Male depression and suicide

The Perinatal Assessment of Paternal Affectivity (PAPA): Italian validation of a new tool for the screening of perinatal depression and affective disorders in fathers

BACKGROUND

Questionnaires for the screening of paternal perinatal psychological distress are based on clinical manifestations expressed by women, showing limitations in capturing the wide array of signs and symptoms exhibited by men. The current study aimed to validate the Perinatal Assessment of Paternal Affectivity, a new self-report tool for the screening of paternal depressive and affective disorder.

METHOD

This study used a cross-sectional design with a 3-month test-retest, involving respectively 385 (T1) and a sub-sample of 111(T2) fathers. Confirmatory factor analysis (CFA) was performed to test structural validity and concurrent validity was assessed by Spearman correlations. We assessed reliability using McDonald's ω and ordinal alpha. Group differences in PAPA scores based on sociodemographic were also tested.

RESULTS

The CFA reported a one factor structure as the optimal solution. The PAPA also showed adequate reliability and internal consistency as well as acceptable test-retest indices. Concurrent validity was confirmed by significant correlations between PAPA total score and standardized test scores. Non-Italian fathers and fathers who experienced recent stressful life events reported higher PAPA scores.

LIMITATIONS

Our sample was not homogeneous in terms of nationality and most of the participants, were from Northern Italy. Some risk factors associated with paternal parental psychological distress (e.g., unplanned pregnancy) have not been considered.

CONCLUSION

This study provides initial evidence of validity and reliability of the PAPA as a brief and sensitive screening tool to detect signs and symptoms of paternal affective disorder during both prenatal and postnatal period.

The Relationship Between Workplace Burnout and Male Depression Symptom Assessed by the Korean Version of the Gotland Male Depression Scale

Screening for depression in males is important because their symptoms differ from those of females, ranging from indications of aggression to attempts at suicide. Men and women differ in their responses to job stress. There are no tools that have been verified, developed, or translated for screening male depression in Korea. Our team translated the Gotland Male Depression Scale (GMDS) into Korean. The Korean version of GMDS (K-GMDS) and Maslach Burnout Inventory-General Survey (MBI-GS) were administered to 277 office workers in one public institution. Gender differences in each scale score were measured along with the correlation between the K-GMDS and the MBI-GS. There was no significant difference in the K-GMDS score between males and females, whereas females scored significantly higher on the MBI-GS (p < .001). The correlation between the K-GMDS total score and the MBI total score (male: r = .702, p < .001, female: r = .375, p < .001) and MBI subscale scores were higher in males than females. Gender moderated the relationship between total K-GMDS and total MBI scores (p < .001). The Korean version of the GMDS is suitable for screening male depression symptoms in the workplace. The results of the K-GMDS demonstrated a strong correlation between depressive symptoms and work-related burnout among men. This study can be used as a basis for studying male depression symptoms in Korea, which has not been studied extensively. This will prove beneficial for work environments.

[Gender-Sensitive Depression Screening (GSDS) - Further Validation of a New Self-Rating Instrument]

OBJECTIVE

To check the validity of the preliminary results with the Gender-Sensitive Depression Screening (GSDS) in two German samples of non-psychiatric outpatients.

METHODS

The psychometric validation of the GSDS-33 was performed in a sample of non-psychiatric outpatients of different clinics belonging to the Ludwig-Maximilians-University of Munich (n = 958) and in a male non-psychiatric sample of the Men's Health Center in Berlin (n = 237).

RESULTS

Findings of the first validation study of the GSDS (Möller-Leimkühler, Mühleck 2020) were largely confirmed. The data also confirmed the factors 'aggressiveness' and 'emotional control' as important components of an increasing depression risk. Compared to a standard screening the GSDS again identified more risk cases among men in the two samples (8 % and 18 %).

CONCLUSIONS

The GSDS-25 is a multidimensional, valid and reliable scale for better identifying men with a risk of depression.

Gender-Specific Differences in Depressive Behavior Among Forensic Psychiatric Patients

Background

Women are almost twice as likely to develop depression than men, but men commit suicide more often. One explanation for this paradox is that current depression inventories do not fully capture typical male symptoms of depression. Several studies showed that most depression symptoms in men are masked by externalizing behaviors, such as aggressiveness, addiction, and risky behavior. Here, we explored the differences in depression symptoms between men and women in a forensic psychiatric sample.

Methods

We screened 182 forensic psychiatric patients and selected a matched sample (21 women and 21 men). External symptoms of depression were assessed with the Gender-Sensitive Depression Screening (GSDS) and internal symptoms with the Beck Depression Inventory Revision.

Results

Although externalizing behaviors were similar in both groups, we found a significant relationship between external and internal depression symptoms only in men. In addition, male forensic patients with a history of suicide had higher scores in the GSDS, whereas female patients with a history of suicide had higher scores in the Beck Depression Inventory Revision.

Discussion

The finding that the GSDS detected depression symptoms in men indicates that this instrument might be useful for developing assessments to prevent suicide in forensic practice.

Similarities and Differences of Mental Health in Women and Men: A Systematic Review of Findings in Three Large German Cohorts

In Germany, large, population-based cohort studies have been implemented in order to identify risk and protective factors for maintaining health across the life span. The purpose of this systematic review is to analyse findings from three large ongoing cohorts and to identify sex-specific prevalence rates, risk and protective factors for mental health. Published studies from the Cooperative Health Research in the Region Augsburg (KORA), the Study of Health in Pomerania (SHIP) and the Gutenberg Health Study (GHS)), representing the southern, north-eastern and middle parts of Germany, were identified through searches of the databases PubMed and Web of Science. A total of 52 articles was identified from the start of each cohort until June 2019. Articles reporting prevalence rates of mental health [N = 22], explanatory factors for mental health [N = 25], or both [N = 5] were identified. Consistent across cohorts, higher prevalence rates of internalizing disorders were found for women and more externalizing disorders for men. Risk and protective factors for mental health included social factors, lifestyle, physical health, body mass index (BMI), diabetes, genetic and biological factors. In all areas, differences and similarities were found between women and men. The most evident were the sex-specific risk profiles for depression with mostly external risk factors for men and internal risk factors for women. Gender was not assessed directly, therefore we examined whether socioeconomic and family-related factors reflecting gender roles or institutionalized gender could be used as a proxy for gender. Overall, this systematic review shows differences and similarities in prevalence rates and determinants of mental health indicators between women and men. They underline the importance of focussing on sex specific approaches in mental health research and in the development of prevention measures. Current research on mental health still lacks focus on gender aspects. Therefore, an increased focus on sex and gender in mental health research is of great importance.

"You have to fight to legitimize your existence all the time": The social context of depression in men with physical disabilities

Little is known about the common experience of depression in men with physical disabilities. To help address this gap, we present findings from a qualitative study situated in the social determinants of health (SDH). Findings describe the detrimental effects of marginalization, economic precarity, restrictive masculine norms, stigma, and the need to resist ableist messages on men's health and well-being. It is our intention to raise awareness of the impact of the SDH on depression in men with physical disabilities and encourage clinicians and policy makers to address the social domain as they seek to improve mental health in this population.

