The characteristics of serious suicide attempters in Japanese adolescents--comparison study between adolescents and adults

The characteristics of suicide attempters in Chinese patients: Comparison of adolescents, youths, middle-aged and elderly

BACKGROUND

Potential risk factors for suicide differ by age group. Therefore, this study aims to investigate the characteristics of patients with suicide attempts according to age group and any the relevant risk factors.

METHODS

This study retrospectively reviewed the medical records of attempted suicide patients who were admitted to the emergency departments (ED) of the First Affiliated Hospital of Wenzhou Medical University between January 1, 2017, and December 31, 2021. Demographic information and clinical characteristics were collected. The participants were divided into four age groups and the characteristics of each group were compared.

RESULTS

A total of 834 participants were included in this study. Suicide attempts were more prevalent in females, and the gender difference decreased with age. Having religious belief and less educated suicide attempts were concentrated in the elderly groups. Adolescents suicide attempts were more likely to occur in the spring, autumn and during non-office hours. Mental disorders were the major motivation for suicide among adolescents, and interpersonal and social problems were more prevalent among youths. Psychiatric medication was the leading suicidal substances among adolescents, while pesticides and herbicides were more prevalent in adults. The history of psychiatric diagnosis was more common in adolescents, while the history of somatic disorder was more prevalent in the elderly.

CONCLUSION

This study confirmed differences in the demographic and clinical characteristics of patients in different age groups. Therefore, it is necessary to construct individualized intervention strategies for each age group based on the characteristics of the patients in order to reduce suicide.

Understanding and comparing risk factors and subtypes in South Korean adult and adolescent women's suicidal ideation or suicide attempt using survey and social media data

Objective

This study aimed to investigate the similarities and differences in risk factors for suicide among adult and adolescent women in South Korea and identify subtypes of suicidal ideation or suicide attempt in each group.

Methods

Multifaceted data were collected and analyzed by linking survey and social media data. Interpretable machine learning models were constructed to predict suicide risk and major risk factors were extracted by investigating their feature importance. Additionally, subtypes of suicidal adult and adolescent women were identified and explained using risk factors.

Results

The risk factors for adult women were primarily related to mental disorders, while those for adolescent women were primarily related to interpersonal experiences and needs. Two subtypes of suicidal adult women were one with high psychiatric symptoms and mental disorders of them and/or their families and the other with excessive social media use and high online victimization. Two subtypes of suicidal adolescent women were one with high psychiatric symptoms, high ACEs, and high social connectedness, and the other with frequent social media use, high online sexual victimization, and high social assurance.

Conclusions

These findings enable a stratified and targeted understanding of suicide in women and help develop customized suicide prevention plans in South Korea.

The relationship between mood disorders, personality disorder and suicidality in adolescence: does general personality disturbance play a significant role in predicting suicidal behavior?

INTRODUCTION

Current research points to the importance personality pathology and Major Depression e as relevant psycopathological risk factors for understanding suicidal risk in adolescence. Literature has mainly focused on the role of BPD, however current orientations in personality pathological functioning suggest that BPD may be the representative of a general personality disturbance, a factor of vulnerability underlying diverse psychopathological variants and aspects of maladaptive functioning. However, recent studies seem to have neglected the contributions that other specific personality disorders and personality pathology as a general factor of vulnerability for suicidality; and only marginally investigated the interaction of personality disorder (PD) as an overall diagnosis and individual PDs and major depression (MDD). In this paper, the independent and cumulative effects of MDD and DSM-IV PDs on suicidal risk are investigated in a sample of adolescents observed in a longitudinal window of observation ranging from three months preceding the assessment to a six-month follow up period of clinical monitoring.

METHODS

A sample of 118 adolescents (mean age = 15.48 ± 1.14) referred for assessment and treatment on account of suicidal ideation or behavior were administered the CSSRS, SCID II, Kiddie-SADS at admission at inpatient and outpatient Units. All subjects included in the study had reported suicidal ideation or suicide attempts at the C-SSRS; The CSSRS was applied again to all patients who reported further suicidal episodes during the six-months follow-up period of clinical monitoring. Dimensional diagnoses of PDs was obtained by summing the number of criteria met by each subject at SCID-%-PD 5, In order, to test the significance of the associations between the variables chosen as predictors (categorical and dimensional PDs and MD diagnosis), and the suicidal outcomes variables suicide attempts, number of suicide attempts and potential lethality of suicide attempt, non-parametric bivariate correlations, logistic regression models and mixed-effects Poisson regression were performed PD.

