Suicide attempts and related factors in patients admitted to a general hospital: a ten-year cross-sectional study (1997-2007)

Effectiveness of early and intensive intervention on suicide prevention: CARS programme

The aim of this study was to evaluate the outcomes of the Programme for Management of Suicidal Behaviour and Suicide Prevention (CARS). Individuals treated in the emergency department of University Hospital Marqués de Valdecilla for suicidal thoughts or attempts (N = 401) between 1-March-2016 and 31-December-2018 were considered. No randomization by patients or groups was performed. Student's t-test, chi-square and repeated measure analysis of variance were used. Kaplan-Meier survival function and Cox proportional hazard regression models were employed to estimate the risks of relapse. Outcome of those who voluntary enrol CARS were compared with treatment as usual (TAU) at 6- and 12-months follow-up. The results indicate a significant reduction and delayed occurrence of suicidal behaviour over a 12-month follow-up period with the CARS programme compared to TAU, along with a decreased frequency of hospital admissions. CARS programme demonstrates a substantial impact, significantly reducing the risk of recurrent suicidal behaviour by 35.5 % and the risk of repeated suicidal attempts by 47.2 % at the 12-month follow-up. The programme exhibits a dual protective effect, diminishing suicidal behaviour and fostering improved long-term outcomes. In conclusion, CARS effectively reduced suicidal behaviour recurrence, achieving significant decreases in suicidal thoughts, plans and attempts.

A Comparison of Patients Presenting with Suicide Attempts, Psychopathology Symptoms, or Pain within Emergency Departments

Previous suicide attempts, psychopathology symptoms, and pain significantly increase risk of suicide, a leading cause of death. It is possible that patients across these three groups exhibit key differences that could provide insights into unique interventions for suicide-related outcomes. Data were collected using a standardized form at 432 emergency departments (EDs; 14,018 participants [females, n = 8,042; 57.4%; males, n = 5,976; 42.6%]). We conducted a series of ANOVAs to investigate if patients presenting for (1) suicide attempts (n = 33; 0.2%), (2) psychopathology symptoms (n = 1,104; 7.9%), or (3) pain (n = 12,881; 91.9%) varied across a variety of healthcare-relevant variables. Findings indicated that patients presenting with suicide attempts were seen with more urgency (F[2,12054] = 66.41, p < .001) and were more likely to be admitted to hospitalization (F[2,14015] = 187.296, p < .001), observation unit overall (F[2,14015] = 78.572, p < .001), or transferred to another hospital (F[2,14015] = 406.568, p < .001); they also required longer visits (F [2, 12054] = 66.41, p < .001) as compared to patients with psychopathology symptoms or pain. Notably, potentially important similarities between groups emerged: groups did not differ across leaving without medical screening, leaving against medical advice, or contact with healthcare providers in the long-term (i.e., twelve months) or short-term (i.e., 72 hours) preceding ED admission. These findings in particular indicate that there could be ample time (1) prior to admission to intervene and (2) during care in EDs to connect patients to goal-oriented, time-limited evidence based psychotherapies at a time when they may be particularly willing to engage in care.

Suicidality and mood disorders in psychiatric emergency patients: Results from SBQ-R

Patients with mood disorders are at high risk of suicidality, and emergency departments (ED) are essential in the management of this risk. This study aims to (1) describe the suicidal thoughts and behaviours of patients with mood disorders who come to ED; (2) assess the psychometric properties of the Suicidal Behaviours Questionnaire-Revised (SBQ-R) in a psychiatric ED; and (3) determine the best predictors of suicidality for these patients. A total of 300 participants with mood disorders recruited for the Signature Bank of the Institut universitaire en santé mentale de Montréal (IUSMM) were retained. Suicidality was assessed using the SBQ-R. Other clinical and demographic details were recorded. Bivariate analyses, correlations and multivariate regression analyses were conducted. SBQ-R's internal consistency, construct and convergent validities were also tested. In the Patient Health Questionnaire-9 (PHQ-9), 53.3% of the sample stated they had suicidal or self-harm thoughts in the last 2 weeks. The mean score obtained at the SBQ-R was 8.3. Multivariate analysis found that SBQ-R scores were associated with depressive symptoms and substance use, especially alcohol, accounting for 44.3% of the model variance. Cronbach's alpha was 0.81 [0.78, 0.84] and factor loadings for items 1-4 were 0.68, 0.88, 0.54, and 0.85, respectively. The confirmatory factor analysis indicated that the model fit the data well. The SBQ-R is a brief and valid instrument that can easily be used in busy emergency departments to assess suicide risk. Depressive symptoms and alcohol use shall also be assessed, as they are determinants of increased risk of suicidality.