The Role of Perceived Social Support in the Association Between Stressful Life Events and Suicidal Behavior

Background: Suicide is a serious public health concern for which there have been well-established protective and risk factors reported in literature. There is a lack of evidence on the indirect effects of other variables on these factors. Specifically, the association between stressful life events and suicidal behavior may be affected by perceived social support, but its role in this association is largely uninvestigated. Objectives: Thus, this paper aims to explore the role of perceived social support in the association between stressful life events and suicidal behavior. Perceived social support will be explored as a mediator and as a moderator in this association. Methods: Data were obtained from the Determinants of Suicidal Behavior Conventional and Emergent Risk (DISCOVER), a study conducted to identify risk factors of suicidal behavior. The study participants are individuals with suicide attempts admitted to hospital. Participants (n = 343) were recruited from hospital setting. Suicidal behavior was measured using two outcomes (1) the occurrence of a suicide attempt (2) level of suicide intent as measured by the Pierce Suicide Intent Scale. Perceived social support was measured using the Sarason Social Support Questionnaire. Results: Stressful life events were significantly associated with suicide attempts (OR 1.440, 95% CI 1.440, 1.682, p < 0.001) and perceived social support (B -0.785, 95% CI -1.501, -0.068, p = 0.032). There was no significant mediation effect by perceived social support in the association between stressful life events and suicide attempts (Sobel's test statistic 1.64, p = 0.100). Perceived social support did not moderate the relationship between stressful life events and suicide attempts [(OR 1.007, 95% CI 0.987, 1.027, p = 0.514] or the relationship between stressful life events and level of suicidal intent (B -0.043, 95% CI -0.132, 0.046, p = 0.343). Conclusion: Stressful life events are associated with increased risk of suicide attempts. The study also identified an inverse relationship between stressful life events and perceived social support. These associations were independent of perceived social support. This study highlights the effects of stressful life events on suicide risk is not affected by perceived social support, requiring further investigation into measures to reduce the impact of social stressors on people with risk of suicide.

Sex, Gender, and Suicidal Behavior

This chapter reviews gender differences in suicide, commonly known as the gender paradox in suicide. While men are more likely to complete suicide, suicide attempts are more frequent in women. Although there are exceptions, this paradox occurs in most countries over the world, and it is partially explained by the preference of men for more lethal methods. Nevertheless, there are differences in the known risk factors for suicide between men and women, and this chapter summarizes the more relevant findings for the gender paradox. Apart from previous attempts, which still is the strongest predictor of death by suicide, with a higher rate in males than in females, we will emphasize in the role of male depression. It is commonly recognized that over 90% of people who die by suicide had a psychiatric diagnosis, mostly depression, and male depression seems to be a distinct clinical phenotype challenging to recognize, which might contribute to the gender paradox. Finally, in light of all the information reviewed, some recommendations on prevention of suicide from a gender perspective in the clinical setting will be made.

Depression and prostate cancer: implications for urologists and oncologists

Many patients with prostate cancer experience severe levels of depression, which can negatively affect their treatment and disease course. Some prostate cancer treatments can increase the severity of a patient's depression, for example, by increasing anhedonia and erectile dysfunction. Depression is often thought of as a unitary phenomenon, but multiple subtypes can be distinguished. This variety of manifestations challenges the successful application of universal antidepressant treatment options and argues for a multi-symptom assessment process that considers a patient's disease burden and their particular form of depression. Inclusion of screening and detailed diagnosis of depression can be argued to be part of good practice, and clinicians are urged to consider when and how this might be accomplished within their urological practice.

Prevalence, symptomatology, risk factors and healthcare services utilization regarding paternal depression in Germany: study protocol of a controlled cross-sectional epidemiological study

BACKGROUND

While postpartum depression is a well-researched disorder in mothers, there is growing evidence indicating that some fathers also develop depressive symptoms (paternal postpartum depression, PPD). A recent meta-analysis revealed a total prevalence of paternal depression during pregnancy and up to one year postpartum of 8.4%, with significant heterogeneity observed among prevalence rates. International studies suggest that PPD is characterized by additional symptoms compared to maternal postpartum depression. Furthermore, various risk factors of PPD have been identified. However, the prevalence, symptomatology, risk factors and healthcare situation of fathers affected by PPD in Germany are unknown.

METHODS/DESIGN

This study comprises a controlled, cross-sectional epidemiological survey administered via postal questionnaires. The primary objective is to compare the prevalence of depressive symptoms in fathers with a 0-12-month-old infant to the prevalence of depressive symptoms in men without recent paternity. Two structurally differing regions (concerning birthrate, employment status, socioeconomic structure, and nationality of inhabitants) will be included. A random sample of 4600 fathers (2300 in each region) in the postpartum period and 4600 men without recent paternity matched by age, nationality and marital status will be assessed regarding depressive symptoms using the PHQ-9. Contact data will be extracted from residents' registration offices. As secondary objectives, the study aims to provide insights into symptoms and risk factors of PPD in fathers and to assess the current healthcare situation of fathers with PPD in Germany. In an add-on study, genetic and epigenetic mechanisms of PPD will be explored.

DISCUSSION

This study will conduct the first direct comparison between fathers in the postpartum period of one year after childbirth and a matched sample of men without a newborn child. Besides closing this research gap, the findings will provide prevalence estimates as well as insights into specific symptomatology, risk factors, and the current healthcare situation regarding fathers with PPD in Germany. The results will identify low-threshold approaches as a relevant issue for healthcare. Moreover, the findings should inform the development of PPD-specific screening instruments and healthcare offers addressing fathers with PPD.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS): DRKS00013339 ; Trial registration date: August 20, 2018; Universal Trial Number (UTN): U1111-1218-8185.

Men's Mental Health: Social Determinants and Implications for Services

Numerous scholars have stated that there is a silent crisis in men's mental health. In this article, we aim to provide an overview of core issues in the field of men's mental health, including a discussion of key social determinants as well as implications for mental health services. Firstly, we review the basic epidemiology of mental disorders with a high incidence and prevalence in men, including suicide and substance use disorder. Secondly, we examine controversies around the low reported rates of depression in men, discussing possible measurement and reporting biases. Thirdly, we explore common risk factors and social determinants that may explain higher rates of certain mental health outcomes in men. This includes a discussion of 1) occupational and employment issues; 2) family issues and divorce; 3) adverse childhood experience; and 4) other life transitions, notably parenthood. Fourthly, we document and analyze low rates of mental health service utilization in men. This includes a consideration of the role of dominant notions of masculinity (such as stubbornness and self-reliance) in deterring service utilization. Fifthly, we note that some discourse on the role of masculinity contains much "victim blaming," often adopting a reproachful deficit-based model. We argue that this can deflect attention away from social determinants as well as issues within the mental health system, such as claims that it is "feminized" and unresponsive to men's needs. We conclude by calling for a multipronged public health-inspired approach to improve men's mental health, involving concerted action at the individual, health services, and societal levels.

