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Mamtani H, Pathak H, Sakhardande K, Gowda GS, Muliyala KP, Philip M, Moirangthem S, Reddi VSK, Varambally S. Suicide attempts in schizophrenia - A large retrospective cohort study from a tertiary care psychiatry centre in India. Asian J Psychiatr 2024; 96:104053. [PMID: 38678797 DOI: 10.1016/j.ajp.2024.104053] [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: 10/11/2023] [Revised: 02/26/2024] [Accepted: 04/14/2024] [Indexed: 05/01/2024]
Abstract
The extent of variability in identified risk factors for suicide attempts (SA) in schizophrenia limits their generalization. This study aimed to identify the rates and associated correlates of SA in schizophrenia by reviewing a large cohort (n=500). Nearly one-fourth had a history of SA, which was independently associated with a family history of SA, more inpatient admissions, and better long-term treatment response. These findings highlight the complex interaction between biological factors influencing SA and illness determinants in schizophrenia. Furthermore, they reinforce the need for future research to unravel the association between suicide vulnerability and the pathophysiology of schizophrenia to attenuate morbidity and mortality associated with the same.
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Affiliation(s)
- Harkishan Mamtani
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Harsh Pathak
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Kasturi Sakhardande
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Krishna Prasad Muliyala
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Mariamma Philip
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | | | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
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Ma Z, Zhou HX, Chen DC, Wang DM, Zhang XY. Association between suicidal behavior and impaired glucose metabolism in first-episode drug-naïve patients with schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2024; 129:110900. [PMID: 38007210 DOI: 10.1016/j.pnpbp.2023.110900] [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: 05/12/2023] [Revised: 11/09/2023] [Accepted: 11/19/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Schizophrenia (SZ) patients have been reported to have comorbid suicidal behavior (SB) and impaired glucose metabolism in early psychosis, but it is unclear whether impaired glucose metabolism plays a role in the occurrence of SB in patients with first-episode drug-naïve (FEDN) SZ. Therefore, our main aim was to examine the relationship between SB and glucose metabolism in FEDN SZ patients. METHODS We recruited 319 FEDN SZ patients and collected information on their sociodemographic characteristics, clinical data, and glucose metabolism parameters. Participants' psychotic and depressive symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS) and the Hamilton Depression Rating Scale (HAMD), respectively. Fasting plasma glucose and insulin levels were also measured. RESULTS The percentage of FEDN SZ patients with SB was 45.5% (145/319). Compared to SZ patients without SB, SZ patients with SB exhibited higher scores on HAMD, PANSS positive subscale, as well as higher levels of fasting plasma glucose, fasting plasma insulin, and homeostasis model assessment of insulin resistance index (all p<0.05). Logistic regression analysis indicated that increased levels of insulin resistance (adjusted OR = 1.920), body mass index (adjusted OR = 0.931), and PANSS general psychopathology (adjusted OR = 1.041) were independently associated with SB. The Receiver Operating Characteristic Curve showed an Area Under Curve value of 0.732 for the combination of three factors in regression model to distinguish between SB and non-SB. CONCLUSIONS Our results indicate that fasting glucose, fasting insulin, and insulin resistance are strongly associated with SB in FEDN SZ patients, suggesting that glucose metabolism abnormalities may be potential biomarkers of SB in SZ patients. Regular monitoring of glucose metabolism variables is essential for suicide prevention.
