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Nöhles VB, Bermpohl F, Falkai P, Reif-Leonhard C, Jessen F, Adli M, Otte C, Meyer-Lindenberg A, Bauer M, Rubarth K, Anghelescu IG, Rujescu D, Correll CU. Patient characteristics, validity of clinical diagnoses and Outcomes Associated with Suicidality in Inpatients with Symptoms of Depression (OASIS-D): design, procedures and outcomes. BMC Psychiatry 2023; 23:744. [PMID: 37828493 PMCID: PMC10571442 DOI: 10.1186/s12888-023-05230-9] [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: 06/15/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Suicidality, ranging from passive suicidal thoughts to suicide attempt, is common in major depressive disorder (MDD). However, relatively little is known about patient, illness and treatment characteristics in those with co-occurring MDD and suicidality, including the timing of and factors associated with the offset, continuation or reemergence of suicidality. Here, we present the background, rationale, design and hypotheses of the Patient Characteristics, Validity of Clinical Diagnoses and Outcomes Associated with Suicidality in Inpatients with Symptoms of Depression (OASIS-D) study, an investigator-initiated, observational study, funded by Janssen-Cilag GmbH. METHODS/RESULTS OASIS-D is an eight-site, six-month, cohort study of patients aged 18-75 hospitalized with MDD. Divided into three sub-studies and patient populations (PPs), OASIS-D will (i) systematically characterize approximately 4500 consecutively hospitalized patients with any form of unipolar depressive episode (PP1), (ii) evaluate the validity of the clinical diagnosis of moderate or severe unipolar depressive episode with the Mini-International Neuropsychiatric Interview (M.I.N.I.) and present suicidality (at least passive suicidal thoughts) present ≥ 48 h after admission with the Sheehan-Suicide Tracking Scale (S-STS), assessing also predictors of the diagnostic concordance/discordance of MDD in around 500 inpatients (PP2), and (iii) characterize and prospectively follow for 6 months 315 inpatients with a research-verified moderate or severe unipolar depressive episode and at least passive suicidal thoughts ≥ 48 h after admission, evaluating treatment and illness/response patterns at baseline, hospital discharge, 3 and 6 months. Exploratory objectives will describe the association between the number of days with suicidality and utilization of outpatient and inpatient care services, and structured assessments of factors influencing the risk of self-injurious behavior without suicidal intent, and of continuous, intermittent or remitted suicidality during the 6-month observation period. CONCLUSION Despite their frequency and clinical relevance, relatively little is known about patient and treatment characteristics of individuals with MDD and suicidality, including factors moderating and mediating the outcome of both MDD and suicidality. Results of the OASIS-D study are hoped to improve the understanding of the frequency, correlates and 6-month naturalistic treatment and outcome trajectories of different levels of suicidality in hospitalized adults with MDD and suicidality. TRIAL REGISTRATION NCT04404309 [ClinicalTrials.gov].
