sleep and current substance use. In addition, higher education appeared to be a protective factor against suicidal ideation.

CONCLUSIONS

This study highlighted that PWDs had an increased risk of suicide; that is, one-fourth of them had past-year suicidal ideation. This may have been because of COVID-19-related restrictions and stressors. Thus, the government and policy makers need to pay more attention to developing effective suicide assessment, treatment and management strategies, especially for at-risk groups, to minimise the impact of the COVID-19 outbreak.

The Mediating Role of Depression Severity on the Relationship Between Suicidal Ideation and Self-Injury in Adolescents With Major Depressive Disorder

Objectives

Suicide is the leading cause of death among adolescents in South Korea, and depression and personality profiles have been identified as significant risk factors for self-injurious behavior. This study examined the influence of depressive mood and temperament/ character on self-injury in adolescents.

Methods

A total of 116 adolescents (aged 12–18 years) with a primary diagnosis of major depressive disorder (MDD) and their parents were enrolled in this study. The participants were divided into three groups based on adolescent’s self-injury frequency, and their Children’s Depression Inventory (CDI), Youth Self-Report (YSR), and Temperament and Character Inventory (TCI) scores were compared. Finally, mediation analysis was conducted to investigate the relationship between suicidal ideation and self-injury.

Results

Of study participants, 75.9% answered that they had suicidal ideation, and 55.2% answered that they had engaged in self-injurious behavior in the last six months. There were significant differences in CDI and suicidal ideation among the groups. After adjusting for age and sex, mediation analysis indicated that depressive mood mediated the relationship between suicidal ideation and self-injury.

Conclusion

This study emphasizes the importance of evaluating and managing depressive mood severity in adolescents with MDD as these factors partially mediate the transition from suicidal ideation to self-injury.

Suicidal behaviors and university entrance test-related factors: A Bangladeshi exploratory study

PURPOSE

The present study is the first investigating unexplored psychological issues of university entrance test-taking students in Bangladesh.

DESIGN AND METHODS

This cross-sectional study investigates suicidal behaviors and their socio-demographic, admission test-related, and psychopathological risk factors among a total of 911-Bangladeshi university entrance test-takers.

FINDINGS

About 17.7% of the participants report suicidal thoughts, whereas it is 8.0% and 2.5% for suicide plans and suicide attempts, respectively. Significantly higher suicidal thought is observed in the repeat test-taking students compared to the first-time test-takers (20.7% vs. 14.6%, χ ²  = 5.669, p = 0.017), though the suicide plan and suicide attempt are not associated with student status. The suicidal thought risk factors include female gender, urban residence, satisfaction with the mock test, mental disorders etc. PRACTICAL IMPLICATIONS: The present findings warrant implementing initiatives for this suicide-prone cohort, especially for the test-failing students.

Suicidality in Bangladeshi Young Adults During the COVID-19 Pandemic: The Role of Behavioral Factors, COVID-19 Risk and Fear, and Mental Health Problems

BACKGROUND

It is said that psychological stressors have risen during the COVID-19 pandemic, which may contribute to suicidality. A few studies were conducted investigating suicidality amid the first wave of the pandemic in Bangladesh, but none of these studies explored the predictive role of the suicidality-related factors (eg, behavior and health-related variables, COVID-19 risk, fear of COVID-19). Thus, this study aimed to investigate the prevalence of suicidality and the predictive models explaining suicidality variance among Bangladeshi young adults during the second wave of the pandemic.

METHODS

An online-based cross-sectional survey was conducted during the second wave of the pandemic (between 1 and 13 April 2021; a year after the pandemic's inception in the country). The survey questionnaire collected information on socio-demographics, behavior and health-related variables, COVID-19 risk, fear of COVID-19, depression, anxiety, and suicidality. A total of 756 data were analyzed (male 59%; mean age 22.24 ±4.39 years), and hierarchical regression was performed considering suicidality as the dependent variable. A p-value <0.05 was set to be statistically significant with a 95% of confidence interval.

RESULTS

About 8.2% reported having at least suicidal thoughts within the pandemic inception to survey time (one-year suicidal ideation). More specifically, 7.40% had only suicidal ideation, whereas 0.10% planned for suicide, 0.70% attempted suicide. None of the socio-demographic variables was significantly associated with suicidality. Taking drugs, performing less physical activity, poor self-reporting health condition, being comorbid, being at higher COVID-19 risk, having fear of COVID-19 infection, and suffering from depression and anxiety were significantly associated with a higher risk of suicidality. However, the final model including all of the studied variables explained a 17.1% (F=8.245, p<0.001) variance in terms of suicidality.

CONCLUSION

Although this study reported a lower severity of suicidality than prior Bangladeshi studies conducted during the first wave of the pandemic, a portion of people are still at risk of suicide and they should be given attention.

Suicide prevention in childhood and adolescence: a narrative review of current knowledge on risk and protective factors and effectiveness of interventions

INTRODUCTION

Suicide is a global mental health problem for people of all ages. While rates of suicide in children and adolescents are reported as lower than those in older populations worldwide, they represent the third leading cause of death in 15-19-year-olds. The rates are higher among boys than girls worldwide, though the death rates for girls exceed those for boys in Bangladesh, China, India, and Nepal. There has been a general decrease in adolescent suicide rates over recent decades. However, increases are reported in South East Asia as well as South America over the same time period.

METHODS

A narrative review method has been used to summarize current knowledge about risk and protective factors for suicide among children and adolescents and to discuss evidence-based strategy for suicide prevention in this age group.

RESULTS

Identified suicide risk and protective factors for children and adolescents largely overlap with those for adults. Nevertheless, developmental characteristics may strengthen the impact of some factors, such as decision-making style, coping strategies, family and peer relationships, and victimization. The implementation of evidence-based suicide preventive strategies is needed. Restricting access to lethal means, school-based awareness and skill training programs, and interventions delivered in clinical and community settings have been proven effective. The effectiveness of gatekeeper training and screening programs in reducing suicidal ideation and behavior is unproven but widely examined in selected settings.

DISCUSSION

Since most studies have been conducted in western countries, future research should assess the effectiveness of these promising strategies in different cultural contexts. The use of more rigorous study designs, the use of both short- and long-term follow-up evaluations, the larger inclusion of individuals belonging to vulnerable groups, the evaluation of online intervention, and the analysis of programs' cost-effectiveness are also required.

