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Abascal-Peiró S, Alacreu-Crespo A, Peñuelas-Calvo I, López-Castromán J, Porras-Segovia A. Characteristics of Single vs. Multiple Suicide Attempters Among Adult Population: A Systematic Review and Meta-Analysis. Curr Psychiatry Rep 2023; 25:769-791. [PMID: 37740850 DOI: 10.1007/s11920-023-01461-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE OF REVIEW We aimed to examine the factors that differentiate single and multiple suicide attempters in adult population. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to conduct this review and meta-analysis. The review protocol was registered in PROSPERO. We carried out a systematic literature search in three databases to identify original studies that explored the differences between single and multiple suicide attempters among adult population. RECENT FINDINGS There might be meaningful differences between those individuals that attempt suicide once in their lifespan and those who make multiple attempts in terms of sociodemographic and clinical characteristics. There are no previous meta-analysis addressing this topic in the adult population. A total of 75 studies were included in the review and 69 were included in the meta-analysis. Multiple attempters were more likely to present certain disorders such as mood and psychotic disorders, as well as personality or substance use disorders. Higher suicide ideation and suicide intent scores also characterized this group. Childhood trauma experiences, stressful life events, and higher rates of hopelessness were statistically significant in multiple attempters. Identifying the factors predicting multiple suicide attempts helps to delineate a high-risk suicidal profile that should be taken into account in the clinical and suicide prevention scenario.
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Affiliation(s)
- Sofía Abascal-Peiró
- Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
| | - Adrián Alacreu-Crespo
- Department of Psychology and Sociology, Area of Personality, Assessment and Psychological Treatment, Universidad of Zaragoza, Teruel, Spain
| | - Inmaculada Peñuelas-Calvo
- Department of Child and Adolescent Psychiatry, Hospital 12 de Octubre, Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain
| | - Jorge López-Castromán
- Department of Psychiatry, CNRS-INSERM, University of Montpellier, CHU Nîmes & IGF, Montpellier, France
| | - Alejandro Porras-Segovia
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
- Division of Psychiatry, Imperial College, London, UK
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2
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Siria S, Leza L, López-Goñi JJ, Fernández-Montalvo J. Lifetime suicidal-related behaviour among patients in treatment for substance use disorder: A cross-sectional study. Psychiatry Res 2022; 317:114921. [PMID: 37732864 DOI: 10.1016/j.psychres.2022.114921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/08/2022] [Accepted: 10/20/2022] [Indexed: 10/31/2022]
Abstract
Suicidal-related behaviours are an important concern in individuals who present with substance use disorders (SUDs). The distinction among the specific characteristics of the different patients might help to improve prevention strategies. We describe and compare the sociodemographic characteristics, severity of addiction, and psychopathology of the participants depending on the severity of their lifetime suicidal behaviour. In addition, we examine whether the number of suicide attempts can be estimated based on the variables that differentiate the groups. A sample of 318 men and 86 women who sought treatment for addiction were assessed. The sample was divided into: no ideation or attempts, suicidal ideation, one suicide attempt, and two or more suicide attempts. The group with two or more suicide attempts exhibited a greater severity in the addiction profile. The group with one suicide attempt presented a higher psychopathological symptomatology at the time of the assessment. The severity of the Psychiatric area was related to the group with two or more attempts and to the number of suicide attempts. The presence of any number of attempts is associated with greater severity of addiction. Providing specific intervention strategies for SUD patients depending on their suicidal behaviours is promising for clinical application.
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Affiliation(s)
- Sandra Siria
- Universidad del País Vasco (UPV/EHU). San Sebastián. Guipúzcoa Spain
| | - Leire Leza
- Departamento de Ciencias de la Salud. Universidad Pública de Navarra. Campus de Arrosadía, 31006 Pamplona. Spain
| | - José J López-Goñi
- Departamento de Ciencias de la Salud. Universidad Pública de Navarra. Campus de Arrosadía, 31006 Pamplona. Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA). Pamplona. Navarra. Spain.
| | - Javier Fernández-Montalvo
- Departamento de Ciencias de la Salud. Universidad Pública de Navarra. Campus de Arrosadía, 31006 Pamplona. Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA). Pamplona. Navarra. Spain
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3
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Tachikawa H, Takahashi S, Nemoto K, Yonemoto N, Oda H, Miyake Y, Hirayasu Y, Arai T, Kawanishi C. Predictive factors for recurrent suicide attempts: Evidence from the ACTION-J study. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2022; 1:e7. [PMID: 38868638 PMCID: PMC11114385 DOI: 10.1002/pcn5.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/29/2022] [Accepted: 03/14/2022] [Indexed: 06/14/2024]
Abstract
Aim Risk factors for attempted suicide have been widely studied. However, there is limited evidence on predictive factors for suicide reattempts. We aimed to identify these in suicide attempters admitted to emergency departments. Methods This is the second analysis from a randomized controlled multicenter trial, ACTION-J. Patient characteristics were extracted from baseline demographic data and clinical data of participants. Predictive factors for a recurrent suicide attempt in each gender were examined using Cox proportional hazards regression analysis. Dependent variables were months from trial entry to the first reattempt. Independent variables were characteristics regarded as potential predictive factors. Results The study included 914 adults (400 men and 514 women). A visit to a psychiatrist within a month of the suicide attempt was significantly associated with reattempts in men (hazard ratio [HR] 2.49, 95% confidence interval [CI] 1.21-5.25). Substance-related disorders (HR 3.65, 95% CI 1.16-7.9.60), drinking alcohol less than once per month (HR 0.42, 95% CI 0.17-0.88), previous suicide attempts (HR 2.28, 95% CI 1.40-3.87), and taking a drug overdose for the first suicide attempt (HR 1.82, 95% CI 1.14-3.01) were significantly associated with reattempts in women. Conclusion Our data highlight the importance of visits to a psychiatrist a short time before the first suicide attempt in men and substance-related disorder, previous suicide attempts, and drug overdose in the first suicide attempt in women as predictive factors for future suicide reattempts.
