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Wafy G, Ajayi L, Siddiqi S, Saravanamuttoo T, Shorr R, Solmi M, Colman I, Fiedorowicz JG. The Progression of Lethality Across Multiple Suicide Attempts: A Systematic Review. Arch Suicide Res 2024:1-22. [PMID: 39185957 DOI: 10.1080/13811118.2024.2394671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
OBJECTIVE Suicide is a major global public health concern. While some progress has been made in understanding risk factors for suicidal behavior, other relevant questions have received less attention. One such question relates to the longitudinal course of suicidal behavior amongst individuals with multiple suicide attempts. This systematic review investigated whether there is an increase in the lethality across multiple suicide attempts. METHOD This systematic review followed PRISMA 2020 reporting guidelines. A literature search was conducted in MEDLINE, Embase and PsycINFO electronic databases from inception to August 2023 to identify studies with key terms related to multiple suicide attempts and lethality. The review included longitudinal studies with data on multiple suicide attempts, and any rating of their lethality. Covidence was used to guide the screening and extraction process. A narrative synthesis approach was used to descriptively summarize included studies. RESULTS After identifying 828 unique abstracts for screening, 11 studies were included for narrative synthesis. Suicide attempt assessment methods and definitions were heterogenous, often indirectly inferring lethality based on suicide attempt method. Individuals with repeat attempts may be more likely to continue using the same method. CONCLUSIONS There was no evidence to support increasing lethality across repeat suicide attempts. However, this should be interpreted along with the fact that the evidence base is scarce, heterogenous, and methodologically limited.
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Szücs A, Galfalvy H, Alessi MG, Kenneally LB, Valderas JM, Maier AB, Szanto K. Diligent for better or worse: Conscientiousness is associated with higher likelihood of suicidal behavior and more severe suicidal intent in later life. Compr Psychiatry 2024; 135:152523. [PMID: 39126760 DOI: 10.1016/j.comppsych.2024.152523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/18/2024] [Accepted: 08/04/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Contradictory findings link trait conscientiousness in mid- and late life to increased healthspan and lifespan, as well as to death by suicide. It remains unclear whether conscientiousness is associated with higher odds of attempting suicide or with more severe suicidal behavior among attempters, and whether its relationship to suicide risk varies with aging-related stressors, such as declining health. METHODS In this cross-sectional study comprising 313 depressed adults aged ≥40 years and participating in the Longitudinal Research Program in Late-Life Suicide (Pittsburgh, USA), we employed logistic and linear regression to test whether conscientiousness was associated with the presence of recent suicidal behavior (≤2 years) and with intent severity in recent attempters (n = 84). We further tested whether the above relationships varied based on mental, cognitive, and physical health status, measured as depression severity, cognitive functioning, and the presence/absence of severe physical illness. RESULTS Participants were 62.1 years old on average (SD = 7.6), 85% White, and 53% female. Recent attempters had a mean age of 61.8 years at their most recent attempt (SD = 8.5), had lower cognitive functioning and were more likely severely physically ill than comparisons. Conscientiousness was positively associated with a higher likelihood of recent suicidal behavior overall (adjusted OR = 1.44, 95% CI = 1.09, 1.90, p = .010), but not in case of co-occurring severe physical illness (interaction OR = 0.54, 95% CI = 0.30, 0.97, p = .039). Conscientiousness was also positively associated with suicidal intent at the most recent attempt (adjusted β = 1.60, SE = 0.62, p = .012), explaining 7% of its variance, although this association lost significance after adjusting for other personality dimensions. CONCLUSIONS Highly conscientious middle-aged and older adults may be at increased risk of resolute suicidal behavior, although conscientiousness may not confer additional suicide risk among those severely physically ill.
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Affiliation(s)
- Anna Szücs
- Vrije Universiteit Amsterdam, Faculty of Behavioural and Movement Sciences, The Netherlands; National University of Singapore, Yong Loo Lin School of Medicine, Department of Medicine, Singapore.
| | | | - Maria G Alessi
- University of North Carolina at Charlotte, Program in Health Psychology, USA
| | | | - Jose M Valderas
- National University of Singapore, Yong Loo Lin School of Medicine, Department of Medicine, Singapore
| | - Andrea B Maier
- Vrije Universiteit Amsterdam, Faculty of Behavioural and Movement Sciences, The Netherlands; National University of Singapore, Yong Loo Lin School of Medicine, Department of Medicine, Singapore
| | - Katalin Szanto
- University of Pittsburgh, School of Medicine, Department of Psychiatry, USA
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Sun S, Liu Q, Wang Z, Huang YY, Sublette ME, Dwork AJ, Rosoklija G, Ge Y, Galfalvy H, Mann JJ, Haghighi F. Brain and blood transcriptome profiles delineate common genetic pathways across suicidal ideation and suicide. Mol Psychiatry 2024; 29:1417-1426. [PMID: 38278992 PMCID: PMC11189724 DOI: 10.1038/s41380-024-02420-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/28/2024]
Abstract
Human genetic studies indicate that suicidal ideation and behavior are both heritable. Most studies have examined associations between aberrant gene expression and suicide behavior, but behavior risk is linked to the severity of suicidal ideation. Through a gene network approach, this study investigates how gene co-expression patterns are associated with suicidal ideation and severity using RNA-seq data in peripheral blood from 46 live participants with elevated suicidal ideation and 46 with no ideation. Associations with the presence of suicidal ideation were found within 18 co-expressed modules (p < 0.05), as well as in 3 co-expressed modules associated with suicidal ideation severity (p < 0.05, not explained by severity of depression). Suicidal ideation presence and severity-related gene modules with enrichment of genes involved in defense against microbial infection, inflammation, and adaptive immune response were identified and investigated using RNA-seq data from postmortem brain that revealed gene expression differences with moderate effect sizes in suicide decedents vs. non-suicides in white matter, but not gray matter. Findings support a role of brain and peripheral blood inflammation in suicide risk, showing that suicidal ideation presence and severity are associated with an inflammatory signature detectable in blood and brain, indicating a biological continuity between ideation and suicidal behavior that may underlie a common heritability.
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Affiliation(s)
- Shengnan Sun
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- James J. Peters VA Medical Center, Bronx, NY, 10468, USA
| | - Qingkun Liu
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- James J. Peters VA Medical Center, Bronx, NY, 10468, USA
| | - Zhaoyu Wang
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- James J. Peters VA Medical Center, Bronx, NY, 10468, USA
| | - Yung-Yu Huang
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - M Elizabeth Sublette
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Andrew J Dwork
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Gorazd Rosoklija
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Yongchao Ge
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Hanga Galfalvy
- James J. Peters VA Medical Center, Bronx, NY, 10468, USA
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA
| | - J John Mann
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Fatemeh Haghighi
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- James J. Peters VA Medical Center, Bronx, NY, 10468, USA.
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Chang YW, Buerke M, Galfalvy H, Szanto K. Childhood trauma is associated with early-onset but not late-onset suicidal behavior in late-life depression. Int Psychogeriatr 2024; 36:371-384. [PMID: 37642013 PMCID: PMC10902201 DOI: 10.1017/s1041610223000662] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVES To examine the relationship between childhood traumatic experiences and early and late-onset suicidal behavior among depressed older adults. DESIGN Cross-sectional study. SETTING Inpatient and outpatient psychiatric services in Pennsylvania. PARTICIPANTS Our sample included 224 adults aged 50+ (M ± SD = 62.5 ± 7.4) recruited into three depressed groups: (1) 84 suicide attempters, (2) 44 suicide ideators, and (3) 58 non-suicidal comparisons, and a non-psychiatric healthy comparison group (N = 38). MEASUREMENTS The Childhood Trauma Questionnaire measured experiences of childhood trauma such as emotional abuse, physical abuse, emotional neglect, physical neglect, and sexual abuse. RESULTS Attempters were separated into early- and late-onset based on age of first attempt using a statistical algorithm that identified a cutoff age of 30 years old. Overall, we found group differences in emotional and physical abuse and neglect in both genders and sexual abuse in females, but not in males. Early-onset attempters experienced more childhood emotional abuse and neglect than late-onset attempters and were more likely to have experienced multiple forms of abuse. They also experienced more emotional abuse and neglect than all comparison groups. Consistently, early-onset attempters more often met criteria for current or lifetime PTSD relative to late-onset attempters and most comparison groups. Late-onset attempters had similar levels of childhood trauma as other depressed groups. CONCLUSIONS Our study reaffirms that there are distinct pathways to suicidal behavior in older adults based on their age of first suicide attempt and that trauma experienced in childhood has long-lasting emotional and behavioral consequences, even into late life.
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Affiliation(s)
- Ya-Wen Chang
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Morgan Buerke
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - Katalin Szanto
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Barker J, Oakes-Rogers S, Lince K, Roberts A, Keddie R, Bruce H, Selvarajah S, Fish D, Aspen C, Leddy A. Can clinician's risk assessments distinguish those who disclose suicidal ideation from those who attempt suicide? DEATH STUDIES 2024; 48:129-139. [PMID: 36961770 DOI: 10.1080/07481187.2023.2192532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Participants were 85 individuals who made suicide attempts within two years of their Improving Access to Psychological Therapies (IAPT) assessment, identified using record linkage. Two comparison groups, non-suicidal controls (n = 1416) and (ideators, n = 743) were compared on variables extracted from the standardized IAPT risk assessment interview. Disclosure of a historical suicide attempt or non-suicidal self-injury (NSSI) distinguished those making an attempt from those with suicidal ideation only, but suicidal intent did not. A third of the participants concealed a historical suicide attempt. The IAPT Phobia Scale classified 49.30% of attempters with 100% specificity. The IAPT Phobia Scale may have clinical value in assessing risk but requires validation. Past suicide attempt and NSSI have better clinical risk assessment utility than current suicidal ideation intensity. Risk assessment relying on disclosure is likely to be flawed and risks support being withheld from those assumed to be at lower risk.
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Affiliation(s)
- Joseph Barker
- Department of Clinical Psychology, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Sophie Oakes-Rogers
- Department of Clinical Psychology, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Karen Lince
- Wellbeing Norfolk and Suffolk, The Conifers, Norwich, UK
| | - Ashley Roberts
- Wellbeing Norfolk and Suffolk, The Conifers, Norwich, UK
| | - Ronan Keddie
- Wellbeing Norfolk and Suffolk, The Conifers, Norwich, UK
| | - Harley Bruce
- Wellbeing Norfolk and Suffolk, The Conifers, Norwich, UK
| | | | - Daisy Fish
- Wellbeing Norfolk and Suffolk, The Conifers, Norwich, UK
| | - Caitlin Aspen
- Wellbeing Norfolk and Suffolk, The Conifers, Norwich, UK
| | - Adrian Leddy
- Department of Clinical Psychology, University of East Anglia, Norwich Research Park, Norwich, UK
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Herzog S, Galfalvy H, Keilp JG, Mann JJ, Sublette ME, Burke A, Oquendo MA, Stanley BH. Relationship of stress-reactive cortisol to suicidal intent of prior attempts in major depression. Psychiatry Res 2023; 327:115315. [PMID: 37542793 PMCID: PMC10530442 DOI: 10.1016/j.psychres.2023.115315] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/02/2023] [Accepted: 06/16/2023] [Indexed: 08/07/2023]
Abstract
Higher intent suicide attempts carry elevated risk of future suicidal behavior. Abnormal functioning of the hypothalamic-pituitary-adrenal (HPA) axis is both linked to nonfatal suicidal behavior and suicide deaths in major depressive disorder. Few studies, however, have identified biological markers of a high-intent suicidal subgroup. We examined HPA axis output and reactivity to the Trier Social Stress Test (TSST) via salivary cortisol in depressed individuals (N=68) with a suicide attempt (SA) history. A median split of higher and lower suicidal intent scores was used to define groups. Individuals with high intent SA had attenuated total cortisol output (AUCg), F(1,60)=10.04, SE=5.095, p=.003, and lower HPA-axis stress responsivity to the TSST (AUCi), F(1,60)=4.50, SE=4.604, p=.039, compared with the low intent SA group. The high intent group also reported more pronounced negative affect than the low intent group (F[1,61]=6.413, SE=10.55, p=.014) both at baseline (meandiff=22.32, p=.038) and in response to the stressor task (meandiff=37.62, p=.003). Vulnerability to suicidal behavior in high-intent individuals may be related to the combined profile of impaired physiological responses to stress and greater negative affectivity. This clinical and biologic subgroup may benefit from targeted suicide prevention interventions.