Risk Factors for Depression and Anxiety Disorders Among Bangladeshi Dental Students: A Cross-Sectional Survey Study

Dental students are highly prone to mental health suffering due to the stressors related to their educational, academic, and clinical environment. However, there are no previous studies that evaluated the mental health problems among dental students in Bangladesh. Therefore, the present study assessed the prevalence of depression and anxiety and its covariates. A cross-sectional survey was carried out among the students of five (out of a total of nine) Bangladeshi public dental institutes. The survey included the Patient Health Questionnaire, the Generalized Anxiety Disorder scale, and questions relating to sociodemographic factors, personal suffering, and family mental health history. Results indicated that the prevalence rates for moderate to severe depression and anxiety were 27.4% and 18.2%, respectively. The risk factors for depression and anxiety were being female, coming from city areas, having past-year psychological and physical suffering, having past-year traumatic events, and having a family history of mental illness, as well as a range of suicide-related behaviors. The prevalence rates of depression and anxiety in the present study were relatively lower than other dental student cohorts residing outside Bangladesh. Further investigations are suggested based on the limitations and strengths of the present study.

Characteristics of depressed suicide attempters with remitted substance use disorders

Substance use disorder (SUD) comorbidity in mood disorders increases suicide risk. Suicide attempters with active SUD appear to have distinct characteristics but little is known whether these characteristics persist during remission and if they are related to different aspects of suicidal behavior. In this study, suicide attempters with a DSM mood disorder and remitted SUD (AT+SUD) (N = 135) were compared to those without lifetime SUD (AT-SUD) (N = 219) in terms of demographic, clinical and suicidal behavioral characteristics. Factor analyses were conducted to generate subjective distress and impulsivity/aggression factors - previously identified by our group to predict suicide risk in mood disorders. Associations between these traits and SUD history and suicidal behavior characteristics were then tested. Compared with AT-SUD, AT+SUD were more likely to be male, less educated and to have a Cluster B personality disorder. AT+SUD individuals had greater impulsivity/aggression factor scores, but comparable subjective distress scores. AT+SUD made a greater number of suicide attempts, with higher lethality, despite comparable suicide intent and degree of planning with AT-SUD. Impulsivity/aggression was higher in multiple versus single attempters, but did not correlate with suicide attempt lethality. Among suicide attempters with mood disorders, a history of lifetime SUD was associated with more frequent and more lethal suicide attempts. Among other correlates of lifetime SUD in this sample, impulsive/aggressive traits may explain greater frequency of suicide attempts. The results underscore that persons with mood disorders and lifetime SUD are at particularly high risk of frequent and lethal suicide attempts where more intensive prevention efforts are warranted.

A meta-study on transcription factor networks in the suicidal brain

There is evidence supporting the presence of brain gene expression differences between suicides and non-suicides. Such differences have been implicated in suicide pathophysiology. However, regulatory factors underlying these gene expression differences have not been fully understood. Therefore, the identification of differences in regulatory mechanisms, i.e., transcriptional factors between suicides and non-suicides is crucial for the understanding of suicide neurobiology. In this study, we conducted a transcription factor network meta-study with freely available data from the prefrontal cortex of suicides and non-suicides with different mental disorders, including major depression disorder, bipolar disorder and schizophrenia, as well as healthy controls. Disorder-specific characteristics of suicides and non-suicides transcription factor networks were detected, i.e., the presence of immune response genes in both suicides and non-suicides with major depression disorder networks. Also, we found the presence of ESR1, which has been implicated to give resilience to social stress, in the non-suicides network but not in the suicides with major depression network. Suicides and non-suicides with bipolar disorder shared only three genes in common: FOS, CRY1 and PER2. In addition, we found a higher number of genes involved in immune response in the non-suicides with bipolar disorder compared to the suicides with bipolar disorder network. The suicides and non-suicides with schizophrenia networks exhibited clear differences, including the presence of circadian cycle genes in the suicides with schizophrenia network and their absence in the non-suicides with schizophrenia network. The results of this study provide insight on the regulatory mechanisms underpinning transcriptional changes in the suicidal brain.

Associations Between Sad Feelings and Suicide Behaviors in the 2019 Youth Risk Behavior Survey: A Call for Action

Purpose: Suicide is the second leading cause of death among high school aged students in the United States. Significant risk factors for suicidal behaviors among youth include diagnoses of depression or other mental illnesses. The association between self-reported sad feelings and suicidal behaviors has been understudied in the literature among United States high school students. Methods: The 2019 National Youth Risk Behavior Survey (YRBS) school-based questionnaire, coordinated by the CDC, captured a nationally-representative sample (N = 13,677) of students' responses to health-related behaviors. National sex-stratified prevalences of sad feelings and suicidal behaviors were calculated. Adjusted weighted logistic regression was used to examine the association between self-reported sad feelings and suicidal behaviors. Results: Out of 13,677 high-school students, 35.8% of students self-reported sad feelings. Suicidal behaviors in the overall sample included 18.2% had seriously considered suicide, 15.2% made a plan on how they would attempt suicide, and 7.3% attempted suicide within the past 12 months. There was an 8-11-fold increased odds of all suicidal behaviors among those who reported sad feelings among both females and males. Conclusions: This study reveals a remarkably high prevalence of sad feelings among US youth, and underscores a significant association between self-reported sad feelings and suicidal behaviors among this population. The YRBS survey, routinely administered across US high school students, should be better leveraged to target interventions toward these high-risk youth in order to decrease the significant burden of suicidal behaviors among adolescents.