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Affiliation(s)
- Hirokazu Tachikawa
- Department of Disaster and Community Psychiatry, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Sho Takahashi
- Department of Disaster and Community Psychiatry, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Kiyotaka Nemoto
- Department of Psychiatry, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Naohiro Yonemoto
- Department of Neuropsychopharmacology, National Institute of Mental HealthNational Center of Neurology and PsychiatryKodairaJapan
| | - Hiroyuki Oda
- Department of NeuropsychiatryKansai Medical UniversityHirakataJapan
| | - Yasufumi Miyake
- Department of Emergency MedicineTeikyo University HospitalItabashi‐kuJapan
| | | | - Tetsuaki Arai
- Department of Psychiatry, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Chiaki Kawanishi
- Department of NeuropsychiatrySapporo Medical University Graduate School of MedicineSapporoJapan
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Labonté B, Abdallah K, Maussion G, Yerko V, Yang J, Bittar T, Quessy F, Golden SA, Navarro L, Checknita D, Gigek C, Lopez JP, Neve RL, Russo SJ, Tremblay RE, Côté G, Meaney MJ, Mechawar N, Nestler EJ, Turecki G. Regulation of impulsive and aggressive behaviours by a novel lncRNA. Mol Psychiatry 2021; 26:3751-3764. [PMID: 31907380 PMCID: PMC7436429 DOI: 10.1038/s41380-019-0637-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/26/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022]
Abstract
High impulsive and aggressive traits associate with poor behavioural self-control. Despite their importance in predicting behavioural negative outcomes including suicide, the molecular mechanisms underlying the expression of impulsive and aggressive traits remain poorly understood. Here, we identified and characterized a novel long noncoding RNA (lncRNA), acting as a regulator of the monoamine oxidase A (MAOA) gene in the brain, and named it MAOA-associated lncRNA (MAALIN). Our results show that in the brain of suicide completers, MAALIN is regulated by a combination of epigenetic mechanisms including DNA methylation and chromatin modifications. Elevated MAALIN in the dentate gyrus of impulsive-aggressive suicides was associated with lower MAOA expression. Viral overexpression of MAALIN in neuroprogenitor cells decreased MAOA expression while CRISPR-mediated knock out resulted in elevated MAOA expression. Using viral-mediated gene transfer, we confirmed that MAALIN in the hippocampus significantly decreases MAOA expression and exacerbates the expression of impulsive-aggressive behavioural traits in CD1 aggressive mice. Overall, our findings suggest that variations in DNA methylation mediate the differential expression of a novel lncRNA that acts on MAOA expression to regulate impulsive-aggressive behaviours.
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Affiliation(s)
- Benoit Labonté
- Centre de Recherche CERVO, Department of Neuroscience and Psychiatry, Laval University, 2601, Chemin de la Canardière, Québec, QC, G1J 2G3, Canada.
| | - Khaled Abdallah
- Centre de Recherche CERVO, Department of Neuroscience and Psychiatry, Laval University, 2601, Chemin de la Canardière, Québec, QC, G1J 2G3, Canada
| | - Gilles Maussion
- McGill Group for Suicide Studies, Douglas Research Centre, Department of Psychiatry, McGill University, Frank B. Common Pavilion, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| | - Volodymyr Yerko
- McGill Group for Suicide Studies, Douglas Research Centre, Department of Psychiatry, McGill University, Frank B. Common Pavilion, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| | - Jennie Yang
- McGill Group for Suicide Studies, Douglas Research Centre, Department of Psychiatry, McGill University, Frank B. Common Pavilion, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| | - Thibault Bittar
- Centre de Recherche CERVO, Department of Neuroscience and Psychiatry, Laval University, 2601, Chemin de la Canardière, Québec, QC, G1J 2G3, Canada
| | - Francis Quessy
- Centre de Recherche CERVO, Department of Neuroscience and Psychiatry, Laval University, 2601, Chemin de la Canardière, Québec, QC, G1J 2G3, Canada
| | - Sam A Golden
- Fishberg Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luis Navarro
- Unitat de Genètica Molecular Institut de Biomedicina de València, Valencia, Spain
| | - Dave Checknita
- McGill Group for Suicide Studies, Douglas Research Centre, Department of Psychiatry, McGill University, Frank B. Common Pavilion, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| | - Carolina Gigek
- McGill Group for Suicide Studies, Douglas Research Centre, Department of Psychiatry, McGill University, Frank B. Common Pavilion, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| | - Juan Pablo Lopez
- McGill Group for Suicide Studies, Douglas Research Centre, Department of Psychiatry, McGill University, Frank B. Common Pavilion, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| | - Rachael L Neve
- Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Scott J Russo
- Fishberg Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard E Tremblay
- Research Unit on Children's Psychosocial Maladjustment, Université de Montréal, Montreal, QC, Canada
| | - Gilles Côté
- Philippe-Pinel Institute of Montreal, University of Montreal, Montreal, QC, Canada
| | - Michael J Meaney
- McGill Group for Suicide Studies, Douglas Research Centre, Department of Psychiatry, McGill University, Frank B. Common Pavilion, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, McGill University, Montreal, QC, Canada
| | - Naguib Mechawar
- McGill Group for Suicide Studies, Douglas Research Centre, Department of Psychiatry, McGill University, Frank B. Common Pavilion, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| | - Eric J Nestler
- Fishberg Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Research Centre, Department of Psychiatry, McGill University, Frank B. Common Pavilion, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada.
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Haliczer LA, Harnedy LE, Oakley M, Dixon-Gordon KL. Clarifying the Role of Multiple Self-Damaging Behaviors in the Association Between Emotion Dysregulation and Suicide Risk Among College Students. J Prim Prev 2021; 42:473-492. [PMID: 34236585 DOI: 10.1007/s10935-021-00639-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/29/2022]
Abstract
Suicidal behaviors are increasingly prevalent among college students. Although emotion dysregulation is theorized to increase suicide risk, research supporting this relationship is mixed. Engagement in self-damaging behaviors may play a role in the relationship between emotion dysregulation and suicide risk, theoretically by increasing one's capability of engaging in suicidal behaviors. Such behaviors may interact with emotion dysregulation to predict suicide risk. Alternatively, engaging in self-damaging behaviors may mediate the emotion dysregulation-suicide risk relationship. We examined the potential moderating and mediating roles of engagement in multiple self-damaging behaviors in the relationship between emotion dysregulation and suicide risk among college students. Participants were 181 undergraduate students who reported a history of self-damaging behaviors (i.e., non-suicidal self-injury, alcohol misuse, drug misuse, disordered eating), overall emotion dysregulation, and suicide risk. Findings revealed an interactive effect of emotion dysregulation and self-damaging behaviors on suicide risk, with engagement in more forms of self-damaging behaviors conferring higher risk for suicide, particularly in the context of greater emotion dysregulation. The model testing self-damaging behaviors as a mediator was also significant, such that greater emotion dysregulation had an indirect effect on elevated suicide risk via number of self-damaging behaviors. These findings help clarify associations among emotion dysregulation, self-damaging behaviors, and suicide risk, and have implications for specific targets of intervention and for the prevention of suicide by college students.