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Affiliation(s)
- Viktor B Nöhles
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus St. Hedwig Hospital, Berlin, Germany
| | - Peter Falkai
- Clinic for Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christine Reif-Leonhard
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Mitte, Berlin, Germany
- Center for Psychiatry, Psychotherapy and Psychosomatic Medicine, Fliedner Klinik Berlin, Berlin, Germany
| | - Christian Otte
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Kerstin Rubarth
- Institute of Medical Informatics, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ion-George Anghelescu
- Clinic for Psychiatry, Psychosomatics and Psychotherapy, Mental Health Institute Berlin, Berlin, Germany
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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Ezquerra B, Alacreu-Crespo A, Peñuelas-Calvo I, Abascal-Peiró S, Jiménez-Muñoz L, Nicholls D, Baca-García E, Porras-Segovia A. Characteristics of single vs. multiple suicide attempters among adolescents: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02260-2. [PMID: 37470845 DOI: 10.1007/s00787-023-02260-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023]
Abstract
There might be differential characteristics between those who have attempted suicide once in their lifetime (single attempters) and those who have attempted suicide two or more times (multiple attempters). We aimed to identify the factors that differentiate single and multiple attempters in child and adolescents. This study was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, and the review protocol was registered in PROSPERO. We conducted a systematic literature search in three databases to identify original studies exploring the characteristics of single attempters vs. multiple attempters among adolescents. We considered a wide range for the definition of adolescent, following most recent recommendations: 10-24 years. We carried out a meta-analysis. Fourteen studies were included in the systematic review and 13 in the meta-analysis with a total sample of with a total of 4286 participants. The factors statistically significantly associated with being a multiple attempter in the meta-analysis were: anxiety disorders, depression severity, alcohol abuse, substance abuse, aggressiveness, and hopelessness. Multiple attempters have a more severe clinical profile, with greater severity of symptoms. Knowledge of the risk factors associated with being a multiple attempter could help us to predict which patients are more likely to reattempt suicide and need further monitoring and a tailored treatment. Prevention programs tailored for the adolescent population, along with identification of early risk factors, could help to prevent suicidal behavior among this vulnerable population.
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Affiliation(s)
- Berta Ezquerra
- Department of Psychiatry, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | - Adrián Alacreu-Crespo
- Department of Psychology and Sociology, Area of Personality, Assessment and Psychological Treatment, Universidad of Zaragoza, Teruel, Spain
| | - Inmaculada Peñuelas-Calvo
- Department of Child and Adolescent Psychiatry, Hospital 12 de Octubre, Madrid, Spain.
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain.
| | - Sofía Abascal-Peiró
- Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Enrique Baca-García
- Department of Psychiatry, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
- Department of Child and Adolescent Psychiatry, Hospital 12 de Octubre, Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Central de Villalba, Madrid, Spain
- Universidad Católica del Maule, Talca, Chile
- CIBERSAM, Madrid, Spain
- Université de Nîmes, Nîmes, France
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alejandro Porras-Segovia
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain.
- Division of Psychiatry, Imperial College, London, UK.
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Alabi AA. Suicide attempts among students of higher education, Nelson Mandela Bay Municipality, South Africa. S Afr Fam Pract (2004) 2022; 64:e1-e7. [PMID: 36453798 PMCID: PMC9724133 DOI: 10.4102/safp.v64i1.5609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Worldwide, death by suicide is a leading cause of death among young people, and students of higher educational institutions constitute a vulnerable group. This study aimed to determine the lifetime prevalence and associated factors of suicide attempt among students of a higher education institution in Nelson Mandela Municipality. METHODS A cross sectional study was conducted among students of East Cape Midland College in Nelson Mandela Municipality. The participants were selected by stratified random sampling and a standardised self-administered questionnaire was used to collect data. RESULTS The prevalence of lifetime suicide attempts was 16.0% among the participants. Multivariate logistic regression analysis revealed higher odds of suicide attempts among participants who: experienced bullying (OR: 1.66, CI: 1.05-2.61; p 0.001), had underlying medical conditions (OR: 3.27, CI: 2.08-5.14; p 0.001), had abnormal body weight perceptions (OR: 1.64, CI: 1.03-2.62; p 0.05), had experienced sexual abuse (OR: 5.72, CI: 2.86-11.45; p 0.001), or had someone very close who had experienced sexual abuse (OR: 1.77, CI: 1.02-3.05; p 0.05). CONCLUSION This study identified history of sexual abuse, bullying, perceptions of abnormal body weight and underlying medical conditions as associated risk factors of suicide attempts among the participants. The high prevalence of suicide attempts among the participants (16%) demonstrates the urgent need for campus-based interventions and prevention strategies aimed at addressing the identified associated factors.
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Affiliation(s)
- Adeyinka A Alabi
- Department of Family Medicine, Faculty of Health Science, Walter Sisulu University, Port Elizabeth, South Africa; and, Department of Family Medicine, Dora Nginza Provincial Hospital, Port Elizabeth.
