Revisiting the association of aggression and suicidal behavior in schizophrenic inpatients

Suicidality in emergency medicine: Results from a retrospective analysis of emergency documentation forms

BACKGROUND

To analyze suicidal care episodes in emergency medical responses in Germany.

METHOD

Anonymized data from emergency care episodes in Ulm from 2004 to 2013 were analyzed retrospectively.

RESULTS

158 of 933 psychiatric emergencies (16 %) were suicide related, including 14 completed suicides, 25 care episodes with suicidal ideation, and 119 suicide attempts. Significantly more men than women completed suicide (χ²(2,N = 934) = 12.70, p = 0.02). 93 % of the total psychiatric emergencies received any medication at all, and only about 33 % were transported to a psychiatric hospital.

CONCLUSION

Psychiatric treatment for suicidality in emergency medicine requires improvement to ensure that patients receive adequate therapy.

Associations between impulsivity, aggression, and suicide in Chinese college students

Background

Although there are accumulating data regarding the epidemiology of suicide in China, there are meager data on suicidal ideation and attempts among college students. Interestingly, elevated impulsivity is thought to facilitate the transition from suicidal thoughts to suicidal behavior. Therefore, the objective of this research was to identify the associations between suicide and the personality factors of impulsivity and aggression.

Methods

This study’s sampling method employed stratified random cluster sampling. A multi-stage stratified sampling procedure was used to select participants (n = 5,245). We conducted structured interviews regarding a range of socio-demographic characteristics and suicidal morbidity. The Patient Health Questionnaire depression module (PHQ-9) was used to acquire the information about thoughts of being better off dead or hurting themselves in some ways during the past two weeks. The impulsivity symptoms in this study were assessed with the BIS-11-CH (i.e., the Chinese version of the BIS-11), and the Aggressive symptoms were assessed with the BAQ. The statistical package for social science (SPSS) v.13.0 program (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Socio-demographic variables such as ethnic and gender were compared between groups, through the use of χ² tests. The nonparametric test (k Independent Sample test, Kruskal-Wallis H) was performed to determine differences between the personality factors of impulsivity and aggression and suicide.

Results

In total, 9.1% (n = 479) of the 5,245 students reported they have ever thought about committing suicide; and 1% (n = 51) reported a history of attempted suicide (attempters). The analyses detected significant differences in scores on cognitive impulsivity (p < 0.01), when comparing individuals who only had suicidal ideation and individuals who had attempted suicide. Moreover, significant differences were found between ideators only and attempters on scores of self-oriented attack (p < .001).

Conclusions

Suicidal ideation is prevalent among Chinese university students. Students with high aggression scores were more susceptible to committing suicide. Scores on self-oriented attack and cognitive impulsivity may be important factors for differentially predicting suicide ideation and suicide attempts.

Plasma total cholesterol in psychiatric patients after a suicide attempt and in follow-up

BACKGROUND

Low plasma total cholesterol (TC) levels have been found in subjects after a suicide attempt in most studies. Other studies question these results because of possible influences on TC of somatic effects due to the attempt (drugs, somatic trauma, hospitalization), or nutritional habits and physical activity before attempt, especially in patients with depression.

METHODS

To address this issue, TC levels were estimated in 51 subjects on admission to psychiatric clinic after a suicide attempt, as well as later in follow-up when patients were back in their normal activities. Patients were evaluated for suicide intent (SIS), aggression, and severity of depression (BDI).

RESULTS

A small (7% in the mean) but statistically significant increase in plasma cholesterol levels was observed in samples taken in follow-up compared to samples after attempt. However, TC levels of patients were significantly lower than controls in both assessments. There were no differences in TC between violent and non-violent attempters, either after attempt or in follow-up. In the subgroup of patients with major affective disorder, TC levels were lower compared to age-matched controls in both assessments, although patients showed significant reductions in BDI score in follow-up. In this subgroup, TC levels after attempt correlated negatively to SIS score.

CONCLUSIONS

TC levels in psychiatric patients after a suicide attempt are lower than healthy controls and remain low in follow-up, independently from the severity of psychopathology. The results support the role of plasma total cholesterol as a biological risk factor in suicidal behavior, especially in affective patients.