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Affiliation(s)
- Zheng Ma
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Hui-Xia Zhou
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Da-Chun Chen
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Dong-Mei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Hosseini FA, Shaygan M, Jahandideh Z. Positive imagery in depressive suicidal patients: A randomized controlled trial of the effect of viewing loved ones' photos on mood states and suicidal ideation. Heliyon 2023; 9:e22312. [PMID: 38058624 PMCID: PMC10695982 DOI: 10.1016/j.heliyon.2023.e22312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/08/2023] Open
Abstract
According to research, it has been suggested that individuals who are affected by depression could potentially engage in the creation and experience emotional advantages relating to positive events directed towards the past or future, with the condition that they are provided with suitable mental imagery techniques. The main aim of this study was to assess the impact of utilizing positive imagery, specifically through the utilization of photographs featuring loved ones, on mood states and suicidal ideation among individuals diagnosed with depression and exhibiting suicidal tendencies. This randomized, double-blind, controlled crossover trial was conducted among 78 hospitalized depressive patients at three psychiatric services between April and August 2019. The patients participated in four individual picture-viewing sessions on four consecutive days. The four categories of pictures were included: loved ones, neutral faces of strangers, natural landscapes, and optical illusions. Directly prior to and immediately following the observation of the visual stimuli (photographs), the Brunel Mood Scale (BRUMS) and the Beck Scale for Suicide Ideation (BSSI) were completed by the patients. Repeated measures ANOVAs conducted in this study revealed a significant main effect of time on ratings of tension, depression, fatigue, vigor, calmness, and happiness (P values < 0.001). Additionally, statistically significant interactions were identified between picture category and time in relation to the variables of tension, depression, fatigue, vigor, calmness, and happiness (P values < 0.001). The analysis did not reveal a significant main effect of time on ratings of anger, confusion, and suicidal ideation (P values > 0.05). Likewise, the interaction between picture category and time did not yield significant results for the variables of anger, confusion, and suicidal ideation (P values > 0.05). The positive imagery procedure using the presentation of loved ones' photos showed beneficial effects on the mood states of depressed patients. The findings of this study suggest that incorporating a greater emphasis on positive imagery within the context of clinical depression may offer potential advantages. This highlights the potential for novel opportunities in the treatment of depression. Trial registration The study has been registered in the Iranian Registry of Clinical Trials (registration number: IRCT20180808040744N1; first registration date: December 22, 2018; website: https://en.irct.ir/trial/33186).
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Affiliation(s)
- Fahimeh Alsadat Hosseini
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Shaygan
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Jahandideh
- School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Khoso AB, Noureen A, Un Nisa Z, Hodkinson A, Elahi A, Arshad U, Naz A, Bhatti MM, Asif M, Husain MO, Husain MI, Chaudhry N, Husain N, Chaudhry IB, Panagioti M. Prevalence of suicidal ideation and suicide attempts in individuals with psychosis and bipolar disorder in South Asia: systematic review and meta-analysis. BJPsych Open 2023; 9:e179. [PMID: 37814419 PMCID: PMC10594255 DOI: 10.1192/bjo.2023.570] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Suicidal ideation and attempts are growing public health concerns globally. Evidence from high-income countries suggests that individuals with psychosis and bipolar disorder are at increased risk of suicidal ideation and attempts, but there is a scarcity of evidence from South Asia. AIMS To estimate the prevalence of suicidal ideation and attempts in individuals with psychosis and bipolar disorder in South Asia. METHOD In this systematic review and meta-analysis, four databases (PsycINFO, Web of Science, EMBASE and Medline) were searched until December 2022. Pooled prevalence was estimated with random-effects models. Heterogeneity was quantified with the I2-statistic. RESULTS The pooled sample size across the 21 studies was 3745 participants, 1941 (51.8%) of which were male. The pooled prevalence of suicide attempts in South Asian people with either psychosis or bipolar disorder was 22% (95% CI 17-27; n = 15). The pooled prevalence of suicidal ideation with psychosis or bipolar disorder combined was 38% (95% CI 27-51; n = 10). Meta-regression, subgroup and sensitivity analysis showed that the pooled prevalence estimates for both suicide attempt and ideation remained unaffected by variations in critical appraisal ratings and study designs. Only one study reported data on suicide-related deaths. CONCLUSIONS One in four individuals diagnosed with psychosis or bipolar disorder have reported suicide attempts, whereas up to one in three have experienced suicidal ideation. These findings underscore the urgent need for clinicians to regularly assess and monitor suicidal ideation and attempts among individuals with these disorders in South Asia.
