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Risk-Taking Behavior among Suicide Attempters. J Clin Med 2022; 11:jcm11144177. [PMID: 35887941 PMCID: PMC9320022 DOI: 10.3390/jcm11144177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 01/10/2023] Open
Abstract
Background: Suicidal behavior is a major mental health concern both for the individual and for the public health. Among others, suicidal behavior is associated with impulsivity, risk taking, pain tolerance, and a state of overarousal. In the present study, we investigated if suicide attempters (SAs) reported higher scores for risk-taking when compared with healthy controls (HC) of the general population. Methods: A total of 616 individuals (mean age: 27.07 years; 51.5% females) took part in the study; of those, 240 (39%) were individuals with a suicide attempt (SA) within a time lapse of one to three months, and 376 (61%) were healthy controls (HC). Participants completed a series of self-rating questionnaires covering sociodemographic information, risk-taking (Risk-Taking Questionnaire 18; RT-18), and suicidal behavior (Suicide Behaviors Questionnaire-Revised; SBQ-R). Results: Compared with HCs, individuals with SA reported higher risk-taking and suicidal behavior scores. The risk-taking questionnaire yielded a four-factor solution: Thrill and sensation seeking; Cautious procedure; Cautious decision making; Impulsive behavior. Compared with HCs, SAs showed the highest scores for thrill and sensation seeking and impulsive behavior. Conclusions: Compared with healthy controls, individuals reporting a recent suicide attempt also reported a higher propensity to thrill and sensation seeking and impulsive behavior as a proxy of risk-taking behavior. The present results corroborate the notion that, among others, suicide attempts appeared to be less related to premeditation, but rather to impulsive and thus spontaneous behavior.
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Learning from gain and loss: Links to suicide risk. J Psychiatr Res 2022; 147:126-134. [PMID: 35032945 DOI: 10.1016/j.jpsychires.2021.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/27/2021] [Accepted: 12/10/2021] [Indexed: 11/21/2022]
Abstract
Despite preliminary evidence that people with suicide attempt histories demonstrate deficits in processing feedback, no studies have examined the interrelations of learning from feedback and emotional state on suicide risk. This study examined the influence of suicide risk and negative emotions on learning accuracy and rates among individuals with a range of borderline personality features (N = 145). Participants completed a reinforcement learning task after neutral and negative emotion inductions. Results revealed interactions between suicide risk and emotion condition, with elevated risk linked to greater increases in loss learning rate (training phase models) and gain learning rate (test phase models) post-negative emotion induction. Emotion-dependent fluctuations in learning performance may be markers of decision-making that are associated with greater suicide risk. This line of work has the potential to identify the contexts that confer greater risk for suicidal behaviors.
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Schechter M, Goldblatt MJ, Ronningstam E, Herbstman B. The Psychoanalytic Study of Suicide, Part I: An Integration of Contemporary Theory and Research. J Am Psychoanal Assoc 2022; 70:103-137. [PMID: 35451317 DOI: 10.1177/00030651221086622] [Citation(s) in RCA: 6] [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] [Indexed: 11/15/2022]
Abstract
Psychodynamic psychotherapy has an important role in suicide prevention. The psychoanalytic study of suicide has taught us a great deal about the human experience and the process of suicidality. There is also much to be learned from other fields of study and from empirical research that can be integrated into psychoanalytic therapies. Central to the psychoanalytic approach to suicide has been understanding the patient's internal subjective experience of unbearable emotional or psychic pain and the urgent need for relief. Emotional pain can include intense affects such as shame, humiliation, self-hate, and rage. Factors that can increase vulnerability to suicidal states include problems with early attunement, dissociation and deficits in bodily love and protection, conscious and unconscious fantasy, and certain character traits and dynamics. Empirical research has confirmed many basic psychoanalytic concepts about suicide, including escape from unbearable pain as the primary driver of suicidal behavior, the role of dissociation in increasing risk of bodily attack, and the importance of unconscious processes. Further research into implicit processes and their role in the suicidal process holds potential to improve suicide risk assessment and to enhance psychotherapy by bringing otherwise inaccessible material into the treatment.