The androgen model of suicide completion

Suicide is a devastating public health issue that imposes severe psychological, social, and economic burdens not only for the individuals but also for their relatives, friends, clinicians, and the general public. Among the different suicidal behaviors, suicide completion is the worst and the most relevant outcome. The knowledge of biological etiopathological mechanisms involved in suicide completion is limited. Hitherto, no objective markers, either alone or in combination, can reliably predict who will complete a suicide. However, such parameters are strongly needed to establish and optimize prediction and prevention. We introduce here a novel ideation-to-completion framework in suicide research and discuss the problems of studies aiming at identifying and validating clinically useful markers. The male gender is a specific risk factor for suicide, which suggests that androgen effects are implicated in the transition from suicidal ideation to suicide completion. We present multiple lines of direct and indirect evidence showing that both an increased prenatal androgen load (with subsequent permanent neuroadaptations) and increased adult androgen activity are involved in suicide completion. We also review data arguing that modifiable maternal behavioral traits during pregnancy contribute to the offspring's prenatal androgen load and increase the risk for suicide completion later in life. We conclude that in utero androgen exposure and adult androgen levels facilitate suicide completion in an synergistic manner. The androgen model of suicide completion provides the basis for the development of novel predictive and preventive strategies in the future.

Gender Differences of Occupational Stress Associated with Suicidal Ideation among South Korean Employees: The Kangbuk Samsung Health Study

OBJECTIVE

In this study, the relationship between occupational stress and suicidal ideation was investigated, focusing on gender differences among Korean employees.

METHODS

Cross-sectional data for 53,969 workers were collected at Kangbuk Samsung Hospital health screening centers. Risk of suicidal ideation was assessed using a self-reported questionnaire examining suicidal ideation during the past year. Occupational stress was measured using 24 items of the Korean Occupational Stress Scale-Short Form (KOSS-SF). Logistic regression analysis was employed to estimate the odds ratios and 95% confidence intervals of the relationships between suicidal ideation and components of occupational stress.

RESULTS

In multivariable-adjusted models, all job stress contributed to increased risk of suicidal ideation in males. Most subscales, except insufficient job control and organizational system, were risk factors of suicidal ideation in females. Further adjustments for depression markedly attenuated this relationship. However, the effects of insufficient job control and lack of reward on suicidal ideation remained significant in males, and interpersonal conflict remained significant in females.

CONCLUSION

The results suggest that occupational stress plays a significant role in increasing risk of suicidal ideation through elevation of depressive symptoms. Gender differences in components of occupational stress associated with suicidal ideation were also observed.

From Default Mode Network to the Basal Configuration: Sex Differences in the Resting-State Brain Connectivity as a Function of Age and Their Clinical Correlates

Connectomics is a framework that models brain structure and function interconnectivity as a network, rather than narrowly focusing on select regions-of-interest. MRI-derived connectomes can be structural, usually based on diffusion-weighted MR imaging, or functional, usually formed by examining fMRI blood-oxygen-level-dependent (BOLD) signal correlations. Recently, we developed a novel method for assessing the hierarchical modularity of functional brain networks-the probability associated community estimation (PACE). PACE uniquely permits a dual formulation, thus yielding equivalent connectome modular structure regardless of whether positive or negative edges are considered. This method was rigorously validated using the 1,000 functional connectomes project data set (F1000, RRID:SCR_005361) (1) and the Human Connectome Project (HCP, RRID:SCR_006942) (2, 3) and we reported novel sex differences in resting-state connectivity not previously reported. (4) This study further examines sex differences in regard to hierarchical modularity as a function of age and clinical correlates, with findings supporting a basal configuration framework as a more nuanced and dynamic way of conceptualizing the resting-state connectome that is modulated by both age and sex. Our results showed that differences in connectivity between men and women in the 22-25 age range were not significantly different. However, these same non-significant differences attained significance in both the 26-30 age group (p = 0.003) and the 31-35 age group (p < 0.001). At the most global level, areas of diverging sex difference include parts of the prefrontal cortex and the temporal lobe, amygdala, hippocampus, inferior parietal lobule, posterior cingulate, and precuneus. Further, we identified statistically different self-reported summary scores of inattention, hyperactivity, and anxiety problems between men and women. These self-reports additionally divergently interact with age and the basal configuration between sexes.

The Meaning of Depression Symptoms for Young Black Men Employed at a Community-Based Reentry Facility

Only 10% of Black men are predicted to experience depression despite widespread disparities in education, employment, socioeconomic status, and incarceration. Gender, cultural, and situational variables force divergence from traditional symptoms of depression and complicate accurate identification of depression in young Black men. Twenty young Black men who were employed by a community-based reentry facility were interviewed about their perceptions of items on the Center for Epidemiologic Studies Depression (CES-D) Scale. Generally, participants endorsed CES-D questions that screen for depressive, somatic, and positive affect symptoms. However, participants rejected questions that screen for negative impact on interpersonal relationships by indicating that these symptoms were not related to depression and offering alternative interpretations of the questions. Questions in the interpersonal domain need restructuring and should be supplemented with interviews to mitigate misinterpretation.

Educational inequalities in premature mortality in Poland, 2002-2011: a population-based cross-sectional study

BACKGROUND

The aim of the study is to evaluate the differences in premature mortality between educational groups of Polish inhabitants in 2002 and 2011.

METHODS

The analysis included all deaths among inhabitants of Poland, aged 25-64 years, which occurred in 2002 (N=97 004) and 2011 (N=104 598). We calculated age-standardised death rates (SDRs) and summary measures on inequalities. The relative index of inequality (RII) was calculated with Poisson regression.

RESULTS

The SDR for Poland decreased from 285.7 per 100 000 in 2002 to 246.0 in 2011 among males with higher education and increased from 1141.0 in 2002 to 1183.0 in 2011 among males with lower secondary or less education (the rate ratio increased from 4.0 to 4.8). With regard to females with higher education, the SDR decreased from 127.2 per 100 000 in 2002 to 115.6 in 2011. Among females with lower secondary or less education, the SDR increased from 375.8 per 100 000 in 2002 to 423.1 in 2011 (the rate ratio increased from 3.0 to 3.7). The RII increased from 5.8 to 9.7 in the male group and from 4.4 to 8.3 in the female group. The greatest educational inequalities in 2011 were observed in females who died of cardiovascular diseases (RII=14.9) and lung cancer (RII=6.6) and in males who died of suicides (RII=19.3) and lung cancer (RII=11.9).

CONCLUSIONS

Educational inequalities in premature mortality in Poland are growing. There is a need to implement health education programmes targeted at groups of the most poorly educated Polish inhabitants, especially for diseases resulting from smoking and excessive alcohol consumption.