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Affiliation(s)
- Ameer B. Khoso
- Division of At-Risk Mental State, Schizophrenia Spectrum, and other Psychotic Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan; and Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Amna Noureen
- Division of Child and Adolescent Mental Health, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Zaib Un Nisa
- Division of At-Risk Mental State, Schizophrenia Spectrum, and other Psychotic Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Alexander Hodkinson
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK; and National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK
| | - Anam Elahi
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, UK
| | - Usman Arshad
- Division of Child and Adolescent Mental Health, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Anum Naz
- Division of At-Risk Mental State, Schizophrenia Spectrum, and other Psychotic Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | | | - Muqaddas Asif
- Division of Substance-Related and Addiction Disorders, Pakistan Institute of Living and Learning, Lahore, Pakistan; and Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Muhammad Omair Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; and Department of Psychiatry, University of Toronto, Canada
| | - Muhammad Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; and Department of Psychiatry, University of Toronto, Canada
| | - Nasim Chaudhry
- Division of Neurodevelopmental Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Nusrat Husain
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; and Mersey Care NHS Foundation Trust, Prescot, UK
| | - Imran B. Chaudhry
- Division of At-Risk Mental State, Schizophrenia Spectrum, and other Psychotic Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; and Department of Psychiatry, Ziauddin University, Karachi, Pakistan
| | - Maria Panagioti
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK; and National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK
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Temko JE, Grigorian A, Barrios C, Lekawa M, Nahmias L, Kuza CM, Nahmias J. Race, Age, and Lack of Insurance Increase Risk of Suicide Attempt in Trauma Patients. Arch Suicide Res 2022; 26:846-860. [PMID: 33186511 DOI: 10.1080/13811118.2020.1838370] [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] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The overall rate of suicide between 1999 and 2017 increased by 33% in the United States. We sought to examine suicide attempts in the trauma patient population, hypothesizing that in adult trauma patients race and lack of insurance status would be predictors of suicide attempt. METHOD The Trauma Quality Improvement Program (2010-2016) was queried for trauma patients ≥18 years old. The primary outcome was suicide attempt. A multivariable logistic regression model was performed including covariates that influence risk of suicide attempt. RESULTS From 1,403,466 adult trauma admissions, 16,263 (1.2%) patients attempted suicide. Death after suicide attempt occurred in 30.2% of patients. Independent predictors of suicide attempt were age < 40 years old (odds ratio [OR] = 1.46, 95% confidence interval [CI] [1.41, 1.51], p < .001) and no insurance (OR = 1.92, 95% CI [1.85, 2.00], p < .001). Black (vs. White) race was associated with decreased risk of suicide attempt (OR = 0.63, 95% CI [0.60, 0.67], p < .001). Hispanic (versus non-Hispanic) patients demonstrated lower associated risk of suicide attempt by gun (OR = 0.50, 95% CI [0.45, 0.54], p < .001), while Asian (vs. White) patients exhibited higher risk of suicide attempt overall (OR = 1.25, 95% CI [1.12, 1.39], p < .001) and more specifically by knife (OR = 2.55, 95% CI [2.16, 3.00], p < .001). CONCLUSIONS Age younger than 40 years and lack of insurance were associated with higher risk of suicide attempt in adult trauma patients. Asian race was associated with the highest risk of suicide, with >2.5 times increased risk of attempt by knife. Awareness of these demographic-specific risk factors for suicide attempt, and in particular violent mechanisms of suicide attempt, is critical to implementation of effective suicide prevention efforts.HighlightsAge younger than 40 and no insurance were associated with risk of suicide attempt.Black (vs. White) race was associated with decreased risk of suicide attempt.Asian race was associated with an increased risk of suicide attempt with a knife.