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Affiliation(s)
- Sarah Herzog
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY; Mental Health Data Science Division, New York State Psychiatric Institute, New York, NY; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - John G Keilp
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - J John Mann
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - M Elizabeth Sublette
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Ainsley Burke
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara H Stanley
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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Wang C, Keilp JG, Galfalvy H, Bridge JA, Sheftall AH, Szanto K. Entrapment and social problem-solving in suicidal behavior across the adult lifespan. J Affect Disord 2023; 329:176-183. [PMID: 36842650 PMCID: PMC10033364 DOI: 10.1016/j.jad.2023.02.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Feelings of entrapment and deficits in social problem-solving skills have been associated with risk for suicidal behavior in the context of depression. However, few studies have examined the effect of age on the association between these risk factors and suicidal behavior across most of the adult lifespan. METHODS In a three-site study, we tested interactions of age with feelings of entrapment and social problem-solving style in 105 depressed patients with a recent suicide attempt, 95 depressed patients with no history of suicide attempt, and 97 demographically similar non-psychiatric participants (age 16-80). Attempter/non-attempter differences, age interactions, and the relative contribution of entrapment and social problem-solving style to past attempter were examined. RESULTS Entrapment significantly interacted with age such that it discriminated past attempters from depressed non-attempters better at older ages. Social Problem-Solving Inventory (SPSI) total score and most subscales did not distinguish past attempters, but the SPSI Impulsive Style Problem-Solving was an effective discriminator of past suicide attempts across the full adult lifespan and did not interact with age. In a multipredictor model, both the entrapment by age interaction and SPSI Impulsive Style Problem-Solving score were significant predictors for the classification of attempters. LIMITATIONS The cross-sectional nature of our research design limited conclusions that may be drawn about individual change over time or cohort effects. CONCLUSIONS Entrapment did not distinguish past attempters at younger ages but became a better discriminator in middle to late adulthood. An impulsive problem-solving style was associated with past suicide attempts across the full adult lifespan.
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Affiliation(s)
- C Wang
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - J G Keilp
- Columbia University, Department of Psychiatry, New York, NY, USA; Columbia University, Department of Biostatistics, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - H Galfalvy
- Columbia University, Department of Psychiatry, New York, NY, USA; Columbia University, Department of Biostatistics, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - J A Bridge
- The Abigail Wexner Research Institute at Nationwide Children's and The Ohio State University College of Medicine, Departments of Pediatrics and Psychiatry & Behavioral Health, Columbus, OH, USA
| | - A H Sheftall
- University of Rochester Medical Center, School of Medicine and Dentistry, Department of Psychiatry, Rochester, NY, USA
| | - K Szanto
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA.
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Kaurin A, Dombrovski AY, Hallquist MN, Wright AGC. Suicidal urges and attempted suicide at multiple time scales in borderline personality disorder. J Affect Disord 2023; 329:581-588. [PMID: 36781143 PMCID: PMC10693674 DOI: 10.1016/j.jad.2023.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND There is strong evidence for an enduring suicidal diathesis among individuals with a history of suicide attempts, particularly among people diagnosed with borderline personality disorder (BPD). However, the progression of suicidal crises among people predisposed to suicidal behavior remains poorly understood. METHODS Via multilevel structural equation modeling we tested the hypothesis that a history of attempted suicide predicts a stronger dynamic link between affect and impulsivity with suicidal ideation (i.e., suicidal urges) - both moment-to-moment and day-to-day. 153 patients diagnosed with BPD, 105 of whom had a history of medically serious suicide attempts completed a 21-day ecological momentary assessment protocol (17,926 total assessments). RESULTS Individuals with higher average levels of negative affect reported more suicidal thoughts. Moments characterized by more negative affect, hostility, impulsivity, and less positive affect were also characterized by elevated suicidal ideation. For hostility and positive affect, these significant links generalized to the daily level. At the same time, for negative affect and hostility the within-person coupling was stronger among attempters in comparison to non-attempters, and these effects did not significantly differ across timescales. LIMITATIONS Follow-up studies replicating our findings of the dysregulation-suicidality nexus in clinically more diverse samples are needed. CONCLUSIONS The diathesis for suicidal behavior manifests in tighter dynamic links between negative affect or hostility and suicidal ideation. Because these within-person links were amplified in attempters compared to non-attempters, differential coupling patterns may index potentially lethal processes that generalize beyond BPD reflecting distinct diathesis components.
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Affiliation(s)
| | | | - Michael N Hallquist
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, USA
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Cáceda R, Mirmina J, Kim DJ, Rafiaa M, Carbajal JM, Akram F, Lau J, Chacko M, Tedla A, Teng Y, Perlman G. Low global frontal brain activity is associated with non-planned or impulsive suicide attempts. A preliminary study. J Affect Disord 2023; 326:44-48. [PMID: 36708954 DOI: 10.1016/j.jad.2023.01.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/08/2023] [Accepted: 01/22/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Suicide prevention is limited by the frequent non-planned or impulsive nature of suicidal behavior. For instance, 25-62 % of suicide attempts, occur within 30 min of the onset of suicidal ideation. We aimed to examine frontal brain activity in depressed patients following a suicide attempt and its relationship with the duration of the suicidal process. METHODS We recruited 35 adult patients within three days of a suicide attempt of at least moderate lethality. Duration of the suicidal process was recorded in a semi-structured interview, including suicide contemplation (time from onset of suicidal ideation to decision to kill oneself) and suicide action intervals (time from the decision to kill oneself to suicide attempt). Resting state EEG data from AF7, AF8, TP9 and TP10 leads was collected with a portable MUSE 2 headband system. The average frequency values throughout a 5-minute portable EEG recording were extracted for delta (1-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), and beta (13-30 Hz) waves. RESULTS Delta (r = 0.450, p = 0.021) and theta power (r = 0.395, p = 0.044) were positively correlated with the duration of the suicide action interval. There were no significant correlations of the suicide contemplation interval with clinical or EEG measures. Patients with suicide action interval shorter than 30 min showed lower delta power (U = 113, p = 0.049) compared with those with longer duration. CONCLUSIONS Lower theta and delta activity may reflect hindered cognitive control and inhibition in impulsive suicide attempters. Portable EEG may provide a valuable tool for clinical research and in the management of acutely suicidal patients.
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Affiliation(s)
- Ricardo Cáceda
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA; Psychiatry Service, Northport Veterans Affairs Medical Center, Northport, New York, USA.
| | - Julianne Mirmina
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - Diane J Kim
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - Marianne Rafiaa
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - Jessica M Carbajal
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - Faisal Akram
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - Jaisy Lau
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - Mason Chacko
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - Alemante Tedla
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - York Teng
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - Greg Perlman
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
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Duval F, Mokrani MC, Danila V, Lopera FG, Erb A, Tomsa M. Hypothalamic-prolactin axis regulation in major depressed patients with suicidal behavior. Psychoneuroendocrinology 2023; 151:106050. [PMID: 36801657 DOI: 10.1016/j.psyneuen.2023.106050] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND So far, little is known about the control of hypothalamic-prolactin axis activity by dopamine (DA) and thyrotropin-releasing hormone (TRH) in depressed patients with suicidal behavior disorder (SBD). METHODS We evaluated prolactin (PRL) responses to apomorphine (APO; a DA direct receptor agonist) and 0800 h and 2300 h protirelin (TRH) tests in 50 medication-free euthyroid DSM-5 major depressed inpatients with SBD (either current [n = 22], or in early remission [n = 28]); and 18 healthy hospitalized controls (HCs). RESULTS Baseline (BL) PRL levels were comparable across the three diagnostic groups. SBDs in early remission did not differ from HCs regarding PRL suppression to APO (PRLs), PRL stimulation to 0800 h and 2300 h TRH tests (∆PRL), and ∆∆PRL values (difference between 2300 h-∆PRL and 0800 h-∆PRL values). Current SBDs showed lower PRLs and ∆∆PRL values than HCs and SBDs in early remission. Further analyses revealed that current SBDs with a history of violent and high-lethality suicide attempts were more likely to exhibit co-occurrence of low ∆∆PRL and PRLS values. CONCLUSIONS Our results suggest that regulation of the hypothalamic-PRL axis is impaired in some depressed patients with current SBD, particularly those who have made serious suicide attempts. Considering the limitations of our study, our findings support the hypothesis that decreased pituitary D2 receptor functionality (possibly adaptive to increased tuberoinfundibular DAergic neuronal activity) together with decreased hypothalamic TRH drive might be a biosignature for high-lethality violent suicide attempts.
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Affiliation(s)
- Fabrice Duval
- Pôle 8/9 Psychiatry, APF2R, Centre Hospitalier, Rouffach, France.
| | | | - Vlad Danila
- Pôle 8/9 Psychiatry, APF2R, Centre Hospitalier, Rouffach, France
| | | | - Alexis Erb
- Pôle 8/9 Psychiatry, APF2R, Centre Hospitalier, Rouffach, France
| | - Mihaela Tomsa
- Pôle 8/9 Psychiatry, APF2R, Centre Hospitalier, Rouffach, France
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Lyu S, Li Y. The Roles of Endorsement and Stigma in Suicidal Ideation and Behavior among Chinese College Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:877. [PMID: 36613198 PMCID: PMC9820051 DOI: 10.3390/ijerph20010877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
Previous studies have suggested that stereotypes towards suicide, including endorsement of suicide and stigma toward suicide, may contribute to suicidal ideation and behaviors. However, this has not been examined directly. In this study, we examined whether endorsement of suicide and stigma toward suicide are involved in the pathway from suicidal ideation to suicide attempts among college students. To this end, we used the Suicidal Ideation Attributes Scale (SIDAS), the Suicidal Behaviors Questionnaire-Revised (SBQ-R), and the Stigma of Suicide Scale (SOSS) to assess suicidal ideation, suicide attempts, endorsement of suicide, and stigma toward suicide, respectively, in a sample of 944 Chinese college students (mean age, 20.97 years). Using mediation analysis, we found that suicidal ideation partially mediated the relationship between endorsement of suicide and suicide attempts and between stigma toward suicide and suicide attempts. These findings provide novel evidence that endorsement of suicide and stigma toward suicide are closely associated with suicide attempts, but partially through the influences of suicidal ideation. Future studies should elaborate on their longitudinal relationships. Implications of these findings for clinical practices are discussed with reference to the ideation-to-action framework of suicide, aiming to reduce suicidal behaviors.
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12
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Huckins-Noss AM, Stubbing J, Fox KR, Nock MK, Millner AJ. The classification of suicide gestures: Examining the validity, measurement, and level of intent of a controversial construct. Suicide Life Threat Behav 2022; 53:188-197. [PMID: 36440794 DOI: 10.1111/sltb.12930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/24/2022] [Accepted: 10/30/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The inclusion of suicide gestures in modern nomenclatures for self-injurious thoughts and behaviors (SITB) is contentious due to their history of pejorative connotations and inconsistent operationalization and measurement. Here we sought to investigate the extent to which participants who endorse this behavior on a standardized SITB measure: (1) describe their behavior in a way that is consistent with contemporary definitions for suicide gestures; (2) accurately classify their behavior when presented with multiple SITB response options; and (3) consistently report their level of intent to die across survey items. METHODS Participants were 83 adults from a community-based sample who endorsed lifetime suicide gesture(s) in an online survey containing self-report measures assessing their prior SITB engagement, followed by open-ended questions eliciting narrative descriptions of their behaviors. RESULTS Approximately 13% of participants who endorsed lifetime suicide gestures provided narrative descriptions that met criteria for the behavior, and around one-third consistently reported zero intent to die in their explicit ratings. Additionally, some participants reported non-zero intent to die from behaviors without direct potential for physical injury. CONCLUSIONS Overall, this study highlights substantial issues with the validity of current approaches to measuring suicide gestures. Implications for the classification of suicide gestures in clinical and research settings are discussed.