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Affiliation(s)
- Lauren A Haliczer
- University of Massachusetts Amherst, 617 Tobin Hall, 135 Hicks Way, Amherst, MA, 01003, USA
| | - Lauren E Harnedy
- University of Massachusetts Amherst, 617 Tobin Hall, 135 Hicks Way, Amherst, MA, 01003, USA
| | - Marykate Oakley
- University of Massachusetts Amherst, 617 Tobin Hall, 135 Hicks Way, Amherst, MA, 01003, USA
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6
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Aouidad A, Cohen D, Mirkovic B, Pellerin H, Garny de La Rivière S, Consoli A, Gérardin P, Guilé JM. Borderline personality disorder and prior suicide attempts define a severity gradient among hospitalized adolescent suicide attempters. BMC Psychiatry 2020; 20:525. [PMID: 33148207 PMCID: PMC7643473 DOI: 10.1186/s12888-020-02930-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 10/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) and history of prior suicide attempt (SA) have been shown to be high predictors for subsequent suicide. However, no previous study has examined how both factors interact to modify clinical and suicide severity among adolescents. METHODS This study presents a comprehensive assessment of 302 adolescents (265 girls, mean age = 14.7 years) hospitalized after a SA. To test clinical interactions between BPD and history of prior SA, the sample was divided into single attempters without BPD (non-BPD-SA, N = 80), single attempters with BPD (BPD-SA, N = 127) and multiple attempters with BPD (BPD-MA, N = 95). RESULTS Univariate analyses revealed a severity gradient among the 3 groups with an additive effect of BPD on the clinical and suicide severity already conferred by a history of SA. This gradient encompassed categorical (anxiety and conduct disorders and non-suicidal-self-injury [NSSI]) and dimensional comorbidities (substance use and depression severity) and suicide characteristics (age at first SA). According to regression analyses, the BPD-MA group that was associated with the most severe clinical presentation also showed specific features: the first SA at a younger age and a higher prevalence of non-suicidal self-injury (NSSI) and anxiety disorders. The BPD-MA group was not associated with higher impulsivity or frequency of negative life events. CONCLUSIONS Based on these findings and to improve youth suicide prevention, future studies should systematically consider BPD and the efficacy of reinforcing early interventions for anxiety disorders and NSSI.
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Affiliation(s)
| | - David Cohen
- grid.462015.40000 0004 0617 9849Institut des Systemes Intelligents et de Robotique, Paris, France
| | - Bojan Mirkovic
- grid.417615.00000 0001 2296 5231Hopital Charles Nicolle, Rouen, France
| | - Hugues Pellerin
- grid.411439.a0000 0001 2150 9058Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - Angèle Consoli
- grid.411439.a0000 0001 2150 9058Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - Jean-Marc Guilé
- grid.134996.00000 0004 0593 702XCentre Hospitalier Universitaire Amiens-Picardie, Amiens, France
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7
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Alberdi-Paramo I, Saiz-Gonzalez MD, Diaz-Marsa M, Carrasco-Perera JL. Bullying and childhood trauma events as predictive factors of suicidal behavior in borderline personality disorder: Preliminary findings. Psychiatry Res 2020; 285:112730. [PMID: 31831199 DOI: 10.1016/j.psychres.2019.112730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 11/26/2022]
Abstract
Traumas in childhood could present a significant association with suicidal behavior in BPD. The aim of the report is to study the link between a traumatic childhood involving school bullying and the different forms and degrees of suicidal behavior in BPD. A cross-sectional study was carried out on a sample of 109 BPD patients. It is divided into two groups whether or not there is a history of suicidal behavior. The clinical variables are compared with Chi square and Student's T tests. Traumatic childhood history and bullying, in particular, showed a statistically significant association with the incidence of suicidal behaviors.
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Affiliation(s)
| | | | - Marina Diaz-Marsa
- Department of Psychiatry, Hospital Clinico San Carlos, Madrid, Spain; Department of Psychiatry, School of Medicine, Universidad Complutense de Madrid. Centro de Investigacion Biomédica en Red de Salud Mental, Cibersam, Spain
| | - Jose Luis Carrasco-Perera
- Department of Psychiatry, Hospital Clinico San Carlos, Madrid, Spain; Department of Psychiatry, School of Medicine, Universidad Complutense de Madrid. Centro de Investigacion Biomédica en Red de Salud Mental, Cibersam, Spain
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8
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Psychiatric diagnosis, gender, aggression, and mode of attempt in patients with single versus repeated suicide attempts. Psychiatry Res 2020; 284:112747. [PMID: 31927168 DOI: 10.1016/j.psychres.2020.112747] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 12/01/2019] [Accepted: 01/01/2020] [Indexed: 12/31/2022]
Abstract
There is evidence that patients with multiple suicide attempts in their history are at greater risk to repeat attempt and eventually die by suicide compared to those with a single attempt. This cross-sectional study aimed to explore possible differences in clinical characteristics between patients with a single attempt and patients with repeated attempts. Two hundred thirty one patients hospitalised in psychiatric department after suicide attempt were studied. Comparisons were made in relation to age, gender, psychiatric diagnosis, aggression, depression severity, suicide intent and mode of attempt. Highest frequencies of patients with repeated attempts were found for bipolar disorder (69%) and lowest for adjustment/personality disorders (39%). In patients with repeated attempts, female gender was associated with non-violent attempt mode. Depressive symptomatology was higher in patients with repeated attempts among females. In patients with depression those with repeated attempts were younger than patients with single attempt. In patients with mood disorders, total aggression and hostility scores were higher in females with repeated attempts but not in males. Psychiatric diagnosis, gender and attempt mode are features that differentiate patients with single and repeated attempts and should be considered to identify patients at increased risk to repeat attempt and design effective prevention interventions.
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Abstract
Although recent years have seen large decreases in the overall global rate of suicide fatalities, this trend is not reflected everywhere. Suicide and suicidal behaviour continue to present key challenges for public policy and health services, with increasing suicide deaths in some countries such as the USA. The development of suicide risk is complex, involving contributions from biological (including genetics), psychological (such as certain personality traits), clinical (such as comorbid psychiatric illness), social and environmental factors. The involvement of multiple risk factors in conveying risk of suicide means that determining an individual's risk of suicide is challenging. Improving risk assessment, for example, by using computer testing and genetic screening, is an area of ongoing research. Prevention is key to reduce the number of suicide deaths and prevention efforts include universal, selective and indicated interventions, although these interventions are often delivered in combination. These interventions, combined with psychological (such as cognitive behavioural therapy, caring contacts and safety planning) and pharmacological treatments (for example, clozapine and ketamine) along with coordinated social and public health initiatives, should continue to improve the management of individuals who are suicidal and decrease suicide-associated morbidity.
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10
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Baer MM, LaCroix JM, Browne JC, Hassen HO, Perera KU, Soumoff A, Weaver J, Ghahramanlou-Holloway M. Impulse control difficulties while distressed: A facet of emotion dysregulation links to Non-Suicidal Self-Injury among psychiatric inpatients at military treatment facilities. Psychiatry Res 2018; 269:419-424. [PMID: 30195229 DOI: 10.1016/j.psychres.2018.08.082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/31/2018] [Accepted: 08/23/2018] [Indexed: 01/22/2023]
Abstract
Links between emotion dysregulation, suicide ideation, and suicidal versus non-suicidal self-injury (NSSI) are poorly understood within military samples. United States service members and beneficiaries (N = 186), psychiatrically hospitalized following a suicidal crisis, completed the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004), and reported lifetime suicide ideation, attempts, and NSSI. We expected that emotion dysregulation would positively associate with worst lifetime suicide ideation, multiple suicide attempt status, and lifetime NSSI. Suicide ideation severity and multiple suicide attempts did not associate with DERS components. Notably, difficulties with impulse control (feeling out of control while distressed) was positively associated with NSSI history. Theoretical models that clearly describe the role of emotion dysregulation in suicidal thoughts, its progression to suicidal actions, and NSSI are needed to advance clinical care for this highly vulnerable group. Longitudinal and micro-longitudinal study designs require further investigation.
