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De Las Cuevas C, de Leon VC, Blasco-Fontecilla H, Baca-García E, Sagud M, Sanz EJ, de Leon J. Clozapine may consistently protect from suicidal behaviors while other antipsychotics may lack a specific protective effect: a comprehensive VigiBase study interpreted in the context of the prior literature. Expert Opin Drug Saf 2024:1-11. [PMID: 39223773 DOI: 10.1080/14740338.2024.2399094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 08/05/2024] [Accepted: 08/10/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND In the United States, clozapine was first approved for treatment-resistant schizophrenia and then for suicidality in schizophrenia psychoses. Systematic reviews support clozapine's anti-suicidal effect, but the forensic literature stresses its lethality during overdoses. RESEARCH DESIGN AND METHODS Clozapine reports to the international pharmacovigilance database (VigiBase) were analyzed for suicidal ideation, suicide attempts, intentional overdose, and completed suicides from introduction to 1 January 2024. VigiBase uses the information component (IC) as a disproportionality analysis. RESULTS The clozapine ICs (range: other antipsychotics) were: 1) suicidal ideation IC = 0.570 with IC025 = 0.454 to IC975 = 0.680 (IC = 3.568 for aripiprazole and 1.729 for risperidone), 2) suicide attempt IC = 1.428 with IC025 = 1.323 to IC975 = 1.529 (IC = 4.150 for quetiapine and 2.968 for risperidone), 3) intentional overdose: IC = 0.995 with IC025 = 0.864 to IC975 = 1.120 (IC = 4.080 for quetiapine and 1.957 for aripiprazole), and 4) completed suicide IC = 1.133 with IC025 = 1.026 to IC975 = 1.235 (IC = 4.648 for quetiapine and 2.160 for risperidone). In summary, all clozapine ICs were significantly lower. We found 2391 clozapine-treated patients on the suicidality spectrum (627 cases with suicidal ideation, 752 with suicide attempt, 488 with intentional overdose, and 731 with completed suicide) but many were taking other antipsychotics. The most frequent reporting countries were the United States, the United Kingdom, and Croatia. CONCLUSION This pharmacovigilance study, with all its inherent limitations, provides independent proof, not overlapping with prior literature, that clozapine may have specific strong anti-suicidal effects that do not appear to be present in other antipsychotics. Further VigiBase studies are needed to compare the lethality of an intentional overdose of clozapine (14.3%) with other antipsychotics.
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Affiliation(s)
- Carlos De Las Cuevas
- Department of Internal Medicine, Dermatology, and Psychiatry and Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, La Laguna, Spain
| | - Victoria C de Leon
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - Hilario Blasco-Fontecilla
- Instituto de Investigación, Transferencia e Innovación, Ciencias de la Saludy Escuela de Doctorado, Universidad Internacional de La Rioja, Logroño, Spain
- Emooti, Madrid, Spain
- Center of Biomedical Network Research on Mental Health (CIBERSAM), Carlos III Institute of Health, Madrid, Spain
| | - Enrique Baca-García
- Center of Biomedical Network Research on Mental Health (CIBERSAM), Carlos III Institute of Health, Madrid, Spain
- Department of Psychiatry, Hospital Fundación Jiménez Díaz, Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
- Universidad Católica del Maule, Talca, Chile
- Department of Psychiatry, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Marina Sagud
- School of Medicine, University of Zagreb, Zagreb, Croatia
- University Hospital Centre Zagreb, Zagreb, Croatia
| | - Emilio J Sanz
- Department of Physical Medicine and Pharmacology, School of Medicine, Universidad de La Laguna, Spain
- Hospital Universitario de Canarias, Tenerife, Spain
| | - Jose de Leon
- Mental Health Research Center, Eastern State Hospital, Lexington, KY, USA
- Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain
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Wafy G, Ajayi L, Siddiqi S, Saravanamuttoo T, Shorr R, Solmi M, Colman I, Fiedorowicz JG. The Progression of Lethality Across Multiple Suicide Attempts: A Systematic Review. Arch Suicide Res 2024:1-22. [PMID: 39185957 DOI: 10.1080/13811118.2024.2394671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
OBJECTIVE Suicide is a major global public health concern. While some progress has been made in understanding risk factors for suicidal behavior, other relevant questions have received less attention. One such question relates to the longitudinal course of suicidal behavior amongst individuals with multiple suicide attempts. This systematic review investigated whether there is an increase in the lethality across multiple suicide attempts. METHOD This systematic review followed PRISMA 2020 reporting guidelines. A literature search was conducted in MEDLINE, Embase and PsycINFO electronic databases from inception to August 2023 to identify studies with key terms related to multiple suicide attempts and lethality. The review included longitudinal studies with data on multiple suicide attempts, and any rating of their lethality. Covidence was used to guide the screening and extraction process. A narrative synthesis approach was used to descriptively summarize included studies. RESULTS After identifying 828 unique abstracts for screening, 11 studies were included for narrative synthesis. Suicide attempt assessment methods and definitions were heterogenous, often indirectly inferring lethality based on suicide attempt method. Individuals with repeat attempts may be more likely to continue using the same method. CONCLUSIONS There was no evidence to support increasing lethality across repeat suicide attempts. However, this should be interpreted along with the fact that the evidence base is scarce, heterogenous, and methodologically limited.
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Pemau A, Marin-Martin C, Diaz-Marsa M, de la Torre-Luque A, Ayad-Ahmed W, Gonzalez-Pinto A, Garrido-Torres N, Garrido-Sanchez L, Roberto N, Lopez-Peña P, Mar-Barrutia L, Grande I, Guinovart M, Hernandez-Calle D, Jimenez-Treviño L, Lopez-Sola C, Mediavilla R, Perez-Aranda A, Ruiz-Veguilla M, Seijo-Zazo E, Toll A, Elices M, Perez-Sola V, Ayuso-Mateos JL. Risk factors for suicide reattempt: a systematic review and meta-analysis. Psychol Med 2024; 54:1897-1904. [PMID: 38623694 DOI: 10.1017/s0033291724000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Suicide is one of the main external causes of death worldwide. People who have already attempted suicide are at high risk of new suicidal behavior. However, there is a lack of information on the risk factors that facilitate the appearance of reattempts. The aim of this study was to calculate the risk of suicide reattempt in the presence of suicidal history and psychosocial risk factors and to estimate the effect of each individual risk factor. METHODS This systematic review and meta-analysis were conducted following the PRISMA-2020 guidelines. Studies on suicide reattempt that measured risk factors were searched from inception to 2022. The risk factors studied were those directly related to suicide history: history of suicide prior to the index attempt, and those that mediate the transition from suicidal ideation to attempt (alcohol or drug misuse, impulsivity, trauma, and non-suicidal self-injury). RESULTS The initial search resulted in 11 905 articles. Of these, 34 articles were selected for this meta-analysis, jointly presenting 52 different effect sizes. The pooled effect size across the risk factors was significant (OR 2.16). Reattempt risk may be increased in presence of any of the following risk factors: previous history, active suicidal ideation, trauma, alcohol misuse, and drug misuse. However, impulsivity, and non-suicidal self-injury did not show a significant effect on reattempt. CONCLUSION Most of the risk factors traditionally associated with suicide are also relevant when talking about suicide reattempts. Knowing the traits that define reattempters can help develop better preventive and intervention plans.
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Affiliation(s)
- Andres Pemau
- Universidad Complutense de Madrid, Madrid, Spain
| | | | - Marina Diaz-Marsa
- San Carlos University Clinic Hospital, Madrid, Spain
- Araba University Hospital, Vitoria, Spain
| | - Alejandro de la Torre-Luque
- Universidad Complutense de Madrid, Madrid, Spain
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | | | - Ana Gonzalez-Pinto
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Araba University Hospital, Vitoria, Spain
- University of the Basque Country, Bilbao, Spain
| | - Nathalia Garrido-Torres
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Virgen del Rocio University Hospital, Seville, Spain
- Seville Biomedical Research Institute (IBiS), Seville, Spain
| | | | - Natalia Roberto
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Purificación Lopez-Peña
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Araba University Hospital, Vitoria, Spain
- University of the Basque Country, Bilbao, Spain
- BIOARABA, Vitoria, Spain
| | - Lorea Mar-Barrutia
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Araba University Hospital, Vitoria, Spain
- University of the Basque Country, Bilbao, Spain
- BIOARABA, Vitoria, Spain
| | - Iria Grande
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Marti Guinovart
- Institut d'Investigacio i Innovacio ParcTauli (I3PT), Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Daniel Hernandez-Calle
- La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Luis Jimenez-Treviño
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
- Principado de Asturias Health Research Institute (ISPA), Oviedo, Spain
- University of Oviedo, Oviedo, Spain
- Principado de Asturias Neuroscience Research Institute (INEUROPA), Oviedo, Spain
| | - Clara Lopez-Sola
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Roberto Mediavilla
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Autonomous University of Madrid, Madrid, Spain
| | | | - Miguel Ruiz-Veguilla
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Virgen del Rocio University Hospital, Seville, Spain
- Seville Biomedical Research Institute (IBiS), Seville, Spain
- University of Seville, Seville, Spain
| | - Elisa Seijo-Zazo
- Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
- Principado de Asturias Health Research Institute (ISPA), Oviedo, Spain
- University of Oviedo, Oviedo, Spain
- Principado de Asturias Neuroscience Research Institute (INEUROPA), Oviedo, Spain
| | - Alba Toll
- Autonomous University of Barcelona, Barcelona, Spain
- Neurosciences Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Matilde Elices
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Autonomous University of Barcelona, Barcelona, Spain
- Neurosciences Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Victor Perez-Sola
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Neurosciences Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
- Hospital de Mar, Mental Health Institute, Barcelona, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Jose Luis Ayuso-Mateos
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
- Autonomous University of Madrid, Madrid, Spain
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Wang H, Lyu N, Huang J, Fu B, Shang L, Yang F, Zhao Q, Wang G. Real-world evidence from a retrospective study on suicide during depression: clinical characteristics, treatment patterns and disease burden. BMC Psychiatry 2024; 24:300. [PMID: 38641767 PMCID: PMC11031916 DOI: 10.1186/s12888-024-05726-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/27/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Suicide stands as both a primary symptom and the direst outcome of major depressive disorder (MDD). The scarcity of effective treatment strategies makes managing MDD patients with suicide especially challenging. Hence, it is crucial to investigate disease characteristics and efficacious therapeutic strategies for these patients, drawing insights from disease databases and real-world data. METHODS In this retrospective study, MDD patients hospitalized between January 2013 and December 2020 were investigated using Electronic Health Records (EHR) data from Beijing Anding Hospital. The study enrolled 4138 MDD patients with suicidal ideation or behavior (MDS) and 3848 without (MDNS). Demographic data, clinical attributes, treatment approaches, disease burden, and re-hospitalization within one year of discharge were extracted and compared. RESULTS Patients in the MDS group were predominantly younger and female, exhibiting a higher prevalence of alcohol consumption, experiencing frequent life stress events, and having an earlier onset age. Re-hospitalizations within six months post-discharge in the MDS group were significantly higher than in the MDNS group (11.36% vs. 8.91%, p < 0.001). Moreover, a more considerable fraction of MDS patients underwent combined electroconvulsive therapy treatment (56.72% vs. 43.71%, p < 0.001). Approximately 38% of patients in both groups were prescribed two or more therapeutic regimes, and over 90% used antidepressants, either alone or combined. Selective serotonin reuptake inhibitors (SSRIs) were the predominant choice in both groups. Furthermore, antidepressants were often prescribed with antipsychotics or mood stabilizers. When medication alterations were necessary, the favoured options involved combination with antipsychotics or transitioning to alternative antidepressants. Yet, in the MDS group, following these initial modifications, the addition of mood stabilizers tended to be the more prioritized alternative. CONCLUSIONS MDD patients with suicidal ideation or behaviour displayed distinctive demographic and clinical features. They exhibited intricate treatment patterns, a pronounced burden of illness, and an increased likelihood of relapse.
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Affiliation(s)
- Han Wang
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, 5 Ankang Hutong Road, Xicheng District, 100088, Beijing, China
| | - Nan Lyu
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, 5 Ankang Hutong Road, Xicheng District, 100088, Beijing, China
| | - Juan Huang
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, 5 Ankang Hutong Road, Xicheng District, 100088, Beijing, China
| | - Bingbing Fu
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, 5 Ankang Hutong Road, Xicheng District, 100088, Beijing, China
| | - Lili Shang
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, 5 Ankang Hutong Road, Xicheng District, 100088, Beijing, China
| | - Fan Yang
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, 5 Ankang Hutong Road, Xicheng District, 100088, Beijing, China
| | - Qian Zhao
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, 5 Ankang Hutong Road, Xicheng District, 100088, Beijing, China.
- The Advanced Innovation Center for Human Brain Protection, Capital Medical University, 100069, Beijing, China.
| | - Gang Wang
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, 5 Ankang Hutong Road, Xicheng District, 100088, Beijing, China.
- The Advanced Innovation Center for Human Brain Protection, Capital Medical University, 100069, Beijing, China.
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5
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Sánchez-Carro Y, de la Torre-Luque A, Díaz-Marsá M, Aguayo-Estremera R, Andreo-Jover J, Ayad-Ahmed W, Bobes J, Bobes-Bascarán T, Bravo-Ortiz MF, Canal-Rivero M, Cebrià AI, Crespo-Facorro B, Elices M, Fernández-Rodrigues V, Lopez-Peña P, Grande I, Palao-Tarrero Á, Pemau A, Roberto N, Ruiz-Veguilla M, Pérez-Solà V. Psychiatric profiles in suicidal attempters: Relationships with suicide behaviour features. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2024:S2950-2853(24)00011-5. [PMID: 38331321 DOI: 10.1016/j.sjpmh.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Suicide constitutes a major health concern worldwide, being a significant contributor of death, globally. The diagnosis of a mental disorder has been extensively linked to the varying forms of suicidal ideation and behaviour. The aim of our study was to identify the varying diagnostic profiles in a sample of suicide attempters. METHODS A sample of 683 adults (71.3% females, 40.10±15.74 years) admitted at a hospital emergency department due to a suicide attempt was recruited. Latent class analysis was used to identify diagnostic profiles and logistic regression to study the relationship between comorbidity profile membership and sociodemographic and clinical variables. RESULTS Two comorbidity profiles were identified (Class I: low comorbidity class, 71.3% of attempters; Class II: high comorbidity class, 28.7% of attempters). Class I members were featured by the diagnosis of depression and general anxiety disorder, and low comorbidity; by contrast, the high comorbidity profile was characterized by a higher probability of presenting two or more coexisting psychiatric disorders. Class II included more females, younger, with more depressive symptoms and with higher impulsivity levels. Moreover, Class II members showed more severe suicidal ideation, higher number of suicide behaviours and a greater number of previous suicide attempts (p<.01, for all the outcomes), compared to Class I members. CONCLUSIONS Psychiatric profiles may be considered for treatment provision and personalized psychiatric treatment in suicidal attempters as well as tackle suicide risk.