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Affiliation(s)
| | - Jessica Stubbing
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Kathryn R Fox
- Department of Psychology, University of Denver, Denver, Colorado, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA.,Mental Health Research, Franciscan Children's, Brighton, Massachusetts, USA
| | - Alexander J Millner
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA.,Mental Health Research, Franciscan Children's, Brighton, Massachusetts, USA
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13
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Bayliss LT, Christensen S, Lamont-Mills A, du Plessis C. Suicide capability within the ideation-to-action framework: A systematic scoping review. PLoS One 2022; 17:e0276070. [PMID: 36301944 PMCID: PMC9612581 DOI: 10.1371/journal.pone.0276070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/28/2022] [Indexed: 11/19/2022] Open
Abstract
Suicide capability is theorised to facilitate the movement from suicidal ideation to suicide attempt. Three types of contributors are posited to comprise suicide capability: acquired, dispositional, and practical. Despite suicide capability being critical in the movement from ideation-to-attempt, there has been no systematic synthesis of empirical evidence relating to suicide capability that would enable further development and refinement of the concept. This study sought to address this synthesis gap. A scoping review was conducted on suicide capability studies published January 2005 to January 2022. Eleven electronic databases and grey literature sources were searched returning 5,212 potential studies. After exclusion criteria application, 90 studies were included for final analysis. Results synthesis followed a textual narrative approach allocating studies based on contributors of suicide capability. Most studies focused on investigating only one factor within contributors. Painful and provocative events appear to contribute to acquired capability more so than fearlessness about death. Whilst emerging evidence for dispositional and practical contributors is promising, the small number of studies prevents further conclusions from being drawn. An unexpected additional cognitive contributor was identified. The focus of a single factor from most studies and the limited number of studies on contributors other than acquired capability limits the theoretical development and practical application of suicide capability knowledge. Given that suicide is a complex and multifaceted behaviour, future research that incorporates a combination of contributors is more likely to advance our understandings of suicide capability.
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14
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Kaurin A, Dombrovski AY, Hallquist MN, Wright AG. Momentary interpersonal processes of suicidal surges in borderline personality disorder. Psychol Med 2022; 52:2702-2712. [PMID: 33298227 PMCID: PMC8190164 DOI: 10.1017/s0033291720004791] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Suicide rates are high in borderline personality disorder (BPD) where interpersonal problems trigger intense affective dysregulation and impulses to act on suicidal thoughts. To date, however, no study has examined how interpersonal stressors contribute to momentary within-person links among affect and impulsivity with suicidal ideation (SI), and how those links vary over time in people's daily lives. METHODS A total of 153 individuals diagnosed with BPD and 52 healthy controls completed a 21-day ecological momentary assessment protocol. Of these 153 individuals with BPD, 105 had a history of suicide attempts. Multilevel structural equation modeling was used to examine dynamic links among interpersonal perceptions, affect, state impulsivity, and suicidal intent. RESULTS Aggregated across interactions, lower perceived warmth in others was associated with SI. This direct relationship, however, did not extend to momentary within-person associations. Instead, interpersonal conflicts were linked to SI indirectly via greater negative affect and lower positive affect. While a robust within-person link between interpersonal perceptions and impulsivity emerged, impulsivity did not account for the relationship between interpersonal perceptions and SI. CONCLUSION This intensive longitudinal study illustrates momentary interpersonal signatures of an emerging suicidal crisis. Among people with BPD at high risk for suicide, interpersonal triggers initiate a cascade of affective dysregulation, which in turn gives rise to SI.
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Affiliation(s)
| | | | - Michael N. Hallquist
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill
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15
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Allen TA, Hallquist MN, Wright AGC, Dombrovski AY. Negative affectivity and disinhibition as moderators of an interpersonal pathway to suicidal behavior in borderline personality disorder. Clin Psychol Sci 2022; 10:856-868. [PMID: 36172259 PMCID: PMC9514132 DOI: 10.1177/21677026211056686] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
This longitudinal study examined whether personality traits moderate the link between interpersonal dysfunction and suicidal behavior in a high-risk sample of 458 individuals diagnosed with borderline personality disorder (BPD). Participants were assessed annually for up to 30 years (mean number of follow-ups = 7.82). Using multilevel structural equation modeling, we examined i) longitudinal, within-person relationships among interpersonal dysfunction, suicidal ideation, and suicide attempts; and ii) moderation of these relationships by negative affectivity and disinhibition. Negative affectivity predicted a stronger within-person coupling between interpersonal dysfunction and suicidal ideation. Disinhibition predicted a stronger coupling between ideation and suicide attempts. Assessing negative affectivity and disinhibition in a treatment setting may guide clinician vigilance toward those at highest risk for interpersonally triggered suicidal behaviors.
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Affiliation(s)
| | - Michael N. Hallquist
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
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16
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Rozanov V. Psychosocial and Psychiatric Factors Associated with Expected Fatality during Suicide Attempt in Men and Women. CONSORTIUM PSYCHIATRICUM 2022; 3:48-59. [PMID: 39045117 PMCID: PMC11262108 DOI: 10.17816/cp161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/23/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Differential factors that influence intention and subjectively perceived fatality during non-fatal suicidal acts amongst men and women have rarely been explored in the extant literature. Exploring these factors may help to understand how they influence medical outcomes and may also be used in a post-crisis counselling. This study aims to assess factors influencing intent in relation to expected fatality during suicidal acts in men and women. METHOD In the current study, 433 individuals who attempted suicide (age 24.89±0.98 years, male/female ratio=1.29) were surveyed using the WHO-5 Well-Being Index, Beck Depression Inventory, Beck Suicide Intent Scale, Plutchik Feelings and Acts of Violence Scale, and Spielberger State/Trait Anger Scale. Life stress was evaluated as an accumulation of negative life events, whilst psychiatric disorders were assessed using CIDI 2.1 inventory. RESULTS It was found that the higher expected fatality was associated with higher suicide intention scores, whereas the medical severity of attempts and violent/non-violent attempts distribution did not differ between groups. Although there was no difference in suicide intent scores and medical severity between men and women, men demonstrated a 2.4-3.5 times higher proportion of violent attempts, depending on the group. Higher perceived fatality was associated with lower general well-being, higher depression and violence, hopelessness, and total life stress in men, whereas among women higher perceived fatality was only associated with total life stress. Moreover, in men and women, higher intent and expected fatality was associated with a differential set of negative life events that occurred during childhood. The prevalence of mental health disturbances in the entire sample was about 50% and equally distributed among men and women. However, addictions prevailed among men, while neurotic and stress-related disorders were more common among women. Among those who expected more fatality the number of people with diagnoses and comorbidity was higher, especially in men. CONCLUSION There is a difference in risk factors for expected fatality and intent in men and women attempting suicide, which may not necessarily result in severe medical outcomes but may help during the post-crisis counseling of suicide attempters. Expected fatality deserves more attention as a component of general intent. An in-depth study of this phenomenon may help to understand motives of men and women attempting suicide and help prevent future suicidal attempts.
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17
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Impulsivity as a mediator between childhood maltreatment and suicidal behavior: A systematic review and meta-analysis. J Psychiatr Res 2022; 151:95-107. [PMID: 35477079 DOI: 10.1016/j.jpsychires.2022.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 03/28/2022] [Accepted: 04/18/2022] [Indexed: 01/15/2023]
Abstract
Childhood maltreatment is a known risk factor for the development of suicidal behavior. Possible mediators of the association between childhood maltreatment and suicide have been analyzed. Some studies have considered impulsivity as one of these mediators, but there are no previous reviews on this topic. We, therefore, present a systematic review and mediation meta-analysis of the literature summarizing the evidence on impulsivity as a mediator of the relationship between childhood maltreatment and lifetime suicidal behavior. This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The review was registered in the PROSPERO database. We searched PubMed, PsycINFO, WebOfScience, and EMBASE databases up to February 2021 to identify studies exploring the association between childhood maltreatment and suicide through impulsivity. Fourteen articles met the selection criteria and were included in the review. Seven articles could be included in the mediation meta-analysis. Impulsivity was a significant mediator of the relationship between childhood maltreatment and suicidal behavior in ten of the fourteen included studies. This result was confirmed using mediation meta-analysis (β = .06, 95% CI 0.03-0.10). Studies suggest that exposure to traumatic situations in childhood affects the proper neurobiological, cognitive, and affective development of individuals. This may increase impulsivity, which in turn would be related to an increased risk of suicide. The effects of childhood maltreatment and impulsivity may be both therapeutic targets of interest to reduce suicide rates.
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18
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Jopling E, LeMoult J, Kerns CM, Nugent S, Eslami A. Potential lethality of suicide attempts in youth. Eur Child Adolesc Psychiatry 2022; 31:919-927. [PMID: 33523314 DOI: 10.1007/s00787-021-01724-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
Rates of suicide in youth have increased over the last 50 years, yet our ability to predict suicidal behaviours has not significantly improved during this time. Examining predictors of suicide attempt lethality can enhance our understanding of suicidality in youth, yet research has focused on actual medical lethality (the actual danger to life resulting from a suicide attempt) rather than potential lethality (the potential for death that is associated with a suicide attempt). Thus, the aim of the present study was twofold: first, we quantified the percentage of youth for whom the severity of suicide attempt was misclassified by considering only actual lethality; second, we tested whether key variables that predict the actual lethality of suicide attempts also predict the potential lethality of suicide attempts in youth. We examined these questions in a sample of children and adolescents admitted to a psychiatric inpatient unit following a suicide attempt. Over 70% of youth who made serious suicide attempts would have been misclassified by assessments relying on only actual lethality. Although several variables relevant to the construct of actual lethality significantly predicted potential lethality (e.g., male sex, substance use disorder), others did not. In addition, we found that the subset of youth who would have been misclassified as low risk based on actual lethality had a disproportionately high need for healthcare resources due to future hospital admissions. The present study provides evidence to suggest that considering potential lethality may lead to improved detection and prediction of suicide risk in youth, and in doing so supports recent calls to broaden considerations of the lethality associated with suicide attempts.
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Affiliation(s)
- E Jopling
- Department of Psychology, University of British Columbia, Vancouver, Canada.
| | - J LeMoult
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - C M Kerns
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - S Nugent
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - A Eslami
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
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19
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Sher L. The pathophysiology of high-lethality suicide attempts: a vital area of suicide research. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2022; 44:237-238. [PMID: 35239837 PMCID: PMC9169476 DOI: 10.1590/1516-4446-2021-2281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/18/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Leo Sher
- James J. Peters Veterans’ Administration Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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20
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Yang HJ, Jung YE, Park JH, Kim MD. The Moderating Effects of Accurate Expectations of Lethality in the Relationships between Suicide Intent and Medical Lethality on Suicide Attempts. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2022; 20:180-184. [PMID: 35078960 PMCID: PMC8813318 DOI: 10.9758/cpn.2022.20.1.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The purpose of this study was to explore the accuracy of expectation of medical lethality and to identify characteristics related to high medical lethality in suicide attempters. METHODS A total of 370 suicide attempters (173 men, 197 women) who visited the emergency department at one university hospital were interviewed. RESULTS Using the Lethality Scale, 103 (27.8%), 114 (30.8%), and 153 (41.4%) suicide attempters were assigned to the low, medium, and high medical lethality groups, respectively. The medium and high medical lethality groups were older, and reported poorer socioenvironmental conditions, compared with the low lethality group. Higher levels of suicide intent were associated with more lethal attempts but only for those attempters who had accurate expectations of the medical lethality of their attempts. CONCLUSION The accuracy of expectations about the likelihood of dying was found to moderate the relationships between suicide intent and medical lethality.