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Shipley SR, Clark MS, Norris DR. The Suicidal Patient. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cho GY, Waite EE, Ammerman BA, Dixon-Gordon KL. Testing the Influence of Brooding and Anger Rumination on the Association Between Suicidal Outcomes and BPD Features in Undergraduate Students. Arch Suicide Res 2022; 26:290-303. [PMID: 32329411 DOI: 10.1080/13811118.2020.1755920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Borderline personality disorder (BPD) symptoms and suicidal behaviors are prevalent among undergraduate students. Although rumination contributes to self-destructive behaviors in BPD, less research examines the role of rumination in distinct suicidal outcomes among individuals with BPD features instead focusing more on self-destructive behaviors as a latent variable. The present study examined the main and interactive effects of BPD features and two forms of rumination (brooding and anger) in the prediction of suicide-related outcomes (ideation and attempts) among college students. Participants (N = 181 undergraduate students, overrecruited for BPD features; 55.2% female) reported their lifetime suicide risk, brooding rumination, anger rumination, and BPD features. Brooding rumination and BPD features were associated with suicidal ideation. Anger rumination was not associated with suicide-related outcomes. Findings suggest that brooding rumination is a potential intervention target for suicidal ideation in undergraduate students whereas further research is required to determine the association between anger rumination and suicidal ideation and attempts.
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Fu J, Abiodun O, Lowery Wilson M, Shaikh MA. Adolescent suicide attempts in three diverse island nations: patterns, contextual differences and demographic associations. BMC Res Notes 2021; 14:464. [PMID: 34949211 PMCID: PMC8697498 DOI: 10.1186/s13104-021-05804-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/10/2021] [Indexed: 12/04/2022] Open
Abstract
Objective Most epidemiological studies on suicidal behavior have been focused on high-income country settings. This study examine factors associated with suicidal behaviors among school-attending adolescents in three island nations. In this secondary analysis of the publicly available 2015 nationally representative GSHS data, we tested demographic, social, and behavioral attributes using multivariable logistic regression to association with suicide attempts. Results Within the recall period, 13.6% of participants reported having attempted suicide one or more times in the Cook Islands, 10.8% in Curaçao, and 9.8% in East Timor. In the Cook Islands, suicide ideation (AOR = 19.42, 95% CI = 9.11–41.41), anxiety (AOR = 2.51, 95% CI = 1.08–5.82), physical bullying (AOR = 3.3, 95% CI = 1.10–9.91), and cigarette smoking (AOR = 3.82, 95% CI = 1.38–10.54) were associated with suicide attempts. For Curaçaoo, suicide ideation (AOR = 7.88, 95% CI = 5.20–11.95) and suicide planning (AOR = 7.01, 95% CI = 4.24–11.60) were statistically significant. While for East Timor, suicide ideation (AOR = 4.59, 95% CI = 2.14–9.88), suicide planning (AOR = 3.36, 95% CI = 1.76–6.29), bullying victimization (AOR = 2.69, 95% CI = 1.02–7.12), and serious injuries (AOR = 2.22, 95% CI = 1.31–3.74) were statistically significant. Suicide attempt is relatively common in each of the three island nations. The socioeconomic context of adolescents might play a significant role in moderating suicidal behavior. Therefore, prevention efforts should be grounded in view of geographic, demographic, and socioeconomic contexts of the populations at risk. Supplementary Information The online version of this article 10.1186/s13104-021-05804-4 contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jinrong Fu
- Centre for Injury Prevention and Community Safety (CIPCS), PeerCorps Trust Fund, 352/64 Makunganya Street, Co-Architecture Building, 4th Floor, P.O. Box 22499, Dar es Salaam, Tanzania.,Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Olumide Abiodun
- ICT University, 1 Avenue Dispensaire Messassi, Zoatoupsi, Yaounde, Cameroon
| | - Michael Lowery Wilson
- Centre for Injury Prevention and Community Safety (CIPCS), PeerCorps Trust Fund, 352/64 Makunganya Street, Co-Architecture Building, 4th Floor, P.O. Box 22499, Dar es Salaam, Tanzania.
