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Vimalanathane M, Abhilasha P, Prasad A, Ramachandran AS, Subramanian K. Suicidal Behavior and Its Association With Psychological Distress, Coping Mechanisms, and Resilience: A Cross-Sectional Study. Cureus 2024; 16:e60322. [PMID: 38883099 PMCID: PMC11177240 DOI: 10.7759/cureus.60322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Recent literature reveals that psychological factors such as resilience and coping mechanisms can act as buffers against suicide risk. Indian literature on the interplay between psychological risk and protective factors of suicidal behavior is scarce. Methods A cross-sectional descriptive study was done among suicide attempters in a tertiary care hospital in Southern India. A semi-structured proforma was used to obtain sociodemographic data and suicide attempt characteristics. Suicide intent, lethality, stressful life events, perceived stress, subjective distress, coping strategies, and resilience were recorded using standard rating scales. Inferential analyses were carried out with p≤ 0.05 set as statistical significance. Results Pesticide poisoning (46.7%) was the most common mode of suicide attempt. Significant gender differences emerged in the mode of suicide attempt, coping strategies, and resilience. Depression (48.7%) was the most common psychiatric comorbidity. Increased perceived stress was associated with the presence of psychiatric comorbidity, past history of suicide attempts, and high-intent suicide attempts. Maladaptive coping strategies were associated with substance abuse and a history of past suicide attempts. Low resilience levels were associated with hanging attempts, psychiatric or substance use disorder comorbidity, past history of suicide attempts, high-intent suicide attempts, and less lethal suicide attempts. Conclusion Perceived stress levels, coping strategies, and resilience have significant relationships with suicidal behavior and act as avenues for suicide prevention efforts.
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Affiliation(s)
- Mayura Vimalanathane
- Department of Psychiatry, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed-to-be University), Puducherry, IND
| | | | - Amritha Prasad
- Department of Psychiatry, Sree Gokulam Medical College Hospital and Research Foundation, Trivandrum, IND
| | - Arul Saravanan Ramachandran
- Department of Psychiatry, SRM (Sri Ramaswamy Memorial) Medical College Hospital & Research Institute, SRM (Sri Ramaswamy Memorial) Institute of Science and Technology, Chennai, IND
| | - Karthick Subramanian
- Department of Psychiatry, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed-to-be University), Puducherry, IND
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Zerach G, Levinstein Y, Levi-Belz Y. Longitudinal associations between exposure to potentially morally injurious events and suicidal ideation among recently discharged veterans - The mediating roles of depression and loneliness. J Affect Disord 2024; 350:689-697. [PMID: 38224741 DOI: 10.1016/j.jad.2024.01.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Exposure to potentially morally injurious events (PMIEs) during military service is associated with heightened suicidal ideation (SI). However, no longitudinal study has established temporal associations between these variables and examined the possible mediating roles of depression and loneliness in this effect. METHODS Participants were 374 active-duty Israeli combatants who participated in a five-year longitudinal study with four measurement points: T1- one year before enlistment, T2- one month before discharge from army service, and then again six months and twelve months following their discharge (T3 and T4, respectively). Data were assessed through semi-structured interviews and validated self-report questionnaires. RESULTS Above and beyond pre-enlistment personal characteristics (T1) and combat exposure (T2), PMIEs-'betrayal' (T2) predicted more frequent SI over the past twelve months (T4) through the mediation of depression. Moreover, both PMIEs-'betrayal' and 'self' (T2) predicted more frequent SI over the past twelve months (T4) through the mediation of loneliness. LIMITATIONS We used self-report measures to assess PMIEs and SI, which may suffer from various biases. CONCLUSIONS Our findings are the first to provide evidence of longitudinal, temporal associations between exposure to PMIEs and SI. Notably, potential interventions might consider addressing the loneliness experienced following exposure to PMIEs during military service, among recently discharged traumatized veterans.