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Affiliation(s)
- Hyun-Ju Yang
- Department of Psychiatry, College of Medicine, Jeju National University, Jeju, Korea
| | - Young-Eun Jung
- Department of Psychiatry, College of Medicine, Jeju National University, Jeju, Korea
| | - Joon Hyuk Park
- Department of Psychiatry, College of Medicine, Jeju National University, Jeju, Korea
| | - Moon-Doo Kim
- Department of Psychiatry, College of Medicine, Jeju National University, Jeju, Korea
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21
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Bootstrapping semi-supervised annotation method for potential suicidal messages. Internet Interv 2022; 28:100519. [PMID: 35281704 PMCID: PMC8913319 DOI: 10.1016/j.invent.2022.100519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/09/2022] [Accepted: 02/25/2022] [Indexed: 11/21/2022] Open
Abstract
The suicide of a person is a tragedy that deeply affects families, communities, and countries. According to the standardized rate of suicides per number of inhabitants worldwide, in 2022 there will be approximately about 903,450 suicides and 18,069,000 unconsummated suicides, affecting people of all ages, countries, races, beliefs, social status, economic status, sex, etc. The publication of suicidal intentions by users of social networks has led to the initiation of research processes in this field, to detect them and encourage them not to commit suicide. This study focused on determining a semi-supervised method to populate the Life Corpus, using a bootstrapping technique, to automatically detect and classify texts extracted from social networks and forums related to suicide and depression based on initial supervised samples. To carry out the experiments we used two different classifiers: Support Vector Machine (SVM) (with Bag of Words (BoW) features with and without Term-Frequency/Inverse Document Frequency (Tf/Idf), as a weighted term, and with or without stopwords) and Rasa (with the default feature extraction system). In addition, we performed the experiments using five data collections: Life, Reddit, Life+Reddit, Life_en, and Life_en + Reddit. Using the semi-supervised method, we managed to increase the size of the Life Corpus from 102 to 273 samples with texts from the social network Reddit, in a combination Life+Reddit+BoW_Embeddings, with the SVM classifier, with which a macro f1 value of 0.80 was achieved. These texts were in turn evaluated by annotators manually with a Cohen's Kappa level of agreement of 0.86.
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22
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Graph theory analysis of whole brain functional connectivity to assess disturbances associated with suicide attempts in bipolar disorder. Transl Psychiatry 2022; 12:7. [PMID: 35013103 PMCID: PMC8748935 DOI: 10.1038/s41398-021-01767-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/25/2021] [Accepted: 11/12/2021] [Indexed: 12/22/2022] Open
Abstract
Brain targets to lower the high risk of suicide in Bipolar Disorder (BD) are needed. Neuroimaging studies employing analyses dependent on regional assumptions could miss hubs of dysfunction critical to the pathophysiology of suicide behaviors and their prevention. This study applied intrinsic connectivity distribution (ICD), a whole brain graph-theoretical approach, to identify hubs of functional connectivity (FC) disturbances associated with suicide attempts in BD. ICD, from functional magnetic resonance imaging data acquired while performing a task involving implicit emotion regulation processes important in BD and suicide behaviors, was compared across 40 adults with BD with prior suicide attempts (SAs), 49 with BD with no prior attempts (NSAs) and 51 healthy volunteers (HVs). Areas of significant group differences were used as seeds to identify regional FC differences and explore associations with suicide risk-related measures. ICD was significantly lower in SAs than in NSAs and HVs in bilateral ventromedial prefrontal cortex (vmPFC) and right anterior insula (RaIns). Seed connectivity revealed altered FC from vmPFC to bilateral anteromedial orbitofrontal cortex, left ventrolateral PFC (vlPFC) and cerebellum, and from RaIns to right vlPFC and temporopolar cortices. VmPFC and RaIns ICD were negatively associated with suicidal ideation severity, and vmPFC ICD with hopelessness and attempt lethality severity. The findings suggest that SAs with BD have vmPFC and RaIns hubs of dysfunction associated with altered FC to other ventral frontal, temporopolar and cerebellar cortices, and with suicidal ideation, hopelessness, and attempt lethality. These hubs may be targets for novel therapeutics to reduce suicide risk in BD.
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23
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Dombrovski AY, Hallquist MN. Search for solutions, learning, simulation, and choice processes in suicidal behavior. WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2022; 13:e1561. [PMID: 34008338 PMCID: PMC9285563 DOI: 10.1002/wcs.1561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/06/2021] [Accepted: 04/07/2021] [Indexed: 12/25/2022]
Abstract
Suicide may be viewed as an unfortunate outcome of failures in decision processes. Such failures occur when the demands of a crisis exceed a person's capacity to (i) search for options, (ii) learn and simulate possible futures, and (iii) make advantageous value-based choices. Can individual-level decision deficits and biases drive the progression of the suicidal crisis? Our overview of the evidence on this question is informed by clinical theory and grounded in reinforcement learning and behavioral economics. Cohort and case-control studies provide strong evidence that limited cognitive capacity and particularly impaired cognitive control are associated with suicidal behavior, imposing cognitive constraints on decision-making. We conceptualize suicidal ideation as an element of impoverished consideration sets resulting from a search for solutions under cognitive constraints and mood-congruent Pavlovian influences, a view supported by mostly indirect evidence. More compelling is the evidence of impaired learning in people with a history of suicidal behavior. We speculate that an inability to simulate alternative futures using one's model of the world may undermine alternative solutions in a suicidal crisis. The hypothesis supported by the strongest evidence is that the selection of suicide over alternatives is facilitated by a choice process undermined by randomness. Case-control studies using gambling tasks, armed bandits, and delay discounting support this claim. Future experimental studies will need to uncover real-time dynamics of choice processes in suicidal people. In summary, the decision process framework sheds light on neurocognitive mechanisms that facilitate the progression of the suicidal crisis. This article is categorized under: Economics > Individual Decision-Making Psychology > Emotion and Motivation Psychology > Learning Neuroscience > Behavior.
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Affiliation(s)
| | - Michael N. Hallquist
- Department of Psychology and NeuroscienceUniversity of North CarolinaChapel HillNorth CarolinaUSA
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24
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Buerke M, Galfalvy H, Keilp J, Sheftall A, Burke A, Bridge J, Mann J, Szanto K. Age effects on clinical and neurocognitive risk factors for suicide attempt in depression - Findings from the AFSP lifespan study. J Affect Disord 2021; 295:123-130. [PMID: 34425314 PMCID: PMC8551053 DOI: 10.1016/j.jad.2021.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Studies of risk factors for suicidal behavior are typically restricted to narrow age ranges, making it difficult to determine if they have the same relevance or potency across the full adult lifespan. METHODS This study examined selected clinical and neurocognitive risk factors for suicidal behavior - borderline personality traits, aggression, depressive rumination, memory performance, and language fluency- in a multi-site sample (N = 309, ages 16-80) of depressed patients with a recent (last 5 years) suicide attempt or no history of attempt, and demographically similar non-psychiatric controls. We examined cross-sectional age and attempter/non-attempter differences on these risk factors, and whether certain risk factors were more prominent discriminators of past suicide attempt earlier or later in the lifespan. Correlations with age were computed, and logistic regression was used to classify attempter status based on each risk factor and its interaction with age. RESULTS Nearly all risk factors were negatively correlated with age. Borderline traits, aggression, memory, and category fluency each predicted attempter status (p < 0.05), but these effects were not different across ages. In contrast, the association between rumination and suicide attempt status differed across the lifespan, becoming a stronger discriminator of past suicidal behavior at older ages. LIMITATIONS The cross-sectional design limits our developmental findings. CONCLUSIONS Despite age-related changes in symptom severity or neurocognitive performance, key risk factors for suicidal behavior previously identified in studies with more restricted age-ranges are salient throughout the adult lifespan. In contrast, depressive rumination may be particularly salient in later life.
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Affiliation(s)
- M. Buerke
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - H. Galfalvy
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA,New York State Psychiatric Institute, Department of Molecular Imaging and Neuropathology, New York, NY, USA
| | - J. Keilp
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA,New York State Psychiatric Institute, Department of Molecular Imaging and Neuropathology, New York, NY, USA
| | - A. Sheftall
- Ohio State University College of Medicine, Departments of Pediatrics and Psychiatry & Behavioral Health, Columbus, OH, USA
| | - A. Burke
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA,New York State Psychiatric Institute, Department of Molecular Imaging and Neuropathology, New York, NY, USA
| | - J. Bridge
- Ohio State University College of Medicine, Departments of Pediatrics and Psychiatry & Behavioral Health, Columbus, OH, USA
| | - J. Mann
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA,New York State Psychiatric Institute, Department of Molecular Imaging and Neuropathology, New York, NY, USA
| | - K. Szanto
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
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25
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Sastre-Buades A, Alacreu-Crespo A, Courtet P, Baca-Garcia E, Barrigon ML. Decision-making in suicidal behavior: A systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 131:642-662. [PMID: 34619171 DOI: 10.1016/j.neubiorev.2021.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 01/19/2023]
Abstract
Impaired decision-making (DM) is well-known in suicidal behavior (SB). We aimed to review the evidence on DM and its mediating factors in SB and perform a meta-analysis on DM assessed using the Iowa Gambling Task (IGT). We conducted a search on databases of papers published on DM and SB up to 2020: 46 studies were included in the systematic review, and 18 in the meta-analysis. For meta-analysis, we compared DM performance between suicide attempters (SAs) and patients (PCs) or healthy controls (HCs). The systematic review showed that SAs have greater difficulties in all DM domains. The meta-analysis found worse IGT performance among SAs in comparison with PCs and HCs. A meta-regression did not find differences for age, gender, psychiatric disorder, and clinical status. Our findings indicate that SAs exhibited deficits in DM under conditions of risk though not ambiguity. Worse DM was independent of age, gender, psychiatric disorder, and suggested that DM impairment could be considered a cognitive trait of suicidal vulnerability, a risk factor and an attribute of SAs.
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Affiliation(s)
- Aina Sastre-Buades
- Department of Psychiatry, Fundación Jimenez Diaz University Hospital, Madrid, Spain; Department of Neurology, Son Llatzer University Hospital, Palma, Spain.
| | - Adrián Alacreu-Crespo
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France; Department of Psychology and Sociology, Area of Personality, Assessment and Psychological Treatment, University of Zaragoza, Teruel, Spain.
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.
| | - Enrique Baca-Garcia
- Department of Psychiatry, Fundación Jimenez Diaz University Hospital, Madrid, Spain; Fundación Jimenez Diaz Health Research Institute, Madrid, Spain; Department of Psychiatry, Autonomous University of Madrid, Spain; Department of Psychiatry, Rey Juan Carlos University Hospital, Móstoles, Spain; Department of Psychiatry, General Hospital of Villalba, Madrid, Spain; Department of Psychiatry, Infanta Elena University Hospital, Valdemoro, Madrid, Spain; Universidad Católica del Maule, Talca, Chile.
| | - Maria Luisa Barrigon
- Department of Psychiatry, Fundación Jimenez Diaz University Hospital, Madrid, Spain; Fundación Jimenez Diaz Health Research Institute, Madrid, Spain; Department of Psychiatry, Autonomous University of Madrid, Spain; Department of Psychiatry, Virgen del Rocío University Hospital, Sevilla, Spain.
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Melhem NM, Zhong Y, Miller JM, Zanderigo F, Ogden RT, Sublette ME, Newell M, Burke A, Keilp JG, Lesanpezeshki M, Bartlett E, Brent DA, Mann JJ. Brain 5-HT1A Receptor PET Binding, Cortisol Responses to Stress, and the Familial Transmission of Suicidal Behavior. Int J Neuropsychopharmacol 2021; 25:36-45. [PMID: 34555145 PMCID: PMC8756092 DOI: 10.1093/ijnp/pyab060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/22/2021] [Accepted: 10/04/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The serotonin 1A (5-HT1A) receptor has been implicated in depression and suicidal behavior. Lower resting cortisol levels are associated with higher 5-HT1A receptor binding, and both differentiate suicide attempters with depression. However, it is not clear whether 5-HT1A receptor binding and cortisol responses to stress are related to familial risk and resilience for suicidal behavior. METHODS [11C]CUMI-101 positron emission tomography imaging to quantify regional brain 5-HT1A receptor binding was conducted in individuals considered to be at high risk for mood disorder or suicidal behavior on the basis of having a first- or second-degree relative(s) with an early onset mood disorder and history of suicidal behavior. These high-risk individuals were subdivided into the following groups: high risk resilient having no mood disorder or suicidal behavior (n = 29); high risk with mood disorder and no suicidal behavior history (n = 31); and high risk with mood disorder and suicidal behavior (n = 25). Groups were compared with healthy volunteers without a family history of mood disorder or suicidal behavior (n = 34). Participants underwent the Trier Social Stress Task (TSST). All participants were free from psychotropic medications at the time of the TSST and PET scanning. RESULTS We observed no group differences in 5-HT1A receptor binding considering all regions simultaneously, nor did we observe heterogeneity of the effect of group across regions. These results were similar across outcome measures (BPND for all participants and BPp in a subset of the sample) and definitions of regions of interest (ROIs; standard or serotonin system-specific ROIs). We also found no group differences on TSST outcomes. Within the high risk with mood disorder and suicidal behavior group, lower BPp binding (β = -0.084, SE = 0.038, P = .048) and higher cortisol reactivity to stress (β = 9.25, 95% CI [3.27,15.23], P = .004) were associated with higher lethality attempts. There were no significant relationships between 5-HT1A binding and cortisol outcomes. CONCLUSIONS 5-HT1A receptor binding in ROIs was not linked to familial risk or resilience protecting against suicidal behavior or mood disorder although it may be related to lethality of suicide attempt. Future studies are needed to better understand the biological mechanisms implicated in familial risk for suicidal behavior and how hypothalamic-pituitary-adrenal axis function influences such risk.