Years of Life Lost due to Premature Mortality in a Province with the Shortest Life Expectancy in Poland

AIM

The aim of the study was to evaluate years of life lost for citizens of the Lodz Province, which is characterized by the lowest life expectancy in Poland, and to identify current trends in this area according to the most common causes of death.

METHODS

The study material included a database containing information gathered from 470,000 death certificates of Lodz Province inhabitants, who died between 1999 and 2011. In order to calculate years of life lost, the authors applied the SEYLLp (Standard Expected Years of Life Lost per living person) and SEYLLd (per death) indices. The analysis of time trends was carried out with the application of joinpoint models.

RESULTS

The SEYLLp measure was 2,300 years per 10,000 males and 1,500 years per 10,000 females in 2011. Cardiovascular diseases contributed to the highest number of years of life lost (SEYLLp=682 years per 10,000 males and 559 years per 10,000 females). Next were malignant neoplasms (SEYLLp=505 years per 10,000 males and 437 years per 10,000 females), external causes of death (SEYLLp=361 years per 10,000 males and 83 years per 10,000 females). The number of years of life lost due to acute myocardial infarction decreased most rapidly, the Annual Percent Change (APC) was -10.1% in males and -3.7% in females. However, heart failure contributed to the highest increase in the number of years of life lost (APC=10.8% in males and 10.9% in females).

CONCLUSIONS

A further decrease in the mortality rate due to cardiovascular diseases might contribute to the highest reduction of years of life lost. The most effective preventive activities are those aimed at reducing productive years of life lost due to a particular cause of death, i.e. road traffic accidents, suicides, cirrhosis of the liver, alcoholic liver disease, and malignant neoplasms of the trachea, bronchi and lungs.

Temperaments in completed suicides: Are they different from those in suicide attempters and controls?

BACKGROUND

Temperaments in completed suicides have never been assessed whereas there is substantial research on temperaments in attempted suicides and psychiatric patients.

METHODS

The significant others of 18 completed suicides participated in this study in order to provide an assessment of temperaments, hopelessness, depression and the suicide risk of their loved ones. The data were compared with data from 244 psychiatric patients of whom 83 had attempted suicide in the previous month. The following instruments were used: the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-auto questionnaire (TEMPS-A), the Beck Hopelessness Scale (BHS), the Gotland Scale for Male Depression (GSMD), and the Mini International Neuropsychiatric Interview (MINI) module for assessing suicide risk.

RESULTS

Individuals who died by suicide more frequently had scores of 9 or higher on the BHS and higher MINI suicide risk scores compared with patients with mood disorders who had not attempted suicide in the previous month. Completed suicides also had lower scores on the TEMPS-A Cyclothymia and Anxiety scales and on the MINI suicide risk scale than mood disorder patients with a recent suicide attempt.

LIMITATIONS

Proxy assessment of variables through survivors can result in underestimation of psychiatric morbidity and other parameters investigated, and limits the generalization of our results

CONCLUSIONS

Our study adds information about temperamental subtypes and other variables in completed suicides and points to their difference from attempted suicides and non-suicidal psychiatric patients.

The Chinese Version of the Gotland Male Depression Scale (GMDS): Mokken scaling

OBJECTIVE

Invariant item ordering (IIO) is defined as the extent to which items have the same order for each respondent who completes a scale. IIO is crucial for establishing a scale hierarchy that is replicable across samples; however, no research has demonstrated IIO in the Gotland Male Depression Scale (GMDS). The aim of this study was to determine if an IIO hierarchy of depressive symptoms existed in a clinical sample of men who completed the GMDS.

METHODS

A convenience sample of 231 men (age: mean (SD) = 46.1 (11.0) yrs) who visited a men's health polyclinic in Taiwan and completed the GMDS. Mokken scale analysis was conducted to evaluate the psychometric properties of the GMDS.

RESULTS

All items on the GMDS formed a strong uni-dimensional scale (H=0.592). Except for item #9 (alcohol/drug abuse, or hyperactivity), IIO was found for the remaining 12 items (H(T)=0.366). These symptoms reflected the following hierarchy: positive family history (#13), complaining (#12), anxiety (#8), loss of vitality (#10), depressed mood (#11), indecisiveness (#6), aggression (#2), irritability (#5), stress (#1), burn-out (#3), fatigue (#4), and sleep problems (#7).

CONCLUSION

The GMDS is a psychometrically sound measure of depressive symptoms in Taiwanese male outpatients. The GMDS has both cumulative and hierarchical properties.

Validity of Gotland Male Depression Scale for male depression in a community study: the Sudurnesjamenn study

BACKGROUND

Several studies suggest a "male depressive syndrome", where not only the standard symptoms of major depressive disorder (MDD) but also symptoms of anxiety, anger, irritability and antisocial behaviour are prominent.

METHOD

In a community study, 534 males were screened for possible depression by the Gotland Male Depression Scale (GMDS) and Beck's Depression Inventory (BDI). For comparison psychiatrists examined a sub-sample of healthy and depressive males (n=137). The validity of the GMDS was compared both with the BDI and MDD diagnosis according to DSM-IV.

RESULTS

GMDS was as good as BDI for screening males. ROC-curve analysis gave AUC 0.945 (95% CI 0.923-0.968) for GMDS when tested against BDI. Second, when both scales were tested by ROC-curves against DSM-IV, the GMDS had AUC=0.861 (95% CI 0.800-0.921) and BDI had AUC=0.822 (95% CI 0.751-0.893). The estimated prevalence was 14-15%.

LIMITATIONS

Low participation rate (25%) in the screening phase.

CONCLUSION

GMDS is a valid screening tool for detecting male depression (MDD). Furthermore it is a short self-rating scale, easy to use in daily practice to screen for depression. Our results support recent reports of high prevalence of depressions in the community which supports active screening of males in clinical practice.

Gender differences in suicide prevention responses: implications for adolescents based on an illustrative review of the literature

Background: There are well-documented gender differences in adolescent suicidal behavior; death by suicide is more common in males, while nonfatal suicide attempts are more common among females. Over the past three decades, researchers have documented the effectiveness of a myriad of suicide prevention initiatives. However, there has been insufficient attention to which types of suicide prevention interventions are effective in changing attitudes and behaviors for young males and females. In this review of the literature, we consider common examples of primarily universal suicide prevention programs from three implementation settings: school-based, community-based, and healthcare-based. Our purpose is to delineate how the potential gender bias in such strategies may translate into youth suicide prevention efforts. Methods: Research in which gender was found to moderate program success was retrieved through online databases. Results: The results that feature programming effects for both males and females are provocative, suggesting that when gender differences are evident, in almost all cases, females seem to be more likely than males to benefit from existing prevention programming. Conclusions: We conclude by considering recommendations that may benefit males more directly. Implications for adolescent suicide prevention in particular are discussed. Personalization of suicide intervention is presented as a promising solution to reduce suicide rates.