Prevalence and Predisposing Factors of Suicidal Ideation Among the University Students in Bangladesh: A Single-Site Survey

Recently, suicide among Bangladeshi university students has become a serious problem. However, to date, there have been no studies assessing suicidal behaviors among Bangladeshi students. Therefore, the present study investigated suicidal ideation (SI) and its risk factors among this population. A classroom-based convenience sampling method was utilized to survey 665 students of a university in Bangladesh (67.5% males; aged 21.16 years: SD ± 1.6). In addition to socio-demographic questions, the survey also included the Smartphone Application-Based Addiction Scale, Bergen Facebook Addiction Scale, and Depression Anxiety Stress Scale–21. Results showed that the prevalence of suicidal ideation was 2.3% in the past 24 h, 4.8% in the past 15 days, 6.9% in the past month, 14.7% in the past year, and 61.1% in the lifetime. The unadjusted regression model showed that being divorced (or separated) from a partner (OR = 4.486, 95% CI = 1.972–10.207, p < 0.0001), Facebook addiction (OR = 1.550, 95% CI = 1.006–2.388, p = 0.047), depression (OR = 1.657, 95% CI = 1.677–4.211, p < 0.0001), anxiety (OR = 2.649, 95% CI = 1.624–4.320, p < 0.0001), and stress (OR = 2.626, 95% CI = 1.673–4.122, p < 0.0001) were the risk factors of past-year SI. Compared with global prevalence rates, the present study reported higher levels of SI prevalence. Therefore, supportive suicide prevention programs are needed to tackle SI and alongside comorbid psychopathology.

Suicidal attempts, insomnia, and major depressive disorder among family members of suicide victims in South Korea

BACKGROUND

Suicide survivors are defined as victims who experienced suicide of siblings or parents, spouses, or lineal relatives within the fourth degree who had lived with them. We compared the effects of major depressive disorder (MDD), symptoms of posttraumatic stress disorder (PTSD), and impulsivity on lifetime suicide attempts among suicide survivors.

METHODS

Participants included 272 suicide survivors. We compared them to 5,200 members from the general population who were matched by age, sex, and years of education. We evaluated participants using the Patient Health Questionnaire-9 (PHQ-9), the EuroQuality of Life (EuroQol) scale, the Impact of Events Scale-Revised (IES-R), the Barratt Impulsiveness Scale-11 (BIS-11), and the Composite International Diagnostic Interview (K-CIDI).

RESULTS

Among the 272 suicide survivors, MDD was nine times higher (47.1% vs. 5.3%), and suicidal attempts were six times higher (20.5% vs. 3.3%) than reported among the general population. The suicide survivors showed more severe depression, greater impulsivity, and poorer quality of life than did the general population. In multivariate logistic regression analyses performed to evaluate each IES-R item, "trouble staying asleep" was the only PTSD symptom item that was significantly associated with suicide attempts among suicide survivors. Suicide survivors who had both MDD with insomnia and high impulsivity were at four times higher risk for suicide attempts than the general population with no MDD (AOR = 4.04, 95% CI: 1.25-13.09).

CONCLUSIONS

Surviving suicide by family members is an important risk factor for suicide attempts. In particular, MDD with insomnia and impulsivity are associated with suicide attempts among suicide survivors.

Validation and calibration of the patient-reported outcomes measurement information system: Pediatric PROMIS® Emotional Distress domain item banks, Portuguese version (Brazil/Portugal)

OBJECTIVE

This paper goal was to validate the Portuguese version (Brazil/Portugal) of the Anger, Anxiety, and Depressive Symptoms item banks of the Pediatric PROMIS^® Emotional Distress domain (version 1.0) for the Brazilian and Portuguese pediatric population.

METHOD

The total of 1216 participants answered a self-applied version of the Portuguese Anger, Anxiety, and Depressive Symptoms item banks. Reliability was assessed through internal consistency, test-retest reliability, and total information curve (TIC). Confirmatory Factor Analysis (CFA) with a bifactor model was used to confirm construct validity and IRT assumptions. Item calibration was performed according to Graded Response Model (GRM). Differential Item Functioning (DIF) was analyzed according the participants' age, gender, health condition (healthy versus chronic disease), and language.

RESULTS

Internal consistency reliability (Cronbach's alpha coefficient = 0.84) and test-retest reliability (intraclass correlation = 0.93) were accurate. Unidimensionality, Local Independency, and construct validity were verified by CFA (CFI = 0.93; TLI = 0.93; RMSEA = 0.05; χ² = 3052.4 with DIF = 557 and P value = 0.595). GRM was adjusted, and Emotional Distress had a satisfactory coverage. DIF was not significant.

CONCLUSION

The results obtained indicate the adequacy of the psychometric properties of the Portuguese version (Brazil/Portugal) of the Anger, Anxiety, and Depressive Symptoms item banks of the Pediatric PROMIS^® Emotional Distress domain.

Exploratory analysis of genetic variants influencing molecular traits in cerebral cortex of suicide completers

Genetic factors have been implicated in suicidal behavior. It has been suggested that one of the roles of genetic factors in suicide could be represented by the effect of genetic variants on gene expression regulation. Alteration in the expression of genes participating in multiple biological systems in the suicidal brain has been demonstrated, so it is imperative to identify genetic variants that could influence gene expression or its regulatory mechanisms. In this study, we integrated DNA methylation, gene expression, and genotype data from the prefrontal cortex of suicides to identify genetic variants that could be factors in the regulation of gene expression, generally called quantitative trait locus (xQTLs). We identify 6,224 methylation quantitative trait loci and 2,239 expression quantitative trait loci (eQTLs) in the prefrontal cortex of suicide completers. The xQTLs identified influence the expression of genes involved in neurodevelopment and cell organization. Two of the eQTLs identified (rs8065311 and rs1019238) were previously associated with cannabis dependence, highlighting a candidate genetic variant for the increased suicide risk in subjects with substance use disorders. Our findings suggest that genetic variants may regulate gene expression in the prefrontal cortex of suicides through the modulation of promoter and enhancer activity, and to a lesser extent, binding transcription factors.

Risk and protective factors for suicide among Guyanese youth: Youth and stakeholder perspectives

Guyana, a low-to-middle-income country (LMIC) in South America, leads the world in youth suicide. As an understanding of risk and protective factors is critical to the development of culturally informed suicide prevention efforts, research exploring these factors among youth in Guyana is needed. The current study expands on current research on adolescent suicide in Guyana and LMICs broadly by using qualitative focus groups and interviews to explore adult stakeholders' and youth's perspectives. Participants included 17 adult stakeholders and 40 adolescents in Guyana. Data were analysed using a grounded theory approach. Themes related to participants' perceptions of risk factors for suicide included demographic characteristics, pressure and expectations, adults' responses to youth, limited coping with stressful life events and exposure to suicide. Themes related to protective factors for suicide included positive social support and involvement in community activities. Findings have implications for the development and tailoring of suicide prevention efforts for Guyanese youth.