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Affiliation(s)
- Margaret M Baer
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda 20814-4799, MD, USA
| | - Jessica M LaCroix
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda 20814-4799, MD, USA
| | - Joy C Browne
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda 20814-4799, MD, USA
| | - Helena O Hassen
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda 20814-4799, MD, USA
| | - Kanchana U Perera
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda 20814-4799, MD, USA
| | - Alyssa Soumoff
- Walter Reed National Military Medical Center, National Intrepid Center of Excellence, Bethesda, MD, USA
| | | | - Marjan Ghahramanlou-Holloway
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda 20814-4799, MD, USA.
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11
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Pennel L, Quesada JL, Dematteis M. Neuroticism and anxious attachment as potential vulnerability factors of repeat suicide attempts. Psychiatry Res 2018; 264:46-53. [PMID: 29626831 DOI: 10.1016/j.psychres.2018.03.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 11/30/2022]
Abstract
The recurrence risk of suicide attempts can reach 50% in the first year, each attempt increasing suicide-risk by 32%. No screening tool efficiently identifies potential repeat suicide attempters who are too often regarded as borderline personality. Our aim was to identify individual and interpersonal psychopathological dimensions that could represent a vulnerability to repeat suicide attempts. Sixty first-time and repeat suicide attempters consecutively admitted in emergency rooms were compared for fundamental dimensions of personality, patterns of attachment, personality and mental disorders using standardized questionnaires. Confounding and significantly different factors were evaluated using univariate and multivariate logistic regressions. Repeat suicide attempters differed from first-attempters by higher neuroticism and anxious attachment. Combined in an 11-item measure, these two parameters identified a 3.99 times higher risk of repeat suicide attempt. These traits associated with the other two best predictors (non-suicidal self-injury history, current psychotropic drugs) provide a vulnerability model with better screening performance compared to each factor individually. Repeat suicide attempters have more psychological features impairing emotional stability and social interactions than first attempters. Cross-sectional study design, sample size, lack of independent sample and of fearful-avoidant attachment evaluation are the main limitations. The model needs to be validated in a prospective and controlled study.
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Affiliation(s)
- Lucie Pennel
- Univ. Grenoble Alpes, F-38042 Grenoble, France; CHU Grenoble Alpes, Department of Addiction Medicine, F-38043 Grenoble, France
| | - Jean-Louis Quesada
- CHU Grenoble Alpes, Clinical Investigation Center 1406, F-38043 Grenoble, France
| | - Maurice Dematteis
- Univ. Grenoble Alpes, F-38042 Grenoble, France; CHU Grenoble Alpes, Department of Addiction Medicine, F-38043 Grenoble, France.
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12
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Li R, Cai Y, Wang Y, Gan F, Shi R. Psychological pathway to suicidal ideation among men who have sex with men in Shanghai, China: A structural equation model. J Psychiatr Res 2016; 83:203-210. [PMID: 27661416 DOI: 10.1016/j.jpsychires.2016.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 08/31/2016] [Accepted: 09/02/2016] [Indexed: 01/19/2023]
Abstract
We aimed to explore the relationships and develop an inter-theoretical model among psychological variables in the progression to suicidal ideation among men who have sex with men (MSM). A cross-sectional study was conducted among 547 MSM in four districts in Shanghai from March to May in 2014. Socio-demographic, psychological, and behavioral information of the participants was collected. A structural equation model (SEM)-Path Analysis was constructed to interpret the intricate relationships among various psychological variables. Suicidal ideation among MSM during the past year was 10.6%. The developed model agreed well with existing suicide models and had a good fit to the data (χ2/df = 2.497, comparative fit index = 0.983, root mean squared error of approximation = 0.052). Suicidal ideation was predicted by perceived defeat and entrapment (β = 0.21, p < 0.001), which was in turn predicted by temperament (β = 0.60, p < 0.001) and perceived social support (β = 0.34, p < 0.001). Perceived social support fully mediated the relationships among mood states, perceived social status, and perceived defeat and entrapment. MSM with certain types of temperament might be predisposed to a higher perception of defeat and entrapment. Perceived social support can effectively alleviate the negative appraisals and emotions and lower the risk for suicidal ideation among MSM.
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Affiliation(s)
- Rui Li
- School of Public Health, Shanghai Jiao Tong University, No. 227, South Chongqing Road, Shanghai, 200025, PR China
| | - Yong Cai
- School of Public Health, Shanghai Jiao Tong University, No. 227, South Chongqing Road, Shanghai, 200025, PR China; Shanghai Jiao Tong University Institute of Social Cognitive and Behavioral Sciences, No. 800, Dongchuan Road, Shanghai, 200240, PR China.
| | - Ying Wang
- School of Public Health, Shanghai Jiao Tong University, No. 227, South Chongqing Road, Shanghai, 200025, PR China; Shanghai Jiao Tong University Institute of Social Cognitive and Behavioral Sciences, No. 800, Dongchuan Road, Shanghai, 200240, PR China.
| | - Feng Gan
- School of Continuing Education, Shanghai Jiao Tong University, No. 1954, Hua Shan Road, Shanghai, 200030, PR China
| | - Rong Shi
- School of Public Health, Shanghai University of Traditional Chinese Medicine, No. 1200, Cai Lun Road, Shanghai, 201203, PR China.
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Gómez-Expósito A, Wolz I, Fagundo AB, Granero R, Steward T, Jiménez-Murcia S, Agüera Z, Fernández-Aranda F. Correlates of Non-suicidal Self-Injury and Suicide Attempts in Bulimic Spectrum Disorders. Front Psychol 2016; 7:1244. [PMID: 27597836 PMCID: PMC4992685 DOI: 10.3389/fpsyg.2016.01244] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/04/2016] [Indexed: 11/23/2022] Open
Abstract
Objective: The aim of this study was to examine the implication of personality, impulsivity, and emotion regulation difficulties in patients with a bulimic-spectrum disorder (BSD) and suicide attempts (SA), BSD patients with non-suicidal self-injury (NSSI), and BSD patients without these behaviors. Method: One hundred and twenty-two female adult BSD patients were assessed using self-report questionnaires. Patients were clustered post-hoc into three groups depending on whether they presented BSD without NSSI or SA (BSD), BSD with lifetime NSSI (BSD + NSSI) or BSD with lifetime SA (BSD + SA). Results: The BSD + NSSI and BSD + SA groups presented more emotion regulation difficulties, more eating and general psychopathology, and increased reward dependence in comparison with the BSD group. In addition, BSD + SA patients specifically showed problems with impulse control, while also presenting higher impulsivity than both the BSD and BSD + NSSI groups. No differences in impulsivity between the BSD and BSD + NSSI groups were found. Conclusions: The results show that BSD + NSSI and BSD + SA share a common profile characterized by difficulties in emotion regulation and low reward dependence, but differ in impulsivity and cooperativeness. This suggests that self-injury, in patients without a history of suicide attempts (i.e., BSD + NSSI), may have a regulatory role rather than being due to impulsivity.
