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Kim S, Dunn N, Moon K, Casement MD, Nam Y, Yeom JW, Cho CH, Lee HJ. Childhood maltreatment and suicide attempts in major depression and bipolar disorders in South Korea: A prospective nationwide cohort study. J Affect Disord 2024; 361:120-127. [PMID: 38851432 DOI: 10.1016/j.jad.2024.06.012] [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: 03/09/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Childhood maltreatment (CM) is prevalent among patients with mood disorders and considered an important risk factor for suicide in the general population. Despite mood disorders being implicated in up to 60 % of completed suicides, the predictive role of CM on suicide attempt (SA) among early mood disorder patients remains poorly understood. METHODS We enrolled 480 participants diagnosed with early-onset major depressive disorder (MDD), bipolar I disorder (BD I), and bipolar II disorder (BD II). Over an average of 60 weeks, participants underwent follow-up assessments at 12-week intervals. Using multivariate logistic regression, we examined the association between CM and SA history at baseline. Further, the Cox proportional hazard model assessed the predictive role of childhood maltreatment in SA during follow-up. RESULTS At baseline, 38 % of the total participants reported SA history, with a follow-up prevalence of 10 %. Childhood maltreatment was significantly associated with past SAs and was a robust predictor of future SA, adjusting for relevant clinical risk factors. Emotional abuse and sexual abuse related to SA history, and physical abuse increased future SA risk. LIMITATIONS Potential biases in reporting SA and childhood maltreatment, along with unexplored factors such as additional environmental and familial risks, may affect the study's findings. CONCLUSIONS Childhood maltreatment emerged as a robust predictor of SA among early-onset mood disorder patients. Systematic evaluation of CM early in the clinical process may be crucial for effective risk management. Additionally, our findings highlight the importance of implementing proactive interventions for CM to prevent the onset of adverse psychological trajectories.
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Affiliation(s)
- Sojeong Kim
- Department of Psychology, University of Oregon, Eugene, USA
| | - Natalie Dunn
- Department of Psychology, University of Oregon, Eugene, USA
| | - Kibum Moon
- Department of Psychology, Georgetown University, Washington, DC, USA
| | | | - Yaerim Nam
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea; Korea University Chronobiology Institute, Seoul, Republic of Korea
| | - Ji Won Yeom
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea; Korea University Chronobiology Institute, Seoul, Republic of Korea
| | - Chul-Hyun Cho
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea; Korea University Chronobiology Institute, Seoul, Republic of Korea; Department of Biomedical Informatics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea; Korea University Chronobiology Institute, Seoul, Republic of Korea.
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Kim MJ, Yang JH, Koh MJ, Kim Y, Lee B, Ahn YM. Risk factors of reattempt among suicide attempters in South Korea: A nationwide retrospective cohort study. PLoS One 2024; 19:e0300054. [PMID: 38635747 PMCID: PMC11025816 DOI: 10.1371/journal.pone.0300054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/21/2024] [Indexed: 04/20/2024] Open
Abstract
This study aimed to identify underlying demographic and clinical characteristics among individuals who had previously attempted suicide, utilizing the comprehensive Health Insurance Review and Assessment Service (HIRA) database. Data of patients aged 18 and above who had attempted suicide between January 1 and December 31, 2014, recorded in HIRA, were extracted. The index date was identified when a suicide attempt was made within the year 2014. The medical history of the three years before the index date and seven years of follow-up data after the index date were analyzed. Kaplan-Meier estimate was used to infer reattempt of the suicide attempters, and Cox-proportional hazard analysis was used to investigate risk factors associated with suicide reattempts. A total of 17,026 suicide attempters were identified, of which 1,853 (10.9%) reattempted suicide; 4,925 (28.9%) patients had been diagnosed with depressive disorder. Of the reattempters, 391 (21.1%) demonstrated a history of suicide attempts in the three years before the index date, and the mean number of prior attempts was higher compared to that of the non-reattempters (1.7 vs.1.3, p-value < 0.01). Prior psychiatric medication, polypharmacy, and an increase in the number of psychotropics were associated with suicide reattempt in overall suicide attempters. (Hazard ratio (HR) = 3.20, 95% confidence interval [CI] = 2.56-4.00; HR = 2.42, 95% CI = 1.87-3.14; HR = 19.66, 95% CI = 15.22-25.39 respectively). The risk of reattempt decreased in individuals receiving antidepressant prescriptions compared to those unmedicated, showing a reduction of 78% when prescribed by non-psychiatrists and 89% when prescribed by psychiatrists. Similar risk factors for suicide reattempts were observed in the depressive disorder subgroup, but the median time to reattempt was shorter (556.5 days) for this group compared to that for the overall attempters (578 days). Various risk factors including demographics, clinical characteristics, and medications should be considered to prevent suicide reattempts among suicide attempters, and patients with depressive disorder should be monitored more closely.
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Affiliation(s)
- Min Ji Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Jeong Hun Yang
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Min Jung Koh
- Medical Affairs, Janssen Korea Ltd., Seoul, Korea
| | - Youngdoe Kim
- Medical Affairs, Janssen Korea Ltd., Seoul, Korea
| | - Bolam Lee
- Medical Affairs, Janssen Korea Ltd., Seoul, Korea
| | - Yong Min Ahn
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
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Sun F, Yan J, Pang J, Song M, Wang M, Huang T, Zhao Z. Distinct effects of first-episode and recurrent major depressive disorder on brain changes related to suicidal ideation: Evidence from the REST-meta-MDD Project. J Affect Disord 2024; 351:472-480. [PMID: 38286226 DOI: 10.1016/j.jad.2024.01.213] [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: 08/04/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Significant differences in clinical manifestations between first-episode and recurrent major depression disorder (FE-MDD/R-MDD) have been demonstrated in previous studies, including the degree of suicide attempt. However, the potential brain mechanism underlying the effect of depressive episode frequency on suicidal ideation (SI) remains unclear. METHODS In this study, 102 patients with FE-MDD (SI/non-SI: N = 70/32) and 71 matched normal controls (NCs), as well as 75 patients with R-MDD (SI/non-SI: N = 37/38) and 49 matched NCs were screened from the Chinese REST-meta-MDD consortium. T1-weighted and resting-state fMRI images were used to calculate gray matter volume (GMV) and fractional amplitude of low-frequency fluctuations (fALFF), respectively. RESULTS Group comparisons revealed that FE-MDD showed changes only in GMV, while R-MDD showed changes in both GMV and fALFF compared to NCs. SI-specific GMV decreases were observed in the right cerebellum, superior marginal gyrus, and left middle temporal gyrus in FE-MDD patients, while SI-specific fALFF decreases in bilateral superior frontal gyrus and increases in bilateral cerebellum and left parahippocampal gyrus were obserevd in R-MDD patients. Moreover, a negative correlation was found between GMV value in right cerebellum and HAMD score. CONCLUSIONS These findings suggest that first-episode and recurrent MDD show different effects on brain structure and function in patients with SI, providing a potential explanation for the distinct clinical manifestations of MDD patients from a brain mechanisms perspective.
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Affiliation(s)
- Fenfen Sun
- Center for Brain, Mind, and Education, Shaoxing University, Shaoxing 312000, China
| | - Jin Yan
- Center for Brain, Mind, and Education, Shaoxing University, Shaoxing 312000, China
| | - Jianan Pang
- Center for Brain, Mind, and Education, Shaoxing University, Shaoxing 312000, China
| | - Mingqiao Song
- Department of Psychosomatic Disorders, Shaoxing Seventh People's Hospital, Shaoxing 312000, China; Affiliated Mental Health Center, Medical College of Shaoxing University, Shaoxing 312000, China
| | - Minmin Wang
- Binjiang Institute of Zhejiang University, Zhejiang University, Hangzhou 310027, China
| | - Tianming Huang
- Shanghai changning mental health center, Shanghai 200335, China
| | - Zhiyong Zhao
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, China.
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Lei X, Fang X, Ren J, Teng X, Guo C, Wu Z, Yu L, Wang D, Chen Y, Zhou Y, Wu Y, Zhang Y, Zhang C. Plasma Apo-E mediated corticospinal tract abnormalities and suicidality in patients with major depressive disorder. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-023-01749-w. [PMID: 38265467 DOI: 10.1007/s00406-023-01749-w] [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: 06/24/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024]
Abstract
This study aims to explore the link between Apo-E, brain white matter, and suicide in patients with major depressive disorder (MDD) to investigate the potential neuroimmune mechanisms of Apo-E that may lead to suicide. Thirty-nine patients with MDD (22 patients with suicidality) and 57 age, gender, and education-matched healthy controls participated in this study, provided plasma Apo-E samples, and underwent diffusion tensor imaging scans. Plasma Apo-E levels and white matter microstructure were analyzed among the MDD with suicidality, MDD without suicidality, and HC groups using analysis of variance with post hoc Bonferroni correction and tract-based spatial statistics (TBSS) with threshold-free cluster enhancement correction. Mediation analysis investigated the relationship between Apo-E, brain white matter, and suicidality in MDD. The MDD with suicidality subgroup had higher depressive and suicide scores, longer disease course, and lower plasma Apo-E levels than MDD without suicidality. TBSS revealed that the MDD non-suicide subgroup showed significantly increased mean diffusivity in the left corticospinal tract and body of the left corpus callosum, as well as increased axial diffusivity in the left anterior corona radiata and the right posterior thalamic radiation compared to the suicidal MDD group. The main finding was that the increased MD of the left corticospinal tract contributed to the elevated suicide score, with Apo-E mediating the effect. Preliminary result that Apo-E's mediating role between the left corticospinal tract and the suicide factor suggests the neuroimmune mechanism of suicide in MDD. The study was registered on ClinicalTrials.gov (NCT03790085).
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Affiliation(s)
- Xiaoxia Lei
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinyu Fang
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juanjuan Ren
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinyue Teng
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chaoyue Guo
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zenan Wu
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingfang Yu
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dandan Wang
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Chen
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunshan Zhou
- Department of Psychiatry, Huaian No. 3 People's Hospital, Huaian, Jiangsu, China
| | - Yujie Wu
- Department of Psychiatry, Shanghai Xuhui Mental Health Center, Shanghai, China
| | - Yi Zhang
- Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai, 200030, China.
| | - Chen Zhang
- Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai, 200030, China.
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Can AT, Mitchell JS, Dutton M, Bennett M, Hermens DF, Lagopoulos J. Insights into the neurobiology of suicidality: explicating the role of glutamatergic systems through the lens of ketamine. Psychiatry Clin Neurosci 2023; 77:513-529. [PMID: 37329495 DOI: 10.1111/pcn.13572] [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: 01/19/2023] [Revised: 05/16/2023] [Accepted: 06/08/2023] [Indexed: 06/19/2023]
Abstract
Suicidality is a prevalent mental health condition, and managing suicidal patients is one of the most challenging tasks for health care professionals due to the lack of rapid-acting, effective psychopharmacological treatment options. According to the literature, suicide has neurobiological underpinnings that are not fully understood, and current treatments for suicidal tendencies have considerable limitations. To treat suicidality and prevent suicide, new treatments are required; to achieve this, the neurobiological processes underlying suicidal behavior must be thoroughly investigated. Although multiple neurotransmitter systems, particularly serotonergic systems, have been studied in the past, less has been reported in relation to disruptions in glutamatergic neurotransmission, neuronal plasticity, and neurogenesis that result from stress-related abnormalities of the hypothalamic-pituitary-adrenal system. Informed by the literature, which reports robust antisuicidal and antidepressive properties of subanaesthetic doses of ketamine, this review aims to provide an examination of the neurobiology of suicidality (and relevant mood disorders) with implications of pertinent animal, clinical, and postmortem studies. We discuss dysfunctions in the glutamatergic system, which may play a role in the neuropathology of suicidality and the role of ketamine in restoring synaptic connectivity at the molecular levels.
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Affiliation(s)
- Adem Tevfik Can
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Jules Shamus Mitchell
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Megan Dutton
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Maxwell Bennett
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | | | - Jim Lagopoulos
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
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Brousseau-Paradis C, Lesage A, Larue C, Labelle R, Giguère CÉ, Rassy J. Suicidality and mood disorders in psychiatric emergency patients: Results from SBQ-R. Int J Ment Health Nurs 2023; 32:1301-1314. [PMID: 37150928 DOI: 10.1111/inm.13161] [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: 07/01/2022] [Revised: 04/13/2023] [Accepted: 04/25/2023] [Indexed: 05/09/2023]
Abstract
Patients with mood disorders are at high risk of suicidality, and emergency departments (ED) are essential in the management of this risk. This study aims to (1) describe the suicidal thoughts and behaviours of patients with mood disorders who come to ED; (2) assess the psychometric properties of the Suicidal Behaviours Questionnaire-Revised (SBQ-R) in a psychiatric ED; and (3) determine the best predictors of suicidality for these patients. A total of 300 participants with mood disorders recruited for the Signature Bank of the Institut universitaire en santé mentale de Montréal (IUSMM) were retained. Suicidality was assessed using the SBQ-R. Other clinical and demographic details were recorded. Bivariate analyses, correlations and multivariate regression analyses were conducted. SBQ-R's internal consistency, construct and convergent validities were also tested. In the Patient Health Questionnaire-9 (PHQ-9), 53.3% of the sample stated they had suicidal or self-harm thoughts in the last 2 weeks. The mean score obtained at the SBQ-R was 8.3. Multivariate analysis found that SBQ-R scores were associated with depressive symptoms and substance use, especially alcohol, accounting for 44.3% of the model variance. Cronbach's alpha was 0.81 [0.78, 0.84] and factor loadings for items 1-4 were 0.68, 0.88, 0.54, and 0.85, respectively. The confirmatory factor analysis indicated that the model fit the data well. The SBQ-R is a brief and valid instrument that can easily be used in busy emergency departments to assess suicide risk. Depressive symptoms and alcohol use shall also be assessed, as they are determinants of increased risk of suicidality.