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Affiliation(s)
- Yolanda Sánchez-Carro
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain; CIBERSAM ISCIII, Madrid, Spain
| | | | - Marina Díaz-Marsá
- CIBERSAM ISCIII, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain; Hospital Clinico San Carlos, Madrid, Spain.
| | | | - Jorge Andreo-Jover
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain; Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | | | | | - Teresa Bobes-Bascarán
- CIBERSAM ISCIII, Madrid, Spain; Universidad de Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Spain; Instituto de Neurocias del Principado de Asturias, Spain
| | - María Fé Bravo-Ortiz
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain; Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain; Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
| | - Manuel Canal-Rivero
- CIBERSAM ISCIII, Madrid, Spain; UGC-Salud Mental de Hospital Virgen del Rocío/IBIS Sevilla, Spain; Universidad de Sevilla, Spain
| | | | - Benedicto Crespo-Facorro
- CIBERSAM ISCIII, Madrid, Spain; UGC-Salud Mental de Hospital Virgen del Rocío/IBIS Sevilla, Spain; Universidad de Sevilla, Spain
| | - Matilde Elices
- Institut Hospital del Mar d'Investigacions Mediques (IMIM), Barcelona, Spain
| | | | - Purificacion Lopez-Peña
- CIBERSAM ISCIII, Madrid, Spain; Department Psychiatry, Hospital Universitario Alava, Bioaraba, UPV/EHU, Osakidetza, Spain
| | - Iría Grande
- CIBERSAM ISCIII, Madrid, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Institute of Neurosciences (UBNeuro), Spain
| | - Ángela Palao-Tarrero
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain; Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain; Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
| | - Andrés Pemau
- Universidad Complutense de Madrid, Madrid, Spain
| | - Natalia Roberto
- CIBERSAM ISCIII, Madrid, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Institute of Neurosciences (UBNeuro), Spain
| | - Miguel Ruiz-Veguilla
- CIBERSAM ISCIII, Madrid, Spain; UGC-Salud Mental de Hospital Virgen del Rocío/IBIS Sevilla, Spain; Universidad de Sevilla, Spain
| | - Víctor Pérez-Solà
- CIBERSAM ISCIII, Madrid, Spain; Institut Hospital del Mar d'Investigacions Mediques (IMIM), Barcelona, Spain
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Soullane S, Israël M, Steiger H, Chadi N, Low N, Dewar R, Ayoub A, Auger N. Association of hospitalization for suicide attempts in adolescent girls with subsequent hospitalization for eating disorders. Int J Eat Disord 2023; 56:2223-2231. [PMID: 37646466 DOI: 10.1002/eat.24052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To determine the association between adolescent hospitalization for suicide attempts and the subsequent risk of eating disorder hospitalization. METHOD This was a cohort study of 162,398 adolescent girls in Quebec, Canada, including 7741 with suicide attempts before 20 years of age, matched to 154,657 adolescents with no attempt between 1989 and 2019. The main exposure measure was suicide attempt hospitalization. The main outcome measure was hospitalization for an eating disorder up to 31 years later, including anorexia nervosa, bulimia nervosa, and other eating disorders. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between adolescent suicide attempts and eating disorder hospitalization. RESULTS Adolescent girls admitted for a suicide attempt had 5.55 times the risk of eating disorder hospitalization over time (95% CI 3.74-8.23), compared with matched controls. Suicide attempt was associated with anorexia nervosa (HR 3.57, 95% CI 1.78-7.17) and bulimia nervosa and other eating disorders (HR 8.55, 95% CI 5.48-13.32). Associations were pronounced in girls with repeated suicide attempts. Girls who attempted suicide through self-poisoning had an elevated risk of anorexia nervosa, whereas girls who used violent methods such as cutting or piercing had a greater risk of bulimia nervosa and other eating disorders. Suicide attempt was strongly associated with eating disorder hospitalization in the year following the attempt, but associations persisted throughout follow-up. DISCUSSION Suicide attempt admission is associated with the long-term risk of eating disorder hospitalization in adolescent girls. PUBLIC SIGNIFICANCE This study of adolescent girls suggests that suicide attempt admission is associated with the long-term risk of hospitalization for eating disorders. The risk is greatest in the year after the attempt, but persists over time. Adolescents who present with a suicide attempt may benefit from screening for eating disorders and long-term follow-up to help prevent the exacerbation or development of eating disorders.
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Affiliation(s)
- Safiya Soullane
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Mimi Israël
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Howard Steiger
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Nicholas Chadi
- Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada
| | - Nancy Low
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ron Dewar
- Cancer Care Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Aimina Ayoub
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
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7
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Azizi H, Fakhari A, Farahbakhsh M, Davtalab Esmaeili E, Chattu VK, Ali Asghari N, Nazemipour M, Mansournia MA. Prevention of Re-attempt Suicide Through Brief Contact Interventions: A Systematic Review, Meta-analysis, and Meta-regression of Randomized Controlled Trials. JOURNAL OF PREVENTION (2022) 2023; 44:777-794. [PMID: 37707696 DOI: 10.1007/s10935-023-00747-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/15/2023]
Abstract
Brief contact intervention (BCI) is a low-cost intervention to prevent re-attempt suicide. This meta-analysis and meta-regression study aimed to evaluate the effect of BCI on re-attempt prevention following suicide attempts (SAs). We systematically searched using defined keywords in MEDLINE, Embase, and Scopus up to April, 2023. All randomized controlled trials (RCTs) were eligible for inclusion after quality assessment. Random-effects model and subgroup analysis were used to estimate pooled risk difference (RD) and risk ratio (RR) between BCI and re-attempt prevention with 95% confidence intervals (CIs). Meta-regression analysis was carried out to explore the potential sources of heterogeneity. The pooled estimates were (RD = 4%; 95% CI 2-6%); and (RR = 0.62; 95% CI 0.48-0.77). Subgroup analysis demonstrated that more than 12 months intervention (RR = 0.46; 95% CI 0.10-0.82) versus 12 months or less (RR = 0.67; 95% CI 0.54-0.80) increased the effectiveness of BCI on re-attempt suicide reduction. Meta-regression analysis explored that BCI time (more than 12 months), BCI type, age, and female sex were the potential sources of the heterogeneity. The meta-analysis indicated that BCI could be a valuable strategy to prevent suicide re-attempts. BCI could be utilized within suicide prevention strategies as a surveillance component of mental health since BCI requires low-cost and low-educated healthcare providers.
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Affiliation(s)
- Hosein Azizi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Fakhari
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mostafa Farahbakhsh
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Vijay Kumar Chattu
- Department of OS & OT, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5G 1V7, Canada
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, 600077, India
| | - Nasrin Ali Asghari
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Nazemipour
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, P.O. Box 14155-6446, Tehran, Iran.
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Abascal-Peiró S, Alacreu-Crespo A, Peñuelas-Calvo I, López-Castromán J, Porras-Segovia A. Characteristics of Single vs. Multiple Suicide Attempters Among Adult Population: A Systematic Review and Meta-Analysis. Curr Psychiatry Rep 2023; 25:769-791. [PMID: 37740850 DOI: 10.1007/s11920-023-01461-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE OF REVIEW We aimed to examine the factors that differentiate single and multiple suicide attempters in adult population. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to conduct this review and meta-analysis. The review protocol was registered in PROSPERO. We carried out a systematic literature search in three databases to identify original studies that explored the differences between single and multiple suicide attempters among adult population. RECENT FINDINGS There might be meaningful differences between those individuals that attempt suicide once in their lifespan and those who make multiple attempts in terms of sociodemographic and clinical characteristics. There are no previous meta-analysis addressing this topic in the adult population. A total of 75 studies were included in the review and 69 were included in the meta-analysis. Multiple attempters were more likely to present certain disorders such as mood and psychotic disorders, as well as personality or substance use disorders. Higher suicide ideation and suicide intent scores also characterized this group. Childhood trauma experiences, stressful life events, and higher rates of hopelessness were statistically significant in multiple attempters. Identifying the factors predicting multiple suicide attempts helps to delineate a high-risk suicidal profile that should be taken into account in the clinical and suicide prevention scenario.
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Affiliation(s)
- Sofía Abascal-Peiró
- Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
| | - Adrián Alacreu-Crespo
- Department of Psychology and Sociology, Area of Personality, Assessment and Psychological Treatment, Universidad of Zaragoza, Teruel, Spain
| | - Inmaculada Peñuelas-Calvo
- Department of Child and Adolescent Psychiatry, Hospital 12 de Octubre, Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain
| | - Jorge López-Castromán
- Department of Psychiatry, CNRS-INSERM, University of Montpellier, CHU Nîmes & IGF, Montpellier, France
| | - Alejandro Porras-Segovia
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
- Division of Psychiatry, Imperial College, London, UK
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Clapperton AJ, Dwyer J, Spittal MJ. Identification of young females at high risk of suicide following hospital-treated self-harm in Victoria, Australia. Aust N Z J Psychiatry 2023; 57:1163-1171. [PMID: 37026564 PMCID: PMC10566220 DOI: 10.1177/00048674231165226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
OBJECTIVE We conducted a data linkage study in Victoria, Australia, to determine the proportion of young females who are treated in hospital for self-harm who go on to die by suicide within 5 years and to identify factors associated with increased suicide risk in this same cohort. METHOD We undertook a cohort study following 3689 female patients aged 10-24 years, who were initially treated in hospital for self-harm during the 2-year period January 2011 to December 2012. We followed each patient for 5 years unless they died first, in which case, they were followed until their date of death. We used inpatient admissions from the Victorian Admitted Episodes Dataset and emergency department presentations from the Victorian Emergency Minimum Dataset linked to death data from two sources, the Victorian Suicide Register and the National Death Index. RESULTS Twenty-eight individuals (0.76% of the total cohort) died by suicide within 5 years of their index admission. In multivariate survival analysis, only suicide ideation at the time of self-harm (hazard ratio = 4.59; 95% confidence interval: 1.70, 12.38) and a decreasing time between successive self-harm episodes (hazard ratio = 4.38; 95% confidence interval: 1.28, 15.00) were associated with increased suicide risk. CONCLUSION Although the vast majority of young females who present to hospital for self-harm do not die by suicide within 5 years, our results suggest young females expressing suicide ideation and those presenting frequently with decreasing time between successive episodes should be prioritised for suicide-prevention efforts.
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Affiliation(s)
- Angela J Clapperton
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Jeremy Dwyer
- Coroners Prevention Unit, Coroners Court of Victoria, Southbank, VIC, Australia
| | - Matthew J Spittal
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
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Ezquerra B, Alacreu-Crespo A, Peñuelas-Calvo I, Abascal-Peiró S, Jiménez-Muñoz L, Nicholls D, Baca-García E, Porras-Segovia A. Characteristics of single vs. multiple suicide attempters among adolescents: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02260-2. [PMID: 37470845 DOI: 10.1007/s00787-023-02260-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023]
Abstract
There might be differential characteristics between those who have attempted suicide once in their lifetime (single attempters) and those who have attempted suicide two or more times (multiple attempters). We aimed to identify the factors that differentiate single and multiple attempters in child and adolescents. This study was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, and the review protocol was registered in PROSPERO. We conducted a systematic literature search in three databases to identify original studies exploring the characteristics of single attempters vs. multiple attempters among adolescents. We considered a wide range for the definition of adolescent, following most recent recommendations: 10-24 years. We carried out a meta-analysis. Fourteen studies were included in the systematic review and 13 in the meta-analysis with a total sample of with a total of 4286 participants. The factors statistically significantly associated with being a multiple attempter in the meta-analysis were: anxiety disorders, depression severity, alcohol abuse, substance abuse, aggressiveness, and hopelessness. Multiple attempters have a more severe clinical profile, with greater severity of symptoms. Knowledge of the risk factors associated with being a multiple attempter could help us to predict which patients are more likely to reattempt suicide and need further monitoring and a tailored treatment. Prevention programs tailored for the adolescent population, along with identification of early risk factors, could help to prevent suicidal behavior among this vulnerable population.
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Affiliation(s)
- Berta Ezquerra
- Department of Psychiatry, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | - Adrián Alacreu-Crespo
- Department of Psychology and Sociology, Area of Personality, Assessment and Psychological Treatment, Universidad of Zaragoza, Teruel, Spain
| | - Inmaculada Peñuelas-Calvo
- Department of Child and Adolescent Psychiatry, Hospital 12 de Octubre, Madrid, Spain.
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain.
| | - Sofía Abascal-Peiró
- Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Enrique Baca-García
- Department of Psychiatry, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
- Department of Child and Adolescent Psychiatry, Hospital 12 de Octubre, Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Central de Villalba, Madrid, Spain
- Universidad Católica del Maule, Talca, Chile
- CIBERSAM, Madrid, Spain
- Université de Nîmes, Nîmes, France
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alejandro Porras-Segovia
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain.
- Division of Psychiatry, Imperial College, London, UK.
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11
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Adrien V, Liewig J, Diot T, Ferreri F, Mouchabac S, Dubertret C, Bourgin J. Association between family functioning and psychotic transition in ultra-high risk adolescents and young adults. Front Psychiatry 2023; 14:1177311. [PMID: 37415693 PMCID: PMC10320389 DOI: 10.3389/fpsyt.2023.1177311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/24/2023] [Indexed: 07/08/2023] Open
Abstract
Background Psychotic transition (PT) is a crucial stage in schizophrenia. The Comprehensive Assessment of At-Risk Mental States (CAARMS) scale can be used to identify individuals at ultra-high risk (UHR) for psychosis and to evaluate their risk of PT. Many environmental and genetic factors have been identified as contributing to the development and decompensation of schizophrenia. This study aimed to determine if the quality of family functioning is associated with PT risk in UHR individuals aged between 11 and 25 years after 1 year of follow-up. Methods From January to November 2017, 45 patients aged 12 to 25 consulting for psychiatric reasons were included. Twenty-six were classified as UHR of PT at the CAARMS. Family functioning was assessed by the Family Assessment Device-Global Functioning (FAD-GF). Thirty-seven of these patients (30% men, mean age 16 ± 2.5) were reassessed at 8-14 months of recruitment. Survival analysis was used to examine the impact of family functioning on PT risk. Results A total of 40% of UHR patients were classified as psychotic at reassessment. Survival analysis showed that better family functioning is a significant protective factor for PT in this population. Discussion This result suggests that the global family functioning has an impact at 1 year on the risk of PT in the population of adolescents and young adults who consult the hospital for psychiatric reasons. A family intervention may be effective in reducing PT risk in this population and should be considered as a potential therapeutic option.
