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Hsu TW, Kao YC, Tsai SJ, Bai YM, Su TP, Chen TJ, Liang CS, Chen MH. Suicide Attempts After a Diagnosis of Polycystic Ovary Syndrome : A Cohort Study. Ann Intern Med 2024; 177:335-342. [PMID: 38315996 DOI: 10.7326/m23-2240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Limited evidence exists about suicide risk in persons with polycystic ovary syndrome (PCOS). OBJECTIVE To assess suicide risk in persons with PCOS, accounting for psychiatric comorbid conditions and age group. DESIGN Cohort study. SETTING Data from the Taiwanese nationwide database from 1997 to 2012. PATIENTS A cohort of 18 960 patients diagnosed with PCOS, each matched with control participants in a 1:10 ratio on the basis of age, psychiatric comorbid conditions, urbanization level, and income. Suicide attempts were evaluated using Cox regression models. MEASUREMENTS Suicide risk with hazard ratios (HRs). RESULTS Participants with PCOS had a notable 8.47-fold increase in risk for suicide attempt compared with the control group (HR, 8.47 [95% CI, 7.54 to 9.51]), after adjustment for demographic characteristics, psychiatric comorbid conditions, Charlson Comorbidity Index scores, and frequency of all-cause clinical visits. The elevated risk was evident across the adolescent (HR, 5.38 [CI, 3.93 to 7.37]), young adult (<40 years; HR, 9.15 [CI, 8.03 to 10.42]), and older adult (HR, 3.75 [CI, 2.23 to 6.28]) groups. Sensitivity analyses involving the exclusion of data from the first year or the first 3 years of observation yielded consistent results. LIMITATION Potential underestimation of PCOS and mental disorder prevalence due to use of administrative claims data; lack of clinical data, such as body mass index and depressive symptoms; and no assessment of a confounding effect of valproic acid exposure. CONCLUSION This study underscores the heightened risk for suicide attempt that persons with PCOS face, even after adjustment for demographics, psychiatric comorbid conditions, physical conditions, and all-cause clinical visits. This suggests the importance of routine monitoring of mental health and suicide risk in persons diagnosed with PCOS. PRIMARY FUNDING SOURCE Taipei Veterans General Hospital, Yen Tjing Ling Medical Foundation, and Ministry of Science and Technology of Taiwan.
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Affiliation(s)
- Tien-Wei Hsu
- Department of Psychiatry, E-DA Dachang Hospital, and Department of Psychiatry, E-DA Hospital, Kaohsiung, Taiwan (T.-W.H.)
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, and Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan (Y.-C.K., C.-S.L.)
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, and Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (S.-J.T., Y.-M.B., M.-H.C.)
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, and Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (S.-J.T., Y.-M.B., M.-H.C.)
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University; and Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan (T.-P.S.)
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, and Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan, and Department of Family Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu, Taiwan (T.-J.C.)
| | - Chih-Sung Liang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, and Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan (Y.-C.K., C.-S.L.)
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, and Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (S.-J.T., Y.-M.B., M.-H.C.)
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Oladunjoye AF, Li E, Aneni K, Onigu-Otite E. Cannabis use disorder, suicide attempts, and self-harm among adolescents: A national inpatient study across the United States. PLoS One 2023; 18:e0292922. [PMID: 37847698 PMCID: PMC10581466 DOI: 10.1371/journal.pone.0292922] [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: 07/01/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Suicide is among the top three causes of adolescent mortality. There is a scarcity of research examining cannabis use and suicidal behavior in adolescents. OBJECTIVES To determine the association between cannabis use disorder (CUD) and suicide attempt/self-harm in a hospitalized sample of adolescents. METHODS We conducted a cross-sectional observation study using data from the Nationwide Inpatient Sample collected over four years from January 1, 2016, through December 31, 2019. We included adolescents aged 10-19 hospitalized during the above period (N = 807,105). The primary outcome was suicide attempt/self-harm and the main predictor was CUD. The International Classification of Diseases Tenth Revision (ICD 10) diagnostic codes was used to identify a diagnosis of CUD, suicide attempt/self-harm, and other diagnoses included in the analyses. Adolescents diagnosed with CUD (n = 53,751) were compared to adolescents without CUD (n = 753,354). Univariate and multivariate logistic regressions were conducted to determine the association between CUD and suicide attempts/self-harm. RESULTS 807,105 adolescent hospitalizations were analyzed, of which 6.9% had CUD. Adolescents with CUD were more likely to be older (17 years vs. 15 years), female (52% vs. 48%), have depression (44% vs. 17%), anxiety (32% vs. 13%), an eating disorder (1.9% vs. 1.2%), ADHD (16.3% vs. 9.1%), Conduct Disorder (4.1% vs. 1.3%), Alcohol Use Disorder (11.9% vs. 0.8%), Nicotine Use Disorder (31.1% vs. 4.1%), Cocaine Use Disorder (5.4% vs. 0.2%), Stimulant Use Disorder (0.8% vs. 0.4%) and report suicide attempts/self-harm (2.8% vs. 0.9%) [all ps<0.001]. After adjusting for potential confounders, CUD was associated with a higher risk of suicide attempts/self-harm (OR = 1.4, 95% CI 1.3-1.6, p <0.001). Post-hoc analyses showed the presence of depression moderated the association between CUD and suicide attempts/self-harm in that adolescents with CUD and depression had 2.4 times the odds of suicide attempt/self-harm compared to those with CUD but no depression after controlling for potential confounders (p<0.001). CONCLUSIONS Our study provides evidence for the association between CUD and suicide risk among hospitalized adolescents and underscores the importance of recognizing and addressing co-occurring mental and substance use disorders along with CUD to mitigate suicide risk. Identifying high-risk adolescents in inpatient settings provides an opportunity for intervention.
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Affiliation(s)
- Adeolu Funso Oladunjoye
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, Texas, United States of America
| | - Elijah Li
- School of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Kammarauche Aneni
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Edore Onigu-Otite
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, Texas, United States of America
- School of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
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Teng Z, Zhang Y, Wei Z, Liu M, Tang M, Deng Y, Chen Z, Wu Y, Liu R, Yang Y, Gao M, Kun J, Chen J, Wu R, Huang J. Internet addiction and suicidal behavior among vocational high school students in Hunan Province, China: A moderated mediation model. Front Public Health 2023; 10:1063605. [PMID: 36703819 PMCID: PMC9871611 DOI: 10.3389/fpubh.2022.1063605] [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: 10/07/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023] Open
Abstract
Background Vocational education is an important part of high school education in China. However, there is little research on high school students' mental health. This study aimed to investigate the prevalence of suicidal behavior (SB) among this population and the mediating role of insomnia, depression, anxiety, and stress in the relationship between Internet addiction (IA) and SB using a structural equation model. Methods A cross-sectional questionnaire survey was conducted among several vocational high school students in Hunan Province, and 7,968 valid questionnaires were obtained. General demographic data and data from the Dual-Mode Self-Control Scale, Athens Insomnia Scale, Depression Anxiety Stress scale-21, and Revised Chen Internet Addiction Scale were collected. A structural equation model was used to explore the different pathways from IA to SB. Results Among the participants, 37.7, 15.7, and 21.8% reported suicidal ideation, plans, and attempts, respectively. The structural equation model confirmed that IA was indirectly related to SB and was mediated by insomnia and/or depression, anxiety, and stress. Limitations First, we only recruited students from vocational schools in Hunan Province, therefore, the sample may not represent the entire population of vocational students in China. Second, self-report scales were used in this study, and clinical diagnosis required professional interviews. Third, since this study had a cross-sectional design, the causal relationship between the variables could not be determined. Conclusions The prevalence of SB among vocational high school students in China was significantly high. The prevention of SB related to IA can be attributed to the improvement of insomnia and emotional problems.
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Affiliation(s)
- Ziwei Teng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yaru Zhang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zirou Wei
- Mental Health Center, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Mengdong Liu
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Meidai Tang
- Department of Psychiatry, Chenzhou No. 2 Middle School, Chenzhou, Hunan, China
| | - Yizhi Deng
- Department of Psychiatry, Chenzhou No. 2 Middle School, Chenzhou, Hunan, China
| | - Zhuohui Chen
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ying Wu
- Department of Intensive Care Unit, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Runqi Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yuanguang Yang
- Department of Psychiatry, The Third Peoples Hospital of Tongren, Tongren, China
| | - Menghui Gao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jin Kun
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jindong Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Renrong Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jing Huang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China,*Correspondence: Jing Huang ✉
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Hofstra E, Bakker M, Diepstraten CAM, Elfeddali I, Lucas MS, van Nieuwenhuizen C, van der Feltz-Cornelis CM. The Association Between Suicide-Related Media Coverage and Suicide: A Cross-Sectional Observational Study. Arch Suicide Res 2022; 26:1094-1107. [PMID: 33275539 DOI: 10.1080/13811118.2020.1851833] [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: 10/22/2022]
Abstract
OBJECTIVE To examine the association between the publication and content of suicide-related media reports and actual suicide in Noord Brabant, a province of the Netherlands. METHOD Between April 2017 and March 2018, a retrospective cross-sectional observational study was conducted on suicide-related media reports and incident data regarding suicides. Linear regression, Mann-Whitney U and negative binomial regression analyses were conducted. RESULTS In Noord-Brabant, a total of 352 people died from suicide during the observation period and 440 reports were identified by using the search terms "suicide", "self-killing", and "self-murder". No associations between media reports and actual suicides were found for any of the analyses performed. CONCLUSIONS No indications were found for an association between media coverage of suicide and increases or decreases in actual suicides in Noord-Brabant. The descriptive statistics of this study reveal that the regional and national Dutch media are doing well with respect to not including elements in their reports that could encourage copycat behavior, such as simplifying, romanticizing or dramatizing. They could improve on including protective content, for example, providing supportive background information. A recommendation for further research is to evaluate causal relationships between media and actual suicide. A stepped wedge trial might be needed, as this provides an ethical research design to investigate this issue in a controlled setting. Also, in such a study, other variables influencing the decision to attempt suicide should be taken into account as much as possible.
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Horváth ON, Tóth MD, Àdám S, Purebl G. Factors associated with serious intent to die among suicide attempters in Hungary. Int J Ment Health Nurs 2020; 29:632-638. [PMID: 31994320 DOI: 10.1111/inm.12695] [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] [Accepted: 01/02/2020] [Indexed: 11/28/2022]
Abstract
As suicide attempts pose major risk for future suicide death, understanding the underlying factors of suicide attempts and suicidal behaviour is an important mental health imperative. The aim of this study was to examine suicide attempts with a special focus on the intention. A total of 2540 discharge summaries were collected between 2009 and 2011 in Miskolc, Hungary, and a content analysis was conducted. Data regarding the method, the reason for suicide attempts, the amount, the source, and the type of the medication taken were examined. Deliberate self-poisoning was the most frequent method (73.8%) committed with more than 200 different types of drugs. 40.5% of the patients attempted suicide with an intent to die, whilst 35.6% of the patients wanted to escape from an unbearable situation. Older age groups, greater amount of taken pills, and affective disorders were associated with self-reported serious intention to die. Our findings should be taken into consideration when monitoring drugs for older patients with depressive disorders.