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Chiang YH, Ma YC, Lin YC, Jiang JL, Wu MH, Chiang KC. The Relationship between Depressive Symptoms, Rumination, and Suicide Ideation in Patients with Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114492. [PMID: 36361367 PMCID: PMC9658339 DOI: 10.3390/ijerph192114492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/29/2022] [Accepted: 11/02/2022] [Indexed: 05/30/2023]
Abstract
UNLABELLED The relationship between suicide and rumination in depression is a recent topic of attention in mental health. The purpose of this study was to investigate the relationship between demographic variables, depressive symptoms, rumination, and suicide ideation in patients with depression, as well as the predictors of suicide ideation. RESEARCH DESIGN A cross-sectional study of 95 subjects with depression recruited intentionally from the psychiatric ward of Tzu Chi Hospital. The questionnaire included demographic data, the Beck Depression Inventory-II, the Ruminative Response Scale, and the Beck Scale for Suicide Ideation. Independent sample t-test, Pearson product difference correlation, and the stepwise regression test were adopted for data analysis. RESULTS Age (r = -0.41, p < 0.01), age at diagnosis (r = -0.34, p < 0.01), and sleep duration (r = -0.25, p < 0.05) were negatively correlated with rumination-reflection. The depressive symptoms (r = 0.72, p < 0.01) were positively correlated with rumination, whereas rumination (r = 0.57, p < 0.01) and suicide ideation were positively correlated. Depressive symptoms and rumination could predict suicide ideation, and the effective explanatory power reached 60%. CONCLUSIONS If the patient with depression was younger or the patient was diagnosed at a younger age, the depressive symptoms of the reflection subscale of rumination thinking and suicide ideation were more serious. Our results indicate that clinicians who care for patients with depression should be aware of rumination and its impact on suicide ideation, specifically in younger patients.
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Affiliation(s)
- Yi-Hsuan Chiang
- Department of Nursing, Fu Jen Catholic University, New Taipei City 24205, Taiwan
| | - Yu-Chin Ma
- Department of Nursing, Tzu Chi University, Hualien 97004, Taiwan
| | - Yu-Chuan Lin
- Department of Nursing, Tzu Chi University, Hualien 97004, Taiwan
| | - Jin-Ling Jiang
- Department of Nursing, Tzu Chi University, Hualien 97004, Taiwan
| | - Mei-Hui Wu
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien 970302, Taiwan
| | - Kuo-Cheng Chiang
- Psychiatric Ward for Hualien Tzu Chi Hospital, Hualien 97004, Taiwan
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Aaltonen KI, Rosenström T, Jylhä P, Holma I, Holma M, Pallaskorpi S, Riihimäki K, Suominen K, Vuorilehto M, Isometsä ET. Do Suicide Attempts of Mood Disorder Patients Directly Increase the Risk for a Reattempt? Front Psychiatry 2020; 11:547791. [PMID: 33324247 PMCID: PMC7725715 DOI: 10.3389/fpsyt.2020.547791] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/09/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Preceding suicide attempts strongly predict future suicidal acts. However, whether attempting suicide per se increases the risk remains undetermined. We longitudinally investigated among patients with mood disorders whether after a suicide attempt future attempts occur during milder depressive states, indicating a possible lowered threshold for acting. Methods: We used 5-year follow-up data from 581 patients of the Jorvi Bipolar Study, Vantaa Depression Study, and Vantaa Primary Care Depression Study cohorts. Lifetime suicide attempts were investigated at baseline and during the follow-up. At follow-up interviews, life-chart data on the course of the mood disorder were generated and suicide attempts timed. By using individual-level data and multilevel modeling, we investigated at each incident attempt the association between the lifetime ordinal number of the attempt and the major depressive episode (MDE) status (full MDE, partial remission, or remission). Results: A total of 197 suicide attempts occurred among 90 patients, most during MDEs. When the dependencies between observations and individual liabilities were modeled, no association was found between the number of past suicide attempts at the time of each attempt and partial remissions. No association between adjusted inter-suicide attempt times and the number of past attempts emerged during follow-up. No indication for direct risk-increasing effects was found. Conclusion: Among mood disorder patients, repeated suicide attempts do not tend to occur during milder depressive states than in the preceding attempts. Previous suicide attempts may indicate underlying diathesis, future risk being principally set by the course of the disorder itself.