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Affiliation(s)
- Vladimir Adrien
- AP-HP, Department of Psychiatry, Saint-Antoine Hospital, Sorbonne Université, Paris, France
- Infrastructure for Clinical Research in Neuroscience (iCRIN), Paris Brain Institute, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Justine Liewig
- Department of Child and Adolescent Psychiatry, Nord-Essonne Hospital, Bures-sur-Yvette, France
| | - Thomas Diot
- AP-HP, Department of Psychiatry, Saint-Antoine Hospital, Sorbonne Université, Paris, France
| | - Florian Ferreri
- AP-HP, Department of Psychiatry, Saint-Antoine Hospital, Sorbonne Université, Paris, France
- Infrastructure for Clinical Research in Neuroscience (iCRIN), Paris Brain Institute, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Stephane Mouchabac
- AP-HP, Department of Psychiatry, Saint-Antoine Hospital, Sorbonne Université, Paris, France
- Infrastructure for Clinical Research in Neuroscience (iCRIN), Paris Brain Institute, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Caroline Dubertret
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Université Paris Cité, Faculté de Médecine, Colombes, France
| | - Julie Bourgin
- Department of Child and Adolescent Psychiatry, Nord-Essonne Hospital, Bures-sur-Yvette, France
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Adrados-Pérez M, Llorca-Bofí V, Laín MM, Porcar CA, Nicolau-Subires E, Ibarra-Pertusa L, Jiménez-Mayoral A, Buil-Reiné E, Budny F, Resa-Pérez B, Velásquez-Acebey VG, Arenas-Pijoan L, Irigoyen-Otiñano M, López-Castroman J. Trajectories of children and adolescents attending a psychiatric emergency unit during the COVID-19 confinements: 2020-2022 longitudinal study. Child Adolesc Psychiatry Ment Health 2023; 17:66. [PMID: 37291582 PMCID: PMC10248990 DOI: 10.1186/s13034-023-00619-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/19/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION The prevalence of psychiatric disorders has not shifted widely through the COVID pandemic, except for some specific groups such as young people or women. Our objective is to examine prospectively the evolution of children and adolescents who consulted in a psychiatric emergency service during the COVID-19 confinements. METHOD We collected prospective clinical information about 296 young people under 18 who visited a tertiary hospital for psychiatric reasons during the confinement periods in Spain. Clinical diagnoses, suicide attempts, hospital admissions, and pharmacological prescriptions were extracted from electronic health records through 2020, 2021, and 2022. Features of those who maintained psychiatric care and those who did not were compared. RESULTS Three out of four children and adolescents who visited the psychiatric emergency department during the confinements continued psychiatric care at the end of 2022. Those who did not showed better premorbid adjustment at baseline. During follow-up, diagnoses of neurodevelopmental disorders and eating disorders, as well as the dosage of psychotropic drug prescriptions, increased. The diagnoses of major depressive disorder and eating disorder at baseline were associated with attempting suicide during follow-up. Patients with internalizing symptoms were admitted earlier than those with externalizing symptoms but no differences were found in terms of suicide attempts. CONCLUSIONS The continuity of psychiatric care after an initial emergency visit during the confinements implied greater clinical severity, as reflected by changes in clinical diagnoses and pharmacological regimens. Emergent symptoms of depression or eating disorders after social distancing or isolation could predict subsequent suicidal behavior in young populations.
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Affiliation(s)
- Marina Adrados-Pérez
- Department of Psychiatry, Santa Maria University Hospital, Lleida, Spain
- Institut de Recerca Biomèdica Lleida, Biological Foundations of Mental Disorders, Lérida, Spain
| | - Vicent Llorca-Bofí
- Department of Psychiatry, Santa Maria University Hospital, Lleida, Spain
- Institut de Recerca Biomèdica Lleida, Biological Foundations of Mental Disorders, Lérida, Spain
- Department of Medicine, University of Barcelona School of Medicine, Barcelona, Spain
| | - María Mur Laín
- Department of Psychiatry, Santa Maria University Hospital, Lleida, Spain
- Institut de Recerca Biomèdica Lleida, Biological Foundations of Mental Disorders, Lérida, Spain
- University of Lleida, Lérida, Spain
| | - Carla Albert Porcar
- Department of Psychiatry, Santa Maria University Hospital, Lleida, Spain
- Institut de Recerca Biomèdica Lleida, Biological Foundations of Mental Disorders, Lérida, Spain
| | - Eugènia Nicolau-Subires
- Department of Psychiatry, Santa Maria University Hospital, Lleida, Spain
- Institut de Recerca Biomèdica Lleida, Biological Foundations of Mental Disorders, Lérida, Spain
| | - Lucía Ibarra-Pertusa
- Department of Psychiatry, Santa Maria University Hospital, Lleida, Spain
- Institut de Recerca Biomèdica Lleida, Biological Foundations of Mental Disorders, Lérida, Spain
| | | | - Esther Buil-Reiné
- Department of Psychiatry, Santa Maria University Hospital, Lleida, Spain
| | - Filip Budny
- Department of Psychiatry, Santa Maria University Hospital, Lleida, Spain
| | - Belén Resa-Pérez
- Department of Psychiatry, Santa Maria University Hospital, Lleida, Spain
| | | | | | - María Irigoyen-Otiñano
- Department of Psychiatry, Santa Maria University Hospital, Lleida, Spain.
- Institut de Recerca Biomèdica Lleida, Biological Foundations of Mental Disorders, Lérida, Spain.
- CIBERSAM, Madrid, Spain.
| | - Jorge López-Castroman
- University of Montpellier, IGF, CNRS-INSERM, Montpellier, France
- Department of Psychiatry, Nimes University Hospital, Nimes, France
- CIBERSAM, Madrid, Spain
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13
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Rusé J, Clenet A, Vaiva G, Debien C, Arbus C, Salles J. The association between reattempted suicide and incoming calls to the brief contact intervention service, VigilanS: a study of the clinical profile of callers. BMC Psychiatry 2023; 23:21. [PMID: 36624409 PMCID: PMC9829445 DOI: 10.1186/s12888-022-04503-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Suicide is a major health problem globally. As attempted suicide is a major risk factor for suicide, specific prevention strategies have been designed for use thereafter. An example is the brief contact intervention (BCI). In this regard, France employs a composite BCI, VigilanS, which utilizes three types of contact: phone calls, postcards and a 'who to contact in a crisis' card. Previous studies have found that this system is effective at preventing suicide. Nevertheless, VigilanS was not effective in the same way for all the patients included. This observation raises the question of specific adaptation during follow-up for populations that were less receptive to the service. In consideration of this issue, we identified one study which found that incoming calls to the service were linked with a higher risk of suicide reattempts. However, this study did not document the profiles of the patients who made these calls. Better understanding of why this population is more at risk is important in terms of identifying factors that could be targeted to improve follow-up. This research therefore aims to bring together such data. METHODS We performed a retrospective analysis of 579 patients referred to VigilanS by Toulouse University Hospital (France). We examined the sociodemographics, clinical characteristics, and follow-ups in place and compared the patients who made incoming calls to the service versus those who did not. Subsequently, we conducted a regression analysis using the significantly associated element of patients calling VigilanS. Then, in order to better understand this association, we analyzed the factors, including such calls, that were linked to the risk of suicide reattempts. RESULTS We found that 22% of the patients in our sample called the VigilanS service. These individuals: were older, at 41.4 years versus 37.9 years for the non-callers; were more likely to have a borderline personality disorder (BPD) diagnosis (28.9% versus 19.3%); and had a history of suicide attempts (71.9% versus 54.6%). Our analysis confirmed that incoming calls to VigilanS (OR = 2.9) were associated with reattempted suicide, as were BPD (OR = 1.8) and a history of suicide attempts (OR = 1.7). CONCLUSION There was a high risk that the patients calling VigilanS would make another suicide attempt. However, this association was present regardless of the clinical profile. We postulate that this link between incoming calls and reattempted suicide may arise because this form of contact is, in fact, a way in which patients signal that a further attempt will be made.
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Affiliation(s)
- Jeanne Rusé
- grid.411175.70000 0001 1457 2980Department of Psychiatry, University Hospital of Toulouse, CHU Toulouse, Toulouse, France
| | - Adeline Clenet
- grid.411175.70000 0001 1457 2980Department of Psychiatry, University Hospital of Toulouse, CHU Toulouse, Toulouse, France
| | - Guillaume Vaiva
- Centre National de Ressources et de Résilience Lille-Paris, Lille, France ,grid.410463.40000 0004 0471 8845Department of Psychiatry, Centre Hospitalier Universitaire de Lille, Inserm, U1172-LilNCog-Lille Neuroscience and Cognition, Lille, France
| | - Christophe Debien
- Centre National de Ressources et de Résilience Lille-Paris, Lille, France ,grid.410463.40000 0004 0471 8845Department of Psychiatry, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Christophe Arbus
- grid.411175.70000 0001 1457 2980University Hospital of Toulouse, CHU Toulouse, Department of Psychiatry, Toulouse NeuroImaging Center, ToNIC, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Juliette Salles
- University Hospital of Toulouse, CHU Toulouse, Department of Psychiatry, Infinity (Toulouse Institute for Infectious and Inflammatory Diseases), INSERM UMR1291, CNRS UMR5051, Université Toulouse III, Toulouse, France.
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Bhaskaran AS, Reddi VSK, Suchandra HH, Gowda GS, Muliyala KP. Predictors of future suicide attempts in individuals with high suicide risk admitted to an acute psychiatry suicide intervention unit in India. A survival analysis study. Asian J Psychiatr 2022; 78:103270. [PMID: 36252324 DOI: 10.1016/j.ajp.2022.103270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/29/2022] [Accepted: 09/23/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Determination of suicide vulnerability remains challenging in mental illness. Variability in risk factors identified compound its poor predictability. Longitudinal studies, offering more reliable indices of risk, from developing countries are conspicuously limited. Furthermore, research advances allude to inherent vulnerability. This study, the first of its kind from India, consequently aimed to delineate factors influencing subsequent attempts in mental illness and acute suicidality. METHOD Baseline and follow-up information (up to five years) was obtained from medical records of individuals (n = 130) with acute suicidality [recent attempt (first attempt/ reattempt) and high-risk ideators]. Variables were compared between individuals with, and without subsequent suicide attempts. Time to attempt and factors influencing the same was determined using survival analysis, and Cox proportional hazard for estimating the likelihood of a subsequent suicide attempt. RESULTS Median duration of follow up of the sample (n = 130) was 23 months. The sample comprised of individuals with a recent attempt (first-time attempt), recent reattempt and recent high-risk ideators. Subsequent suicide attempts were noted in 30 (23.1 %) patients. Baseline sociodemographic and clinical variables, including suicidality, could not differentiate individuals with a subsequent suicide attempt. Survival analysis indicated that 65 % of subsequent attempts occurred within 9 months of discharge. Family history of suicide and the presence of impulsive-aggressive traits were associated with both, reduced survival time and overall increased risk of a subsequent suicide attempt. CONCLUSION This study delineates both, the time frame associated with greatest risk, as well as individuals most likely to reattempt suicide. It thereby offers insights into potential windows of opportunity to mitigate prospective suicide risk. Strategies such as enhanced after-care and integrating specific interventions to attenuate impulsive-aggressive behaviors could be a focus to prevent future attempts, thereby decreasing rates of suicide amongst those with mental illness. Furthermore, the findings of this study reaffirm the role of factors that independently confer vulnerability to suicide. Traversing noted regional variations, the findings importantly reinforce the distinct pathophysiological underpinnings of suicide in mental illness.
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Affiliation(s)
| | | | - Hari Hara Suchandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Krishna Prasad Muliyala
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
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15
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Peltzer K, Pengpid S. Factors associated with single and multiple suicide attempts in adolescent school children in Morocco: A national cross-sectional survey. JOURNAL OF PSYCHOLOGY IN AFRICA 2022. [DOI: 10.1080/14330237.2022.2121467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Karl Peltzer
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
- Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Supa Pengpid
- Department of Health Education and Behavioural Sciences, Mahidol University, Bangkok, Thailand
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
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Siria S, Leza L, López-Goñi JJ, Fernández-Montalvo J. Lifetime suicidal-related behaviour among patients in treatment for substance use disorder: A cross-sectional study. Psychiatry Res 2022; 317:114921. [PMID: 37732864 DOI: 10.1016/j.psychres.2022.114921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/08/2022] [Accepted: 10/20/2022] [Indexed: 10/31/2022]
Abstract
Suicidal-related behaviours are an important concern in individuals who present with substance use disorders (SUDs). The distinction among the specific characteristics of the different patients might help to improve prevention strategies. We describe and compare the sociodemographic characteristics, severity of addiction, and psychopathology of the participants depending on the severity of their lifetime suicidal behaviour. In addition, we examine whether the number of suicide attempts can be estimated based on the variables that differentiate the groups. A sample of 318 men and 86 women who sought treatment for addiction were assessed. The sample was divided into: no ideation or attempts, suicidal ideation, one suicide attempt, and two or more suicide attempts. The group with two or more suicide attempts exhibited a greater severity in the addiction profile. The group with one suicide attempt presented a higher psychopathological symptomatology at the time of the assessment. The severity of the Psychiatric area was related to the group with two or more attempts and to the number of suicide attempts. The presence of any number of attempts is associated with greater severity of addiction. Providing specific intervention strategies for SUD patients depending on their suicidal behaviours is promising for clinical application.
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Affiliation(s)
- Sandra Siria
- Universidad del País Vasco (UPV/EHU). San Sebastián. Guipúzcoa Spain
| | - Leire Leza
- Departamento de Ciencias de la Salud. Universidad Pública de Navarra. Campus de Arrosadía, 31006 Pamplona. Spain
| | - José J López-Goñi
- Departamento de Ciencias de la Salud. Universidad Pública de Navarra. Campus de Arrosadía, 31006 Pamplona. Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA). Pamplona. Navarra. Spain.
| | - Javier Fernández-Montalvo
- Departamento de Ciencias de la Salud. Universidad Pública de Navarra. Campus de Arrosadía, 31006 Pamplona. Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA). Pamplona. Navarra. Spain
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Peñas-Lledó EM, Guillaume S, de Andrés F, Cortés-Martínez A, Dubois J, Kahn JP, Leboyer M, Olié E, LLerena A, Courtet P. A one-year follow-up study of treatment-compliant suicide attempt survivors: relationship of CYP2D6-CYP2C19 and polypharmacy with suicide reattempts. Transl Psychiatry 2022; 12:451. [PMID: 36257936 PMCID: PMC9579135 DOI: 10.1038/s41398-022-02140-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/09/2022] [Accepted: 08/24/2022] [Indexed: 11/30/2022] Open
Abstract
This study of a cohort of 1-year treatment-compliant survivors of a suicide attempt examined for the first time whether a high CYP2D6-CYP2C19 metabolic capacity (pharmacogenes related to psychopathology, suicide, and attempt severity) and/or polypharmacy treatments predicted repeat suicide attempts, adjusting for sociodemographic and clinical factors as confounders. Of the 461 (63% women) consecutively hospitalized patients who attempted suicide and were evaluated and treated after an index attempt, 191 (67.5% women) attended their 6- and 12-month follow-up sessions. Clinicians were blinded to the activity scores (AS) of their genotypes, which were calculated as the sum of the values assigned to each allele (CYP2C19 *2, *17; CYP2D6 *3, *4, *4xN, *5, *6, *10, wtxN). No differences were found in polypharmacy prescription patterns and the variability of CYP2D6 and CYP2C19 genotypes between adherents and dropouts, but the formers were older, with a higher frequency of anxiety and bipolar disorders and fewer alcohol and substance use disorders. The risk of reattempts was higher for CYP2D6 ultrarapid (AS > 2) metabolizers (β = 0.561, p = 0.005) and violent suicide survivors (β = -0.219, p = 0.042) if the attempt occurred during the first 6-month period, individuals with an increased number of MINI DSM-IV Axis I mental disorders (β = 0.092, p = 0.032) during the second 6-month period and individuals with a combined high CYP2D6-CYP2C19 metabolic capacity (AS > 4) (β = 0.345, p = 0.024) and an increased use of drugs other than antidepressants, anxiolytics-depressants and antipsychotics-lithium (β = 0.088, p = 0.005) in multiple repeaters during both periods. CYP2D6 and CYP2C19 rapid metabolism and polypharmacy treatment for somatic comorbidities must be considered to prevent the severe side effects of short-term multiple suicide reattempts after a previous attempt.