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Bai W, Liu ZH, Jiang YY, Zhang QE, Rao WW, Cheung T, Hall BJ, Xiang YT. Worldwide prevalence of suicidal ideation and suicide plan among people with schizophrenia: a meta-analysis and systematic review of epidemiological surveys. Transl Psychiatry 2021; 11:552. [PMID: 34716297 PMCID: PMC8556328 DOI: 10.1038/s41398-021-01671-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 09/19/2021] [Accepted: 09/30/2021] [Indexed: 12/18/2022] Open
Abstract
Schizophrenia is a severe psychiatric disorder with high premature mortality rates. This is a meta-analysis and systematic review of the prevalence of suicidal ideation (SI) and suicide plan (SP) among people with schizophrenia. PubMed, Web of Science, Embase, and PsycINFO were systematically searched from their respective inception to October 10, 2020. Data on prevalence of SI and/or SP were synthesized using the random effects model. Twenty-six studies covering 5079 people with schizophrenia were included for meta-analysis. The lifetime and point prevalence of SI were 34.5% (95% CI: 28.2-40.9%), and 29.9% (95% CI: 24.2-35.6%), respectively. The lifetime prevalence of SP was 44.3% and the point prevalence of SP ranged between 6.4 and 13%. Subgroup and meta-regression analyses revealed that source of patients, survey countries, and sample size were significantly associated with the point prevalence of SI, while male proportion and quality assessment scores were significantly associated with the lifetime and point prevalence of SI. Survey time and mean age were significantly associated with lifetime prevalence of SI. Both SI and SP are common in people living with schizophrenia, especially in males and inpatients. Routine screening and effective interventions for SI and SP should be implemented in this population.
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Affiliation(s)
- W Bai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Z H Liu
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Y Y Jiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Q E Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - W W Rao
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - T Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - B J Hall
- New York University (Shanghai), Shanghai, China
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Y T Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
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Basha EA, Mengistu BT, Engidaw NA, Wubetu AD, Haile AB. Suicidal Ideation and Its Associated Factors Among Patients with Major Depressive Disorder at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. Neuropsychiatr Dis Treat 2021; 17:1571-1577. [PMID: 34045859 PMCID: PMC8149284 DOI: 10.2147/ndt.s311514] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/04/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Suicidal ideation is thinking about suicide/serving as the agent of one's own death. Patients with a major depressive disorder are the highest group which are affected by suicidal ideation. It is a pre-condition for suicide attempts and to commit suicide among major depressive patients. Suicidal behavior and major depressive disorder have been becoming the main attention in recent years. In Ethiopia, there is limited knowledge of suicidal ideation among major depressive disorder patients and the factors of suicidal ideation are also limited. OBJECTIVE This study assessed the prevalence of suicidal ideation and its associated factors among major depressive disorder patients at Amanuel Mental Specialized Hospital, Ethiopia. METHODS A cross-sectional study was conducted from March 1-30, 2019. A total of 337 major depressive disorder patients were successfully interviewed using structured and pre-tested questionnaires. A systematic random sampling technique was applied. Logistic regression was applied to identify factors of suicidal ideation. Statistical significance was considered at P-value < 0.05. RESULTS In this study, the prevalence of suicidal ideation among major depressive disorder patients was 48.4%. Being female (AOR 2.4, 95% CI=1.40, 4.25), family history of suicide (AOR 3.2, 95% CI=1.26, 8.11), and having poor social support (AOR 4.2, 95% CI=2.29, 7.59) were significantly associated with suicidal ideation among patients with major depressive disorder. CONCLUSION The prevalence of suicidal ideation among major depressive disorder patients was relatively high. Hence, due attention should be given to the screening of suicidal ideation for all patients with major depressive disorder to initiate timely interventions.