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Affiliation(s)
- Camille Brousseau-Paradis
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, Quebec, Canada
- Department of Psychiatry, University of Montreal, Montréal, Quebec, Canada
| | - Alain Lesage
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, Quebec, Canada
- Department of Psychiatry, University of Montreal, Montréal, Quebec, Canada
- Quebec Network on Suicide, Mood Disorders and Associated Disorders, Montréal, Quebec, Canada
| | - Caroline Larue
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, Quebec, Canada
- Faculty of Nursing, University of Montreal, Montréal, Quebec, Canada
- Quebec Network on Nursing Intervention Research, Montréal, Quebec, Canada
| | - Réal Labelle
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, Quebec, Canada
- Department of Psychiatry, University of Montreal, Montréal, Quebec, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, Quebec, Canada
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, Quebec, Canada
| | - Charles-Édouard Giguère
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, Quebec, Canada
| | - Jessica Rassy
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, Quebec, Canada
- Quebec Network on Suicide, Mood Disorders and Associated Disorders, Montréal, Quebec, Canada
- Quebec Network on Nursing Intervention Research, Montréal, Quebec, Canada
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, Quebec, Canada
- School of Nursing, University of Sherbrooke, Montréal, Quebec, Canada
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Olié E, Catanzaro T, Malestroit M, Guija JA, Giner L, Courtet P. The capacity to consent to treatment is altered in suicidal patients. Ann Gen Psychiatry 2023; 22:35. [PMID: 37689691 PMCID: PMC10492405 DOI: 10.1186/s12991-023-00459-w] [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: 05/05/2023] [Accepted: 07/24/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Many patients with depression refuse treatment. Moreover, suicide attempters often display low perceived need of treatment and impaired decision-making. These observations raise questions about the capacity to treatment consent in depressed suicide attempters (SA). METHODS In patients with current depressive episode (N = 33 SAs and N = 27 non-SAs), consent capacity was evaluated with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), insight with the Beck Cognitive Insight Scale, and depression severity with the Beck Depression Inventory (BDI). RESULTS The median BDI score in the whole sample (N = 60) was 21 [10;36], and was higher in SAs than non-SAs (27 [11;36] vs. 15 [10:33], p < 0.001). Consent capacity was impaired in 30% (appreciation), 53% (reasoning) and 60% (understanding) of all patients. MacCAT-T sub-scores were lower in SAs than non-SAs (understanding: 4.4 [2.35;5.8] vs. 5.3 [3.13;6]); appreciation: 3 [1;4] vs. 4 [2;4]); reasoning (4 [1;7] vs. 7 [3;8]), and ability to express a choice: 1 [0;2] vs. 2 [0;2]; all p < 0.001). In multivariate analyses, suicide attempt history and depression severity (but not insight) were negatively associated with MacCAT-T sub-scores. CONCLUSION More research is needed on the capacity to consent to treatment of patients with depression, particularly suicidal individuals, to make informed choices about their treatment. Trial registration The Montpellier University Hospital Institutional Review Board approved the study (No. 202100714).
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Affiliation(s)
- Emilie Olié
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France.
- IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.
| | - Thomas Catanzaro
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | | | - Julio A Guija
- Department of Psychiatry, Universidad de Sevilla, Seville, Spain
- Service of Psychiatry. Institute of Legal Medicine, Seville, Spain
| | - Lucas Giner
- Department of Psychiatry, Universidad de Sevilla, Seville, Spain
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
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Diószegi J, Rihmer Z, Torzsa P, Pál L, Czifra Á, Gonda X, Sándor J. Psychiatric health care need in Hungary identified by the short screening algorithm of depression and suicide risk used in general medical practices. Sci Rep 2023; 13:14249. [PMID: 37652947 PMCID: PMC10471575 DOI: 10.1038/s41598-023-41437-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/26/2023] [Indexed: 09/02/2023] Open
Abstract
Suicides are often related to depression. General medical practices (GMPs) should play a role in screening depression. We aimed to test the screening algorithm of Rihmer and Torzsa for depression and suicide and determine the prevalence and number of patients in the nationwide representative Hungarostudy 2002 population, and to estimate the corresponding extra health care need in an average GMP and in the Hungarian population in addition to patients who are already cared for by specialized care. The short version of the Beck Hopelessness Scale (BHS) and the Hungarian version of the short form of the Beck Depression Inventory (BDI-9) were used to screen for suicide risk and depression. The prevalence of suicidal thoughts and depression was determined and findings were extrapolated to an average GMP of 1,600 adults and to the population over 25 years of age. This screening would generate a considerable extra psychiatric care to organize and implement in an average GMP and throughout the country. Our findings show that with easily administered screening instruments a significant number of patients likely to have depression can be identified at the primary care level, arguing for the establishment of the extra psychiatric care capacity in Hungary.
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Affiliation(s)
- Judit Diószegi
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai út 26, Debrecen, 4028, Hungary.
| | - Zoltán Rihmer
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Balassa utca 6, Budapest, 1082, Hungary
- National Institute of Mental Health, Neurology and Neurosurgery, Amerikai út 57, Budapest, 1145, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Stáhly u. 7-9, Budapest, 1085, Hungary
| | - László Pál
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai út 26, Debrecen, 4028, Hungary
| | - Árpád Czifra
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai út 26, Debrecen, 4028, Hungary
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Balassa utca 6, Budapest, 1082, Hungary
| | - János Sándor
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai út 26, Debrecen, 4028, Hungary
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai út 26, Debrecen, 4028, Hungary
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Sander LB, Beisemann M, Karyotaki E, van Ballegooijen W, Cuijpers P, Teismann T, Doebler P, Domhardt M, Baumeister H, Büscher R. Effects of digital cognitive behavioral therapy for depression on suicidal thoughts and behavior: Protocol for a systematic review and meta-analysis of individual participant data. PLoS One 2023; 18:e0285622. [PMID: 37289758 PMCID: PMC10249902 DOI: 10.1371/journal.pone.0285622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/22/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Digital cognitive behavioral therapy (i-CBT) interventions for the treatment of depression have been extensively studied and shown to be effective in the reduction of depressive symptoms. However, little is known about their effects on suicidal thoughts and behaviors (STB). Information on the impact of digital interventions on STB are essential for patients' safety because most digital interventions are self-help interventions without direct support options in case of a suicidal crisis. Therefore, we aim to conduct a meta-analysis of individual participant data (IPDMA) to investigate the effects of i-CBT interventions for depression on STB and to explore potential effect moderators. METHODS Data will be retrieved from an established and annually updated IPD database of randomized controlled trials investigating the effectiveness of i-CBT interventions for depression in adults and adolescents. We will conduct a one-stage and a two-stage IPDMA on the effects of these interventions on STB. All types of control conditions are eligible. STB can be measured using specific scales (e.g., Beck scale suicide, BSS) or single items from depression scales (e.g., item 9 of the PHQ-9) or standardized clinical interviews. Multilevel linear regression will be used for specific scales, and multilevel logistic regression will be used for treatment response or deterioration, operationalized as a change in score by at least one quartile from baseline. Exploratory moderator analyses will be conducted at participant, study, and intervention level. Two independent reviewers will assess the risk of bias using the Cochrane Risk of Bias Tool 2. CONCLUSION This IPDMA will harness the available data to assess the effects (response and deterioration) of i-CBT interventions for depression interventions on STB. Information about changes in STB is essential to estimate patients' safety when engaging in digital treatment formats. TRIAL REGISTRATION We will pre-register this study with the open science framework after article acceptance to ensure consistency between online registration and the published trial protocol.
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Affiliation(s)
- Lasse Bosse Sander
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Marie Beisemann
- Department of Statistics, TU Dortmund University, Dortmund, Germany
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wouter van Ballegooijen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Philipp Doebler
- Department of Statistics, TU Dortmund University, Dortmund, Germany
| | - Matthias Domhardt
- Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Harald Baumeister
- Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Rebekka Büscher
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Guo Y, Jiang X, Jia L, Zhu Y, Han X, Wu Y, Liu W, Zhao W, Zhu H, Wang D, Tu Z, Zhou Y, Sun Q, Kong L, Wu F, Tang Y. Altered gray matter volumes and plasma IL-6 level in major depressive disorder patients with suicidal ideation. Neuroimage Clin 2023; 38:103403. [PMID: 37079937 PMCID: PMC10148078 DOI: 10.1016/j.nicl.2023.103403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUNDS Suicidal ideation (SI) is one of the most serious consequences of major depressive disorder (MDD). Understanding the unique mechanism of MDD with SI (MDD + S) is crucial for treatment development. While abundant research has studied MDD, past studies have not reached a consensus on the mechanism of MDD + S. The study aimed to investigate the abnormalities of the gray matter volumes (GMVs) and plasma IL-6 level in MDD + S to further reveal the mechanism of MDD + S. METHODS We tested the plasma IL-6 level using Luminex multifactor assays and collected the Structural Magnetic Resonance Imaging (SMRI) data from 34 healthy controls (HCs), 36 MDD patients without SI (MDD - S) and 34 MDD + S patients. We performed a partial correlation between the GMVs of the brain regions with significant differences and plasma IL-6 level with age, sex, medication, scores of HAMD-17 and HAMA as the covariates. RESULTS Compared with HCs and MDD - S, MDD + S had significantly decreased GMVs in the left cerebellum Crus I/II and significantly increased plasma IL-6 level; compared with HCs, both the MDD + S and MDD - S had significantly decreased GMVs in right precentral and postcentral gyri. No significant correlation was found between the GMVs and the plasma IL-6 level in the MDD + S and MDD - S, respectively. While the GMVs of the right precentral and postcentral gyri negatively correlated with the level of IL-6 in the whole MDD (r = -0.28, P = 0.03). The GMVs of the left cerebellum Crus I/II (r = -0.47, P = 0.02), and the right precentral and postcentral gyri (r = -0.42, P = 0.04) negatively correlated with the level of IL-6 in HCs. CONCLUSION The altered GMVs and the plasma IL-6 level may provide a scientific basis to understand the pathophysiological mechanisms of MDD + S.
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Affiliation(s)
- Yingrui Guo
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Xiaowei Jiang
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China; Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Linna Jia
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Yue Zhu
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Xinyu Han
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Yifan Wu
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Wen Liu
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Wenhui Zhao
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Huaqian Zhu
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Dahai Wang
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Zhaoyuan Tu
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Yifang Zhou
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Qikun Sun
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Lingtao Kong
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Feng Wu
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Yanqing Tang
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Department of Geriatric Medicine, The First Hospital of China Medical University, Shenyang, China.
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Gonda X, Dome P, Serafini G, Pompili M. How to save a life: From neurobiological underpinnings to psychopharmacotherapies in the prevention of suicide. Pharmacol Ther 2023; 244:108390. [PMID: 36940791 DOI: 10.1016/j.pharmthera.2023.108390] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 03/23/2023]
Abstract
The impact of suicide on our societies, mental healthcare, and public health is beyond questionable. Every year approximately 700 000 lives are lost due to suicide around the world (WHO, 2021); more people die by suicide than by homicide and war. Although suicide is a key issue and reducing suicide mortality is a global imperative, suicide is a highly complex biopsychosocial phenomenon, and in spite of several suicidal models developed in recent years and a high number of suicide risk factors identified, we still have neither a sufficient understanding of underpinnings of suicide nor adequate management strategies to reduce its prevalence. The present paper first overviews the background of suicidal behavior including its epidemiology, prevalence, age and gender correlations and its association with neuropsychiatric disorders as well as its clinical assessment. Then we give an overview of the etiological background, including its biopsychosocial contexts, genetics and neurobiology. Based on the above, we then provide a critical overview of the currently available intervention options to manage and reduce risk of suicide, including psychotherapeutic modalities, traditional medication classes also providing an up-to-date overview on the antisuicidal effects of lithium, as well as novel molecules such as esketamine and emerging medications and further molecules in development. Finally we give a critical overview on our current knowledge on using neuromodulatory and biological therapies, such as ECT, rTMS, tDCS and other options.
