Contributors to suicidality in rural communities: beyond the effects of depression

Social network typologies moderate the association of loneliness with depressive symptomatology in middle-aged and older adults

Background

Depression remains among the most prevalent mental disorders, and it severely affects daily functioning and quality of life. There has been extensive research reporting on the impact of social relationships on depression, but much of this research has only considered isolated aspects of relationships. This study derived social network types based on the multiple components of social relationships, and then investigated their effects on depressive symptoms.

Methods

Using samples of 620 adults (M_age = 53.52), Latent Profile Analysis (LPA) was conducted to uncover network types based on the structural (network size, contact frequency, marital status, and social engagement), functional (levels of support and conflict), and qualitative (satisfaction with relationships) aspects of social relationships. Multiple regressions were used to test if distinct network types directly impact on depressive symptoms and whether network types moderate the association of loneliness (perceived social isolation) with depressive symptoms.

Results

LPA identified four distinct network types (diverse, family-focused, friend-focused, and restricted) and there were significant differences in depressive symptoms among four network types. Analysis using the BCH method showed that individuals in the restricted network type had the highest depressive symptoms, followed in order by individuals in the friend-focused, family-focused, and diverse network types. Regression results further indicated that an individual's network network type membership was significantly associated with depressive symptoms, and being in the diverse and family-focused network types alleviated the negative effect of loneliness on depressive symptoms.

Conclusion

The results suggest that both quantitative and qualitative aspects of social relationships are important in buffering against the adverse effect of loneliness on depressive symptoms. These findings underscore the utility of taking a multi-dimensional approach to uncover heterogeneity in the social networks of adults and their implications on depression.

Depressive Symptoms as a Mediator between Excessive Daytime Sleepiness and Suicidal Ideation among Chinese College Students

The purpose of this study was to verify the mediating role of depressive symptoms between excessive daytime sleepiness and suicidal ideation in college students. Of the 6944 participants, 2609 (37.6%) were male and 4335 (62.4%) were female. College students with excessive daytime sleepiness (p < 0.001) and those with depressive symptoms (p < 0.001) were more likely to have suicidal ideation. Moreover, both excessive daytime sleepiness (β = 0.14, 95% CI: 1.01−1.32) and depressive symptoms (β = 1.47, 95% CI: 3.80−5.00) were associated with suicidal ideation. The effect size of the mediating role of depressive symptoms in excessive daytime sleepiness to suicidal ideation was 50.41% for the entire sample, 58.33% for males, and 42.98% for females. Depressive symptoms partially mediated the relationship between excessive daytime sleepiness and suicidal ideation. The timely assessment of depressive symptoms in college students with excessive daytime sleepiness, and intervention, may reduce their risk of suicidal ideation.

Associations between anxiety, depression, and risk of suicidal behaviors in Chinese medical college students

Background

Previous studies have established a strong association between depression and suicidal behaviors, yet the relationship between anxiety and suicidal behaviors remains unclear. This study examines whether anxiety and depression are independent risk factors for suicidal behaviors in medical college students, and further, whether anxiety may increase the greater risk of suicidal behaviors (SB) in participants with depression.

Methods

This cross-sectional study was conducted among 4,882 medical students. Demographic information, anxiety, and depression data were collected using online questionnaires or through a widely used social media app named WeChat.

Results

Anxiety and depression were independent risk factors for suicidal behaviors, and levels of risk correlated positively with the severity of both anxiety and depressive symptoms. A dose-response relationship was identified between the severity of anxiety and the risk of SB, as well as the severity of depression and SB. Furthermore, anxiety increased the risk of suicidal behaviors in participants with depression, with a dose-response relationship between the severity of anxiety symptoms and the risk of SB.

Conclusion

The findings highlight the importance of screening for anxiety and depressive symptoms in medical college students, as well as reducing anxiety in addition to depressive symptoms in treatment. This study provides valuable data as a reference for clinicians for suicide risk assessments.

Disadvantaged by More Than Distance: A Systematic Literature Review of Injury in Rural Australia

Rural populations experience injury-related mortality and morbidity rates 1.5 times greater than metropolitan residents. Motivated by a call for stronger epidemiological evidence around rural injuries to inform prevention, a systematic review of peer-reviewed literature published between January 2010 and March 2021 was undertaken to explore the epidemiology of rural injury and associated risk factors in Australia. A subsequent aim was to explore definitions of rurality used in injury prevention studies. There were 151 papers included in the review, utilizing 23 unique definitions to describe rurality. People living in rural areas were more likely to be injured, for injuries to be more severe, and for injuries to have greater resulting morbidity than people in metropolitan areas. The increase in severity reflects the mechanism of rural injury, with rural injury events more likely to involve a higher energy exchange. Risk-taking behavior and alcohol consumption were significant risk factors for rural injury, along with rural cluster demographics such as age, sex, high socio-economic disadvantage, and health-related comorbidities. As injury in rural populations is multifactorial and nonhomogeneous, a wide variety of evidence-based strategies are needed. This requires funding, political leadership for policy formation and development, and implementation of evidence-based prevention interventions.

Network modeling of anxiety and psychological characteristics on suicidal behavior: Cross-sectional study

BACKGROUND

Suicide is influenced by complex interactions among various psychopathological features. We aimed to examine the relationship between suicide risk and psychological risk factors such as defense mechanisms, personality, and anxiety.