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Affiliation(s)
| | - Ines Wolz
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELLBarcelona, Spain; Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos IIIBarcelona, Spain
| | - Ana B Fagundo
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELLBarcelona, Spain; Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos IIIBarcelona, Spain
| | - Roser Granero
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos IIIBarcelona, Spain; Departament de Psicobiologia i Metodologia. Universitat Autònoma de BarcelonaBarcelona, Spain
| | - Trevor Steward
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELLBarcelona, Spain; Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos IIIBarcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELLBarcelona, Spain; Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos IIIBarcelona, Spain; Department of Clinical Sciences, School of Medicine, University of BarcelonaBarcelona, Spain
| | - Zaida Agüera
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELLBarcelona, Spain; Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos IIIBarcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELLBarcelona, Spain; Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos IIIBarcelona, Spain; Department of Clinical Sciences, School of Medicine, University of BarcelonaBarcelona, Spain
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Benson O, Gibson S, Boden ZV, Owen G. Exhausted without trust and inherent worth: A model of the suicide process based on experiential accounts. Soc Sci Med 2016; 163:126-34. [DOI: 10.1016/j.socscimed.2016.06.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 06/21/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
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15
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Lopez-Castroman J, Cerrato L, Beziat S, Jaussent I, Guillaume S, Courtet P. Heavy tobacco dependence in suicide attempters making recurrent and medically serious attempts. Drug Alcohol Depend 2016; 160:177-82. [PMID: 26832932 DOI: 10.1016/j.drugalcdep.2016.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 01/06/2016] [Accepted: 01/06/2016] [Indexed: 11/28/2022]
Abstract
AIMS Tobacco dependence and suicidal behaviors have been repeatedly associated in several studies but their relationship is still unclear. We aim to investigate, specifically, the association between the level of tobacco dependence and the severity of suicidal outcomes among suicide attempters, as well as the relationship of impulsivity with both conditions. METHODS We examined a cross-sectional sample of 542 adult suicide attempters to compare the characteristics of the attempts depending on the level of tobacco dependence, which was assessed with the Fagerstrom test. RESULTS Smokers with heavy dependence (Fagerstrom ≥7) made more attempts and reached higher medical lethality compared to non-smokers. Smokers with moderate dependence were not associated with features of severity in the suicide attempts. The combination of high impulsivity and heavy tobacco dependence showed an additive effect on the number of suicide attempts. CONCLUSIONS A high or very high level of tobacco dependence could indicate a specific vulnerability leading to more severe suicide attempts. Impulsive attempters with heavy tobacco dependence were particularly at risk.
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Affiliation(s)
- Jorge Lopez-Castroman
- Department of Psychiatry, CHRU Nimes, 585 Chemin du Mas de Lauze, 30029 Nîmes, France; Inserm U1061, Université Montpellier, 39 Av. Charles Flahault, 34093 Montpellier, France.
| | - Laurent Cerrato
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 191 Av. du Doyen Gaston Giraud, 34093 Montpellier, France
| | - Severine Beziat
- Inserm U1061, Université Montpellier, 39 Av. Charles Flahault, 34093 Montpellier, France
| | - Isabelle Jaussent
- Inserm U1061, Université Montpellier, 39 Av. Charles Flahault, 34093 Montpellier, France
| | - Sebastien Guillaume
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 191 Av. du Doyen Gaston Giraud, 34093 Montpellier, France; Inserm U1061, Université Montpellier, 39 Av. Charles Flahault, 34093 Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 191 Av. du Doyen Gaston Giraud, 34093 Montpellier, France; Inserm U1061, Université Montpellier, 39 Av. Charles Flahault, 34093 Montpellier, France; Fondamental Foundation, 40 Rue de Mesly, 94000 Créteil, France
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16
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Kaess M, Brunner R, Parzer P, Edanackaparampil M, Schmidt J, Kirisgil M, Fischer G, Wewetzer C, Lehmkuhl G, Resch F. Association of Adolescent Dimensional Borderline Personality Pathology with Past and Current Nonsuicidal Self-Injury and Lifetime Suicidal Behavior: A Clinical Multicenter Study. Psychopathology 2016; 49:356-363. [PMID: 27614954 DOI: 10.1159/000448481] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/17/2016] [Indexed: 11/19/2022]
Abstract
Descriptive diagnoses of nonsuicidal self-injury (NSSI) and suicide attempts (SAs) may detract from underlying dimensional borderline personality pathology (D-BPP). This study aimed to investigate D-BPP in adolescent inpatients with NSSI and SAs. A consecutive sample of 359 adolescent inpatients was assessed for current and past NSSI and life-time SAs. D-BPP and current mental health problems were measured using the Dimensional Assessment of Personality Pathology and the Strengths and Difficulties Questionnaire, respectively. D-BPP was significantly associated with both current (p < 0.001) and past NSSI (p = 0.025) and life-time SAs (p < 0.001) compared to their non-self-harming peers. Patients with current and past NSSI did not differ in terms of D-BPP or current mental health problems. A multivariate model did not show any additional influence of current mental health problems over and above D-BPP in predicting NSSI and SAs. It can be hypothesized that D-BPP underlies adolescent self-harm and may persist even after its termination, promoting a higher burden of mental health problems.
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Affiliation(s)
- Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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17
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Hong JS, Kral MJ, Sterzing PR. Pathways From Bullying Perpetration, Victimization, and Bully Victimization to Suicidality Among School-Aged Youth: A Review of the Potential Mediators and a Call for Further Investigation. TRAUMA, VIOLENCE & ABUSE 2015; 16:379-390. [PMID: 24903399 DOI: 10.1177/1524838014537904] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In the wake of several highly publicized adolescent suicides attributed to bullying victimization, national attention has been brought to bear on the profound public health problem of bullying. This article reviews the extant literature on the associations between bullying perpetration, victimization, and thoughts of or attempts at suicide and proposes five potential mediators, namely depression, anxiety, low self-esteem, loneliness, and hopelessness, that may explain this relationship. Numerous studies have found empirical support for the interrelations between internalizing behaviors and both bullying perpetration and victimization and suicide. We find that further longitudinal research needs to be conducted to more conclusively determine the role and causal ordering these various psychosocial factors may play in bullying perpetration, victimization, and suicide. Although the research literature implies causal directions among all these potential mediators, untangling the unique influence of bullying perpetration, victimization, and bully victimization on suicide and its mechanisms of action has major research and practice implications.