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Affiliation(s)
- Nadine M Melhem
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
- Correspondence: Nadine Melhem, PhD, 3811 O’Hara Street, Pittsburgh, PA 15213, USA ()
| | - Yongqi Zhong
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
- Graduate School of Public Health, University of Pittsburgh
| | - Jeffrey M Miller
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, New York, United States
- Department of Psychiatry, Columbia University, New York, New York, United States
| | - Francesca Zanderigo
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, New York, United States
- Department of Psychiatry, Columbia University, New York, New York, United States
| | - R Todd Ogden
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, New York, United States
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States
| | - M Elizabeth Sublette
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, New York, United States
- Department of Psychiatry, Columbia University, New York, New York, United States
| | - Madison Newell
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, New York, United States
| | - Ainsley Burke
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, New York, United States
- Department of Psychiatry, Columbia University, New York, New York, United States
| | - John G Keilp
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, New York, United States
- Department of Psychiatry, Columbia University, New York, New York, United States
| | - Mohammad Lesanpezeshki
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, New York, United States
- Department of Psychiatry, Columbia University, New York, New York, United States
| | - Elizabeth Bartlett
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, New York, United States
- Department of Psychiatry, Columbia University, New York, New York, United States
| | - David A Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - J John Mann
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, New York, United States
- Department of Psychiatry, Columbia University, New York, New York, United States
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Stanley B, Itzhaky L, Oquendo MA. Identifying Neurobiological Underpinnings of Two Suicidal Subtypes. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2021; 6:e210016. [PMID: 34926832 PMCID: PMC8681698 DOI: 10.20900/jpbs.20210016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Despite substantial suicide prevention efforts, US suicide rates continue to climb, currently reaching about 14 per 100,000 individuals. Suicidal behavior has been linked to neurobiological, neurocognitive and behavioral factors; however, integrative, multi-modal studies are rare. Furthermore, prospective studies, crucial to understanding future risk factors, have focused on a single predictor and a single outcome, implying that suicidal behavior is homogeneous. But recent research shows suicidal behavior is complex and heterogeneous, with the possible existence of subtypes. The present report describes a project testing a model that posits two putative subtypes, using a prospective, multi-model design. The subtypes differ in regard to the patterns of suicidal ideation and underlying mechanisms. One hundred subjects diagnosed with a Major Depressive episode, half of whom have attempted suicide in the past, are enrolled and followed for two years, notably the highest risk period for suicidal behavior. Baseline assessments include a clinical assessment, neurocognitive and behavioral tasks, Ecological Momentary Assessments (EMA), PET imaging, and a cognitive emotion regulation task in the MRI scanner. The follow-up assessment includes a clinical assessment and EMA. The study findings have the potential to pave the way for a clearer understanding of suicidal ideation and behaviors and to improve our ability to treat those at risk for suicide by developing tailored approaches that will allow for more accurate pharmacological and psychosocial interventions.
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Affiliation(s)
- Barbara Stanley
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Unit 42, 1051 Riverside Drive, New York, NY 10032, USA
- Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Liat Itzhaky
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Unit 42, 1051 Riverside Drive, New York, NY 10032, USA
- Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Maria A. Oquendo
- Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 200, Philadelphia, PA 19104, USA
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Benatti B, Dell'Osso B, Shen H, Filippou-Frye M, Varias A, Sanchez C, Jo B, Hollander E, Fineberg NA, Stein DJ, Nicolini H, Lanzagorta N, Marazziti D, Pallanti S, Van Ameringen M, Lochner C, Karamustafalioglu O, Hranov L, Figee M, Drummond L, Grant JE, Denys D, Fontenelle LF, Menchon JM, Zohar J, Pellegrini L, Rodriguez CI. Prevalence and correlates of current suicide risk in an international sample of OCD adults: A report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) network and Obsessive Compulsive and Related Disorders Network (OCRN) of the European College of Neuropsychopharmacology. J Psychiatr Res 2021; 140:357-363. [PMID: 34139458 PMCID: PMC10168716 DOI: 10.1016/j.jpsychires.2021.05.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 05/02/2021] [Accepted: 05/21/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD), characterized by repetitive anxiety-inducing intrusive thoughts and compulsive behaviors, is associated with higher suicide ideation and suicide attempts than the general population. This study investigates the prevalence and the correlates of current suicide risk in adult outpatients in an international multisite cross-sectional sample of OCD outpatients. METHODS Data were derived from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) network's cross-sectional data set (N = 409). Current suicide risk (assessed by Item C of the MINI) and diagnoses of psychiatric disorders were based on DSM-IV. Chi-squared test for categorical variables and t-test for continuous variables were used to make statistical inferences about main features associated with current suicide risk. P < .05 was considered as statistically significant. RESULTS The prevalence of current suicidal risk was 15.9%, with equal likelihood in sociodemographic variables, including age and gender. Increased rates of major depression and generalized anxiety disorder were associated to higher current suicide risk. Current suicide risk was also associated with higher severity of OCD, depressive comorbidity, and higher levels of disability. There were no significant differences in treatment correlates-including type of treatment and psychiatric hospitalizations-between the groups of individuals with and without current suicide risk. CONCLUSION Our findings suggest that current suicide risk is common in patients with OCD and associated with various forms of pathology. Our work also provides further empirical data to support what is already known clinically: a worse clinical picture characterized by a high severity of OCD, high distress related to obsessions and compulsions, and the presence of comorbidities such as major depression and generalized anxiety disorder should be considered as relevant risk factors for suicide risk.
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Affiliation(s)
- Beatrice Benatti
- Luigi Sacco University Hospital, Psychiatry 2 Unit, University of Milan, Milan, Italy; CRC 'Aldo Ravelli' for Neuro-technology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
| | - Bernardo Dell'Osso
- Luigi Sacco University Hospital, Psychiatry 2 Unit, University of Milan, Milan, Italy; CRC 'Aldo Ravelli' for Neuro-technology and Experimental Brain Therapeutics, University of Milan, Milan, Italy; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Hanyang Shen
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Maria Filippou-Frye
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Andrea Varias
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Catherine Sanchez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Eric Hollander
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine and Montefiore Medical Center, New York, NY, USA
| | - Naomi A Fineberg
- School of Life and Medical Sciences, University of Hertfordshire and Hertfordshire Partnership University NHS Foundation Trust, Hatfield, Hertfordshire, United Kingdom
| | - Dan J Stein
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Humberto Nicolini
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico City, Mexico; Carracci Medical Group, Mexico City, Mexico
| | | | - Donatella Marazziti
- Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotechnologie, Università di Pisa, Italy
| | - Stefano Pallanti
- Department of Psychiatry, University of Florence, Institute of Neurosciences, Florence, Italy
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Christine Lochner
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Stellenbosch, South Africa
| | | | - Luchezar Hranov
- University Multiprofile Hospital for Active Treatment in Neurology and Psychiatry Sveti Naum, Sofia, Bulgaria
| | - Martin Figee
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Lynne Drummond
- Formerly National and Trustwide Services for OCD/BDD, SWLondon and St. George's, National Health Service Trust, London, United Kingdom
| | - Jon E Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Illinois, USA
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Leonardo F Fontenelle
- Turner Institute for Brain and Mental Health, Monash University, VIC, Australia; Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ); and D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Jose M Menchon
- Psychiatry Unit at the Hospital Universitari de Bellvitge-IDIBELL, University of Barcelona, Cibersam, Barcelona, Spain
| | - Joseph Zohar
- Tel Aviv University, Sackler School of Medicine, Israel Post-Trauma Center, Research Foundation by the Sheba Medical Center, Israel
| | - Luca Pellegrini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy; Highly Specialised Service for OCD and BDD, Hertfordshire Partnership University NHS Foundation Trust and University of Hertfordshire, Hatfield, UK
| | - Carolyn I Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
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Risk factors for pre-adolescent onset suicidal behavior in a high-risk sample of youth. J Affect Disord 2021; 290:292-299. [PMID: 34015624 PMCID: PMC8223608 DOI: 10.1016/j.jad.2021.04.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/20/2021] [Accepted: 04/25/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify risk factors for preadolescent onset suicidal behavior compared with adolescent/young adult onset suicidal behavior in a longitudinal sample of youth with parental history of mood disorders. METHODS The sample includes 545 youth who were age 21 years or less at the time of their baseline assessment. Participants underwent baseline and yearly study assessments. Observations were censored at the time point closest to the first episode of suicidal behavior for youth with suicidal behavior and at the time of last observation for youth without suicidal behavior. Youth were categorized into 3 groups: first onset of suicidal behavior before the age of 13 (n = 32), first onset of suicidal behavior between the ages of 13-21 (n = 51) and those without suicide related behaviors (n = 462). ANOVA, Chi-square, Fisher's exact test and multinomial regression were used to test the hypotheses. RESULTS Significant predictors of preadolescent onset suicidal behavior were diagnosis of depressive disorder (RRR = 11.41, p<.001) and diagnosis of ADHD (RRR = 2.86, p = .02). Adolescent onset was predicted by diagnosis of depressive disorder (RRR = 4.12, p = .008), female sex (RRR = 2.68, p = .02) and self-reported suicidal ideation (RRR = 1.48, p = .004). LIMITATIONS These results are most applicable to offspring of parents with significant mood disorders. CONCLUSIONS The strongest predictor of suicidal behavior in both groups was a diagnosis of depressive disorder, and the risk was nearly 3 times higher in preadolescents. ADHD was a significant predictor only for preadolescents, while female sex and self-reported suicidal ideation predicted suicidal behavior in adolescents.
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Characteristics of depressed suicide attempters with remitted substance use disorders. J Psychiatr Res 2021; 137:572-578. [PMID: 33158553 PMCID: PMC8084874 DOI: 10.1016/j.jpsychires.2020.10.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/06/2020] [Accepted: 10/28/2020] [Indexed: 01/26/2023]
Abstract
Substance use disorder (SUD) comorbidity in mood disorders increases suicide risk. Suicide attempters with active SUD appear to have distinct characteristics but little is known whether these characteristics persist during remission and if they are related to different aspects of suicidal behavior. In this study, suicide attempters with a DSM mood disorder and remitted SUD (AT+SUD) (N = 135) were compared to those without lifetime SUD (AT-SUD) (N = 219) in terms of demographic, clinical and suicidal behavioral characteristics. Factor analyses were conducted to generate subjective distress and impulsivity/aggression factors - previously identified by our group to predict suicide risk in mood disorders. Associations between these traits and SUD history and suicidal behavior characteristics were then tested. Compared with AT-SUD, AT+SUD were more likely to be male, less educated and to have a Cluster B personality disorder. AT+SUD individuals had greater impulsivity/aggression factor scores, but comparable subjective distress scores. AT+SUD made a greater number of suicide attempts, with higher lethality, despite comparable suicide intent and degree of planning with AT-SUD. Impulsivity/aggression was higher in multiple versus single attempters, but did not correlate with suicide attempt lethality. Among suicide attempters with mood disorders, a history of lifetime SUD was associated with more frequent and more lethal suicide attempts. Among other correlates of lifetime SUD in this sample, impulsive/aggressive traits may explain greater frequency of suicide attempts. The results underscore that persons with mood disorders and lifetime SUD are at particularly high risk of frequent and lethal suicide attempts where more intensive prevention efforts are warranted.