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Affiliation(s)
- Elyas Adamsu Basha
- Department of Nursing, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Bethelehem Taye Mengistu
- Department of Nursing, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Nigus Alemnew Engidaw
- Department of Nursing, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Abate Dargie Wubetu
- Department of Nursing, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Assalif Beyene Haile
- Department of Midwifery, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
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Zaheer J, Olfson M, Mallia E, Lam JSH, de Oliveira C, Rudoler D, Carvalho AF, Jacob BJ, Juda A, Kurdyak P. Predictors of suicide at time of diagnosis in schizophrenia spectrum disorder: A 20-year total population study in Ontario, Canada. Schizophr Res 2020; 222:382-388. [PMID: 32507375 DOI: 10.1016/j.schres.2020.04.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/23/2020] [Accepted: 04/19/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Suicide is a major cause of mortality for individuals with schizophrenia spectrum disorders (SSD). Understanding the risk factors for suicide at time of diagnosis can aid clinicians in identifying people at risk. METHODS Records from linked administrative health databases in Ontario, Canada were used to identify individuals aged 16 through 45 years who received a first lifetime diagnosis of SSD (schizophrenia, schizoaffective disorder, psychotic disorder not otherwise specified (NOS)) using a validated algorithm between 01/01/1993 and 12/31/2010. The main outcome was death by suicide following cohort entry until 12/31/2012. OUTCOMES 75,989 individuals with a first SSD diagnosis (60.1% male, 39.9% female) were followed for an average of 9.56 years. During this period, 1.71% of the total sample (72.1% male, 27.9% female) died by suicide, after an average of 4.32 years. Predictors of suicide death included male sex (HR 2.00, 95% CI 1.76-2.27), age at diagnosis between 26 and 35 (HR 1.27, 95% CI 1.10-1.45) or 36-45 (HR 1.34, 95% CI 1.16-1.54), relative to 16-25, and suicide attempt (HR 2.23, 95% CI 1.86-2.66), drug use disorder (HR 1.21, 95% CI 1.04-1.41), mood disorder diagnosis (HR 1.32, 95% CI 1.17-1.50), or mental health hospitalization (HR 1.30 95% CI 1.13-1.49) in the 2 years prior to SSD diagnosis. INTERPRETATION Death by suicide occurs in 1 out of every 58 individuals and occurred early following first diagnosis of SSD. Psychiatric hospitalizations, mood disorder diagnoses, suicide attempts prior to SSD diagnosis, as well as a later age at first diagnosis, are all predictors of suicide and should be integrated into clinical assessment of suicide risk in this population.
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Affiliation(s)
- Juveria Zaheer
- Health Outcomes and Performance Evaluation (HOPE) Research Unit, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Canada.
| | - Mark Olfson
- New York State Psychiatric Institute, United States; Columbia University, New York, NY, United States
| | - Emilie Mallia
- Health Outcomes and Performance Evaluation (HOPE) Research Unit, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Canada; Centre for Addiction and Mental Health, Canada; Mental Health and Addictions Research Program, Institute for Clinical Evaluative Sciences (ICES), Canada
| | - June S H Lam
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Canada
| | - Claire de Oliveira
- Health Outcomes and Performance Evaluation (HOPE) Research Unit, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Canada; ICES, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation (IHPME), University of Toronto, Canada; Centre for Health Economics, University of York, York, England
| | - David Rudoler
- ICES, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation (IHPME), University of Toronto, Canada; University of Ontario Institute of Technology, Ontario, Canada; Centre for Addiction and Mental Health, Canada
| | - Andre F Carvalho
- Centre for Addiction and Mental Health, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Binu J Jacob
- University Health Network, Toronto, Ontario, Canada
| | - Ari Juda
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Health Outcomes and Performance Evaluation (HOPE) Research Unit, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation (IHPME), University of Toronto, Canada; Mental Health and Addictions Research Program, Institute for Clinical Evaluative Sciences (ICES), Canada
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Kar N, Prasad T. Suicide by psychiatric patients: Nature of risk, risk categorisation and preventability. MEDICINE, SCIENCE, AND THE LAW 2019; 59:255-264. [PMID: 31378145 DOI: 10.1177/0025802419867507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study considers risk factors associated with suicide by psychiatric patients, the perceived risk at last contact and risk categorisation and reflects upon the potential for prevention. Information regarding 63 consecutive suicides known to mental health services in Wolverhampton, UK, over a 15-year period was collected as part of an audit using a semi-structured questionnaire covering sociodemographic and clinical risk factors, along with information about preventability. A complex mixture of historical, enduring and current risk factors was observed. In addition to common risk factors, a considerable proportion had histories of multiple co-morbid psychiatric (52.5%) and physical diagnoses (27.6%) and psychiatric admission (70.5%). Common suicide methods included hanging (36.5%) and poisoning (36.5%). Most suicides occurred in the post-discharge months up to around two years (75.8%). Although a range of psychopathologies and suicidal cognitions were observed at the last clinical contact, the immediate suicide risk was considered low (46.2%) or not present (38.5%) in the majority of cases. Clinicians suggested various factors that could have made suicides less likely. Clinical assessment can identify risk factors, but categorisation may not be indicative of the outcome. A focus on modifiable factors, with support for psychosocial and clinical issues, may assist with prevention.