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Affiliation(s)
- Jun Sung Hong
- School of Social Work, Wayne State University, Detroit, MI, USA
| | - Michael J Kral
- School of Social Work, Wayne State University, Detroit, MI, USA
| | - Paul R Sterzing
- School of Social Welfare, University of California, Berkeley, CA, USA
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18
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Pisetsky EM, Wonderlich SA, Crosby RD, Peterson CB, Mitchell JE, Engel SG, Joiner TE, Bardone-Cone A, Le Grange D, Klein MH, Crow SJ. Depression and Personality Traits Associated With Emotion Dysregulation: Correlates of Suicide Attempts in Women with Bulimia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2015; 23:537-44. [PMID: 26315489 DOI: 10.1002/erv.2401] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/20/2015] [Accepted: 08/05/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The objective of this study was to identify personality traits and psychiatric comorbidities associated with a lifetime history of a suicide attempt in women with bulimia nervosa (BN). METHOD Data from two samples of women with BN (n = 204 and n = 133) were examined. Participants in both samples completed the Dimensional Assessment of Personality Pathology-Basic Questionnaire and reported whether they had ever had a lifetime suicide attempt. Comorbid psychopathology was based on self-reported questionnaire and interview data. Univariate and multivariate logistic regression analyses were run, predicting a lifetime suicide attempt. RESULTS Based on the Dimensional Assessment of Personality Pathology-Basic Questionnaire, identity problems were associated with a lifetime suicide attempt in both samples; cognitive dysregulation, anxiousness and insecure attachment were associated with a lifetime suicide attempt in one but not both samples. Lifetime anxiety disorder was associated with a lifetime suicide attempt in one sample, and depression was associated with a lifetime suicide attempt in both samples. Multivariate analyses revealed that only depression was uniquely associated with a lifetime suicide attempt in both samples. DISCUSSION Although personality traits associated with aspects of emotion dysregulation were associated with a lifetime suicide attempt, depression was found to have the strongest association with a lifetime suicide attempt in two samples of women with BN. These findings suggest that depression severity may be the most important target of treatment and suicide prevention efforts in women with BN.
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Affiliation(s)
- Emily M Pisetsky
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Stephen A Wonderlich
- Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.,Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Ross D Crosby
- Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.,Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - James E Mitchell
- Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.,Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Scott G Engel
- Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.,Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Anna Bardone-Cone
- Department of Psychology, University of North Carolina, Chapel Hill, NC, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Marjorie H Klein
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.,The Emily Program, St. Paul, MN, USA
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19
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Law KC, Khazem LR, Anestis MD. The role of emotion dysregulation in suicide as considered through the ideation to action framework. Curr Opin Psychol 2015. [DOI: 10.1016/j.copsyc.2015.01.014] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Lopez-Castroman J, Jaussent I, Beziat S, Guillaume S, Baca-Garcia E, Olié E, Courtet P. Posttraumatic Stress Disorder following childhood abuse increases the severity of suicide attempts. J Affect Disord 2015; 170:7-14. [PMID: 25217758 DOI: 10.1016/j.jad.2014.08.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/01/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Posttraumatic Stress Disorder (PTSD) and childhood abuse are both consistently associated with a higher risk for suicide attempts. We hypothesize that among patients reporting childhood abuse, PTSD diagnoses are correlated with an increased severity of suicidal features. METHOD We investigated 726 adult patients who had attempted suicide. These participants were assessed on lifetime clinical diagnoses and childhood abuse. The association of PTSD and childhood abuse dimensions with age at first suicide attempt, number of suicide attempts, violent attempts, serious attempts and suicide intent was studied. An adjusted multinomial logistic regression was performed to ascertain if childhood abuse and PTSD increased the severity of the suicidal behavior when combined. RESULTS Several types of childhood abuse (emotional, physical and sexual abuse) when combined with a lifetime diagnosis of PTSD showed an increased risk for more suicide attempts, serious attempts, and a higher level of suicidal intent compared with the absence of any or both risk factors. CONCLUSION The combination of PTSD and childhood abuse should be investigated in clinical settings due to an augmented risk for more severe suicidal behavior.
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Affiliation(s)
- Jorge Lopez-Castroman
- Inserm U1061, Ho^pital La Colombiere, Montpellier, France; IIS-Fundacion Jimenez Diaz, Department of Psychiatry, CIBERSAM, Madrid, Spain; Department of Emergency Psychiatry, CHRU Montpellier, France.
| | | | | | - Sebastien Guillaume
- Inserm U1061, Ho^pital La Colombiere, Montpellier, France; Department of Emergency Psychiatry, CHRU Montpellier, France; University of Montpellier 1, Montpellier, France
| | - Enrique Baca-Garcia
- IIS-Fundacion Jimenez Diaz, Department of Psychiatry, CIBERSAM, Madrid, Spain; Department of Psychiatry at the New York State Psychiatric Institute and Columbia University, NY, USA
| | - Emilie Olié
- Inserm U1061, Ho^pital La Colombiere, Montpellier, France; Department of Emergency Psychiatry, CHRU Montpellier, France; University of Montpellier 1, Montpellier, France
| | - Philippe Courtet
- Inserm U1061, Ho^pital La Colombiere, Montpellier, France; Department of Emergency Psychiatry, CHRU Montpellier, France; University of Montpellier 1, Montpellier, France
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Abstract
Suicide ranks among the leading causes of death around the world and takes a heavy emotional and public health toll on most societies. Both distal and proximal factors contribute to suicidal behaviour. Distal factors - such as familial and genetic predisposition, as well as early-life adversity - increase the lifetime risk of suicide. They alter responses to stress and other processes through epigenetic modification of genes and associated changes in gene expression, and through the regulation of emotional and behavioural traits. Proximal factors are associated with the precipitation of a suicidal event and include alterations in key neurotransmitter systems, inflammatory changes and glial dysfunction in the brain. This Review explores the key molecular changes that are associated with suicidality and discusses some promising avenues for future research.
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22
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Cabaj JL, McDonald SW, Tough SC. Early childhood risk and resilience factors for behavioural and emotional problems in middle childhood. BMC Pediatr 2014; 14:166. [PMID: 24986740 PMCID: PMC4083129 DOI: 10.1186/1471-2431-14-166] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 06/25/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Mental disorders in childhood have a considerable health and societal impact but the associated negative consequences may be ameliorated through early identification of risk and protective factors that can guide health promoting and preventive interventions. The objective of this study was to inform health policy and practice through identification of demographic, familial and environmental factors associated with emotional or behavioural problems in middle childhood, and the predictors of resilience in the presence of identified risk factors. METHODS A cohort of 706 mothers followed from early pregnancy was surveyed at six to eight years post-partum by a mail-out questionnaire, which included questions on demographics, children's health, development, activities, media and technology, family, friends, community, school life, and mother's health. RESULTS Although most children do well in middle childhood, of 450 respondents (64% response rate), 29.5% and 25.6% of children were found to have internalising and externalising behaviour problem scores in the lowest quintile on the NSCLY Child Behaviour Scales. Independent predictors for problem behaviours identified through multivariable logistic regression modelling included being male, demographic risk, maternal mental health risk, poor parenting interactions, and low parenting morale. Among children at high risk for behaviour problems, protective factors included high maternal and child self-esteem, good maternal emotional health, adequate social support, good academic performance, and adequate quality parenting time. CONCLUSIONS These findings demonstrate that several individual and social resilience factors can counter the influence of early adversities on the likelihood of developing problem behaviours in middle childhood, thus informing enhanced public health interventions for this understudied life course phase.