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Affiliation(s)
- Eva M. Peñas-Lledó
- grid.8393.10000000119412521INUBE Biosanitary University Research Institute, University of Extremadura, Badajoz, Spain ,grid.8393.10000000119412521University of Extremadura Medical School, Badajoz, Spain
| | - Sebastien Guillaume
- grid.121334.60000 0001 2097 0141IGF, CNRS, INSERM, Univ. Montpellier, Montpellier, France ,grid.157868.50000 0000 9961 060XDepartment of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, 34090 Montpellier, France
| | - Fernando de Andrés
- grid.8393.10000000119412521INUBE Biosanitary University Research Institute, University of Extremadura, Badajoz, Spain
| | - Ana Cortés-Martínez
- grid.8393.10000000119412521INUBE Biosanitary University Research Institute, University of Extremadura, Badajoz, Spain
| | - Jonathan Dubois
- grid.121334.60000 0001 2097 0141IGF, CNRS, INSERM, Univ. Montpellier, Montpellier, France ,grid.157868.50000 0000 9961 060XDepartment of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, 34090 Montpellier, France
| | - Jean Pierre Kahn
- grid.29172.3f0000 0001 2194 6418Université de Lorraine, Nancy, France, Clinique Soins-Etudes de Vitry le François, Fondation Sant´e des Etudiants de France (FSEF), Paris, France
| | - Marion Leboyer
- FondaMental Foundation, Créteil, France ,grid.462410.50000 0004 0386 3258Univ Paris Est Créteil, INSERM U955, IMRB, Translational NeuroPsychiatry Laboratory, Créteil, France ,grid.511339.cAP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d’Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - Emilie Olié
- grid.121334.60000 0001 2097 0141IGF, CNRS, INSERM, Univ. Montpellier, Montpellier, France ,grid.157868.50000 0000 9961 060XDepartment of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, 34090 Montpellier, France
| | - Adrián LLerena
- grid.8393.10000000119412521INUBE Biosanitary University Research Institute, University of Extremadura, Badajoz, Spain ,grid.8393.10000000119412521University of Extremadura Medical School, Badajoz, Spain ,grid.413448.e0000 0000 9314 1427CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Philippe Courtet
- IGF, CNRS, INSERM, Univ. Montpellier, Montpellier, France. .,Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, 34090, Montpellier, France.
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Pengpid S, Peltzer K. Factors associated with single and multiple suicide attempts in adolescents attending school in Argentina: national cross-sectional survey in 2018. BJPsych Open 2022; 8:e128. [PMID: 35795969 PMCID: PMC9301764 DOI: 10.1192/bjo.2022.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Factors associated with single suicide attempts (SSA) and multiple suicide attempts (MSA) may differ. AIMS The study aimed to assess the factors associated with MSA in adolescents with a history of suicide attempts during the past 12 months in Argentina. METHOD National cross-sectional data from the Global School-based Student Health Survey in Argentina in 2018 were analysed. Students who reported having a history of suicide attempts in the past 12 months were included in the final sample (n = 8507). Students with MSA were compared with students with an SSA through multiple logistic regression. RESULTS In a subsample of adolescents attending school (mean age 14.8 years, s.d. = 1.3), 59.4% had an SSA and 40.6% had MSA in the past 12 months. In the final adjusted logistic regression model, compared with participants with SSA, both male and female students with MSA more frequently had no close friends, reported feeling more lonely and had more anxiety-induced sleep disturbances. Furthermore, among female participants, having been physically attacked, having participated in physical fights, low parental support, current tobacco use and lifetime amphetamine use were associated with MSA. Among male students, multiple sexual partners were associated with MSA. Furthermore, among both boys and girls, compared with participants without psychosocial distress, participants with one, two, three or more psychosocial distress factors had higher odds of MSA. Compared with students with one or two social or environmental risk factors, students with seven or eight social or environmental risk factors had higher odds of MSA; compared with students who had zero or one health risk behaviours, students with six or more health risk behaviours had higher odds of MSA. CONCLUSIONS Psychosocial distress (anxiety-induced sleep disturbance, having no close friends and loneliness) increased the odds of MSA among both sexes. The odds of MSA were increased by interpersonal violence, low parental support and substance use among girls, and by having multiple sexual partners among boys. This suggests the potential relevance of these variables in identifying multiple suicide attempters among adolescents attending school in Argentina.
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Affiliation(s)
- Supa Pengpid
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand; and Department of Research Administration and Development, University of Limpopo, Turfloop, South Africa
| | - Karl Peltzer
- Department of Psychology, University of the Free State, Bloemfontein, South Africa; and Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
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Qin P, Stanley B, Melle I, Mehlum L. Association of Psychiatric Services Referral and Attendance Following Treatment for Deliberate Self-harm With Prospective Mortality in Norwegian Patients. JAMA Psychiatry 2022; 79:651-658. [PMID: 35583901 PMCID: PMC9118082 DOI: 10.1001/jamapsychiatry.2022.1124] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Psychiatric care following somatic treatment for deliberate self-harm (DSH) is pivotal in patients' lives both in the short and long term, but evidence to guide such care is limited. OBJECTIVE To examine follow-up psychiatric care for patients treated for DSH (ie, intentional self-injury or self-poisoning, irrespective of motivation) at hospital emergency departments and to assess the association of psychiatric referral and treatment attendance with risk of subsequent mortality in these patients. DESIGN, SETTING, AND PARTICIPANTS Retrospective data from several Norwegian registries were interlinked to follow up a national cohort of all patients with hospital-treated DSH for up to 11 years from 2008 through 2018. Data were analyzed from March to October 2021. EXPOSURES Socioeconomic characteristics, psychiatric history, and clinical features of DSH. MAIN OUTCOMES AND MEASURES Referral to psychiatric services, attendance in psychiatric treatment, and prospective mortality were the 3-stage outcomes during follow-up. Logistic regression with odds ratios and cause-specific survival analysis with hazard ratios were used to examine associations between exposures and outcomes. RESULTS The study identified 43 153 patients (24 286 [56.3%] female; median [IQR] age at index DSH, 39.0 [23.0-56.0] years) involving 69 569 DSH episodes. Of these patients, 6762 (15.7%) were referred to psychiatric services after somatic treatment for DSH, and 22 008 patients (51.0%) attended psychiatric treatment within 3 months of discharge following somatic treatment for DSH. Prior psychiatric history and psychiatric disorders comorbid with DSH were associated with both referral to and attendance in psychiatric care. During follow-up, 7041 patients died by suicide (n = 911) or other causes (n = 6130). While suicide risk was associated with male sex, age 35 to 64 years, and particularly prior and coexisting psychopathologies, other-cause mortality was associated with age 65 years and older and socioeconomic disadvantage. Patients with psychiatric referrals generally had an increased risk of suicide, but the risk was particularly high among patients who received a referral but did not subsequently attend psychiatric treatment (adjusted hazard ratio, 3.07; 95% CI, 2.28-4.12). The observed association was more pronounced during the first years of follow-up and in patients aged 10 to 34 years or 35 to 64 years and those with a clear intent of self-harm. CONCLUSIONS AND RELEVANCE This national cohort study found an association between psychiatric care attendance following treatment for DSH and prospective mortality, highlighting the importance of patient engagement in psychiatric treatment.
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Affiliation(s)
- Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Barbara Stanley
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
| | - Ingrid Melle
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Esmaeili ED, Farahbakhsh M, Sarbazi E, Khodamoradi F, Gaffari Fam S, Azizi H. Predictors and incidence rate of suicide re-attempt among suicide attempters: A prospective study. Asian J Psychiatr 2022; 69:102999. [PMID: 34979473 DOI: 10.1016/j.ajp.2021.102999] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/26/2021] [Accepted: 12/28/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Recent investigations and advances include improved understanding of trends, epidemiology, risk and protective factors on suicide. However, predictors of suicide re-attempt are poorly understood in a prospective design, at least in Iran. This prospective study was performed to investigate predictors and epidemiological aspects of suicide re-attempt during a 5-years of follow-up among Suicide Attempters (SAs). METHODS All the 1034 SAs of Malekan County were followed up and interviewed from 2014 to 2018. Cox regression analysis was used to estimate crude and adjusted hazard ratios and 95% confidence intervals for suicide re-attempt risk. RESULTS The overall prevalence of re-attempt was 117 (11.7%) over 5 years period. The overall incidence and person-time incidence rates of re-attempt were 113.15 per 1000 attempters and 7.1 per 100 person-year, respectively. The majority of re-attempts 161 (81.3%) took place within the first-18 months of follow-up while the peak of re-attempt was 6 months after attempts. In the final analysis, age ≤ 25, family income (≥ 10 million Rials), having any psychiatric disorder, poor education, stressful life events, alcohol abuse, and smoking were the most reliable predictors of suicide re-attempt. CONCLUSION Health systems should be informed about the predictors for subsequent SA after any attempt. Appropriate suicide prevention strategies should be tailored to the specific profile of each group for moderating predictors of suicide re-attempt.
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Affiliation(s)
| | - Mostafa Farahbakhsh
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ehsan Sarbazi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Farzad Khodamoradi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Saber Gaffari Fam
- School of Nursing of Miyandoab, Urmia University of Medical Sciences, Urmia, Iran.
| | - Hosein Azizi
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Arafat SMY, Khan MM, Menon V, Ali SA, Rezaeian M, Shoib S. Psychological autopsy study and risk factors for suicide in Muslim countries. Health Sci Rep 2021; 4:e414. [PMID: 34622034 PMCID: PMC8485607 DOI: 10.1002/hsr2.414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/07/2021] [Accepted: 09/12/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Suicide and risk factors have been poorly studied in the Muslim-majority countries that hinder the formulation of prevention strategies and affect suicide prevention eventually. OBJECTIVES We aimed at identifying and analyzing the psychological autopsy studies assessing the risk factors for suicide conducted in Muslim-majority countries. METHODS We did a search to trace all the available psychological autopsy studies in the Muslim countries with the search term "psychological autopsy study in Muslim countries." We also checked the available bibliographies to identify the psychological autopsy studies in the Muslim countries so that all the possible studies could be included. RESULTS Out of the Muslim countries, only eight psychological autopsy studies were identified in five countries (Bangladesh [1], Indonesia [1], Iran [1], Pakistan [2], and Turkey [3]). Six studies adopted a case-control study design, and all were carried out in urban settings. The prevalence of psychiatric disorders among case-control studies varied from 52.8% in Turkey to 96% in Pakistan. Psychiatric illness, self-harm, and stressful life events were the commonly replicated risk factors for suicide across studies. CONCLUSIONS Psychological autopsy studies have been conducted only in five Muslim countries revealing that the risk factor for suicide is certainly under-researched in the incumbent countries. This review identified a similar list of risk factors for suicide, namely, psychiatric disorder, past non-fatal attempts, and adverse life events compared to the Western countries even though the rate varies.
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Affiliation(s)
- S. M. Yasir Arafat
- Department of PsychiatryEnam Medical College and HospitalDhakaBangladesh
| | - Murad M. Khan
- Department of PsychiatryAga Khan UniversityKarachiPakistan
| | - Vikas Menon
- Department of PsychiatryJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)PuducherryIndia
| | | | - Mohsen Rezaeian
- Epidemiology and Biostatistics DepartmentRafsanjan Medical School, Occupational Environmental Research Center, Rafsanjan University of Medical SciencesRafsanjanIran
| | - Sheikh Shoib
- Department of PsychiatryJawahar Lal Nehru Memorial Hospital (JLNMH)SrinagarIndia
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Loo JL, Mohamad Kamal NA, Goon JA, Ahmad Damanhuri H, Tan JAC, Abdul Murad NA, Shah SA, Sulaiman SA, Fazry S, Sharip S, Mohamed Saini S, Gunasekaran G, Maniam T, A. Jamal AR, Wan Ngah WZ, Mohd Badli Shah FS, Chan LF. The Role of Oxidative Stress in Suicidal Behaviour Among Bipolar Patients: A Cross-Sectional Study in a Malaysian Sample. Front Psychiatry 2021; 12:698911. [PMID: 34916966 PMCID: PMC8669431 DOI: 10.3389/fpsyt.2021.698911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/28/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Oxidative stress markers are found to be linked with depression and suicide attempts in bipolar disorder (BD), although the role of DNA damage as a marker of suicidal ideation and attempt has yet to be determined. We aim to investigate the association between DNA damage and suicidal behaviour, i.e., suicidal ideation and suicide attempt, among suicidal ideators in BD patients while accounting for clinical and psychosocial risk factors. Methods: A cross-sectional study was conducted in the Universiti Kebangsaan Malaysia Medical Centre on 62 consecutive BD patients diagnosed using the M.I.N.I. Neuropsychiatric Interview and 26 healthy control participants. Socio-demographic and clinical assessments were performed using the Columbia Suicide Severity Rating Scale (C-SSRS) for lifetime suicidal ideation and attempt, Quick Inventory of Depressive Symptomatology (QIDS) for depression severity, Clinical Global Impression for Bipolar Disorder (CGI-BD) for illness severity [both mania (CGI-Mania) and major depressive episode (CGI-MDE)], Social Readjustment Rating Scale (SRRS) for change in life events, and Barratt Impulsiveness Scale (BIS) for behavioural impulsivity. The degree of DNA damage in peripheral blood samples was determined using a standard protocol of comet assay. Results: Multivariable logistic regression revealed higher scores of CGI-MDE as the sole significant factor for lifetime suicidal ideation (OR = 1.937, 95% CI = 1.799-2.076). Although initial bivariate analysis showed a significant association between DNA damage, malondialdehyde (MDA), catalase (CAT), and suicidal behaviour, the findings were not seen in multivariable logistic regression. Bivariate subgroup analysis showed that moderate and severe DNA damage (p = 0.032 and p = 0.047, respectively) was significantly associated with lifetime suicide attempts among lifetime suicidal ideators. The study is the first to look at the connexion between DNA damage and suicidal risk in bipolar patients. It is limited by the small sample size and lack of information on illicit substance use. Conclusions: More severe DNA damage was significantly associated with lifetime suicide attempts among lifetime suicidal ideators in BD. However, the severity of depression was found to be independently associated with lifetime suicidal ideation per se rather than DNA damage in BD. Larger prospective studies are required to ascertain the potential of DNA damage as a biomarker for the transition from suicidal ideation to a suicide attempt.