Current situation and influencing factors for suicidal intent in patients with intentional acute pesticide poisoning

Introduction

Since pesticides have been widely used in agricultural production, acute pesticide poisoning (APP) has gradually become a worldwide public health problem. Recently, the number of APP cases has been high in China, and the intentional self-administration of pesticides is the main cause of APP. However, there is a lack of relevant studies on the factors influencing suicidal intent in patients with intentional APP. This study aimed to explore the current situation and influencing factors for suicidal intent among patients with intentional APP.

Methods

In this cross-sectional study, we enrolled a total of 225 patients with intentional APP admitted to the emergency department of our Grade A comprehensive hospital in Shandong Province between June 2019 and January 2021. Patients were investigated using a health status interview questionnaire, Beck Suicidal Intent Scale, Duke Social Support Index, psychological stress scale, Dickman Impulsivity Inventory, Trait Anxiety Inventory, Center for Epidemiologic Studies Depression Scale, and Beck Hopelessness Scale. Descriptive statistics, single-factor analysis, and multiple linear regression were used for data analysis.

Results

Suicidal intent scores were collected and averaged (14.23 ± 6.22). Multiple linear regression analysis revealed that marital status, residential area, impulsivity, hopelessness, depression, psychological strain, and social support impact suicidal intent.

Conclusion

Patients with intentional APP have high suicidal intent. Therefore, different interventions should be tailored to different patients.

Suicide risk in medically ill inpatients referred to consultation-liaison psychiatric services: A multicenter study

BACKGROUND

The aim of this multicenter study was to investigate the suicide risk in medically ill patients admitted to six Italian hospitals for whom a consultation-liaison intervention was requested.

METHODS

Participants completed socio-demographic and clinical report forms and the Brief Illness Perception Questionnaire. Suicidality was assessed using the P4 screener that investigates the presence of Past suicide attempts, Plans to commit a suicide, Probability of completing suicide, and Preventive factors. Participants were categorized as being at no, low or high suicide risk. Univariate and multivariable associations of categorical and continuous variables with suicide risk were investigated using multinomial logistic regression.

RESULTS

Of the 641 inpatients, with mean age 60 years (SD = 16.9) and 49.2 % male, 13.2 % were at high suicidal risk (HR), 7.6 % low risk (LR) and 79.2 % no risk. Contacts with psychiatrists in the previous six months were associated with LR and HR (OR = 2.159 and 2.634, respectively), ongoing benzodiazepine use was associated with a threefold likelihood of LR (OR = 3.005), and the experienced intensity of illness symptoms was associated with LR and HR (OR = 1.257 and OR = 1.248, respectively). CL psychiatrists prescribed appropriate psychotropic drugs and activated liaison interventions and psychological support for the level of suicidal risk.

LIMITATIONS

The use of self-report measures bears the risk of recall bias.

CONCLUSIONS

Our findings based on psychiatric consultations in the general hospital underscore the need to include suicide risk in the routine assessment of inpatients referred to CL psychiatric services and to plan an appropriate management of suicidal risk after discharge.

Suicide attempts and related factors in patients referred to Gachsaran Hospital, Iran

Background

Suicide is considered as an important, widespread phenomenon in the world, causing numerous deaths annually. This study is going to investigate how suicidal attempts are affected by several demographic and other underlying factors.

Objective

The present study was designed to investigate suicide attempts and its related factors in patients referred to Gachsaran Hospital, Iran.

Materials and methods

This cross-sectional study was conducted on 348 people who had attempted suicide (Please note that 348 was the number of suicidal attempts not the number of suicidal deaths). The data were collected by consent of Shiraz University of Medical Sciences and necessary coordination with the Emergency Management Statistics Center of Shahid Rajaee Hospital in Gachsaran city. The data analysis was performed through the logistic regression test using SPSS software version 19. The significance level was considered 0.05.

Results

A total of 348 individuals with a mean age of 23.9 ± 8.1 had attempted suicide in Gachsaran. Of these, 185 were female (53.2%) and 163 were male (46.8%). The results of multivariate regression showed that, after controlling the effect of probable confounding variables, the following variables had a significant relationship with suicide attempts in the individuals who had attempted to suicide: male gender, unemployment, and love problems.