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Affiliation(s)
- Orsolya N Horváth
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary.,Department of Dermatology and Allergy, Ludwig-Maximilians University, Munich, Germany
| | - Mónika Ditta Tóth
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Szilvia Àdám
- Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
| | - György Purebl
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
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Papadakis SA, Pallis D, Galanakos S, Georgiou DF, Kateros K, Macheras G, Sapkas G. Falls from height due to accident and suicide attempt in Greece. A comparison of the injury patterns. Injury 2020; 51:230-234. [PMID: 31902573 DOI: 10.1016/j.injury.2019.12.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/16/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Falls from height are a common cause of death and disability. Falls from height can be divided between accidental and suicide attempts. The aim of this study is to ascertain the demographic characteristics of these patients, and to identify the fracture patterns. METHODS In this retrospective cross sectional comparative study we present 244 patients who sustained injuries as a result of a fall from height. They were divided into those with accidental falls (n = 180, group I) and those with suicide attempts (n = 64, group II). Data collected included age, gender, associated trauma, injury severity score (ISS), Glasgow Coma Scale (GCS), haemodynamic status, length of intensive care unit (ICU) and hospital stay. The diagnosis of mental disorder was ascertained by psychiatric specialists using the criteria of the International Classification of Disease Ninth Version Clinical Modification (ICD - 9CM). Postoperative follow-up ranged from 12 months to 10 years. RESULTS The injuries sustained were as follows: Abdominal trauma in 9 cases (5 in group I, 4 in II), thoracic trauma in 81 cases (49 in group I, 32 in II), head injury in 23 cases (7 in group I, 16 in II), 383 extremities fractures (184 in group I, 199 in II) and 133 spinal fractures (101 in group I, 32 in II). Twenty-one patients died in hospital while 223 patients survived to hospital discharge. The mean height from which the fall occurred was 5.4 m (range, 3 - 25 m). The mean Injury Severity Score was 19 (range, 6 to 58) for all fall victims. CONCLUSIONS Patients following an accidental high fall mostly had upper limb fractures. Patients following a suicidal high fall mostly had lower limb fractures, pelvis, spinal fractures and head injuries. Spinal fractures are common either when the fall is accidental or following suicide attempt.
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Affiliation(s)
- Stamatios A Papadakis
- B' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, Kifisia 14561, Greece.
| | - Dimitrios Pallis
- B' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, Kifisia 14561, Greece
| | - Spyridon Galanakos
- D' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, Kifisia 14561, Greece
| | - Dimitrios Florin Georgiou
- B' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, Kifisia 14561, Greece
| | - Konstantinos Kateros
- A' Department of Orthopaedics, "G Gennimatas" General Hospital, Athens 15343, Greece
| | - George Macheras
- D' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, Kifisia 14561, Greece
| | - George Sapkas
- Orthopaedic Department, Metropolitan Hospital, Athens, Greece
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Hofstra E, Elfeddali I, Metz M, Bakker M, de Jong JJ, van Nieuwenhuizen C, van der Feltz-Cornelis CM. A regional systems intervention for suicide prevention in the Netherlands (SUPREMOCOL): study protocol with a stepped wedge trial design. BMC Psychiatry 2019; 19:364. [PMID: 31744476 PMCID: PMC6862736 DOI: 10.1186/s12888-019-2342-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/24/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the Netherlands, suicide rates showed a sharp incline and this pertains particularly to the province of Noord-Brabant, one of the southern provinces in the Netherlands. This calls for a regional suicide prevention effort. METHODS/DESIGN Study protocol. A regional suicide prevention systems intervention is implemented and evaluated by a stepped wedge trial design in five specialist mental health institutions and their adherent chain partners. Our system intervention is called SUPREMOCOL, which stands for Suicide Prevention by Monitoring and Collaborative Care, and focuses on four pillars: 1) recognition of people at risk for suicide by the development and implementation of a monitoring system with decision aid, 2) swift access to specialist care of people at risk, 3) positioning nurse care managers for collaborative care case management, and 4) 12 months telephone follow up. Eligible patients are persons attempting suicide or expressing suicidal ideation. Primary outcome is number of completed suicides, as reported by Statistics Netherlands and regional Public Health Institutes. Secondary outcome is number of attempted suicides, as reported by the regional ambulance transport and police. Suicidal ideation of persons registered in the monitoring system will, be assessed by the PHQ-9 and SIDAS questionnaires at baseline and 3, 6, 9 and 12 months after registration, and used as exploratory process measure. The impact of the intervention will be evaluated by means of the RE-AIM dimensions reach, efficacy, adoption, implementation, and maintenance. Intervention integrity will be assessed and taken into account in the analysis. DISCUSSION The present manuscript presents the design and development of the SUPREMOCOL study. The ultimate goal is to lower the completed suicides rate by 20%, compared to the control period and compared to other provinces in the Netherlands. Moreover, our goal is to provide specialist mental health institutions and chain partners with a sustainable and adoptable intervention for suicide prevention. TRIAL REGISTRATION Netherlands Trial Register under registration number NL6935 (5 April 2018). This is the first version of the study protocol (September 2019).
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Affiliation(s)
- Emma Hofstra
- Specialist Mental Health Institution, GGz Breburg, Tilburg, Netherlands. .,Tranzo-Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands.
| | - Iman Elfeddali
- 0000 0004 0418 4513grid.491213.cSpecialist Mental Health Institution, GGz Breburg, Tilburg, Netherlands ,0000 0001 0943 3265grid.12295.3dTranzo-Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
| | - Margot Metz
- 0000 0004 0418 4513grid.491213.cSpecialist Mental Health Institution, GGz Breburg, Tilburg, Netherlands ,0000 0001 0943 3265grid.12295.3dTranzo-Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
| | - Marjan Bakker
- 0000 0001 0943 3265grid.12295.3dDepartment of Methodology and Statistics, Tilburg University, Tilburg, Netherlands
| | - Jacobus J. de Jong
- 0000 0004 0418 4513grid.491213.cSpecialist Mental Health Institution, GGz Breburg, Tilburg, Netherlands ,0000 0001 0943 3265grid.12295.3dTranzo-Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
| | - Chijs van Nieuwenhuizen
- 0000 0001 0943 3265grid.12295.3dTranzo-Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands ,grid.491104.9Institute for Mental Health Care, GGzE, Eindhoven, Netherlands
| | - Christina M. van der Feltz-Cornelis
- 0000 0004 1936 9668grid.5685.eMental Health and Addiction Research Group, Department of Health Sciences, Hull York Medical School, University of York, York, UK
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A proposal for using the ratio of attempted to completed suicides across several countries worldwide. Epidemiol Psychiatr Sci 2019; 28:473-477. [PMID: 30355373 PMCID: PMC6999028 DOI: 10.1017/s2045796018000628] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Completed suicide (CS) is a leading cause of death worldwide and its rates are available for most developed countries. On the other hand, attempted suicide (AS) is a risk factor for CS but there are limited data on its rates in various countries. In constructing a ratio for AS/CS rates, most would agree that for CS, the denominator should be the annual suicide rate (per 100 000). As for the ratio's numerator (AS) per 100 000, there are three possible calculations: (1) annual prevalence from population surveys, (2) annual prevalence from national clinical registers or (3) lifetime prevalence from population surveys. We think that the first possibility would probably be the best choice but, unfortunately, surveys providing the annual prevalence of AS are lacking for most countries. Annual prevalence from national registers is also lacking for most countries and is contaminated by under-reporting. Therefore, in this editorial, we are left with only the last option, a ratio for lifetime prevalence of AS (per 100 000) divided by annual rate of CS (per 100 000). This ratio for AS/CS rates appears to differ substantially across countries worldwide but presents no big regional differences other than two remarkable exceptions, one per continent. In Europe, Spain and France had greater ratios (174.4 and 152.5, respectively) than Italy (64.1). In Asia/Pacific, New Zealand has a higher ratio (345.9) compared with China (75.8) and Japan (76.9). The ratio for AS/CS rates could be a good index for implementing evidence-informed decision-making regarding suicidal behaviour (SB) among health service managers, and for helping them in the allocation of health resources for the prevention of SB.
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Huh Y, Nam GE, Kim YH, Lee JH. Relationships between Multimorbidity and Suicidal Thoughts and Plans among Korean Adults. J Clin Med 2019; 8:jcm8081094. [PMID: 31344935 PMCID: PMC6723485 DOI: 10.3390/jcm8081094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 11/16/2022] Open
Abstract
Multimorbidity and suicide rates are rising simultaneously among Korean adults. To address this issue, we assessed the association between multimorbidity and suicidal behavior among adults aged ≥19 years in Korea. We analyzed the data from the 2017 Korea National Health and Nutrition Examination Survey. Multimorbidity was defined as experiencing two or more chronic diseases. We compared the presence of suicidal thoughts and plans according to multimorbidity using chi-square test, and examined the associations between multimorbidity and suicidal thoughts and plans using multiple binary logistic regression analyses. Multimorbidity was found in 30.8% of total participants. As the number of chronic diseases increased, the percentage of thoughts and plans tended to increase (p < 0.001 and p = 0.002). Among participants with multimorbidities, 8.5% had suicidal thoughts, whereas only 3.4% without multimorbidity had such thoughts (p < 0.001). Participants with multimorbidity had significantly higher odds of suicidal thoughts (OR = 2.14; 95% CI = 1.54–2.97) and suicidal plans (OR = 2.01; 95% CI = 1.08–3.73) compared to those without multimorbidity after adjusting confounding variables. Conclusion: People with multimorbidity had a higher prevalence of suicidal thoughts and plans. Early detection of and intervention for suicidal thoughts and plans are critical for suicide prevention among people with multimorbidity.
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Affiliation(s)
- Youn Huh
- Department of Family Medicine, Inje University Ilsan Paik Hospital, College of Medicine, Inje University, 170, Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, Seoul 10380, Korea
| | - Ga Eun Nam
- Department of Family Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Korea.
| | - Yang-Hyun Kim
- Department of Family Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Korea
| | - Jun Hyung Lee
- Department of Family Medicine, Inje University Ilsan Paik Hospital, College of Medicine, Inje University, 170, Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, Seoul 10380, Korea.
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Liu X, Huang Y, Liu Y. Prevalence, distribution, and associated factors of suicide attempts in young adolescents: School-based data from 40 low-income and middle-income countries. PLoS One 2018; 13:e0207823. [PMID: 30566431 PMCID: PMC6300318 DOI: 10.1371/journal.pone.0207823] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/05/2018] [Indexed: 02/05/2023] Open
Abstract
Suicide attempts are the most important known predictor of death by suicide. The aim of this study is to examine the prevalence, distribution, and associated factors of suicide attempts among young adolescents in 40 low-income and middle-income countries. We used data from the Global School-Based Student Health Survey (2009–2013) and a nationally representative study in China (2010), which are school-based surveys of students primarily aged 12–18 years that assess health behaviors using an anonymous, standardized, self-reported questionnaire. We calculated the prevalence of suicide attempts in young adolescents from 40 low-income and middle-income countries using the surveys. Multilevel logistic models were used to estimate the associations between suicide attempts and potential risk factors, adjusting for gender, age, school and survey year. Results show that the mean 12-month prevalence of suicide attempts was 17.2%, ranging from 6.7% in Malaysia to 61.2% in Samoa. The overall prevalence of suicide attempts was higher for girls than for boys (18.2% vs 16.2%, P<0.05). Among the suicide attempts, the proportion of suicide attempts with a plan was higher for girls than for boys (62.7% vs 53.2%, P<0.05). Both the prevalence of suicide attempts and the proportion of suicide attempts with a plan increased with age. Factors associated with suicide attempts included poor socioeconomic status, history of bullying, loneliness and anxiety, tobacco and alcohol use, and weak family and social relationships. In conclusion, suicide attempts are frequent among young adolescents in low-income and middle-income countries. Girls and older adolescents tend to make suicide attempts with a plan. The data demonstrate the need to strengthen suicide intervention and prevention programs for young adolescents in low-income and middle-income countries.