METHODS

We established a psychiatric database by utilizing the Observational Medical Outcomes Partnership Common Data Model. We conducted a 1:1 propensity score matching with age, sex, and depression severity, and identified a sample (n = 258) with two groups: those with suicidal behavior and those with non-suicidal behavior. Using principal component analysis, we extracted nine psychological scales and applied network analysis to compare relationships among psychological factors between the two groups.

RESULTS

Patients with non-suicidal behaviors showed associations between trait anxiety and defense mechanisms, while those with suicidal behaviors did not. For patients with suicidal ideation there was an association between somatization and trait anxiety. Patients with suicide attempts showed associations between paranoia and dissociation connected to trait anxiety.

LIMITATIONS

Longitudinal research is required to fully observe transitions from suicidal ideation to attempts and recurrent suicidal events. In addition, these networks may not generalize suicidal behaviors because the group participants are not homogeneous. Lastly, data from self-report questionnaires limits the reliability of responses.

CONCLUSIONS

We presented important new insights on suicidal behavior by estimating psychological networks. Patients with non-suicidal behavior may exhibit discrete relationships between defense mechanisms and anxiety, compared to those with suicidal behavior. Patients with suicidal ideation and suicide attempts may show distinct associations between anxiety and psychopathological features.

Investigating Rurality as a Risk Factor for State and Trait Hopelessness in Hospitalized Patients With Ischemic Heart Disease

Background

Rurality and hopelessness are each associated with increased mortality in adults with ischemic heart disease (IHD), yet there is no known research examining rurality as a risk factor for hopelessness in patients with IHD. This study evaluated rurality as a risk factor for state and trait hopelessness in adults hospitalized with IHD in samples drawn from the Great Lakes and Great Plains regions of the United States.

Methods and Results

A descriptive cross‐sectional design was used. Data were collected from 628 patients hospitalized for IHD in the Great Lakes (n=516) and Great Plains (n=112). Rural–Urban Commuting Area codes were used to stratify study participants by level of rurality. Levels of state hopelessness (measured by the State‐Trait Hopelessness Scale) were higher in rural patients (58.8% versus 48.8%; odds ratio [OR], 1.50; 95% CI, 1.03–2.18), a difference that remained statistically significant after adjusting for demographics, depression severity (measured by the Patient Health Questionnaire–8), and physical functioning (measured by the Duke Activity Status Index; OR, 1.59; 95% CI, 1.06–2.40; P=0.026). There was evidence of an interaction between marital status and rurality on state hopelessness after accounting for covariates (P=0.02). Nonmarried individuals had an increased prevalence of state hopelessness (nonmarried 72.0% versus married 52.0%) in rural areas (P=0.03).

Conclusions

Rural patients with IHD, particularly those who are nonmarried, may be at higher risk for state hopelessness compared with patients with IHD living in urban settings. Understanding rurality differences is important in identifying subgroups most at risk for hopelessness.

Registration

URL: http://www.clinicaltrials.gov. Unique identifier: NCT04498975.

Mental Disorder and Suicide: What's the Connection?

This paper offers a philosophical analysis of the connection between mental disorder and suicide risk. In contemporary psychiatry, it is commonly suggested that this connection is a causal connection that has been established through empirical discovery. Herein, I examine the extent to which this claim can be sustained. I argue that the connection between mental disorder and increased suicide risk is not wholly causal but is partly conceptual. This in part relates to the way suicidality is built into the definitions of some psychiatric diagnoses. It also relates to the broader normative assumption that suicidal behavior is by definition mentally disordered behavior. The above has significant epistemological implications, which I explore. I propose that the claim that suicide is connected with mental disorder cannot be justified solely by appealing to empirical evidence but also warrants a justification on conceptual and normative grounds.

Investigation to identify individual socioeconomic and health determinants of suicidal ideation using responses to a cross-sectional, community-based public health survey

OBJECTIVES

To address a gap in knowledge by simultaneously assessing a broad spectrum of individual socioeconomic and potential health determinants of suicidal ideation (SI) using validated measures in a large UK representative community sample.

DESIGN

In this cross-sectional design, participants were recruited via random area probability sampling to participate in a comprehensive public health survey. The questionnaire examined demographic, health and socioeconomic factors. Logistic regression analysis was employed to identify predictors of SI.

SETTING

Community setting from high (n=20) and low (n=8) deprivation neighbourhoods across the North West of England, UK.

PARTICIPANTS

4319 people were recruited between August 2015 and January 2016. There were 809 participants from low-deprivation neighbourhoods and 3510 from high-deprivation neighbourhoods. The sample comprised 1854 (43%) men and 2465 (57%) women.

PRIMARY OUTCOME MEASURES

SI was the dependent variable which was assessed using item 9 of the Patient Health Questionnaire-9 instrument.

RESULTS

454 (11%) participants reported having SI within the last 2 weeks. Model 1 (excluding mental health variables) identified younger age, black and minority ethnic (BME) background, lower housing quality and current smoker status as key predictors of SI. Higher self-esteem, empathy and neighbourhood belonging, alcohol abstinence and having arthritis were protective against SI. Model 2 (including mental health variables) found depression and having cancer as key health predictors for SI, while identifying as lesbian, gay, bisexual, transgender or queer (LGBTQ) and BME were significant demographic predictors. Alcohol abstinence, having arthritis and higher empathy levels were protective against SI.