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Affiliation(s)
- Jiann Lin Loo
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
- Betsi Cadwaladr University Health Board, Wrexham, United Kingdom
| | - Nurul Ain Mohamad Kamal
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Jo Aan Goon
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hanafi Ahmad Damanhuri
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Jaclyn Ai Chin Tan
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Nor Azian Abdul Murad
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Shamsul Azhar Shah
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Siti Aishah Sulaiman
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Shazrul Fazry
- School of Biosciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Shalisah Sharip
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Suriati Mohamed Saini
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Geetha Gunasekaran
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Thambu Maniam
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - A. Rahman A. Jamal
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Wan Zurinah Wan Ngah
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | | | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Sobanski T, Josfeld S, Peikert G, Wagner G. Psychotherapeutic interventions for the prevention of suicide re-attempts: a systematic review. Psychol Med 2021; 51:2525-2540. [PMID: 34608856 DOI: 10.1017/s0033291721003081] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A history of suicide attempt (SA) is a strong predictor of future suicide re-attempts or suicide. The aim of this systematic review is to evaluate the efficacy of psychotherapeutic interventions specifically designed for the prevention of suicide re-attempts. A systematic search from 1980 to June 2020 was performed via the databases PubMed and Google Scholar. Only randomized controlled trials were included which clearly differentiated suicidal self-harm from non-suicidal self-injury in terms of intent to die. Moreover, psychotherapeutic interventions had to be focused on suicidal behaviour and the numbers of suicide re-attempts had to be used as outcome variables. By this procedure, 18 studies were identified. Statistical comparison of all studies revealed that psychotherapeutic interventions in general were significantly more efficacious than control conditions in reducing the risk of future suicidal behaviour nearly by a third. Separate analyses revealed that cognitive-behavioural therapy as well as two different psychodynamic approaches were significantly more efficacious than control conditions. Dialectical behaviour therapy and elementary problem-solving therapy were not superior to control conditions in reducing the number of SAs. However, methodological reasons may explain to some extent these negative results. Considering the great significance of suicidal behaviour, there is unquestionably an urgent need for further development of psychotherapeutic techniques for the prevention of suicide re-attempts. Based on the encouraging results of this systematic review, it can be assumed that laying the focus on suicidal episodes might be the key intervention for preventing suicide re-attempts and suicides.
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Affiliation(s)
- Thomas Sobanski
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Thüringen-Kliniken GmbH, Rainweg 68, 07318Saalfeld, Germany
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743Jena, Germany
| | - Sebastian Josfeld
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743Jena, Germany
| | - Gregor Peikert
- Network for Suicide Prevention in Thuringia (NeST), Jena, Germany
| | - Gerd Wagner
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743Jena, Germany
- Network for Suicide Prevention in Thuringia (NeST), Jena, Germany
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Tetteh J, Ekem-Ferguson G, Quarshie ENB, Swaray SM, Ayanore MA, Seneadza NAH, Asante KO, Yawson AE. Marijuana use and suicidal behaviours among school-going adolescents in Africa: assessments of prevalence and risk factors from the Global School-Based Student Health Survey. Gen Psychiatr 2021; 34:e100558. [PMID: 34557644 PMCID: PMC8395261 DOI: 10.1136/gpsych-2021-100558] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/13/2021] [Indexed: 11/05/2022] Open
Abstract
Background Marijuana use among adolescents, including high school students, has been consistently reported to be associated with a high incidence of suicidal behaviours. Little empirical research has been conducted on the propensity impact of marijuana use on suicidal behaviours in Africa. Aims To assess factors associated with marijuana use and further quantify marijuana use as an associated factor of suicidal behaviours, including repeated attempted suicide, suicidal ideation and suicide planning, among high school students in Africa. Methods A cross-sectional study was conducted among 32 802 school-going adolescents using the Global School-Based Student Health Survey data from 10 African countries grouped into West Africa, North Africa, South-East Africa, South Africa and East Africa subregions. Marijuana use and repeated attempted suicide were the main outcome variables. We employed double selection least absolute shrinkage and selection operator poisson regression model to assess risk factors associated with marijuana use and dominance analysis to establish ranked important and common risk factors. Inverse probability weighting poisson regression adjustment was applied to assess impact. Results The prevalence of marijuana use and repeated attempted suicide were 3.7% (95% CI: 3.1 to 4.3) and 6.6% (95% CI: 5.9 to 7.4), respectively. The most important risk factor for marijuana use generally across the countries and specifically in three subregions was alcohol consumption, which constituted approximately 40% of the impact. The average treatment effect on the treated (ATT) indicated that marijuana use significantly increased the risk of suicidal ideation, suicide planning and repeated attempted suicide by 12% (ATT=0.12 (95% CI: 0.02 to 0.22)), 18% (ATT=0.18 (95% CI: 0.13 to 0.22)) and 31% (ATT=0.31 (95% CI: 0.20 to 0.41)), respectively. Conclusions Marijuana use was significantly associated with suicidal behaviours (suicidal ideation, planning and repeated attempted suicide) among the students. To achieve Sustainable Development Goal 3.5 (to strengthen prevention and treatment of substance abuse), school-based psychosocial interventions should be streamlined to adequately assess and manage marijuana use. Targeting the most dominant risk factors in this population could translate into the reduction of suicidal behaviours in countries within Africa.
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Affiliation(s)
- John Tetteh
- Community Health, University of Ghana Medical School, Accra, Ghana
| | | | - Emmanuel Nii-Boye Quarshie
- Department of Psychology, School of Social Sciences, University of Ghana College of Humanities, Accra, Ghana
| | | | - Martin Amogre Ayanore
- Department of Family and Community Health, University of Health and Allied Sciences School of Public Health, Hohoe, Ghana
| | | | - Kwaku Oppong Asante
- Department of Psychology, School of Social Sciences, University of Ghana College of Humanities, Accra, Ghana
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Effectiveness of a telephone prevention programme on the recurrence of suicidal behaviour. One-year follow-up. Psychiatry Res 2021; 302:114029. [PMID: 34102375 DOI: 10.1016/j.psychres.2021.114029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/22/2021] [Indexed: 11/24/2022]
Abstract
People who have attempted suicide are considered a risk population for repeating the behaviour. Therapeutic interventions, such as telephone follow-up programmes (TFPs), are promising but more evidence for its efficacy is needed. In this multicentre, open, ex-post-facto, pre/post, one year prospective study, a previous cohort discharged from the emergency department for a suicide attempt (SA) and given routine treatment (n=207) was compared with a similar group who received the same intervention plus a structured TFP of six calls (n=203). At one year of follow-up, the efficacy of the TFP at preventing SA was assessed. A total of 53.2% (n=108) of the patients finished the TFP. A total of 20.3% (n=42) of the routine treatment group and 23.6% (n=48) of the TFP group re-attempted at least once in the follow-up period (χ2=0.7;df=1;p=.412). However, in both groups, different subsamples of patients who presented extreme risk of SA at follow-up (0-57%) were identified. In the TFP group, the recurrence of suicidal behaviour was lower in patients admitted after the index attempt and in those who had more severe psychopathological symptoms, but not in the other profiles. Thus, this study has identified a specific profile of patients who could benefit from a brief-contact intervention.
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Shaker NM, Sultan M, Mohamed MY, Helal SA, Abd El Moneam MHED. Lipid Profile and Impulsivity in Suicidal Patients with Major Depressive Disorder. Arch Suicide Res 2021; 25:641-656. [PMID: 32252618 DOI: 10.1080/13811118.2020.1746456] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Previous observational cohort studies showed an association between low serum lipid levels and suicide. This study was undertaken to examine the relationship between lipid parameters and impulsivity in suicidal patients with major depressive disorder (MDD). METHODS The current study included 100 patients with MDD distributed as 50 patients with recent suicidal attempts and 50 patients with no lifetime history of suicide. Participants were subjected to Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I) to confirm the diagnosis. The risk of suicide was assessed through the Suicide Probability Scale (SPS), while the intent and seriousness of suicide were assessed through Beck's Suicidal Intent Scale. assessment of impulsivity was carried out through Barratt Impulsivity Scale. Serum lipid levels were measured in mg/dL after an overnight fast. RESULTS Total cholesterol (TC) was found significantly lower in the suicidal group compared to the non-suicidal depressed group (p = 0.040). Low high-density lipoprotein (HDL) level was significantly correlated with suicidality and high suicide intent was correlated with hopelessness. Logistic regression for lipid profile in both groups revealed significant TC and low-density lipoprotein (LDL) as predictors for suicide. There was no significant correlation between impulsivity and characteristics of depression, suicide probability, suicide intent, and all elements of the lipid profile. CONCLUSIONS Low TC and LDL could predict suicidal behavior in patients with MDD. Impulsivity could not be a mediator or predictor of suicide risk in patients with MDD.
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Golay P, Ostertag L, Costanza A, Van der Vaeren B, Dorogi Y, Saillant S, Michaud L. Patients with first versus multiple episodes of self-harm: how do their profiles differ? Ann Gen Psychiatry 2021; 20:30. [PMID: 33985548 PMCID: PMC8120773 DOI: 10.1186/s12991-021-00351-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-harm (SH) is among the strongest predictors of further episodes of SH, suicide attempt, and death by suicide. People who repeteadly harm themselves are at even higher risk for suicide. Factors influencing the repetition are important to identify when assessing suicidal risk and thereafter to offer specific interventions. Therefore, this study aimed to compare first versus multiple episodes characteristics in a large sample of patients in french-speaking Switzerland. METHOD We used the database from the French-speaking Swiss program for monitoring SH. Data of the psychiatric assessment of all adults admitted for SH were collected in the emergency department of four Swiss city hospitals between December 2016 and October 2019. RESULTS 1730 episodes of SH were included. Several variables were significantly associated with multiple episodes, including diagnosis (over representation of personality disorders and under representation of anxiety disorders), professional activity (Invalidity insurance more frequent) and prior psychiatry care. CONCLUSIONS Patients suffering from a personality disorder and those with invalidity insurance are at risk for multiple episodes of SH and should be targeted with specific interventions.
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Affiliation(s)
- Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Psychology, Faculty of Social and Political Science, University of Lausanne, Lausanne, Switzerland
| | - Louise Ostertag
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
| | - Bénédicte Van der Vaeren
- Pole of Psychiatry and Psychotherapy, Liaison Psychiatry Service, Hospital Centre of Valais Romand, Sion, Switzerland
| | - Yves Dorogi
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stéphane Saillant
- Center for Psychiatric Emergencies and Liaison Psychiatry, Department of General and Liaison Psychiatry, Neuchâtel Psychiatry Center, Neuchâtel, Switzerland
| | - Laurent Michaud
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Malakouti SK, Nojomi M, Ghanbari B, Rasouli N, Khaleghparast S, Farahani IG. Aftercare and Suicide Reattempt Prevention in Tehran, Iran. CRISIS 2021; 43:18-27. [PMID: 33563037 DOI: 10.1027/0227-5910/a000754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: A previous suicide attempt is one of the strongest risk factors for subsequent suicide. Effective care following a suicide attempt may reduce the risk of suicide reattempts. Aims: We aimed to investigate the effect of a brief educational intervention and contact program on suicide reattempts. Method: This study was performed as a randomized clinical trial (RCT) recruiting 305 individuals who had attempted suicide (brief intervention and contact = 153 individuals, BIC; treatment as usual = 152 individuals, TAU) who were referred to Baharlu Hospital in Tehran. The SUPRE-MISS questionnaire and a discharge follow-up questionnaire were used for data collection. Cox proportional hazard models and log-rank tests were used to assess the association of the variable with the event (reattempt). Kaplan-Meier curves were used to depict the time to the event of reattempt. Results: In the BIC group, 11% of the individuals had attempted suicide once, and 25% of the TAU group had attempted suicide once (12.4%), twice (9.3%), and three times (3.8%), respectively. The results of Kaplan-Meier analysis indicated the mean time of reattempt in the BIC (0.76) and TAU groups (0.25) as the fourth and second months of follow-up, respectively (log rank, χ2 = 12.48, p < .001). The hazard ratio for the TAU group was 2.57 (95% CI [1.4, 5.9]). Limitations: Loss to follow-up due to stigma is one of the serious problems of follow-up services. Conclusion: Implementing a brief educational intervention and contact program on suicide reattempts is feasible and effective in reducing the rate of reattempt; however, it should be accommodated within the mental health services of the county.
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Affiliation(s)
- Seyed Kazem Malakouti
- Mental Health Research Center, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Nojomi
- Preventive Medicine and Public Health Research Center, Department of Community and Family Medicine, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Behrooz Ghanbari
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nafee Rasouli
- Mental Health Research Center, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Shiva Khaleghparast
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Trajectories in suicide attempt method lethality over a five-year period: Associations with suicide attempt repetition, all-cause, and suicide mortality. PLoS One 2021; 16:e0245780. [PMID: 33481936 PMCID: PMC7822301 DOI: 10.1371/journal.pone.0245780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022] Open
Abstract
It is not known if there are discernible patterns in method lethality over successive episodes of self–harm and, if so, how these may be differentially associated with risks of self–harm repetition and suicide. Latent trajectory modelling estimated variation in patterns of suicide attempt lethality in 1,719 individuals attended by ambulance services on at least three occasions between 2012 and 2016. Cox regression modelling investigated hazards of suicide attempt repetition, all–cause, and suicide mortality as a function of these patterns. Two distinct trajectories provided optimal fit (BIC: –39,464.92). The first (Low/Moderate to Low/Moderate Lethality group; 92.5%) consisted of those consistently using methods associated with low to moderate potential lethality throughout the observation period. The second (High to Low/Moderate Lethality group; 7.5%) consisted of those who initially used methods with higher potential lethality but who switched to methods characterised by lower lethality. There were no significant differences between groups in the hazards of reattempting suicide (Hazard Ratio [HR] = 1.41, 95% CI 0.76 to 2.59) or all–cause mortality (HR = 1.21, 95% CI 0.63 to 2.32). However, those assigned to the High to Low/Moderate Lethality trajectory group may be at greater risk of suicide (Sub–Hazard Ratio [SHR] = 2.82, 95% CI 1.16 to 6.86). There may be discernible sub–groups of patients with important differences in clinical treatment needs and suicide risk profiles. These differences should be considered when undertaking psychosocial risk/needs assessments with those presenting to clinical services following self-harm.
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Lübbert M, Bahlmann L, Josfeld S, Bürger J, Schulz A, Bär KJ, Polzer U, Walter M, Kastner UW, Sobanski T, Wagner G. Identifying Distinguishable Clinical Profiles Between Single Suicide Attempters and Re-Attempters. Front Psychiatry 2021; 12:754402. [PMID: 34646179 PMCID: PMC8503539 DOI: 10.3389/fpsyt.2021.754402] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/31/2021] [Indexed: 11/26/2022] Open
Abstract
More than 800,000 individuals die from suicide each year in the world, which has a devastating impact on families and society. Ten to twenty times more attempt suicide. Previous studies showed that suicide attempters represent a heterogeneous group regarding demographic characteristics, individual characteristics of a suicidal attempt, and the assumed clinical factors, e.g., hopelessness or impulsivity, thus differently contributing to the likelihood of suicidal behavior. Therefore, in the present study, we aim to give a comprehensive clinical description of patients with repeated suicide attempts compared to single attempters. We explored putative differences between groups in clinical variables and personality traits, sociodemographic information, and specific suicide attempt-related information. A sample of patients with a recent suicide attempt (n = 252), defined according to DSM-5 criteria for a suicidal behavior disorder (SBD), was recruited in four psychiatric hospitals in Thuringia, Germany. We used a structured clinical interview to assess the psychiatric diagnosis, sociodemographic data, and to collect information regarding the characteristics of the suicide attempt. Several clinical questionnaires were used to measure the suicide intent and suicidal ideations, depression severity, hopelessness, impulsivity, aggression, anger expression, and the presence of childhood trauma. Univariate and multivariate statistical methods were applied to evaluate the postulated risk factors and, to distinguish groups based on these measures. The performed statistical analyses indicated that suicide attempters represent a relatively heterogeneous group, nevertheless associated with specific clinical profiles. We demonstrated that the re-attempters had more severe psychopathology with significantly higher levels of self-reported depression, suicidal ideation as well as hopelessness. Furthermore, re-attempters had more often first-degree relatives with suicidal behavior and emotional abuse during childhood. They also exhibited a higher degree of specific personality traits, i.e., more "urgency" as a reaction to negative emotions, higher excitability, higher self-aggressiveness, and trait anger. The multivariate discriminant analysis significantly discriminated the re-attempters from single attempters by higher levels of self-aggressiveness and suicidal ideation. The findings might contribute to a better understanding of the complex mechanisms leading to suicidal behavior, which might improve the early identification and specific treatment of subjects at risk for repeated suicidal behavior.