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Affiliation(s)
- Xiang Liu
- Department of Health and Social Behavior, School of Public Health, Sichuan University, Chengdu, Sichuan Province, China
| | - Yi Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yuanyuan Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Sichuan University, Chengdu, Sichuan Province, China
- * E-mail:
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11
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Abstract
OBJECTIVES The South Korean government has recently implemented policies to prevent suicide. However, there were few studies examining the recent changing trends in suicide rates. This study aims to examine the changing trends in suicide rates by time and age group. DESIGN A descriptive study using nationwide mortality rates. SETTING Data on the nationwide cause of death from 1993 to 2016 were obtained from Statistics Korea. PARTICIPANTS People living in South Korea. INTERVENTIONS Implementation of national suicide prevention policies (first: year 2004, second: year 2009). PRIMARY OUTCOME MEASURES Suicide was defined as 'X60-X84' code according to the ICD-10 code. Age-standardised suicide rates were estimated, and a Joinpoint regression model was applied to describe the trends in suicide rate. RESULTS From 2010 to 2016, the suicide rates in South Korea have been decreasing by 5.5% (95% CI -10.3% to -0.5%) annually. In terms of sex, the suicide rate for men had increased by 5.0% (95% CI 3.6% to 6.4%) annually from 1993 to 2010. However, there has been no statistically significant change from 2010 to 2016. For women, the suicide rate had increased by 7.5% (95% CI 6.3% to 8.7%) annually from 1993 to 2009, but since 2009, the suicide rate has been significantly decreasing by 6.1% (95% CI -9.1% to -3.0%) annually until 2016. In terms of the age group, the suicide rates among women of almost all age groups have been decreasing since 2010; however, the suicide rates of men aged between 30 and 49 years showed continuously increasing trends. CONCLUSION Our results showed that there were differences in the changing trends in suicide rate by sex and age groups. Our finding suggests that there was a possible relationship between implementation of second national suicide prevention policies and a decline in suicide rate.
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Affiliation(s)
- Sang-Uk Lee
- Department of Mental Health Research, National Center for Mental Health, Seoul, Republic of Korea
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jong-Ik Park
- Department of Psychiatry, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Soojung Lee
- Department of Nursing, Kyungnam University, Changwon, Republic of Korea
| | - In-Hwan Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Joong-Myung Choi
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Chang-Mo Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
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12
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Stoven G, Lachal J, Gokalsing E, Baux L, Jehel L, Spodenkiewicz M. [Acceptability of the systematic screening of suicidal adolescents in emergency departments]. Soins Psychiatr 2018; 39:27-29. [PMID: 29753435 DOI: 10.1016/j.spsy.2018.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Studies of adolescent suicide screening tools have increased with the development of questionnaires that can be used in paediatric emergency departments. This article proposes a literature review of the acceptability of such interventions. Although these tools are well accepted when they are systematized, their usefulness is determined by the availability of child psychiatric care with the right balance between the adolescent's confidentiality and parental involvement.
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Affiliation(s)
- Gabrielle Stoven
- Pôle de santé mentale, CHU Sud Réunion, BP 350, 97448 Saint-Pierre cedex, La Réunion, France
| | - Jonathan Lachal
- CESP, Inserm U1178, université Paris-Saclay, 16, avenue Paul-Vaillant-Couturier, 94805 Villejuif, France; Université Paris Descartes, faculté de médecine, Sorbonne Paris-Cité, 15, rue de l'École-de-médecine, 75006 Paris, France; Maison de Solenn-MDA, hôpital Cochin, 97, boulevard Port-Royal, 75014 Paris, France
| | - Erick Gokalsing
- CEPOI EA 7388, UFR Santé, 1, allée des Aigues-Marines, 97487 Saint-Denis cedex, La Réunion, France; EPSM de la Réunion, 42, avenue Louis-Aragon, 97420 Le Port, La Réunion, France
| | - Lucie Baux
- Pôle de santé mentale, CHU Sud Réunion, BP 350, 97448 Saint-Pierre cedex, La Réunion, France
| | - Louis Jehel
- CESP, Inserm U1178, université Paris-Saclay, 16, avenue Paul-Vaillant-Couturier, 94805 Villejuif, France
| | - Michel Spodenkiewicz
- Pôle de santé mentale, CHU Sud Réunion, BP 350, 97448 Saint-Pierre cedex, La Réunion, France; CEPOI EA 7388, UFR Santé, 1, allée des Aigues-Marines, 97487 Saint-Denis cedex, La Réunion, France; CESP, Inserm U1178, université Paris-Saclay, 16, avenue Paul-Vaillant-Couturier, 94805 Villejuif, France.
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13
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Tóth MD, Ádám S, Zonda T, Birkás E, Purebl G. Risk factors for multiple suicide attempts among Roma in Hungary. Transcult Psychiatry 2018; 55:55-72. [PMID: 29035144 DOI: 10.1177/1363461517731703] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In recent years, suicide rates in Hungary have been among the highest in the European Union. Attempted suicide rates in the Roma population are 2-3 times higher than in the non-Roma population. Since individuals making multiple attempts have a higher pro-bability of eventual death by suicide, and there are limited data on suicidal behaviour of the Roma population, the aim of this study was to explore the sociodemographic and psychological background factors of multiple suicide attempts in the Hungarian Roma population. Semistructured interviews were conducted with 150 individuals admitted to hospital toxicology departments, who made suicide attempts by deliberate self-poisoning, 65 of whom were multiple attempters. Detailed information regarding the current attempt and previous suicidal acts was recorded. Patients also completed the Shortened Beck Depression, the Beck Hopelessness Questionnaire, and the Social Support Questionnaire. Independent samples t-tests were used to evaluate differences in psychological variables between the Roma ( N = 90) and non-Roma ( N = 60) groups. Stepwise linear regression and odds ratios analyses were performed to identify potential background factors of multiple suicide attempts. There was a significantly higher level of previous suicidal events among the Roma in the sample population (3.53 vs. 0.84, p < .001). Roma ethnicity was found to be a strong predictor of multiple suicide attempts. Current major depression, hopelessness, and diagnosed mood disorder were identified as significant risk factors of repeated attempts. Smoking (OR = 5.4), family history of suicide (OR = 4.9), and long-term unemployment (OR = 4.6) were additional risk factors among Roma patients. A thorough understanding of the ethnicity-specific risk factors for multiple suicide attempts could facilitate the development of effective intervention and postvention programmes.
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Affiliation(s)
| | | | - Tamás Zonda
- Hungarian Association for Suicide-Prevention
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14
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Anderson KE, Eberly S, Groves M, Kayson E, Marder K, Young AB, Shoulson I. Risk Factors for Suicidal Ideation in People at Risk for Huntington’s Disease. J Huntingtons Dis 2016; 5:389-394. [DOI: 10.3233/jhd-160206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Karen E. Anderson
- Department of Psychiatry, Research Division, Georgetown University, Washington, DC, USA
- Department of Neurology, Georgetown University, Washington, DC, USA
| | - Shirley Eberly
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Mark Groves
- Department of Psychiatry, Icahn School of Medicine at Mt. Sinai, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mt. Sinai, New York, NY, USA
| | - Elise Kayson
- Center for Human Experimental Therapeutics/Clinical Trials Coordination Center, University of Rochester, Rochester, NY, USA
| | - Karen Marder
- Department of Neurology, Psychiatry, and Taub Institute for Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - Anne B. Young
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ira Shoulson
- Department of Neurology, Georgetown University, Washington, DC, USA
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15
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Kvernmo S, Rosenvinge JH. Self-mutilation and suicidal behaviour in Sami and Norwegian adolescents: prevalence and correlates. Int J Circumpolar Health 2016; 68:235-48. [DOI: 10.3402/ijch.v68i3.18331] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Kennedy AJ, Versace VL, Brumby SA. Research protocol for a digital intervention to reduce stigma among males with a personal experience of suicide in the Australian farming community. BMC Public Health 2016; 16:1204. [PMID: 27899094 PMCID: PMC5129616 DOI: 10.1186/s12889-016-3874-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/24/2016] [Indexed: 11/24/2022] Open
Abstract
Background Australian farming communities have up to twice the suicide rate of the general population. Men, particularly, demonstrate debilitating self- and perceived-stigma associated with an experience of suicide. The Ripple Effect is aimed to reduce suicide stigma within the social, cultural, geographical and psychological contexts in which it occurs. Methods A mixed-method design with multi-level evaluation will be effected following the development and delivery of a personalised website experience (combining shared stories, education, personal goal setting and links to resources) to farming men, aged 30–64 years, with an experience of suicide. Pre- and post-surveys will be used to assess changes in self- and perceived-stigma and suicide literacy. Online feedback from participants and semi-structured interviews during follow-up will be thematically analysed. Discussion This project will provide information about increasingly accessible, innovative approaches to reducing the debilitating health and wellbeing effects of suicide stigma on a population of Australia’s farmers. Trial registration This research protocol was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN: ACTRN12616000289415) on 7th March, 2016.
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Affiliation(s)
- Alison J Kennedy
- National Centre for Farmer Health/Deakin University, Tyers Street, Hamilton, VIC, Australia, 3300.
| | - Vincent Lawrence Versace
- Deakin University, School of Medicine, Deakin Rural Health (DRH), Princes Highway, Warrnambool, VIC, Australia, 3280
| | - Susan A Brumby
- National Centre for Farmer Health/Deakin University, Tyers Street, Hamilton, VIC, Australia, 3300
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17
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Tóth MD, Ádám S, Birkás E, Székely A, Stauder A, Purebl G. Gender differences in deliberate self-poisoning in Hungary: analyzing the effect of precipitating factors and their relation to depression. CRISIS 2016; 35:145-53. [PMID: 24491825 DOI: 10.1027/0227-5910/a000245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The suicide rate in Hungary is one of the highest in the European Union, with a male-female ratio of 3.55:1. Suicide rates correlate positively with suicide attempts, for which depression is the most frequent underlying disorder. AIMS The aim of this qualitative study was to examine gender differences in suicide attempts, with a focus on the effect of precipitating factors on depression. METHOD Semistructured interviews were conducted among 150 suicide attempters. Data on circumstances, reason, and method of attempt were recorded. Patients completed the Shortened Beck Depression Inventory, the Beck Hopelessness Scale, the Sense of Coherence Scale, and the Social Support Questionnaire. RESULTS Interpersonal conflict was found to be the most frequent precipitating factor. There were significant gender differences in depressive symptoms among patients with interpersonal conflicts. We found differences in depressive symptoms according to presence or absence of interpersonal conflicts among men, but not among women. Male suicide attempters who indicated interpersonal conflicts had lower levels of depression. CONCLUSION Depressive symptoms are frequent among suicide attempters. However, a subgroup of male attempters reporting interpersonal conflicts are characterized by a lower level of depression. This subgroup of attempters would probably not be detected with depression screening programs and may have an unmet need for other forms of screening and prevention.
