Suicidal ideation in primary care patients suffering from panic disorder with or without agoraphobia

The prevalence of suicidal behaviour and its associated risk factors among school-going adolescents resident in the United Arab Emirates

Suicidal behaviour which includes suicidal ideation, having a plan to commit suicide and suicide attempts remains a global public health issue as it substantially impacts adolescent health and wellbeing. Suicidal behaviour, however, remains understudied in Middle Eastern contexts. This study analysed data from the 2016 Global School-based Student Health Survey collected in the United Arab Emirates (UAE). A sample of 5826 adolescents aged between 11 and 18 years were sampled. Potential risk factors associated with an elevated risk for engagement in suicidal behaviour were examined. These factors were stratified into categories for analysis (demographics, psychosocial, risky health, and socio-environmental). The age-adjusted prevalence of suicidal behaviour amongst the school-going adolescent population in the UAE was 54%. Analyses indicated that elevated risk was significantly associated with anxiety difficulties, the experience of loneliness, and amongst those who smoked tobacco. None of the socio-environmental factors emerged as significant. A dose-dependent relationship was evident in that the degree of risk that was evident appeared to compound as the number of adverse risk factors increased. The data suggest that suicidal behaviour may be highly prevalent in this location. Findings highlight the immense need to develop preventative interventions, some of which may be school-delivered and targeted at parents. Our findings provide initial indications as to which risk factors could be targeted for remediation in developing these interventions.

Network analysis of comorbid depression, suicidality and biomarkers on HPA axis among mood disorder patients to psychiatric emergency services

Rapid assessment and intervention of suicide risk are common and challenging in psychiatric emergency departments (PED). It is unclear whether distinct pathophysiological processes exist among depressive patients with suicidality. This study examined the network structures of biomarkers on Hypothalamic-Pituitary-Adrenal (HPA) axis, such as Adrenocorticotropic hormone (ACTH) and Corticosterone (Cort), as well as suicidality and depressive symptoms in mood disorder patients in PED. Mood disorder patients in PED were assessed with the measurements of suicidality and depressive symptoms, respectively. A network analysis was performed to identify central symptoms and bridge symptoms of this network and their links to ACTH and Cort. Network stability was examined using the case-dropping procedure. The Network Comparison Test (NCT) was conducted to evaluate whether network characteristics differed by gender. A total of 1815 mood disorder patients were recruited. The prevalence of SI was 31.2% (95% CI: 28.15-34.21%), SP was 30.4% (95% CI: 27.39-33.41%), SA was 30.62% (95% CI: 27.61-33.64%) among psychiatric outpatients. The mean score of HAMD-24 was 13.87 ± 8.02. Network analysis revealed that 'Somatic anxiety' had the highest expected centrality, followed by 'Hopelessness' and 'Suicide attempt'. 'Corticosterone' and 'Retardation' may be the main bridge symptoms between depressive symptoms and the suicidality community. The network model showed a high degree of stability. Gender did not significantly influence the network structure. The central symptoms and key bridge symptoms identified could be potential targets for interventions of the HPA axis, which is designed for regular screening of a range of suicidal activity. In the light of this, timely treatment should be provided for psychiatric emergency care.

Premature death and causes of death among patients with panic disorder and comorbid psychiatric disorders: A nationwide cohort study

OBJECTIVES

Panic disorder (PD) is associated with high psychiatric and physical comorbidity, but the cause of mortality has not been well studied. This study investigated mortality rates and causes of death in an Asian cohort with PD.

METHODS

We enrolled a nationwide retrospective cohort of 298,466 persons diagnosed with PD from January 1, 2001, to December 31, 2016. Each cohort member was matched with a comparison one randomly selected from the general population with the same sex, age at entry, and birth year. The data of both the PD cohort and the comparison group were linked with the national mortality database to obtain each individual's mortality status. We used mortality rate ratios (MRRs) to compare mortality risks between the patients with PD and the general population. Stratified analysis of mortality risks was performed based on sex and psychiatric comorbidities.