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Affiliation(s)
- Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary.
| | - Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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12
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Balint L, Osvath P, Kapitany B, Rihmer Z, Nemeth A, Dome P. Suicide in Hungary during the first year of the COVID-19 pandemic: Subgroup investigations. J Affect Disord 2023; 325:453-458. [PMID: 36642307 PMCID: PMC9836994 DOI: 10.1016/j.jad.2023.01.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND COVID-19 may unfavourably affect the mental health of individuals in various ways. Accordingly, the concern has been raised that national suicide rates will increase in the wake of the outbreak of the pandemic. METHODS In the current study, we tested this conjecture in three age groups (<25; 25-64; ≥65) of the Hungarian total population and the male and female populations. In addition, we assessed whether the pandemic had different effects on counts of suicides committed by violent or non-violent methods. Finally, by comparing the monthly suicide rates in 2020 and the corresponding monthly rates in 2019, we also investigated the "pulling together" hypothesis that postulates that a temporary decrease in suicides may occur after large-scale catastrophic events. RESULTS With regard to the total population only the suicide counts of individuals aged 25-64 rose significantly (p < 0.05) during the COVID months of 2020. Similar patterns, but at lower levels of significance (0.05 < p < 0.1), were found in those members of the total population aged 65 or older and among males aged between 25 and 64. Furthermore, we found that the number of violent suicides increased significantly (p < 0.05) during the COVID months. Finally, our results have not confirmed the existence of a "pulling together" phenomenon in association with the COVID-19 pandemic in Hungary. LIMITATIONS We used non-individual level data and were therefore unable to control suicide risk factors at the level of individuals. DISCUSSION The number of suicides rose significantly in some subgroups of the Hungarian population during the COVID months of 2020.
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Affiliation(s)
- Lajos Balint
- Demographic Research Institute of the Hungarian Central Statistical Office, Budapest, Hungary; Department of Sociology, University of Pecs, Pecs, Hungary
| | - Peter Osvath
- Department of Psychiatry and Psychotherapy, Medical School, University of Pecs, Pecs, Hungary
| | - Balazs Kapitany
- Demographic Research Institute of the Hungarian Central Statistical Office, Budapest, Hungary
| | - Zoltan Rihmer
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Attila Nemeth
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary.
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Kandula S, Martinez-Alés G, Rutherford C, Gimbrone C, Olfson M, Gould MS, Keyes KM, Shaman J. County-level estimates of suicide mortality in the USA: a modelling study. Lancet Public Health 2023; 8:e184-e193. [PMID: 36702142 PMCID: PMC9990589 DOI: 10.1016/s2468-2667(22)00290-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/11/2022] [Accepted: 10/31/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Suicide is one of the leading causes of death in the USA and population risk prediction models can inform decisions on the type, location, and timing of public health interventions. We aimed to develop a prediction model to estimate county-level suicide risk in the USA using population characteristics. METHODS We obtained data on all deaths by suicide reported to the National Vital Statistics System between Jan 1, 2005, and Dec 31, 2019, and age, sex, race, and county of residence of the decedents were extracted to calculate baseline risk. We also obtained county-level annual measures of socioeconomic predictors of suicide risk (unemployment, weekly wage, poverty prevalence, median household income, and population density) and state-level prevalence of major depressive disorder and firearm ownership from US public sources. We applied conditional autoregressive models, which account for spatiotemporal autocorrelation in response and predictors, to estimate county-level suicide risk. FINDINGS Estimates derived from conditional autoregressive models were more accurate than from models not adjusted for spatiotemporal autocorrelation. Inclusion of suicide risk and protective covariates further reduced errors. Suicide risk was estimated to increase with each SD increase in firearm ownership (2·8% [95% credible interval (CrI) 1·8 to 3·9]), prevalence of major depressive episode (1·0% [0·4 to 1·5]), and unemployment rate (2·8% [1·9 to 3·8]). Conversely, risk was estimated to decrease by 4·3% (-5·1 to -3·2) for each SD increase in median household income and by 4·3% (-5·8 to -2·5) for each SD increase in population density. An increase in the heterogeneity in county-specific suicide risk was also observed during the study period. INTERPRETATION Area-level characteristics and the conditional autoregressive models can estimate population-level suicide risk. Availability of near real-time situational data are necessary for the translation of these models into a surveillance setting. Monitoring changes in population-level risk of suicide could help public health agencies select and deploy targeted interventions quickly. FUNDING US National Institute of Mental Health.
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Affiliation(s)
- Sasikiran Kandula
- Department of Environmental Health Sciences, Columbia University, New York, NY, USA.
| | - Gonzalo Martinez-Alés
- Department of Epidemiology, Columbia University, New York, NY, USA; CAUSALab, Harvard T H Chan School of Public Health, Boston, MA, USA; Mental Health Network Biomedical Research Center, Madrid, Spain; Mental Health Research Group, Hospital La Paz Institute for Health Research, Madrid, Spain
| | | | | | - Mark Olfson
- Department of Epidemiology, Columbia University, New York, NY, USA; Department of Psychiatry, Columbia University, New York, NY, USA
| | - Madelyn S Gould
- Department of Epidemiology, Columbia University, New York, NY, USA; Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - Jeffrey Shaman
- Department of Environmental Health Sciences, Columbia University, New York, NY, USA
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14
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Rihmer Z, Dome P. Fortification of drinking water with lithium to reduce suicide in the population. Eur Neuropsychopharmacol 2023; 71:3-5. [PMID: 36867985 DOI: 10.1016/j.euroneuro.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/04/2023] [Accepted: 02/08/2023] [Indexed: 03/05/2023]
Affiliation(s)
- Zoltan Rihmer
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary.
| | - Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary.
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15
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Salomaa AC, Matsick JL, Exten C, Kruk M. Different Categorizations of Women's Sexual Orientation Reveal Unique Health Outcomes in a Nationally Representative U.S. Sample. Womens Health Issues 2023; 33:87-96. [PMID: 35989158 DOI: 10.1016/j.whi.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 05/24/2022] [Accepted: 07/18/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Sexual minority women (i.e., women minoritized for their sexualities) are identified as high risk for mental health and substance use problems; however, there is no consensus on the criteria by which women are categorized as sexual minority. Though there is some evidence suggesting that certain subgroups of women are at higher risk than others based on sexual orientation, different categorization schemes for sexual orientation have yet to be compared within the same sample. METHOD Using data from the National Epidemiologic Survey of Alcohol and Related Conditions-III (N = 19,528), we examined how multiple categorization schemes (i.e., identity, behavior, recency of sexual behavior) for categorizing women who have sex with women (WSW) yield different estimates of prevalence of mental health and substance use issues. We used chi-square and logistic regression to analyze the link between sexual orientation categorization schemes and health, categorizing by 1) self-identification only, 2) behavior only, and 3) the combination of self-identification and behavior (recent vs. past). RESULTS We discovered high prevalence rates of health problems among heterosexual-identified WSW who reported no recent sexual activity with women (i.e., previously had sex with women but not within the past 12 months); this category of women comprised 35% of all WSW. DISCUSSION Step by step, we found more detailed information about these women's experiences by moving to the complex categorization scheme (the combination of self-identification and behavior). Heterosexual-identified women who have had sex with women in their past (though not recently) presented as a large group with high prevalence rates of substance use and mental disorders. These women remain invisible to researchers who categorize sexual orientation only by sexual identity or by behavior and ignore the role of behavior change over time-imprecisely categorizing such women as heterosexual or as women who have sex with men. They thus are underserved by health research and represent a significant population for further study and intervention.
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Affiliation(s)
- Anna C Salomaa
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania
| | - Jes L Matsick
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania; Department of Women's, Gender, and Sexuality Studies, The Pennsylvania State University, University Park, Pennsylvania
| | - Cara Exten
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania
| | - Mary Kruk
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania; Department of Women's, Gender, and Sexuality Studies, The Pennsylvania State University, University Park, Pennsylvania.
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Choi W, Kang HJ, Kim JW, Kim HK, Kang HC, Lee JY, Kim SW, Stewart R, Kim JM. Age-specific associations between serum cholesterol levels and suicidal behaviors in patients with depressive disorders: A naturalistic prospective observational cohort study. Front Psychiatry 2023; 14:1095579. [PMID: 37139327 PMCID: PMC10150039 DOI: 10.3389/fpsyt.2023.1095579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction This study investigated the effects of total cholesterol levels on prevalent, and incident suicidal behaviors according to age group (<60 vs. ≥60 years) in depressed patients. Methods Consecutive outpatients with depressive disorders who visited the Chonnam National University Hospital between March 2012 and April 2017 were recruited. Among 1,262 patients assessed at baseline, 1,094 agreed to blood sampling for measurement of serum total cholesterol levels. Among the patients, 884 completed the 12-week acute treatment phase and were followed up at least once during the 12-month continuation treatment phase. Suicidal behaviors assessed at baseline included baseline suicidal severity; behaviors assessed at the 1-year follow-up included increased suicidal severity and fatal/non-fatal suicide attempts. Associations of baseline total cholesterol levels with the above-mentioned suicidal behaviors were analyzed using logistic regression models after adjustment for relevant covariates. Results Of 1,094 depressed patients, 753 (68.8%) were women. The mean (SD) age of patients was 57.0 (14.9) years. Lower total cholesterol levels (87-161 mg/dl) were associated with increased suicidal severity (Linear Wald = 4.478, p < 0.05) and fatal/non-fatal suicide attempt (Linear Wald = 7.490, p < 0.01) in patients <60 years of age. U-shaped associations between total cholesterol levels and 1-year follow-up suicidal outcomes (increased suicidal severity, Quadratic Wald = 6.299, p < 0.05; fatal/non-fatal suicide attempt, Quadratic Wald = 5.697, p < 0.05) were observed in patients ≥60 years of age. Conclusions These findings suggest that differential consideration of serum total cholesterol levels according to age group may have clinical utility for predicting suicidality in patients with depressive disorders. However, because our research participants came from a single-hospital, the generalizability of our findings may be limited.
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Affiliation(s)
- Wonsuk Choi
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Robert Stewart
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
- *Correspondence: Jae-Min Kim,
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17
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Hao Z, Li H, Lin Y. The characterization of static and dynamic brain functional networks in suicide attempters with major depressive disorder and its relation to psychological pain. Psychiatry Res Neuroimaging 2022; 327:111562. [PMID: 36335047 DOI: 10.1016/j.pscychresns.2022.111562] [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: 04/06/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 12/05/2022]
Abstract
Psychological pain is a robust predictor of suicide attempts in patients with major depressive disorder (MDD). However, whether suicide and psychological pain share a common neural basis remains unclear. Patients with MDD (n = 64) and healthy controls (HC) (n = 35) were recruited and patients were allocated to two groups: those with a history of suicide attempts (MDD-SA) (n = 25) and those without such a history (MDD-NSA) (n = 39). All participants completed the measurements and underwent functional magnetic resonance imaging to investigate the resting-state static and dynamic brain functional networks in default mode (DMN), central executive (CEN), salience (SN), and basal ganglia (BGN) networks. The MDD-SA group scored higher in pain avoidance than the MDD-NSA and HC groups. Functional connectivity within the dorsal DMN in the MDD-SA group was greater than that in the MDD-NSA and HC groups, and was significantly correlated with pain avoidance and suicide attempts. Dynamic functional connectivity analysis revealed that the proportion of State I in the fraction windows in the MDD-SA group was higher than those in the MDD-NSA and HC groups. Therefore, the increased functional connectivity within the dorsal DMN and segregation of networks may represent potential biological markers for suicide attempts related to psychological pain processing.
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Affiliation(s)
- Ziyu Hao
- Department of Psychology, Renmin University of China, Beijing, China
| | - Huanhuan Li
- Department of Psychology, Renmin University of China, Beijing, China.
| | - Yixuan Lin
- Department of Psychology, Renmin University of China, Beijing, China
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18
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Comparisons of deep learning and machine learning while using text mining methods to identify suicide attempts of patients with mood disorders. J Affect Disord 2022; 317:107-113. [PMID: 36029873 DOI: 10.1016/j.jad.2022.08.054] [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: 05/27/2022] [Revised: 08/05/2022] [Accepted: 08/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Suicide attempt is one of the most severe consequences for patients with mood disorders. This study aimed to perform deep learning and machine learning while using text mining to identify patients with suicide attempts and to compare their effectiveness. METHODS A total of 13,100 patients with mood disorders were selected. Two traditional text mining methods, logistic regression and Support vector machine (SVM), and one deep learning model (Convolutional neural network, CNN) were adopted to perform overall analysis and gender-specific subgroup analysis of patients to identify suicide attempts. The classification effectiveness of these models was evaluated by accuracy, F1-value, precision, recall, and the area under Receiver operator characteristic curve (ROC). RESULTS CNN's results were greater than the other two for all indicators except recall which was slightly smaller than SVM in male subgroup analysis. The accuracy values of the CNN were 98.4 %, 98.2 %, and 98.5 % in the overall analysis and the subgroup analysis for males and females, respectively. The results of McNemar's test showed that CNN and SVM models' predictions were statistically different from the logistic regression model's predictions in the overall analysis and the subgroup analysis for females (P < 0.050). LIMITATIONS A fixed number of features were selected based on document frequency to train models; this was a single-site study. CONCLUSIONS CNN model was a better way to detect suicide attempts in patients with mood disorders prior to hospital admission, saving time and resources in recognizing high-risk patients and preventing suicide.