Risk factors of geriatric depression among elderly Bangladeshi people: A pilot interview study

Globally, geriatric depression (GD) has been recognized to be one of the most prevalent problems among the elderly. However, there is an only one previous Bangladeshi study addressing the issue. Consequently, the present study investigated GD and its associated risk factors. A semi-structured face-to-face interview was conducted among 168 self-reported healthy elderly residents (59.5% female) aged 60-80 years in Patuakhali city and the neighboring village. Measures included the Geriatric Depression Scale-15, socio-demographic variables, psychosocial factors, physical health-related factors, lifestyle factors, and dietary factors. Results showed the GD prevalence rate was 36.9% (n = 62). Risk factors for GD included living in a rural area, having no history of chronic disease, having a history of previous personal and/or family depression, not engaging in daily life activities, not exercising regularly, having no hobbies, having a poor diet, and not engaging in religious practices regularly. The GD prevalence rate was generally higher compared to previous studies in other countries. This may have been due to the inclusion criterion of selecting self-reported healthy elderly individuals. It is recommended that a nationally representative study is carried out to assess the actual figure of GD in Bangladesh. The findings are helpful for depression-reducing intervention programs.

Clinical risk factors among youth at high risk for suicide in South Africa and Guyana

INTRODUCTION

Suicide is the second leading cause of death among youth worldwide, but low- and middle-income countries (LMICs) account for 78% of all suicides. The LMICs South Africa and Guyana rank high in the global suicide rates. To better understand and prevent suicide among the youth, the present study targets youths at high risk for suicide, in an LMIC, to contextually and representatively identify clinical risk factors for suicide.

METHODS

One hundred-ninety youths, aged 11-21, separated from biological parents at the time of assessment, in South Africa and Guyana, were administered the Child Behavior Checklist and Behavior Assessment System for Children to assess clinical symptoms. The youths were asked about current suicide ideation and previous attempt(s). Self-report responses to clinical items yielded scale scores for depression, social stress, atypicality, somatization, anxiety, and ADHD. Using an integrative data analytic technique, clinical scale scores were standardized and used to predict suicidal behaviors in a binary logistic regression analysis.

RESULTS

Approximately 22% of Black South African youths and 60% of Guyanese youths endorsed suicide ideation and attempt or suicide attempt only. In fully adjusted analyses, the odds of atypicality and somatization were 1.96 and 1.67 times greater among the youths who endorsed suicidal ideation when compared with those who did not (p < .04). Youth social stress was significantly associated with the suicide attempt, controlling for model covariates (odds ratio [OR], 1.88, p = .05). Gender moderated the effect of somatization on youth suicide.

CONCLUSION

Our results contextualize how social stress, atypicality, and somatization relate to LMIC youth suicide. Further study on high-risk samples will contribute to generalizable suicide-prevention models.

The time course of responding to aversiveness in females with a history of non-suicidal self-injury

Non-suicidal self-injury is a risk factor for suicidal behavior, particularly in females. Two prominent theories of suicide suggest that habituation to the psychophysiological aversiveness of NSSI is a mechanism by which NSSI exposure may lead to increased risk for suicide. Several laboratory studies examining the relationship between physiological habituation and suicide attempt history have yielded mixed results, potentially due to their use of broad measures of physiological arousal and/or focus on specific psychopathologies. However, no studies have examined the association between the time course (e.g., habituation, initial reactivity) of responding to aversiveness and NSSI, which may help to elucidate psychophysiological mechanisms of NSSI. Therefore, we examined habituation and initial reactivity to aversiveness (indexed by the time course of acoustic startle reflex, a well-validated measure of defensive responding) in three groups of young adult females - those with a history of NSSI, psychiatric controls matched on potential confounds (e.g., psychopathology, trauma history, demographics), and healthy controls. Results indicated that individuals with a history of NSSI exhibited blunted initial reactivity and marginally slower habituation to aversiveness relative to the two control groups. The NSSI group's insensitivity to aversiveness may reflect prior psychophysiological habituation, and may be a mechanism through which prior NSSI exposure leads to increased risk for suicidal behavior.

Help-seeking behavior of Jimma university students with common mental disorders: A cross-sectional study

BACKGROUND

Globally, the mental health help-seeking behavior of university students is reported to be poor; less than one-third of university students with common mental disorders (CMDs) report having sought help from formal sources. Failure to seek treatment is associated with prolonged disability and poor mental health outcomes, including suicide. In Ethiopia, little is known about the help-seeking behavior of university students for CMDs.

OBJECTIVE

This study aimed to assess the prevalence and determinants of help seeking, and sources of help sought by Jimma University undergraduate students with CMDs.

METHOD

Seven hundred and sixty students were selected to participate in this cross-sectional study using multi-stage sampling. Sources of help were identified using the Actual Help-Seeking Questionnaire. CMDs were assessed using the 10-item Kessler Psychological Distress Scale. Binary logistic regression analysis was used for both univariate and multivariable analysis.

RESULTS

Of the sampled students, 58.4% were found to have current CMDs. Of those with current CMDs, 78.4% had sought help for their problems. The majority (83.8%) of participants who sought help did so from informal sources. Compared to students who had 'very good' overall levels of satisfaction with life, those who had 'good', 'fair', and 'poor or very poor' overall level of satisfaction with life were less likely to seek help (p-value = 0.021, 0.014, and 0.011, respectively). Lastly, having no previous history of help-seeking was significantly associated with seeking help for CMDs (p-value<0.001).

CONCLUSION

More than half of Jimma University students were found to have a high risk of CMDs and the majority of those with CMDs sought help from informal sources. Future studies are needed to explore the barriers of seeking help from formal resources, and the effects of not receiving help from formal sources for CMDs symptoms.