CONCLUSIONS

This study suggests that it could be useful to increase community support and sense of belonging using a public health approach for vulnerable groups (e.g. those with cancer) and peer support for people who identify as LGBTQ and/or BME. Also, interventions aimed at increasing empathic functioning may prove effective for reducing SI.

A cross-sectional study on associations of physical symptoms, health self-efficacy, and suicidal ideation among Chinese hospitalized cancer patients

BACKGROUND

Epidemiological studies have shown increased risk of suicide in cancer patients compared with the general population. The present study aimed to examine the association between physical symptoms and suicidal ideation in Chinese hospitalized cancer patients and test the modifying effect of health self-efficacy on the association.

METHODS

A cross-sectional study was conducted with 544 hospitalized cancer patients in two general hospitals in northeast China via face-to-face interviews. Suicidal ideation was measured by using the first four items on the Yale Evaluation of Suicidality scale and then dichotomized into a positive and negative score. Multivariate logistic regression analyses were conducted to examine the impacts of physical symptoms, health self-efficacy, and their interactions on suicidal ideation.

RESULTS

The suicidal ideation rate was 26.3% in the enrolled cancer patients. Logistic regression showed that insomnia (aOR = 1.84, 95% CI 1.13 to 3.00, p = 0.015) and lack of appetite (aOR = 2.14, 95% CI 1.26 to 3.64, p = 0.005) were significantly associated with suicidal ideation. Low health self-efficacy had a marginally significant exaggerating effect on the association between pain and suicidal ideation (aOR = 2.77, 95% CI 0.99 to 7.74, p = 0.053), after adjusting for significant socio-demographics, clinical characteristics, and depression.

CONCLUSIONS

These findings demonstrate significant associations between physical symptoms (insomnia and/or lack of appetite) and suicidal ideation and highlight the potential modifying role of health self-efficacy in the identification and prevention of suicide among cancer patients.

Suicide attempts in chronically depressed individuals: What are the risk factors?

Chronically depressed individuals have a high suicide risk. However, it is an open question whether previously observed risk factors for suicide attempts also apply to chronic depression or whether there are specific risk factors related to chronic-recurrent illness. We drew from a large group of chronically depressed individuals seeking psychotherapy to investigate demographic and psychological factors related to previous suicide attempts. Participants took part in the SCID and filled out established questionnaires. Among 368 chronically depressed individuals (68.7% women; M_age = 40.95 years), 75 participants (19.4%) reported previous suicide attempts. Men were more likely to have used violent methods. We tested the links of having attempted suicide with different variables using logistic regression analyses. Our findings corroborate previously observed risk factors (e.g. sexual abuse, personality disorders) and suggest other risk factors which could be especially relevant in chronic depression (e.g. depression severity, interpersonal problems, self-injurious behavior, and overall years of depression). Other risk factors from previous studies were not related to suicidal behavior within our sample (e.g. anxiety disorders, PTSD). Thus, mental health professionals should be aware that risk factors for suicidal behavior might vary between diagnosis groups and that chronic illness might be a risk factor in itself.

Ecological contributions to maternal-infant functioning: Differences between rural and urban family contexts

AIMS

This study considered urban-rural differences in maternal-infant interactions (sensitivity/responsiveness and synchrony/reciprocity), infant temperament, and parenting stress, for samples similar in socioeconomic and racial composition. Higher sensitivity/responsiveness and synchrony/reciprocity were hypothesized for urban dyads, with more challenging temperament profiles predicted for rural infants. Rural mothers were expected to report more parenting-role stress.

METHODS

Urban (n = 68; San Francisco Bay) and rural (n = 120; inland Pacific Northwest) mothers of infants provided ratings of temperament and parenting stress. Parental sensitivity/responsiveness and synchrony/reciprocity were coded from mother-infant play observations. Groups were compared via analyses of covariance.

RESULTS

Urban mothers demonstrated significantly more sensitivity/responsiveness and synchrony/reciprocity compared to their rural counterparts. Rural mothers rated their infants significantly higher in negative affectivity and distress in response to limitations.

CONCLUSION

Although socioeconomic status is traditionally implicated in rural and urban population differences, our results suggest other factors (e.g., isolation, access to resources) warrant further exploration. Rural ecology appears to present risk that should be examined more closely in maternal-infant interactions and child social-emotional development. The variability of risk within urban and rural classifications (e.g., suburban, inner-city) also requires consideration.

Excessive daytime sleepiness in medical students of Hunan province: Prevalence, correlates, and its relationship with suicidal behaviors

BACKGROUND

Excessive daytime sleepiness (EDS) is common among medical students, but may have some serious consequences. This study aimed to investigate the prevalence and correlates of EDS among the medical students of Hunan Province, China. The correlation between EDS and suicidal ideation in our participants was also explored.