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Affiliation(s)
- Jason L Cabaj
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sheila W McDonald
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne C Tough
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Huang YC, Wu YW, Chen CK, Wang LJ. Methods of suicide predict the risks and method-switching of subsequent suicide attempts: a community cohort study in Taiwan. Neuropsychiatr Dis Treat 2014; 10:711-8. [PMID: 24833904 PMCID: PMC4015797 DOI: 10.2147/ndt.s61965] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Suicide is a major public health concern. This study aimed to determine the predictors of repeated suicide attempts, focusing on whether lethality level of the suicidal method predicts the risk of subsequent suicide attempts. METHODS All consecutive individuals (N=2,070) with an episode of nonfatal self-harm registered in a surveillance database provided by the Department of Health of Keelung City Government in Taiwan from January 1, 2006 to December 31, 2010 were enrolled and followed up until the end of 2011. The earliest attempt recorded in the database was defined as the index attempt. Subjects were classified according to suicide method into low-lethal and high-lethal groups. Data on time of and methods chosen for subsequent suicide attempts during the follow-up period were analyzed. RESULTS Of the total people screened for the study, 18.1% made a repeated suicide attempt. Subjects in the high-lethal group were more likely to be male; aged 35-64 years; and single, divorced, or widowed. Compared to other time intervals, most subsequent suicide attempts occurred within 6 months from the index attempt. The independent predictors for repeated suicide attempts were the use of low-lethal methods in the index attempt and being 35-49 years old. Using high-lethal methods and being older than 50 years were associated with changing suicide method for the second attempt. CONCLUSION Lethality level of former suicidal method could predict repeated suicide attempts and changing of suicide methods. Further clarification is needed on whether a higher risk of repeat attempts is associated with higher rates of suicide mortality.
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Affiliation(s)
- Yu-Chi Huang
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ya-Wen Wu
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Ken Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung and Chang Gung University School of Medicine, Taoyuan, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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24
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Beghi M, Rosenbaum JF, Cerri C, Cornaggia CM. Risk factors for fatal and nonfatal repetition of suicide attempts: a literature review. Neuropsychiatr Dis Treat 2013; 9:1725-36. [PMID: 24235836 PMCID: PMC3825699 DOI: 10.2147/ndt.s40213] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This review aimed to identify the evidence for predictors of repetition of suicide attempts, and more specifically for subsequent completed suicide. METHODS We conducted a literature search of PubMed and Embase between January 1, 1991 and December 31, 2009, and we excluded studies investigating only special populations (eg, male and female only, children and adolescents, elderly, a specific psychiatric disorder) and studies with sample size fewer than 50 patients. RESULTS The strongest predictor of a repeated attempt is a previous attempt, followed by being a victim of sexual abuse, poor global functioning, having a psychiatric disorder, being on psychiatric treatment, depression, anxiety, and alcohol abuse or dependence. For other variables examined (Caucasian ethnicity, having a criminal record, having any mood disorders, bad family environment, and impulsivity) there are indications for a putative correlation as well. For completed suicide, the strongest predictors are older age, suicide ideation, and history of suicide attempt. Living alone, male sex, and alcohol abuse are weakly predictive with a positive correlation (but sustained by very scarce data) for poor impulsivity and a somatic diagnosis. CONCLUSION It is difficult to find predictors for repetition of nonfatal suicide attempts, and even more difficult to identify predictors of completed suicide. Suicide ideation and alcohol or substance abuse/dependence, which are, along with depression, the most consistent predictors for initial nonfatal attempt and suicide, are not consistently reported to be very strong predictors for nonfatal repetition.
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Affiliation(s)
- Massimiliano Beghi
- Psychiatry Clinic, University of Milano Bicocca, Milan, Italy ; Department of Psychiatry, Salvini Hospital, Rho, Italy
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25
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Palmier-Claus JE, Taylor PJ, Varese F, Pratt D. Does unstable mood increase risk of suicide? Theory, research and practice. J Affect Disord 2012; 143:5-15. [PMID: 22842024 DOI: 10.1016/j.jad.2012.05.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 05/27/2012] [Accepted: 05/28/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Suicide represents a substantial problem, with significant societal and personal impact. The identification of factors influencing suicide risk is an important step in preventing self-harming behaviour. In this article the authors explore whether emotional instability increases risk of suicide, beyond that of mood intensity. METHOD This article provides a summary of existing theory and indirect evidence in support of an association between emotional instability and suicidality. A systematic literature search (Embase, Medline, PsychInfo) was carried out on literature conducted up to October, 2011. Meta-analysis was used to assess the strength of the proposed association. RESULTS The systematic search identified 20 journal articles meeting the inclusion criteria, including retrospective questionnaire design studies and research conducted across several time-points. Meta-analysis revealed a moderate association, which remained statistically significant even when only including studies conducted over multiple time-points. This effect was attenuated, but remained significant, when controlling for study selection bias. LIMITATIONS Retrospective questionnaire studies failed to adequately control for mood level. Little is still currently understood about the types of emotional instability (e.g., dysoria, anxiety) most associated with suicidality. CONCLUSIONS Future avenues of investigation include micro- to macro-longitudinal research and the differentiation of emotion subtypes and instability metrics. Momentary assessment techniques may help to detect subtle fluctuations in mood leading to more effective and immediate intervention. Psychosocial intervention strategies for treating unstable emotions are discussed.
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Affiliation(s)
- J E Palmier-Claus
- The School of Community Based Medicine, University of Manchester, Manchester, UK.
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Suicidal phenotypes associated with family history of suicidal behavior and early traumatic experiences. J Affect Disord 2012; 142:193-9. [PMID: 22842027 DOI: 10.1016/j.jad.2012.04.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 04/09/2012] [Accepted: 04/10/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Family history of suicidal behavior and personal history of childhood trauma are risk factors for suicidal behaviors. We hypothesize that subjects with any of these risk factors will show differential features and that subjects with both of them will display more severe phenotypes. METHODS This study compares three groups of suicide attempters (n=878): subjects with a family history of suicidal behavior and a personal history of early traumatic experiences, subjects with a family history of suicidal behavior or a personal history of early traumatic experiences, and subjects with neither of these two risk factors, with regards to psychopathology, personality traits and suicidal behavior. RESULTS Subjects with a family history of suicidal behavior and childhood trauma were younger at their first suicide attempt and made more frequent, severe and violent attempts when compared with the other groups. Differences in number and precocity of attempts remained after adjustments in a multinomial regression model. Finally, personality profiles were also substantially different in the group with higher impulsiveness, novelty seeking, affective lability and hopelessness. LIMITATIONS The information provided by subjects regarding childhood abuse and family history of suicidal behavior was not confirmed by other sources. CONCLUSIONS Suicide attempters with a family history of suicidal behavior and childhood trauma show specific characteristics that might be used to prevent future suicidal behaviors in this population. Both risk factors should be routinely investigated when assessing the suicidal risk of a patient.