| | - Masood Ali Shaikh
- Centre for Injury Prevention and Community Safety (CIPCS), PeerCorps Trust Fund, 352/64 Makunganya Street, Co-Architecture Building, 4th Floor, P.O. Box 22499, Dar es Salaam, Tanzania
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Sun L, Zhang J, Lamis DA, Wang Y. Risk Assessment on Suicide Death and Attempt among Chinese Rural Youths Aged 15-34 Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413362. [PMID: 34948972 PMCID: PMC8708552 DOI: 10.3390/ijerph182413362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/25/2022]
Abstract
Background: Although many suicide risk assessment tools are available in the world, their validity is not adequately assessed. In this study, we aimed to develop and evaluate a suicide risk assessment model among Chinese rural youths aged 15–34 years. Method: Subjects were 373 suicide deaths and 507 suicide attempters aged 15–34 years in three Chinese provinces (Shandong, Liaoning, and Hunan). Information about the community residents was also collected as the control groups. Social-demographic, social and psychological variables were examined for the suicides, suicide attempters, and community residents. Logistic regressions based on subjects from Shandong and Liaoning provinces were conducted to establish the suicide risk assessment models. Receiver operating characteristic (ROC) curves were drawn, and area under the ROC curves (AUC) were calculated to show how well the models separated the group being tested into those with and without suicide attempt or suicide. Results: The assessment model for suicide death included education years (OR = 0.773, p < 0.001), agricultural worker (OR = 2.091, p < 0.05), physical health (OR = 0.445, p < 0.05), family suicide history (OR = 6.858, p < 0.001), negative life events (OR = 1.340, p < 0.001), hopelessness (OR = 1.171, p < 0.001), impulsivity (OR = 1.151, p < 0.001), and mental disorder (OR = 8.384, p < 0.001). All these factors were also supported in the assessment model for suicide attempt, with an extension of very poor economic status (OR = 1.941, p < 0.01) and social interaction (OR = 0.855, p < 0.001). The AUC was 0.950 and 0.857 for the sample used to establish the assessment models of suicide death and attempt, respectively. The AUC was 0.967 and 0.942 for the sample used to verify the established assessment models of suicide death and attempt, respectively. Conclusions: Compared with some other assessment tools, the models for suicide death and attempt in the current study performed well among Chinese rural youths aged 15–34 years. A reliable suicide risk assessment approach, which includes multiple risk factors, should be evaluated in various cultures and populations.
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Affiliation(s)
- Long Sun
- Center for Suicide Prevention Research, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China; (L.S.); (Y.W.)
- Key Laboratory for Health Economics and Policy Research (Shandong University), National Health Commission of China, 44 Wenhuaxi Road, Jinan 250012, China
| | - Jie Zhang
- Center for Suicide Prevention Research, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China; (L.S.); (Y.W.)
- Department of Sociology, Central University of Finance and Economics, 39 Xueyuannan Road, Beijing 100081, China
- Department of Sociology, State University of New York Buffalo State, 1300 Elmwood Avenue, Buffalo, NY 14222, USA
- Correspondence: ; Tel.: +1-716-878-6425; Fax: +1-716-878-4009
| | - Dorian A. Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 10 Park Place, Atlanta, GA 30303, USA;
| | - Yifan Wang
- Center for Suicide Prevention Research, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China; (L.S.); (Y.W.)
- Key Laboratory for Health Economics and Policy Research (Shandong University), National Health Commission of China, 44 Wenhuaxi Road, Jinan 250012, China
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Arafat SMY, Khan MAS, Knipe D, Khan MM. Population attributable fractions of clinical and social risk factors for suicide in Bangladesh: Finding from a case-control psychological autopsy study. Brain Behav 2021; 11:e2409. [PMID: 34758201 PMCID: PMC8671769 DOI: 10.1002/brb3.2409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/15/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Our knowledge of suicide in low-income countries is limited. Understanding the importance of factors that contribute to suicide risk will allow for the appropriate allocation of limited resources. In order to prioritize suicide prevention activities in Bangladesh, we estimate the fractions of suicides attributable to key risk factors. METHODS Using data from matched cases (100) and controls (100) as part of a psychological autopsy study in Dhaka, we estimate the population attributable fraction for key clinical (psychiatric disorders and physical disability), and social (life events, psychical and/or sexual abuse, unemployment, and social isolation) risk factors for suicide in Bangladesh. RESULTS Assuming a causal relationship, life events were responsible for the largest proportion of suicide deaths (85.9%; confidence interval [CI], 79.6-90.2), followed by mental disorder (49.5%; CI, 45.3-53.4). The population attributable fraction for the risk factors was 42.9% (CI, 40.6-45) for depression, 11% (CI, 8.9-13) for sexual abuse, and 34.9% (CI, 10.1-52.9) for social isolation. CONCLUSIONS The study determined the population attributable fraction of risk factors for suicide in Bangladesh. Prevention strategies should be prioritized on the management of the aftermaths of adverse life events, treatment of psychiatric disorders, sexual abuse, and social isolation in the country.