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Affiliation(s)
- Mónika Ditta Tóth
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Szilvia Ádám
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Emma Birkás
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - András Székely
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Adrienne Stauder
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - György Purebl
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
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18
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Paget LM, Chan Chee C, Sauvage C, Saboni L, Beltzer N, Velter A. Facteurs associés aux tentatives de suicide chez les minorités sexuelles : résultats de l’enquête presse gays et lesbiennes 2011. Rev Epidemiol Sante Publique 2016; 64:153-63. [DOI: 10.1016/j.respe.2016.01.098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 11/26/2015] [Accepted: 01/04/2016] [Indexed: 11/28/2022] Open
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19
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Morrison AP, Law H, Barrowclough C, Bentall RP, Haddock G, Jones SH, Kilbride M, Pitt E, Shryane N, Tarrier N, Welford M, Dunn G. Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BackgroundRecovery in mental health is a relatively new concept, but it is becoming more accepted that people can recover from psychosis. Recovery-orientated services are recommended for adult mental health, but with little evidence base to support this.ObjectivesTo facilitate understanding and promotion of recovery in psychosis and bipolar disorder (BD), in a manner that is empowering and acceptable to service users.MethodThere were six linked projects using qualitative and quantitative methodologies: (1) developing and piloting a service user-defined measure of recovery; (2) a Delphi study to determine levels of consensus around the concept of recovery; (3) examination of the psychological factors associated with recovery and how these fluctuate over time; (4) development and evaluation of cognitive–behavioural approaches to guided self-help including a patient preference trial (PPT); (5) development and evaluation of cognitive–behavioural therapy (CBT) for understanding and preventing suicide in psychosis including a randomised controlled trial (RCT); and (6) development and evaluation of a cognitive–behavioural approach to recovery in recent onset BD, including a RCT of recovery-focused cognitive–behavioural therapy (RfCBT). Service user involvement was central to the programme.ResultsMeasurement of service user-defined recovery from psychosis (using the Subjective Experience of Psychosis Scale) and BD (using the Bipolar Recovery Questionnaire) was shown to be feasible and valid. The consensus study revealed a high level of agreement among service users for defining recovery, factors that help or hinder recovery and items which demonstrate recovery. Negative emotions, self-esteem and hope predicted recovery judgements, both cross-sectionally and longitudinally, whereas positive symptoms had an indirect effect. In the PPT, 89 participants entered the study, three were randomised, 57 were retained in the trial until 15-month follow-up (64%). At follow-up there was no overall treatment effect on the primary outcome (Questionnaire about the Process of Recovery total;p = 0.82). In the suicide prevention RCT, 49 were randomised and 35 were retained at 6-month follow-up (71%). There were significant improvements in suicidal ideation [Adult Suicidal Ideation Questionnaire; treatment effect = –12.3, 95% confidence interval (CI) –24.3 to –0.14], Suicide Probability Scale (SPS; treatment effect = –7.0, 95% CI –15.5 to 0) and hopelessness (subscale of the SPS; treatment effect = –3.8, 95% CI –7.3 to –0.5) at follow-up. In the RCT for BD, 67 participants were randomised and 45 were retained at the 12-month follow-up (67%). Recovery score significantly improved in comparison with treatment as usual (TAU) at follow-up (310.87, 95% CI 75.00 to 546.74). At 15-month follow-up, 32 participants had experienced a relapse of either depression or mania (20 TAU vs. 12 RfCBT). The difference in time to recurrence was significant (estimated hazard ratio 0.38, 95% CI 0.18 to 0.78;p < 0.006).ConclusionsThis research programme has improved our understanding of recovery in psychosis and BD. Key findings indicate that measurement of recovery is feasible and valid. It would be feasible to scale up the RCTs to assess effectiveness of our therapeutic approaches in larger full trials, and two of the studies (CBT for suicide prevention in psychosis and recovery in BD) found significant benefits on their primary outcomes despite limited statistical power, suggesting definitive trials are warranted.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Anthony P Morrison
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Heather Law
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | | | - Richard P Bentall
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Gillian Haddock
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Steven H Jones
- The Spectrum Centre for Mental Health Research, University of Lancaster, Lancaster, UK
| | - Martina Kilbride
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Elizabeth Pitt
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Nicholas Shryane
- School of Social Sciences, University of Manchester, Manchester, UK
| | - Nicholas Tarrier
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Mary Welford
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Graham Dunn
- Centre for Biostatistics, University of Manchester, Manchester, UK
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20
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Marutani M, Yamamoto-Mitani N, Kodama S. Public Health Nurses' Activities for Suicide Prevention in Japan. Public Health Nurs 2016; 33:325-34. [PMID: 26813038 DOI: 10.1111/phn.12247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Suicide is a major health issue worldwide, including in Japan. Japanese public health nurses (PHNs) play a distinctive role in suicide prevention, although few studies have delineated this role. The purpose of this study was to develop a conceptual framework that elucidates PHNs' activities for suicide prevention. DESIGN AND SAMPLE Semi-structured interviews were conducted in 2012-2013 with 15 PHNs who worked in Tokyo metropolitan regions. Data were analyzed qualitatively using grounded theory, and a conceptual framework with seven categories was developed. RESULTS Three phases that depict the PHNs' suicide prevention activities emerged. Phase I, Pursuing to understand suicide cases, included two categories: tracing back individual suicide cases and raising consciousness among the general public. Phase II, Spreading a web of care, included three categories: knitting a caring network, weaving regular programs into the web, and continuing to be a member of the web. Phase III, Maintaining motivation and commitment, included two categories: legitimatizing suicide prevention and cultivating continued commitment in the community. CONCLUSION The activities of suicide prevention by PHNs included a process of developing a caring network that lead to the enhancement of the caring capacity of the community as a whole.
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Affiliation(s)
- Miki Marutani
- Department of Community Health Nursing and Nursing Informatics, Kagoshima University, Kagoshima-Ken, Japan
| | | | - Shimpei Kodama
- Department of Community Health Nursing and Nursing Informatics, Kagoshima University, Kagoshima-Ken, Japan
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21
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Macleod E, Nada-Raja S, Beautrais A, Shave R, Jordan V. Primary prevention of suicide and suicidal behaviour for adolescents in school settings. Cochrane Database Syst Rev 2015. [DOI: 10.1002/14651858.cd007322.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Emily Macleod
- University of Otago; Department of Preventive and Social Medicine; PO Box 56 Dunedin Otago New Zealand 9054
| | - Shyamala Nada-Raja
- University of Otago; Department of Preventive and Social Medicine; PO Box 56 Dunedin Otago New Zealand 9054
| | - Annette Beautrais
- University of Canterbury; School of Health Sciences; Christchurch New Zealand
| | - Roger Shave
- Clinical Advisory Services Aotearoa; PO Box 12088, Beckenham Christchurch New Zealand 8242
| | - Vanessa Jordan
- University of Auckland; Department of Obstetrics and Gynaecology; Private Bag 92019 Auckland New Zealand 1003
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22
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Panagioti M, Gooding PA, Pratt D, Tarrier N. An empirical investigation of suicide schemas in individuals with Posttraumatic Stress Disorder. Psychiatry Res 2015; 227:302-8. [PMID: 25850967 DOI: 10.1016/j.psychres.2015.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 01/30/2015] [Accepted: 02/21/2015] [Indexed: 10/23/2022]
Abstract
Posttraumatic Stress Disorder (PTSD) has been strongly associated with suicidality. Despite the growing evidence suggesting that suicidality is heightened by the presence of an elaborated suicide schema, investigations of suicide schemas are sparse. Using novel methodologies, this study aimed to compare the suicide schema of PTSD individuals with and without suicidal ideation in the past year. Fifty-six participants with a diagnosis of PTSD (confirmed via the Clinician Administered PTSD Scale) completed questionnaires to assess suicidality, depressive severity and hopelessness. A series of direct and indirect cognitive tasks were used to assess suicide schemas. The pathfinder technique was employed to construct graphical representations of the groups׳ suicide schemas. The suicidal group reported significantly more severe PTSD symptoms, depressive symptoms, hopelessness and suicidality. The suicide schema of the suicidal group was significantly more extensive compared to the non-suicidal group even after taking into account in the analyses group differences in clinical measures. Moreover, the suicide schemas of the two groups were qualitatively distinct from each other. These findings provide support for contemporary theories of suicide which view suicide schemas as an important indicator of suicide risk. The investigation of schema constructs opens a new avenue of research for understanding suicide.
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Affiliation(s)
- Maria Panagioti
- Institute of Population Health, Centre for Primary Care, University of Manchester, UK.
| | | | - Daniel Pratt
- School of Psychological Sciences, University of Manchester, UK
| | - Nicholas Tarrier
- Department of Psychology, Institute of Psychiatry, Kings College London, UK
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23
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Wasserman D, Hoven CW, Wasserman C, Wall M, Eisenberg R, Hadlaczky G, Kelleher I, Sarchiapone M, Apter A, Balazs J, Bobes J, Brunner R, Corcoran P, Cosman D, Guillemin F, Haring C, Iosue M, Kaess M, Kahn JP, Keeley H, Musa GJ, Nemes B, Postuvan V, Saiz P, Reiter-Theil S, Varnik A, Varnik P, Carli V. School-based suicide prevention programmes: the SEYLE cluster-randomised, controlled trial. Lancet 2015; 385:1536-44. [PMID: 25579833 DOI: 10.1016/s0140-6736(14)61213-7] [Citation(s) in RCA: 302] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Suicidal behaviours in adolescents are a major public health problem and evidence-based prevention programmes are greatly needed. We aimed to investigate the efficacy of school-based preventive interventions of suicidal behaviours. METHODS The Saving and Empowering Young Lives in Europe (SEYLE) study is a multicentre, cluster-randomised controlled trial. The SEYLE sample consisted of 11,110 adolescent pupils, median age 15 years (IQR 14-15), recruited from 168 schools in ten European Union countries. We randomly assigned the schools to one of three interventions or a control group. The interventions were: (1) Question, Persuade, and Refer (QPR), a gatekeeper training module targeting teachers and other school personnel, (2) the Youth Aware of Mental Health Programme (YAM) targeting pupils, and (3) screening by professionals (ProfScreen) with referral of at-risk pupils. Each school was randomly assigned by random number generator to participate in one intervention (or control) group only and was unaware of the interventions undertaken in the other three trial groups. The primary outcome measure was the number of suicide attempt(s) made by 3 month and 12 month follow-up. Analysis included all pupils with data available at each timepoint, excluding those who had ever attempted suicide or who had shown severe suicidal ideation during the 2 weeks before baseline. This study is registered with the German Clinical Trials Registry, number DRKS00000214. FINDINGS Between Nov 1, 2009, and Dec 14, 2010, 168 schools (11,110 pupils) were randomly assigned to interventions (40 schools [2692 pupils] to QPR, 45 [2721] YAM, 43 [2764] ProfScreen, and 40 [2933] control). No significant differences between intervention groups and the control group were recorded at the 3 month follow-up. At the 12 month follow-up, YAM was associated with a significant reduction of incident suicide attempts (odds ratios [OR] 0·45, 95% CI 0·24-0·85; p=0·014) and severe suicidal ideation (0·50, 0·27-0·92; p=0·025), compared with the control group. 14 pupils (0·70%) reported incident suicide attempts at the 12 month follow-up in the YAM versus 34 (1·51%) in the control group, and 15 pupils (0·75%) reported incident severe suicidal ideation in the YAM group versus 31 (1·37%) in the control group. No participants completed suicide during the study period. INTERPRETATION YAM was effective in reducing the number of suicide attempts and severe suicidal ideation in school-based adolescents. These findings underline the benefit of this universal suicide preventive intervention in schools. FUNDING Coordination Theme 1 (Health) of the European Union Seventh Framework Programme.