METHODS

A cross-sectional study was employed among 4882 students from three medical schools in Hunan Province. Each student completed a survey on demographic variables, daytime sleepiness (Epworth sleepiness scale), anxiety (Self-Rating Anxiety Scale), depression (Self-Rating Depression Scale), and suicidal behaviors. Logistic regression analyses were conducted to investigate the risk factors for EDS among all participants and suicidal behaviors among those with EDS.

RESULTS

Overall, the prevalence of EDS in this population was 24.6%. Multivariate logistic regression analysis revealed that being female, alcohol consumption, a history of physical disorder, body mass index, anxiety, depression, and suicidal ideation were independent correlates for EDS. Moreover, the prevalence of suicidal ideation among EDS participants was 38.6%, variables such as physical disorder history, age, anxiety, or depression were independently associated with suicidal ideation.

LIMITATIONS

No causal relationships could be established as this was a cross-sectional study. Recall biases might exist due to the utilization of self-reported measurements. Moreover, participants were primarily female medical students (89%,4345/4882).

CONCLUSION

EDS is very common among medical students. Special attention should be paid to students with EDS, especially when risks for suicidal ideation are particularly high among this population. These data are valuable for healthcare professionals in assessing the risks of suicide among participants with EDS.

Differences in the cluster of depressive symptoms between subjects with type 2 diabetes and individuals with a major depressive disorder and without diabetes

BACKGROUND

Depressive disorder encompasses a wide spectrum of somatic and psychological symptoms. It is not known whether there are differences regarding the cluster of depressive symptomatology between subjects with depression with and without T2DM.

PURPOSE

To explore whether the cluster of depression that prevails among depressive subjects with T2DM differs from individuals with depression, but without T2DM.

METHODS

87 T2DM patients with a pathological Beck Depression Inventory test (BDI) were compared with 50 age- and gender-matched individuals with a major depressive disorder. All 21 items expressed in the BDI were compared between the two groups.

RESULTS

The score obtained after administering the BDI was comparable between patients with T2DM and significant depressive symptoms and the control group (18.8 ± 2.7 vs 18.9 ± 3.4; p = 0.9). Subjects with T2DM had higher scores compared with the control group in the following items: sadness (1.4 ± 0.9 vs 0.9 ± 0.9; p = 0.011), difficulty in concentration (1.3 ± 0.8 vs 0.8 ± 0.8; p = 0.01), indecisiveness (1.1 ± 0.8 vs 0.5 ± 0.9; p = 0.012), worries about their health (1.3 ± 0.9 vs 0.6 ± 0.9; p < 0.0001), fatigue (1.2 ± 0.6 vs 0.8 ± 0.7; p = 0.003) and loss of sexual appetite (2.7 ± 0.6 vs 1.2 ± 1.3; p = 0.0001). Suicidal ideation was significantly lower among subjects with T2DM compared with the control group (0.1 ± 0.3 vs 0.6 ± 0.8; p = 0.0001).

CONCLUSIONS

Subjects with T2DM and a positive screening for depression presented a different cluster of depression compared with depressed subjects without T2DM, with a predominance of somatic-biological depressive symptoms rather than psychological-cognitive cluster and negative emotions, such as suicidal ideation.

The tide does turn: Predictors of remission from suicidal ideation and attempt among Canadians who previously attempted suicide

The objectives of this study were to identify factors that contribute to (1) remission from suicidal ideation, and (2) remission from suicide attempt, among Canadians with a lifetime history of suicide attempt. Data for this study came from Statistics Canada's nationally representative 2012 Canadian Community Health Survey-Mental Health. A sample of 769 adult respondents who had ever attempted suicide was analyzed with remission from past year suicidal ideation and remission from past year suicide attempt as outcome variables. Of the 769 respondents who had ever attempted suicide, more than two-thirds (69%) were free from suicidal ideation within the past year, and approximately 87% were free from suicide attempts within the past year. Compared to men, odds were 2.66 times greater for women to be free of suicide attempt and 2.65 times greater to be free of suicidal ideation in the past year. Older age, being free of sleep problems and major depressive episode, having no history of chronic childhood physical abuse, and having two or fewer previous suicide attempts were associated with higher odds of remission from both suicide attempt and ideation in the past year.

Environmental factors and suicide in Australian farmers: A qualitative study

Farmers and farm workers have been recognized as a group at high risk of suicide in Australia. This study aims to identify and better understand environmental factors associated with suicide among Australian farmers and farm workers. Qualitative analysis was undertaken in accordance with the Consolidated Criteria for Reporting Qualitative Research. Male and female focus groups were conducted separately with people who lived or worked on a farm in six farming communities. Qualitative analyses showed that a number of environmental influences may contribute to the increased risk of suicide: extreme climatic events; isolation; service availability; access to, and frequent use of firearms; death and suffering of animals; government and legislation; technology; and property values. Both the physical and socio-cultural environments in which farmers operate appear to contribute to farmer suicide and need to be considered in suicide prevention.

Incidence of suicide among military police officers in South Brazil: An 11-year retrospective cohort study

BACKGROUND

Suicide is known to be the leading cause of death among police officers (PO) worldwide. However, most studies were conducted in developed countries, with no data from Brazil. The present study aimed to evaluate the incidence and the sociodemographic profile of suicide among a military PO subpopulation in South Brazil.