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Which Clinical and Biochemical Parameters Are Associated with Lifetime Suicide Attempts in Bipolar Disorder? Diagnostics (Basel) 2022; 12:diagnostics12092215. [PMID: 36140615 PMCID: PMC9498201 DOI: 10.3390/diagnostics12092215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 08/26/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Bipolar Disorder (BD) is a disabling condition with suicidal behavior as one of the most common adverse outcomes. The purpose of the present research is to investigate the relationship between lifetime suicide attempts and the clinical factors/biochemical parameters in a large sample of bipolar patients. Methods: A total of 561 patients, consecutively hospitalized for BD in Milan and Monza (Italy), were recruited. Data about the demographic and clinical variables, as well as the values of blood analyses, were collected. The groups identified according to the presence/absence of lifetime suicide attempts were compared using univariate analyses. Then, three preliminary binary logistic regressions and a final logistic regression model were performed to identify the clinical and biochemical parameters associated with lifetime suicide attempts in BD. Results: Lifetime suicide attempts in BD were predicted by a longer duration of untreated illness (DUI) (p = 0.005), absence of lifetime psychotic symptoms (p = 0.025), presence of poly-substance use disorders (p = 0.033), comorbidity with obesity (p = 0.022), a last mood episode of manic polarity (p = 0.044), and lower bilirubin serum levels (p = 0.002); higher total cholesterol serum levels showed a trend toward statistical significance (p = 0.058). Conclusions: BD patients with lifetime suicide attempts present unfavorable clinical features. Some specific biochemical characteristics of bipolar patients may represent potential markers of suicidal behavior and need to be better investigated to identify new targets of treatment in the framework of personalized medicine. These preliminary findings have to be confirmed by further studies in different clinical settings.
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Sher L, Bierer LM, Flory J, Makotkine I, Yehuda R. Brain-derived neurotrophic factor in war veterans with or without a history of suicide attempt. J Affect Disord 2022; 308:160-165. [PMID: 35427710 DOI: 10.1016/j.jad.2022.04.047] [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: 01/11/2022] [Revised: 03/23/2022] [Accepted: 04/09/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) plays a central role in brain development and plasticity and has been demonstrated to be altered in neuropsychiatric diseases and suicidal behavior. We examined whether there is a difference with regard to plasma BDNF levels between veterans who made or did not make a suicide attempt post-deployment. METHODS Combat veterans who made or did not make post-deployment suicide attempts were interviewed using Mini-International Neuropsychiatric Interview, the Montgomery-Åsberg Depression Rating Scale, the Barratt Impulsivity Scale (BIS) and the Scale for Suicidal Ideation (SSI). Reaction to the most recent suicide attempt was evaluated using item 16 of the Suicide Intent Scale. Plasma BDNF levels were determined by the BDNF ELISA kit. RESULTS Controlling for age and body-mass index (BMI), BDNF levels were higher among suicide attempters than non-attempters. We observed a positive correlation between BDNF levels and SSI scores among non-attempters but not among attempters. BDNF levels positively correlated with BIS scores among suicide attempters but not among non-attempters. Suicide attempters who regretted that they made a suicide attempt had significantly higher BDNF levels in comparison to attempters who did not regret their attempts, controlling or not controlling for age and BMI. LIMITATIONS A modest sample size is a shortcoming of our study. CONCLUSIONS Our study demonstrates that BDNF may be involved in the pathophysiology of suicidal behavior in combat veterans. Given the relative ease of measuring plasma BDNF levels, it may be appropriate to consider adding such assessments to studies of suicidal behavior.
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Affiliation(s)
- Leo Sher
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Linda M Bierer
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Janine Flory
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Iouri Makotkine
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Yehuda
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Grover S, Avasthi A, Chakravarty R, Dan A, Chakraborty K, Neogi R, Desouza A, Nayak O, Praharaj SK, Menon V, Deep R, Bathla M, Subramanyam AA, Nebhinani N, Ghosh P, Lakdawala B, Bhattacharya R. Factors associated with lifetime suicide attempts: findings from the bipolar disorder course and outcome study from India (BiD-CoIN study). Nord J Psychiatry 2022; 77:227-233. [PMID: 35732027 DOI: 10.1080/08039488.2022.2083231] [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] [Indexed: 10/17/2022]
Abstract
AIM To evaluate the risk factors associated with lifetime suicide attempts in bipolar disorder (BD) patients. METHODOLOGY 773 BD patients with a duration of illness of at least ten years, currently in clinical remission, were evaluated for suicidal attempts in their lifetime. Those with and without lifetime suicide attempt(s) were compared for various demographic and clinical risk factors. RESULTS 242 (31.3%) patients had a history of at least one lifetime suicide attempt. Compared to those without lifetime suicide attempts, those with suicidal attempts were less educated, were more often females, spent more time in episodes, and had a significantly more number of total episodes (in the lifetime, first five years of illness, and per year of illness), had significantly more number of total depressive episodes (in the lifetime, first five years of illness, and per year of illness), spent more time in depressive episodes, had more severe depressive episodes, more often had depression as the first episode in the lifetime, spent more time in mania/hypomania/mixed episodes, had higher residual depressive and manic symptoms, more often had rapid cycling affective disorder pattern in the lifetime, use of cannabis in dependence pattern, had poorer insight into their illness and had a higher level of disability (especially in three out of the four domains of Indian disability evaluation assessment scale). CONCLUSIONS About one-third of the patients with BD have at least one-lifetime suicidal attempt, and those with suicide attempts usually have a poorer course of illness.
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Affiliation(s)
- Sandeep Grover
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ajit Avasthi
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Rahul Chakravarty
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Amitava Dan
- Burdwan Medical College & Hospital, Burdwan, India
| | | | | | - Avinash Desouza
- Lokmanya Tilak Municipal General Hospital (SION Hospital), Mumbai, India
| | - Omkar Nayak
- Lokmanya Tilak Municipal General Hospital (SION Hospital), Mumbai, India
| | - Samir Kumar Praharaj
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Vikas Menon
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Raman Deep
- All India Institute of Medical Sciences, New Delhi, India
| | - Manish Bathla
- Maharishi Markandeshwar Institute of Medical Sciences & Research, Mullana, India
| | | | | | | | - Bhavesh Lakdawala
- Ahmedabad Municipal Corporation Medical Education Trust Medical College, Ahmedabad, India
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22
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Yang C, Duan Y, Lei L, Liu P, Zhang A, Li G, Sun N, Wang Y, Liu Z, Zhang K. Altered Cingulum Functioning in Major Depressive Disorder Patient With Suicide Attempts: A Resting-State Functional Magnetic Resonance Imaging Study. Front Neurosci 2022; 16:849158. [PMID: 35418833 PMCID: PMC8995705 DOI: 10.3389/fnins.2022.849158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Major depressive disorder (MDD) with suicide attempts (SA) poses a significant public health issue. This study aims to identify neurobiological markers for MDD with SA on resting-state brain functional magnetic resonance imaging (rs-fMRI). Methods Fifty-one unmedicated adult MDD participants, 27 with SA on the Beck Scale for Suicidal Ideation and 24 without SA, underwent rs-fMRI scanning. A group of 30 healthy controls (HC) matched for age, gender, and education-level with MDD were chosen. A whole brain analysis of regional homogeneity (ReHo) was performed on subjects to identify regions where brain activity was associated with SA. Multiple comparison analysis was performed for ReHo. Pearson’s correlation analysis was performed between HAMD-SA scores and ReHo. The statistical significance level was set at p < 0.05. Results We examined whether there were significant differences among the three groups in whole brain ReHo during resting state. Subjects with SA showed significant increase of ReHo in the right Cingulum Post in comparison with those without SA. Subjects with SA showed significant decrease of ReHo in the right Cingulate Gyrus/Precuneus in comparison with HC. The mean ReHo from the significant brain region was associated with HAMD-SA (item 3 of the HAMD) scores (r = 0.349, P = 0.012) but was not associated with HAMD-24 scores. Conclusion These results indicate that SA is associated with altered resting-state brain activity. The pattern of elevated activity in the cingulum functioning may be related to SA. Identifying cingulum activity associated with SA may help to elucidate its pathogenesis and etiology.
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Affiliation(s)
- Chunxia Yang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yajuan Duan
- The First Hospital, Shanxi Medical University, Taiyuan, China
| | - Lei Lei
- The First Hospital, Shanxi Medical University, Taiyuan, China
| | - Penghong Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Aixia Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Gaizhi Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ning Sun
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- Nursing College of Shanxi Medical University, Taiyuan, China
| | - Yikun Wang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Zhifen Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- *Correspondence: Zhifen Liu,
| | - Kerang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- Kerang Zhang,
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23
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Investigation of the association between lithium levels in drinking water and suicide mortality in Hungary. J Affect Disord 2022; 298:540-547. [PMID: 34800573 DOI: 10.1016/j.jad.2021.11.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/13/2021] [Accepted: 11/14/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND In recent decades, a series of ecological studies from various countries have attempted to reveal whether there is an association between trace amounts of lithium in drinking water and suicide mortality. With some notable exceptions, results have indicated that there is an inverse association between these two variables. Since Hungary had extremely high rates of suicide with a persistent spatial pattern, we consider that our country is ideal to investigate this research question. METHODS We carried out our research on Hungarian data at the level of districts (n = 197). The dependent variable was the age- and gender-standardized mortality ratio for suicide (sSMR). Our main explanatory variable was the tap water lithium level (Li) from public drinking water supply systems using their own water source (n = 1 325). Those data, which give full national coverage, were aggregated to the level of districts. Confounding factors were religiosity, alcohol consumption and income. Various regression models were used for statistical calculations. RESULTS Findings from our most appropriate regression model - adjusted for relevant confounding variables and able to handle spatial autocorrelation and heteroscedasticity - suggest a significant (p < 0.05) and a trend-like (p < 0.1) negative association between Li and sSMR in the total population and among males, respectively. However, such an association was not found between these two variables among females. CONCLUSION In line with the majority of findings from other countries, our results indicate that the intake of lithium with drinking water may have a gender-dependent suicide-protective effect.
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24
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Choi W, Kang HJ, Kim JW, Kim HK, Kang HC, Lee JY, Kim SW, Stewart R, Kim JM. Associations of serum cortisol levels, stress perception, and stressful events with suicidal behaviors in patients with depressive disorders. J Affect Disord 2022; 297:602-609. [PMID: 34715157 DOI: 10.1016/j.jad.2021.10.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/02/2021] [Accepted: 10/23/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Stress is a well-known risk factor of suicide. However, there is a lack of research on the best psychobiological markers of stress for monitoring and predicting suicidal behaviors in depressed patients. We aimed to investigate the individual and interactive effects of serum cortisol levels and stress-related parameters, including perceived stress and life stressors, on suicidal behavior in depressed patients. METHODS At baseline, serum cortisol levels were measured and stress-related data, i.e., Perceived Stress Scale (PSS) scores and the number of stressful life events (SLEs), were collected from 1,094 patients with a depressive disorder, of whom 884 were followed up for 1 year. Suicidal behaviors evaluated at baseline included previous suicide attempts and baseline suicidal severity, while those at the 1-year follow-up were increased suicidal severity and fatal/non-fatal suicide attempts. Individual and interactive associations of exposure variables with suicidal outcomes were analyzed using logistic regression models after adjusting for relevant covariates. RESULTS Higher serum cortisol levels were significantly associated with suicidal outcomes at the 1-year follow-up. In addition, higher PSS scores were significantly associated with higher baseline severity, whereas the number of SLEs was not associated with any suicidal outcomes. A significant interactive effect of cortisol level and PSS score on suicidal outcomes at the 1-year follow-up was observed. Higher cortisol levels and PSS scores were associated with increased suicidal severity and more fatal/non-fatal suicide attempts. CONCLUSIONS The combination of serum cortisol levels and PSS scores may be useful for monitoring and predicting suicidal behaviors in depressed patients.
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Affiliation(s)
- Wonsuk Choi
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, South Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, South Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, South Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Robert Stewart
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea.
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25
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Strumila R, Nobile B, Korsakova L, Lengvenyte A, Olie E, Lopez-Castroman J, Guillaume S, Courtet P. Psilocybin, a Naturally Occurring Indoleamine Compound, Could Be Useful to Prevent Suicidal Behaviors. Pharmaceuticals (Basel) 2021; 14:ph14121213. [PMID: 34959614 PMCID: PMC8704767 DOI: 10.3390/ph14121213] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/24/2022] Open
Abstract
The available interventions for people who are at risk of suicide have limited efficacy. Recently, research on new mental health treatments has started to consider psychedelic compounds, particularly psilocybin, a molecule with a few thousand years of history of use in human societies. The possible effects of psilocybin on suicidal ideation and behaviors have not been specifically studied yet; however, the current knowledge on the suicidal process and the available data on es/ketamine suggest that psylocibin could be used to modulate the thoughts and behavioral patterns in individuals who are at risk of suicidal behaviors. Here, we summarize the available evidence on the possible mechanisms underlying psilocybin positive effects on suicide risk. Major pathways related to suicidal behaviors that might be modulated by psylocibin include serotonin receptors. Specifically, psylocibin directly stimulates the serotonin 2A receptor (5HT2A), targeting the inflammatory and oxidative stress pathways and leading to a rapid increase in brain plasticity and inflammation suppression and increases in cognitive flexibility, spirituality, and empathy. We also present preliminary epidemiological data and provide a rationale for studying psilocybin in individuals with suicidal ideation or who are at risk of suicidal behaviors. This review presents a framework to understand the basis for psilocybin use in individuals who are at risk of suicidal behaviors and calls for clinical studies.