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Perry M, Buerke M, Szücs A, Allen TA, Bruine de Bruin W, Szanto K, Dombrovski A. A lifetime of challenges: real-life decision outcomes in early- and late-onset suicide attempters. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 4:100105. [PMID: 34109322 PMCID: PMC8186299 DOI: 10.1016/j.jadr.2021.100105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND People who have attempted suicide display suboptimal decision-making in the lab. Yet, it remains unclear whether these difficulties tie in with other detrimental outcomes in their lives besides suicidal behavior. We hypothesize that this is more likely the case for individuals who first attempted suicide earlier than later in life. METHODS A cross-sectional case-control study of 310 adults aged ≥ 50 years (mean: 63.9), compared early- and late-onset attempters (first attempt < 55 vs. ≥ 55 years of age) to suicide ideators, non-suicidal depressed controls and non-psychiatric healthy controls. Participants reported potentially avoidable negative decision outcomes across their lifetime, using the Decision Outcome Inventory (DOI). We employed multi-level modeling to examine group differences overall, and in three factor-analytically derived domains labeled Acting Out, Lack of Future Planning, and Hassles. RESULTS Psychopathology predicted worse decision outcomes overall, and in the more serious Acting Out and Lack of Future Planning domains, but not in Hassles. Early-onset attempters experienced more negative outcomes than other groups overall, in Lack of Future Planning, and particularly in Acting Out. Late-onset attempters were similar to depressed controls and experienced fewer Acting out outcomes than ideators. LIMITATIONS The cross-sectional design precluded prospective prediction of attempts. The assessment of negative outcomes may have lacked precision due to recall bias. CONCLUSIONS Whereas early-onset suicidal behavior is likely the manifestation of long-lasting decision-making deficits in several serious aspects of life, late-onset cases appear to function similarly to non-suicidal depressed adults, suggesting that their attempt originates from a more isolated crisis.
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Affiliation(s)
- M. Perry
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - M. Buerke
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - A. Szücs
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - T. A. Allen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - W. Bruine de Bruin
- Department of Public Policy, University of Southern California, Los Angeles, CA, United States
| | - K. Szanto
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - A.Y. Dombrovski
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Osborn E, Brooks J, O'Brien PMS, Wittkowski A. Suicidality in women with Premenstrual Dysphoric Disorder: a systematic literature review. Arch Womens Ment Health 2021; 24:173-184. [PMID: 32936329 PMCID: PMC7979645 DOI: 10.1007/s00737-020-01054-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/16/2020] [Indexed: 12/15/2022]
Abstract
Previous research has identified how menstruation is an important factor in both attempted and completed suicides for women. The purpose of this review was to outline (a) the risk profile for suicidality in women who were identified to experience Premenstrual Dysphoric Disorder (PMDD), a condition characterized by severe physical and psychological changes that occur during the luteal menstrual phase, and (b) the implications of these findings for clinical practice. A systematic literature review was conducted using five databases to identify any peer-reviewed articles published between 1989 and 2019. Ten papers eligible for inclusion were identified: three pertaining to suicide cognitions, five to suicide attempts and two to both cognitions and attempts. Findings showed that suicidal thoughts, ideation, plans and attempts were strongly associated with experiences of PMDD and that these findings were independent of psychiatric co-morbidities. However, women with PMDD did not present with more severe risk profiles for suicide attempts (in terms of frequency, impulsivity and lethality) or make more frequent attempts during the luteal menstrual phase compared with suicide attempters without PMDD. Women with PMDD should be considered a high risk group for suicidality; thus, identifying and treating symptoms are vital in reducing suicide attempts. Implications for clinical practice are outlined in the discussion.
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Affiliation(s)
- E Osborn
- Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, Manchester Academic Health Science Centre, The University of Manchester, 2nd floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - J Brooks
- Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, Manchester Academic Health Science Centre, The University of Manchester, 2nd floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
| | - P M S O'Brien
- Emeritus Professor, School of Medicine, Keele University, Staffordshire, UK
| | - A Wittkowski
- Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, Manchester Academic Health Science Centre, The University of Manchester, 2nd floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
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Lin C, Huang CM, Karim HT, Liu HL, Lee TMC, Wu CW, Toh CH, Tsai YF, Yen TH, Lee SH. Greater white matter hyperintensities and the association with executive function in suicide attempters with late-life depression. Neurobiol Aging 2021; 103:60-67. [PMID: 33845397 DOI: 10.1016/j.neurobiolaging.2020.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/27/2020] [Accepted: 12/15/2020] [Indexed: 10/21/2022]
Abstract
Late-life depression (LLD) is associated with greater risk of suicide and white matter hyperintensities (WMH), which are also found in suicide attempters regardless of age. Greater periventricular WMH are related to worse cognitive function. We investigated the spatial distribution of WMH in suicide attempters with LLD and its association with cognitive function. We recruited 114 participants with LLD (34 with history of suicide attempt and 80 without) and 47 older adult controls (individuals without LLD or history of suicide attempt). WMH were quantified by an automated segmentation algorithm and were classified into different regions. Suicide attempters with LLD had significantly higher global WMH (F3, 150 = 2.856, p = 0.039) and periventricular WMH (F3, 150 = 3.635, p = 0.014) compared to other groups. Suicide attempters with high WMH had significantly lower executive function, which could be an underlying mechanism for cognitive decline in older adults with suicidality.
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Affiliation(s)
- Chemin Lin
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Mao Huang
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ho-Ling Liu
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tatia Mei-Chun Lee
- Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong; State Key Laboratory of Brain and Cognitive Science, The University of Hong Kong, Hong Kong
| | - Changwei W Wu
- Brain and Consciousness Research Center, Shuang-Ho Hospital, New Taipei, Taiwan; Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
| | - Cheng Hong Toh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taoyuan County, Taiwan
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan City, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan City, Taiwan
| | - Tzung-Hai Yen
- College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shwu-Hua Lee
- College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Department of Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan County, Taiwan.
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Zhong S, Lu L, Wilson A, Wang Y, Duan S, Ou J, Shi L, Ge J, Chen L, Zhao K, Chen R. Attention-deficit/ hyperactivity disorder symptoms and suicidal ideation among college students: A structural equation modeling approach. J Affect Disord 2021; 279:572-577. [PMID: 33152561 DOI: 10.1016/j.jad.2020.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 08/26/2020] [Accepted: 10/11/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Suicidal ideation (SI) among college students is frequently reported. However, the mediating roles of depressive and anxiety symptoms between attention-deficit/hyperactivity disorder (ADHD) symptoms and SI has yet to be explored among college students. METHOD A cross-sectional survey of college freshmen in China was conducted between October 2018 and December 2018. Standardized questionnaires were used to collect information on basic sociodemographic characteristics, including SI, ADHD symptoms, and anxiety and depressive symptoms. A structural equation model (SEM) was then constructed. RESULTS A total of 904 college freshmen were included in the analysis. The prevalence of ADHD symptoms and lifetime SI were 11.9% (95% CI: 9.9%-14.2%) and 29.2% (95% CI: 26.3%-32.2%), respectively. The SEM revealed that there were no direct paths from inattention, executive dysfunction, and hyperactivity to SI. Under the mediating role of anxiety and depressive symptoms, executive dysfunction (β = 0.011, p < 0.05) and hyperactivity (β = 0.015, p < 0.05) had indirect relationships with the risk of SI, and the role of inattention was not identified. Depressive and anxiety symptoms had direct influences on increasing SI. There also were indirect effects from anxiety symptoms to SI, which were mediated by depressive symptoms (β = 0.023, p < 0.001). CONCLUSIONS The current study indicated the indirect relationships between ADHD symptoms and SI among college freshmen. The findings could provide useful clues for clinical treatment and school-based prevention that aims to improve college students' mental well-being.
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Affiliation(s)
- Shaoling Zhong
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, and China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Li Lu
- Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France
| | - Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Yuanyuan Wang
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, and China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China; Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Suqian Duan
- Institute of Psychiatry, Psychology & Neuroscience, King's college London, London, UK
| | - Jianjun Ou
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, and China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China.
| | - Lijuan Shi
- School of Education, Hunan University of Science and Technology, Xiangtan, Hunan, China
| | - Jianyu Ge
- School of Education, Hunan University of Science and Technology, Xiangtan, Hunan, China
| | - Li Chen
- School of Education, Hunan University of Science and Technology, Xiangtan, Hunan, China
| | - Kaihong Zhao
- School of Education, Hunan University of Science and Technology, Xiangtan, Hunan, China
| | - Runsen Chen
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, and China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China.
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Zortea TC, Gray CM, O'Connor RC. The Relationship Between Adult Attachment and Suicidal Thoughts and Behaviors: A Systematic Review. Arch Suicide Res 2021; 25:38-73. [PMID: 31545148 DOI: 10.1080/13811118.2019.1661893] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We aimed to (1) determine the extent of the relationship between attachment and suicidal thoughts and behaviors (STB), (2) investigate whether any gender differences exist, and (3) conduct a theoretical synthesis of the included studies. A systematic search of the databases Web of Science; EBSCO Host Medical and Psychology-related resources, which includes CINAHL, Health Source: Nursing/Academic Edition, Psychology and Behavioral Sciences Collection, and PsycINFO; and EMBASE was conducted, with 52 studies meeting the inclusion criteria. While secure attachment acts as protective factor, insecure attachment orientations appear to be vulnerability factors compromising an individual's capacity to cope with relationship issues, increasing suicide risk. There is insufficient evidence about gender differences. The theoretical synthesis suggests that attachment, interacting with other psychological traits in response to negative life events, acts as a vulnerability or protective factor for STB. Implications for treatment are also discussed.
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Sex-dependent grades of haematopoietic modulation in patients with major depressive episodes are associated with suicide attempts. Eur Neuropsychopharmacol 2020; 40:17-30. [PMID: 32600963 DOI: 10.1016/j.euroneuro.2020.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/08/2020] [Accepted: 06/09/2020] [Indexed: 01/10/2023]
Abstract
Suicide is the leading cause of non-natural death worldwide, and major depressive disorder (MDD) is the mood disorder with the highest prevalence among individuals with suicidal behaviour (SB). The role of inflammation and immunomodulation in mood disorders has raised interest in recent years, as inflammation biomarkers have been reported to be increased in mood disorder patients, suggesting a role of inflammation in their pathogenesis. The influence of inflammation on the haematopoietic production is well known; however, a comprehensive study of the haematopoietic production in patients with major depressive episodes (MDE) is lacking. We examined global haematopoietic parameters from complete blood counts (CBC) of patients with MDE, in search of prognostic patterns. MDE patients presented differences in several CBC parameters, differences that were clearly pronounced and/or significant in concurrence with suicide attempts (SA). Red and white blood cell lineage parameters were affected, suggesting general haematopoietic modulation or imbalance. We observed distinct haematological parameter changes in women versus men, with men presenting milder alterations than women. Interestingly, we found that the List of Threatening Experiences (LTE) score, but not the Childhood Trauma Questionnaire (CTQ), was associated with the haematopoietic alterations observed exclusively in women and, more importantly, served as a parameter to stratify female MDE patients based on concurrence or non-concurrence with SA. In conclusion, grades of haematopoietic modulation in MDE patients are associated with absence or presence of SA. Haematopoietic manifestations differ between men and women and, in the latter, are markedly influenced by late, and not early, traumatic events.
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Szanto K, Galfalvy H, Kenneally L, Almasi R, Dombrovski AY. Predictors of serious suicidal behavior in late-life depression. Eur Neuropsychopharmacol 2020; 40:85-98. [PMID: 32778367 PMCID: PMC7655527 DOI: 10.1016/j.euroneuro.2020.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 05/16/2020] [Accepted: 06/09/2020] [Indexed: 12/16/2022]
Abstract
The present study aimed to identify pathways to suicidal behavior in late life that can guide identification of those most at risk and improve treatment. In a longitudinal study of late-life depression, we prospectively assessed risk factors specifically associated with fatal and near-fatal as compared to less lethal suicidal behavior. We enrolled 401 participants (age 66+9.9): 311 with unipolar non-psychotic depression and 90 non-psychiatric controls. The median follow-up was 5.4 years. Results indicated that history of suicide attempt predicted a two-fold increase in the risk of dying from natural causes. In univariate models, male gender, higher income, current depression and current and worst lifetime suicidal ideation severity, cognitive control deficits, and low levels of non-planning impulsivity predicted fatal and near-fatal suicidal behavior. In contrast, incident less lethal suicidal behavior was mostly associated with maladaptive personality traits, impulsivity, and severity of psychiatric illness in univariate models. In multipredictor models, male gender, worst lifetime suicidal ideation, and deficits in cognitive control independently predicted fatal/near-fatal suicidal behavior, while introversion, history of suicide attempt, and earlier age of onset of depression predicted less lethal suicidal behavior. While clinicians may be familiar with suicide risk factors identified in younger samples such as dysfunctional personality, impulsivity, and co-morbid substance use, in late life these characteristics only pertain to lower-lethality suicidal behavior. Cognitive control deficits, which likely play a greater role in old age, predict serious suicidal behavior.