METHODS

This retrospective cohort evaluated 31,110 military PO with available data on cause of death from 2006 to 2016. Participants were monitored for an average of 18.8 ± 9.6 years following the date of entry into the military police.

RESULTS

Mean age at the end of the follow up time was 41.4 ± 9.1 years, with 90.7% males. A total of 650 participants died (2.1%), with 43 suicides (6.6% of all deaths) - cumulative incidence of 138/100,000. Bivariate analysis revealed a significant association (p < 0.05) between suicide and age (HR = 0.70, 95%CI = 0.66-0.74), females (HR = 1.67, 95%CI = 1.08-2.60) and enlisted military rank (HR = 14.9, 95%CI = 2.05-108.5). Multivariate models showed an independent association between suicide and age (HR = 0.71, 95%CI = 0.67-0.74) and enlisted military rank (HR = 9.96, 95%CI = 1.30-76.3).

CONCLUSIONS

The incidence of suicide among military PO in South Brazil was high, compared to the national suicide rate. Younger age and lower military rank were independent predictors of suicide in this subpopulation.

The Challenges of Predicting Suicidal Thoughts and Behaviours in a Sample of Rural Australians with Depression

Suicide is a leading cause of death, particularly in rural and remote areas. Although depression is strongly related to both suicidal ideation and attempt, it lacks specificity as a predictor, and little is known about characteristics that increase suicide risk among people with depression. A telephone version of the World Mental Health Composite International Diagnostic Interview explored lifetime depression, suicidal ideation, suicide attempt, and related factors among a community-dwelling sample of rural and remote Australians, selected for an interview based on a screener for psychological distress (100% of those with high distress, 75% of those with moderate distress, and 16% of those with low distress). Of 1051 participants interviewed, 364 reported lifetime symptoms of depression; of these, 48% reported lifetime suicidal ideation and 16% reported a lifetime suicide attempt. While depression severity was a significant correlate of suicidality for both males and females, suicide attempt was significantly more common among females with a younger age of depression onset, and a higher number of psychiatric comorbidities. No additional factors were significant for males. Among rural and remote residents with lifetime symptoms of depression, the identification of suicide risk may be enhanced by considering individual and contextual factors beyond depression severity. Further research focusing on risk factors for males would be beneficial.

Cumulative incidence of suicidal ideation and associated factors among adults living in temporary housing during the three years after the Great East Japan Earthquake

BACKGROUND

The effect of disasters on suicidality is not known. We aimed to retrospectively determine the cumulative incidence of suicidal ideation during the 3 years after the Great East Japan Earthquake among residents in temporary housing without prior suicidal ideation, as compared to the general population. Moreover, we aimed to identify the risk factors for the onset of suicidal ideation.

METHODS

A cross-sectional survey involving face-to-face interviews was conducted 3 years after the earthquake with adult community residents in disaster-affected areas and a control area using the World Health Organization Composite International Diagnostic Interview version 3.0. We compared the cumulative incidence of suicidal ideation between the two areas using the Cox proportional hazard model and examined risk factors for the onset of suicidal ideation using a multiple logistic regression analysis.

RESULTS

Among 1019 respondents in the disaster-affected areas, the cumulative incidence of suicidal ideation over 1, 2, and 3 years after the earthquake was 1.4%, 2.4%, and 2.8%, respectively, which was significantly higher than that in the control area. Not being married, being injured in the disaster, and poor subjective physical health were associated with the onset of suicidal ideation.

LIMITATIONS

We estimated the time of onset of suicidal ideation based on the respondents' current age and self-reported onset age, which limits the accuracy of the onset timing.

CONCLUSIONS

We revealed a higher incidence of suicidal ideation in temporary housing residents and identified several risk factors, which suggests the importance of developing countermeasures to prevent suicide after a disaster.

Gender-Specific Factors Associated with Suicide Attempts among the Community-Dwelling General Population with Suicidal Ideation: the 2013 Korean Community Health Survey

We identified traditional risk factors and investigated poorly understood risk factors for suicide attempts according to gender in a large Korean population. We analyzed the data from 6,768 males and 12,475 females with suicidal ideation obtained from the nationwide 2013 Korean Community Health Survey. The dependent variable was suicide attempts within the past year. There was a significant trend towards an increase in suicide attempts with decreasing age in both genders. Compared with those who were married, suicide attempts were significantly higher among those who were widowed, divorced, or separated for males (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.34-3.20), but lower for females (OR, 0.66; 95% CI, 0.45-0.98). Current smoking and depression were significant risk factor for suicide attempts in males and females. However, monthly household income, myocardial infarction, and osteoporosis were significantly associated with suicide attempts only in males, whereas education level, recipient of National Basic Livelihood Security, family contact, leisure activity, and drinking frequency were significantly associated only in females. These findings indicate that gender difference should be considered in the assessment, prevention, and management of future suicide attempts by community policy-makers and clinicians.

Suicidal ideation reported by adults with Type 1 or Type 2 diabetes: results from Diabetes MILES-Australia

AIMS

To examine the prevalence and correlates of suicidal ideation (SI) in a community-based sample of adults with Type 1 or Type 2 diabetes.