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Affiliation(s)
- Gadi Zerach
- Dept. of Psychology, Ariel University, Ariel, Israel.
| | - Yoav Levinstein
- Dept. of Health and Well-being, Medical Corps, IDF, School of Social Work, Bar-Ilan University, Ramat-Gan, Israel
| | - Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
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Pereira CA, Reis-de-Oliveira G, Pierone BC, Martins-de-Souza D, Kaster MP. Depicting the molecular features of suicidal behavior: a review from an "omics" perspective. Psychiatry Res 2024; 332:115682. [PMID: 38198856 DOI: 10.1016/j.psychres.2023.115682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 12/05/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024]
Abstract
Background Suicide is one of the leading global causes of death. Behavior patterns from suicide ideation to completion are complex, involving multiple risk factors. Advances in technologies and large-scale bioinformatic tools are changing how we approach biomedical problems. The "omics" field may provide new knowledge about suicidal behavior to improve identification of relevant biological pathways associated with suicidal behavior. Methods We reviewed transcriptomic, proteomic, and metabolomic studies conducted in blood and post-mortem brains from individuals who experienced suicide or suicidal behavior. Omics data were combined using systems biology in silico, aiming at identifying major biological mechanisms and key molecules associated with suicide. Results Post-mortem samples of suicide completers indicate major dysregulations in pathways associated with glial cells (astrocytes and microglia), neurotransmission (GABAergic and glutamatergic systems), neuroplasticity and cell survivor, immune responses and energy homeostasis. In the periphery, studies found alterations in molecules involved in immune responses, polyamines, lipid transport, energy homeostasis, and amino and nucleic acid metabolism. Limitations We included only exploratory, non-hypothesis-driven studies; most studies only included one brain region and whole tissue analysis, and focused on suicide completers who were white males with almost none confounding factors. Conclusions We can highlight the importance of synaptic function, especially the balance between the inhibitory and excitatory synapses, and mechanisms associated with neuroplasticity, common pathways associated with psychiatric disorders. However, some of the pathways highlighted in this review, such as transcriptional factors associated with RNA splicing, formation of cortical connections, and gliogenesis, point to mechanisms that still need to be explored.
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Affiliation(s)
- Caibe Alves Pereira
- Laboratory of Translational Neurosciences, Department of Biochemistry, Federal University of Santa Catarina (UFSC), Florianopolis, Santa Catarina, Brazil
| | - Guilherme Reis-de-Oliveira
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Bruna Caroline Pierone
- Laboratory of Translational Neurosciences, Department of Biochemistry, Federal University of Santa Catarina (UFSC), Florianopolis, Santa Catarina, Brazil
| | - Daniel Martins-de-Souza
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, SP, Brazil; Instituto Nacional de Biomarcadores Em Neuropsiquiatria (INBION) Conselho Nacional de Desenvolvimento Científico E Tecnológico, São Paulo, Brazil; Experimental Medicine Research Cluster (EMRC), University of Campinas, Campinas, SP, Brazil; D'Or Institute for Research and Education (IDOR), São Paulo, Brazil; INCT in Modelling Human Complex Diseases with 3D Platforms (Model3D), São Paulo, Brazil.
| | - Manuella Pinto Kaster
- Laboratory of Translational Neurosciences, Department of Biochemistry, Federal University of Santa Catarina (UFSC), Florianopolis, Santa Catarina, Brazil.