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Affiliation(s)
| | | | - Laura Kenneally
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, 23504, USA
| | - Rebeka Almasi
- Carnegie Mellon University, Pittsburgh, PA, 15213, USA
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38
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Hyer JM, Kelly EP, Paredes AZ, Tsilimigras DI, Diaz A, Pawlik TM. Mental illness is associated with increased risk of suicidal ideation among cancer surgical patients. Am J Surg 2020; 222:126-132. [PMID: 33268055 DOI: 10.1016/j.amjsurg.2020.10.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/01/2020] [Accepted: 10/19/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Mental illness and depression can be associated with increased risk of suicidal ideation (SI). We sought to determine the association between mental illness and SI among cancer surgical patients. METHODS Medicare beneficiaries who underwent resection of lung, esophageal, pancreatic, colon, or rectal cancer were analyzed. Patients were categorized as no mental illness, anxiety and/or depression disorders or bipolar/schizophrenic disorders. RESULTS Among 211,092 Medicare beneficiaries who underwent surgery for cancer, the rate of suicidal ideation was 270/100,000 patients. Antecedent mental health diagnosis resulted in a marked increased SI. On multivariable analysis, patients with anxiety alone (OR 1.49, 95%CI 1.04-2.14), depression alone (OR 2.60, 95%CI 1.92-3.38), anxiety + depression (OR 4.50, 95%CI 3.48-5.86), and bipolar/schizophrenia (OR 7.30, 95%CI 5.27-10.30) had increased odds of SI. CONCLUSIONS Roughly 1 in 370 Medicare beneficiaries with cancer who underwent a wide range of surgical procedures had SI. An antecedent mental health diagnosis was a strong risk factor for SI.
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Affiliation(s)
- J Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Elizabeth Palmer Kelly
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Anghela Z Paredes
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Adrian Diaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
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Acuña Caicedo RW, Gómez Soriano JM, Melgar Sasieta HA. Assessment of supervised classifiers for the task of detecting messages with suicidal ideation. Heliyon 2020; 6:e04412. [PMID: 32775739 PMCID: PMC7399252 DOI: 10.1016/j.heliyon.2020.e04412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/22/2020] [Accepted: 07/07/2020] [Indexed: 02/01/2023] Open
Abstract
According to the World Health Organization (WHO) close to 800,000 people worldwide die by suicide each year, and many more attempts to do it. In consequence, the WHO recognizes suicide as a global public health priority, which affects not only rich countries but poor and middle-income countries as well. This study makes a systematic analysis of 28 supervised classifiers using different features of the corpus Life to detect messages with suicidal ideation and depression to know if these can be used in an automatic prevention online system. The Life Corpus, used in this research, is a bilingual text corpus (English and Spanish) oriented to the detection of suicide ideation. This corpus was constructed retrieving texts from several social networks and its quality was measured using mutual annotation agreement. The different experiments determined that the classifier with the best performance was KStar, with the corpus features POS-SYNSETS-NUM, achieving the best results with the ROC Area metrics of 0,81036 and F-measure of 0,7148. The present research fulfilled the objective of discovering which supervised classifiers and which features are the most suitable for the automatic classification of messages with suicidal ideation using the Life Corpus. Also, given the imbalance of the results, a new precision measure was developed called the Two-dimensional Accuracy and Recovery Index (GDP), which can provide better results, in unbalanced systems, than the usual measures to assess the quality of the results (measure F, Area ROC), and thus increase the number of messages at risk of suicidal ideation, detected at the cost of receiving more messages that are not related to suicide or vice versa.
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Affiliation(s)
- Roberto Wellington Acuña Caicedo
- Carrera de Tecnología de la Información, Universidad Estatal del Sur de Manabí, Ecuador
- Departamento de Ingeniería, Sección de Ingeniería Informática, Escuela de Posgrado, Pontificia Universidad Católica del Perú, Lima, Peru
| | | | - Héctor Andrés Melgar Sasieta
- Departamento de Ingeniería, Sección de Ingeniería Informática, Escuela de Posgrado, Pontificia Universidad Católica del Perú, Lima, Peru
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40
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Kim B, Kim Y, Park CHK, Rhee SJ, Kim YS, Leventhal BL, Ahn YM, Paik H. Identifying the Medical Lethality of Suicide Attempts Using Network Analysis and Deep Learning: Nationwide Study. JMIR Med Inform 2020; 8:e14500. [PMID: 32673253 PMCID: PMC7380907 DOI: 10.2196/14500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 01/08/2020] [Accepted: 03/23/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Suicide is one of the leading causes of death among young and middle-aged people. However, little is understood about the behaviors leading up to actual suicide attempts and whether these behaviors are specific to the nature of suicide attempts. OBJECTIVE The goal of this study was to examine the clusters of behaviors antecedent to suicide attempts to determine if they could be used to assess the potential lethality of the attempt. To accomplish this goal, we developed a deep learning model using the relationships among behaviors antecedent to suicide attempts and the attempts themselves. METHODS This study used data from the Korea National Suicide Survey. We identified 1112 individuals who attempted suicide and completed a psychiatric evaluation in the emergency room. The 15-item Beck Suicide Intent Scale (SIS) was used for assessing antecedent behaviors, and the medical outcomes of the suicide attempts were measured by assessing lethality with the Columbia Suicide Severity Rating Scale (C-SSRS; lethal suicide attempt >3 and nonlethal attempt ≤3). RESULTS Using scores from the SIS, individuals who had lethal and nonlethal attempts comprised two different network nodes with the edges representing the relationships among nodes. Among the antecedent behaviors, the conception of a method's lethality predicted suicidal behaviors with severe medical outcomes. The vectorized relationship values among the elements of antecedent behaviors in our deep learning model (E-GONet) increased performances, such as F1 and area under the precision-recall gain curve (AUPRG), for identifying lethal attempts (up to 3% for F1 and 32% for AUPRG), as compared with other models (mean F1: 0.81 for E-GONet, 0.78 for linear regression, and 0.80 for random forest; mean AUPRG: 0.73 for E-GONet, 0.41 for linear regression, and 0.69 for random forest). CONCLUSIONS The relationships among behaviors antecedent to suicide attempts can be used to understand the suicidal intent of individuals and help identify the lethality of potential suicide attempts. Such a model may be useful in prioritizing cases for preventive intervention.
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Affiliation(s)
- Bora Kim
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Younghoon Kim
- Center for Supercomputing Applications, Division of Supercomputing, Korea Institute of Science and Technology Information (KISTI), Daejeon, Republic of Korea
| | - C Hyung Keun Park
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Jin Rhee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Shin Kim
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Bennett L Leventhal
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Yong Min Ahn
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyojung Paik
- Center for Supercomputing Applications, Division of Supercomputing, Korea Institute of Science and Technology Information (KISTI), Daejeon, Republic of Korea
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41
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Cliffe C, Shetty H, Himmerich H, Schmidt U, Stewart R, Dutta R. Suicide attempts requiring hospitalization in patients with eating disorders: A retrospective cohort study. Int J Eat Disord 2020; 53:458-465. [PMID: 32043625 DOI: 10.1002/eat.23240] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Suicide attempts requiring hospitalization are known to be common in patients who are diagnosed with eating disorders. Attempting suicide is a major indicator for those at risk of completed suicide. Both the specific eating disorder diagnosis and the influence of psychiatric comorbidities on suicide attempts requiring hospitalization were investigated, with demographic and socioeconomic variables as confounders, over a 10-year observation period from January 2007 to March 2017. METHODS Anonymized health-record data from the South London and Maudsley NHS Foundation Trust (SLaM) were retrieved through the Clinical Record Interactive Search (CRIS) data resource; this is linked to national Hospital Episode Statistics (HES) data. These data include all diagnoses for inpatient admissions. Hazard ratios, with 95% confidence intervals (CIs), were calculated from cox regression analyses and the effects of a number of confounders were estimated by performing multivariable analyses. RESULTS In total, 4,895 patients were diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder otherwise not specified (EDNOS). Of these, 331 (6.7%) had attempted suicide requiring hospitalization and 21 (0.04%) completed suicide. The eating disorder category associated with the highest risk of a suicide attempt was AN (HR: 1.43, 95%CI: 1.08-1.89, p = .01). The risk was significantly increased further if the patient had a comorbid diagnosis of personality disorder, depression, bipolar affective disorder, and substance misuse. DISCUSSION Suicide attempts requiring hospitalization have a high incidence rate among patients with eating disorders, and the risk is significantly increased in AN. Comorbid psychiatric illness and suicidal ideation should be carefully assessed in all eating disorder patients.
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Affiliation(s)
- Charlotte Cliffe
- Institute of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Hitesh Shetty
- Institute of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Hubertus Himmerich
- Institute of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Ulrike Schmidt
- Institute of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Robert Stewart
- Institute of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Rina Dutta
- Institute of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Trust, London, UK
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Green J, Berry K, Danquah A, Pratt D. The role of psychological and social factors in the relationship between attachment and suicide: A systematic review. Clin Psychol Psychother 2020; 27:463-488. [PMID: 32167194 DOI: 10.1002/cpp.2445] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 11/08/2022]
Abstract
Insecure attachment is widely accepted to be a risk factor for suicidal thoughts and behaviour. To increase our understanding of this distal association, the current systematic review aimed to evaluate empirical evidence that has investigated the role of psychosocial mechanisms within this relationship. Sixteen original research articles were identified, with the majority carrying out mediational analyses to test their hypotheses. Substantial heterogeneity was found across studies with regards to their theoretical approach to assessing attachment, suicide-related outcomes, sample population, statistical analyses, and the psychological factors under investigation. Nevertheless, this emergent evidence base indicates that a range of predisposing, precipitating, and crisis-state factors may mediate the association between attachment security and suicidality. Studies that investigated moderating factors did not report significant findings, and the mediating role for psychiatric diagnoses remains unclear. Furthermore, this emerging research base is limited by an over-reliance on cross-sectional designs and self-reported data. Longitudinal and experimental designs are required to verify causal pathways and to investigate whether trait vulnerabilities interact with acute stressors to increase suicide risk. Finally, disorganized attachment has been overlooked so far and should be given greater consideration going forward.
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Affiliation(s)
- Jessica Green
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Katherine Berry
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Adam Danquah
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Daniel Pratt
- School of Health Sciences, University of Manchester, Manchester, UK
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Tripodianakis J, Markianos M, Sarantidis D, Istikoglou C, Andara A, Bistolaki E. Platelet monoamine oxidase in attempted suicide. Relations to sex, psychiatric diagnosis, mode of attempt, and previous attempts. Eur Psychiatry 2020; 10:44-8. [DOI: 10.1016/0767-399x(96)80074-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/1993] [Accepted: 05/16/1993] [Indexed: 11/15/2022] Open
Abstract
SummaryPlatelet monoamine oxidase (MAO) activities were assessed in 82 patients, 57 females and 25 males, who were admitted to the medical ward of a general hospital after a suicide attempt. The enzyme activities were compared to the activities of healthy subjects, 35 females and 26 males. In addition, MAO activities were analyzed in relation to sex, psychiatric diagnosis, mode of attempt, drugs ingested, and previous attempts. Compared to normal controls, only female patients showed lower MAO activities. In the male population, lower activities were found in the subgroup of patients who had made previous attempts. In relation to diagnosis, analysis performed in the female population revealed lower MAO activities in the dysthymic and personality disorder, and not in the adjustment or major affective disorder subgroups. MAO activities were not related to the violent mode of attempt, the type of medication used, or the score in the Beck Suicidal Intent scale. The finding of low platelet MAO activities in dysthymic disorder, indicates the need for further studies of biological variables in this underdiagnosed and undertreated diagnostic group.