RESULTS

PD was associated with a slightly increased mortality risk (MRR, 1.14 [99% CI, 1.11-1.17]). The risk of unnatural death (MRR, 2.83 [99% CI, 2.59-3.10]) was significantly higher among the individuals with PD than among the general population, whereas the risk of overall natural death across all categories was not (MRR, 1.01 [99% CI, 0.98-1.04]). The mortality risk was the highest for suicide (MRR, 4.94 [99% CI, 4.32-5.72]) and was higher in women (MRR, 6.37 [99% CI, 5.25-7.96]) than in men (MRR, 3.77 [99% CI, 3.14-4.64]). Comorbid substance use disorders increased the risk of mortality from natural (MRR, 3.23 [99% CI, 2.59-4.14]) and unnatural (MRR, 9.45 [99% CI, 6.29-17.85]) causes.

CONCLUSION

PD was associated with increased all-cause mortality, especially suicide. Substance use further increased mortality risk in persons with PD. Targeted treatment for substance use and suicide prevention are essential among persons with PD.

Life Satisfaction and Suicidal Ideation Among Chinese College Students During the Recurrent Outbreak of COVID-19: A Moderated Mediation Model

The present study examined a moderated mediation model between life satisfaction and suicidal ideation among Chinese college students during the recurrent outbreak of COVID-19. Seven hundred and ninety college students participated in the study and completed questionnaires on life satisfaction, suicidal ideation, depression, and gratitude. Findings indicated that (1) Depression played a partial mediating role between life satisfaction and suicidal ideation. Life satisfaction was not only directly affected suicidal ideation, but also indirectly affected suicidal ideation through the mediating effect of college students' depression; (2) Gratitude played a moderating role in the effect of life satisfaction on depression, and the link between life satisfaction and suicide ideation was only significant for those with higher gratitude. This study provides practical implications for the prevention of suicidal behavior among Chinese college students during the recurrent outbreak of COVID-19.

Suicidality and Its Relation with Physical and Mental Conditions: Results from a Cross-Sectional Study of the Nationwide Primary Care Population Sample in Latvia

Background and Objectives: Physical and mental conditions are important risk factors for suicidality. However, there is no clear understanding of these relationships and the effect of co-occurrence on suicidality. We aimed to investigate the associations between current suicidality and mental disorders, physical conditions, and health-related factors in the nationwide primary care population in Latvia. Materials and Methods: A cross-sectional study was performed within the framework of the National Research Program BIOMEDICINE 2014-2017 at 24 primary care settings across Latvia in 2015. Adult patients were evaluated over one week at each facility. Socio-demographic variables, physical condition, and health-related factors were assessed on-site by trained psychiatrists. Mental disorders and suicidality were determined using the Mini International Neuropsychiatric Interview, and assessments were conducted over the telephone within two weeks after the visit to the general practitioner. Results: Of the 1485 cases, 18.6% reported suicidality. Only current depression, any anxiety disorder, any alcohol use disorder, and physical-mental multimorbidity were significantly associated with suicidality in the multivariate logistic regression analysis. Gastrointestinal diseases were associated with current depression alone (odds ratio (OR) 10.36; 95% confidence interval (CI) 2.34-45.76) and comorbid depression with any anxiety disorder (OR 7.55; 95% CI 2.15-26.49) among persons with current suicidality. Conclusions: Screening for depression, anxiety, and alcohol use disorders regularly among patients with physical illness may be important to help recognise suicidality in primary care that could improve the quality of life of patients and prevent suicides.

Videoconferencing Psychotherapy for Panic Disorder and Agoraphobia: Outcome and Treatment Processes From a Non-randomized Non-inferiority Trial

BACKGROUND

In the context of the COVID-19 pandemic, legislations are being modified around the world to allow patients to receive mental health services through telehealth. Unfortunately, there are no large clinical trial available to reliably document the efficacy of delivering videoconferencing psychotherapy (VCP) for people with panic disorder and agoraphobia (PDA) and whether basic psychotherapeutic processes are altered.

METHODS

This 2-arm intent-to-treat non-inferiority study reports on a clinical trial on VCP and documents how therapeutic working alliance and motivation toward psychotherapy are associated to treatment outcome. We hypothesized that VCP would not be inferior to standard face-to-face (FF) cognitive behavior therapy for PDA. No specific hypothesis was stated to address working alliance and treatment mechanisms. VCP was compared to a gold-standard psychotherapy treatment for PDA, which was delivered either in person or in videoconference, with a strict tolerance criterion of about 2 points on the primary outcome measure. Seventy one adult patients were recruited. Measures of working alliance were collected after the first, fifth, and last session. Motivation toward therapy at pre-treatment and working alliance after the fifth therapy session were used as predictors of treatment outcome and compared with change in dysfunctional beliefs toward bodily sensations.