The associations among childhood maltreatment, "male depression" and suicide risk in psychiatric patients

In the current cross-sectional study, we aimed to investigate the presence and severity of "male" depressive symptoms and suicidal behaviors in psychiatric patients with and without a history of child abuse and neglect, as measured by the Childhood Trauma Questionnaire (CTQ), as well as to explore the associations among childhood maltreatment, "male depression" and suicide risk. The sample consisted of 163 consecutively admitted adult inpatients (80 men; 83 women). The patients were administered the CTQ, Gotland Male Depression Scale (GMDS), and Suicidal History Self-Rating Screening Scale (SHSS). Those with a moderate-severe childhood maltreatment history were more likely to be female (p<0.05) and reported more "male depression" (p<0.001) and suicidal behaviors (p<0.01) as compared to those not having or having a minimal history of child abuse and neglect. In the multivariate analysis, only the minimization/denial scale of the CTQ (odds ratio=0.31; p<0.001) and "male depression" (odds ratio=1.83; p<0.05) were independently associated with moderate/severe history of child maltreatment. The findings suggest that exposure to abuse and neglect as a child may increase the risk of subsequent symptoms of "male depression", which has been associated with higher suicidal risk.

The iceberg of suicide and self-harm in Irish adolescents: a population-based study

PURPOSE

Suicide is a leading cause of death among adolescents. Self-harm is the most important risk factor for suicide, yet the majority of self-harm does not come to the attention of health services. The purpose of this study was to establish the relative incidence of adolescent suicide, hospital-treated self-harm and self-harm in the community.

METHODS

Annual suicide rates were calculated for 15-17 year-old in the Cork and Kerry region in Ireland based on data from the Central Statistics Office. Rates of hospital-treated self-harm were collected by the Irish National Registry of Deliberate Self-Harm. Rates of self-harm in the community were assessed using a survey of 3,881 adolescents, the Child and Adolescent Self-harm in Europe study.

RESULTS

The annual suicide rate was 10/100,000. Suicide was six times more common among boys than girls. The annual incidence rate of hospital-treated self-harm was approximately 344/100,000, with the female rate almost twice the male rate. The rate of self-harm in the community was 5,551/100,000, and girls were almost four times more likely to report self-harm. For every boy who died by suicide, 16 presented to hospital with self-harm and 146 reported self-harm in the community. For every female suicide, 162 girls presented to hospital with self-harm and 3,296 reported self-harm.

CONCLUSIONS

Gender differences in relative rates of self-harm and suicide are very large, with boys who have harmed themselves at particularly high risk of suicide. Knowledge of the relative incidence of self-harm and suicide in adolescents can inform prevention programmes and services.

The ZInEP Epidemiology Survey: background, design and methods

This article introduces the design, sampling, field procedures and instruments used in the ZInEP Epidemiology Survey. This survey is one of six ZInEP projects (Zürcher Impulsprogramm zur nachhaltigen Entwicklung der Psychiatrie, i.e. the "Zurich Program for Sustainable Development of Mental Health Services"). It parallels the longitudinal Zurich Study with a sample comparable in age and gender, and with similar methodology, including identical instruments. Thus, it is aimed at assessing the change of prevalence rates of common mental disorders and the use of professional help and psychiatric sevices. Moreover, the current survey widens the spectrum of topics by including sociopsychiatric questionnaires on stigma, stress related biological measures such as load and cortisol levels, electroencephalographic (EEG) and near-infrared spectroscopy (NIRS) examinations with various paradigms, and sociophysiological tests. The structure of the ZInEP Epidemiology Survey entails four subprojects: a short telephone screening using the SCL-27 (n of nearly 10,000), a comprehensive face-to-face interview based on the SPIKE (Structured Psychopathological Interview and Rating of the Social Consequences for Epidemiology: the main instrument of the Zurich Study) with a stratified sample (n = 1500), tests in the Center for Neurophysiology and Sociophysiology (n = 227), and a prospective study with up to three follow-up interviews and further measures (n = 157). In sum, the four subprojects of the ZInEP Epidemiology Survey deliver a large interdisciplinary database.

Men, Masculinities, and Murder-Suicide

Murder-suicide (M-S) is a complex phenomenon that can involve a multifaceted set of interrelated biological and social factors. M-S is also sexed and gendered in that the perpetrators are most often male and their underpinning motives and actions link to masculinities in an array of diverse ways. With the overarching goal to describe connections between men, masculinities, and M-S, 296 newspaper articles describing 45 North American M-S cases were analyzed. The inductively derived findings revealed three themes: (a) domestic desperation, (b) workplace justice, and (c) school retaliation. Cases in the domestic desperation theme were characterized by the murder of a family member(s) and were often underpinned by men’s self-perceptions of failing to provide economic security. Workplace justice cases emerged from men’s grievances around paid-work, job insecurity, and perceptions of being bullied and/or marginalized by coworkers or supervisors. The school retaliation cases were strongly linked to “pay back” against individuals and/or society for the hardships endured by M-S perpetrators. Prevailing across the three themes was men’s loss of control in their lives, hopelessness, and marginalized masculine identities. Also evident were men’s alignments to hegemonic masculinities in reasserting one’s masculine self by protesting the perceived marginalization invoked on them. Overall, the findings give pause to consider the need for men-centered M-S prevention strategies to quell the catastrophic impacts of this long-standing but understudied men’s health issue.

Characterization of patients with mood disorders for their prevalent temperament and level of hopelessness

BACKGROUND

Mood disorders (MD) are disabling conditions throughout the world associated with significant psychosocial impairment. Affective temperaments, as well as hopelessness, may play a significant role in the pathophysiology of MD. The present study was designed to characterize patients with MD for their prevalent affective temperament and level of hopelessness.

METHODS

Five hundred fifty-nine (253 men and 306 women) consecutive adult inpatients were assessed using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire version (TEMPS-A), the Gotland Scale for Male Depression (GSMD), the Beck Hopelessness Scale (BHS) and the Mini International Neuropsychiatric Interview (MINI).

RESULTS

Higher cyclothymia and irritable temperaments were found in bipolar disorder-I (BD-I) patients compared to those with other Axis I diagnoses. Major depressive disorder (MDD) patients had lower hyperthymia than BD-I and BD-II patients and higher anxiety than patients with other Axis I diagnoses. Severe "male" depression was more common in BD-II patients compared to BD-I and MDD patients. BD-I patients and those with other axis I diagnoses reported lower BHS ≥9 scores than those with BD-II and MDD.

LIMITATIONS

The study had the limitations of all naturalistic designs, that is, potentially relevant variables were not addressed. Furthermore, the cross-sectional nature of the study did not allow conclusions about causation, and the use of self-report measures could be potentially biased by social desirability.

CONCLUSION

MDD patients were more likely to have higher anxious temperament, higher hopelessness and lower hyperthymic temperament scores, while BD-I patients more often had cyclothymic and irritable temperaments than patients with other Axis I diagnoses. The implications of the present results were discussed.