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Affiliation(s)
- Robertas Strumila
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 34000 Montpellier, France; (A.L.); (E.O.); (S.G.); (P.C.)
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 34295 Montpellier, France;
- Psychiatric Clinic, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
- Correspondence: (R.S.); (B.N.)
| | - Bénédicte Nobile
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 34000 Montpellier, France; (A.L.); (E.O.); (S.G.); (P.C.)
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 34295 Montpellier, France;
- Correspondence: (R.S.); (B.N.)
| | - Laura Korsakova
- Laboratory of Preclinical Drug Investigation, Institute of Cardiology, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
| | - Aiste Lengvenyte
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 34000 Montpellier, France; (A.L.); (E.O.); (S.G.); (P.C.)
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 34295 Montpellier, France;
| | - Emilie Olie
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 34000 Montpellier, France; (A.L.); (E.O.); (S.G.); (P.C.)
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 34295 Montpellier, France;
| | - Jorge Lopez-Castroman
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 34295 Montpellier, France;
- Department of Adult Psychiatry, Nimes University Hospital, 44307 Nimes, France
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28001 Madrid, Spain
| | - Sébastien Guillaume
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 34000 Montpellier, France; (A.L.); (E.O.); (S.G.); (P.C.)
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 34295 Montpellier, France;
| | - Philippe Courtet
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 34000 Montpellier, France; (A.L.); (E.O.); (S.G.); (P.C.)
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 34295 Montpellier, France;
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Sher L, Bierer LM, Makotkine I, Yehuda R. The effect of oral dexamethasone administration on testosterone levels in combat veterans with or without a history of suicide attempt. J Psychiatr Res 2021; 143:499-503. [PMID: 33243458 DOI: 10.1016/j.jpsychires.2020.11.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/15/2020] [Accepted: 11/18/2020] [Indexed: 01/25/2023]
Abstract
Combat exposure has been linked to increased risk of suicidal ideation, suicide attempts, and death by suicide, and suicidality has been linked with altered testosterone levels. In this study, we examined morning baseline free and total testosterone levels and the effect of dexamethasone administration on testosterone levels in male combat veterans with or without a history of suicide attempt. Demographic and clinical parameters of the study participants were assessed and recorded. Blood samples were collected between 8:00 and 8:30 a.m. on the day prior to and following dexamethasone (0.5 mg) ingestion. Suicide attempters had higher schedule for suicidal ideation (SSI) scores in comparison to non-attempters. Baseline free and total testosterone levels were lower in suicide attempters compared to non-attempters. In the whole sample, both baseline free and total testosterone levels negatively correlated with SSI scores. Free testosterone levels decreased after dexamethasone administration among non-attempters but not among attempters. Free testosterone post-dexamethasone levels positively correlated with aggression scores among non-attempters but not among suicide attempters. Our findings indicate that there are substantial differences in the testosterone regulation between combat veterans with or without a history of suicide attempt. Studies of the relation between the testosterone function and suicidal behavior among combat veterans may lead to improvement in detection of suicidality and finding new pharmacological targets for prevention of suicide among veterans.
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Affiliation(s)
- Leo Sher
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Linda M Bierer
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Iouri Makotkine
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Yehuda
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
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27
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Sher L, Kilmade ME, Feinberg A, Govindarajulu U, Byne W, Kahn RS, Hazlett EA. Clinical features and psychiatric comorbidities in military veterans with schizophrenia with or without suicidality. J Psychiatr Res 2021; 143:262-267. [PMID: 34517189 DOI: 10.1016/j.jpsychires.2021.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/29/2021] [Accepted: 09/06/2021] [Indexed: 11/25/2022]
Abstract
Suicide is currently among the leading causes of death among individuals with schizophrenia. Reducing mortality from suicide remains a major clinical challenge in the care of veterans with schizophrenia. There is a need to increase our understanding of what elevates suicide risk in veterans with schizophrenia as a first step towards the future development of suicide prevention interventions. This study compared demographic and clinical features of military veterans with schizophrenia with vs. without suicidality to determine specific risk factors for suicidality. The sample consisted of two groups of veterans with schizophrenia: suicide ideators and/or attempters (SIA) and individuals without a history of suicidal ideation or attempts (no-SIA). Participants were interviewed using the Structured Clinical Interview for DSM-5 Axis I disorders (SCID-I), Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Hamilton Depression Rating Scale (HDRS), and Schizotypal Personality Questionnaire (SPQ). In bivariate analyses, the PANSS-Positive Symptom scores, PANSS-General Psychopathology scores, HDRS total score, HDRS-Paranoid symptoms item score, and SPQ total scores were higher among SIA compared with no-SIA patients. In this unique clinical sample of veterans with schizophrenia, SIA patients were more likely to have mood disorders, post-traumatic stress disorder (PTSD), and/or alcohol use disorder in comparison to the no-SIA group. Logistic regression analysis indicated that the HDRS total score and presence/absence of comorbid mood disorder drive the difference between the groups. These results indicate that suicide risk assessment in veterans with schizophrenia should include identifying individuals with comorbid mood disorders/symptoms, PTSD, alcohol use disorder, marked positive symptoms, and schizotypal features.
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Affiliation(s)
- Leo Sher
- James J. Peters VA Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | - Abigail Feinberg
- James J. Peters VA Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - William Byne
- New York State Psychiatric Institute, New York, NY, USA; Columbia University College of Physicians, New York, NY, USA
| | - René S Kahn
- James J. Peters VA Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin A Hazlett
- James J. Peters VA Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
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28
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Campos AI, Thompson PM, Veltman DJ, Pozzi E, van Veltzen LS, Jahanshad N, Adams MJ, Baune BT, Berger K, Brosch K, Bülow R, Connolly CG, Dannlowski U, Davey CG, de Zubicaray GI, Dima D, Erwin-Grabner T, Evans JW, Fu CHY, Gotlib IH, Goya-Maldonado R, Grabe HJ, Grotegerd D, Harris MA, Harrison BJ, Hatton SN, Hermesdorf M, Hickie IB, Ho TC, Kircher T, Krug A, Lagopoulos J, Lemke H, McMahon K, MacMaster FP, Martin NG, McIntosh AM, Medland SE, Meinert S, Meller T, Nenadic I, Opel N, Redlich R, Reneman L, Repple J, Sacchet MD, Schmitt S, Schrantee A, Sim K, Singh A, Stein F, Strike LT, van der Wee NJA, van der Werff SJA, Völzke H, Waltemate L, Whalley HC, Wittfeld K, Wright MJ, Yang TT, Zarate CA, Schmaal L, Rentería ME. Brain Correlates of Suicide Attempt in 18,925 Participants Across 18 International Cohorts. Biol Psychiatry 2021; 90:243-252. [PMID: 34172278 PMCID: PMC8324512 DOI: 10.1016/j.biopsych.2021.03.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Neuroimaging studies of suicidal behavior have so far been conducted in small samples, prone to biases and false-positive associations, yielding inconsistent results. The ENIGMA-MDD Working Group aims to address the issues of poor replicability and comparability by coordinating harmonized analyses across neuroimaging studies of major depressive disorder and related phenotypes, including suicidal behavior. METHODS Here, we pooled data from 18 international cohorts with neuroimaging and clinical measurements in 18,925 participants (12,477 healthy control subjects and 6448 people with depression, of whom 694 had attempted suicide). We compared regional cortical thickness and surface area and measures of subcortical, lateral ventricular, and intracranial volumes between suicide attempters, clinical control subjects (nonattempters with depression), and healthy control subjects. RESULTS We identified 25 regions of interest with statistically significant (false discovery rate < .05) differences between groups. Post hoc examinations identified neuroimaging markers associated with suicide attempt including smaller volumes of the left and right thalamus and the right pallidum and lower surface area of the left inferior parietal lobe. CONCLUSIONS This study addresses the lack of replicability and consistency in several previously published neuroimaging studies of suicide attempt and further demonstrates the need for well-powered samples and collaborative efforts. Our results highlight the potential involvement of the thalamus, a structure viewed historically as a passive gateway in the brain, and the pallidum, a region linked to reward response and positive affect. Future functional and connectivity studies of suicidal behaviors may focus on understanding how these regions relate to the neurobiological mechanisms of suicide attempt risk.
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Affiliation(s)
- Adrian I Campos
- Genetic Epidemiology Lab, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul M Thompson
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, California
| | - Dick J Veltman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Elena Pozzi
- Department of Psychiatry, The University of Melbourne & Melbourne Health, Melbourne, Victoria, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - Laura S van Veltzen
- Department of Psychiatry, The University of Melbourne & Melbourne Health, Melbourne, Victoria, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - Neda Jahanshad
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, California
| | - Mark J Adams
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Bernhard T Baune
- Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia; The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia; Department of Psychiatry, University of Münster, Münster, North Rhine-Westphalia, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, North Rhine-Westphalia, Germany
| | - Katharina Brosch
- Department of Psychiatry, Philipps-University Marburg, Marburg, Hesse, Germany
| | - Robin Bülow
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Colm G Connolly
- Department of Biomedical Sciences, Florida State University, Tallahassee, Florida
| | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Münster, North Rhine-Westphalia, Germany
| | - Christopher G Davey
- Department of Psychiatry, The University of Melbourne & Melbourne Health, Melbourne, Victoria, Australia
| | - Greig I de Zubicaray
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Danai Dima
- Department of Psychology, School of Arts and Social Sciences, City, University of London, London, United Kingdom; Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Tracy Erwin-Grabner
- Laboratory of Systems Neuroscience and Imaging in Psychiatry, Department of Psychiatry and Psychotherapy, University Medical Center, Göttingen, Lower Saxony, Germany
| | - Jennifer W Evans
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Cynthia H Y Fu
- Centre for Affective Disorders, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom; School of Psychology, University of East London, London, United Kingdom
| | - Ian H Gotlib
- Department of Psychology, Stanford University, Stanford, California
| | - Roberto Goya-Maldonado
- Laboratory of Systems Neuroscience and Imaging in Psychiatry, Department of Psychiatry and Psychotherapy, University Medical Center, Göttingen, Lower Saxony, Germany
| | - Hans J Grabe
- German Center for Neurodegenerative Disease, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Dominik Grotegerd
- Department of Psychiatry, University of Münster, Münster, North Rhine-Westphalia, Germany
| | - Matthew A Harris
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Ben J Harrison
- Department of Psychiatry, The University of Melbourne & Melbourne Health, Melbourne, Victoria, Australia
| | - Sean N Hatton
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Marco Hermesdorf
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, North Rhine-Westphalia, Germany
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Tiffany C Ho
- Department of Psychiatry & Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Tilo Kircher
- Department of Psychiatry, Philipps-University Marburg, Marburg, Hesse, Germany
| | - Axel Krug
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, North Rhine-Westphalia, Germany; Department of Psychiatry, Philipps-University Marburg, Marburg, Hesse, Germany
| | - Jim Lagopoulos
- Thompson Institute, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia; Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Hannah Lemke
- Department of Psychiatry, University of Münster, Münster, North Rhine-Westphalia, Germany
| | - Katie McMahon
- Herston Imaging Research Facility & School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Frank P MacMaster
- Department of Pediatrics and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Strategic Clinical Network for Addictions and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Nicholas G Martin
- Genetic Epidemiology Lab, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Andrew M McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Sarah E Medland
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Psychiatric Genetics Lab, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Austalia; School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Susanne Meinert
- Department of Psychiatry, University of Münster, Münster, North Rhine-Westphalia, Germany
| | - Tina Meller
- Department of Psychiatry, Philipps-University Marburg, Marburg, Hesse, Germany
| | - Igor Nenadic
- Department of Psychiatry, Philipps-University Marburg, Marburg, Hesse, Germany
| | - Nils Opel
- Department of Psychiatry, University of Münster, Münster, North Rhine-Westphalia, Germany
| | - Ronny Redlich
- Department of Psychiatry, University of Münster, Münster, North Rhine-Westphalia, Germany
| | - Liesbeth Reneman
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
| | - Jonathan Repple
- Department of Psychiatry, University of Münster, Münster, North Rhine-Westphalia, Germany
| | - Matthew D Sacchet
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Harvard Medical School, Belmont, Massachusetts
| | - Simon Schmitt
- Department of Psychiatry, Philipps-University Marburg, Marburg, Hesse, Germany
| | - Anouk Schrantee
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
| | - Kang Sim
- West Region, Institute of Mental Health, Buangkok View, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Aditya Singh
- Laboratory of Systems Neuroscience and Imaging in Psychiatry, Department of Psychiatry and Psychotherapy, University Medical Center, Göttingen, Lower Saxony, Germany
| | - Frederike Stein
- Department of Psychiatry, Philipps-University Marburg, Marburg, Hesse, Germany
| | - Lachlan T Strike
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Steven J A van der Werff
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Lena Waltemate
- Department of Psychiatry, University of Münster, Münster, North Rhine-Westphalia, Germany
| | - Heather C Whalley
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Katharina Wittfeld
- German Center for Neurodegenerative Disease, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Margaret J Wright
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia; Centre for Advanced Imaging, The University of Queensland, Brisbane, Queensland, Australia
| | - Tony T Yang
- Department of Psychiatry & Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Lianne Schmaal
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.