Conclusion

Considering the high rate of suicide attempts among unemployed male individuals during one year, counseling centers in Gachsaran city should pay special attention to this group of people. Measures such as creating jobs for young people can help prevent this social dilemma.

Psychological and genetic risk factors associated with suicidal behavior in Korean patients with mood disorders

INTRODUCTION

To prevent suicide, a nationwide important issue in Korea, understanding its etiology is essential. This study aimed to delineate the risk factors for suicidal behavior in mood disorder patients in Korea.

METHODS

216 patients with mood disorders were recruited. We measured suicidal ideation (SI) and suicide attempt (SA) history and the association of six gene polymorphisms with SB: COMT (rs4680), HTR1A (rs6295), TPH1 (rs1800532), BDNF (rs6265), SLC1A3 (rs2269272), and SLC1A2 (rs4755404).

RESULTS

Patients in the high-SI and SA groups reported more severe depressive, hopelessness, and anxiety symptoms and lower resilience and used less social support-seeking coping than those in the non-significant SI and non-SA groups. Multivariate logistic analysis revealed that depressive disorder, depressive symptoms, poor social support, and less social support-seeking coping were significant independent predictors of suicidal ideation. After adjustment for covariates, age, alcohol consumption, and the rs4680 AA genotype in the COMT gene were associated with suicide attempt.

LIMITATIONS

The modest sample size and a relatively few candidate genes are limitations of the study. In addition, there is no normal control group and the retrospective evaluation of SA limits the interpretation of the causal relationship with factors affecting SA.

CONCLUSIONS

Suicidal behavior in Korean patients with mood disorders may be associated with younger age, alcohol consumption, depressive symptoms, poor social support, less social support-seeking coping, and the COMT rs4680 Met/Met genotype.

Variables related to suicide attempt in a Spanish province over a three-year period (2009-2011)

The aim was to identify and describe socio demographic and clinical variables in individuals who have made a suicide attempt. An analysis of electronically stored records on persons admitted to the emergency departments of a northern health district during the period 2009-2011 for mental disorders was conducted. The records of 826 patients (30.1% of the total), where 485 (58.7%) were female, aged between 14 and 94 years (M = 49.3; SD = 12.7), were selected. This amounted to 412 individuals (49.9%) who had made a suicide attempt, and were compared with others without prior suicide attempt. A binary logistic regression analysis was performed to examine the strongest predictors of suicide attempt. The results show that the risk of making a suicide attempt increases with age, those most at risk being aged 34 to 53 years (p < 0.01; OR = 6.99), female (p < 0.05; OR = 2.70) and unemployed (p < 0.05; OR = 4.98). The most predictive psychopathological diagnoses for suicide attempt were anxiety disorders (p < 0.01; OR = 3.95) and impulse control disorders/addictions (p < 0.01; OR = 3.76). The importance of creating specific risk and protection profiles when implementing contextualized health policies on suicide attempt prevention is discussed.

The investigation of the relationship between probability of suicide and reasons for living in psychiatric inpatients

AIM

This study was carried out to determine the reasons of the suicide probability and reasons for living of the inpatients hospitalized at the psychiatry clinic and to analyze the relationship between them.

MATERIALS AND METHODS

The sample of the study consisted of 192 patients who were hospitalized in psychiatric clinics between February and May 2016 and who agreed to participate in the study. In collecting data, personal information form, suicide probability scale (SPS), reasons for living inventory (RFL), and Beck's depression inventory (BDI) were used. Stepwise regression method was used to determine the factors that predict suicide probability.

RESULTS

In the study, as a result of analyses made, the median score on the SPS was found 76.0, the median score on the RFL was found 137.0, the median score on the BDI of the patients was found 13.5, and it was found that patients with a high probability of suicide had less reasons for living and that their depression levels were very high. As a result of stepwise regression analysis, it was determined that suicidal ideation, reasons for living, maltreatment, education level, age, and income status were the predictors of suicide probability (F = 61.125; P < 0.001).

DISCUSSION

It was found that the patients who hospitalized in the psychiatric clinic have high suicide probability and the reasons of living are strong predictors of suicide probability in accordance with the literature.