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Affiliation(s)
- Nilamadhab Kar
- Department of Psychiatry, Black Country Partnership NHS Foundation Trust, Steps to Health, UK
| | - Tulika Prasad
- Department of Psychiatry, Black Country Partnership NHS Foundation Trust, Penn Hospital, UK
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Dong M, Zeng LN, Lu L, Li XH, Ungvari GS, Ng CH, Chow IHI, Zhang L, Zhou Y, Xiang YT. Prevalence of suicide attempt in individuals with major depressive disorder: a meta-analysis of observational surveys. Psychol Med 2019; 49:1691-1704. [PMID: 30178722 DOI: 10.1017/s0033291718002301] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Suicide attempt (SA), which is one of the strongest predictors of completed suicide, is common in major depressive disorder (MDD) but its prevalence across epidemiological studies has been mixed. The aim of this comprehensive meta-analysis was to examine the pooled prevalence of SA in individuals with MDD. METHODS A systematic literature search was conducted in PubMed, Embase, PsycINFO, Web of Science and Cochrane Library from their commencement date until 27 December 2017. Original studies containing data on prevalence of SA in individuals with MDD were analyzed. RESULTS In all, 65 studies with a total of 27 340 individuals with MDD were included. Using the random effects model, the pooled lifetime prevalence of SA was 31% [95% confidence interval (CI) 27-34%], 1-year prevalence was 8% (95% CI 3-14%) and 1-month prevalence was 24% (95% CI 15-34%). Subgroup analyses revealed that the lifetime prevalence of SA was significantly associated with the patient setting, study region and income level, while the 1-month prevalence of SA was associated with only the patient setting. CONCLUSION This meta-analysis confirmed that SA was common in individuals with MDD across the world. Careful screening and appropriate interventions should be implemented for SA in the MDD population.
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Affiliation(s)
- Min Dong
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
| | - Liang-Nan Zeng
- Department of Neurosurgery,The Affiliated Hospital of Southwest Medical University,Luzhou,China
| | - Li Lu
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
| | - Xiao-Hong Li
- The National Clinical Research Center for Mental Disorders, China & Center of Depression, Beijing Institute for Brain Disorders & Mood Disorders Center, Beijing Anding Hospital, Capital Medical University,Beijing,China
| | - Gabor S Ungvari
- University of Notre Dame Australia/Marian Centre,Perth,Australia
| | - Chee H Ng
- Department of Psychiatry,University of Melbourne,Melbourne, Victoria,Australia
| | - Ines H I Chow
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
| | - Ling Zhang
- Department of Epidemiology and Health Statistics,School of Public Health, Capital Medical University & Beijing Municipal Key Laboratory of Clinical Epidemiology,Beijing,China
| | - Yuan Zhou
- CAS Key Laboratory of Behavioral Science & Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences,Beijing,China
| | - Yu-Tao Xiang
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
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11
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Service utilization and suicide among people with schizophrenia spectrum disorders. Schizophr Res 2018; 202:347-353. [PMID: 29935885 DOI: 10.1016/j.schres.2018.06.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 03/20/2018] [Accepted: 06/10/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare individuals with and without schizophrenia spectrum disorders (SSD) (schizophrenia, schizoaffective disorder, or psychotic disorder not otherwise specified) who die by suicide. METHOD This is a retrospective case control study which compared all individuals who died by suicide in Ontario, Canada with (cases) and without (controls) SSD between January 1, 2008 and December 31, 2012. Cases (individuals with SSD) were compared to controls on demographics, clinical characteristics, and health service utilization proximal to suicide. A secondary analysis compared the characteristics of those with SSD and those with severe mental illness (defined as those without SSD who have had a psychiatric hospitalization within the five-years before suicide (excluding the 30 days prior to death)). RESULTS Among 5650 suicides, 663 (11.7%) were by individuals with SSD. Compared to other suicides, SSD suicides were significantly more likely to be between the ages of 25-34. SSD suicide victims were significantly more likely to reside in the lowest income neighbourhoods and to reside in urban areas. SSD victims were also significantly more likely to have comorbid mood and personality disorders and all types of health service utilization, including outpatient mental health service contact in the 30 days prior to death, even when compared only with those who had a history of mental health hospitalization. CONCLUSIONS Individuals with schizophrenia spectrum disorder account for over 1 in 10 suicide deaths, tend to be younger, poorer, urban, more clinically complex, and have higher rates of mental health service contact prior to death. The demographic and service utilization differences persist even when the SSD group is compared with a population with severe mental illness that is not SSD. Suicide prevention strategies for people with schizophrenia spectrum disorder should emphasize the importance of clinical suicide risk assessment during clinical encounters, particularly early in the course of illness.