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Affiliation(s)
- S. M. Yasir Arafat
- Department of PsychiatryEnam Medical College and HospitalDhakaBangladesh
| | | | - Duleeka Knipe
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Murad M. Khan
- Department of PsychiatryAga Khan UniversityKarachiPakistan
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Bryson WC, Piel J, Thielke SM. Arrest and non-fatal suicide attempts among men: analysis of survey data from the National Survey on Drug Use and Health. BMC Psychiatry 2021; 21:537. [PMID: 34711202 PMCID: PMC8555258 DOI: 10.1186/s12888-021-03544-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies have found an association between recent arrest and suicide attempts, but the population-level significance of this link has not been reported. We estimated the population attributable risk percent (PAR%) of self-reported non-fatal suicide attempts based on recent arrest in a national sample of adult men. METHODS This study included men aged ≥18 who completed the 2008-2019 National Surveys on Drug Use and Health. The outcome measure was any non-fatal suicide attempts in the past year. The primary independent variable was any arrest in the past year. Major depression and substance use disorders were also included as independent variables for comparison. Descriptive statistics and multivariate logistic regression with postestimation marginal effects ascertained the PAR% of non-fatal suicide attempts for arrest, major depression, and substance use disorders, while controlling for sociodemographic covariates. All analyses applied survey weights. We disaggregated analyses by race/ethnicity. RESULTS In the sample of 220,261 men, arrest accounted for 8.9% (99% CI 5.1 to 12.6%, p < 0.001) of non-fatal suicide attempts, while major depression accounted for 40.3% (99% CI 35.0 to 45.1%. p < 0.001) and substance use disorders for 24.1% (99% CI 17.6 to 30.2%, p < 0.001). After disaggregating by race/ethnicity, arrest accounted for 9.5% (99% CI 4.5 to 14.3%, p < 0.001) of suicide attempts among Non-Hispanic White men and fell short of statistical significance for Non-Hispanic Black men (10.2, 99% CI - 3.0 to 21.6%, p = 0.043) and Hispanic men (8.1, 99% CI - 0.5 to 15.9%, p = 0.016). CONCLUSIONS Arrest accounted for nearly one in eleven non-fatal suicide attempts in a national sample of American men, which is by extension about 50,000 suicide attempts per year. Results were similar for Non-Hispanic White, Non-Hispanic Black, and Hispanic men, although there were differences in prevalence of arrest and suicide attempts. Unlike major depression, arrest is an easily identifiable event, and the period after arrest might provide an opportunity to support mental health and coping.
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Affiliation(s)
- William C. Bryson
- grid.34477.330000000122986657Departtment of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA ,grid.413919.70000 0004 0420 6540VA Puget Sound Health Care System, Outpatient Mental Health Service, Seattle, WA USA
| | - Jennifer Piel
- grid.34477.330000000122986657Departtment of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA ,grid.413919.70000 0004 0420 6540VA Puget Sound Health Care System, Outpatient Mental Health Service, Seattle, WA USA
| | - Stephen M. Thielke
- grid.34477.330000000122986657Departtment of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
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Dixon-Gordon KL, Fitzpatrick S, Haliczer LA. Emotion regulation and borderline personality features in daily life: The role of social context. J Affect Disord 2021; 282:677-685. [PMID: 33445091 DOI: 10.1016/j.jad.2020.12.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/27/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is associated with emotional dysfunction and interpersonal sensitivity. Yet, little work has characterized how BPD features predicts emotional reactivity and emotion regulation behaviors in response to interpersonal stress relative to other forms of stress. METHODS Participants were 152 university students who completed baseline measures of BPD features and complied with two-week daily diary procedures assessing daily emotion regulation strategy use in response to social and non-social stressors. RESULTS Generalized estimating equations revealed that BPD features predicted greater negative and positive emotions in response to daily stressors, and interacted with type of stressor in predicting urges and behaviors. Elevated BPD features was associated with greater urges for dysfunctional emotion regulatory behaviors and fewer functional emotion regulatory behaviors to a greater extent in response to social (versus non-social) stressors. LIMITATIONS This study was limited by its focus on past-day retrospective recall. Further, the student sample limits the generalizability of these findings. CONCLUSIONS These findings suggest that individuals with elevated BPD features may have less functional emotion regulation in social contexts.