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Affiliation(s)
- Kari I Aaltonen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Mental Health Unit, Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Tom Rosenström
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Pekka Jylhä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Mental Health Unit, Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Irina Holma
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Mental Health Unit, Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Mikael Holma
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Mental Health Unit, Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Sanna Pallaskorpi
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Mental Health Unit, Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Kirsi Riihimäki
- Mental Health Unit, Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Kirsi Suominen
- Department of Mental Health and Substance Abuse Services, Department of Health and Social Services, Helsinki, Finland
| | - Maria Vuorilehto
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Mental Health Unit, Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Erkki T Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Mental Health Unit, Finnish Institute of Health and Welfare, Helsinki, Finland
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Bergmans Y, Gordon E, Eynan R. Surviving moment to moment: The experience of living in a state of ambivalence for those with recurrent suicide attempts. Psychol Psychother 2017; 90:633-648. [PMID: 28497887 DOI: 10.1111/papt.12130] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 02/25/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This qualitative study aimed to capture the experience of living in the ambivalent space between life and death for adults with recurrent suicide attempts (RSA). It sought to expand upon an earlier study that explored the processes involved in transitioning away from RSA among adults, which revealed that occupying this ambivalent space is a crucial part of this process. DESIGN Interpretive phenomenological analysis (IPA) was used. This methodology was designed to explore the lived experiences and meaning making and enabled interpretation of the multidimensional subjective experiences of RSA participants. METHODS In-depth semi-structured interviews were conducted with eight adult women with a history of RSA who had participated in a therapeutic intervention at the research site (Skills for Safer Living: A Psychosocial/Psychoeducational Intervention for People with Recurrent Suicide Attempts [SfSL/PISA]). The six stages of IPA were followed to analyse the interview data. RESULTS Analysis revealed the superordinate theme, 'surviving moment to moment', which refers to a precarious state of making decisions about one's life and destiny on a moment-to-moment basis without clear commitment to either life or death. Two subordinate themes were identified: 'deciding not to die in the moment' when the participants were more invested in dying than living and 'deciding to live in the moment' when they were more invested in living than dying. CONCLUSION The study illuminated the complex process of making decisions about ones' destiny on a moment-to-moment basis. It revealed the torment experienced when occupying this state, while paradoxically, also revealing how indecision about life and death provided a lifeline opportunity for those with RSA. Clinicians who recognize the subtle distinctions associated with this in-between state can tailor their interventions accordingly. PRACTITIONER POINTS Surviving moment to moment is characterized by a state of emotional flux and uncertainty about one's destiny, where the person has not fully committed to either life or death. Within this state, there are two interlinked subprocesses, whereby the person is leaning more towards death or life. A critical feature in working with this client group is to recognize their ambiguity and the fragility and temporality of their decisions about their destiny. The practitioner has an opportunity to be a catalyst in the momentum towards life by demonstrating understanding of this survival struggle and tailoring intervention to fit with the nuanced processes within this state.