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Affiliation(s)
- Marlehn Lübbert
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Lydia Bahlmann
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Sebastian Josfeld
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Jessica Bürger
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Alexandra Schulz
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Thüringen-Kliniken Georgius Agricola GmbH, Saalfeld, Germany
| | - Karl-Jürgen Bär
- Department of Gerontopsychiatry and Psychosomatics, Jena University Hospital, Jena, Germany
| | - Udo Polzer
- Clinics for Psychiatry, Psychotherapy and Addition Disorders, Asklepios Fachklinikum Stadtroda, Stadtroda, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Ulrich W Kastner
- Department of Psychiatry and Psychotherapy, Helios Fachkliniken Hildburghausen, Hildburghausen, Germany
| | - Thomas Sobanski
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Thüringen-Kliniken Georgius Agricola GmbH, Saalfeld, Germany
| | - Gerd Wagner
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
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Pons-Baños J, Ballester-Ferrando D, Riesco-Miranda L, Escoté-Llobet S, Jiménez-Nuño J, Fuentes-Pumarola C, Serra-Millàs M. Sociodemographic and Clinical Characteristics Associated with Suicidal Behaviour and Relationship with a Nurse-Led Suicide Prevention Programme. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238765. [PMID: 33255772 PMCID: PMC7728328 DOI: 10.3390/ijerph17238765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/13/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022]
Abstract
Suicidal behaviour is a major public health problem that needs to be tackled by all health agents including mental health nurses. Aims: The purpose of this study was to analyse the relationship between demographic and clinical characteristics and different kinds of suicidal behaviour with a nurse-led suicide prevention programme. Methods: The design was a cross-sectional study, performed in the region of Osona (Catalonia) in the five-year period 2013–2017. Suicidal behaviour was classified as suicidal ideation, interrupted self-directed violence, suicide attempt or completed suicide. Results: The sample included 753 patients (of whom 53 completed suicide) who experienced 931 suicidal behaviour episodes. Men represented only 38.4% of the sample but 81.1% of completed suicides. Mental disorders were associated with suicidal behaviour in 75.4% of the sample. Two thirds (66.4%) of the individuals (0.8% (n = 4) of whom completed suicide) were participants in a nurse-led suicidal behaviour case management programme. Conclusion: The main risk factors were being a woman for suicidal behaviour and being a man and being older for completed suicide. Mental disorders, widowhood and retirement were also associated with completed suicide. The completed suicide rate was lower among participants in the nurse-led programme.
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Affiliation(s)
- Judit Pons-Baños
- Department of Psychiatry and Mental Health, Consorci Hospitalari de Vic, 08500 Vic, Spain; (J.P.-B.); (L.R.-M.); (S.E.-L.); (M.S.-M.)
- Faculty of Health Sciences and Wellbeing, University of Vic—Central University of Catalonia, 08500 Vic, Spain
- Interinstitutional Research Group, Department of Mental Health and Social Innovation, 08500 Vic, Spain
| | - David Ballester-Ferrando
- Health and Healthcare Research Group, Department of Nursing, University of Girona, 17003 Girona, Spain;
- Correspondence: ; Tel.: +34-972-418771
| | - Lola Riesco-Miranda
- Department of Psychiatry and Mental Health, Consorci Hospitalari de Vic, 08500 Vic, Spain; (J.P.-B.); (L.R.-M.); (S.E.-L.); (M.S.-M.)
- Faculty of Health Sciences and Wellbeing, University of Vic—Central University of Catalonia, 08500 Vic, Spain
| | - Santiago Escoté-Llobet
- Department of Psychiatry and Mental Health, Consorci Hospitalari de Vic, 08500 Vic, Spain; (J.P.-B.); (L.R.-M.); (S.E.-L.); (M.S.-M.)
- Interinstitutional Research Group, Department of Mental Health and Social Innovation, 08500 Vic, Spain
| | - Jordi Jiménez-Nuño
- Vic Forensic Medicine Department, Institute of Legal Medicine and Forensic Sciences of Catalonia, 08500 Vic, Spain;
| | | | - Montserrat Serra-Millàs
- Department of Psychiatry and Mental Health, Consorci Hospitalari de Vic, 08500 Vic, Spain; (J.P.-B.); (L.R.-M.); (S.E.-L.); (M.S.-M.)
- Faculty of Health Sciences and Wellbeing, University of Vic—Central University of Catalonia, 08500 Vic, Spain
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Núñez D, Ulloa JL, Guillaume S, Olié E, Alacreu-Crespo A, Courtet P. Suicidal ideation and affect lability in single and multiple suicidal attempters with Major Depressive Disorder: An exploratory network analysis. J Affect Disord 2020; 272:371-379. [PMID: 32553380 DOI: 10.1016/j.jad.2020.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/28/2020] [Accepted: 04/01/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION A better understanding of the specific contribution of risk factors to suicidal behavior could arise from analyzing suicidal ideation (SI) in clinical samples, and comparing single versus multiple suicide attempters through contemporary methods allowing complex and dynamical analyses of multiple and simultaneously interacting suicide risk factors. METHOD We explored associations among suicidal ideation (SI), affect lability and other suicide risk factors in 323 suicidal attempters diagnosed with major depressive disorder (MDD). We analyzed the network structure and centrality of the total sample, and compared single versus multiple attempters and subjects with low and high suicidal ideation. RESULTS SI was connected with anxiety (trait) and hopelessness. Central nodes for global and specific groups were affect lability (from anxiety to depression), anxiety as a trait, and harm avoidance. We observed some specific differences between clinical profiles of repeaters and non-repeaters and significant network density between high and low SI. LIMITATIONS Because our cross-sectional design, we cannot establish casual relationships among variables. We only examined associations at group level but not at single subject level. CONCLUSIONS Affect lability (mainly the shifts from anxiety to depression) and trait anxiety were central in each estimated network. These symptoms might be suitable targets for early detecting and treating suicidal patients.
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Affiliation(s)
- D Núñez
- Faculty of Psychology, Universidad de Talca, Chile.; Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay.
| | - J L Ulloa
- Faculty of Psychology, Universidad de Talca, Chile
| | - S Guillaume
- Département d'Urgences & Post Urgence Psychiatrique, CHU Montpellier, University of Montpellier, France
| | - E Olié
- Département d'Urgences & Post Urgence Psychiatrique, CHU Montpellier, University of Montpellier, France
| | - A Alacreu-Crespo
- Département d'Urgences & Post Urgence Psychiatrique, CHU Montpellier, University of Montpellier, France
| | - P Courtet
- Département d'Urgences & Post Urgence Psychiatrique, CHU Montpellier, University of Montpellier, France
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Analysis of attempted suicide episodes presenting to the emergency department: comparison of young, middle aged and older people. Int J Ment Health Syst 2020; 14:46. [PMID: 32582367 PMCID: PMC7310195 DOI: 10.1186/s13033-020-00378-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 06/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background Attempted suicide remains difficult for clinicians to predict with some established risk factors. We investigate the detailed characteristics of attempted suicide especially according to age and methods of suicide attempts. Methods A retrospective study was conducted to evaluate patients who visited the emergency department due to attempted suicide. A retrospective medical record review of all patients who presented to the emergency department (ED) of two tertiary teaching hospitals in Korea after suicide attempt between January 1, 2010, and December 31, 2017 was performed. Demographic information and detailed variables (methods and reasons of suicide attempts and variables regarding reattempts) were investigated. Total participants were classified into 3 groups according to age, young group, middle aged group and the older group, and each characteristics were compared. Results A total of 3698 patients were enrolled in this study. Deliberate self-poisoning (DSP) was the most common method of attempted suicide (66.5%) followed by cutting (24.4%), hanging (7.9%), falling (2.6%), and drowning (1.1%). In patients who had previous suicide attempts (n = 1029, 27.8%), attempted methods were likely to be concordant with previous attempted methods. The most common reason for suicide attempts was interpersonal relationship issues followed by socio-economic reasons. Older patients (n = 412, 11.2%) were significantly different from other 2 groups (n = 3286, 88.8%) regarding gender, suicide re-attempt, occupation, alcohol co-ingestion, previous psychiatric history, and discharge outcomes (all p-values < 0.001). Especially, in older patients, use of critical method and reason of physical illness were more common. Conclusion Our findings indicated that people who attempted suicide might have different sociodemographic and clinical factors depending on age group. Depending on age, it is necessary to apply additional suicide intervention programs in different ways.
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Alexithymia and self-harm: A review of nonsuicidal self-injury, suicidal ideation, and suicide attempts. Psychiatry Res 2020; 288:112920. [PMID: 32279008 DOI: 10.1016/j.psychres.2020.112920] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Suicide attempts are a significant global public health concern. Research into non-traditional factors, such as the presence of alexithymia, may shed light on the prediction of suicidal behaviours, which can aid intervention and prevention strategies. To ascertain whether alexithymia is a unique risk factor for suicide attempts, this article reviews the evidence on alexithymia related to suicidal ideation, attempts, and non-suicidal self-injury (NSSI). METHODS A literature search was conducted for original articles examining the general and psychiatric populations. RESULTS There is consistent evidence linking alexithymia with suicidal ideation and NSSI, but inconsistent evidence linking it to suicide attempts. CONCLUSION The relationship between alexithymia and suicidality seems to differ based on whether the research focuses on suicidal ideation, suicide attempts, or NSSI. The relationship between alexithymia and suicidality can be understood within the context of multiple code theory and childhood trauma. Future research should explore the whether alexithymia can reliably distinguish between those with a single attempt and those with multiple suicide attempts as well as alexithymia levels pre- and post-intervention with suicide-related behavior as outcomes in treatment studies.
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Taron M, Nunes C, Maia T. Suicide and suicide attempts in adults: exploring suicide risk 24 months after a psychiatric emergency room visit. ACTA ACUST UNITED AC 2020; 42:367-371. [PMID: 32491023 PMCID: PMC7430398 DOI: 10.1590/1516-4446-2019-0583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 12/20/2019] [Indexed: 11/22/2022]
Abstract
Objective: Suicide risk (including attempted and completed suicide) should be measured over short periods of time after contacting health services. The objective of this study was to identify the patterns of attempted and completed suicides within 24-months of a psychiatric emergency department visit, as well as to investigate predictive risk factors, including sociodemographic and clinical variables, previous suicidal behavior, and service utilization. Method: A convenience sample (n=147), recruited at a general hospital’s psychiatric emergency room, included patients with suicidal ideation, suicidal plans or previous suicide attempts. These patients were followed for 24 months, focusing on two main outcomes: attempted and completed suicides. Results: After six months there were no completed suicides and 36 suicide attempts, while after 24 months there were seven completed suicides and 69 suicide attempts. A final logistic regression model for suicide attempts at 24 months identified somatic pathology and the number of previous psychiatric hospitalizations as predictive factors, with a good area under the receiver operating characteristic curve. Conclusions: The findings showed distinct patterns of attempted and completed suicides over time, indicating the importance of a systematic multidisciplinary suicide risk evaluation in psychiatric emergency rooms.
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Affiliation(s)
- Marisa Taron
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Carla Nunes
- Departamento de Estatística, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Teresa Maia
- Departamento de Saúde Mental, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
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Hodé Y, Dubreucq J, Valladier E, Guillard Bouhet N, Lemestré S, Attal J, Canceil O, Biotteau M, Laffond P, Raynaud A, Chéreau-Boudet I, Montagne Larmurier A, Giordana JY, Saingery B, d'Amato T, Willard D. [Suicidal risk prevention in schizophrenia: Importance of family psychoeducation]. Encephale 2020; 46:450-454. [PMID: 32317163 DOI: 10.1016/j.encep.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 02/03/2020] [Accepted: 02/07/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Although mortality by suicide in schizophrenia seems to have decreased in some countries over the last 30 years, it remains much higher than in the general population. Studies have shown this risk to impact around 5% of patients, corresponding to a risk almost 2.5 times higher than in the general population. Family psychoeducation in schizophrenia has been demonstrated to lead to symptom reductions and to an improvement of the quality of life, two factors that should contribute to decreasing the suicidal risk. Therefore, if families attend an efficient psychoeducation program, we can expect a decrease in the patient suicidal risk. Attending a family psychoeducation program at the beginning of the disease would also be associated with a stronger preventive effect on suicidal mortality. The objective of this study is to describe the suicide attempt rate of patients who suffer from schizophrenia before and one year after one of their relatives participated to the family psychoeducation program Profamille. METHOD We performed a retrospective study on 1209 people who attended the Profamille (V3.2 version) Family Psychoeducation Program. This program has 2 modules: an initial training module of 14 weekly or fortnightly sessions, and a consolidation module of 4 sessions over 2 years. Sessions last 4 hours and follow a precise and structured course. Data were collected from 40 different centers in France, Belgium and Switzerland and were based on participants assessed at the beginning and one year after the first module. Self-assessment from the relatives participating in the program provided the measure of patients' suicide attempts. An assessment at T0 explored the attempts over the 12 months before the beginning of the program while the assessment at T1 analyzed those during the 12 months following the end of the Program. The Chi2 test was used to compare the suicide attempt rates for each period, using a significance threshold of 0.05. Since the risk of suicide is greater in the first years of the illness, rates of attempts are also calculated according to the age of disorder. The analysis was carried out with the statistical software R. RESULTS The number of participants reporting that their relative had attempted suicide in the previous 12 months decreased from 41 to 21. The annual attempts rate was evaluated at 6.4 % before the Profamille program and decreased to 2.4 % a year after the end of the program (P=0.0003). The reduction of the attempt rate was observed even for patients with schizophrenia for more than 10 years. CONCLUSION This study shows the positive impact of Profamille on reducing the rate of suicide attempts in patients with schizophrenia. It has been shown that the risk is highest at the beginning of the disorder. Therefore, based on our results, it would seem appropriate to propose the Profamille program at an early stage.