Psychological Implications of Unemployment Among Bangladesh Civil Service Job Seekers: A Pilot Study

Background: Recent trends suggest that university graduates seeking jobs are more susceptible to common mental disorders, such as depression, anxiety, or stress. However, the mental health issues among unemployed graduates has not been explored in Bangladesh yet. Aims: This study aimed to assess for the first time the prevalence and associated risk factors of depression, anxiety, and stress among Bangladesh Civil Service (BCS) job seekers. Three hundred four graduates residing in Rajshahi, Bangladesh, who were preparing to attend the 40^th BCS examination, the most sought-after employment opportunity in the country, were surveyed. Methods: Measures included socio-demographics, field of study, and career-related variables, and the Bangla Depression Anxiety Stress Scale (DASS-21). Chi-square test, Fisher exact test, and binary logistic regression with "depression," "anxiety," and "stress" as the dependent variables were carried out to identify the factors associated with these. Results: Overall, the prevalence of moderate to extremely severe depression, anxiety, and stress was 49.3%, 53.6%, and 28.3%, respectively, with no detectable differences between genders. Insecurity related to a BCS job (OR = 0.41; CI = 0.26-0.65, p < 0.001; ref: job insecurity), family and social pressure to obtain a BCS job (OR = 4.58; CI = 1.67-12.56, p < 0.001), and stress (OR = 8.33; CI = 4.47-15.51, p < 0.001) emerged as independent predictors for depression. In addition, having part-time job was associated with anxiety (OR = 2.38; CI = 1.34-4.23, p = 0.003), and security in a BCS job and serving the nation through this job were negatively associated with stress (OR = 0.59; CI = 0.35-0.98, p = 0.042 vs. OR = 0.59; CI = 0.36-1.00, p = 0.05). Conclusion: The relatively high rates of depression, anxiety, and stress among graduate job seekers should prompt implementation of market force initiatives that incorporate interventions related to the major risk factors uncovered herein.

Impact of an online depression prevention intervention on suicide risk factors for adolescents and young adults

BACKGROUND

Adolescent death by suicide is an emergent health crisis in the United States of America. Although many suicide prevention programs have been created to address suicide in this population, rates continue to increase. Online interventions can disseminate treatments world-wide and reach large numbers of users. Thus, the purpose of the present study was to determine the effects of CATCH-IT, an Internet-based depression prevention intervention on risk factors for suicide (i.e., suicidal ideation, hopelessness, low self-esteem and social isolation).

METHODS

A total of 83 participants aged 14-21 years [mean =17.5; standard deviation (SD) =2.04] consented to take part in the intervention study.

RESULTS

Results indicated that suicidal ideation decreased from baseline to post-intervention. For those who completed the entire CATCH-IT program, the effect size was moderate (d =0.60, P<0.05). For those who partially completed the program the effect size was small (d =0.22, P<0.05). Interestingly, scales measuring hopelessness and social isolation were not associated with changes in suicidal ideation.

CONCLUSIONS

The findings provide initial evidence that online depression prevention programs could be related to decreased suicidal ideation, and that those who complete the entire program may benefit more than those who complete only a part of CATCH-IT.

Psychological autopsy review on mental health crises and suicide among youth in Pakistan

INTRODUCTION

Ascertaining putative sociodemographic and clinical causes for death by probable suicide can potentially help implement region-specific strategies to reduce suicide rates. In this study, we wanted to investigate methods utilized and the psychosocial and mental health characteristics of youths (aged 12-26 y) who died by probable suicide.

METHOD

We examined data from mental health clinical files and forensic reports and performed qualitative psychological autopsy interview from more than multiple sources for each youth who died by probable suicide between 1 May and 31 December 2015 in the Khyber Pakhtunkhwa Province of Pakistan.

RESULTS

The two most common methods of probable suicide were by firearm use and self-poisoning utilizing pesticides that were significantly associated with male and female gender, respectively. The most common mental health difficulties were major depressive disorder and harmful use of psychoactive substances. Other clinical features particularly evident included thoughts of self-harm, irritability and aggression, low self-esteem, treatment nonadherence, family dispute, and financial distress.

CONCLUSION

Efforts to reduce the ease of access to firearms and pesticides may potentially have a beneficial effect in reducing the suicide rate in this region of Pakistan.

Brain Gene Expression Pattern of Subjects with Completed Suicide and Comorbid Substance Use Disorder

Background/Aim

Although individuals with substance use disorder (SUD) are at high risk of committing suicide, most studies of postmortem gene expression exclude subjects with SUD due to the potential confounding effect of drugs in the transcriptome. Thus, little is known about the gene expression profile in suicides with SUD. The identification of altered biological processes in suicides with SUD is crucial in the comprehension of the interaction between both pathologies.

Methods

We evaluated the gene expression profile in the dorsolateral prefrontal area of suicides and nonsuicides with and without SUD by microarrays.

Results

We identified 222 differentially expressed genes, predominately enriched in cell proliferation in the comparison between suicides with and without SUD. When comparing the transcriptome of suicides with SUD to nonsuicides with SUD, we identified 550 differentially expressed genes, mainly enriched in oxidative phosphorylation. Differentially expressed genes (1,417) between suicides and nonsuicides without SUD were detected. Most of them were related to mitochondrial function.

Conclusion

Interaction between suicide and SUD seems to influence the expression of genes involved in glial proliferation and glutamatergic neurotransmission. These results highlight, for the first time, that suicides with SUD have a gene expression profile distinct from that of subjects with only one of these disorders.

An appraisal of the trustworthiness of practice guidelines for depression and anxiety in children and youth

OBJECTIVE

Little is known about the trustworthiness of clinical practice guidelines (PGs) relevant to child and youth depression or anxiety. To address this gap, we used systematic review methods to identify all available relevant PGs, quality appraise them, and make recommendations regarding which PGs are trustworthy and should be used by clinicians.

METHODS

Prespecified inclusion criteria identified eligible PGs. Two independent trained reviewers applied the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Using three AGREE II domain scores (stakeholder involvement, rigor of development [clinical validity/trustworthiness], and editorial independence), PG quality was designated as (1) minimum (≥50%) and (2) high (≥70%).

RESULTS

Of 25 eligible PGs, five met minimum quality criteria (depression, n = 4; anxiety, n = 1); three out of five met high-quality criteria (depression, n = 2; anxiety, n = 1). Among the five minimum quality PGs, developers included government (n = 2), independent expert groups (n = 2), and other (n = 1). No PGs developed by specialty societies achieved minimum or high-quality ratings; eight of 25 PGs were up-to-date.