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Affiliation(s)
- Katherine L Dixon-Gordon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01002, USA.
| | | | - Lauren A Haliczer
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01002, USA
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Gec D, Broadbear JH, Bourton D, Rao S. Ten-week Intensive Group Program (IGP) for borderline personality disorder: making the case for more accessible and affordable psychotherapy. EVIDENCE-BASED MENTAL HEALTH 2021; 24:e1. [PMID: 33402379 PMCID: PMC10231581 DOI: 10.1136/ebmental-2020-300195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/13/2020] [Accepted: 11/23/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND The availability of specialist psychotherapies for treating borderline personality disorder (BPD) is limited by costs associated with training, resourcing and treatment duration. Developing a programme that incorporates effective strategies from a range of evidence-based specialist treatments, concentrates their delivery and uses a group-based format will improve treatment access. OBJECTIVE To assess the short-term clinical efficacy, acceptability and feasibility of a bespoke manualised programme for the treatment of BPD. This 10-week group-based outpatient programme was delivered 2 days per week in 4 hour sessions; participants received 80 hours of treatment in total. METHODS Forty-three participants, many having severe BPD symptomatology, were assessed before and after the 10-week programme using a range of validated self-report questionnaires and a self-appraisal feedback form. The primary outcome measured was BPD symptom severity. FINDINGS Statistically significant improvements were measured in BPD symptom severity, depression, trait anxiety, emotional regulation, general health, hopefulness, self-compassion and anger, several with moderate to large effect sizes. Many of these improvements remained at 4-6 months post treatment. More than 90% of surveyed participants expressed a moderate or high level of satisfaction with the programme. CONCLUSIONS This integrated treatment programme delivered in a highly concentrated format demonstrated short-term efficacy across many BPD-relevant endpoints; its acceptability was endorsed by most clients. CLINICAL IMPLICATIONS Incorporation of key aspects of evidence-based treatment using a time-intensive group format could greatly enhance the capacity of mental health services to meet the needs of people who experience BPD within a population-based mental health service framework.
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Affiliation(s)
- Dervila Gec
- Spectrum Personality Disorder Service for Victoria, Eastern Health, box hill, Victoria, Australia
| | - Jillian Helen Broadbear
- Spectrum Personality Disorder Service for Victoria, Eastern Health, box hill, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - David Bourton
- Spectrum Personality Disorder Service for Victoria, Eastern Health, box hill, Victoria, Australia
| | - Sathya Rao
- Spectrum Personality Disorder Service for Victoria, Eastern Health, box hill, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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Zhong S, Zhu X, Mellsop G, Zhou J, Wang X. Correlates of Presence and Remission of Post-trauma Stress Disorder in Incarcerated Women: A Case-Control Study Design. Front Psychiatry 2021; 12:748518. [PMID: 34955914 PMCID: PMC8692654 DOI: 10.3389/fpsyt.2021.748518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Women in prison are vulnerable to post-trauma stress disorder (PTSD). However, little is known about the presence of PTSD in imprisoned women or of the natural course of that disorder. The purpose of this study was to assess the risk factors for PTSD in incarcerated women and document correlations of remission. We conducted a retrospective case-control study in the Female Prison of Hunan Province, China. Participants were screened for PTSD and depression using the Chinese version of the MINI International Neuropsychiatric Interview (MINI) 5.0. Of the 2,322 women screened, 220 met the criterion for PTSD on admission. Remission (N = 142) and non-remission PTSD (N = 78) were then separated depending on current PTSD status. History of drug use (OR = 0.43, 95% CI: 0.28-0.66, p < 0.001) and violent offense (OR = 1.56, 95% CI: 1.17-2.09, p < 0.001) were associated with the presence of PTSD. Positive associations with remission were found for longer length of sentence (61-120 vs. 13-60 months) (OR = 4.20, 95% CI: 1.50-11.75, p = 0.006), violent offense (OR = 2.50, 95% CI: 1.12-5.60, p = 0.03), and comorbid depression (OR = 29.69, 95% CI: 3.50-251.78, p = 0.002); while a negative correlate was identified for past depression (OR = 0.24, 95% CI: 0.11-0.53, p < 0.001). Although some incarcerated women with PTSD can spontaneously remit, this study suggested certain criminological and clinical risk factors are associated with the presence of PTSD and others with remission over time. Timely screening and effective intervention should be tailored for individuals with PTSD in prisons.