| | - Miguel E Rentería
- Genetic Epidemiology Lab, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
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Kucuker MU, Almorsy AG, Sonmez AI, Ligezka AN, Doruk Camsari D, Lewis CP, Croarkin PE. A Systematic Review of Neuromodulation Treatment Effects on Suicidality. Front Hum Neurosci 2021; 15:660926. [PMID: 34248523 PMCID: PMC8267816 DOI: 10.3389/fnhum.2021.660926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/17/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: Neuromodulation is an important group of therapeutic modalities for neuropsychiatric disorders. Prior studies have focused on efficacy and adverse events associated with neuromodulation. Less is known regarding the influence of neuromodulation treatments on suicidality. This systematic review sought to examine the effects of various neuromodulation techniques on suicidality. Methods: A systematic review of the literature from 1940 to 2020 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was conducted. Any reported suicide-related outcome, including suicidal ideation, suicide intent, suicide attempt, completed suicide in reports were considered as a putative measure of treatment effect on suicidality. Results: The review identified 129 relevant studies. An exploratory analysis of a randomized controlled trial comparing the effects of sertraline and transcranial direct-current stimulation (tDCS) for treating depression reported a decrease in suicidal ideation favoring tDCS vs. placebo and tDCS combined with sertraline vs. placebo. Several studies reported an association between repetitive transcranial magnetic stimulation and improvements in suicidal ideation. In 12 of the studies, suicidality was the primary outcome, ten of which showed a significant improvement in suicidal ideation. Electroconvulsive therapy (ECT) and magnetic seizure therapy was also shown to be associated with lower suicidal ideation and completed suicide rates. There were 11 studies which suicidality was the primary outcome and seven of these showed an improvement in suicidal ideation or suicide intent and fewer suicide attempts or completed suicides in patients treated with ECT. There was limited literature focused on the potential protective effect of vagal nerve stimulation with respect to suicidal ideation. Data were mixed regarding the potential effects of deep brain stimulation on suicidality. Conclusions: Future prospective studies of neuromodulation that focus on the primary outcome of suicidality are urgently needed. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=125599, identifier: CRD42019125599.
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Affiliation(s)
- Mehmet Utku Kucuker
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Ammar G. Almorsy
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Ayse Irem Sonmez
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Anna N. Ligezka
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, United States
| | - Deniz Doruk Camsari
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Charles P. Lewis
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Paul E. Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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Ancheta AJ, Bruzzese JM, Hughes TL. The Impact of Positive School Climate on Suicidality and Mental Health Among LGBTQ Adolescents: A Systematic Review. J Sch Nurs 2021; 37:75-86. [PMID: 33287652 PMCID: PMC8142116 DOI: 10.1177/1059840520970847] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) adolescents are more likely to report suicidality and worse mental health than their heterosexual peers. We conducted a systematic review to examine the relationship between positive school climate and suicidality and mental health among LGBTQ adolescents. We searched the literature using PubMed, PsycINFO, and CINAHL. Six studies met inclusion criteria, and all had low to moderate risks of bias. Results indicate that LGBTQ students in schools with more positive school climates were at lower risk of suicidality and reported fewer depressive symptoms compared to students in less positive school climates. Being at the forefront of health in schools, school nurses have the opportunity to advocate for changes in school environments that promote positive mental health for all youth, including LGBTQ adolescents.
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Affiliation(s)
- April J. Ancheta
- Program for the Study of LGBT Health, Columbia University School of Nursing, New York, NY, USA
| | | | - Tonda L. Hughes
- Program for the Study of LGBT Health, Columbia University School of Nursing, New York, NY, USA
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Au JS, Martinez de Andino A, Mekawi Y, Silverstein MW, Lamis DA. Latent class analysis of bipolar disorder symptoms and suicidal ideation and behaviors. Bipolar Disord 2021; 23:186-195. [PMID: 32579284 DOI: 10.1111/bdi.12967] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
UNLABELLED Individuals with bipolar disorder are at increased risk of dying by suicide compared to healthy controls and those with unipolar depression. Previous studies show that depressive symptoms and mixed episodes of mania and depression are related to suicide. However, most of these studies adopt a variable-centered approach to understanding how specific symptoms relate to suicidal ideation, without addressing how these symptoms and symptom profiles relate to suicidal behaviors. OBJECTIVES Using latent class analysis, this study adopts a person-centered approach to examine whether subtypes of patients with bipolar disorder differ in their levels of suicidal ideation and behaviors. METHODS A total of 150 patients from a behavioral health outpatient clinic were recruited. Latent classes were generated based on self reports of their depressive and manic symptoms. RESULTS Five classes of patients with bipolar disorder were identified, namely, a minimal symptom, mania, moderately depressed, severely depressed, and mixed depression-mania subtypes. Those in the severely depressed and mixed depression-mania groups reported significantly higher levels of suicidal ideation and behaviors compared to the other groups. CONCLUSIONS Our findings provide further support for the strong relationship between depressive symptoms and suicidality. These findings are significant as they shed light on the different suicide risk profiles among a heterogenous group of patients with bipolar disorder. Name of clinical trial: Suicidal Behavior in Patients Diagnosed with Bipolar Disorder: The Roles of Biological and Childhood and Adult Environmental Risk Factors. ClinicalTrials.gov Identifier: NCT02604277.
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Affiliation(s)
- Josephine S Au
- Child and Adolescent Psychiatry Division, McLean Hospital/Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Ana Martinez de Andino
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, USA
| | - Yara Mekawi
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, USA
| | - Madison W Silverstein
- Department of Psychological Sciences, Loyola University New Orleans, New Orleans, LA, USA
| | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, USA
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Shafiee M, Vatanparast H, Janzen B, Serahati S, Keshavarz P, Jandaghi P, Pahwa P. Household food insecurity is associated with depressive symptoms in the Canadian adult population. J Affect Disord 2021; 279:563-571. [PMID: 33152560 DOI: 10.1016/j.jad.2020.10.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND It is essential to identify factors associated with depression as it is a highly prevalent and disabling mental disorder. The aim of this study was to examine the association between depressive symptoms and household food security status among the Canadian adult population. METHODS This is a cross-sectional study of the adult population in the five provinces and one territory (Northwest Territories) of Canada using data from the 2015-2016 Canadian Community Health Survey-Annual Component (n=19,118). Depressive symptoms were assessed using the 9-item Patient Health Questionnaire. Household food insecurity was measured using the Household Food Security Survey Module. A weighted logistic regression analysis with robust variance estimation technique was performed. RESULTS Approximately 22% of the Canadian adult population reported mild-to-severe depressive symptoms, and 8.3% were from households classified as food insecure. Household food insecurity remained a predictor of mild-to-severe depressive symptoms after adjustment for other known risk factors (ORajd: 2.87, 95% CI: 2.33-3.55, p<0.001). In the multivariable model, significant associations were also found with multimorbidity, lower household income, a history of illicit drug use, being a current smoker, being a widowed/divorced/separated, obesity, and being a non-drinker. Significant interactions also emerged between employment status and age (p=0.03), employment status and gender (p<0.001), and physical activity level and gender (p<0.001). LIMITATIONS The cross-sectional nature of the study does not allow inferring causality. CONCLUSIONS Household food insecurity is associated with depressive symptoms in Canadian adults. Additional longitudinal research is required to further elucidate the nature of this relationship.
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Affiliation(s)
- Mojtaba Shafiee
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Hassan Vatanparast
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada; School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Bonnie Janzen
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Sara Serahati
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Pardis Keshavarz
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Parisa Jandaghi
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Punam Pahwa
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada; Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada.
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Doblytė S. Shame in a post-socialist society: a qualitative study of healthcare seeking and utilisation in common mental disorders. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1858-1872. [PMID: 32780502 DOI: 10.1111/1467-9566.13170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 07/07/2020] [Accepted: 07/14/2020] [Indexed: 06/11/2023]
Abstract
After the regime collapse, the former socialist societies in Central and Eastern Europe experienced rapid social and economic transformations. Consequently, mental health deterioration coupled with ambitions to break with the past triggered reforms of mental health systems. Yet, 30 years later, mental health in the region remains poor. Stigma of mental illness may be one of the factors that delays help seeking and, therefore, maintains status quo. Thus, the aim of the article is to better understand the roots of stigma and the process of stigmatisation in one of these countries - Lithuania. Drawing on Norbert Elias's model of established-outsider relations, the article presents the analysis of 23 in-depth interviews with healthcare providers and users of services diagnosed with depression or anxiety disorders. Said analysis reveals how stigma of mental illness might result in damaged self-image and shame of feeling different. Mental illness and healthcare seeking are perceived as a threat to culturally and historically determined self-values, at the core of which seems to be intolerance of difference. The article contributes not only to research concerning mental health in a relatively understudied region of Central and Eastern Europe, but also to existing literature on stigma as embedded in a local context.
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Balint L, Fuzer K, Gonda X, Dome P. Estimation of the relationship between the persistent decrease of the suicide rate and the changes in sociodemographic composition in Hungary between 1990 and 2011. PLoS One 2020; 15:e0241314. [PMID: 33095839 PMCID: PMC7584192 DOI: 10.1371/journal.pone.0241314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 10/13/2020] [Indexed: 11/19/2022] Open
Abstract
From the end of the 1980s, the Hungarian suicide rate, which had been until that point the highest in the world for decades, has decreased drastically. The reason behind this decrease was probably due to the changes in numerous and often interlinked risk factors. Studies on this topic have mostly ignored to interrogate to what extent the change of the population composition, for example the improvement of educational level, contributed to the decrease of the rate in the given period? Our aim was to assess the contribution of changes in some sociodemographic factors to the decrease of the suicide rate in Hungary. During the analysis, data from 1990 were compared with data from 2011. For the statistical calculations, the method of “Standardization and Decomposition (SDA)” was used, which according to our best knowledge, has not yet been applied in Hungarian suicide studies. The results show that the improvement of educational level helped to decrease the rate for men by about a third, while for women only by about a tenth. However, the benefit of the improvement in educational attainment during the period investigated was significantly offset by the changes primarily in marital status (the ratios of unmarried and divorced subjects increased for both genders) and in age distribution (the ratio of the elderly persons increased for both genders). The results of our study emphasise the inverse relationship between suicide and educational level and support the hypothesis that we can regard educational policy as indirect health policy.