CONCLUSIONS

Trustworthy PGs are available to support clinical decisions about depression and anxiety in children and youth, but are few in number. Many existing PGs (up to 80%) may not be clinically valid. Clinicians who implement the high-quality PGs identified here can increase the number of children and youth who receive effective interventions for depression and anxiety, minimize harm, and avoid wasted resources. Clinicians, service planners, youth, and their families should encourage PG developers to increase the pool of high-quality PGs using internationally recognized PG development standards.

"This is a question we have to ask everyone": asking young people about self-harm and suicide

WHAT IS KNOWN ON THE SUBJECT?: An essential part of the mental health assessment is to evaluate the risk of harm to self. Fundamentally this involves asking directly about self-harming behaviour and suicidal thoughts or urges, but practitioners often find it difficult to open up these conversations. This evaluation of risk is particularly important as self-harm and suicidal thoughts are frequently found in young people who attend mental health services. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Young people are not always routinely asked directly about self-harm or suicidal thoughts when they are assessed. There are two ways that mental health practitioners introduce this topic: first, by building up to it by initially asking about general feelings, and second by stating that it is a requirement to ask everyone. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: These questions should not be avoided by mental health practitioners just because they are difficult. We offer suggestions as to how to ask questions about self-harm and suicide based on real-world practice.

ABSTRACT

Introduction Questions about self-harm and suicide are essential in risk assessments with children and young people, yet little is known about how mental health practitioners do this. Aim The core aim was to examine how questions about self-harm and suicidal ideation are asked in real-world practice. Method A qualitative design was employed to analyse 28 video-recorded naturally occurring mental health assessments in a child and adolescent mental health service. Data were analysed using conversation analysis (CA). Results In 13 cases young people were asked about self-harm and suicide, but 15 were not. Analysis revealed how practitioners asked these questions. Two main styles were revealed. First was an incremental approach, beginning with inquiries about emotions and behaviours, building to asking about self-harm and suicidal intent. Second was to externalize the question as being required by outside agencies. Discussion The study concluded that the design of risk questions to young people had implications for how open they were to engaging with the practitioner. Implications for practice The study has implications for training and practice for psychiatric nurses and other mental health practitioners in feeling more confident in communicating with young people about self-harm and suicidal ideation.

Psychological factors of risk of suicidal behavior in adolescents

Modern approaches towards analysis of the main psychological risk factors of ado- lescents’ suicidal behaviour with consideration of external and internal develop- mental conditions in adolescence are discussed. The role of mass-media and social networks in the Internet in the genesis of suicidal behaviour is indicated. Personality factors of suicidal behaviour in the system of problems of an adolescent’s identity forming, his/ her dispositional traits, as well as of personality disorders are described. The contribution of cognitive beliefs and thoughts in suicidal behaviour is noted. Typical trajectories of suicidal behaviour development are delineated.

Global trends in teenage suicide: 2003-2014

The object of this article is to review the past decade of research on teenage suicide, with a particular emphasis on epidemiologic trends by age, gender and indigenous ethnicity. As such, a review of research literature from 2003 to 2014 was conducted via a comprehensive search of relevant psychological and medical databases. Wide gaps in our knowledge base exist concerning the true extent of teenage suicide due to lack of data, particularly in developing countries, resulting in a Western bias. The gender paradox of elevated suicidality in females with higher completed suicide rates in males is observed in teenage populations worldwide, with the notable exceptions of China and India. Native and indigenous ethnic minority teens are at significantly increased risk of suicide in comparison to general population peers. Often those with the highest need for mental health care (such as the suicidal adolescent) have least access to therapeutic support.Globally, suicide in teenagers remains a major public health concern. Further focused research concerning completed suicides of youth below the age of 18 is required across countries and cultures to understand more about risk as children progress through adolescence. Gender and ethnic variations in suicidality are embedded within cultural, historical, psychological, relational and socio-economic domains. Worldwide, the absence of child/adolescent-specific mental health policies may delay the development of care and suicide prevention. Overall, it is vital that clinicians adopt a holistic approach that incorporates an awareness of age and gender influences, and that cultural competency informs tailored and evaluated intervention programmes.

Suicide among the youth in Malaysia: What do we know?

INTRODUCTION

This article aims to study the pattern of youth suicide cases in Malaysia, following which preventive actions can then be planned and practiced to reduce these suicide cases.

METHODS

This is a cross-sectional study looking at notifications of all suicides involving members of the youth population, as had been reported to National Suicide Registry Malaysia from January 1, 2009 to December 31, 2009. Information such as profile demographics and methods of suicide were utilized accordingly.

RESULTS

There were 53 youths between the ages of 15 and 24 years reported to have undergone completed suicides. The suicide rate among youths was 1.03 per 100,000 populations in 2009, accounting for the male gender (66.0%), with Indians being the highest suicide completers (40.4% and 5.6 per 100,000 populations). The most common method of suicide was hanging (56.6%) followed by self-poisoning (15.1%).

DISCUSSION

The suicide rate among Malaysian youth is relatively lower compared with other countries in the Asian region. Majority were male, of Indian descent, and were still in secondary school. Preventive actions need to be taken especially for specific groups such as the Indian youth.

Insomnia Symptom, Mental Disorder and Suicide: A Case-Control Study in Chinese Rural Youths

Insomnia has been reported as a risk factor of suicidal behaviors, but few studies have examined the association among insomnia, mental disorder and suicide, especially among Chinese populations. In this study, we examined the effect of insomnia symptoms on completed suicide in a large sample of suicides and their controls in Chinese rural youths. Subjects were 388 consecutively recruited suicides and 416 community living controls aged 15-34 years in the rural areas of three provinces in China. Established psychological autopsy method was used for the data collection. Insomnia symptoms were assessed with sleep questions in the Hamilton Depression Rating Scale (HAMD) about insomnia, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS) and early morning awakening (EMA). The results showed that DIS (OR=12.01, p<0.001), DMS (OR=12.82, p<0.001) or EMA (OR=12.08, p<0.001) was significantly associated with increased risk of suicide even after mental disorder was controlled for. Our study showed that insomnia can be an independent risk factor for suicide. Mental disorders mediated the association between insomnia and suicide. Insomnia should be assessed and treated for individuals at risk of suicide.