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Affiliation(s)
- Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden.
| | - Christina W Hoven
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA; Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Camilla Wasserman
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA; Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Melanie Wall
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ruth Eisenberg
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Gergö Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Ian Kelleher
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy; National Institute for Health, Migration and Poverty, Rome, Italy
| | - Alan Apter
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Judit Balazs
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary; Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Julio Bobes
- Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, University of Oviedo, Oviedo, Spain
| | - Romuald Brunner
- Section for Disorders of Personality Development, Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | | | - Doina Cosman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Christian Haring
- Institute for Clinical Evaluation, Department for Psychiatry and Psychotherapy B, State Hospital Hall, Tyrol, Austria
| | - Miriam Iosue
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Michael Kaess
- Section for Disorders of Personality Development, Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Jean-Pierre Kahn
- Department of Psychiatry, Nancy University Hospital, Nancy, France
| | - Helen Keeley
- National Suicide Research Foundation, Cork, Ireland
| | - George J Musa
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Bogdan Nemes
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Vita Postuvan
- Slovene Center for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Pilar Saiz
- Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, University of Oviedo, Oviedo, Spain
| | - Stella Reiter-Theil
- Department of Clinical Ethics, Psychiatric Hospitals of the University of Basel, University Hospital Basel, Basel, Switzerland
| | - Airi Varnik
- Estonian-Swedish Mental Health and Suicidology Institute, Tallinn, Estonia; Tallinn University, Tallinn, Estonia
| | - Peeter Varnik
- Estonian-Swedish Mental Health and Suicidology Institute, Tallinn, Estonia; Tallinn University, Tallinn, Estonia
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
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Abstract
AbstractObjectives: To determine the frequency of reported suicidal thoughts and acts in (a) a school-based sample of Irish adolescents, (b) adolescents attending a community child and family mental health service.Method: The study population consisted of: (a) 195 adolescents aged 13-15 years attending ten secondary schools throughout Ireland. The schools were selected to represent a wide social and cultural spread: and (b) 66 adolescents aged 13-15 years attending a community child mental health service. The measures used were the Child Behaviour Checklist completed by the parents of the adolescents and the Youth Self Report completed by the adolescents.Results: Within the school sample, the parents of 3% of adolescents reported that their child had talked of harming him/herself, but none reported acts of self-harm. Fifteen percent of the adolescents themselves reported that they had thoughts of harming or killing themselves, and 8% reported that they had tried to harm or kill themselves.Within the mental health clinic attenders sample, the parents of 33% of the adolescents reported that their child had talked of harming him/herself, and the parents of 27% reported that their child had tried to harm or kill themselves. Twenty-one percent of the adolescents themselves reported that they had thoughts of harming or killing themselves, and 21% percent reported that they had tried to do so. In both groups, adolescents with higher total problem, internalising and externalising scores on the questionnaires, indicating greater disturbance, were more likely to report thoughts and acts of self harm.Conclusions: Thoughts of suicide and acts of self harm are common in Irish adolescents and are not limited to those attending mental health services. Parents are frequently unaware of these thoughts. Further studies involving interviews with adolescents at risk are indicated to determine the significance of these thoughts and how adolescents deal with them.
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Orri M, Paduanello M, Lachal J, Falissard B, Sibeoni J, Revah-Levy A. Qualitative approach to attempted suicide by adolescents and young adults: the (neglected) role of revenge. PLoS One 2014; 9:e96716. [PMID: 24802777 PMCID: PMC4011950 DOI: 10.1371/journal.pone.0096716] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 04/09/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Suicide by adolescents and young adults is a major public health concern, and repetition of self-harm is an important risk factor for future suicide attempts. OBJECTIVE Our purpose is to explore the perspective of adolescents directly involved in suicidal acts. METHODS Qualitative study involving 16 purposively selected adolescents (sex ratio1 ∶ 1) from 3 different centers. Half had been involved in repeated suicidal acts, and the other half only one. Data were gathered through semistructured interviews and analyzed according to Interpretative Phenomenological Analysis. RESULTS We found five main themes, organized in two superordinate themes. The first theme (individual dimensions of the suicide attempt) describes the issues and explanations that the adolescents saw as related to themselves; it includes the subthemes: (1) negative emotions toward the self and individual impasse, and (2) the need for some control over their lives. The second main theme (relational dimensions of attempted suicide) describes issues that adolescents mentioned that were related to others and includes three subthemes: (3) perceived impasse in interpersonal relationships, (4) communication, and (5) revenge. CONCLUSIONS Adolescents involved in suicidal behavior are stuck in both an individual and a relational impasse from which there is no exit and no apparent way to reach the other. Revenge can bridge this gap and thus transforms personal distress into a relational matter. This powerful emotion has been neglected by both clinicians and researchers.
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Affiliation(s)
- Massimiliano Orri
- INSERM 669 research unit, Paris-Sud University and Paris-Descartes University, Paris, France
| | | | - Jonathan Lachal
- INSERM 669 research unit, Paris-Sud University and Paris-Descartes University, Paris, France
- Maison de Solenn, AP-HP Cochin Hospital, Paris, France
| | - Bruno Falissard
- INSERM 669 research unit, Paris-Sud University and Paris-Descartes University, Paris, France
| | - Jordan Sibeoni
- INSERM 669 research unit, Paris-Sud University and Paris-Descartes University, Paris, France
- Maison de Solenn, AP-HP Cochin Hospital, Paris, France
| | - Anne Revah-Levy
- INSERM 669 research unit, Paris-Sud University and Paris-Descartes University, Paris, France
- Centre de Soins Psychothérapeutiques de Transition pour Adolescents, Argenteuil Hospital Centre, Argenteuil, France
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Pompili M, Innamorati M, Di Vittorio C, Sher L, Girardi P, Amore M. Sociodemographic and clinical differences between suicide ideators and attempters: a study of mood disordered patients 50 years and older. Suicide Life Threat Behav 2014; 44:34-45. [PMID: 23937195 DOI: 10.1111/sltb.12051] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 05/19/2013] [Indexed: 11/27/2022]
Abstract
Our study sought to characterize mood disordered suicide ideators and attempters 50 years and older admitted to a psychiatric ward either for a recent suicide attempt or for ongoing suicidal ideation. We enrolled 50 patients with suicide ideation consecutively admitted to an inpatient department and 50 patients admitted for a suicide attempt made in the last 48 hours. Suicide attempters more frequently had low social support and an age of onset of mood disorder of 46 years and older, and less frequently had a history of suicidal behaviors in the family members and pharmacological treatment, despite the fact that the groups did not differ with regard to antidepressants prescribed. The groups were not distinguishable based on several variables assumed to be risk factors for suicide behavior, such as proximal life events and stressors or alcohol use disorders. In both samples, comorbidity with organic diseases, the presence of stressful life events in the past 12 months, and a diagnosis of major depression were frequently reported. In conclusion, the presence of low social support and the absence of a pharmacotherapy may increase suicidal behaviors in patients at risk.
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Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Mirkovic B, Belloncle V, Rousseau C, Knafo A, Guilé JM, Gérardin P. Stratégies de prévention du suicide et des conduites suicidaires à l’adolescence : revue systématique de la littérature. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.neurenf.2013.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zakharov S, Navratil T, Pelclova D. Suicide attempts by deliberate self-poisoning in children and adolescents. Psychiatry Res 2013; 210:302-7. [PMID: 23810383 DOI: 10.1016/j.psychres.2013.03.037] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 03/23/2013] [Accepted: 03/28/2013] [Indexed: 10/26/2022]
Abstract
AIM The objective of the study was to examine the toxicological characteristics of suicide attempts by deliberate self-poisoning in children and adolescents. METHOD From the Toxicological Information Centre's database, the inquiries due to the suicide attempts in children (9-13 years old) and adolescents (14-18 years old) were evaluated. RESULTS AND CONCLUSIONS From 10,492 calls concerning suicide attempts, 2393 concerned children and adolescents. Most suicide attempts were attempted in spring (31.3%). Among the toxic agents, drugs were used in 97.8% cases. The most frequent ingestions appeared using drugs affecting the nervous system and anti-inflammatory non-steroids. The dose was evaluated as toxic in 73.4%, severely toxic in 3.0% and unknown in 11.2% cases. Only one in 10 children used a non-toxic dose. Girls, more frequently than boys (13.2% vs. 8.9%), used non-toxic doses. The symptoms of moderate and severe intoxications were present in 10.5% of the cases. Poison centre consultation was accessed within the first hour after the ingestion in one-fifth of the patients. In both age groups, the severity of the intoxication was greater among elder males who reached the medical facilities later than 4 h after the poisoning. The combinations of three or more drugs affecting central nervous system were present in the most severe cases.
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Affiliation(s)
- Sergey Zakharov
- Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.
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29
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Zakharov S, Navratil T, Pelclova D. Non‐Fatal Suicidal Self‐Poisonings in Children and Adolescents over a 5‐Year Period (2007–2011). Basic Clin Pharmacol Toxicol 2013; 112:425-30. [DOI: 10.1111/bcpt.12047] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 12/27/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Sergey Zakharov
- Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine Charles University in Prague and General University Hospital Prague Czech Republic
| | - Tomas Navratil
- Department of Biophysical Chemistry J. Heyrovský Institute of Physical Chemistry of AS CR, v.v.i Prague Czech Republic
| | - Daniela Pelclova
- Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine Charles University in Prague and General University Hospital Prague Czech Republic
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Morthorst B, Krogh J, Erlangsen A, Alberdi F, Nordentoft M. Effect of assertive outreach after suicide attempt in the AID (assertive intervention for deliberate self harm) trial: randomised controlled trial. BMJ 2012; 345:e4972. [PMID: 22915730 PMCID: PMC3425442 DOI: 10.1136/bmj.e4972] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To assess whether an assertive outreach intervention after suicide attempt could reduce the frequency of subsequent suicidal acts, compared with standard treatment. DESIGN Randomised, parallel group, superiority trial with blinded outcome assessment. SETTING Outpatient intervention at one location at Copenhagen University Hospital, Denmark. PARTICIPANTS Patients older than 12 years admitted to regional hospitals in Copenhagen with a suicide attempt within the past 14 days. We excluded patients diagnosed with schizophrenia spectrum disorders and patients living in institutions. INTERVENTION Case management through assertive outreach that provided crisis intervention and flexible problem solving. This approach incorporated motivational support and actively assisted patients to scheduled appointments to improve adherence with after-treatment as an add on to standard treatment. MAIN OUTCOME Repeated suicide attempt and death by suicide, recorded in medical records and death register at 1-year follow-up. RESULTS 243 patients were included. During 12 months of follow-up, 20/123 (16%) patients in the intervention group had been registered in hospital records with subsequent suicide attempt, compared with 13/120 (11%) in the control group (odds ratio 1.60, 95% confidence interval 0.76 to 3.38; P=0.22). By contrast, self reported data on new events showed 11/95 (12%) in the intervention group versus 13/74 (18%) in the control group (0.61, 0.26 to 1.46; P=0.27). By imputing missing data on the selfreported outcomes, we estimated 15/123 (12%) events in the intervention group and 23/120 (19%) in the control group (0.69, 0.34 to 1.43; P=0.32). CONCLUSION Assertive outreach showed no significant effect on subsequent suicide attempt. The difference in rates of events between register data and self reported data could indicate detection bias. TRIAL REGISTRATION ClinicalTrials.gov NCT00700089.
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Affiliation(s)
- Britt Morthorst
- Research Unit, Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark.