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Affiliation(s)
- Lajos Balint
- Demographic Research Institute of the Hungarian Central Statistical Office, Budapest, Hungary
- Department of Sociology, University of Pécs, Pécs, Hungary
- * E-mail: (LB); , (PD)
| | - Katalin Fuzer
- Department of Sociology, University of Pécs, Pécs, Hungary
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of Medicine, Budapest, Hungary
- Nyiro Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary
- NAP-2-SE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
| | - Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of Medicine, Budapest, Hungary
- Nyiro Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary
- * E-mail: (LB); , (PD)
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Cho CH, Lee T, Lee JB, Seo JY, Jee HJ, Son S, An H, Kim L, Lee HJ. Effectiveness of a Smartphone App With a Wearable Activity Tracker in Preventing the Recurrence of Mood Disorders: Prospective Case-Control Study. JMIR Ment Health 2020; 7:e21283. [PMID: 32755884 PMCID: PMC7439135 DOI: 10.2196/21283] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/19/2020] [Accepted: 07/23/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Smartphones and wearable devices can be used to obtain diverse daily log data related to circadian rhythms. For patients with mood disorders, giving feedback via a smartphone app with appropriate behavioral correction guides could play an important therapeutic role in the real world. OBJECTIVE We aimed to evaluate the effectiveness of a smartphone app named Circadian Rhythm for Mood (CRM), which was developed to prevent mood episodes based on a machine learning algorithm that uses passive digital phenotype data of circadian rhythm behaviors obtained with a wearable activity tracker. The feedback intervention for the CRM app consisted of a trend report of mood prediction, H-score feedback with behavioral guidance, and an alert system triggered when trending toward a high-risk state. METHODS In total, 73 patients with a major mood disorder were recruited and allocated in a nonrandomized fashion into 2 groups: the CRM group (14 patients) and the non-CRM group (59 patients). After the data qualification process, 10 subjects in the CRM group and 33 subjects in the non-CRM group were evaluated over 12 months. Both groups were treated in a similar manner. Patients took their usual medications, wore a wrist-worn activity tracker, and checked their eMoodChart daily. Patients in the CRM group were provided with daily feedback on their mood prediction and health scores based on the algorithm. For the CRM group, warning alerts were given when irregular life patterns were observed. However, these alerts were not given to patients in the non-CRM group. Every 3 months, mood episodes that had occurred in the previous 3 months were assessed based on the completed daily eMoodChart for both groups. The clinical course and prognosis, including mood episodes, were evaluated via face-to-face interviews based on the completed daily eMoodChart. For a 1-year prospective period, the number and duration of mood episodes were compared between the CRM and non-CRM groups using a generalized linear model. RESULTS The CRM group had 96.7% fewer total depressive episodes (n/year; exp β=0.033, P=.03), 99.5% shorter depressive episodes (total; exp β=0.005, P<.001), 96.1% shorter manic or hypomanic episodes (exp β=0.039, P<.001), 97.4% fewer total mood episodes (exp β=0.026, P=.008), and 98.9% shorter mood episodes (total; exp β=0.011, P<.001) than the non-CRM group. Positive changes in health behaviors due to the alerts and in wearable device adherence rates were observed in the CRM group. CONCLUSIONS The CRM app with a wearable activity tracker was found to be effective in preventing and reducing the recurrence of mood disorders, improving prognosis, and promoting better health behaviors. Patients appeared to develop a regular habit of using the CRM app. TRIAL REGISTRATION ClinicalTrials.gov NCT03088657; https://clinicaltrials.gov/ct2/show/NCT03088657.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Psychiatry, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.,Department of Psychiatry, Chungnam National University Sejong Hospital, Sejong, Republic of Korea.,Korea University Chronobiology Institute, Seoul, Republic of Korea
| | - Taek Lee
- Department of Convergence Security Engineering, College of Knowledge-based Services Engineering, Sungshin Women's University, Seoul, Republic of Korea
| | - Jung-Been Lee
- Department of Computer Science, Korea University College of Information, Seoul, Republic of Korea
| | - Ju Yeon Seo
- Korea University Chronobiology Institute, Seoul, Republic of Korea.,Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee-Jung Jee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Serhim Son
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyonggin An
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Leen Kim
- Korea University Chronobiology Institute, Seoul, Republic of Korea
| | - Heon-Jeong Lee
- Korea University Chronobiology Institute, Seoul, Republic of Korea.,Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
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Beevers Z, Hussain S, Boele FW, Rooney AG. Pharmacological treatment of depression in people with a primary brain tumour. Cochrane Database Syst Rev 2020; 7:CD006932. [PMID: 32678464 PMCID: PMC7388852 DOI: 10.1002/14651858.cd006932.pub4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This is the second updated version of the Cochrane Review published in Issue 3, 2010 and first updated in Issue 5, 2013. People with a primary brain tumour often experience depression, for which drug treatment may be prescribed. However, they are also at high risk of epileptic seizures, cognitive impairment, and fatigue, all of which are potential adverse side effects of antidepressants. The benefit, or harm, of pharmacological treatment of depression in people with a primary brain tumour is unclear. OBJECTIVES To assess the benefits and harms of pharmacological treatment of depression in people with a primary brain tumour. SEARCH METHODS We updated the search to include CENTRAL, MEDLINE, Embase, and PsycINFO to September 2019. As in the original review, we also handsearched Neuro-Oncology, Journal of Neuro-Oncology, Journal of Neurology, Neurosurgery and Psychiatry, and Journal of Clinical Oncology: for the current update we handsearched the latest three years of articles from these journals (up to November 2019). SELECTION CRITERIA We searched for all randomised controlled trials (RCTs), controlled clinical trials, cohort studies, and case-control studies of any pharmacological treatment of depression in people with a histologically diagnosed primary brain tumour. DATA COLLECTION AND ANALYSIS No studies met the inclusion criteria. MAIN RESULTS We found no eligible studies evaluating the benefits of any pharmacological treatment of depression in people with a primary brain tumour. AUTHORS' CONCLUSIONS We identified no high-quality studies that investigated the value of pharmacological treatment of depression in people with a primary brain tumour. RCTs and detailed prospective studies are required to inform the effective pharmacological treatment of this common and important complication of brain tumours. Since the last version of this review none of the related new literature has provided additional information to change these conclusions.
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Affiliation(s)
| | - Sana Hussain
- School of Medicine, University of Leeds, Leeds, UK
| | - Florien W Boele
- Leeds Institute of Health Sciences and Leeds Institute of Cancer and Pathology, University of Leeds and Leeds Cancer Centre, Leeds, UK
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Lagerberg T, Fazel S, Molero Y, Franko MA, Chen Q, Hellner C, Lichtenstein P, Chang Z. Associations between selective serotonin reuptake inhibitors and violent crime in adolescents, young, and older adults - a Swedish register-based study. Eur Neuropsychopharmacol 2020; 36:1-9. [PMID: 32475742 PMCID: PMC7347007 DOI: 10.1016/j.euroneuro.2020.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 03/13/2020] [Accepted: 03/30/2020] [Indexed: 01/07/2023]
Abstract
This study identified individuals ever dispensed a selective serotonin reuptake inhibitor (SSRI) aged 15-60 years during 2006-2013, using Swedish national registers. The outcome was violent crime conviction. The main statistical analyses assessed risks of violent crime during periods on compared to off SSRI treatment within individuals. Further analyses investigated risk over time in relation to treatment initiation and discontinuation. The study identified 785,337 individuals (64.2% female), experiencing 32,203 violent crimes in 5,707,293 person-years. Between-individual analyses found statistically significantly elevated Hazard Ratios (HRs) overall (HR = 1.10), and in 15-24 and 25-34 year-olds (HR = 1.19 and 1.16), but non-significant HRs in 35-44 and 45-60-year-olds (HR = 1.02 and 1.04). In within-individual analyses, where 2.6% of SSRI users were informative, hazards were elevated overall (HR = 1.26, 95% CI = 1.19, 1.34), and across age groups (HR of 1.35 [95% CI = 1.19, 1.54] in 25-34-year-olds to 1.15 [95% CI = 0.99, 1.33] in 35-44-year-olds). In the overall cohort, the within-individual HRs were significantly elevated throughout treatment (HRs of 1.24 to 1.35) and for up to 12 weeks post-discontinuation (HRs of 1.37 and 1.20). While questions on causality remain, these results indicate that there may be an increased risk of violent crime during SSRI treatment in a small group of individuals. It may persist throughout medicated periods, across age groups, and after treatment discontinuation. Further confirmation is needed from studies with different designs, and clinical focus should be on high-risk individuals, as a majority of SSRI-users (around 97% in our cohort) will not commit violent crimes.
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Affiliation(s)
- Tyra Lagerberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165 Solna, Stockholm, Sweden.
| | - Seena Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Yasmina Molero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165 Solna, Stockholm, Sweden; Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Andersson Franko
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165 Solna, Stockholm, Sweden
| | - Qi Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165 Solna, Stockholm, Sweden
| | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165 Solna, Stockholm, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165 Solna, Stockholm, Sweden
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Johnson JE, Jones R, Miller T, Miller I, Stanley B, Brown G, Arias SA, Cerbo L, Rexroth J, Fitting H, Russell D, Kubiak S, Stein M, Matkovic C, Yen S, Gaudiano B, Weinstock LM. Study Protocol: A randomized controlled trial of suicide risk reduction in the year following jail release (the SPIRIT Trial). Contemp Clin Trials 2020; 94:106003. [DOI: 10.1016/j.cct.2020.106003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/14/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
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Campos AI, Verweij KJH, Statham DJ, Madden PAF, Maciejewski DF, Davis KAS, John A, Hotopf M, Heath AC, Martin NG, Rentería ME. Genetic aetiology of self-harm ideation and behaviour. Sci Rep 2020; 10:9713. [PMID: 32546850 PMCID: PMC7297971 DOI: 10.1038/s41598-020-66737-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/11/2020] [Indexed: 12/21/2022] Open
Abstract
Family studies have identified a heritable component to self-harm that is partially independent from comorbid psychiatric disorders. However, the genetic aetiology of broad sense (non-suicidal and suicidal) self-harm has not been characterised on the molecular level. In addition, controversy exists about the degree to which suicidal and non-suicidal self-harm share a common genetic aetiology. In the present study, we conduct genome-wide association studies (GWAS) on lifetime self-harm ideation and self-harm behaviour (i.e. any lifetime self-harm act regardless of suicidal intent) using data from the UK Biobank (n > 156,000). We also perform genome wide gene-based tests and characterize the SNP heritability and genetic correlations between these traits. Finally, we test whether polygenic risk scores (PRS) for self-harm ideation and self-harm behaviour predict suicide attempt, suicide thoughts and non-suicidal self-harm (NSSH) in an independent target sample of 8,703 Australian adults. Our GWAS results identified one genome-wide significant locus associated with each of the two phenotypes. SNP heritability (hsnp2) estimates were ~10%, and both traits were highly genetically correlated (LDSC rg > 0.8). Gene-based tests identified seven genes associated with self-harm ideation and four with self-harm behaviour. Furthermore, in the target sample, PRS for self-harm ideation were significantly associated with suicide thoughts and NSSH, and PRS for self-harm behaviour predicted suicide thoughts and suicide attempt. Follow up regressions identified a shared genetic aetiology between NSSH and suicide thoughts, and between suicide thoughts and suicide attempt. Evidence for shared genetic aetiology between NSSH and suicide attempt was not statistically significant.
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Affiliation(s)
- Adrian I Campos
- Department of Genetics & Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia.
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia.
| | - Karin J H Verweij
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Dixie J Statham
- Discipline of Psychology, School of Health and Life Sciences, Federation University, Ballarat, VIC, 3550, Australia
| | - Pamela A F Madden
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Dominique F Maciejewski
- Department of Developmental Psychopathology, Behavioural Science Institute, Nijmegen, the Netherlands
| | - Katrina A S Davis
- KCL Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ann John
- HDRUK, Swansea University Medical School, Swansea, UK
| | - Matthew Hotopf
- KCL Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Andrew C Heath
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Nicholas G Martin
- Department of Genetics & Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
| | - Miguel E Rentería
- Department of Genetics & Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia.
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia.
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Bertschy G, Weibel S, Giersch A, Weiner L. Racing and crowded thoughts in mood disorders: A data-oriented theoretical reappraisal. Encephale 2020; 46:202-208. [DOI: 10.1016/j.encep.2020.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 10/24/2022]
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Clinical and personality profile of depressed suicide attempters: A preliminary study at the open-door policy Mood Disorder Unit of San Raffaele Hospital. Psychiatry Res 2020; 287:112575. [PMID: 31587915 DOI: 10.1016/j.psychres.2019.112575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/18/2019] [Accepted: 09/21/2019] [Indexed: 11/22/2022]
Abstract
Suicidal behavior is a complex phenomenon with high rates among psychiatric inpatients. Mood disorders and personality dysfunctions represent relevant risk factors for suicides attempts and suicidal ideation. Our study aims to investigate the role of the co-occurrence of clinical variables (duration of depressive state, previous suicide attempts), socio-demographic variables (gender, employment and civil status) and narcissistic personality features in the suicide risk of admitted psychiatric patients affected by a mood disorder. The sample was composed of 93 patients consecutively admitted in an open ward psychiatric Unit. Forty-eight participants had a positive history of previous suicide attempts: the suicide attempters (SA) were mostly female, unemployed and married. The SA group were observed to have suffered from a depressive episode with a longer duration; moreover in the SA group, the presence of active suicidal ideation was significantly related to a higher number of previous suicide attempts. In the whole sample, suicidal ideation was significantly related to narcissistic vulnerability personality features. Using a multidimensional approach, the present study allows a preliminary profiling of patients at risk for suicidal behavior during hospitalization.
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Tang W, Kang Y, Xu J, Li T. Associations of Suicidality with Adverse Life Events, Psychological Distress and Somatic Complaints in a Chinese Medical Student Sample. Community Ment Health J 2020; 56:635-644. [PMID: 31919657 DOI: 10.1007/s10597-019-00523-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 12/09/2019] [Indexed: 02/05/2023]
Abstract
The present study aimed to examine the associations of suicidality with psychological distress, somatic symptoms, and stressors in medical school students. We conducted a cross-sectional survey of medical students at a large, top-ranked medical school. A total sample of 662 medical students (269 men) completed a battery of self-reported questionnaire. Of the respondents, 136 (20.5%) reported having suicidal ideation, 40 (6.0%) reported having planned suicide, and 10 (1.5%) reported having attempted suicide during the previous year. Students from rural areas and the 3rd year of study reported higher levels of suicidal ideation than their counterparts. General pain/fatigue was associated with suicidal ideation and planning, while interpersonal difficulties were associated only with suicidal ideation. This study provides evidence linking severe psychological distress, general pain/fatigue, interpersonal stress and psychosocial factors with suicide risk among Chinese medical students which provides targets for future psychological interventions.
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Affiliation(s)
- Wanjie Tang
- Centre for Educational and Health Psychology, Sichuan University, Chengdu, China
- Institute of Emergency Management and Post-disaster Reconstruction, Sichuan University, Chengdu, China
- Mental Health Center, State Key Lab of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yukun Kang
- Mental Health Center, State Key Lab of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Jiuping Xu
- Institute of Emergency Management and Post-disaster Reconstruction, Sichuan University, Chengdu, China.
| | - Tao Li
- Centre for Educational and Health Psychology, Sichuan University, Chengdu, China.