Suicidal ideation and distress in family members bereaved by suicide in Portugal

The present study assessed the impact of suicide and distress on suicidal ideation in a sample of 93 Portuguese family members bereaved by suicide. A control community sample of 102 adults also participated. After controlling for educational level, those bereaved by the suicide of a family member were found to have higher levels of suicidal ideation. Forty-two percent of family members had Suicide Ideation Questionnaire scores at or above the cutoff point. General distress, depression, anxiety, and hostility related to suicidal ideation, whereas time since suicide also interacted with general distress and depression in predicting suicidal ideation.

Antecedents and sex/gender differences in youth suicidal behavior

Suicide is the second leading cause of death in youth globally; however, there is uncertainty about how best to intervene. Suicide rates are typically higher in males than females, while the converse is true for suicide attempts. We review this "gender paradox" in youth, and in particular, the age-dependency of these sex/gender differences and the developmental mechanisms that may explain them. Epidemiologic, genetic, neurodevelopmental and psychopathological research have identified suicidal behaviour risks arising from genetic vulnerabilities and sex/gender differences in early adverse environments, neurodevelopment, mental disorder and their complex interconnections. Further, evolving sex-/gender-defined social expectations and norms have been thought to influence suicide risk. In particular, how youth perceive and cope with threats and losses (including conforming to others' or one's own expectations of sex/gender identity) and adapt to pain (through substance use and help-seeking behaviours). Taken together, considering brain plasticity over the lifespan, these proposed antecedents to youth suicide highlight the importance of interventions that alter early environment(s) (e.g., childhood maltreatment) and/or one's ability to adapt to them. Further, such interventions may have more enduring protective effects, for the individual and for future generations, if implemented in youth.

Psychiatric and psycho-social characteristics of suicide completers: a comprehensive evaluation of psychiatric case records and postmortem findings

Objectives

To explore the demographic, psychosocial and clinical characteristics of individuals known to the mental health services, who died by probable suicide in the West of Ireland.

Methods

Postmortem reports between January 2006 and May 2012 detailed 153 individuals who died by probable suicide, 58 of whom attended the mental health services. Relevant socio-demographic and clinical data was extracted from individuals’ lifetime case notes.

Results

Recurrent depressive disorder (44%) was the most common diagnosis and hanging the most common method of death (58%). Of individuals who died by hanging, 79% previously attempted suicide by the same method. For individuals with a documented history of depression, only 32% had antidepressants detected in their toxicology reports. Similarly, only one individual (20%) with schizophrenia had antipsychotics detected in their toxicology report.

Conclusions

Individuals who died by probable suicide, most commonly died by hanging and drowning; with previous attempts of hanging particularly prevalent in the group who subsequently died by hanging. At the time of death, less than one-third of individuals according to toxicology reports were taking the medication that was last prescribed to them by the mental health services suggesting a high rate of treatment non-concordance in individuals who died by probable suicide.

Mapping the evidence of prevention and intervention studies for suicidal and self-harming behaviors in young people

BACKGROUND

Suicide and self-harm (SSH) in young people is a major cause of disability-adjusted life years. Effective interventions are of critical importance to reducing the mortality and morbidity associated with SSH.

AIMS

To investigate the extent and nature of research on interventions to prevent and treat SSH in young people using evidence mapping.

METHOD

A systematic search for SSH intervention studies was conducted (participant mean age between 6-25 years). The studies were restricted to high-quality evidence in the form of systematic reviews, meta-analyses, and controlled trials.

RESULTS

Thirty-eight controlled studies and six systematic reviews met the study inclusion criteria. The majority (n = 32) involved psychological interventions. Few studies (n = 9) involved treating young people with recognized mental disorders or substance abuse (n = 1) which also addressed SSH.

CONCLUSION

The map was restricted to RCTs, CCTs, systematic reviews, and meta-analyses, and thus might have neglected important information from other study designs. The effectiveness of interventions within the trials was not evaluated. The evidence base for SSH interventions in young people is not well established, which hampers best-practice efforts in this area. Promising interventions that need further research include school-based prevention programs with a skills training component, individual CBT interventions, interpersonal psychotherapy, and attachment-based family therapy. Gaps in the research exist in evaluations of interventions for SSH in young people with identifiable psychopathology, particularly substance use disorder, and research that classifies participants on the basis of their suicidal intent.

Analysis of the cost effectiveness of a suicide barrier on the Golden Gate Bridge

Background: The Golden Gate Bridge (GGB) is a well-known “suicide magnet” and the site of approximately 30 suicides per year. Recently, a suicide barrier was approved to prevent further suicides. Aims: To estimate the cost-effectiveness of the proposed suicide barrier, we compared the proposed costs of the barrier over a 20-year period ($51.6 million) to estimated reductions in mortality. Method: We reviewed San Francisco and Golden Gate Bridge suicides over a 70-year period (1936–2006). We assumed that all suicides prevented by the barrier would attempt suicide with alternative methods and estimated the mortality reduction based on the difference in lethality between GGB jumps and other suicide methods. Cost/benefit analyses utilized estimates of value of statistical life (VSL) used in highway projects. Results: GGB suicides occur at a rate of approximately 30 per year, with a lethality of 98%. Jumping from other structures has an average lethality of 47%. Assuming that unsuccessful suicides eventually committed suicide at previously reported (12–13%) rates, approximately 286 lives would be saved over a 20-year period at an average cost/life of approximately $180,419 i.e., roughly 6% of US Department of Transportation minimal VSL estimate ($3.2 million). Conclusions: Cost-benefit analysis suggests that a suicide barrier on the GGB would result in a highly cost-effective reduction in suicide mortality in the San Francisco Bay Area.

Psychiatric disorders in patients presenting to hospital following self-harm: a systematic review

BACKGROUND

Psychiatric disorders occur in approximately 90% of individuals dying by suicide. The prevalence of psychiatric disorders in people who engage in non-fatal self-harm has received less attention.

METHOD

Systematic review using electronic databases (Embase, PsychINFO and Medline) for English language publications of studies in which psychiatric disorders have been assessed using research or clinical diagnostic schedules in self-harm patients of all ages presenting to general hospitals, followed by meta-analyses using random effects methods.