METHODS

Participants were 3338 adults aged 18-70 years with Type 1 diabetes (n = 1376) or Type 2 diabetes (non-insulin: n = 1238; insulin: n = 724) from a national survey administered to a random sample registered with the National Diabetes Services Scheme. Depression and SI were assessed using the Patient Health Questionnaire, and diabetes-specific distress with the Problem Areas In Diabetes scale. Separate logistic regression analyses by diabetes type/treatment were used to determine relative contribution to SI.

RESULTS

Overall, we observed a SI rate of 14% in our sample. Participants with Type 2 diabetes using insulin reported more frequent depressive symptoms, and were more likely to report recent SI (19%) compared with those with either Type 1 diabetes or Type 2 diabetes not using insulin (14 and 12%, respectively). After controlling for depression, there was little difference in the prevalence of SI between diabetes types/treatments, but higher diabetes-specific distress significantly increased the odds of SI.

CONCLUSIONS

As SI is a significant risk factor for a suicide attempt, the findings have implications for healthcare professionals, pointing to the importance of adequate screening and action plans for appropriate follow-up of those reporting depression. Our findings are also indicative of the psychological toll of diabetes more generally, and the need to integrate physical and mental healthcare for people with diabetes.

Natrelle Silicone Breast Implant Follow-Up Study: Demographics, Lifestyle, and Surgical Characteristics of More Than 50,000 Augmentation Subjects

Background:

A large, multicenter, 10-year observational study is being conducted to compare the long-term safety and effectiveness of Natrelle silicone breast implants with saline implants or national norms. Study baseline data and surgical characteristics are reported here.

Methods:

Women seeking primary augmentation, revision-augmentation, primary reconstruction, or revision-reconstruction participated. Eligible subjects had completed surgery and received one implant or matching implants. Baseline demographics, health, lifestyle, and surgical characteristics were recorded. Data are presented here for subjects (≥22 years old) who underwent primary augmentation or revision-augmentation.

Results:

Of 50,979 subjects who underwent augmentation procedures, 35,756 received silicone implants and 15,223 received saline implants. Of these, 86.3 percent underwent primary augmentation, and 13.7 percent underwent revision-augmentation; nearly all subjects (99.3 percent) received bilateral implants. In the primary augmentation group, 67.6 percent of subjects received silicone implants versus 86.1 percent in the revision-augmentation group. Median age was lower in the primary augmentation group compared with the revision-augmentation group (33 versus 42 years old, respectively). Most subjects were white nonsmokers and had attended college. Hispanic subjects and subjects with a body mass index of 25 kg/m² or greater were more likely to receive saline versus silicone implants. Across groups, the most common characteristics by procedure or implant type included inframammary incision site (54.6 percent), partial (58.2 percent) or complete (31.9 percent) submuscular placement, smooth surface implants (93.1 percent), and implant size of 300 to 399 cc. Incision size was larger for silicone versus saline implants.

Conclusion:

These data add to the body of knowledge on women undergoing augmentation procedures by providing an unprecedented look at a large number of subjects.

PTSD, Depression, and Substance Use in Relation to Suicidality Risk among Traumatized Minority Lesbian, Gay, and Bisexual Youth

Youths who are lesbian, gay, or bisexual (LGB) are more likely than heterosexuals to commit suicide. Substance use, PTSD, and depression are independent risk factors for suicidality; however, the extent to which these factors interact to predict suicidality is unclear. The current study examined the association between substance use, PTSD symptoms (PTSS), depressive symptoms, and suicidality in a sample of 68 traumatized minority LGB youths. Participants were recruited from an LGBT community center and completed a packet of questionnaires. Substance use and depressive symptoms were positively associated with prior suicide attempts. A significant three-way interaction revealed that substance use interacted with both PTSS and depressive symptoms to increase the odds of attempted suicide. Results underscore the importance of integrating substance use components into PTSD/depression treatment to reduce suicide risk in LGB youth.

Psychological trauma exposure and co-morbid psychopathologies in HIV+Men and Women

This study examined the association between trauma exposure, PTSD, suicide attempts, and other psychopathology among 316 racially/ethnically diverse HIV-infected men and women who underwent semi-structured psychiatric assessment. In addition, the role of psychological resilience in trauma exposure was examined in the context of neurological symptoms and functional status. Nearly half (47.8%; 151/316) of the participants reported trauma exposure, of which 47.0% (71/151) developed PTSD. Among trauma-exposed individuals, those with a current psychiatric diagnosis reported more neurological symptoms and lower functional status. Trauma exposure without PTSD was associated with a higher rate of panic disorder and substance-induced mental disorders. Trauma-exposed individuals who did not develop PTSD were less likely than those who reported no trauma exposure to meet criteria for major depressive disorder (MDD). Trauma exposure, MDD, borderline personality disorder, and substance-induced mental disorders were independently associated with increased odds of suicide attempt. These results indicate that co-morbid psychiatric disorders are common among trauma exposed individuals with a history of PTSD, but those with trauma exposure who do not develop PTSD are less likely to experience MDD. The role of other co-morbid psychopathologies in the genesis of suicidal behavior among individuals living with HIV deserves further study.

Natrelle Silicone Breast Implant Follow-up Study: Demographics, Lifestyle, and Surgical Characteristics of More Than 5000 Reconstruction Subjects

BACKGROUND

A large, multicenter, 10-year observational study is comparing the long-term safety and effectiveness of Natrelle silicone breast implants versus saline implants or national norms.