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Kokkevi A, Richardson C, Olszewski D, Matias J, Monshouwer K, Bjarnason T. Multiple substance use and self-reported suicide attempts by adolescents in 16 European countries. Eur Child Adolesc Psychiatry 2012; 21:443-50. [PMID: 22535305 DOI: 10.1007/s00787-012-0276-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 04/04/2012] [Indexed: 11/29/2022]
Abstract
Substance use and suicide attempts are high-risk behaviors in adolescents, with serious impacts on health and well-being. Although multiple substance use among young people has become a common phenomenon, studies of its association with suicide attempts are scarce. The present study examines the association between multiple substance use and self-reported suicide attempts in a large multinational sample of adolescent students in Europe. Data on multiple substance use (tobacco, alcohol, tranquillizers/sedatives, cannabis, other illegal drugs) and self-reported suicide attempts were drawn from the 2007 European School Survey Project on Alcohol and Other Drugs (ESPAD). The ESPAD survey follows a standardized methodology in all participating countries. The present study is based on 45,086 16-year-old adolescents from 16 countries that had used the optional "psychosocial module" of the questionnaire, thereby including the question on suicide attempts. Logistic regression analyses were performed to examine the associations of any self-reported suicide attempt (dependent variable) with substance use controlling for country and gender. The strongest association with self-reported suicide attempts was for any lifetime tranquillizer or sedative use (odds ratio 3.34, 95 % confidence interval 3.00-3.71) followed by any lifetime use of illegal drugs other than cannabis (2.41, 2.14-2.70), 30-day regular tobacco use (2.02, 1.84-2.21), 30-day frequent alcohol use (1.47, 1.32-1.63) and any 30-day cannabis use (1.37, 1.18-1.58). The odds ratio of reporting a suicide attempt approximately doubled for every additional substance used. These findings on the association between multiple substance use, including legal drugs (tranquillizers or sedatives and tobacco), and the life-threatening behavior of suicide attempts provide important cues for shaping prevention policies.
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Affiliation(s)
- Anna Kokkevi
- Department of Psychiatry, Medical School, Athens University, Greece.
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Suicidality and sexual orientation among men in Switzerland: findings from 3 probability surveys. J Psychiatr Res 2012; 46:980-6. [PMID: 22591853 DOI: 10.1016/j.jpsychires.2012.04.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 04/06/2012] [Accepted: 04/13/2012] [Indexed: 11/24/2022]
Abstract
Few population-based surveys in Europe have examined the link between suicidality and sexual orientation. The objective of this study was to assess the prevalences of and risk for suicidality by sexual orientation, especially among adolescent and young adult men. Data came from three probability-based surveys in Switzerland from 2002: 1) Geneva Gay Men's Health Survey (GGMHS) with 571 gay/bisexual men, 2) Swiss Multicenter Adolescent Survey on Health (SMASH) with 7,428 16-20 year olds, and 3) Swiss Recruit Survey (ch-x) with 22,415 new recruits. In GGMHS, suicidal ideation (12 months/lifetime) was reported by 22%/55%, suicide plans 12%/38%, and suicide attempts 4%/19%. While lifetime prevalences and ratios are similar across age groups, men under 25 years reported the highest 12-month prevalences for suicidal ideation (35.4%) and suicide attempts (11.5%) and the lowest attempt ratios (1:1.5 for attempt to plan and 1:3.1 for attempt to ideation). The lifetime prevalence of suicide attempts among homo/bisexual men aged 16-20 years varies from 5.1% in ch-x to 14.1% in SMASH to 22.0% in GGMHS. Compared to their heterosexual counterparts, significantly more homo/bisexual men reported 12-month suicidal ideation, plans, and attempts (OR = 2.09-2.26) and lifetime suicidal ideation (OR = 2.15) and suicide attempts (OR = 4.68-5.36). Prevalences and ratios vary among gay men by age and among young men by both sexual orientation and study population. Lifetime prevalences and ratios of non-fatal suicidal behaviors appear constant across age groups as is the increased risk of suicidality among young homo/bisexual men.
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Kokkevi A, Rotsika V, Arapaki A, Richardson C. Adolescents' self-reported suicide attempts, self-harm thoughts and their correlates across 17 European countries. J Child Psychol Psychiatry 2012; 53:381-9. [PMID: 21895649 DOI: 10.1111/j.1469-7610.2011.02457.x] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Suicide is a leading cause of death among adolescents in Europe. Self-harm thoughts and behaviours are documented precursors of completed suicide. It is therefore of great importance to investigate the prevalence of suicide thoughts and attempts and their correlates, with the aim of preventing this major life-threatening public health problem. This study provides cross-national European data on self-reported suicidal thoughts and attempts among adolescents. METHODS Data were obtained from 45,806 high school students aged 15-16 years from 17 countries that participated in the European School Survey Project on Alcohol and Other Drugs (ESPAD) 2007 school survey. The standardised methods of the ESPAD survey ensure comparability across countries. Students completed an anonymous questionnaire in their classrooms. The prevalences of suicidal thoughts and attempts are reported as well as their sociodemographic and psychosocial correlates identified in logistic regression. RESULTS The median prevalence of any lifetime self-reported suicide attempt was 10.5% across the participating countries (range 4.1%-23.5%). The median of frequent self-harm thoughts (at least five times) was 7.4% (range 2.1%-15.3%). Suicidal behaviour and thoughts had significant associations with gender, substance use, family integrity and socioeconomic status. Countries with higher prevalence of substance use tended to have a weaker association between substance use and self-reported suicide attempts. CONCLUSION Although self-reported self-harm thoughts and suicide attempts vary in prevalence within Europe, there are common correlates across countries. These have an important impact on understanding the phenomenon of suicide among young people and in guiding prevention.
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Affiliation(s)
- A Kokkevi
- A'Department of Psychiatry, Medical School, Athens University, University Mental Health Research Institute, Soranou tou Efesiou 2, Athens, Greece.
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Attempted suicide among immigrants in European countries: an international perspective. Soc Psychiatry Psychiatr Epidemiol 2012; 47:241-51. [PMID: 21197530 DOI: 10.1007/s00127-010-0336-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 12/14/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE This study compares the frequencies of attempted suicide among immigrants and their hosts, between different immigrant groups, and between immigrants and their countries of origin. METHODS The material, 27,048 persons, including 4,160 immigrants, was obtained from the WHO/EURO Multicentre Study on Suicidal Behaviour, the largest available European database, and was collected in a standardised manner from 11 European centres in 1989-2003. Person-based suicide-attempt rates (SARs) were calculated for each group. The larger immigrant groups were studied at each centre and compared across centres. Completed-suicide rates of their countries of origin were compared to the SARs of the immigrant groups using rank correlations. RESULTS 27 of 56 immigrant groups studied showed significantly higher, and only four groups significantly lower SARs than their hosts. Immigrant groups tended to have similar rates across different centres. Moreover, positive correlation between the immigrant SAR and the country-of-origin suicide rate was found. However, Chileans, Iranians, Moroccans, and Turks displayed high SARs as immigrants despite low suicide rates in the home countries. CONCLUSIONS The similarity of most immigrant groups' SARs across centres, and the correlation with suicidality in the countries of origin suggest a strong continuity that can be interpreted in either cultural or genetic terms. However, the generally higher rates among immigrants compared to host populations and the similarity of the rates of foreign-born and those immigrants who retained the citizenship of their country of origin point to difficulties in the acculturation and integration process. The positive correlation found between attempted and completed suicide rates suggests that the two are related, a fact with strong implications for suicide prevention.
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Deliberate self-harm in children and adolescents: an 11-year case note study. Ir J Psychol Med 2011; 28:191-195. [PMID: 30200005 DOI: 10.1017/s0790966700011630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To retrospectively examine the case-notes of all children and adolescents admitted with deliberate self-harm (DSH) or suicidal ideation during the study period 1993-2003. The study aimed to identify underlying reasons why children and adolescents engage in DSH, and to identify common psychiatric, psychosocial and familial factors which may predispose or contribute to an individual's engagement in such behaviour. METHOD All children presenting to the hospital with DSH or suicidal ideation were identified and data collected from their case notes. A study specific questionnaire was designed to collect demographic details, details on clinical presentation, past attempts, comorbid psychiatry disorders, family history and family circumstances. Information was also recorded on hospital stay and discharge planning. RESULTS During the 11-year period, 231 children presented with suicidal ideation or behaviour. The mean age was 12.85 with an age range from 6-17 years, with a female:male ratio of 2.5:1. Overdose was the most common method (81.2%) and paracetamol most commonly the drug of choice. More than half of the group (55.7%) expressed a wish to die. More than half (51.8%) had expressed suicidal ideation in the past, 31% had made a previous attempt, and 11.7% had been previously admitted. Of the children 8% presented with suicidal behaviour more than once over the study period. There was a family history of completed suicide in 6.6%. CONCLUSION Deliberate self-harm in young people is a significant public health problem in Ireland. During the period of this study, rates have continued to increase. There is an urgent need for national bodies such as the National Suicide Review Group to extend their focus to include those under age 18 and for services to be developed that might reduce DSH behaviours. More research is needed in the area of childhood suicidal behaviour.
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Folly WSD. The threshold bias model: a mathematical model for the nomothetic approach of suicide. PLoS One 2011; 6:e24414. [PMID: 21909431 PMCID: PMC3164734 DOI: 10.1371/journal.pone.0024414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 08/10/2011] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Comparative and predictive analyses of suicide data from different countries are difficult to perform due to varying approaches and the lack of comparative parameters. METHODOLOGY/PRINCIPAL FINDINGS A simple model (the Threshold Bias Model) was tested for comparative and predictive analyses of suicide rates by age. The model comprises of a six parameter distribution that was applied to the USA suicide rates by age for the years 2001 and 2002. Posteriorly, linear extrapolations are performed of the parameter values previously obtained for these years in order to estimate the values corresponding to the year 2003. The calculated distributions agreed reasonably well with the aggregate data. The model was also used to determine the age above which suicide rates become statistically observable in USA, Brazil and Sri Lanka. CONCLUSIONS/SIGNIFICANCE The Threshold Bias Model has considerable potential applications in demographic studies of suicide. Moreover, since the model can be used to predict the evolution of suicide rates based on information extracted from past data, it will be of great interest to suicidologists and other researchers in the field of mental health.
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Affiliation(s)
- Walter Sydney Dutra Folly
- Núcleo Integrado de Pesquisa e Pós-Graduação em Educação e Ciências Universidade Federal de Sergipe, SE, Brazil.
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Non-fatal suicidal behaviour in Padua, Italy, in two different periods: 1992-1996 and 2002-2006. Soc Psychiatry Psychiatr Epidemiol 2011; 46:805-11. [PMID: 20563551 DOI: 10.1007/s00127-010-0251-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Accepted: 06/07/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE The WHO/EURO multicentre study on suicidal behaviour showed the lowest rates of suicide attempts in the Italian centre of Padua. Present study aims to discover changes in non-fatal suicidal behaviour rates and characteristics by comparing hospital-admitted subjects in two study periods (1992-1996 and 2002-2006). METHODS Data were obtained from the University Hospital of Padua. The crude prevalence rates of events and persons by year per 100,000 (subjects aged 15+ years) were calculated. Rate ratios, Chi-square tests and t tests were calculated. RESULTS The mean prevalence rate per year showed a significant increase during the second study period from 59.2 to 93.6 per 100,000 (RR = 1.58, 95%CI = 1.24-2.02). Changes were significant for both genders, but the increase was stronger in males. The proportion of subjects with non-fatal suicidal behaviour was highest in the youngest age group (15-29 years) in the first period and in adults (30-44 years) in the second period. The absolute number of subjects with non-fatal suicidal behaviour increased more than two times for adults aged 30-44 years. Changes in other age groups were minor. The absolute numbers of non-Italian-born subjects with non-fatal suicidal behaviour increased from 11 to 135 persons. The proportion of poisoning was significantly lower in the second period. CONCLUSIONS When comparing the time periods 1992-1996 and 2002-2006, there was a significant increase in suicidal events in Padua. There have been remarkable changes in the characteristics of suicide attempt(er)s. The most remarkable change was in the number of non-Italian-born subjects, who should be specifically targeted by suicide prevention activities.