RESULTS

Panic disorder, agoraphobia, fear of sensations and depressed mood all showed significant improvements and large effect-sizes from pre to post-treatment. Gains were maintained at follow-up. No significant differences were found between VCP and FF, and effect sizes were trivial for three of the four outcome measures. Non-inferiority tests confirmed that VCP was no less effective than FF therapy on the primary outcome measure and two of the three secondary outcome measures. Working alliance was very strong in VCP and did not statistically differ from FF. Working alliance and motivation did not predict treatment outcome, which was significantly predicted by the reduction in dysfunctional beliefs. The strength of the therapeutic bond was correlated with change in dysfunctional beliefs.

CONCLUSION

Mental health professionals can use VCP to provide services to patients with PDA. Building and maintaining a sound working alliance should not be a source concern. Practical recommendations are formulated.

ISRCTN TRIAL REGISTRATION NUMBER

ISRCTN76456442.

Prevalence and associated factors of mental disorders in the nationwide primary care population in Latvia: a cross-sectional study

BACKGROUND

Mental disorders are common amongst patients in primary care. There are no published studies on the prevalence of mental disorders in primary care patients in Latvia. The purpose of the study was to evaluate the current prevalence of mental disorders in the nationwide Latvian primary care population and to study possible associated factors and comorbidity of mental disorders.

METHODS

A cross-sectional study within the framework of the National Research Program BIOMEDICINE 2014-2017 was performed at 24 primary care settings across Latvia. Adult patients seen over a 1-week time period at each facility were invited to participate in the study. Sociodemographic variables (age, sex, education, employment and marital status, place of residence, and ethnicity) were assessed onsite. A Mini-International Neuropsychiatric Interview assessment was conducted over the telephone within 2 weeks after the visit to the general practitioner (GP).

RESULTS

Overall, 1485 individuals completed the interview. The current prevalence of any mental disorder was 37.2% and was significantly greater in women. Mood disorders (18.4%), suicidality (18.6%) and anxiety disorders (15.8%) were the most frequent diagnostic categories. The current prevalence of any mood disorder was associated with being 50-64 years of age, female sex, economically inactive status, divorced or widowed marital status and urban place of residence, whilst any current anxiety disorder was associated with female sex, lower education, and single marital status; however, being of Russian ethnicity and residing in a small city were protective factors. Suicidality was associated with female sex, lower education, unemployment or economically inactive status, being divorced or widowed and residing in a small city. The comorbidity rates between mental disorders varied from 2.9 to 53.3%.

CONCLUSIONS

High prevalence rates of mental disorders, comorbidity and certain associated socio-demographic factors were found in primary care settings in Latvia. This highlights the importance of screening for depression and anxiety disorders and suicidal risk assessment by GPs. The results are fundamentally important for integrative medicine, monitoring and promotion of mental healthcare at the primary care level, as well as for healthcare policy and development of strategic plans in Latvia.

Determinants of suicidal ideation among patients with mental disorders visiting psychiatry outpatient unit in Mekelle town, psychiatric clinics, Tigray, Northern Ethiopia: a case-control study

BACKGROUND

Globally, more than 450 million people suffer from a mental or behavioral disorder. Psychiatric disorder and its duration, physical illness, family history of mental illness, previous suicidal attempt, unemployment, poor social support, and psychotic symptoms are of the main reasons enabling patients to be suicidal ideates. The purpose of this study is to identify the determinants of suicidal ideation among patients with mental disorders in Mekelle, Ethiopia.

METHODS

Case-control study design was employed with a total of 221 study subjects (74 cases and 147 controls) in Mekelle, Ethiopia. Suicidal ideation was measured by the Suicidal Behavior Questionnaire-Revised (SBQ-R) scale. Bivariate and multiple logistic regression analyses were performed to determine between the independent and dependent variables.