RESULTS

A total of 50 studies from 24 countries were identified. Psychiatric (Axis I) disorders were identified in 83.9% (95% CI 74.7-91.3%) of adults and 81.2% (95% CI 60.9-95.5%) of adolescents and young persons. The most frequent disorders were depression, anxiety and alcohol misuse, and additionally attention deficit hyperactivity disorder (ADHD) and conduct disorder in younger patients. Personality (Axis II) disorders were found in 27.5% (95% CI 17.6-38.7%) of adult patients. Psychiatric disorders were somewhat more common in patients in Western (89.6%, 95% CI 83.0-94.7%) than non-Western countries (70.6%, 95% CI 50.1-87.6%).

LIMITATIONS

Heterogeneity between study results was generally high. There were differences between studies in identification of study participants and diagnostic procedures.

CONCLUSIONS

Most self-harm patients have psychiatric disorders, as found in people dying by suicide. Depression and anxiety disorders are particularly common, together with ADHD and conduct disorder in adolescents. Psychosocial assessment and aftercare of self-harm patients should include careful screening for such disorders and appropriate therapeutic interventions. Longitudinal studies of the progress of these disorders are required.

Attempted and completed suicide: not what we expected?

BACKGROUND

Suicide attempters and suicide completers are two overlapping but distinct suicide populations. This study aims to present a more accurate characterization by comparing populations of suicide attempters and completers from the same geographical area.

METHODS

Samples and procedure: All cases of attempted suicide treated at the emergency room of the Corporacio Sanitària i Universitària Tauli Parc de Sabadell in 2008 (n=312) were compared with all completed suicides recorded in the same geographical area from 2008 to 2011 (n=86). Hospital and primary care records were reviewed for sociodemographic and clinical variables.

STATISTICAL ANALYSIS

Chi-square, ANOVA, and Mann-Whitney U tests were used to identify characteristics related to suicide completion.

RESULTS

Compared to suicide attempters, suicide completers were more likely to be male (73.3% vs. 37.8%; p<0.001), pensioners (73.7% vs. 23.4%; p<0.001), and people living alone (31.8% vs. 11.4%; p=0.006). Suicide completers more frequently presented somatic problems (71.7 vs. 15.7; p<0.001), Major Depressive Disorder (54.7% vs. 27.9%; p<0.001), and made use of more lethal methods (74.1 vs. 1.9; p<0.001). Suicide completers were more likely to have been followed by a primary care provider (50.0% vs. 16.0%; p<0.001). 92.3% of the suicides committed were completed during the first or second attempt.

LIMITATIONS

Suicide completers were not evaluated using the psychological autopsy method.

CONCLUSIONS

Despite presenting a profile of greater social and clinical severity, suicide completers are less likely to be followed by Mental Health Services than suicide attempters. Current prevention programs should be tailored to the specific profile of suicide completers.

Toxicology findings in suicides: concentrations of ethanol and other drugs in femoral blood in victims of hanging and poisoning in relation to age and gender of the deceased

Over-consumption of alcohol and/or abuse of other drugs are closely linked to attempted or completed suicides. In this retrospective 10-year study (2001-2010), we compared the toxicology findings in hanging suicides (n = 4551) with drug poisoning (intoxication) suicides (n = 2468). The mean age of hanging deaths was 49 ± 19 y (±SD) and 80% were male, compared with a mean age of 52 ± 17 y and 47% males for the intoxication deaths. Poly-drug use was more common in poisoning suicides with an average of 3.6 drugs/case compared with 1.8 drugs/case in hangings. Moreover, 31% of hangings were negative for alcohol and/or drugs. Alcohol was detected (>0.20 g/L) in femoral blood in 30% of hanging suicides (mean 1.39 g/L) and 36% of drug poisonings (mean 1.39 g/L). The median BACs did not depend on the person's age or gender (p > 0.05). Ethanol, paracetamol, citalopram, diazepam, propiomazine, alimemazine and zopiclone were amongst the top-ten drugs detected in both methods of suicide. With the exception of ethanol, the concentrations of drugs in blood were considerably higher in the poisoning deaths, as might be expected. Regardless of the method of suicide, antidepressants and/or antipsychotics were common findings, which could implicate mental health as a significant suicide risk factor.

A psychological autopsy study of suicide among Inuit in Nunavut: methodological and ethical considerations, feasibility and acceptability

INTRODUCTION

The increasing global prevalence of suicide has made it a major public health concern. Research designed to retrospectively study suicide cases is now being conducted in populations around the world. This field of research is especially crucial in Aboriginal populations, as they often have higher suicide rates than the rest of the country.

OBJECTIVE

This article presents the methodological aspects of the first psychological autopsy study on suicide among Inuit in Nunavut. Qaujivallianiq Inuusirijauvalauqtunik (Learning from lives that have been lived) is a large case-control study, including all 120 cases of suicide by Inuit that occurred in Nunavut between 1 January 2003 and 31 December 2006. The article describes the research design, ethical considerations and strategies used to adapt the psychological autopsy method to Nunavut Inuit. Specifically, we present local social and cultural issues; data collection procedures; and the acceptability, reliability and validity of the method.

METHOD

A retrospective case-control study using the psychological autopsy approach was carried out in 22 communities in Nunavut. A total of 498 individuals were directly interviewed, and medical and correctional charts were also reviewed.

RESULTS

The psychological autopsy method was well received by participants as they appreciated the opportunity to discuss the loss of a family member or friend by suicide. During interviews, informants readily identified symptoms of psychiatric disorders, although culture-specific rather than clinical explanations were sometimes provided. Results suggest that the psychological autopsy method can be effectively used in Inuit populations.

Have mental health education programs influenced the mental health literacy of those with major depression and suicidal ideation? A comparison between 1998 and 2008 in South Australia

Mental health literacy is the knowledge and beliefs about mental disorders that aid their recognition, management, or prevention and is considered to be an important determinant of help-seeking. This has relevance in suicide prevention, as depression, the clinical condition most frequently associated with suicidality, has been the target of community and professional education programs designed to enhance mental health literacy. In this study, whether such programs have influenced help-seeking attitudes and behavior in those who are depressed and suicidal was considered. The results indicate that despite intensive community education programs over the last two decades, there has been little change in those who are depressed and suicidal in terms of their attitudes toward treatment seeking and, more importantly, their treatment-seeking behavior. These results draw into question the value of current community education programs for those most vulnerable to suicidal behavior.