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Kaess M, Parzer P, Haffner J, Steen R, Roos J, Klett M, Brunner R, Resch F. Explaining gender differences in non-fatal suicidal behaviour among adolescents: a population-based study. BMC Public Health 2011; 11:597. [PMID: 21794184 PMCID: PMC3160991 DOI: 10.1186/1471-2458-11-597] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Accepted: 07/28/2011] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND While suicide is the second leading cause of death among young people in most industrial countries, non-fatal suicidal behaviour is also a very important public health concern among adolescents. The aim of this study was to investigate gender differences in prevalence and emotional and behavioural correlates of suicidal behaviour in a representative school-based sample of adolescents. METHODS A cross-sectional design was used to assess suicidal behaviour and various areas of emotional and behavioural problems by using a self-report booklet including the Youth Self-Report. One hundred sixteen schools in a region of Southern Germany agreed to participate. A representative sample of 5,512 ninth-grade students was studied. Mean age was 14.8 years (SD 0.73); 49.8% were female. RESULTS Serious suicidal thoughts were reported by 19.8% of the female students and 10.8% of the females had ever attempted suicide. In the male group, 9.3% had a history of suicidal thoughts and 4.9% had previously attempted suicide. Internalizing emotional and behavioural problems were shown to be higher in the female group (difference of the group means 4.41) while externalizing emotional and behavioural problems slightly predominated in male students (difference of the group means -0.65). However, the total rate of emotional and behavioural problems was significantly higher in the adolescent female group (difference of the group means 4.98). Using logistic regression models with suicidal thoughts or attempted suicide as dependent variables, the pseudo-R2 of gender alone was only 2.7% or 2.3%, while it was 30% or 23.2% for emotional and behavioural problems measured by the YSR syndrome scales. By adding gender to the emotional and behavioural problems only an additional 0.3% of information could be explained. CONCLUSIONS The findings suggest that gender differences in non-fatal suicidal behaviour among adolescents can to a large extent be explained by the gender differences in emotional and behavioural problems during this age.
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Affiliation(s)
- Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
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Fiedorowicz JG, Mills JA, Ruggle A, Langbehn D, Paulsen JS. Suicidal behavior in prodromal Huntington disease. NEURODEGENER DIS 2011; 8:483-90. [PMID: 21659725 DOI: 10.1159/000327754] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 03/14/2011] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Several studies have suggested a greater risk of suicide in Huntington disease (HD); however, unique risk factors for suicide in HD are not established. OBJECTIVE We sought to determine risk factors for suicidal behavior, defined as suicide or attempted suicide, in prodromal HD. METHODS From the prospective PREDICT-HD cohort, we identified 735 cases with HD gene expansion but no manifest symptoms of HD and 194 non-gene-expanded controls. In survival analysis, a number of potential risk factors for suicidal behavior were assessed, including symptoms of depression, hopelessness, substance abuse, marital status, gender, and psychiatric history. RESULTS During a mean of 3.7 years of prospective follow-up, 12 cases (1.6%) attempted suicide and 1 completed suicide (0.1%). No suicides were observed among controls. In univariate Cox proportional hazards regression models, a history of suicide attempts (HR 8.5, 95% CI 2.8-26.1, p < 0.0002) and a Beck Depression Inventory II score >13 (HR 7.2, 95% CI 2.3-22.0, p < 0.0006) were associated with suicidal behavior. These risk factors had independent effects in multivariate models. A history of incarceration in the past 2 years was also associated (HR 12.5, 95% CI 2.7-56.6, p < 0.002), though uncommon. No further risk factors were identified. CONCLUSION A history of suicide attempts and the presence of depression are strongly predictive of suicidal behavior in prodromal HD. As these risk factors are among the most robust risk factors for suicide, established suicide risk factors appear applicable to those with prodromal HD.
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Affiliation(s)
- Jess G Fiedorowicz
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, USA
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Jo SJ, Lee MS, Yim HW, Kim HJ, Lee K, Chung HS, Cho J, Choi SP, Seo YM. Factors associated with referral to mental health services among suicide attempters visiting emergency centers of general hospitals in Korea: does history of suicide attempts predict referral? Gen Hosp Psychiatry 2011; 33:294-9. [PMID: 21601727 DOI: 10.1016/j.genhosppsych.2011.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 01/15/2011] [Accepted: 01/19/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study examined whether a history of past suicide attempts was a critical factor for referral to mental health services among suicide attempters visiting emergency centers of general hospitals in Korea. METHOD In this cross-sectional study, a resident of emergency medicine at each emergency center interviewed 310 suicide attempters visiting five tertiary general hospitals located in Seoul, using standardized questionnaires, during 7 months in 2007. We examined associations between suicide attempt history and referral to mental health services via multiple logistic regressions. RESULTS Subjects' rate of referral to mental health services was 47.3%. When we controlled for participant age, time of arrival at the emergency center, psychiatric treatment history, use of alcohol, suicide attempt lethality and subjective expectation to suicide attempts, past suicide attempts did not predict referral to mental health services (odds ratio=1.74; 95% confidence interval .88-3.43). CONCLUSION Psychiatric interventions for suicide reattempters visiting emergency centers are important for preventing suicide, but providers have not considered suicide attempt history as a critical factor for referral to mental health services. Therefore, we suggest that more effort is needed to systemize psychiatric interventions for suicide reattempters at emergency centers in Korea.
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Affiliation(s)
- Sun-Jin Jo
- Department of Preventive Medicine, College of Medicine, Catholic University of Korea, and Clinical Research Center for Depression of Korea, South Korea
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Alberdi-Sudupe J, Pita-Fernández S, Gómez-Pardiñas SM, Iglesias-Gil-de-Bernabé F, García-Fernández J, Martínez-Sande G, Lantes-Louzao S, Pértega-Díaz S. Suicide attempts and related factors in patients admitted to a general hospital: a ten-year cross-sectional study (1997-2007). BMC Psychiatry 2011; 11:51. [PMID: 21453478 PMCID: PMC3078091 DOI: 10.1186/1471-244x-11-51] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 03/31/2011] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Suicide and suicide attempts represent a severe problem for public health services. The aim of this study is to determine the socio-demographic and psychopathological variables associated with suicide attempts in the population admitted to a General Hospital. METHODS An observational-descriptive study of patients admitted to the A Coruña University Hospital (Spain) during the period 1997-2007, assessed by the Consultation and Liaison Psychiatric Unit. We include n = 5,234 admissions from 4,509 patients. Among these admissions, n = 361 (6.9%) were subsequent to a suicide attempt. Admissions arising from a suicide attempt were compared with admissions occurring due to other reasons.Multivariate generalised estimating equation logistic regression models were used to examine factors associated with suicide attempts. RESULTS Adjusting by age, gender, educational level, cohabitation status, being employed or unemployed, the psychiatric diagnosis at the time of the interview and the information on previous suicide attempts, we found that the variables associated with the risk of a suicide attempt were: age, psychiatric diagnosis and previous suicide attempts. The risk of suicide attempts decreases with age (OR = 0.969). Psychiatric diagnosis was associated with a higher risk of suicide attempts, with the highest risk being found for Mood or Affective Disorders (OR = 7.49), followed by Personality Disorders (OR = 7.31), and Schizophrenia and Other Psychotic Disorders (OR = 5.03).The strongest single predictive factor for suicide attempts was a prior history of attempts (OR = 23.63). CONCLUSIONS Age, psychopathological diagnosis and previous suicide attempts are determinants of suicide attempts.
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Affiliation(s)
- Jesús Alberdi-Sudupe
- Department of Psychiatry, A Coruña Hospital, UPIE Planta Baja, Hospital de Oza, As Xubias, 84, 15006 A Coruña, Spain.
| | - Salvador Pita-Fernández
- Clinical Epidemiology and Biostatistics Unit, A Coruña Hospital, As Xubias, 84, 15006 A Coruña, Spain
| | - Sonia M Gómez-Pardiñas
- Department of Psychiatry, A Coruña Hospital, UPIE Planta Baja, Hospital de Oza, As Xubias, 84, 15006 A Coruña, Spain
| | | | - Jorge García-Fernández
- Department of Psychiatry, A Coruña Hospital, UPIE Planta Baja, Hospital de Oza, As Xubias, 84, 15006 A Coruña, Spain
| | - Gonzalo Martínez-Sande
- Department of Psychiatry, A Coruña Hospital, UPIE Planta Baja, Hospital de Oza, As Xubias, 84, 15006 A Coruña, Spain
| | - Sara Lantes-Louzao
- Department of Psychiatry, A Coruña Hospital, UPIE Planta Baja, Hospital de Oza, As Xubias, 84, 15006 A Coruña, Spain
| | - Sonia Pértega-Díaz
- Clinical Epidemiology and Biostatistics Unit, A Coruña Hospital, As Xubias, 84, 15006 A Coruña, Spain
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James AC, Winmill L, Anderson C, Alfoadari K. A Preliminary Study of an Extension of a Community Dialectic Behaviour Therapy (DBT) Programme to Adolescents in the Looked After Care System. Child Adolesc Ment Health 2011; 16:9-13. [PMID: 32847224 DOI: 10.1111/j.1475-3588.2010.00571.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adolescents in the Looked After Care (LAC) system demonstrate high rates of psychiatric disorder and self-harm; however, there is little evidence for therapies reducing self-harm in this population. METHOD An open evaluation of DBT for adolescents with repeated serious self-harm in the LAC system was undertaken. RESULTS An intention-to-treat (ITT) analysis showed that DBT was successful at reducing the core elements of depression, hopelessness and self-harm; however, 35% (7/20) failed to engage. CONCLUSION DBT is a useful treatment option; the failure, however, of some adolescents to engage in therapy may be due to their higher initial rates of depression and hopelessness.
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Affiliation(s)
- Anthony C James
- Highfield Adolescent Unit, Warneford Hospital, Oxford OX3 7JX, UK. E-mail:
| | - Louise Winmill
- Highfield Adolescent Unit, Warneford Hospital, Oxford OX3 7JX, UK. E-mail:
| | - Ciorsdan Anderson
- Highfield Adolescent Unit, Warneford Hospital, Oxford OX3 7JX, UK. E-mail:
| | - Kielly Alfoadari
- Highfield Adolescent Unit, Warneford Hospital, Oxford OX3 7JX, UK. E-mail:
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Johnson J, Gooding P, Wood A, Taylor P, Pratt D, Tarrier N. Resilience to suicidal ideation in psychosis: Positive self-appraisals buffer the impact of hopelessness. Behav Res Ther 2010; 48:883-9. [DOI: 10.1016/j.brat.2010.05.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 05/13/2010] [Accepted: 05/18/2010] [Indexed: 11/15/2022]
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Bernardes SS, Turini CA, Matsuo T. Perfil das tentativas de suicídio por sobredose intencional de medicamentos atendidas por um Centro de Controle de Intoxicações do Paraná, Brasil. CAD SAUDE PUBLICA 2010; 26:1366-72. [DOI: 10.1590/s0102-311x2010000700015] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 04/01/2010] [Indexed: 11/21/2022] Open
Abstract
Este trabalho apresenta o perfil das tentativas de suicídio atendidas pelo Centro de Controle de Intoxicações da cidade de Londrina, Paraná, Brasil. Foi realizado um estudo retrospectivo dos casos atendidos entre 1997-2007. As tentativas de suicídio foram significativas entre homens desempregados e mulheres donas-de-casa/aposentadas, e houve associação com outras substâncias em 51,5% dos casos, sendo a freqüência maior entre os homens. 51,1% dos homens associaram o medicamento com bebida alcoólica, e entre as mulheres, 84,8% das associações se referiram a medicamentos. Os grupos farmacológicos de maior freqüência foram os tranqüilizantes (25,5%), antidepressivos (17%), anticonvulsivos (15%) e AINES (11,9%), respectivamente. Os prescritores devem avaliar corretamente o paciente antes de receitar psicofármacos, uma vez que esse é o grupo farmacológico mais freqüente nas tentativas de suicídio. Campanhas de conscientização para o uso racional de medicamentos, juntamente com programas sociais de atendimento ao paciente suicida, também poderiam contribuir na diminuição da freqüência desses casos.