Years of life lost due to external causes of death in the lodz province, poland

BACKGROUND

The aim of the study is the analysis of years of life lost due to external causes of death, particularly due to traffic accidents and suicides.

MATERIALS AND METHODS

The study material includes a database containing information gathered from 376,281 death certificates of inhabitants of the Lodz province who died between 1999 and 2010. The Lodz province is characterized by the highest mortality rates in Poland. The SEYLLp (Standard Expected Years of Life Lost per living person) and the SEYLLd (per death) indices were used to determine years of life lost. Joinpoint models were used to analyze time trends.

RESULTS

In 2010, deaths due to external causes constituted 6.0% of the total number of deaths. The standardized death rate (SDR) due to external causes was 110.0 per 100,000 males and was five times higher than for females (22.0 per 100,000 females). In 2010, the SEYLLp due to external causes was 3746 per 100,000 males and 721 per 100,000 females. Among males, suicides and traffic accidents were the most common causes of death (the values of the SEYLLp were: 1098 years and 887 years per 100,000 people, respectively). Among females, the SEYLLp values were 183 years due to traffic accidents and 143 years due to suicides (per 100,000 people).

CONCLUSIONS

A decrease in the number of years of life lost due to external causes is much higher among females. The authors observe that a growing number of suicides contribute to an increase in the value of the SEYLLp index. This directly contributes to over-mortality of males due to external causes. The analysis of the years of life lost focuses on the social and economic aspects of premature mortality due to external causes.

Symptom-based subtypes of depression and their psychosocial correlates: a person-centered approach focusing on the influence of sex

BACKGROUND

Reducing the complexity of major depressive disorder by symptom-based subtypes constitutes the basis of more specific treatments. To date, few studies have empirically derived symptom subtypes separated by sex, although the impact of sex has been widely accepted in depression research.

METHODS

The community-based sample included 373 males and 443 females from the Zurich Program for Sustainable Development of Mental Health Services (ZInEP) manifesting depressive symptoms in the past 12 months. Latent Class Analysis (LCA) was performed separately by sex to extract sex-related depression subtypes. The subtypes were characterized by psychosocial characteristics.

RESULTS

Three similar subtypes were found in both sexes: a severe typical subtype (males: 22.8%; females: 35.7%), a severe atypical subtype (males: 17.4%; females: 22.6%), and a moderate subtype (males: 25.2%; females: 41.8%). In males, two additional subgroups were identified: a severe irritable/angry-rejection sensitive (IARS) subtype (30%) comprising the largest group, and a small psychomotor retarded subtype (4%). Males belonging to the severe typical subtype exhibited the lowest masculine gender role orientation, while females of the typical subtype showed more anxiety disorders. The severe atypical subtype was associated with eating disorders in both sexes and with alcohol/drug abuse/dependence in females. In contrast, alcohol/drug abuse/dependence was associated with the severe IARS subtype in males.

LIMITATIONS

The study had a cross-sectional design, allowing for no causal inferences.

CONCLUSIONS

This study contributes to a better understanding of sex-related depression subtypes, which can be well distinguished on the basis of symptom profiles. This provides the base for future research investigating the etiopathogenesis and effective treatment of the heterogeneous depression disorder.

Validity and clinical utilization of the Chinese version of the Gotland Male Depression Scale at a men's health polyclinic

INTRODUCTION

Symptoms of depression in males, such as aggression and irritability, are different from those in females. However, there are no adequate scales for detecting possible diagnoses in the Chinese population. The aim of this study was to assess whether the Chinese version of the Gotland Male Depression Scale (CV-GMDS) could identify male depression as effectively as the English version.

MATERIALS AND METHODS

A total of 231 male outpatients were sampled from a men's health polyclinic. We used questionnaires to evaluate the characteristics and mood status of participants, including the CV-GMDS, the Chinese version of the Beck Depressive Inventory II (CV-BDI-II), and the Chinese version of the Aging Males' Symptoms (CV-AMS) scale. Cronbach's α-coefficient and Levene's test were used to investigate internal consistency and homogeneity, respectively. External validity was evaluated using Spearman's correlation coefficient. A factor analysis was conducted to evaluate the conceptual structure of the CV-GMDS, and a regression analysis was used to determine the relationship of the CV-AMS scale with the CV-GMDS and CV-BDI-II.

RESULTS

The mean age of the 231 participants was 46.1 years (standard deviation 11.0). Of the participants, 36.8% (n=85) were found to have depression according to the CV-GMDS and 34.6% (n=80) according to the CV-BDI-II. The internal consistency of the CV-GMDS was demonstrated by a Cronbach's α of 0.933, and the test of homogeneity revealed a P-value of 0.762. The external validity for the CV-GDMS and CV-BDI-II was demonstrated by an intercorrelation of 0.835. The third and fourth items of the GMDS differed from the others, and the CV-GMDS showed a better relationship (R (2)=0.616) with the CV-AMS scale than the CV-BDI-II did.

CONCLUSION

The CV-GMDS is a satisfactory and suitable psychometric questionnaire for detecting depression among a Chinese-speaking middle-aged or older male population. The results of this study could be used as a basis for investigating specific male depression and aging symptoms.

Saliva cortisol and male depressive syndrome in a community study. The Sudurnesjamenn study

BACKGROUND

The degree and direction of hypothalamic-pituitary-adrenal (HPA) dysfunction to male mental health is unclear.

AIMS

The aim of the study was to investigate the relationship between cortisol and male mental health.

METHODS

In this community study, 534 males were screened, using the Beck Depression Inventory (BDI), Gotland Male Depression Scale (GMDS) and a general health questionnaire. Those with signs of depression (n = 65) and controls (n = 69) were evaluated in a psychiatric examination according to the DSM-IV criteria for depressive disorder (DD). In a sub-sample (n = 51) saliva cortisol was measured five times on a single day.

RESULTS

Evening cortisol was significantly higher in untreated individuals with DD. Significantly higher evening cortisol (at 22 h) correlated also with a history of physical disorder, a history of any mental disorder and MADRS score ≥ 20 (Montgomery-Åsberg Depression Rating Scale). High cortisol, measured as AUC (area under curve), correlated with a high MADRS score but not with any other health variable tested. Morning cortisol did not correlate with any health variable; however, cortisol awakening response (CAR) could not be investigated. The BDI and GMDS scores did not correlate with cortisol measurements.

CONCLUSION

Evening saliva cortisol measurement seems most informative, as it correlates with male depressive syndrome in our study but replications with larger studies are needed.

Testosterone in the brain: neuroimaging findings and the potential role for neuropsychopharmacology

Testosterone plays a substantial role in a number of physiological processes in the brain. It is able to modulate the expression of certain genes by binding to androgen receptors. Acting via neurotransmitter receptors, testosterone shows the potential to mediate a non-genomic so-called "neuroactive effect". Various neurotransmitter systems are also influenced by the aromatized form of testosterone, estradiol. The following article summarizes the findings of preclinical and clinical neuroimaging studies including structural and functional magnetic resonance imaging (MRI/fMRI), voxel based morphometry (VBM), as well as pharmacological fMRI (phfMRI) and positron emission tomography (PET) regarding the effects of testosterone on the human brain. The impact of testosterone on the pathogenesis of psychiatric disorders and on sex-related prevalence differences have been supported by a wide range of clinical studies. An antidepressant effect of testosterone can be implicitly explained by its effects on the limbic system--especially amygdala, a major target in the treatment of depression--solidly demonstrated by a large body of neuroimaging findings.