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12
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Ludwig B, Dwivedi Y. The concept of violent suicide, its underlying trait and neurobiology: A critical perspective. Eur Neuropsychopharmacol 2018; 28:243-251. [PMID: 29254658 PMCID: PMC5809305 DOI: 10.1016/j.euroneuro.2017.12.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/14/2017] [Accepted: 12/02/2017] [Indexed: 12/21/2022]
Abstract
Suicide is one of the leading causes of death and represents a significant public health problem world-wide. Individuals who attempt or die by suicide represent a highly heterogeneous population. Recently, efforts have been made to identify sub-populations and variables to categorize them. A popular dichotomy in suicide research of the past years is violent versus non-violent suicide - based on the method. This dichotomy is important given that there is an association between method of attempted suicide and risk of subsequent death by suicide. The differentiation concerning suicide methods is also critical regarding preventive efforts. In this review, we have tried to approach the concept of violent suicide from different perspectives, including a discussion about its definition and overlapping categories. In addition, we have critically discussed aggression as underlying trait, the question of intent to die, and sociodemographic, environmental, neuropsychological, and neurobiological factors potentially associated with violent suicide.
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Affiliation(s)
- Birgit Ludwig
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yogesh Dwivedi
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA.
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13
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Jakhar K, Beniwal RP, Bhatia T, Deshpande SN. Self-harm and suicide attempts in Schizophrenia. Asian J Psychiatr 2017; 30:102-106. [PMID: 28865243 PMCID: PMC5694351 DOI: 10.1016/j.ajp.2017.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 08/09/2017] [Accepted: 08/13/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The risk of suicide among persons with schizophrenia (SZ) is higher than in general population, with multiple contributory factors. We assessed the prevalence of risk of deliberate self-harm and suicide attempts, along with associated socio-demographic and clinical factors in a group of SZ outpatients (n=61) as part of a larger study on overall schizophrenia-associated risks. AIMS To investigate factors associated with risk of deliberate self-harm and suicide among persons with schizophrenia. METHOD Out of 270 SZ participants evaluated for various risks using Ram Manohar Lohia Risk Assessment Interview (RML-RAI), 61 reported risk of self-harm including suicide attempt/s. The factors associated with this risk were further evaluated on clinical details and Diagnostic Interview for Genetic Studies. RESULTS Risk of reported self-harm was 22.59%. Among them, 10% had attempted suicide at least once. Current age and past month Global Assessment of Functioning score from DIGS (GAF) were significantly correlated with suicide attempt. Attempters had significantly lower current GAF score, indicating poorer functioning. Among 27 attempters, 9 attempted at the onset of illness while 6 others attempted suicide within one year. Most common method of attempt was ingestion of insecticides or overdose of medication, followed by hanging or jumping from height. CONCLUSION In our hospital-based sample of suicide attempters, 10% had attempted suicide, among them over 55% within first year of illness. Attempters were significantly older than non-attempters and suffered from significantly more severe illness than non-attempters. Positive symptoms were significantly associated with attempt, irrespective of time at which suicide was attempted.