Life satisfaction and degree of suicide intent: A test of the strain theory of suicide

BACKGROUND

Various factors contribute to suicide. Psychological strains are hypothesized to precede suicidal thought and attempt. Life satisfaction can be a measure of relative deprivation strain and aspiration-reality strain.

AIMS

This study was to compare the suicide attempters with various levels of life satisfaction and find out how life satisfaction affects the degree of suicide intent among medically serious suicide attempters.

METHODS

Subjects for study were recruited in some rural counties in China. Interview data were from hospital emergency rooms with medically serious attempters of suicide (n=791). The subjects were aged between 15 and 54years and 293 males and 498 females. Face to face interview was conducted for each suicide attempter with a semi-structural protocol including life satisfaction, physical health, demographic, sociological, and psychological measures, as well as psychological strains.

FINDINGS

The multiple linear regression analysis showed that mental disorder, aspiration strain and relative deprivation strain were significant risk factors for high intent of suicide among suicide attempters. The interaction between the two psychological strains also indicated that both failed aspiration and self-perceived low economic status in village play an important role in suicidal intent.

CONCLUSION

Low level of life satisfaction is associated with strong intent for suicide. Lack of life satisfaction is exemplified by relative deprivation perceived by the individuals and the discrepancy between an individual's aspiration for life and his/her reality. The findings from the suicide attempt data in rural China support the Strain Theory of Suicide.

Suicide behavior as a quantitative trait and its genetic background

INTRODUCTION

Studies have not given yet a clear answer what is the genetic background of suicidal predisposition. The associations between polymorphisms of the TPH1 and 5-HTTLPR genes and violent suicidal behavior was revealed with the least inconsistencies.

METHOD

We selected 10 "strong candidate genes" and 35 SNPs, SLC6A4 and ACP1 for replication study. We searched associations between precisely described suicidal phenotype in 825 affective patients and polymorphisms of selected neurobiological pathways genes as well as their interactions that constitute suicidal risk.

RESULTS

The results confirm the role of TPH1, TPH2, 5HT2A, CRHR1 and ACP1 variants in the risk of suicidal behavior.

LIMITATIONS

In our study we analyzed limited number of candidate genes and only one of them is linked to lithium mechanism of action. We had no data on pharmacological treatment of investigated patients and its relation to the time of suicide attempt.

CONCLUSION

Our results indicate that polymorphisms of various signaling pathways are involved in the pathogenesis of suicidal behavior. Non-genetic factors are also involved in the risk of suicidal attempts.

Suicide attempts in Brazil, 1998-2014: an ecological study

BACKGROUND

Attempted suicide is the main predictor of suicide constituting a major public health issue worldwide. It is estimated that for every completed suicide, 10 to 20 suicide attempts occur. Important part of the occurrences of suicide attempts in Brazil are registered in the hospital information system for coverage of more than 70 % allows to evaluate the extent of this problem in the country. The scope of this article is to analyse hospitalizations resulting from suicide attempts at public hospitals or services contracted out by the public health system (SUS) in Brazil from 1998 to 2014.

METHODS

This is an ecological study of secondary morbidity data obtained from the Hospital Information System. The overall rate of suicide attempts per 100 000 (10(5)) individuals and rates stratified by age group and sex were calculated. To measure trends, simple linear regression coefficients were calculated. The hospital mortality rate was calculated per 100 individuals.

RESULTS

The overall rate of hospitalization decreased from 1998 to 2014. The young and adult age groups had the highest hospitalization rates. Men were admitted more and the elderly had higher hospital mortality rates. The main cause of hospitalization was poisoning, accounting for 70.4 % of hospitalizations. Among the people who used poisoning by non-medical drugs as the method of attempted suicide, 58 178 (69.6 %) were men and 49 585 people who are poisoned by medical drugs (60.1 %) were women.

CONCLUSIONS

Although hospitalization rates for attempted suicide have declined in Brazil, it remains a serious public health problem. Because a suicide attempt is the main predictor of suicide, studies to identify those most vulnerable to attempted suicide will help in the development of prevention strategies for mental health.

Frequency of Anxiety in Patients With Drug Poisoning in Rafsanjan City, Iran, in 2013

BACKGROUND

Expansion of technology and progression of sciences have led to wider access to agricultural and industrial drugs and chemicals, which has resulted in many problems. Both in wanted and unwanted ways people may take these toxic agents, which perhaps may be along with many unpredictable, life-threatening and mortal outcomes. Based on many studies, most of intentional poisonings arise from an origin of patients' psychological backgrounds, which confirms necessity and importance of the recent study.