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Affiliation(s)
- Yvonne Bergmans
- Arthur Sommer Rotenberg Chair in Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada.,University of Toronto, Ontario, Canada
| | | | - Rahel Eynan
- Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Rahme E, Low NCP, Lamarre S, Daneau D, Habel Y, Turecki G, Bonin JP, Morin S, Szkrumelak N, Singh S, Lesage A. Correlates of Attempted Suicide from the Emergency Room of 2 General Hospitals in Montreal, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:382-393. [PMCID: PMC4910406 DOI: 10.1177/0706743716639054] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Introduction: The epidemiology of attempted suicide has not been well characterized because of lack of national data or an International Classification of Diseases (ICD) code for suicide attempts. We conducted a retrospective chart review in 2 adult general hospitals (tertiary and community) in Montreal, Canada, in 2009-2010 to 1) describe the characteristics of men and women who presented to the emergency department (ED) and/or were hospitalized following a suicide attempt, 2) identify factors associated with attempts requiring hospitalizations, and 3) validate the use of International Classification of Diseases, 10th Revision (ICD-10) codes for “intentional self-harm” as a method to detect suicide attempts from hospital abstract summary records. Method: All potential suicide attempts were identified from hospital abstract summary records and ED nursing triage file using ICD-10 codes and keywords suggestive of suicide attempts. All identified charts were examined, and those with confirmed suicide attempts were fully reviewed. Results: Of the 5746 identified charts, 369 were fully reviewed. Of these, 176 were for suicide attempters treated in the ED and 193 for hospitalized attempters, of whom 46% had an ICD-10 code for intentional self-harm. Poisoning (46%) was the most frequent method of suicide used. Half of attempters were younger than 34 years, 53% were female, and 75% had a history of mental disorders. Conclusion: About half of individuals who seek medical care for attempted suicide are admitted to hospital. About half of attempters use poisoning as a method of suicide, and a quarter do not have a history of mental disorders. Intentional self-harm codes capture only about half of hospitalized attempters.
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Affiliation(s)
- Elham Rahme
- Research Institute of the McGill University Health Centre, Montreal, Quebec
- Department of Medicine, McGill University, Montreal, Quebec
| | - Nancy C. P. Low
- Department of Psychiatry, McGill University Health Centre, Montreal, Quebec
| | - Suzanne Lamarre
- Department of Psychiatry, McGill University, St-Mary’s Hospital Center, Montreal, Quebec
| | - Diane Daneau
- Douglas Mental Health University Institute, Montreal, Quebec
| | - Youssef Habel
- Department of Psychiatry, McGill University Health Centre, Montreal, Quebec
| | - Gustavo Turecki
- Department of Psychiatry, McGill University Health Centre, Montreal, Quebec
| | | | - Suzanne Morin
- Research Institute of the McGill University Health Centre, Montreal, Quebec
- Department of Medicine, McGill University, Montreal, Quebec
| | - Nadia Szkrumelak
- Department of Psychiatry, McGill University Health Centre, Montreal, Quebec
| | - Santokh Singh
- Department of Psychiatry, McGill University, St-Mary’s Hospital Center, Montreal, Quebec
| | - Alain Lesage
- Department of Psychiatry, Université de Montréal, Montreal, Quebec
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Abstract
Depression is the most common psychiatric illness in the general community, with 3% to 4% of depressives dying by suicide today. Studies have shown that depression has considerable morbidity and mortality. This article focuses on depressed patients and their management within the emergency department. Understanding the intricacies of the interview process and identifying which patients need immediate attention are important skills for the emergency physician.