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44
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Soloff PH, Chiappetta L. Time, Age, and Predictors of Psychosocial Outcome in Borderline Personality Disorder. J Pers Disord 2020; 34:145-160. [PMID: 30179578 PMCID: PMC9233907 DOI: 10.1521/pedi_2018_32_386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In longitudinal studies, BPD symptoms diminish over time, though psychosocial functioning lags far behind. The effects of time and advancing age on BPD are poorly understood. We sought prospective predictors of psychosocial outcome and recovery in 150 BPD subjects followed 2 to 31 years (mean 9.94 years) using a multidimensional assessment method and biannual follow-ups. Time-in-study had no significant effect on achieving diagnostic remission in BPD, good psychosocial outcomes, meaningful interpersonal relationships, full employment, or total recovery; however, younger age was associated with social and vocational achievement independent of BPD remission. Significant contributions to psychosocial outcome were found for age, employment status, MDD, SUD, Any Anxiety Disorder, and Alcohol abuse/dependence (ALC). Remission from BPD was neither necessary or sufficient for good interpersonal relationships or full-time employment. Full-time employment and social and vocational adjustment (SAS-sr) predicted good psychosocial outcome. Axis I comorbidity with Any Anxiety Disorder, MDD, or SUD predicted poor outcome.
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Affiliation(s)
- Paul H. Soloff
- Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Laurel Chiappetta
- Statistics Department, University of Pittsburgh, Pittsburgh, Pennsylvania
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45
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Szücs A, Szanto K, Wright AG, Dombrovski AY. Personality of late- and early-onset elderly suicide attempters. Int J Geriatr Psychiatry 2020; 35:384-395. [PMID: 31894591 PMCID: PMC7291767 DOI: 10.1002/gps.5254] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 12/21/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES While suicidal behavior often manifests in adolescence and early adulthood, some people first attempt suicide in late life, often with remarkable lethal intent and determination. Given these individuals' more adaptive functioning earlier in life, they may possess traits that hinder adjustment to aging, such as high conscientiousness, rather than impulsive-aggressive traits associated with suicidal behavior in younger adults. METHODS A cross-sectional case-control study was conducted in older adults aged ≥50 (mean: 65), divided into early- and late-onset attempters (age at first attempt ≤ or >50, mean: 31 vs 61), suicide ideators as well as non-suicidal depressed and healthy controls. Personality was assessed in terms of the five-factor model (FFM, n = 200) and five DSM personality disorders analyzed on the trait level as continuous scores (PDs, n = 160). Given our starting hypothesis about late-onset attempters, the FFM dimension conscientiousness was further tested on the subcomponent level. RESULTS All clinical groups displayed more maladaptive profiles than healthy subjects. Compared to depressed controls, higher neuroticism, and borderline traits characterized both suicide ideators and early-onset attempters, while only early-onset attempters further displayed lower extraversion and higher antisocial traits. Late-onset attempters were similar to depressed controls on most measures, but scored higher than them on orderliness, a conscientiousness subcomponent. CONCLUSIONS While neuroticism, introversion, and cluster B traits are prominent in early-onset suicidal behavior, late-onset cases generally lack these features. In contrast, higher levels of orderliness in late-onset suicidal behavior are compatible with the age-selective maladjustment hypothesis. Key points Personality of elderly attempters differed between those with early- and late-onset first attempts. Early-onset attempters possessed personality traits generally found in younger suicidal populations (high neuroticism, low extraversion, antisocial, and borderline PD traits), supporting that constitutional suicide risk factors persist into late life in some individuals. Late-onset suicide attempters had higher levels of orderliness than non-suicidal depressed participants, suggesting that this generally adaptive trait may facilitate suicidal behavior in a subset of depressed elderly.
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Affiliation(s)
- Anna Szücs
- Dept. of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Dept. of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Katalin Szanto
- Dept. of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aidan G.C. Wright
- Dept. of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Goodman M, Brown GK, Galfalvy HC, Spears AP, Sullivan SR, Kapil-Pair KN, Jager-Hyman S, Dixon L, Thase ME, Stanley B. Group ("Project Life Force") versus individual suicide safety planning: A randomized clinical trial. Contemp Clin Trials Commun 2020; 17:100520. [PMID: 32043013 PMCID: PMC7000793 DOI: 10.1016/j.conctc.2020.100520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 12/20/2019] [Accepted: 01/04/2020] [Indexed: 11/28/2022] Open
Abstract
One in five suicide deaths is a Veteran and in spite of enhanced suicide prevention services in the Veterans Health Administration (VHA), twenty Veterans die by suicide each day. One component of the VHA's coordinated effort to treat high-risk suicidal Veterans, and diminish suicide risk, is the use of the safety plan. The current study aims to examine a novel intervention integrating skills training and social support with safety planning for Veterans at high-risk for suicide, "Project Life Force" (PLF). A randomized clinical trial (RCT) will be conducted examining if Veterans who are at high-risk for suicide will benefit from the novel group intervention, PLF, compared to Veterans who receive treatment as usual (TAU). We plan to randomize 265 Veterans over the course of the study. The primary outcome variable is the incidence of suicidal behavior, during follow-up, established using a rigorous, multi-method assessment. Secondary outcomes include depression, hopelessness, suicide coping and treatment utilization. Exploratory analyses include safety plan quality and belongingness for those in both arms as well as group cohesion for those in the PLF intervention. Strengths and limitations of this protocol are discussed.
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Affiliation(s)
- Marianne Goodman
- James J Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Gregory K. Brown
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA
| | - Hanga C. Galfalvy
- Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY USA
| | | | | | - Kalpana Nidhi Kapil-Pair
- James J Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Shari Jager-Hyman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Lisa Dixon
- Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Michael E. Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA
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Kim DW, Cho SE, Kang JM, Woo SK, Kang SG, Yeon BK, Cho SJ. Risk Factors for Serious Suicide Attempts: Difference Between Older and Younger Attempters in the Emergency Department. Front Psychiatry 2020; 11:607811. [PMID: 33488429 PMCID: PMC7820120 DOI: 10.3389/fpsyt.2020.607811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/07/2020] [Indexed: 01/11/2023] Open
Abstract
Objective: Suicide attempts of the older adults are known to be more serious than that of the younger adults. Despite its major social impact in South Korea, the behavioral mechanism of serious suicide attempt (SSA) in old people remains to be elucidated. Thus, we investigated the risk factors for SSA in older and younger suicide attempters in the emergency department. Methods: Demographic data, clinical information, and the level of seriousness of suicide with Risk Rescue Rating Scale were compared between older (age ≥65) and younger (age <65) adults who visited the emergency department for a suicide attempt. Regression analyses were performed to identify the risk factors for SSA in these two groups. Results: Among 370 patients, 37 were older adults (10%; aged 74.41 ± 6.78), more likely to have another medical disease (p < 0.001), and a higher suicide completion rate (16.2 vs. 5.4%, p = 0.023). In the younger group, old age (B = 0.090, p < 0.001), male sex (B = -0.038, p = 0.019), and impression of schizophrenia (B = 0.074, p = 0.027) were associated with a higher risk-rescue ratio and interpersonal stress condition was associated with a lower risk-rescue ratio (B = -0.045, p = 0.006). In the older group, however, no variables were included significant in the regression model for the Risk Rescue Rating Scale. Conclusions: Demographic and clinical factors such as old age, male sex, interpersonal stress, and impression of schizophrenia were associated with lethality in the younger suicide attempters. However, no factors were associated with SSA in the older adult group. Different mechanisms may underly the lethality in old age suicide.
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Affiliation(s)
- Dong Wook Kim
- College of Medicine, Gachon University, Incheon, South Korea
| | - Seo Eun Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Jae Myeong Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Soo Kyun Woo
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Seung-Gul Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Byeong Kil Yeon
- Department of Psychiatry, Gyeonggi Provincial Medical Center Suwon Hospital, Suwon, South Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
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Rogers ML, Hom MA, Dougherty SP, Gallyer AJ, Joiner TE. Comparing Suicide Risk Factors Among Individuals with a History of Aborted, Interrupted, and Actual Suicide Attempts. Arch Suicide Res 2020; 24:57-74. [PMID: 30303461 DOI: 10.1080/13811118.2018.1522283] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Recent standardized nomenclature has suggested distinctions among aborted, interrupted, and actual suicide attempts. This study examined differences in self-reported symptoms among individuals with a history of aborted, interrupted, and actual suicide attempts. 167 young adults with a history of suicidality completed self-report measures of suicide attempt history and current symptoms, a clinical interview assessing past suicidal behavior, and a pain tolerance task. Only 78.8% of participants who initially reported a suicide attempt history were classified as suicide attempters following the clinical interview. Individuals who reported only aborted attempts during the clinical interview reported less severe clinical symptoms than those reporting a history of at least one actual attempt. Individuals with a history of actual suicide attempts may represent a more clinically severe group than those with a history of aborted attempts only.
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Rogers ML, Joiner TE. Interactive Effects of Acute Suicidal Affective Disturbance and Pain Persistence on Suicide Attempt Frequency and Lethality. CRISIS 2019; 40:413-421. [DOI: 10.1027/0227-5910/a000588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract. Background: Acute suicidal affective disturbance (ASAD) has been proposed as a suicide-specific entity that confers risk for imminent suicidal behavior. Preliminary evidence suggests that ASAD is associated with suicidal behavior beyond a number of factors; however, no study to date has examined potential moderating variables. Aims: The present study tested the hypotheses that physical pain persistence would moderate the relationship between ASAD and (1) lifetime suicide attempts and (2) attempt lethality. Method: Students ( N = 167) with a history of suicidality completed self-report measures assessing the lifetime worst-point ASAD episode and the presence of a lifetime suicide attempt, a clinical interview about attempt lethality, and a physical pain tolerance task. Results: Physical pain persistence was a significant moderator of the association between ASAD and lifetime suicide attempts ( B = 0.00001, SE = 0.000004, p = .032), such that the relationship between ASAD and suicide attempts strengthened at increasing levels of pain persistence. The interaction between ASAD and pain persistence in relation to attempt lethality was nonsignificant ( B = 0.000004, SE = 0.00001, p = .765). Limitations: This study included a cross-sectional/retrospective analysis of worst-point ASAD symptoms, current physical pain perception, and lifetime suicide attempts. Conclusion: ASAD may confer risk for suicidal behavior most strongly at higher levels of pain persistence, whereas ASAD and pain perception do not influence attempt lethality.
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Affiliation(s)
- Megan L. Rogers
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Thomas E. Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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Zelazny J, Melhem N, Porta G, Biernesser C, Keilp JG, Mann JJ, Oquendo MA, Stanley B, Brent DA. Childhood maltreatment, neuropsychological function and suicidal behavior. J Child Psychol Psychiatry 2019; 60:1085-1093. [PMID: 31342521 PMCID: PMC6837731 DOI: 10.1111/jcpp.13096] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Suicide is the second leading cause of death in young people. Childhood maltreatment, neuropsychological dysfunction and psychopathology have each been shown to increase risk for suicidal behavior. However, few studies have examined their interactions and the effects of those interactions on suicidal behavior. METHODS Across two sites, a total of 382 offspring of depressed parents underwent neuropsychological assessments. This high-risk sample included nearly equal numbers of males and females. Average age at the time of neuropsychological assessment was 18.5 years. The most prevalent lifetime psychiatric disorders were mood (43%), anxiety (37%) and alcohol and substance use disorders (21%). Childhood maltreatment was reported by 44% of offspring. Participants underwent extensive neuropsychological testing assessing the following domains: attention, memory, executive function, working memory, language fluency, and impulse control. Logistic regression was used to examine the association of reported childhood maltreatment, neuropsychological functioning, psychopathology and their interactions with suicidal behavior. Bonferroni correction was used to adjust for multiple comparisons. RESULTS Maltreatment was associated with increased risk of suicidal behavior with odds ratios ranging between 2.40 and 4.43. Moderation analyses found that adaptive neuropsychological functioning was not protective against childhood maltreatment's effect on suicidal risk. While lifetime history of mood disorder was strongly associated with suicidal behavior, higher scores in working memory (OR = 0.21; 95% CI = 0.09, 0.45; p < .001) and executive function (OR = 0.15; 95% CI = 0.05, 0.43; p < .001) were protective against suicidal behavior even in the presence of a lifetime history of mood disorder. CONCLUSIONS Further research is needed to determine how neuropsychological capacity protects depressed patients against the risk of suicidal behavior.
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Affiliation(s)
- Jamie Zelazny
- Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nadine Melhem
- Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Giovanna Porta
- Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Candice Biernesser
- Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John G. Keilp
- New York State Psychiatric Institute, Columbia University, New York, New York
| | - J. John Mann
- New York State Psychiatric Institute, Columbia University, New York, New York
| | | | - Barbara Stanley
- New York State Psychiatric Institute, Columbia University, New York, New York
| | - David A. Brent
- Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
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