OBJECTIVES

This study aimed to study the prevalence of psychiatric disorders in patients with drug poisoning.

PATIENTS AND METHODS

In this descriptive cross-sectional study, 116 cases of poisoning referred to emergency room of Ali-Ebn-Abitaleb Hospital in Rafsanjan city, Iran, were randomly selected. Frequency of anxiety among participants was evaluated through the Spielberger questionnaire. A past history of depression and obsession was also evaluated through interview by a psychiatrist based on diagnostic and statistical manual of mental disorders (DSM-5) criteria. All data were then collected and analyzed using SPSS version 17.

RESULTS

Anxiety, as the second most common reason of psychiatric disorders in cases of poisoning, with a prevalence of 12.1% in form of mild, 75.9% moderate and 12.1% severe, was confirmed among the participants of this study.

CONCLUSIONS

The prevalence of anxiety among cases of poisoning with both drugs and chemicals are noticeably higher than general population. This fact strongly suggests the necessity of in-advance consultation and treatment of any underlying psychiatric disorders of patients to prevent prospective complications.

Psychosocial predictors of suicidal ideation in patients diagnosed with chronic illnesses in Jordan

Suicide ideation (SI) is considered a major psychiatric emergency in patients diagnosed with chronic illnesses. Suicide ideation is a multifaceted issue that involves bio- psychosocial and cultural factors that interfere with patients' abilities. The purpose of this study is to investigate the psychosocial predictors of SI among Jordanian patients with chronic illnesses. A cross-sectional design using self-administered questionnaires was used to collect data from 480 patients diagnosed with diabetes mellitus, cardiovascular diseases, and cancer. The mean score of suicide ideation was 4.07 (SD  =  1.7) and almost 20% (n  =  85) of the participants found to be suicidal, the majority were suffering from moderate to severe depressive symptoms and low levels of life satisfaction. Also, the analysis showed that the patients had a high level of optimism and moderate perception of social support from family, friends, and significant other. Type of illness has a significant relation to the 'seriousness' component of SI (p  =  0.023). Depression (β  =  0.345, p<0.001) was a significant risk factor for 'thought' component of SI, and optimism (β  =  -0.008, p<0.05) a significant protective factor against the thought component of SI. Patients with chronic illnesses suffer serious psychological disturbances and are in need of psychological care, and periodic psychological screening to maintain their psychological wellbeing.

Psychiatric consultations and therapy recommendations following a suicide attempt in a general hospital and their associations with selected parameters in a 1-year period

OBJECTIVE

Our study aims to determine the frequency and distribution of suicide attempts according to the patients' characteristics and type of suicide attempt as well as the method of treatment proposed by the consultation-liaison service in a general hospital.

METHODS

This retrospective naturalistic study covers a 1-year period (2012), during which 51 suicide attempters were hospitalised in the Charité Berlin, Campus Benjamin Franklin, Germany. The following data were analysed: method of suicide, account of prior psychiatric history and medication, as well as the acute psychiatric diagnosis and treatment - including pharmacotherapy.

RESULTS

Most of the patients were diagnosed with a psychiatric illness. Major depressive disorder was the most frequent diagnosis in consultation. Treatment recommendations more often entailed further psychiatric treatment than medication. In the cases where medication was indeed given, benzodiazepines were the most frequently prescribed.

CONCLUSIONS

Most of the suicide attempters needed further therapy in psychiatric hospitals. A specialised pharmacotherapy (antidepressants, mood stabilisers) was rarely recommended by the psychiatric consultation service. The psychiatric consultation and therapy recommendations are important in guiding future acute treatment procedures.

Socio-Demographic, Clinical and Behavioral Characteristics Associated with a History of Suicide Attempts among Psychiatric Outpatients: A Case Control Study in a Northern Mexican City

BACKGROUND

Little is known about the epidemiology of suicide attempts among psychiatric outpatients in Mexico. This study was aimed to determine the socio-demographic, clinical and behavioral characteristics associated with suicide attempts in psychiatric outpatients in two public hospitals in Durango, Mexico.

METHODS

Two hundred seventy six psychiatric outpatients (154 suicide attempters and 122 patients without suicide attempt history) attended the two public hospitals in Durango City, Mexico were included in this study. Socio-demographic, clinical and behavioral characteristics were obtained retrospectively from all outpatients and compared in relation to the presence or absence of suicide attempt history.