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Affiliation(s)
- Dick C Kuo
- Section of Emergency Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Mina Tran
- Section of Emergency Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Asim A Shah
- Department of Psychiatry, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX 77030, USA
| | - Anu Matorin
- Department of Psychiatry, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX 77030, USA
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9
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Blasco-Fontecilla H, Fernández-Fernández R, Colino L, Fajardo L, Perteguer-Barrio R, de Leon J. The Addictive Model of Self-Harming (Non-suicidal and Suicidal) Behavior. Front Psychiatry 2016; 7:8. [PMID: 26869941 PMCID: PMC4734209 DOI: 10.3389/fpsyt.2016.00008] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/14/2016] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Behavioral addictions such as gambling, sun-tanning, shopping, Internet use, work, exercise, or even love and sex are frequent, and share many characteristics and common neurobiological and genetic underpinnings with substance addictions (i.e., tolerance, withdrawal, and relapse). Recent literature suggests that both non-suicidal self-injury (NSSI) and suicidal behavior (SB) can also be conceptualized as addictions. The major aim of this mini review is to review the literature and explore the neurobiological and psychological mechanisms underlying the addiction to self-harming behaviors. METHOD This is a narrative review. The authors performed literature searches in PubMed and Google for suicidal behavior, self-harming, addiction, and "major repeaters." Given the scarce literature on the topic, a subset of the most closely related studies was selected. The authors also focused on three empirical studies testing the hypothesis that major repeaters (individuals with ≥5 lifetime suicide attempts) represent a distinctive suicidal phenotype and are the individuals at risk of developing an addiction to SB. RESULTS The authors reviewed the concept of behavioral addictions and major repeaters, current empirical evidence testing concerning whether or not NSSI and SB can be understood as "addictions," and the putative mechanisms underlying them. CONCLUSION Our review suggests that both NSSI and SB can be conceptualized as addictions. This is relevant because if some individual's self-harming behaviors are better conceptualized as an addiction, treatment approaches could be tailored to this addiction.
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Affiliation(s)
- Hilario Blasco-Fontecilla
- Department of Psychiatry, Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Puerta de Hierro University Hospital, Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain; Consulting Asistencial Sociosanitario (CAS), Madrid, Spain
| | - Roberto Fernández-Fernández
- Department of Psychiatry, Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Puerta de Hierro University Hospital , Madrid , Spain
| | - Laura Colino
- Department of Psychiatry, Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Puerta de Hierro University Hospital , Madrid , Spain
| | - Lourdes Fajardo
- Department of Psychiatry, Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Puerta de Hierro University Hospital , Madrid , Spain
| | - Rosa Perteguer-Barrio
- Department of Psychiatry, Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Puerta de Hierro University Hospital , Madrid , Spain
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital , Lexington, KY , USA
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10
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Choon MW, Abu Talib M, Yaacob SN, Awang H, Tan JP, Hassan S, Ismail Z. Negative automatic thoughts as a mediator of the relationship between depression and suicidal behaviour in an at-risk sample of Malaysian adolescents. Child Adolesc Ment Health 2015; 20:89-93. [PMID: 32680393 DOI: 10.1111/camh.12075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study examined the mediating role of negative automatic thoughts in the relationship between depression and suicidal behaviour in a sample of at-risk Malaysian adolescents. METHOD A total of 1441 adolescents were initially recruited via multistage cluster sampling. Subsequently, 294 at-risk adolescents were selected for further analyses through a specified cut-off score. RESULTS The results showed significant positive relationships among the study variables. Specifically, negative automatic thoughts emerged as a significant mediator in the relation between depression and suicidal behaviour (z = 7.15, p < .001). CONCLUSIONS The findings suggest that depressed adolescents are at high risk for a host of negative thought processes which in turn lead to suicidal behaviour. The study limitations and recommendations for further research are discussed.