METHODS

Women who underwent primary augmentation, revision-augmentation, primary reconstruction, or revision-reconstruction were invited to participate. Enrolled subjects had completed surgery and received one implant or matching implants. Baseline demographics, health, lifestyle, and surgical characteristics are presented here for adult subjects who underwent primary reconstruction or revision-reconstruction.

RESULTS

Of 5637 subjects who underwent reconstruction surgery (86.7% primary reconstruction; 13.3% revision-reconstruction), 5407 received silicone implants and 230 received saline implants; 72.9% received bilateral implants. Silicone implants were used in 96.2% who underwent primary reconstruction and in 94.1% who underwent revision-reconstruction. Median age was about 3 years lower in those who underwent primary reconstruction versus revision-reconstruction. Most subjects were white nonsmokers and had attended college. Hispanic subjects were more likely to receive saline implants for primary reconstruction. Across groups, the most common characteristics by implant type or procedure included smooth-surface implants (90.8%), mastectomy scar site (69.7%), and partial (59.2%) or complete (33.9%) submuscular placement. Implant size was larger for revision-reconstruction versus primary reconstruction, and incision size was larger for silicone versus saline implants in subjects undergoing primary reconstruction.

CONCLUSIONS

This study provides an unprecedented look at a large subject sample. The data offer surgeons an opportunity to make informed decisions regarding the most appropriate implant attributes and surgical approaches for women who desire breast implants for primary or revisionary breast reconstruction.

The relationship between personality styles of sociotropy and autonomy and suicidal tendency in medical students

The research aim was investigating the relationship between personality styles of autonomy and sociotropy, and suicidal behavior at Zahedan University of medical sciences’ medical students. This was a descriptive correlational study. The population consisted of all medical students at Zahedan University of Medical Sciences internship period 2002-2003. The number of samples was 102 patients, including 47 males and 55 females. To collect information, the personal style inventory (PSI) with 48 items. Twenty four items to assess sociotropy, 24 items to assess autonomy, and to measure suicide the suicidal subscale (MMPI) with 21 items were used. The two scales had the content validity and for the reliability used Cronbach α. So the reliability of the personality styles is 0.84 and the reliability of the suicidal subscales is 0.83. Data were analyzed using Pearson’s correlation methods. The results showed that there is an inverse and significant relation between autonomic style and trends of suicide in men (P = 0.02, r = -0.43), but no association between sociotropy and suicidal tendencies were observed in men. There was no significant relationship between autonomy and sociotropy personality styles and tendency towards suicide in women.

Predictors of suicidal ideation in older people: a decision tree analysis

OBJECTIVES

Suicide among older adults is a major public health issue worldwide. Although studies have identified psychological, physical, and social contributors to suicidal thoughts in older adults, few have explored the specific interactions between these factors. This article used a novel statistical approach to explore predictors of suicidal ideation in a community-based sample of older adults.

DESIGN

Prospective cohort study.

PARTICIPANTS AND SETTING

Participants aged 55-85 years were randomly selected from the Hunter Region, a large regional center in New South Wales, Australia.

MEASUREMENTS

Baseline psychological, physical, and social factors, including psychological distress, physical functioning, and social support, were used to predict suicidal ideation at the 5-year follow-up. Classification and regression tree modeling was used to determine specific risk profiles for participants depending on their individual well-being in each of these key areas.

RESULTS

Psychological distress was the strongest predictor, with 25% of people with high distress reporting suicidal ideation. Within high psychological distress, lower physical functioning significantly increased the likelihood of suicidal ideation, with high distress and low functioning being associated with ideation in 50% of cases. A substantial subgroup reported suicidal ideation in the absence of psychological distress; dissatisfaction with social support was the most important predictor among this group. The performance of the model was high (area under the curve: 0.81).

CONCLUSIONS

Decision tree modeling enabled individualized "risk" profiles for suicidal ideation to be determined. Although psychological factors are important for predicting suicidal ideation, both physical and social factors significantly improved the predictive ability of the model. Assessing these factors may enhance identification of older people at risk of suicidal ideation.

Determinants of suicidal ideation and suicide attempts: parallel cross-sectional analyses examining geographical location

BACKGROUND

Suicide death rates in Australia are higher in rural than urban communities however the contributors to this difference remain unclear. Geographical differences in suicidal ideation and attempts were explored using two datasets encompassing urban and rural community residents to examine associations between socioeconomic, demographic and mental health factors. Differing patterns of association between psychiatric disorder and suicidal ideation and attempts as geographical remoteness increased were investigated.

METHODS

Parallel cross-sectional analyses were undertaken using data from the 2007 National Survey of Mental Health and Wellbeing (2007-NSMHWB, n = 8,463), under-representative of remote and very remote residents, and selected participants from the Australian Rural Mental Health Study (ARMHS, n = 634), over-representative of remote and very remote residents. Uniform measures of suicidal ideation and attempts and mental disorder using the World Mental Health Composite International Diagnostic Interview (WMH-CIDI-3.0) were used in both datasets. Geographic region was classified into major cities, inner regional and other. A series of logistic regressions were undertaken for the outcomes of 12-month and lifetime suicidal ideation and lifetime suicide attempts, adjusting for age, gender and psychological distress. A sub-analysis of the ARMHS sample was undertaken with additional variables not available in the 2007-NSMHWB dataset.