RESULTS

Increased prevalence of suicide attempts was associated with mental and behavioral disorders due to psychoactive substance use (F10-19) (P=0.01), schizophrenia, schizotypal and delusional disorders (F20-29) (P=0.02), mood (affective) disorders (F30-39) (P<0.001), and disorders of adult personality and behavior (F60-69) (P<0.001). Multivariate analysis showed that suicide attempts were associated with young age (OR=1.21, 95% CI: 1.06-1.39; P=0.003), female gender (OR=2.98, 95% CI: 1.55-5.73; P=0.001), urban residence (OR=2.31, 95% CI: 1.17-4.57; P=0.01), memory impairment (OR=1.91, 95% CI: 1.07-3.40; P=0.02), alcohol consumption (OR=2.39, 95% CI: 1.21-4.70; P=0.01), and sexual promiscuity (OR=3.90, 95% CI: 1.74-8.77; P<0.001).

CONCLUSIONS

We report the association of suicide attempts with socio-demographic, clinical and behavioral characteristics in psychiatric outpatients in Mexico. Results may be useful for an optimal planning of preventive measures against suicide attempts in psychiatric outpatients.

Relationship between Personality Profiles and Suicide Attempt via Medicine Poisoning among Hospitalized Patients: A Case-Control Study

Objectives. Inflexible personality traits play an important role in the development of maladaptive behaviors among patients who attempt suicide. This study was conducted to investigate the relationship between personality profiles and suicide attempt via medicine poisoning among the patients hospitalized in a public hospital. Materials and Methods. Fifty-nine patients who attempted suicide for the first time and hospitalized in the poisoning ward were selected as the experimental group. Sixty-three patients hospitalized in the other wards for a variety of reasons were selected as the adjusted control group. Millon Clinical Multiaxial Personality Inventory, 3rd version (MCMI-III) was used to assess the personality profiles. Results. The majority of the suicide attempters were low-level graduates (67.8% versus 47.1%, OR = 2.36). 79.7% of the suicide attempters were suffering from at least one maladaptive personality profile. The most common maladaptive personality profiles among the suicide attempters were depressive personality disorder (40.7%) and histrionic personality disorder (32.2%). Among the syndromes the most common ones were anxiety clinical syndrome (23.7%) and major depression (23.7%). Conclusion. Major depression clinical syndrome, histrionic personality disorder, anxiety clinical syndrome, and depressive personality disorder are among the predicators of first suicide attempts for the patients hospitalized in the public hospital due to the medicine poisoning.

Psychiatric disorders in patients presenting to hospital following self-harm: a systematic review

BACKGROUND

Psychiatric disorders occur in approximately 90% of individuals dying by suicide. The prevalence of psychiatric disorders in people who engage in non-fatal self-harm has received less attention.

METHOD

Systematic review using electronic databases (Embase, PsychINFO and Medline) for English language publications of studies in which psychiatric disorders have been assessed using research or clinical diagnostic schedules in self-harm patients of all ages presenting to general hospitals, followed by meta-analyses using random effects methods.

RESULTS

A total of 50 studies from 24 countries were identified. Psychiatric (Axis I) disorders were identified in 83.9% (95% CI 74.7-91.3%) of adults and 81.2% (95% CI 60.9-95.5%) of adolescents and young persons. The most frequent disorders were depression, anxiety and alcohol misuse, and additionally attention deficit hyperactivity disorder (ADHD) and conduct disorder in younger patients. Personality (Axis II) disorders were found in 27.5% (95% CI 17.6-38.7%) of adult patients. Psychiatric disorders were somewhat more common in patients in Western (89.6%, 95% CI 83.0-94.7%) than non-Western countries (70.6%, 95% CI 50.1-87.6%).

LIMITATIONS

Heterogeneity between study results was generally high. There were differences between studies in identification of study participants and diagnostic procedures.

CONCLUSIONS

Most self-harm patients have psychiatric disorders, as found in people dying by suicide. Depression and anxiety disorders are particularly common, together with ADHD and conduct disorder in adolescents. Psychosocial assessment and aftercare of self-harm patients should include careful screening for such disorders and appropriate therapeutic interventions. Longitudinal studies of the progress of these disorders are required.