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Levkovich I, Elyoseph Z. Suicide Risk Assessments Through the Eyes of ChatGPT-3.5 Versus ChatGPT-4: Vignette Study. JMIR Ment Health 2023; 10:e51232. [PMID: 37728984 PMCID: PMC10551796 DOI: 10.2196/51232] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND ChatGPT, a linguistic artificial intelligence (AI) model engineered by OpenAI, offers prospective contributions to mental health professionals. Although having significant theoretical implications, ChatGPT's practical capabilities, particularly regarding suicide prevention, have not yet been substantiated. OBJECTIVE The study's aim was to evaluate ChatGPT's ability to assess suicide risk, taking into consideration 2 discernable factors-perceived burdensomeness and thwarted belongingness-over a 2-month period. In addition, we evaluated whether ChatGPT-4 more accurately evaluated suicide risk than did ChatGPT-3.5. METHODS ChatGPT was tasked with assessing a vignette that depicted a hypothetical patient exhibiting differing degrees of perceived burdensomeness and thwarted belongingness. The assessments generated by ChatGPT were subsequently contrasted with standard evaluations rendered by mental health professionals. Using both ChatGPT-3.5 and ChatGPT-4 (May 24, 2023), we executed 3 evaluative procedures in June and July 2023. Our intent was to scrutinize ChatGPT-4's proficiency in assessing various facets of suicide risk in relation to the evaluative abilities of both mental health professionals and an earlier version of ChatGPT-3.5 (March 14 version). RESULTS During the period of June and July 2023, we found that the likelihood of suicide attempts as evaluated by ChatGPT-4 was similar to the norms of mental health professionals (n=379) under all conditions (average Z score of 0.01). Nonetheless, a pronounced discrepancy was observed regarding the assessments performed by ChatGPT-3.5 (May version), which markedly underestimated the potential for suicide attempts, in comparison to the assessments carried out by the mental health professionals (average Z score of -0.83). The empirical evidence suggests that ChatGPT-4's evaluation of the incidence of suicidal ideation and psychache was higher than that of the mental health professionals (average Z score of 0.47 and 1.00, respectively). Conversely, the level of resilience as assessed by both ChatGPT-4 and ChatGPT-3.5 (both versions) was observed to be lower in comparison to the assessments offered by mental health professionals (average Z score of -0.89 and -0.90, respectively). CONCLUSIONS The findings suggest that ChatGPT-4 estimates the likelihood of suicide attempts in a manner akin to evaluations provided by professionals. In terms of recognizing suicidal ideation, ChatGPT-4 appears to be more precise. However, regarding psychache, there was an observed overestimation by ChatGPT-4, indicating a need for further research. These results have implications regarding ChatGPT-4's potential to support gatekeepers, patients, and even mental health professionals' decision-making. Despite the clinical potential, intensive follow-up studies are necessary to establish the use of ChatGPT-4's capabilities in clinical practice. The finding that ChatGPT-3.5 frequently underestimates suicide risk, especially in severe cases, is particularly troubling. It indicates that ChatGPT may downplay one's actual suicide risk level.
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Affiliation(s)
- Inbar Levkovich
- Oranim Academic College, Faculty of Graduate Studies, Kiryat Tivon, Israel
| | - Zohar Elyoseph
- Department of Psychology and Educational Counseling, The Center for Psychobiological Research, Max Stern Yezreel Valley College, Emek Yezreel, Israel
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
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Cronn SE, Kant JM, Brandolino A, Kohlbeck S, deRoon-Cassini T, Emerson N, Schramm A. Suicide Data in Trauma Centers: Implications of Imprecision. J Trauma Nurs 2023; 30:255-260. [PMID: 37702726 DOI: 10.1097/jtn.0000000000000739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND Trauma registries exist to provide data for evaluating the quality of care of trauma patients. These data facilitate research and can be used for outreach, planning, and improvement in trauma patient outcomes. However, the accuracy of registry data related to suicide has not been well studied. OBJECTIVE This study sought to evaluate the accuracy of current trauma registry coding practices related to labeling injury as a suicide attempt among patients presenting to a Level I trauma center after self-inflicted injury. METHODS We conducted a single-center, retrospective cohort analysis of a Level I trauma center trauma registry on all patients with self-inflicted injuries from 2011 to 2021. Manual chart review was used to identify cases wherein patients' injuries were categorized as suicidal despite the absence of suicidal intent. RESULTS During this 11-year period, 537 patients were identified as having presented to the trauma center for traumatic self-inflicted injuries. Manual chart review revealed that 16% of these patients were incorrectly categorized as having attempted suicide despite their self-inflicted injury lacking suicidal intent (e.g., accidents, nonsuicidal self-harm). CONCLUSION We found that 16% of trauma registry patients were overcategorized as having attempted suicide. Trauma registry data are an important source of information for activities related to injury prevention in trauma centers. Imprecise coding of self-inflicted injury may lead to poorly targeted programs and interventions due to incorrectly represented injury causes and patterns in trauma patient populations, including suicide prevention.