RESULTS

Rates and determinants of suicidal ideation and suicide attempts across geographical region were similar. Psychiatric disorder was the main determinant of 12-month and lifetime suicidal ideation and lifetime suicide attempts across all geographical regions. For lifetime suicidal ideation and attempts, marital status, employment status, perceived financial adversity and mental health service use were also important determinants. In the ARMHS sub-analysis, higher optimism and better perceived infrastructure and service accessibility tended to be associated with a lower likelihood of lifetime suicidal ideation, when age, gender, psychological distress, marital status and mental health service use were taken into account.

CONCLUSIONS

Rates and determinants of suicidal ideation and attempts did not differ according to geographical location. Psychiatric disorder, current distress, employment and financial adversity remain important factors associated with suicidal ideation and attempts across all regions in Australia. Regional characteristics that influence availability of services and lower personal optimism may also be associated with suicidal ideation in rural communities.

Age-related differences in the influence of major mental disorders on suicidality: a Korean nationwide community sample

BACKGROUND

We compared the influence of major mental disorders on suicidality according to age, adjusting for suicide-related correlates.

METHODS

This study was based on the Korean national epidemiological survey of mental disorders including community-dwelling adults between 18 and 74 years of age (n=6022). Subjects were classified into three age groups; young (18-39), middle-aged (40-59), and late adulthood (60-74). Face-to-face interviews were conducted using the Korean version of the Composite International Diagnostic Interview. According to age groups, the influence of major depressive disorder (MDD), anxiety disorder, and alcohol use disorder on risk for suicidality were investigated by multiple logistic regression models adjusting for sex, years of education, marital status, income, employment, presence of chronic medical illness, and lifetime history of suicide attempt.

RESULTS

After including MDD as a covariate, anxiety disorder remained a risk factor only in the middle-aged group (adjusted OR: 2.83, 95% CI: 1.54-5.22), and alcohol use disorder was a risk factor for suicidality only in the young group (adjusted OR: 2.81, 95% CI: 1.06-7.43). Conversely, MDD was the only mental disorder that significantly increased suicidality in all age groups.

LIMITATIONS

This was a cross-sectional study and did not include subjects over 75 years of age.

CONCLUSION

This study showed that the contribution of psychiatric disorders to risk for suicidality varied according to age group. Therefore, strategies for suicide prevention should be specifically designed for different age groups.

Dealing with wicked problems: conducting a causal layered analysis of complex social psychological issues

Causal layered analysis (CLA) is an emerging qualitative methodology adopted in the discipline of planning as an approach to deconstruct complex social issues. With psychologists increasingly confronted with complex, and "wicked" social and community issues, we argue that the discipline of psychology would benefit from adopting CLA as an analytical method. Until now, the application of CLA for data interpretation has generally been poorly defined and overwhelming for the novice. In this paper we propose an approach to CLA that provides a method for the deconstruction and analysis of complex social psychological issues. We introduce CLA as a qualitative methodology well suited for psychology, introduce the epistemological foundations of CLA, define a space for it adoption within the discipline, and, outline the steps for conducting a CLA using an applied example.

Suicide risk among Thai illicit drug users with and without mental/alcohol use disorders

BACKGROUND

It is not yet known if the increased risk of suicide in substance abusers is caused by the causal and/or coexisting relationship between substance use and psychiatric disorders. This study was designed to estimate the suicide risk among individuals with illicit drug use alone, illicit drug users with mental disorders, and illicit drug users with alcohol use disorders.

METHODS

Subjects were participants of the 2008 Thai National Mental Health Survey. They were asked for their illicit drug use in the past year. The Mini International Neuropsychiatric Interview (MINI), current suicidality (1 month prior to assessment), mood episodes, anxiety disorders, psychotic disorders, and alcohol use disorders were used for assessing mental/alcohol use disorders. A score of 1 or more for the MINI-Suicidality module was defined as the presence of suicide risk.

RESULTS

Of the total 17,140 respondents, 537 currently used illicit drugs, while 1,194 respondents had a suicide risk. Common illicit drugs were kratom (59%) and (meth)amphetamine (24%). Compared with 16,603 Thais without illicit drug use, the illicit drug users with or without mental/alcohol use disorders (n=537) had an increased risk of suicide (adjusted odds ratio [OR], 95% confidence interval [CI] =2.09, 1.55-2.81). While those who used illicit drugs alone (no mental/alcohol use disorder) (n=348) had no increased risk of suicide (adjusted OR, 95% CI =1.04, 0.66-1.65), the illicit drug users with mental or alcohol use disorders (n=27 and n=162, respectively) had significantly increased risk of suicide (adjusted ORs, 95% CIs =14.06, 6.50-30.3 and 3.14, 1.98-4.99, respectively).

CONCLUSION

A key limitation of this study was the combined suicidal behaviors as a suicidality risk. Mental or alcohol use disorders found in this population actually increased the suicide risk. These findings support the coexisting relationship that mental and alcohol use disorders play a vital role in increasing the suicide risk in illicit drug users.