Short-term psychodynamic psychotherapy in patients with "male depression" syndrome, hopelessness, and suicide risk: a pilot study

Objectives and Methods. This was an observational study of the efficacy of short-term psychodynamic psychotherapy (STPP) in a sample of 35 (30 women and 5 men) patients with moderate-to-severe "male depression" (Gotland Scale for Male Depression (GSMD) ≥ 13) comorbid with unipolar mood disorder (dysthymia and major depression) or anxiety disorder. Outcome measures were GSMD and BHS (Beck Hopelessness Scale) score changes from baseline. Results. Patients had a strong response to STPP on the GSMD (estimated mean score change (± SE) = -9.08 ± 2.74; P < 0.01; partial eta squared = 0.50), but not on the BHS (estimated mean score change (± SE) = -0.92 ± 1.55; P = 0.57; partial eta squared   = 0.03). BHS score changes were significantly associated with GSMD score changes (Pearson's r = 0.56; P < 0.001), even when controlling for the severity of hopelessness at the baseline (partial r = 0.62; P < 0.001). Conclusions. STPP proved to be effective in patients suffering from "male depression" although hopelessness was only marginally reduced by this treatment which points to the need to better understand how STPP can be involved in the reduction of suicide risk.

The development and validation of the Peradeniya Depression Scale (PDS)--a culturally relevant tool for screening of depression in Sri Lanka

BACKGROUND

Cultural factors may influence the manner in which a given population interprets and conceptualizes their experience of depression. The aim of this study is to validate the Peradeniya Depression Scale (PDS), a locally created, culturally relevant tool for detection of depression in Sri Lanka.

METHOD

Fifty currently depressed patients (diagnosed via the Structured Clinical Interview for DSM Disorders) and 50 (non-depressed) controls were administered the PDS.

RESULTS

At a score of 10/25 the PDS showed a sensitivity 88.5% and specificity of 85.0% with regards to the detection of depression. Culturally appropriate statements, which referred to international criteria of depression and somatic symptoms, showed significantly higher odds of being positive in depressed patients compared to controls.

LIMITATIONS

The PDS was validated among an outpatient population presenting to a psychiatry clinic in a government hospital in Peradeniya, Sri Lanka. While this is fairly representative of patients presenting to government hospital clinics in this country, further multi-centre studies in different areas of the country maybe useful.

CONCLUSION

The PDS is the first screening tool for depression developed and validated in Sri Lanka, written in Sinhalese, taking into account cultural expressions and idioms of the illness. It shows satisfactory sensitivity and specificity as a screening tool for depression. The findings also suggest that it maybe worthwhile for Asian countries to consider adopting scales which are based on internationally accepted diagnostic criteria for depression, but which incorporate expressions that are more appropriate to their own culture and language.

Forty years of increasing suicide mortality in Poland: undercounting amidst a hanging epidemic?

Background

Suicide rate trends for Poland, one of the most populous countries in Europe, are not well documented. Moreover, the quality of the official Polish suicide statistics is unknown and requires in-depth investigation.

Methods

Population and mortality data disaggregated by sex, age, manner, and cause were obtained from the Polish Central Statistics Office for the period 1970-2009. Suicides and deaths categorized as ‘undetermined injury intent,’ ‘unknown causes,’ and ‘unintentional poisonings’ were analyzed to estimate the reliability and sensitivity of suicide certification in Poland over three periods covered by ICD-8, ICD-9 and ICD-10, respectively. Time trends were assessed by the Spearman test for trend.

Results

The official suicide rate increased by 51.3% in Poland between 1970 and 2009. There was an increasing excess suicide rate for males, culminating in a male-to-female ratio of 7:1. The dominant method, hanging, comprised 90% of all suicides by 2009. Factoring in deaths of undetermined intent only, estimated sensitivity of suicide certification was 77% overall, but lower for females than males. Not increasing linearly with age, the suicide rate peaked at ages 40-54 years.

Conclusion

The suicide rate is increasing in Poland, which calls for a national prevention initiative. Hangings are the predominant suicide method based on official registration. However, suicide among females appears grossly underestimated given their lower estimated sensitivity of suicide certification, greater use of “soft” suicide methods, and the very high 7:1 male-to-female rate ratio. Changes in the ICD classification system resulted in a temporary suicide data blackout in 1980-1982, and significant modifications of the death categories of senility and unknown causes, after 1997, suggest the need for data quality surveillance.

Temperaments mediate suicide risk and psychopathology among patients with bipolar disorders

BACKGROUND

Several studies have demonstrated that bipolar II (BD-II) disorder represents a quite common, distinct form of major mood disorders that should be separated from bipolar I (BD-I) disorder. The aims of this cross-sectional study were to assess temperament and clinical differences between patients with BD-I and BD-II disorders and to assess whether temperament traits are good predictors of hopelessness in patients with bipolar disorder, a variable highly associated with suicidal behavior and ideation.

METHOD

Participants were 216 consecutive inpatients (97 men and 119 women) with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), BD who were admitted to the Sant'Andrea Hospital's psychiatric ward in Rome (Italy). Patients completed the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego--Autoquestionnaire, the Beck Hopelessness Scale (BHS), the Mini International Neuropsychiatric Interview (MINI), and the Gotland Scale of Male Depression.

RESULTS

Patients with BD-II had higher scores on the BHS (9.78 ± 5.37 vs 6.87 ± 4.69; t(143.59) = -3.94; P < .001) than patients with BD-I. Hopelessness was associated with the individual pattern of temperament traits (ie, the relative balance of hyperthymic vs cyclothymic-irritable-anxious-dysthmic). Furthermore, patients with higher hopelessness (compared with those with lower levels of hopelessness) reported more frequently moderate to severe depression (87.1% vs 38.9%; P < .001) and higher MINI suicidal risk.

CONCLUSION

Temperaments are important predictors both of suicide risk and psychopathology and may be used in clinical practice for better delivery of appropriate care to patients with bipolar disorders.

Cyclothymic-depressive-anxious temperament pattern is related to suicide risk in 346 patients with major mood disorders

BACKGROUND

Suicidal behavior is one of the most alarming signs not only in psychiatry, and current major depressive episode is the most frequent medical condition among suicide victims and attempters. The aim of the study was to investigate the relationship between the individual pattern of affective temperaments, non-typical symptoms of depression as measured with the Gotland Scale for Male Depression (GSMD), hopelessness and suicidal behavior in major mood disorder patients.

