Depressed suicide attempters with posttraumatic stress disorder

High-frequency Repetitive Transcranial Magnetic Stimulation (rTMS) Accelerates onset Time of Beneficial Treating Effects and Improves Clinical Symptoms of Depression

BACKGROUND

In recent years, more and more patients with depression demonstrate suicidal intention and suicidal behavior.

OBJECTIVE

To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in treating depression with suicidal ideation.

METHODS

Eighty-nine depression patients with suicide intention were administrated drugs combined with four weeks of Active rTMS (n=40) or sham (n=49) rTMS treatment. The 24-item Hamilton Depression Rating Scale for Depression (HAMD-24) and Self-rating Idea of Suicide Scale (SIOSS) were used to evaluate suicide risk and depression severity at baseline, weeks 2 and 4. A 25% reduction in HAMD-24 score from baseline was defined as treatment response. More than a 20% reduction in HAMD-24 score from baseline within the first 2 weeks of treatment was defined as an early improvement.

RESULTS

No statistical significance was found for baseline sociodemographic and illness characteristics between the two groups (P >0.05). There was a significant difference for HAMD-24 and SIOSS scores between the two groups at weeks 2 and 4. Active rTMS group demonstrated a more significant score reduction compared to the Sham rTMS group at weeks 2 and 4. There was a significantly greater number of patients with early improvement observed in the Active rTMS group compared to those in the Sham rTMS group at weeks 2 (P <0.05). There was a significant difference in responder rates between the two groups at weeks 4 for HAMD-24 scores (P <0.05).

CONCLUSION

rTMS could accelerate the onset time of beneficial treating effects and improve clinical symptoms of depression. During the treatment course, cognitive disorder, sleep disorder, anxiety/ somatization, retardation, and hopelessness symptoms were improved dramatically, and suicidal ideation was reduced.

Suicide attempts in chronically depressed individuals: What are the risk factors?

Chronically depressed individuals have a high suicide risk. However, it is an open question whether previously observed risk factors for suicide attempts also apply to chronic depression or whether there are specific risk factors related to chronic-recurrent illness. We drew from a large group of chronically depressed individuals seeking psychotherapy to investigate demographic and psychological factors related to previous suicide attempts. Participants took part in the SCID and filled out established questionnaires. Among 368 chronically depressed individuals (68.7% women; M_age = 40.95 years), 75 participants (19.4%) reported previous suicide attempts. Men were more likely to have used violent methods. We tested the links of having attempted suicide with different variables using logistic regression analyses. Our findings corroborate previously observed risk factors (e.g. sexual abuse, personality disorders) and suggest other risk factors which could be especially relevant in chronic depression (e.g. depression severity, interpersonal problems, self-injurious behavior, and overall years of depression). Other risk factors from previous studies were not related to suicidal behavior within our sample (e.g. anxiety disorders, PTSD). Thus, mental health professionals should be aware that risk factors for suicidal behavior might vary between diagnosis groups and that chronic illness might be a risk factor in itself.

Posttraumatic Stress and Distress Tolerance: Associations With Suicidality in Acute-Care Psychiatric Inpatients

Trauma and posttraumatic stress disorder (PTSD) symptomatology have been associated with suicidality, including ideation and behavior. The current investigation evaluated, in acute-care psychiatric inpatients, the mediating role of perceived (self-reported) distress tolerance in the association between PTSD symptom severity and suicidality, defined as a) suicidal ideation, intent, or behavior leading to current psychiatric hospitalization; b) self-reported severity of suicidal desire; and c) percentage of days of suicidality during current hospitalization. Participants were composed of 105 adults (55.2% women; mean age, 33.9; SD, 10.9) admitted to a public psychiatric acute-care inpatient hospital in a large metropolitan area; 52.3% of the participants were hospitalized for suicidality. Results indicated that PTSD symptom severity (and severity of each PTSD symptom cluster) may exert an indirect effect on suicidality, specifically suicidality as a basis for current hospital admission and self-reported severity of suicidal desire, through perceived distress tolerance. Effects were documented after controlling for theoretically relevant covariates.

Characteristics of suicidal outpatients with mood, anxiety and somatoform disorders: The role of childhood abuse and neglect

BACKGROUND

The most prevalent psychiatric disorders are mood, anxiety and somatoform (MAS) disorders which show high mutual comorbidity, childhood trauma and elevated risk of suicidality. So far, no studies have compared suicide risk in a secondary care population with comorbid MAS disorders. This gap was taken as starting point for the study.

AIMS

In comparing suicidal and non-suicidal MAS patients, the following was examined: suicide risk in the three disorder groups, socio-demographic and clinical characteristics, occurrence of childhood trauma types and contribution of childhood trauma to suicidality.

METHODS

This cross-sectional study compared suicidal (n = 316) versus non-suicidal comorbid MAS outpatients (n = 929) by means of the Mini-International Neuropsychiatric Interview Plus (MINI-Plus), Brief Symptom Inventory (BSI), Short Form Health Survey 36 (SF-36), Dimensional Assessment of Personality Pathology-Short Form (DAPP-SF) and Childhood Trauma Questionnaire (CTQ).

RESULTS

Compared to non-suicidal MAS patients, suicidal MAS patients mostly had mood disorders (single/comorbid), multiple diagnoses, worse functioning, more personality pathology (self-harm) and more childhood neglect and abuse.

CONCLUSION

Especially (comorbid) depressed patients are at risk for suicide, and routine screening and monitoring of childhood trauma and suicidality in them are recommended, along with the timely deployment of appropriate trauma-focused psychotherapy.