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Affiliation(s)
- Y Hodé
- Institut de psychiatrie GDR 3557 Paris, 1, rue Cabanis, 75014 Paris, France.
| | - J Dubreucq
- C3r CH Alpes-Isère, 3, rue de la Gare, 38120 Saint-Égrève, France
| | - E Valladier
- Service hospitalo-universitaire-S14, centre référent en remédiation cognitive et réhabilitation psychosociale (C3RP), centre hospitalier Sainte-Anne, 75014 Paris, France
| | - N Guillard Bouhet
- CREATIV, centre hospitalier H. Laborit, Poitiers, 370, avenue Jacques-Cœur, 86021 Poitiers, France
| | - S Lemestré
- ASBL Similes Wallonie, rue Lairesse, 15, 4020 Liège, Belgique
| | - J Attal
- Service universitaire de psychiatrie adulte, hôpital la Colombière, CHRU Montpellier, 191, avenue du Doyen Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - O Canceil
- Pôle Paris 12 - Secteur 75G10/11 hôpitaux de Saint-Maurice, 12-4, rue du Val d'Osne, 94410 Saint-Maurice, France
| | - M Biotteau
- Département de psychiatrie, CHU de Tours, 37044 Tours cedex 9, France
| | - P Laffond
- Hôpital de Malévoz, route de Morgins, 10, 1870 Monthey, Suisse
| | - A Raynaud
- Filière ambulatoire, centre hospitalier Esquirol, 15, rue Doct Raymond-Marcland, 87000 Limoges, France
| | - I Chéreau-Boudet
- Service de psychiatrie de l'adulte, CHU de Clermont-Ferrand, rue Montalembert, BP 69, 63003 Clermont-Ferrand, France
| | - A Montagne Larmurier
- Service de psychiatrie adulte, CHU de Caen, avenue de la Côte de Nacre CS 30001, 14033 Caen cedex 9, France
| | - J-Y Giordana
- CHS Sainte-Marie, 87, avenue Joseph-Raybaud, 06200 Nice, France
| | - B Saingery
- EPSM des Ardennes CHS Bélair, 1, rue Pierre-Hallali, 08000 Charleville-Mézières, France
| | - T d'Amato
- SHU pôle est, centre hospitalier Le-Vinatier, BP 30039 - 95, boulevard Pinel, 69678 Bron, France
| | - D Willard
- C3R-P/CJAAD, service hospitalo-universitaire, GHU Paris psychiatrie et neurosciences, 1, rue Cabanis, 75014 Paris, France
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Psychiatric diagnosis, gender, aggression, and mode of attempt in patients with single versus repeated suicide attempts. Psychiatry Res 2020; 284:112747. [PMID: 31927168 DOI: 10.1016/j.psychres.2020.112747] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 12/01/2019] [Accepted: 01/01/2020] [Indexed: 12/31/2022]
Abstract
There is evidence that patients with multiple suicide attempts in their history are at greater risk to repeat attempt and eventually die by suicide compared to those with a single attempt. This cross-sectional study aimed to explore possible differences in clinical characteristics between patients with a single attempt and patients with repeated attempts. Two hundred thirty one patients hospitalised in psychiatric department after suicide attempt were studied. Comparisons were made in relation to age, gender, psychiatric diagnosis, aggression, depression severity, suicide intent and mode of attempt. Highest frequencies of patients with repeated attempts were found for bipolar disorder (69%) and lowest for adjustment/personality disorders (39%). In patients with repeated attempts, female gender was associated with non-violent attempt mode. Depressive symptomatology was higher in patients with repeated attempts among females. In patients with depression those with repeated attempts were younger than patients with single attempt. In patients with mood disorders, total aggression and hostility scores were higher in females with repeated attempts but not in males. Psychiatric diagnosis, gender and attempt mode are features that differentiate patients with single and repeated attempts and should be considered to identify patients at increased risk to repeat attempt and design effective prevention interventions.
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Cepeda MS, Schuemie M, Kern DM, Reps J, Canuso C. Frequency of rehospitalization after hospitalization for suicidal ideation or suicidal behavior in patients with depression. Psychiatry Res 2020; 285:112810. [PMID: 32062326 DOI: 10.1016/j.psychres.2020.112810] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 11/19/2022]
Abstract
This study sought to: 1. determine the frequency of rehospitalization with diagnosis of suicidal ideation or suicide attempt (SI/SA) within a year and how often patients had multiple rehospitalizations; 2. identify the time period for which the risk of rehospitalization is highest; and 3. determine the characteristics of patients with multiple rehospitalizations. We conducted a retrospective cohort study of adults with depression using 4 US health claims databases. We defined hospitalization as an inpatient or emergency room visit with codes indicating a suicide attempt or suicidal thoughts using a validated algorithm. Rates of rehospitalization with SI or SA were analyzed together and separately, including multiple re-hospitalizations with SI/SA. Across all databases 121,065 patients were hospitalized with a diagnosis of SI/SA. Rates of rehospitalization within a year ranged from 7.96% to 11.24%. The risk of rehospitalization with SI/SA is highest during the first month. Nearly 50% of rehospitalizations occurred within 3 months after initial hospitalization. Patients with rehospitalization(s) had more anxiety disorders, sleep disorders and substance use disorders than patients without. Among patients with depression hospitalized for SI/SA, rehospitalization for SI/SA within a year is not uncommon. Risk of rehospitalization with a diagnosis of SI/SA is highest during the first month.
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Affiliation(s)
- M Soledad Cepeda
- Epidemiology Dept. Janssen Research and Development, 1125 Trenton Harbourton Rd., Titusville, NJ 08560.
| | - Martijn Schuemie
- Epidemiology Dept. Janssen Research and Development, 1125 Trenton Harbourton Rd., Titusville, NJ 08560
| | - David M Kern
- Epidemiology Dept. Janssen Research and Development, 1125 Trenton Harbourton Rd., Titusville, NJ 08560
| | - Jenna Reps
- Epidemiology Dept. Janssen Research and Development, 1125 Trenton Harbourton Rd., Titusville, NJ 08560
| | - Carla Canuso
- Neuroscience Dept. Janssen Research and Development, 1125 Trenton Harbourton Rd., Titusville, NJ 08560
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Huang WC, Yen TH, Lin L, Lin C, Juang YY, Wang BH, Lee SH. Clinical Characteristics of Pesticide Self-Harm as Associated with Suicide Attempt Repetition Status. Neuropsychiatr Dis Treat 2020; 16:1717-1726. [PMID: 32764947 PMCID: PMC7371433 DOI: 10.2147/ndt.s258475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/28/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Previous suicide behavior predicts future suicide risk. Studies of suicide repetition are important for suicide prevention. This study examined the clinical characteristics and psychiatric comorbidities of pesticide self-harm as associated with suicide attempt repetition status. PATIENTS AND METHODS This retrospective, observational study included patients admitted to a medical center in northern Taiwan between 2000 and 2015 following suicide attempts by pesticide. Diagnoses were made by a consultation-liaison psychiatry team based on the DSM IV-TR criteria. Independent samples t-test was used to analyze the quantitative variables and Pearson's Chi-squared test with a Bonferroni adjustment for categorical variables. Univariate binary logistic regression analysis was conducted to determine the predictors for repeated suicide attempt and multivariate binary logistic regression analysis to identify significant associated factors. RESULTS Among 151 patients, organophosphate pesticides were the most used (80.8%). The average age was 52.9±17.2 years. Most patients were married males from rural areas, with depressive disorder most often diagnosed (40.4%). Nearly one-third of them were suicide repeaters (n=43, 28.5%); these patients were less likely to be married (53.5%, p=0.001), had previously used psychiatric services (72.1%, p<0.001) and chose complex suicide (46.5%, p=0.014) more often compared to nonrepeaters. No significant differences were found between repeaters and nonrepeaters regarding psychiatric comorbidities. Multivariate logistic regression analysis revealed that marital status (odds ratio: 2.916, 95% confidence interval: 1.234-6.891, p=0.015) and previous psychiatric services usage (odds ratio: 6.897, 95% confidence interval: 3.012-15.625, p<0.001) were significant risk factors associated with suicide repetition. CONCLUSION Pesticide suicide repeaters were characterized by less likely to be married and more likely to use psychiatric services before suicide attempts. These features help ensuring that the needs of people who have made a suicide attempt are addressed, and it reduces the likelihood of repetition.
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Affiliation(s)
- Wei-Chen Huang
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Long Lin
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chemin Lin
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yeong-Yuh Juang
- Department of Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Bi-Hwa Wang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shwu-Hua Lee
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Berrouiguet S, Billot R, Larsen ME, Lopez-Castroman J, Jaussent I, Walter M, Lenca P, Baca-García E, Courtet P. An Approach for Data Mining of Electronic Health Record Data for Suicide Risk Management: Database Analysis for Clinical Decision Support. JMIR Ment Health 2019; 6:e9766. [PMID: 31066693 PMCID: PMC6707587 DOI: 10.2196/mental.9766] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 06/30/2018] [Accepted: 07/26/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In an electronic health context, combining traditional structured clinical assessment methods and routine electronic health-based data capture may be a reliable method to build a dynamic clinical decision-support system (CDSS) for suicide prevention. OBJECTIVE The aim of this study was to describe the data mining module of a Web-based CDSS and to identify suicide repetition risk in a sample of suicide attempters. METHODS We analyzed a database of 2802 suicide attempters. Clustering methods were used to identify groups of similar patients, and regression trees were applied to estimate the number of suicide attempts among these patients. RESULTS We identified 3 groups of patients using clustering methods. In addition, relevant risk factors explaining the number of suicide attempts were highlighted by regression trees. CONCLUSIONS Data mining techniques can help to identify different groups of patients at risk of suicide reattempt. The findings of this study can be combined with Web-based and smartphone-based data to improve dynamic decision making for clinicians.
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Affiliation(s)
- Sofian Berrouiguet
- Adult Psychiatry, Brest Medical University Hospital at Bohars, Brest, France.,EA 7479 Soins Primaires, Santé Publique, Registre des Cancers de Bretagne Occidentale, Université de Bretagne Occidentale, Brest, France.,Mental Health Department, University Hospital of Brest, Brest, France.,F-29238, Laboratoire des Sciences et Techniques de l'information de la Communication et de la Connaissance, IMT Atlantique, Brest, France
| | - Romain Billot
- F-29238, Laboratoire des Sciences et Techniques de l'information de la Communication et de la Connaissance, IMT Atlantique, Brest, France
| | - Mark Erik Larsen
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | | | - Isabelle Jaussent
- Inserm U1061, La Colombières Hospital, University of Montpellier, Montpellier, France
| | - Michel Walter
- Adult Psychiatry, Brest Medical University Hospital at Bohars, Brest, France
| | - Philippe Lenca
- F-29238, Laboratoire des Sciences et Techniques de l'information de la Communication et de la Connaissance, IMT Atlantique, Brest, France
| | - Enrique Baca-García
- Carlos III Institute Of Health, Centro de Investigation en Salud Mental, Madrid, Spain.,Department of Psychiatry, Universitad Catolica del Maule, Talca, Chile.,Department of Psychiatry, General Hospital of Villaba, Madrid, Spain.,Department of Psychiatry, University Hospital Rey Juan Carlos, Mostoles, Spain.,Department of Psychiatry, University Hospital Infanta Elena, Valdemoro, Spain.,Psychiatry Department, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Psychiatry, Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
| | - Philippe Courtet
- Inserm U1061, La Colombières Hospital, University of Montpellier, Montpellier, France.,Department of Psychiatry, General Hospital of Villaba, Madrid, Spain.,Department of Psychiatry, University Hospital Rey Juan Carlos, Mostoles, Spain.,Department of Emergency Psychiatry and Acute Care, Centre Hospitalier Universitaire de Montpellier, Université Montpellier, Montpellier, France.,Fondamental Foundation, Créteil, France
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Mental disorders as risk factors for suicidal behavior in young people: A meta-analysis and systematic review of longitudinal studies. J Affect Disord 2019; 245:152-162. [PMID: 30390504 DOI: 10.1016/j.jad.2018.10.115] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 10/09/2018] [Accepted: 10/24/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Suicide is the second leading cause of death for young people. OBJECTIVE To assess mental disorders as risk factors for suicidal behaviour among adolescents and young adults including population-based longitudinal studies. METHOD We conducted a systematic literature review. Bibliographic searches undertaken in five international databases and grey literature sources until January 2017 yielded a total of 26,883 potential papers. 1701 full-text articles were assessed for eligibility of which 1677 were excluded because they did not meet our eligibility criteria. Separate meta-analyses were conducted for each outcome (suicide death and suicide attempts). Odds ratio (OR) and 95% confidence intervals (95%CI) and beta coefficients and standard errors were calculated. RESULTS 24 studies were finally included involving 25,354 participants (12-26 years). The presence of any mental disorder was associated with higher risk of suicide death (OR = 10.83, 95%CI = 4.69-25.00) and suicide attempt (OR = 3.56; 95%CI 2.24-5.67). When considering suicidal attempt as the outcome, only affective disorders (OR = 1.54; 95%CI = 1.21-1.96) were significant. Finally, the results revealed that psychiatric comorbidity was a primary risk factor for suicide attempts. LIMITATIONS Data were obtained from studies with heterogeneous diagnostic assessments of mental disorders. Nine case-control studies were included and some data were collected in students, not in general population. CONCLUSIONS Mental disorders and comorbidity are strong predictors of suicide behaviour in young people. Detection and management of the affective disorders as well as their psychiatric comorbidity could be a crucial strategy to prevent suicidality in this age group.
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López-Goñi JJ, Goñi-Sarriés A, Azcárate-Jiménez L, Sabater-Maestro P. Suicidal behaviour recurrence in psychiatric emergency departments of patients without a prior suicide attempt, index and reattempters: A prospective study. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2018; 13:192-201. [PMID: 30473478 DOI: 10.1016/j.rpsm.2018.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There has been little change in the incidence of suicidal behaviour and reattempts in recent years. Evidence is needed on the incidence of suicidal behaviour in the psychiatric population and its follow-up. MATERIAL AND METHOD A prospective multi-centre case-control study. The sample covered the cases of 440 patients seen as psychiatric emergencies. For this purpose, we used the Vital Adverse Event Scale by Brugha and screening with the Columbia Scale. The sample was divided into three groups: patients without prior suicide attempts, patients with an index attempt and patients with more than one attempt. At two years, the clinical histories of these patients were reviewed, assessing for suicidal behaviour. RESULTS A total of 49.1% (n=216) of the patients required urgent psychiatric care during the follow-up period, and 2.7% eventually committed suicide. The data shows a differential profile between the three groups analysed. Among them, the group of reattempters required the highest number of interventions regarding suicide behaviour (11.0%; χ2=30.3; d.f.=2; P<.001). Eventually, 6.1% of the patients without prior suicide attempts tried to commit suicide for the first time, and 21.7% (n=60) of the remaining sample repeated their prior attempts. The highest risk of attempt was in the thirty days following the urgent intervention. After this period, risk distribution varied for each group. Three items from the Columbia Scale predict suicide behaviour. CONCLUSIONS The results show the need for assessing suicidal behaviour for all patients who receive psychiatric urgent care, including during the follow-up period. A more thorough control should be performed during the first months for patients without prior suicide attempts, and longer periods for those patients who have already tried to commit suicide.
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Affiliation(s)
| | - Adriana Goñi-Sarriés
- Red de Salud Mental de Navarra, Servicio Navarro de Salud - Osasunbidea, Pamplona, España
| | - Leire Azcárate-Jiménez
- Red de Salud Mental de Navarra, Servicio Navarro de Salud - Osasunbidea, Pamplona, España
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Abstract
OBJECTIVE Conceptual understandings of meaning-making suggest that it may have protective value in regard to alcohol misuse and suicidal behavior. Accordingly, the aim of this study was to examine whether meaning-making attenuated the relationship between alcohol misuse and suicide risk severity in a population of active-duty service members. METHODS The sample (N = 97) was recruited while presenting for emergency behavioral health services in circumstances indicative of high-risk suicidality: endorsing current suicidal ideation with intent to die. Those who reported ideation with a lifetime history of a past suicide attempt were conceptualized as being in a more severe category of suicide risk than ideation without a lifetime history of a past suicide attempt. Participants completed the Suicidal Behaviors Questionnaire-Revised, Meaning in Life Questionnaire, Alcohol Use Disorders Identification Test consumption questions, and items that assessed demographic variables. Data were analyzed using chi-squared test of independence, Fisher's exact test, Kendall rank correlation coefficient, and logistic regression modeling. RESULTS Regression analysis identified a statistically significant association between number of drinks consumed daily and reporting a lifetime history of a past suicide attempt, odds ratio (OR) = 1.60, 95% confidence interval (CI) [1.11, 2.32], p = .01. Number of drinks consumed remained significant even after adjusting for both the search for and presence of meaning, OR = 1.70, 95% CI [1.16, 2.51], p = .01. These results remained unchanged even when adjusting for gender, race, ethnicity, and relationship status. No statistically significant interaction effects were noted between meaning-making and alcohol consumption. CONCLUSIONS Meaning-making did not appear to attenuate the effect of alcohol misuse on suicide risk severity in a sample of service members at high-risk of suicidality. Additional research is needed to better understand the relationship among meaning-making, alcohol misuse, and suicidal behavior.