METHODS

Participants were 346 adult inpatients (151 men and 195 women) with major mood disorders consecutively admitted to the Department of Psychiatry of the Sant'Andrea University Hospital in Rome, Italy. All the patients were administered the TEMPS-A, the GSMD, and the Beck Hopelessness Scale (BHS) and the Mini International Neuropsychiatric Interview (MINI).

RESULTS

A Two Step Cluster Analysis procedure, performed to reveal natural groupings within patients' response set, indicated that there were 2-groups: a cyclothymic-depressive-anxious group and a hyperthymic group. More than 81% of the patients with prevailing cyclothymic-depressive-anxious temperament had mild to severe suicidal risk on the MINI vs. only around 42% of the patients with prevailing hyperthymic temperament. Sixty-four percent of patients with prevailing cyclothymic-depressive-anxious temperament had BHS scores of 9 or higher versus only 13% of patients with prevailing hyperthymic temperament. Also, patients with prevailing cyclothymic-depressive-anxious temperament more likely had higher GSMD than patients with prevailing hyperthymic temperament.

LIMITATIONS

The correlational nature of the study limits causal conclusions to be drawn.

CONCLUSIONS

Our results indicate that affective temperament measure along with Gotland Scale for Male Depression could be useful tools in screening and identifying those affective disorder patients who are at higher risk of suicidal behavior.

Psychometric properties of the Gotland Scale for Depression in Italian psychiatric inpatients and its utility in the prediction of suicide risk

BACKGROUND

Rutz has postulated a "male depressive syndrome" measured by the Gotland Scale of Male Depression (GSMD). The aim of the study was to assess the psychometric properties of the GSMD in a sample of male and female psychiatric inpatients.

METHODS

The sample was composed of 326 Italian inpatients who completed the GSMD and the Beck Hopelessness Scale (BHS).

RESULTS

Our results indicated that all the items of the GSMD, except item #13, were highly interrelated, and that the first 12 items of the GSMD may be considered a homogeneous measure of depression. Furthermore, GSMD scores did not differ by sex. The GSMD had good convergent validity with the BHS and was useful in categorizing individuals admitted for a suicide attempt committed in the last 48h vs. those who had not.

LIMITATIONS

The study was retrospective in nature and did not assess the ability of the GSMD for predicting future suicidal behavior.

CONCLUSIONS

The GSMD may be considered to be a valid instrument for measuring non-typical ("suicidality-related") symptoms of depression in both male and female patients.

Psychometric properties of the suicidal history self-rating screening scale

The aim of this study was to develop a reliable self-report instrument (the Suicide History Self-Rating Screening Scale: SHSS) to identify individuals with a higher propensity for suicide in the near term. One hundred and twenty nine consecutive inpatients with mental illness completed the SHSS (a 16-item measure assessing death thoughts, suicidal ideation and behavior in the last 12 months and lifetime except in the last 12 months), the Mini International Neuropsychiatric Interview, the Beck Hopelessness Scale, and the Gotland Male Depression Scale. SHSS scores had high correlations with commonly used measures in the field of suicide risk assessment. The ROC curves indicated that the SHSS performed well in classifying cases based on their current suicide status (suicide attempt in the last 24-48 hours). The SHSS is a valid and reliable instrument for assessing suicide risk.

Factors associated with deliberate self-harm among Irish adolescents

BACKGROUND

Deliberate self-harm (DSH) is a major public health problem, with young people most at risk. Lifetime prevalence of DSH in Irish adolescents is between 8% and 12%, and it is three times more prevalent among girls than boys. The aim of the study was to identify the psychological, life-style and life event factors associated with self-harm in Irish adolescents.

METHOD

A cross-sectional study was conducted, with 3881 adolescents in 39 schools completing an anonymous questionnaire as part of the Child and Adolescent Self-harm in Europe (CASE) study. There was an equal gender balance and 53.1% of students were 16 years old. Information was obtained on history of self-harm life events, and demographic, psychological and life-style factors.

RESULTS

Based on multivariate analyses, important factors associated with DSH among both genders were drug use and knowing a friend who had engaged in self-harm. Among girls, poor self-esteem, forced sexual activity, self-harm of a family member, fights with parents and problems with friendships also remained in the final model. For boys, experiencing bullying, problems with schoolwork, impulsivity and anxiety remained.

CONCLUSIONS

Distinct profiles of boys and girls who engage in self-harm were identified. Associations between DSH and some life-style and life event factors suggest that mental health factors are not the sole indicators of risk of self-harm. The importance of school-related risk factors underlines the need to develop gender-specific initiatives in schools to reduce the prevalence of self-harm.

A comparison between the Beck's Depression Inventory and the Gotland Male Depression Scale in detecting depression among men visiting a drop-in clinic in primary care

BACKGROUND

Anger attacks and alcohol use may mask depressive symptoms in men. Only the Gotland Male Depression Scale (GS) includes such items.

AIMS

To study the usefulness of the GS and Beck Depression Inventory (BDI) in detecting depression among men in primary care.

METHODS

At a family doctor's drop-in clinic in Stockholm, Sweden, all men were invited into the study 2 days a week (opportunistic screening). On other days, the men who mentioned mental symptoms were invited (targeted screening). The men filled in BDI, GS and a social questionnaire. The doctor invited the men with BDI > or = 10 and /or GS > or = 13 to a repeat visit. The outcome was depression diagnosed according to DSM-IV and the severity was assessed with the Montgomery-Asberg Depression Rating Scale.

RESULTS

223 men were recruited, 190 by opportunistic and 33 by targeted screening. Seventeen per cent of the men reported an alcohol consumption that might put them at risk. In the opportunistic screening, 23% scored BDI > or = 10 and 14% scored GS > or = 13. The prevalence of depression in the opportunistic screening was 10.5%. The proportion of depressed men in the targeted screening was 60.6%. In total, 40 men were depressed, 63% had a mild and 35% moderate depression. The correlation between the scales was 0.80. The GS identified no additional cases.

CONCLUSIONS

Clinical depression was quite common among those men who often had a high alcohol consumption, indicating an advantage for the GS when screening for depression among men. In primary care, a targeted screening procedure seems to be the most feasible method.

[The assessment of free volitional competence in cases of suicide with life insurance]

The German insurance law stipulates that in cases of suicide, life insurance providers are not obligated to pay within a restriction period of 3 years, except if it can be proven that the suicide was committed in a state that precludes the insured's ability to make free choices. The relevant psychiatric assessment criteria are identical with those of mental and volitional competence in general. However, a different profile of patients and other disorders are involved, mainly depressive syndromes, but also chronic alcoholism as well as schizophrenic and paranoid syndromes. The assessment has to be based on the legal concept of mental disorder, which is different from the current diagnostic classifications in psychiatry. Decisive psychopathological symptoms are impairment of reality control, of volition and/or of judgement. These posthumous assessments are particularly difficult and require a thorough knowledge of psychopathology as well as of the relevant jurisdiction. The latter is summarised in this article.