Ethnicity and suicide attempt: analysis in bipolar disorder and schizophrenia

BACKGROUND

Evidence is mixed as to whether White Europeans are at a higher risk for suicide attempts or completions compared to other ethnic groups. The present analysis assessed whether risk for suicide attempt was associated with White European ethnicity in 907 subjects with schizophrenia or bipolar disorder.

METHODS

Subjects were diagnosed using the Structured Clinical Interview for DSM-IV, and ethnicity was determined by self-report. Subjects were recruited from psychiatric care centers in Toronto, Canada. Logistic regression correcting for clinical covariates like age, gender and diagnosis, was used in this study.

RESULTS

We found no difference in suicide attempter status in white and non-white subjects who were diagnosed with schizophrenia and bipolar disorder.

CONCLUSION

Our study does not support the evidence that White-European patients in North America are at higher risk for suicide attempt compared to non-European descent subjects. However, this result has to be replicated in larger studies in patients with these disorders.

Parental affectionless control and suicidality

OBJECTIVE

Although poor parental bonding is a known risk factor for suicidality, current literature is inconsistent about the relative role of low parental care and parental overprotection, as well as the combination of the two, termed "affectionless control". This review presents the current state of knowledge of the relationship between suicidality and these two aspects of parental bonding.

METHOD

The computerized databases Medline, PubMed, PsychINFO, PsychLit, and Google Scholar were searched using combinations of the following keywords: suicidality, suicide, suicide attempt, suicidal behavior, parental bonding, and parental bonding instrument. Using the results, we reviewed the reports on the relationship between suicidality and parental bonding as measured by validated parental bonding instruments.

RESULTS

Twelve papers were analyzed. All of them used the parental bonding instrument (PBI) and one used both the PBI and the object representation inventory (ORI). Most reports agreed that, in mothers, either lack of maternal care and/or overprotection was associated with an increase in suicidal behavior, while in fathers only low care was consistently associated with suicidality. This lack of constancy with regard to the effect of paternal overprotection appears to be due to cultural differences in fathers' role in child rearing. With these differences acknowledged, affectionless control in both parents emerges as the parenting style most strongly associated with suicidal behavior. Common methodological problems included low numbers of subjects, inconsistent control groups, and the lack of a uniform definition of suicidality.

CONCLUSION

Despite methodological limitations, current literature consistently indicates that parental affectionless control is associated with suicidal behavior. Recognizing affectionless control as a risk factor for suicide and developing early interventions aimed at modifying affectionless and overprotective parenting style in families with a history of affective disorders may be effective in reducing suicidal risk.

Suicide attempts and psychological risk factors in patients with bipolar and unipolar affective disorder

Suicide is an important clinical problem in psychiatric patients. The highest risk of suicide attempts is noted in affective disorders. The aim of the study was looking for suicide risk factors among personality dimensions and value system in patients with diagnosis of unipolar and bipolar affective disorder (n=189 patients, n=101 controls). To establish the diagnosis, we used SCID (Structured clinical interview for diagnostic and statistical manual of mental disorders, fourth edition) questionnaire, TCI (Temperament and Character Inventory) questionnaire and Value Survey--to assess the personality. The main limitations of the study are number of participants, lack of data about stressful life events and treatment with lithium. Novelty seeking and harm avoidance dimensions constituted suicide attempt risk factors in the group of patients with affective disorders. Protective role of cooperativeness was discovered. Patients with and without suicide attempt in lifetime history varied in self-esteem position in Value Survey.

Personality disorders in consultation-liaison psychiatry

PURPOSE OF REVIEW

Liaison psychiatrists treat patients who present with self-harm, with medically unexplained symptoms (MUSs) and physical illnesses with psychological comorbidity. We sought to explore recent studies into the impact of personality disorder in liaison psychiatry.

RECENT FINDINGS

One in five patients presenting to most liaison psychiatry services suffers from a personality disorder. Patients who have self-harmed have a high rate of personality disorder, but there is little research on how liaison psychiatrists can engage these patients in appropriate treatments. Most patients with MUSs or a functional somatic syndrome do not have a personality disorder, but the prevalence is probably higher than in the general population. Little is known about how a personality disorder might affect the efficacy of treatment in these conditions. Patients with personality disorders have higher rates of physical illness. Personality disorders may complicate the treatment of patients with long-term physical conditions, and talking therapies have recently been described in primary and secondary care.