RESULTS

The categorical and dimensional diagnosis of PD showed to be a significant risk factors for suicide attempt and their recurrence, independently of BPD, that anyway was confirmed to be a specific significant risk factor for suicidal behaviors. Furthermore, PD assessed at a categorical and dimensional level and Major Depression exert an influence on suicidal behaviors and their lethality both as independent and cumulative risk factors.

LIMITATIONS

Besides incorporating dimensional thinking into our approach to assessing psychopathology, our study still relied on traditionally defined assessment of PD. Future studies should include AMPD-defined personality pathology in adolescence to truly represent dimensional thinking.

CONCLUSION

These results point to the importance of early identification of the level of severity of personality pathology at large and its co-occurrence with Major Depression for the management of suicidal risk in adolescence.

Suicidality and Personality Pathology in Adolescence: A Systematic Review

This work presents a review of research papers examining the role of emerging personality pathology in suicidal ideation and behaviours in adolescence. Initially, 226 studies were selected in line with PRISMA guidelines, and 33 articles were finally included in this review. The data show percentages of any personality disorder diagnosis ranging from 19.5 to 22.8% in suicide attempters, while in autopsy studies, the rate of personality disorder diagnosis varied between 29.6 and 42.1%. The overwhelming majority of the studies focus on the role of borderline personality disorder (BPD) in suicidal behaviours, also highlighting its predictive role at a longitudinal level. Furthermore, the literature review shows that personality traits supposed to underlie BPD, such as affective instability, impulsivity and identity diffusion, have specific predictive links with suicidal conduct. Other personality pathology dimensions, such as aggressiveness, sadism and perfectionism that are associated with other personality disorders, namely, antisocial and narcissistic personality disorders, have also shown a significant mediating role for suicidal risk. Overall, these results seem to parallel the role of personality pathology in predicting suicide in adulthood and point to the relevance of assessing the presence of emerging patterns of personality disorders for the clinical management of suicidal risk in adolescence.

Suicide decline and improved psychiatric treatment status: longitudinal survey of suicides and serious suicide attempters in Tokyo

BACKGROUND

Connecting individuals in need of psychiatric treatment with adequate medical services has been a major strategy for suicide prevention in Japan. By investigating serious suicide attempters admitted to our Critical Care Medical Center (CCM), we aimed to examine longitudinal changes in the psychiatric treatment status of high-risk suicidal individuals, and to explore the association between any improvement in psychiatric treatment status and suicide decline.

METHODS

Subjects from two periods, 2006-2011 and 2012-2017, were enrolled. We collected the data of 32,252 suicides in Tokyo from police reports and the data of 942 suicide attempters admitted to CCM from medical records. Data were annually collected by both age and gender for the number of suicide completers, the number of suicide attempters, and the psychiatric treatment rates, respectively. ANOVA and t-test were used to examine whether there were differences in the number of suicides and attempers between the two periods. The difference in psychiatric treatment rate between the two periods was examined by chi-square test. Additionally, we used Pearson's correlation coefficient to analyze any correlation between annual treatment rate and the number of suicide completers in subgroups with altered psychiatric treatment rates.

RESULTS

The number of suicide attempters in the 20-39-year age group of decreased together with the number of suicides. Psychiatric treatment rates of male attempters aged 20-59 years improved significantly from 48.7 to 70.6% and this improvement correlated with a decrease in suicides. However, psychiatric treatment rates in the elderly, which have the highest number of suicides in both genders, did not improve and remain low.

CONCLUSIONS

The number of suicide attempters, as well as that of suicides, decreased in Tokyo. Improvement of psychiatric treatment status in high-risk suicidal male adults may have contributed to the reduction of suicides in Tokyo. However, the continuing low rate of psychiatric treatment in the elderly is a pressing issue for future suicide prevention.

Does personality problems increase youth suicide risk?: A characteristic analysis study of youth who visit the emergency department following suicide attempt

BACKGROUND

Youth suicide attempts are a major risk factor for future complete suicides. However, the characteristics of suicide attempters based on the emergency department (ED) have rarely been explored, making it challenging to comprehend the characteristics of youth suicide attempters comprehensively. This study aims to investigate the characteristics of youth suicide attempters who visited the ED.

METHODS

We examined the youth (age: 12-25 years) and adult (age: 26-65 years) groups of suicide attempters who visited the ED in Wonju-si, Gangwon-do, Korea. Interviews were conducted with attempters and guardians to identify sociodemographic, clinical, and suicide-related variables. Besides, we performed bivariate logistic regression analysis with statistically adjusted gender, educational age, Socioeconomic Status(SES) level, and medical illness.