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Sociodemographic and psychopathological risk factors in repeated suicide attempts: gender differences in a prospective study. J Affect Disord 2012; 136:35-43. [PMID: 21975134 DOI: 10.1016/j.jad.2011.09.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 08/31/2011] [Accepted: 09/01/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND The prevention of the repetition of suicide attempts is an important feature of the care of attempters but current data fail to give actual predictors of repetition. The aim of this study was to characterize sociodemographic and psychopathological features and risk factors associated with future repetition of suicide attempts in two years. The study focused on differences between men and women. METHODS 273 participants selected in psychiatric emergency units after their admission for a suicide attempt (index) were included in the study. Subsequent suicide attempts occurring within a two year follow-up were identified from the regional observatory of suicide attempts. At inclusion, sociodemographic variables and psychopathological data were collected. In particular, psychometric evaluations were performed using the following scales: BDI-SF, SIS, BIS and BDHI. The lifetime history of suicide attempt was also noted. RESULTS Repetition of suicide attempt in 2 years was associated with current follow up and treatment, a personal history of multiple suicide attempt, post traumatic stress disorder, current recurrent psychotic syndrome and substance misuse. Specific features of men and women repeaters have been identified. Men repeaters were characterized by substance use disorders whereas the re-attempt in women was associated with current follow up and treatment, post traumatic stress disorder and higher BDI-SF score. CONCLUSIONS Repeaters must be considered as a specific population among suicide attempters and gender differences must be taken into account in this particular population in order to promote more personalized prevention programs for suicidal recurrence and completed suicide.
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Turecki G, Ernst C, Jollant F, Labonté B, Mechawar N. The neurodevelopmental origins of suicidal behavior. Trends Neurosci 2011; 35:14-23. [PMID: 22177979 DOI: 10.1016/j.tins.2011.11.008] [Citation(s) in RCA: 183] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 10/28/2011] [Accepted: 11/21/2011] [Indexed: 12/30/2022]
Abstract
Suicide and related behaviors are complex phenomena associated with different risk factors. Although most individuals who display suicidal behavior do not have a history of early-life adversity, a significant minority does. Recent animal and human data have suggested that early-life adversity leads to epigenetic regulation of genes involved in stress-response systems. Here, we review this evidence and suggest that early-life adversity increases risk of suicide in susceptible individuals by influencing the development of stable emotional, behavioral and cognitive phenotypes that are likely to result from the epigenetic regulation of the hypothalamic-pituitary-adrenal axis and other systems involved in responses to stress.
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Affiliation(s)
- Gustavo Turecki
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Montreal, Canada.
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Hakansson A, Bradvik L, Schlyter F, Berglund M. Variables associated with repeated suicide attempt in a criminal justice population. Suicide Life Threat Behav 2011; 41:517-31. [PMID: 21707730 DOI: 10.1111/j.1943-278x.2011.00048.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The aim of this study was to identify factors associated with repeated suicide attempts among criminal justice clients examined for substance abuse using the Addiction Severity Index. Among suicide attempters (n=1,404), repeaters (two or more attempts, n=770) were compared to nonrepeaters. In logistic regression, repetition was associated with younger age, opioid analgesics, somatic medication, overdose, maternal psychiatric problems, delirium tremens, cognitive problems, and violent behavior. As in other settings, factors associated with repetition differed from those associated with suicide attempts in general. In this setting, substance use complications and cognitive problems were connected to repetition and should be addressed in risk assessments.
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Affiliation(s)
- Anders Hakansson
- Clinical Alcohol Research, Lund University, Malmö University Hospital, entrance 108, SE-205 02 Malmö , Sweden.
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Abstract
The objective of this study was to test whether self-injury moderates the relationship between affective vulnerabilities (affective lability/affective intensity) and suicidal behavior. A total of 127 participants were administered structured diagnostic interviews and filled out questionnaires. The moderation effect was significant both for affective lability and affective intensity, with individuals reporting lower levels of affective vulnerability and a more extensive history of self-injury reporting more lifetime suicide attempts. These findings were generally replicated in a subsample of participants meeting diagnostic criteria for borderline personality disorder (n = 72). When accompanied by high levels of self-injury, low levels of affective vulnerabilities may paradoxically become a risk factor for suicidal behavior, perhaps by enabling individuals to persist in the innately frightening experience of a suicide attempt.
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Affiliation(s)
- Michael D Anestis
- Department of Psychology, Florida State University, Jackson, Mississippi, USA.
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Anisi J, Majdian M, Mirzamani SM. The factors associated with suicide ideation in Iranian soldiers. IRANIAN JOURNAL OF PSYCHIATRY 2010; 5:97-101. [PMID: 22952500 PMCID: PMC3430507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The study focuses on psychosocial variables related to suicide ideation in young soldiers. METHOD 1329 Soldiers were randomly selected from the Infantry Forces in different regions. All the soldiers were requested to complete the Beck Scale for Suicide Ideation (BSSI) as well as General Health Questionnaire (GHQ-28). Data were analyzed using correlation tests. RESULTS The results revealed that psychological factors, negative family background, environmental and task-related problems, and sociodemographic problems were significantly associated with suicide ideation. DISCUSSION Overall, suicide ideation could be prevented if soldiers with psychosocial problems were identified and the Army officials applied appropriate methods to solve these psychological problems.
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Affiliation(s)
- Jafar Anisi
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences
| | - Mohammad Majdian
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences
| | - S. Mahmood Mirzamani
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences
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Abstract
Suicide is an important cause of premature death. In the general population, most people who commit suicide have a psychiatric problem at the time. People with epilepsy are thought to be at increased risk from suicide and suicidality (suicidal ideation or behaviour). Standardized mortality ratios estimated for suicide in people with epilepsy are usually between 3 and 5. Risk factors for suicide in people with epilepsy have been suggested, including early age of onset of seizures, temporal lobe epilepsy, severe seizures and recent control of seizures. Psychiatric co-morbidity also seems to be an important factor in people with epilepsy who commit suicide. In recent years, suicidality has been recognized as a complication of several groups of drugs and, most recently, antiepileptic drugs (AEDs) have been implicated. The US FDA performed a meta-analysis of 199 placebo-controlled studies of 11 AEDs used for seizure control, psychiatric or 'other' indications. There were four completed suicides in those taking AEDs and none in those taking placebo. The odds ratio for suicidal behaviour or ideation was 1.8 (95% CI 1.24, 2.66), suggesting that people taking AEDs are more at risk than those taking placebo. The odds ratio was significantly raised for people taking AEDs for epilepsy, but not for the other indications. AEDs may affect mood by means of several mechanisms. In people with epilepsy, however, the concept of forced normalization (or alternative psychosis) may also play a part. In this situation, control of seizures (by AEDs or epilepsy surgery) may alternate with psychotic features or, less commonly, depression, although this is not fully understood. The risk of suicidal ideation and behaviour as adverse effects of AED treatment, although increased, seems low. As a result of the FDA's alert clinicians are supposed to inform patients and their families of this increased risk but it is important to place it in a proper perspective. Some people with epilepsy are more likely to develop psychiatric adverse effects with any AEDs, and these people should be followed closely whenever a new AED is introduced. Nonetheless, in people with epilepsy the risk of suicidality associated with AEDs needs to be balanced against the risk of not treating the seizures. In fact, the risk of stopping AEDs or refusing to start AEDs for the control of a seizure disorder may be significantly worse and may result in serious harm, including death of the patient.
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Affiliation(s)
- Gail S Bell
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, and National Hospital for Neurology and Neurosurgery, UCL Hospitals NHS Foundation Trust, London, UK
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