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De Munck S, Portzky G, Van Heeringen K. Epidemiological trends in attempted suicide in adolescents and young adults between 1996 and 2004. CRISIS 2010; 30:115-9. [PMID: 19767266 DOI: 10.1027/0227-5910.30.3.115] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Notwithstanding the epidemiological studies indicating an increased risk of attempted suicide among adolescents and young adults, there is a scarcity of international studies that examine long-term epidemiological trends in rates and characteristics of this vulnerable group. AIMS This article describes the results of a 9-year monitoring study of suicide attempts in adolescents and young adults referred to the Accident and Emergency Department of the Gent University Hospital (Belgium). METHODS Between January 1996 and December 2004, trends, sociodemographic, and methodrelated characteristics of suicide attempts were assessed by a psychiatrist on data sheets. RESULTS Attempted suicide rates declined from 1996 to 2001 and then rose until 2004, but did not exceed previous rates. During the 9 years of monitoring, there was a preponderance of female suicide attempters, except for 1997. Rates of attempts and of fatal suicide were negatively correlated. Significantly more males than females deliberately injured themselves. Younger attempters, especially females, significantly more often poisoned themselves with analgesics. In nearly one in five attempts, alcohol was used in combination with other methods, and alcohol intake was more commonly observed in older suicide attempters. Nearly half of the adolescents were identified as repeaters. CONCLUSIONS The results of this study warrant further monitoring of trends and characteristics of young suicide attempters.
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Hegerl U, Wittenburg L, Arensman E, Van Audenhove C, Coyne JC, McDaid D, Feltz-Cornelis CMVD, Gusmão R, Kopp M, Maxwell M, Meise U, Roskar S, Sarchiapone M, Schmidtke A, Värnik A, Bramesfeld A. Optimizing suicide prevention programs and their implementation in Europe (OSPI Europe): an evidence-based multi-level approach. BMC Public Health 2009; 9:428. [PMID: 19930638 PMCID: PMC2787518 DOI: 10.1186/1471-2458-9-428] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Accepted: 11/23/2009] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Suicide and non-fatal suicidal behaviour are significant public health issues in Europe requiring effective preventive interventions. However, the evidence for effective preventive strategies is scarce. The protocol of a European research project to develop an optimized evidence based program for suicide prevention is presented. METHOD The groundwork for this research has been established by a regional community based intervention for suicide prevention that focuses on improving awareness and care for depression performed within the European Alliance Against Depression (EAAD). The EAAD intervention consists of (1) training sessions and practice support for primary care physicians,(2) public relations activities and mass media campaigns, (3) training sessions for community facilitators who serve as gatekeepers for depressed and suicidal persons in the community and treatment and (4) outreach and support for high risk and self-help groups (e.g. helplines). The intervention has been shown to be effective in reducing suicidal behaviour in an earlier study, the Nuremberg Alliance Against Depression. In the context of the current research project described in this paper (OSPI-Europe) the EAAD model is enhanced by other evidence based interventions and implemented simultaneously and in standardised way in four regions in Ireland, Portugal, Hungary and Germany. The enhanced intervention will be evaluated using a prospective controlled design with the primary outcomes being composite suicidal acts (fatal and non-fatal), and with intermediate outcomes being the effect of training programs, changes in public attitudes, guideline-consistent media reporting. In addition an analysis of the economic costs and consequences will be undertaken, while a process evaluation will monitor implementation of the interventions within the different regions with varying organisational and healthcare contexts. DISCUSSION This multi-centre research seeks to overcome major challenges of field research in suicide prevention. It pools data from four European regions, considerably increasing the study sample, which will be close to one million. In addition, the study will gather important information concerning the potential to transfer this multilevel program to other health care systems. The results of this research will provide a basis for developing an evidence-based, efficient concept for suicide prevention for EU-member states.
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Affiliation(s)
- Ulrich Hegerl
- University of Leipzig, Department of Psychiatry, Germany
| | | | | | | | - James C Coyne
- University of Pennsylvania, School of Medicine, Pennsylvania, USA
| | - David McDaid
- London School of Economics, Personal Social Services Research Unit, LSE Health and Social Care, UK
| | - Christina M van der Feltz-Cornelis
- Trimbos-Instituut/Netherlands Institute of Mental Health and Addiction, The Netherlands
- VU University Medical Centre Institute of Extramural Research, Dept. of Psychiatry, Amsterdam, the Netherlands
| | - Ricardo Gusmão
- CEDOC, Departamento de Saúde Mental, Faculdade de Ciências, Médicas da Universidade Nova de Lisboa, Portugal
| | - Mária Kopp
- Semmelweis University Budapest, Institute of Behavioural Sciences, Hungary
| | | | - Ullrich Meise
- Gesellschaft für Psychische Gesundheit - pro mente tirol, Austria
| | | | - Marco Sarchiapone
- University of Primorska, PINT, Slovenia
- Current address: University of Molise, Health Science Department, Italy
| | - Armin Schmidtke
- Bayerische Julius-Maximilians-Universität Würzburg, Department of Clinical Psychology, Clinic for Psychiatry and Psychotherapy, Germany
| | - Airi Värnik
- Estonian-Swedish Mental Health and Suicidology Institute, Estonia
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Johnson J, Gooding PA, Wood AM, Tarrier N. Resilience as positive coping appraisals: Testing the schematic appraisals model of suicide (SAMS). Behav Res Ther 2009; 48:179-86. [PMID: 19906364 DOI: 10.1016/j.brat.2009.10.007] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 08/24/2009] [Accepted: 10/14/2009] [Indexed: 12/01/2022]
Abstract
AIMS The Schematic Appraisals Model of Suicide (SAMS) suggests that positive self-appraisals may be important for buffering suicidal thoughts and behaviours, potentially providing a key source of resilience. The current study aimed to explore whether positive self-appraisals buffered individuals from suicidality in the face of stressful life events. METHOD 78 participants who reported experiencing some degree of suicidality were recruited from a student population. They completed a battery of questionnaires including measures of suicidality, stressful life events and positive self-appraisals. RESULTS Positive self-appraisals moderated the association between stressful life events and suicidality. For those reporting moderate or high levels of positive self-appraisals, raised incidence of stressful life events did not lead to increases in suicidality. DISCUSSION These results support the SAMS framework, and suggest that positive self-appraisals may confer resilience to suicide. Positive self-appraisals may be a promising avenue for further resilience research, and an important area to target for suicide interventions.
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Hargus E, Hawton K, Rodham K. Distinguishing between subgroups of adolescents who self-harm. Suicide Life Threat Behav 2009; 39:518-37. [PMID: 19929152 DOI: 10.1521/suli.2009.39.5.518] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The differences in factors associated with subgroups of adolescents in the continuum of deliberate self-harm (DSH) phenomena were investigated. In an anonymous self-report survey of 6,020 adolescents aged 15 and 16 years, 3.2% of adolescents (5.3% females, 1.3% males) reported DSH with intent to die, 2.8% (4.3% females; 1.5% males) reported DSH without intent to die, and 15% (22.4% females; 8.5% males) reported thoughts of DSH without acts. Regression analysis indicated considerable overlap in vulnerability factors along the spectrum of DSH thoughts and acts. A uniquely distinct relationship was found between DSH of a friend and DSH without intent to die on one hand and DSH of a family member with DSH with intent to die on the other. Results indicate that familial and nonfamilial social influences on DSH behavior may be important in designing prevention programs and that educational programs for the promotion of psychological well-being may be helpful for adolescents at any point along the spectrum of DSH that was examined.
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Affiliation(s)
- Emily Hargus
- Oxford University, Centre for Suicide Research, Warneford Hospital, Oxford, OX3 7JX, UK
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Santos SA, Lovisi G, Legay L, Abelha L. Prevalência de transtornos mentais nas tentativas de suicídio em um hospital de emergência no Rio de Janeiro, Brasil. CAD SAUDE PUBLICA 2009; 25:2064-74. [DOI: 10.1590/s0102-311x2009000900020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 05/26/2009] [Indexed: 11/22/2022] Open
Abstract
Há poucos estudos nacionais sobre prevalência de transtornos mentais nas tentativas de suicídio, os quais utilizararam principalmente dados secundários e instrumentos de rastreamento. O objetivo deste estudo foi estimar a prevalência de transtornos mentais em 96 casos de tentativas de suicídio atendidos em hospital de emergência, Rio de Janeiro, Brasil (2006-2007), utilizando o Composite International Development Interview. A maioria da amostra consistiu em mulheres, jovens, baixa escolaridade e ingestão de medicamentos psicoativos como principal meio. Outros fatores: histórias prévias de tentativa e uso de álcool no momento do agravo. Os transtornos mentais mais freqüentes foram: episódio depressivo (38,9%), dependência de substâncias psicoativas (21,9%), transtorno de estresse pós-traumático (20,8%), dependência de álcool (17,7%) e esquizofrenia (15,6%). A taxa total dos transtornos mentais foi de 71,9%. Tais achados são mais próximos aos estudos em países em desenvolvimento. Além do acesso ao tratamento dos transtornos mentais, são necessárias políticas públicas que enfatizem o controle de meios e respostas sociais à redução do comportamento suicida.
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Pompili M, Rihmer Z, Innamorati M, Lester D, Girardi P, Tatarelli R. Assessment and treatment of suicide risk in bipolar disorders. Expert Rev Neurother 2009; 9:109-36. [PMID: 19102673 DOI: 10.1586/14737175.9.1.109] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Completed suicide and suicide attempts are major issues in the management of bipolar disorders. There is evidence that suicide rates among these patients are more than 20-fold higher than the general population and, furthermore, suicidal behavior is much more lethal in bipolar disorder than in the general population. Patients with mood disorders may sometimes exhibit highly perturbed mixed states, which usually increase the risk of suicide. Such states are particularly frequent in bipolar II patients, especially if patients are treated with antidepressant monotherapy (unprotected by mood stabilizers), when depression switches into mania (or vice versa), or when depression lifts and functioning approaches normality. Researchers worldwide agree that treatment involving lithium is the best way to protect patients from suicide risk. Psychosocial activities, including psychoeducation, can protect bipolar patients either directly or, more probably, indirectly by increasing adherence to treatment and helping in daily difficulties that otherwise may lead to demoralization or hopelessness. An extensive understanding of the psychosocial circumstances and the psychopathology of bipolar patients (including temperament) may help clinicians describe the clinical picture accurately and prevent suicidal behavior in these patients.
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