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Affiliation(s)
- Kiran Jakhar
- Dept. Of Psychiatry, Centre of Excellence in Mental Health, PGIMER-Dr. R.M.L. Hospital, New Delhi, India.
| | - Ram Pratap Beniwal
- Dept. Of Psychiatry, Centre of Excellence in Mental Health, PGIMER-Dr. R.M.L. Hospital, New Delhi, India.
| | - Triptish Bhatia
- GRIP- NIH Project, Dept. of Psychiatry, Centre of Excellence in Mental Health, PGIMER-Dr. R.M.L. Hospital, New Delhi, India.
| | - Smita N Deshpande
- Dept. Of Psychiatry, Centre of Excellence in Mental Health, PGIMER-Dr. R.M.L. Hospital, New Delhi, India.
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14
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Xu M, Wen J, Zhu X, Chen P, Wang C. A rare self-injurious case of multiple penetrating brain injury by nails in a young patient with depressive disorder. Acta Neurol Belg 2015; 115:767-9. [PMID: 25739361 DOI: 10.1007/s13760-015-0439-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 01/30/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Min Xu
- Department of Neurosurgery, Northern Jiangsu Province Hospital, Yangzhou, 225001, Jiangsu, China.
- School of Clinical Medicine, Jiangsu University, Zhenjiang, 212001, Jiangsu, China.
| | - Jinkun Wen
- Department of Neurosurgery, Northern Jiangsu Province Hospital, Yangzhou, 225001, Jiangsu, China.
| | - Xun Zhu
- School of Clinical Medicine, Jiangsu University, Zhenjiang, 212001, Jiangsu, China.
| | - Pin Chen
- Department of Neurosurgery, Northern Jiangsu Province Hospital, Yangzhou, 225001, Jiangsu, China.
| | - Cunzu Wang
- Department of Neurosurgery, Northern Jiangsu Province Hospital, Yangzhou, 225001, Jiangsu, China.
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15
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Kim J, Lee KS, Kim DJ, Hong SC, Choi KH, Oh Y, Wang SM, Lee HK, Kweon YS, Lee CT, Lee KU. Characteristic Risk Factors Associated with Planned versus Impulsive Suicide Attempters. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2015; 13:308-15. [PMID: 26598591 PMCID: PMC4662162 DOI: 10.9758/cpn.2015.13.3.308] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/30/2015] [Accepted: 10/04/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The present study aimed to investigate predictors for planned suicide attempters. METHODS This study included 1,003 patients who attempted suicide and visited emergency department. They were divided into two groups, planned suicide attempters (SAs; n=133 [13.3%]) and impulsive SAs (n=870, [86.7%]), and the demographic variables, clinical characteristics, factors related to suicide, and psychiatric resources of the groups were compared. RESULTS Major depressive disorder and substance use disorders were more common among planned SAs than among impulsive SAs. Additionally, the planned SAs were older, more likely to be divorced, separated or widowed, and more likely to have comorbid medical illnesses, severe depression, higher suicidality, and self-blaming tendencies than the impulsive SAs. Financial problems and physical illnesses were more common in planned SAs but interpersonal conflicts were more frequent in impulsive SAs. Planned SAs had fewer previous suicide attempts but these were more serious suicide attempts. The presence of the hope to die, a written will, and suicidal ideation of a repetitive, intense, and continuous nature were predictive of planned SAs. CONCLUSION The present findings demonstrated that planned SAs had more severe psychopathology and medical illnesses than impulsive SAs. Therefore, screening for depression, substance use disorders, and suicidal plans among old and medically ill patients may be important for preventing suicide attempts.
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Affiliation(s)
- Jaeha Kim
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang-Sook Lee
- Department of Preventive Medicine, Catholic Industrial Medical Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dai Jin Kim
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Chul Hong
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung Ho Choi
- Department of Emergency Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youngmin Oh
- Department of Emergency Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sheng-Min Wang
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae-Kook Lee
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Sil Kweon
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chung Tai Lee
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung-Uk Lee
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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