SUMMARY

Liaison psychiatrists have an ideal therapeutic opportunity to engage patients with a personality disorder in treatment when these patients present with self-harm. There is a need to understand and research how personality disorders might affect the prognosis and treatment of patients with MUSs or a functional somatic syndrome. Personality disorders may complicate the treatment of patients with long-term physical conditions, and talking therapies recently described in primary and secondary care may help their physical and psychological health.

Antiepileptic drug monotherapy exposure and suicide-related behavior in older veterans

OBJECTIVES

To examine the association between antiepileptic drug (AED) receipt and suicide-related behavior (SRB) in older veterans.

DESIGN

Retrospective database analysis.

SETTING

Veterans Health Administration (VHA) inpatient and outpatient care.

PARTICIPANTS

Veterans aged 65 and older in 2004 to 2006.

MEASUREMENTS

SRB was identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes, and new AED monotherapy was identified using the VHA product variable in pharmacy data. Comorbid conditions and medications were also identified as potential confounders using previously validated algorithms. Cox proportional hazards models controlling for the propensity to receive AEDs examined the association between any AED exposure, specific AEDs, and time to SRB.

RESULTS

Within the eligible sample of 2.15 million individuals, 332 cases of SRB were found. Overall, 98% of participants were male, and 67% were non-Hispanic white. Affective disorders and severe psychiatric conditions were strongly associated with SRB and were included in the propensity score. AED exposure displayed a significant association with SRB (odds ratio = 4.10, 95% confidence interval (CI) = 3.85-6.63) after adjusting for propensity to receive AEDs. Stratified analyses found similar results for those with (hazard ratio (HR) = 4.00, 95% CI = 2.9-5.5) and without (HR = 4.57, 95% CI = 1.15-18.20) mental health comorbidities. Gabapentin, phenytoin, lamotrigine, levetiracetam, topiramate, and valproate were significantly associated with SRB.

CONCLUSION

Exposure to five common AEDs was associated with SRB in older VHA beneficiaries. Given the strong associations between psychiatric comorbidity and SRB, clinicians treating elderly adults should weigh this potential adverse effect into their consideration for treatment of those receiving AEDs. Particular attention should be given to depression and suicidality screening in people prescribed AEDs.

Depression, suicidal ideation, and associated factors: a cross-sectional study in rural Haiti

BACKGROUND

Since the 2010 earthquake in Haiti, there has been increased international attention to mental health needs throughout the country. The present study represents one of the first epidemiologic studies of depression symptomatology, suicidal ideation, and associated factors in Haiti's Central Plateau.

METHODS

We conducted a cross-sectional, zone-stratified household survey of 408 adults in Haiti's Central Plateau. Depression symptomatology was assessed with a culturally-adapted Kreyòl version of the Beck Depression Inventory (BDI). Multivariable linear and logistic regression models were built using backward elimination, with the outcomes being continuous BDI scores and endorsing suicidal ideation, respectively.

RESULTS

The mean BDI score was 20.4 (95% confidence interval [CI]: 19.3-21.5), and 6.13% (N = 25) of participants endorsed current suicidal ideation. Factors associated with BDI scores were: continuous age (adjusted beta [aβ]: 0.14, CI: 0.06-0.22), female gender (aβ: 2.1, CI: 0.18-4.0), suicidal ideation (aβ: 11.1, CI: 7.3-14.9), death in family (aβ: 2.7, CI: 0.57-4.9), and prior life-threatening illness (aβ: 2.6, CI: 0.77-4.5). Education was a risk factor for depression among women but not among men, and employment was a risk factor for both genders. Factors associated with endorsing suicidal ideation were: BDI score (ten point change) (adjusted odds ratio [aOR]: 2.5, CI: 1.7-3.6), lack of care if sick (aOR: 5.5, CI: 1.1-28.6), alcohol use (aOR: 3.3, CI: 1.3-8.2), and ever having been to a Vodou priest (aOR: 3.2, CI: 1.1-9.5).

CONCLUSIONS

A large proportion of Haiti's Central Plateau may be experiencing high levels of depression symptomatology and/or current suicidal ideation. Screening could be conducted in biomedical, religious, and Vodou healing contexts. For prevention, poverty reduction and improved healthcare access are key elements. For treatment, general psychiatric services, psychosocial services for the medically ill and their families, and substance abuse interventions should be explored. Paradoxical associations related to education and employment require further exploration.