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Affiliation(s)
- Susan E Cronn
- Division of Trauma & Acute Care Surgery, Department of Surgery (Drs Cronn, deRoon-Cassini, and Schramm and Ms Brandolino), and Comprehensive Injury Center (Drs Cronn, Kohlbeck, and Schramm and Ms Kant), Medical College of Wisconsin, Milwaukee; and Froedtert Hospital, Milwaukee, Wisconsin (Mr Emerson)
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Zhao S, Yan W, Tao L, Zhang J. The Association Between Relative Deprivation, Depression, and Youth Suicide: Evidence From a Psychological Autopsy Study. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231190595. [PMID: 37462026 DOI: 10.1177/00302228231190595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
OBJECTIVE Suicide is a serious public health concern in China. In the present study, we investigated the specific mechanisms underlying relative deprivation and suicide in rural China. METHODS A large psychological autopsy study was conducted in rural China, in which 392 suicides and 416 community-living controls were consecutively recruited. Multiple logistic regression analysis was used to assess the relationship between relative deprivation and suicide, with depression as a potential mediator. RESULTS Young people who experienced relative deprivation were at a greater risk of suicide and depression. Depression plays a mediating role in the relationship between relative deprivation and suicide. LIMITATIONS Due to the limitations of the data, we cannot know whether there is mutual causation between relative deprivation and depression. The self-reported relative deprivation may also produce some influence on the results. CONCLUSIONS The current findings demonstrate the importance of relative deprivation as one of the four sources of psychological strain to explain how relative status is associated with suicide. The findings also can be translated into the clinical and preventive practice for suicide.
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Affiliation(s)
- Sibo Zhao
- Central University of Finance and Economics, Beijing, China
| | - Wenqun Yan
- Central University of Finance and Economics, Beijing, China
| | - Lifan Tao
- Central University of Finance and Economics, Beijing, China
| | - Jie Zhang
- Central University of Finance and Economics, Beijing, China
- State University of New York Buffalo State University, Buffalo, NY, USA
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Barker J, Oakes-Rogers S, Leddy A. What distinguishes high and low-lethality suicide attempts in older adults? A systematic review and meta-analysis. J Psychiatr Res 2022; 154:91-101. [PMID: 35933859 DOI: 10.1016/j.jpsychires.2022.07.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/30/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022]
Abstract
Those making suicide attempts with highly lethal medical consequences are arguably the best proxy for those who die by suicide and represent a qualitatively different population from those making lower lethality attempts. Different factors influence the likelihood of a suicide attempt occurring and the lethality of that attempt. Both are important dimensions of risk. Older adults represent a distinct group in suicide research with unique risk factors that influence the lethality of their suicide attempts. This systematic review and meta-analysis summarises factors distinguishing those making high and low-lethality suicide attempts in older adulthood. Databases PsycINFO, PubMed (MEDLINE), Embase and CINAHL were systematically searched with seven of 1182 unique records included. Random effects meta-analyses were conducted on 18 variables in addition to a narrative synthesis regarding executive function. Only increased suicidal intent and planning meaningfully distinguished high from low-lethality attempters in meta-analyses. A large effect size was additionally observed for white ethnicity. Diminished alcohol use disorder prevalence and depression severity, and greater cognitive impairment, may be associated with high lethality attempters but further research is needed. Age and gender were not associated with lethality, contrary to adult populations. A narrative synthesis of studies exploring differences in executive functioning suggested high-lethality attempters were less likely to impulsively act on suicidal urges, allowing them to better plan suicide attempts that are more lethal, and are less likely to alter suicidal plans. Key limitations were that meta-analyses were underpowered to detect small effect sizes, and samples were largely white and limited to the USA.
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Morales S, Barros J. Mental Pain Surrounding Suicidal Behaviour: A Review of What Has Been Described and Clinical Recommendations for Help. Front Psychiatry 2021; 12:750651. [PMID: 35153847 PMCID: PMC8828913 DOI: 10.3389/fpsyt.2021.750651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/21/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To conduct a comprehensive review of scientific publications related to mental pain and suicide risk in order to deepen relevant aspects to guide clinical interventions. METHOD Using a text analysis tool, we collected the terms most frequently linked with that situation in published results of research using various tools to evaluate mental pain or psychache. DISCUSSION We propose clinical interventions for the clinical conditions most commonly associated with mental pain.
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Affiliation(s)
- Susana Morales
- Psychiatry Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
| | - Jorge Barros
- Psychiatry Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
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