RESULTS

Youth were diagnosed more frequently with Personality disorder compared to adults. Besides, youth tended to report interpersonal or abuse as motivations for suicide, whereas adults tended to report medical illness or economic problems. Furthermore, youth attempted suicide more impulsively and repeatedly; however, medical lethality of each attempt tended to be lower than adults.

LIMITATION

We experienced difficulty in collecting complete information because of poor consciousness or cooperation of patients who visited the ED immediately after suicide attempt. Also, the study cohort was only recruited from one hospital in a region.

CONCLUSION

Youth suicide attempters are suggested to have relatively serious and persistent problems involving personality or traits than adults. Thus, this study highlights the significance of preventive strategies based on early psychopathological evaluation and treatment.

Contemporary Characteristics and Lethality Correlates of Serious Suicide Attempts in Children and Adolescents

OBJECTIVE

Adolescent suicide rates have increased in the past decade. Few studies have examined contemporary pediatric suicide attempters with medically serious suicide attempts, particularly among younger pediatric suicide attempters.

METHOD

This preliminary chart review study examined 200 adolescents with medically serious suicide attempts and sought to identify general cohort characteristics, differences in cohort characteristics based on age, correlates of lethality, and correlates of rescue (likelihood of prompt medical attention).

RESULTS

Our study found that younger adolescents specifically endorsed increased cyberbullying (β = 1.1, p = .046) and less hopelessness (β = -0.83, p = .02) compared to older adolescents. Suicide attempt lethality was negatively associated with female gender (β = -0.59, p = .041), rescue (β = -0.19, p = .005), an anxiety diagnosis (β = -0.81, p = .0003), and history of consensual sexual activity (β = -0.79, p = .002). Rescue was positively associated with an ADHD diagnosis (β = 0.73, p = .018) and less attempt planning (β = 0.96, p = .01), while a history of previous suicide attempt (β = -0.54, p = .04) and more proximal suicide attempt (β = -0.045, p = .008) were associated with a lower rescue score.

CONCLUSION

Our preliminary findings suggest clinicians and future researchers may need to assess certain social and diagnostic factors in children and adolescents at particularly high risk for death by suicide.

Characteristics of adolescents who visit the emergency department following suicide attempts: comparison study between adolescents and adults

BACKGROUND

The purpose of this study was to identify the demographic and clinical characteristics of suicide attempts in adolescents who visit the emergency department compared to those of adults.

METHODS

This study included 149 children under the age of 18, and 1427 people in the age of 19-65 who came to the emergency department with suicide attempt from 2009 to 2015. We compare sociodemographic, clinical, and suicide attempt-related characteristics through Chi-square test and logistic regression analysis to evaluate the difference between two groups.

RESULTS

In adolescents, suicide attempters had more number of previous suicide attempt history than adults. Adolescents used more non-lethal method such as poisoning of over the counter drugs and had about 5 times higher odds ratio in suicide attempts with analgesics. The motivation of suicide attempt among adolescents was more related with interpersonal problems but less with financial or illness-related problems. The intention of suicide attempt in adolescents was less serious and lethal compared to adults.

CONCLUSION

Suicide attempts among adolescents had showed different from adults in method, motivation and intention. Considering the characteristics of suicide attempt among adolescent, it is necessary to keep close attention to adolescent's suicide attempters and develop the customized intervention program to prevent the suicide attempt in this groups.

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 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.

THE CHALLENGES OF SCHOOL-BASED YOUTH SUICIDE PREVENTION: EXPERIENCES AND PERCEPTIONS OF MENTAL HEALTH PROFESSIONALS IN SOUTH AFRICAN SCHOOLS

Youth suicidal behaviour poses a significant public health concern. Mental health care professionals working in schools have an important role to play in youth suicide prevention initiatives, although little is known of the experiences of this group of professionals in the developing world. The aim of this study was to explore the experiences of mental health professionals working in South African schools and document their insights, attitudes and beliefs regarding youth suicidal behaviour. In-depth semi-structured interviews were conducted with seven school-based mental health care professionals and data were analysed using Thematic Analysis. Participants reported that they relied on a reactive strategy by responding to youths who were in crisis. They were challenged by a lack of support from faculty staff, lack of access to resources, and heavy caseloads. Findings highlight the need for a proactive and collaborative approach to suicide prevention among mental health care professionals, teachers and parents in South African schools and improved training and supervision.

Seasonality of child and adolescent injury mortality in Japan, 2000-2010

OBJECTIVE

Injury is the leading cause of death among children and adolescents in Japan. Despite this, until now there has been comparatively little research on this phenomenon. The purpose of this study was to examine if there was seasonal variation in child and adolescent injury mortality in Japan in 2000-2010.