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Affiliation(s)
- Min Wai Choon
- Department of Human Development and Family Studies, Universiti Putra Malaysia, Serdang, Malaysia
| | - Mansor Abu Talib
- Department of Human Development and Family Studies, Universiti Putra Malaysia, Serdang, Malaysia
| | - Siti Nor Yaacob
- Department of Human Development and Family Studies, Universiti Putra Malaysia, Serdang, Malaysia
| | - Hamidin Awang
- Department of Psychiatry, Universiti Putra Malaysia, Serdang, Malaysia
| | - Jo Pei Tan
- Department of Social Work and Social Care, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, United Kingdom
| | - Sallahuddin Hassan
- Department of Economics and Agribusiness, Universiti Utara Malaysia, Sintok, Malaysia
| | - Zanariah Ismail
- Department of Human Development and Family Studies, Universiti Putra Malaysia, Serdang, Malaysia
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11
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Bhui K, Everitt B, Jones E. Might depression, psychosocial adversity, and limited social assets explain vulnerability to and resistance against violent radicalisation? PLoS One 2014; 9:e105918. [PMID: 25250577 PMCID: PMC4174521 DOI: 10.1371/journal.pone.0105918] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 07/25/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND This study tests whether depression, psychosocial adversity, and limited social assets offer protection or suggest vulnerability to the process of radicalisation. METHODS A population sample of 608 men and women of Pakistani or Bangladeshi origin, of Muslim heritage, and aged 18-45 were recruited by quota sampling. Radicalisation was measured by 16 questions asking about sympathies for violent protest and terrorism. Cluster analysis of the 16 items generated three groups: most sympathetic (or most vulnerable), most condemning (most resistant), and a large intermediary group that acted as a reference group. Associations were calculated with depression (PHQ9), anxiety (GAD7), poor health, and psychosocial adversity (adverse life events, perceived discrimination, unemployment). We also investigated protective factors such as the number social contacts, social capital (trust, satisfaction, feeling safe), political engagement and religiosity. RESULTS Those showing the most sympathy for violent protest and terrorism were more likely to report depression (PHQ9 score of 5 or more; RR = 5.43, 1.35 to 21.84) and to report religion to be important (less often said religion was fairly rather than very important; RR = 0.08, 0.01 to 0.48). Resistance to radicalisation measured by condemnation of violent protest and terrorism was associated with larger number of social contacts (per contact: RR = 1.52, 1.26 to 1.83), less social capital (RR = 0.63, 0.50 to 0.80), unavailability for work due to housekeeping or disability (RR = 8.81, 1.06 to 37.46), and not being born in the UK (RR = 0.22, 0.08 to 0.65). CONCLUSIONS Vulnerability to radicalisation is characterised by depression but resistance to radicalisation shows a different profile of health and psychosocial variables. The paradoxical role of social capital warrants further investigation.
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Affiliation(s)
- Kamaldeep Bhui
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- * E-mail:
| | - Brian Everitt
- Institute of Psychiatry King's College London, London, United Kingdom
| | - Edgar Jones
- King's Centre for Military Health Research, Institute of Psychiatry, King's College London, London, United Kingdom
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12
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Abstract
The aim of this study is to identify the characteristic features of suicide reattempters. The recognition of the suicide reattempters population as a distinct clinical population may encourage future preventive and clinical work with this high-risk subgroup and thus reduce deaths. A systematic literature review was carried out in order to identify the key demographic, psychological, and clinical variables associated with the repetition of suicide attempts. In addition, we wished to analyze the operational definitions of the repetition of suicide attempts proposed in the scientific literature. Studies published from 2000 to 2012 were identified in PubMed, PsycINFO, and Web of Science databases and were selected according to predetermined criteria. We examined a total of 1480 articles and selected 86 that matched our search criteria. The literature is heterogeneous, with no consensus regarding the operational definitions of suicide reattempters. Comparison groups in the literature have also been inconsistent and include subjects making a single lifetime attempt and subjects who did not reattempt during a defined study period. Suicide reattempters were associated with higher rates of the following characteristics: unemployment, unmarried status, diagnosis of mental disorders, suicidal ideation, stressful life events, and family history of suicidal behavior. Additional research is needed to establish adequate differentiation and effective treatment plans for this population.