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Affiliation(s)
- Marek S Kopacz
- a U.S. Department of Veterans Affairs , VISN 2 Center of Excellence for Suicide Prevention , Canandaigua , New York , USA.,b U.S. Department of Veterans Affairs , Mid-Atlantic Mental Illness Research, Education and Clinical Center, Mental Health and Chaplaincy , Durham , North Carolina , USA
| | - Craig J Bryan
- c National Center for Veterans Studies , The University of Utah , Salt Lake City , Utah , USA
| | - Todd M Bishop
- a U.S. Department of Veterans Affairs , VISN 2 Center of Excellence for Suicide Prevention , Canandaigua , New York , USA.,d University of Rochester Medical Center , Rochester , NY , USA
| | - Lisham Ashrafioun
- a U.S. Department of Veterans Affairs , VISN 2 Center of Excellence for Suicide Prevention , Canandaigua , New York , USA.,d University of Rochester Medical Center , Rochester , NY , USA
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Spivey LA, Prinstein MJ. A Preliminary Examination of the Association between Adolescent Gender Nonconformity and Suicidal Thoughts and Behaviors. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2018; 47:707-716. [PMID: 30264279 DOI: 10.1007/s10802-018-0479-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Suicidal thoughts and behaviors are a significant health concern for adolescents. Extant research suggests that sexual and gender minority adolescents are a vulnerable population at elevated risk for suicidal thoughts and behaviors, yet to date few studies have examined the unique associations between adolescent gender nonconformity and suicide risk. This study examined data from the Youth Risk Behavior Surveillance Survey (n = 7730) to estimate the association between gender nonconformity and high school-aged adolescents' likelihood of endorsing four distinct suicide outcomes: suicidal ideation, suicide plans, any suicide attempts, and single vs. multiple suicide attempts. Multivariate logistic regression analyses were utilized to control for other known risk factors for suicidal thoughts and behaviors, including age, sex, sexual minority status, depression symptoms, and suicidal ideation. Results revealed that gender nonconformity was significantly associated with higher odds of reporting suicidal ideation, suicide plans, and multiple suicide attempts in the past year above and beyond other known risk factors. Gender nonconformity is an understudied vulnerability factor that should be taken into consideration by researchers and clinicians seeking to understand adolescents' risk for suicidal thoughts and behaviors.
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Affiliation(s)
- Leigh A Spivey
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC, 27599, USA.
| | - Mitchell J Prinstein
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC, 27599, USA
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Kim H, Park J, Kweon K, Ahn J. Short- and Long-term Effects of Case Management on Suicide Prevention among Individuals with Previous Suicide Attempts: a Survival Analysis. J Korean Med Sci 2018; 33:e203. [PMID: 30079004 PMCID: PMC6070468 DOI: 10.3346/jkms.2018.33.e203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/08/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study examined the long-term preventive effects of a case management service on suicide reattempts, and clarified the factors related to suicide reattempts. METHODS We reviewed the medical records of suicide attempters who visited the emergency department of Ulsan University Hospital from August 28, 2013 to July 31, 2017. A 4-week case management service was provided to consenting participants, either face-to-face or by telephone. Using survival analysis, we analyzed differences in the time to the next emergency department visit for a suicide attempt according to whether participants completed the case management service. We also assessed which characteristics of participants were associated with suicide reattempts. RESULTS We found no overall difference in time to suicide reattempt between case-managed participants and controls over the entire observation period (median period: 19 months). However, in the first 24 weeks after the initial suicide attempt, the case-managed group showed a longer time to reattempt than did the control group (log-rank test = 4.243; P = 0.039). A higher risk of reattempt was found among participants with the medical benefit type of health insurance compared to those with national health insurance (hazard ratio [HR], 5.134; P < 0.001) and among participants aged 20-39 compared to those aged ≥ 60 (HR, 3.502; P = 0.05). CONCLUSION Case management had only short-term benefits (within 24 weeks of initial suicide attempt). Risk factors for suicide reattempts were having a medical benefit health insurance and being aged 20-39 years.
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Affiliation(s)
- Hyeonjae Kim
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jangho Park
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kukju Kweon
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Joonho Ahn
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Lucero B, Saracini C, Muñoz-Quezada MT, Mendez-Bustos P, Mora M. Laboratory of the Neuropsychology and Cognitive Neurosciences Research Center of Universidad Católica del Maule, Chile. Cogn Process 2018; 19:465-472. [PMID: 29948428 DOI: 10.1007/s10339-018-0871-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022]
Abstract
The Laboratory of the Neuropsychology and Cognitive Neurosciences Research Center (CINPSI Neurocog), located in the "Technological Park" building of the Catholic University of Maule (Universidad Católica del Maule, UCM) campus in Talca, Chile, has been established as "Psychology Lab" recently in July, 2016. Our lines of work include basic and applied research. Among the basic research, we study executive functions, decision-making, and spatial cognition. In the applied field, we have studied neuropsychological and neurobehavioral effects of pesticides exposure, among other interests. One of our aims is to develop collaboration both national and internationally. It is important to mention that to date there are only few psychology laboratories and research centers in Chile involved with the fields of neuropsychology and neurosciences. Thus, this scientific effort could be a groundbreaking initiative to develop specific knowledge in this area locally and interculturally through its international collaborations.
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Affiliation(s)
- Boris Lucero
- Faculty of Health Sciences, Universidad Católica del Maule, Talca, Chile. .,The Neuropsychology and Cognitive Neurosciences Research Center (CINPSI Neurocog), Universidad Católica del Maule, Avenida San Miguel 3605, Edificio Parque Científico Tecnológico, Talca, VII Región del Maule, Talca, 3460000, Chile.
| | - Chiara Saracini
- VRIP de la Universidad Católica del Maule, Talca, Chile.,The Neuropsychology and Cognitive Neurosciences Research Center (CINPSI Neurocog), Universidad Católica del Maule, Avenida San Miguel 3605, Edificio Parque Científico Tecnológico, Talca, VII Región del Maule, Talca, 3460000, Chile
| | - María Teresa Muñoz-Quezada
- Faculty of Health Sciences, Universidad Católica del Maule, Talca, Chile.,The Neuropsychology and Cognitive Neurosciences Research Center (CINPSI Neurocog), Universidad Católica del Maule, Avenida San Miguel 3605, Edificio Parque Científico Tecnológico, Talca, VII Región del Maule, Talca, 3460000, Chile
| | - Pablo Mendez-Bustos
- Faculty of Health Sciences, Universidad Católica del Maule, Talca, Chile.,The Neuropsychology and Cognitive Neurosciences Research Center (CINPSI Neurocog), Universidad Católica del Maule, Avenida San Miguel 3605, Edificio Parque Científico Tecnológico, Talca, VII Región del Maule, Talca, 3460000, Chile
| | - Marco Mora
- LITRP, Universidad Católica del Maule, Talca, Chile
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Pennel L, Quesada JL, Dematteis M. Neuroticism and anxious attachment as potential vulnerability factors of repeat suicide attempts. Psychiatry Res 2018; 264:46-53. [PMID: 29626831 DOI: 10.1016/j.psychres.2018.03.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 11/30/2022]
Abstract
The recurrence risk of suicide attempts can reach 50% in the first year, each attempt increasing suicide-risk by 32%. No screening tool efficiently identifies potential repeat suicide attempters who are too often regarded as borderline personality. Our aim was to identify individual and interpersonal psychopathological dimensions that could represent a vulnerability to repeat suicide attempts. Sixty first-time and repeat suicide attempters consecutively admitted in emergency rooms were compared for fundamental dimensions of personality, patterns of attachment, personality and mental disorders using standardized questionnaires. Confounding and significantly different factors were evaluated using univariate and multivariate logistic regressions. Repeat suicide attempters differed from first-attempters by higher neuroticism and anxious attachment. Combined in an 11-item measure, these two parameters identified a 3.99 times higher risk of repeat suicide attempt. These traits associated with the other two best predictors (non-suicidal self-injury history, current psychotropic drugs) provide a vulnerability model with better screening performance compared to each factor individually. Repeat suicide attempters have more psychological features impairing emotional stability and social interactions than first attempters. Cross-sectional study design, sample size, lack of independent sample and of fearful-avoidant attachment evaluation are the main limitations. The model needs to be validated in a prospective and controlled study.
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Affiliation(s)
- Lucie Pennel
- Univ. Grenoble Alpes, F-38042 Grenoble, France; CHU Grenoble Alpes, Department of Addiction Medicine, F-38043 Grenoble, France
| | - Jean-Louis Quesada
- CHU Grenoble Alpes, Clinical Investigation Center 1406, F-38043 Grenoble, France
| | - Maurice Dematteis
- Univ. Grenoble Alpes, F-38042 Grenoble, France; CHU Grenoble Alpes, Department of Addiction Medicine, F-38043 Grenoble, France.
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Abstract
This study examines the relative risk for suicide attempts (SA) among high-school students self-identifying with one or more disability classifications (nine); assesses the extent to which youth with disabilities are disproportionately vulnerable to risk factors that predict suicidal behavior among all adolescents; and explores whether disability status adds to risk for SA after accounting for a comprehensive set of known risk and protective factors for SA. Analyses using Wisconsin's 2012 Dane County Youth Assessment Survey data found that youth in each disability category were 3-9 times more likely to report suicide attempt(s) relative to peers, and the endorsement of multiple disabilities tripled the risk SA relative to youth reporting a single disability. Some disability sub-groups, including youth reporting autism spectrum disorder, hearing, and vision impairments reported surprisingly high rates of SA. While youth with disabilities reported disproportionate exposure to adversity in every life domain examined, similar to youth reporting SA, disability status added unique risk for suicidal behavior. This suggests that disability may be a 'fundamental cause' of suicidal behavior, a question that requires further investigation.
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Olfson M, Wall M, Wang S, Crystal S, Bridge JA, Liu SM, Blanco C. Suicide After Deliberate Self-Harm in Adolescents and Young Adults. Pediatrics 2018; 141:peds.2017-3517. [PMID: 29555689 DOI: 10.1542/peds.2017-3517] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Among adolescents and young adults with nonfatal self-harm, our objective is to identify risk factors for repeated nonfatal self-harm and suicide death over the following year. METHODS A national cohort of patients in the Medicaid program, aged 12 to 24 years (n = 32 395), was followed for up to 1 year after self-harm. Cause of death information was obtained from the National Death Index. Repeat self-harm per 1000 person-years and suicide deaths per 100 000 person-years were determined. Hazard ratios (HRs) of repeat self-harm and suicide were estimated by Cox proportional hazard models. Suicide standardized mortality rate ratios were derived by comparison with demographically matched general population controls. RESULTS The 12-month suicide standardized mortality rate ratio after self-harm was significantly higher for adolescents (46.0, 95% confidence interval [CI]: 29.9-67.9) than young adults (19.2, 95% CI: 12.7-28.0). Hazards of suicide after self-harm were significantly higher for American Indians and Alaskan natives than non-Hispanic white patients (HR: 4.69, 95% CI: 2.41-9.13) and for self-harm patients who initially used violent methods (HR: 18.04, 95% CI: 9.92-32.80), especially firearms (HR: 35.73, 95% CI: 15.42-82.79), compared with nonviolent self-harm methods (1.00, reference). The hazards of repeat self-harm were higher for female subjects than male subjects (HR: 1.25, 95% CI: 1.18-1.33); patients with personality disorders (HR: 1.55, 95% CI: 1.42-1.69); and patients whose initial self-harm was treated in an inpatient setting (HR: 1.65, 95% CI: 1.49-1.83) compared with an emergency department (HR: 0.62, 95% CI: 0.55-0.69) or outpatient (1.00, reference) setting. CONCLUSIONS After nonfatal self-harm, adolescents and young adults were at markedly elevated risk of suicide. Among these high-risk patients, those who used violent self-harm methods, particularly firearms, were at especially high risk underscoring the importance of follow-up care to help ensure their safety.
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Affiliation(s)
- Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, New York;
| | - Melanie Wall
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, New York
| | - Shuai Wang
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, New York
| | - Stephen Crystal
- Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Jeffrey A Bridge
- Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital and Department of Pediatrics, Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio; and
| | - Shang-Min Liu
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, New York
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Rockville, Maryland
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50
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Gvion Y. Aggression, impulsivity, and their predictive value on medical lethality of suicide attempts: A follow-up study on hospitalized patients. J Affect Disord 2018; 227:840-846. [PMID: 29689698 DOI: 10.1016/j.jad.2017.11.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/27/2017] [Accepted: 11/08/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study examined the role of aggressive-impulsive variants, and suicide history in predicting the medical severity of follow-up suicide attempts. METHODS 97 consecutive psychiatric in-patients who participated in earlier study 2-5 years previously. Thirty-three had a history of a medically serious suicide attempt (MSSA), 29 had a history of a medically non-serious suicide attempt (MNSSA), and 35 had no history of suicide. Participants completed a battery of instruments measuring aggressive-impulsive variables, hopelessness and communication difficulties. Findings were analyzed in relation to follow-up suicide attempts and their severity. RESULTS 32 patients (33%) had attempted suicide: 9 (9.27%) (including one death) MSSSA. Of these, 7 patients were MSSAs in the index attempt and 2 were MNSSAs in the index attempt. 23 (23.7%) MNSSA: Of these, 6 were MSSAs in the index attempt; 13, MNSSAs in the index attempt and 4 from the non-suicidal psychiatric group. 65 patients (67%) did not attempt suicide during the period since the index studies. Anger-out, violence impulsivity and hopelessness had significant positive correlations with medical severity of follow-up suicide attempts. Similar correlations were found between anger-out, violence and the amount of follow-up suicide attempts. A hierarchical regression analysis was conducted to determine contribution of study variables to severity of future suicide attempts. Severity of index attempt, hopelessness aggressive-impulsive variants and two interactions (medical severity of index suicide attempt X impulsivity and self-disclosure X anger-in) accounted for 44.7% of the variance of the medical severity of follow-up suicide attempts. LIMITATIONS (i) Possibly incomplete patient information, as some of the patients who participated in the index studies could not be located. (ii) Relatively small group of patients with an index MSSA. CONCLUSIONS The major findings of this paper are the predictive value of MSSA vs. MNSSA. The Lethality of future suicide attempt is closely linked to the lethality of former suicide attempt, impulsivity and hopelessness. Thus, patients who have made a suicide attempt should be assessed for medical severity of the attempt, impulsive-aggressive measures hopelessness, and communication difficulties, which are important factors in follow-up attempts.
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Affiliation(s)
- Yari Gvion
- Bar Ilan University, Psychology Department, Israel.
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