METHODS

Vital statistics injury mortality data were obtained from the Ministry of Health, Labour and Welfare of Japan. The seasonality of the major causes of unintentional injury (transport accidents, drowning and suffocation) and intentional injury (suicide and homicide) mortality was examined for children and adolescents aged 0-19. Incidence ratios (IR) with 95% confidence intervals (CI) were calculated to determine the difference between the numbers of observed and expected seasonal deaths.

RESULTS

The annual average injury mortality rate among children and adolescents was 9.0 per 100,000. Deaths from transport accidents, drowning, suffocation and suicide had a significant seasonality. There was a summer peak for transport accidents (IR 1.15, 95% CI 1.10-1.19) and drowning (IR 2.00, 95% CI 1.88-2.11), a spring peak for suicide (IR 1.09, 95% CI 1.04-1.14), while the incidence of suffocation was higher in winter (IR 1.12, 95% CI 1.03-1.21).

CONCLUSION

Child and adolescent injury mortality from transport accidents, drowning, suffocation and suicide has a pronounced seasonality in Japan. More research is now needed to find the circumstances underpinning different forms of injury mortality in different periods of the year so that effective interventions can be designed and implemented to reduce the burden of injury mortality among Japanese children.

A comparison of the characteristics of suicide attempters with and without psychiatric consultation before their suicidal behaviours: a cross-sectional study

BACKGROUND

Because psychiatric disorders are risk factors for suicide, psychiatric consultation should be an essential element of suicide prevention among individuals with a high risk of suicide. The aim of the present study was to compare the characteristics of individuals who had or had not received psychiatric consultation before they attempted suicide in Japan.

METHODS

Clinical records were used to identify 300 consecutive persons who were admitted to the hospital for attempting suicide between April 2006 and March 2013. We divided the patients into two groups. One group consisted of patients who consulted a psychiatrist before their suicidal behaviours (the consultation group), and the other group consisted of patients who had not consulted a psychiatrist before their suicidal behaviours (the non-consultation group). Group differences were analysed with respect to gender, age, method of suicide attempts, psychiatric diagnosis (ICD-10), and duration of hospitalisation in the emergency unit.

RESULTS

Females tended to be over-represented in the consultation group (73.0%), and males tended to be over-represented in the non-consultation group (59.8%). Poisoning by prescription drugs was used more frequently as a method of suicide in the consultation group than in the non-consultation group. Neuroticism and related disorders were higher in the non-consultation group (33.7%) than in the consultation group (18.9%). Mood disorders (32.6%) were nearly as common as neuroticism in the non-consultation group, and together they accounted for almost two-thirds of all diagnoses. Mood disorders were comparable between the consultation group (30.9%) and the non-consultation group (32.6%). Adult personality disorders (13.3%) and schizophrenia and related disorders (26.0%) were higher in the consultation group than in the non-consultation group.

CONCLUSIONS

Measures have to be taken to encourage people with these diverse characteristics to consult psychiatrists, and psychiatrists have to regularly evaluate patients for suicide risk. Furthermore, we need further research on the relationship between psychiatric consultation and poisoning by prescribed drugs.

Gender differences in suicide attempters: a retrospective study of precipitating factors for suicide attempts at a critical emergency unit in Japan

BACKGROUND

There is a shortage of empirical data concerning precipitating factors for suicides in Japan. The purpose of the present study was to clarify gender differences of precipitating factors for suicide attempts in Japan.

METHODS

The subjects were high-lethality suicide attempters who were admitted to the Nippon Medical School Hospital Critical Care Medical Center between March 1, 2010 and March 31, 2012. Precipitating factors for suicide attempt, method of suicide attempt, psychiatric diagnoses and other sociodemographic data were collected from the patients' medical records retrospectively, and statistical analyses were performed for categorical variables of male/female.

RESULTS

The total number of subjects was 193 (88 males and 105 females). The rate of subjects attempting suicide by poisonous gas was significantly higher in males while that of subjects attempting suicide by drug overdose was significantly higher in females. The rate of subjects diagnosed with "major depressive disorder, bipolar disorder" was significantly higher in males while that of subjects diagnosed with "personality disorders" or "dysthymic disorder" was significantly higher in females. Subjects with "health problems", "financial problems", "work problems", "debts (others)" or "unwanted transfer" were significantly more numerous among males; subjects with "family problems", "parent-child relations" or "loneliness" were significantly more frequently found among females.

CONCLUSIONS

Mental disorders were the most common precipitating factor for suicide attempts regardless of gender. Significant gender differences were observed in psychiatric diagnoses, methods of suicide attempt and psychosocial problems. This indicates the necessity of suicide prevention measures corresponding to these gender differences.