RESULTS

This study revealed that family suicide history (AOR = 6.87, 95% CI [1.138-41.531, P = 0.036), previous attempts history (AOR = 27.457, 95% CI 10.417-72.368, P = 0.0001), family mental illness history (AOR = 3.029, 95% CI 1.088-8.431, P = 0.034), major depressive disorders (AOR = 11.182, 95% CI 2.382-52.501, P = 0.002), and psychiatric comorbid disorders (AOR = 12.245, 95% CI 1.898-78.986, P = 0.008) were significant factors of suicidal ideation.

CONCLUSION

Family mental illness history, family suicide history, previous suicide attempt history, major depressive disorders, and psychiatric comorbid disorders were significant factors of suicidal ideation.

Pre-treatment peripheral biomarkers associated with treatment response in panic symptoms in patients with major depressive disorder and panic disorder: A 12-week follow-up study

OBJECTIVE

Peripheral biomarkers have been studied to predict treatment response of panic symptoms. We hypothesized that depressive disorder (MDD) vs. panic disorder (PD) would exhibit different peripheral biomarkers, and their correlation with severity of panic attacks (PA) would also differ.

METHODS

Forty-one MDD patients, 52 PD patients, and 59 healthy controls were followed for 12 weeks. We measured peripheral biomarkers along with the Panic Disorder Severity Scale (PDSS) at each visit-pre-treatment, 2, 4, 8, and 12 weeks on a regular schedule. Peripheral biomarkers including serum cytokines, plasma and serum brain-derived neurotrophic factor (BDNF), leptin, adiponectin, and C-reactive protein (CRP) were quantified using enzyme-linked immunosorbent assay (ELISA).

RESULTS

Patients with MDD and PD demonstrated significantly higher levels of pre-treatment IL-6 compared to controls, but no differences were seen in plasma and serum BDNF, leptin, adiponectin, and CRP. Pre-treatment leptin showed a significant clinical correlation with reduction of panic symptoms in MDD patients at visit 5 (p=0.011), whereas pre-treatment IL-6 showed a negative correlation with panic symptom reduction in PD patients (p=0.022). An improvement in three panic-related items was observed to be positively correlated with pre-treatment leptin in MDD patients: distress during PA, anticipatory anxiety, and occupational interference.

CONCLUSION

Higher pre-treatment leptin was associated with better response to treatment regarding panic symptoms in patients with MDD, while higher IL-6 was associated with worse response regarding panic symptoms in PD patients. Different predictive peripheral biomarkers observed in MDD and PD suggest the need for establishing individualized predictive biomarkers, even in cases of similar symptoms observed in different disorders.

Association of adult attachment and suicidal ideation in primary care patients with multiple chronic conditions

BACKGROUND

Suicidal ideation is a common health concern in primary care. Attachment theory indicates that subjects with higher anxiety and/or avoidance may be more susceptible to suicidal ideation. Therefore, the aim of our study was to examine the association of attachment anxiety, avoidance, and suicidal ideation in middle-aged to elderly, chronically ill primary care patients.

METHODS

The APRICARE Study comprised 207 patients aged 50-85 years with a minimum of three chronic diseases. Adult attachment, depressive symptoms and suicidal ideation were measured via the self-report questionnaires Experiences in Close Relationships-Revised (ECR-RD12) and Patient Health Questionnaire - 9 (PHQ-9). Univariable and adjusted associations of suicidal ideation with ECR-RD12-attachment anxiety, ECR-RD12-attachment avoidance, and ECR-RD12-insecure adult attachment were examined via logistic regression analyses.

RESULTS

Suicidal ideation was present in 13% of all patients. ECR-RD12-anxiety was significantly associated with suicidal ideation (OR = 1.88, CI 1.44-2.44), while ECR-RD12-avoidance was not associated. In patients with suicidal ideation, 85% were insecurely attached compared to 63% in those without suicidal ideation - thus the OR for suicidal ideation in insecurely attached patients was 3.33 (CI = 1.10-10.04) with securely attached patients as reference. Further variables associated with suicidal ideation were depressive symptomatology, living alone (especially in men) and obesity (especially in women).

LIMITATIONS

The study was cross-sectional in design, and suicidal ideation was assessed using a single item self-report measure.

CONCLUSION

General practitioners should be aware of attachment styles in order to have a better chance to identify patients at risk for suicide.