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13
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Sun FK, Chiang CY, Lin YH, Chen TB. Short-term effects of a suicide education intervention for family caregivers of people who are suicidal. J Clin Nurs 2013; 23:91-102. [PMID: 23786460 DOI: 10.1111/jocn.12092] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2012] [Indexed: 12/29/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the short-term effects of a suicide care educational intervention on the family's ability to care, family's caring stress levels and family's attitudes towards attempted suicide. BACKGROUND Research has demonstrated that suicide prevention educational programmes are provided mostly for professional staff and not for the family caregivers of people who are suicidal. DESIGN A experimental design, using two groups and a pre- and postintervention survey method, was used. METHODS A randomised controlled study was conducted with 74 family caregivers of people who are suicidal (37 using suicide education and 37 in the control group). The experimental group was provided with a two-hour suicide care education intervention, and the control group received normal suicide care support. Participants were recruited at a Suicide Prevention Centre and two acute psychiatric hospitals between October 2009-December 2010. Three questionnaires were collected: (1) the Suicidal Caring Ability Scale (2) the Caring Stress Scale and (3) the Suicide Attitudes Scale. Descriptive statistics, independent t-tests or Mann-Whitney U-tests were used to analyse the data. RESULTS The results demonstrated that there were statistically significant differences in the Suicidal Caring Ability Scale and the Suicide Attitudes Scale but no statistically significant differences in the Caring Stress Scale. That is, the suicide education programme can promote the ability to care for people who are suicidal and can generate a positive attitude towards people who are suicidal from their caregivers. CONCLUSIONS Family caregivers of suicidal individuals who attended the psycho-education programme had an increased caring ability and positive attitudes for their suicidal relatives. RELEVANCE TO CLINICAL PRACTICE Nurses could use the two-hour personal suicidal education programme to increase one's ability to care for their relatives who had attempted suicide and promote one's positive attitudes towards attempted suicide.
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Affiliation(s)
- Fan-Ko Sun
- Department of Nursing, I-Shou University, Kaohsiung City, Taiwan
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Hawton K, Casañas I Comabella C, Haw C, Saunders K. Risk factors for suicide in individuals with depression: a systematic review. J Affect Disord 2013; 147:17-28. [PMID: 23411024 DOI: 10.1016/j.jad.2013.01.004] [Citation(s) in RCA: 831] [Impact Index Per Article: 75.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 01/10/2013] [Accepted: 01/11/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Depression is the most common psychiatric disorder in people who die by suicide. Awareness of risk factors for suicide in depression is important for clinicians. METHODS In a systematic review of the international literature we identified cohort and case-control studies of people with depression in which suicide was an outcome, and conducted meta-analyses of potential risk factors. RESULTS Nineteen studies (28 publications) were included. Factors significantly associated with suicide were: male gender (OR=1.76, 95% CI=1.08-2.86), family history of psychiatric disorder (OR=1.41, 95% CI=1.00-1.97), previous attempted suicide (OR=4.84, 95% CI=3.26-7.20), more severe depression (OR=2.20, 95% CI=1.05-4.60), hopelessness (OR=2.20, 95% CI=1.49-3.23) and comorbid disorders, including anxiety (OR=1.59, 95% CI=1.03-2.45) and misuse of alcohol and drugs (OR=2.17, 95% CI=1.77-2.66). LIMITATIONS There were fewer studies than suspected. Interdependence between risk factors could not be examined. CONCLUSIONS The factors identified should be included in clinical assessment of risk in depressed patients. Further large-scale studies are required to identify other relevant factors.
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Affiliation(s)
- Keith Hawton
- Centre for Suicide Research, University of Oxford, UK.
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15
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Brådvik L. Last suicide attempt before completed suicide in severe depression: an extended suicidal process may be found in men rather than women. Arch Suicide Res 2013; 17:426-33. [PMID: 24224675 DOI: 10.1080/13811118.2013.803003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objective of this study was to compare the time from last suicide attempt to suicide in men and women with major depressive disorder with melancholic and/or psychotic features. The case records of 100 suicide victims with severe depression were evaluated. All suicide attempts during the course of depression were noted. The time from last suicide attempt to suicide was compared as well as the occurrence of suicide attempt during the last depressive episode, by gender. Male suicide attempters made fewer suicide attempts than women during their last depressive episode before suicide (8% versus 37%). Men appeared to have a more extended suicidal process from suicide attempt to completed suicide, which ought to be considered in the after-care.
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Affiliation(s)
- Louise Brådvik
- a Department of Clinical Sciences, Division of Psychiatry , Lund University , Lund , Sweden
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