- Mental Health Center, State Key Lab of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
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Squassina A, Niola P, Lopez JP, Cruceanu C, Pisanu C, Congiu D, Severino G, Ardau R, Chillotti C, Alda M, Turecki G, Del Zompo M. MicroRNA expression profiling of lymphoblasts from bipolar disorder patients who died by suicide, pathway analysis and integration with postmortem brain findings. Eur Neuropsychopharmacol 2020; 34:39-49. [PMID: 32241689 DOI: 10.1016/j.euroneuro.2020.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 02/26/2020] [Accepted: 03/06/2020] [Indexed: 12/21/2022]
Abstract
Post-mortem brain studies suggest that miRNAs may be involved in suicide, but their role as peripheral biomarkers or targets of preventive pharmacological treatments in suicide has yet to be elucidated. We used nCounter miRNA Expression assay to measure miRNAs expression in lymphoblastoid cell lines (LCLs) from patients with Bipolar Disorder (BD) who died by suicide (SC, n = 7) and with low risk of suicide (LR, n = 11). Five miRNAs were differentially expressed in SC compared to LR (false discovery rate p<0.05). The two most significant miRNAs were measured with RT-qPCR in the same sample and in 12 healthy controls (HC): miR-4286 was increased while miR-186-5p was decreased in SC compared to LR and HC (ANOVA F = 14.92, p = 0.000043 and F = 3.95, p = 0.032 respectively). miR-4286 was also decreased in postmortem brains from 12 patients with BD who died by suicide compared to 13 controls, even though it did not reach statistical significance (FC=0.51, p = 0.07). Treatment with lithium of human neural progenitor cells reduced the expression of miR-4286 (FC=0.30, p = 0.038). Pathway analysis on predicted miR-4286 targets showed that "insulin resistance" was significantly enriched after correction for multiple testing. This pathway comprised 17 genes involved in lipid and glucose metabolism, several of which were also dysregulated in postmortem brains from patients with BD who died by suicide from the Stanley-foundation array collection. In conclusion, our study suggests that miR-4286 could be a biomarker of suicide but further studies are warranted to investigate its targeted genes and how these could be involved in the neurobiology of suicide.
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Affiliation(s)
- Alessio Squassina
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Italy.
| | - Paola Niola
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Italy; UCL Genomics, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Juan Pablo Lopez
- Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Canada
| | - Cristiana Cruceanu
- Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Canada
| | - Claudia Pisanu
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Italy
| | - Donatella Congiu
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Italy
| | - Giovanni Severino
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Italy
| | - Raffaella Ardau
- Unit of Clinical Pharmacology of the University Hospital of Cagliari, Italy
| | - Caterina Chillotti
- Unit of Clinical Pharmacology of the University Hospital of Cagliari, Italy
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gustavo Turecki
- Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Canada
| | - Maria Del Zompo
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Italy; Unit of Clinical Pharmacology of the University Hospital of Cagliari, Italy
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Azorin J, Kaladjian A, Adida M, Fakra E, Belzeaux R, Hantouche E, Lancrenon S. Factors associated with borderline personality disorder in major depressive patients and their relationship to bipolarity. Eur Psychiatry 2020; 28:463-8. [DOI: 10.1016/j.eurpsy.2012.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 11/12/2012] [Accepted: 11/23/2012] [Indexed: 12/31/2022] Open
Abstract
AbstractObjectiveTo analyze the interface between borderline personality disorder (BPD) and bipolarity in depressed patients comorbid with BPD.MethodsAs part of National Multi-site Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1 month apart, 19 (3.9%) had comorbid BPD (BPD+), whereas 474 (96.1%) did not manifest this comorbidity (BPD−).ResultsCompared to BPD (−), BPD (+) patients displayed higher rates of bipolar (BP) disorders and temperaments, an earlier age at onset with a family history of affective illness, more comorbidity, more stressors before the first episode which was more often depressive or mixed, as well as a greater number and severity of affective episodes.ConclusionsThe hypothesis which fitted at best our findings was to consider BPD as a contributory factor in the development of BP disorder, which could have favoured the progression from unipolar major depression to BP disorder. We could not however exclude that some features of BP disorder may have contributed to the development of BPD.
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Male depressive traits in relation to violent suicides or suicide attempts: A systematic review. J Affect Disord 2020; 262:55-61. [PMID: 31707247 DOI: 10.1016/j.jad.2019.10.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/09/2019] [Accepted: 10/28/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Male sex is a consistently reported risk factor for violent suicide. It has been suggested that this association may be driven by so-called male depression - as operationalized by the Gotland Male Depression Scale (GMDS). The aim of this systematic review was to investigate if males dying by or attempting suicide with violent methods, display symptoms compatible with male depression. METHODS This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic search of PubMed, Embase and PsycINFO was performed using search terms covering: male sex, violent suicide/suicide attempt, and symptoms of male depression from the GMDS. Subsequently, a qualitative synthesis of studies meeting predefined inclusion criteria was carried out. RESULTS A total of 28 studies reporting on 91,933 violent suicides and 113 violent suicide attempts were included in the qualitative synthesis. The suicide/suicide attempt methods reported in these studies were predominantly shooting, hanging or drowning. The only two symptoms from the GMDS that was reported in relation to violent suicides/suicide attempts was overconsumption of alcohol or drugs and suicide attempts in the biological family. No studies had systematically assessed suicide victims or attempters for symptoms of male depression. LIMITATIONS Publication-, selection-, and information biases may have affected this review. CONCLUSIONS Symptoms of male depression are rarely reported in relation to violent suicides/suicide attempts. The most likely explanation for this finding is that there has been little focus on this potential association. Future studies should address this void.
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Grundsøe TL, Pedersen ML. Risk factors observed in health care system 6 months prior completed suicide. Int J Circumpolar Health 2020; 78:1617019. [PMID: 31084408 PMCID: PMC6522904 DOI: 10.1080/22423982.2019.1617019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Ten percent of all deaths in Greenland are caused by suicide. The aim of this study was to explore if applicable risk factors could be identified among the suicide victims within the health care system up to 6 months prior to the suicide. The study was performed as an age- and gender-matched case control study including all suicides in Greenland from 2012 to 2015, based on review of medical records for risk factors including suicide ideation, suicide attempts, incidence of alcohol intoxication, incidence of violence and treatment for psychiatric illness within the 6 month period leading up to the suicide. In total, 160 cases and 160 controls were included. Presence of any risk factors were observed in around a third of all suicide cases compared a tenth among the controls. The highest odds ratios for suicide were observed for suicide ideation and suicide attempts. However, no contact with the health care system was observed for two thirds of the suicides victims. Thus, focus on suicide ideation and suicide attempts among patients could help health care professionals to assess suicide risk and initiate prevention. Additional preventive strategies targeting the majority without contact to the health care system need to be explored.
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Affiliation(s)
| | - Michael Lynge Pedersen
- a Queen Ingrid Health Care Center , Nuuk , Greenland.,b Greenland Center of Health Research, Institute of Nursing and Health Science , University of Greenland , Nuuk , Greenland
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Kang SG, Cho SE, Na KS, Lee JS, Joo SW, Cho SJ, Son YD, Lee YJ. Differences in brain surface area and cortical volume between suicide attempters and non-attempters with major depressive disorder. Psychiatry Res Neuroimaging 2020; 297:111032. [PMID: 32028105 DOI: 10.1016/j.pscychresns.2020.111032] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 12/06/2019] [Accepted: 01/17/2020] [Indexed: 12/21/2022]
Abstract
The neurobiological causes underlying suicidal behaviors in major depressive disorder (MDD) have not been identified. This study was performed to investigate the differences in brain cortical thickness, surface area, and volume between suicide attempters and non-attempters with MDD. We performed magnetic resonance imaging (MRI) in 38 MDD patients (18-65 years old; 18 male, 20 female) with and without a history of suicide attempts. FreeSurfer software was used to compare the cortical thickness, surface area, and volume of 19 suicide attempters with MDD and 19 suicide non-attempters with MDD, while controlling for age, sex, mean area (or volume), and severity of depression. Compared with suicide non-attempters, suicide attempters with MDD exhibited a larger surface area in the left postcentral area and left lateral occipital area and a larger cortical volume in the left postcentral area and left lateral orbitofrontal area. Suicide attempters exhibited a smaller surface area in the left superior frontal area than suicide non-attempters. The present findings provide evidence for neuroanatomical risk factors of suicide in MDD. Further research to replicate these results and determine the mechanisms underlying these findings is needed.
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Affiliation(s)
- Seung-Gul Kang
- Department of Psychiatry, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seo-Eun Cho
- Department of Psychiatry, Gil Medical Center, Incheon, Republic of Korea
| | - Kyoung-Sae Na
- Department of Psychiatry, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Jung Sun Lee
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | | | - Seong-Jin Cho
- Department of Psychiatry, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Young-Don Son
- Department of Biomedical Engineering, College of Health Science, Gachon University, Incheon, Republic of Korea
| | - Yu Jin Lee
- Department of Psychiatry, Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Abstract
PURPOSE OF REVIEW Bipolar disorder has the highest rate of suicide of all psychiatric conditions and is approximately 20-30 times that of the general population. The purpose of this review is to discuss findings relevant to bipolar disorder and suicide. RECENT FINDINGS Risk factors include male gender, living alone, divorced, no children, Caucasian, younger age (< 35 years), elderly age (> 75 years), unemployment, and a personal history of suicide attempt and family history of suicide attempt or suicide completion, as well as predominant depressive polarity. Suicide is associated with the depressed or mixed subtypes, not mania. Although there are emerging treatments for bipolar depression, such as ketamine and TMS, lithium remains the only medication associated with lowered suicide rates in bipolar disorder. Understanding clinical and demographic risk factors for suicide in bipolar disorder remains the best way to prevent suicidal behavior. Early intervention and treatment with anti-suicidal medications, such as lithium, along with close observation and follow-up is the best way to mitigate suicide in patients with bipolar disorder.
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Fountoulakis KN. Suicides in Greece before and during the period of austerity by sex and age group: Relationship to unemployment and economic variables. J Affect Disord 2020; 260:174-182. [PMID: 31494368 DOI: 10.1016/j.jad.2019.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/04/2019] [Accepted: 09/01/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is disagreement on the specific mechanism through which the economic recession increased suicides in Greece. Unemployment is considered by many authors to be the determining factor but the data are inconclusive and often negative, especially concerning the temporal relationship between onset of increase in unemployment and increase in suicides AIMS: The aim of this paper was to clarify the specific role of unemployment as well as of other socioeconomic variables on specific age-by-gender groups concerning the increase in suicides. METHODS Data of the Hellenic Statistical Authority ELSTAT (www. STATISTICS gr) were analyzed with Linear Regression Analysis and Bonferroni correction for multiple testing RESULTS: Unemployment correlates with suicide rates only in males aged 20-24, 50-54 and 60-64 years (p < 0.001). Unemployment could held responsible for an additional 148 male deaths during the period 2009-2015, which accounts for 5.3% of the total (29 additional deaths per year). The changes in all the socioeconomic conditions could held responsible for 317 cases of suicide or 9.4% of total CONCLUSIONS: The results of the current study suggest that there was a 33% increase in deaths by suicide in Greece during the early years of recession (2009-2015); one third could be directly attributed to unemployment, one third to other consequences of recession while another third is of unknown origin. The effect of unemployment is specifically restricted to males at the beginning of their working career (20-24 years old) and to middle aged (45-49 and 55-59 years old).
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Affiliation(s)
- Konstantinos N Fountoulakis
- Professor of Psychiatry, 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6, Odysseos str, 55535 Thessaloniki, Greece.
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50
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Martin JS, Novak LA, Perera K, Olsen CH, Kindt MT, LaCroix JM, Bennion L, Lee-Tauler SY, Ghahramanlou-Holloway M. Suicide Typologies in the United States Air Force: A Hierarchical Cluster Analysis. Suicide Life Threat Behav 2019; 49:1707-1720. [PMID: 31034653 DOI: 10.1111/sltb.12553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/04/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study describes characteristics of United States Air Force (USAF) suicide decedents and determines subgroups. METHOD Retrospective review of demographic, psychiatric, event-related, and psychosocial variables for USAF suicide decedents in the Suicide Event Surveillance System database was conducted between February 1999 and July 2009 (N = 376). Hierarchical cluster analysis was used to determine initial clusters and cluster centroids. RESULTS Analyses identified three clusters. Cluster 1 (n = 149) individuals were mostly single or divorced, E-1-E-6 rank, living alone, and less likely to have psychiatric disorder diagnoses or engage with most helping resources. Cluster 2 (n = 126) decedents were mostly married, living with a partner, higher ranking, and least likely to communicate suicide intent. Cluster 3 (n = 101) individuals were mostly E-4-E-6 rank, with the highest rates of most psychiatric diagnoses, previous suicide-related events, engagement with multiple helping resources, communication of intent, and psychosocial precipitants. Clusters differed significantly in marital status, rank, psychiatric diagnoses, precipitants, service utilization, previous suicide-related events, risk factors, communication of intent, location and method of death, and residential status. CONCLUSIONS This study identifies empirically based suicide typologies within a military decedent sample. While further research and replications of findings are needed, these typologies have clinical and policy implications for military suicide prevention.
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Affiliation(s)
- Jeffery S Martin
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Laura A Novak
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Kanchana Perera
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Cara H Olsen
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Michael T Kindt
- Air Force Medical Operations Agency, Lackland AFB, San Antonio, TX, USA
| | - Jessica M LaCroix
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Layne Bennion
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Su Yeon Lee-Tauler
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Marjan Ghahramanlou-Holloway
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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