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Affiliation(s)
- Shaoling Zhong
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Xiaomin Zhu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Graham Mellsop
- Waikato District Health Board (DHB), Hamilton, New Zealand
| | - Jiansong Zhou
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Xiaoping Wang
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
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13
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Widom CS, Li X. The role of psychiatric symptoms and environmental vulnerability factors in explaining the relationship between child maltreatment and suicidality: A prospective investigation. J Affect Disord 2020; 276:720-731. [PMID: 32871705 PMCID: PMC9375955 DOI: 10.1016/j.jad.2020.06.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 05/06/2020] [Accepted: 06/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Childhood maltreatment has been associated with suicide thoughts and attempts; however, few longitudinal studies have assessed risk of suicidality into adulthood. Fewer have examined potential mediators (psychiatric symptoms and environmental vulnerability factors). METHODS Prospective cohort design. Children with documented cases of maltreatment (N = 495, ages 0-11) were matched with non-maltreated children (N = 395) and followed up into adulthood. Psychiatric symptoms (depression, anxiety, dysthymia, post-traumatic stress,antisocial personality,and substance use) and environmental vulnerability (social isolation, physical disability/illness, and homelessness) were assessed at mean age 29 and suicide thoughts and attempts at 39. Structural equation models tested for mediation, controlling for age, sex, race, and IQ. RESULTS Childhood maltreatment predicted suicide attempts (Beta = 0.44, p<0.001), but not suicide thoughts only.Individuals with only suicide thoughts differed significantly from those with suicide attempts in psychiatric symptoms, physical disability/ illness, and homelessness. There were significant paths from child maltreatment to suicide attempts through psychiatric symptoms (0.18, p<0.001), ASPD (0.13, p<0.001), substance use (0.07, p<0.01), and homelessness (0.10, p<0.05). LIMITATIONS Court cases of child maltreatment may not generalize to middle- or upper- class and non-reported cases.Effect sizes were small but significant. CONCLUSIONS Psychiatric risk factors for suicide are well recognized. These new results provide strong evidence that environmental vulnerability factors, particularly homelessness, are associated with increased risk for suicide attempts and warrant attention.Although many people report suicide thoughts, maltreated children with more psychiatric symptoms and experience homelessness are more likely to attempt suicide and warrant targeted interventions.
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Affiliation(s)
- Cathy Spatz Widom
- Psychology Department, John Jay College and City University of New York, New York City, NY, United States.
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14
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Stelnicki AM, Jamshidi L, Ricciardelli R, Carleton RN. Exposures to Potentially Psychologically Traumatic Events Among Nurses in Canada. Can J Nurs Res 2020; 53:277-291. [PMID: 33043686 DOI: 10.1177/0844562120961988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Nurses are regularly exposed to diverse potentially psychologically traumatic events (PPTEs) as a function of their work. Cumulative exposure to PPTEs can lead to clinically significant symptoms of mental disorders. PURPOSE We designed the current study to investigate the prevalence of different PPTEs among Canadian nurses and estimate the associations between diverse exposures and several mental disorders. METHODS Canadian nurses (i.e., registered nurses, registered psychiatric nurses, licensed practical nurses, nurse practitioners) completed an online, self-reported survey. In total, 4067 participants (94.8% women) completed all relevant survey measures. RESULTS Nurses reported exposures to several PPTE categories including severe human suffering, life threatening illness or injury, and physical assault, often 11 or more times. There were significant (p<.05) associations between diverse traumatic events and all mental disorders (i.e., Posttraumatic Stress Disorder, Major Depressive Disorder, Generalized Anxiety Disorder, Panic Disorder) except Alcohol Use Disorder. CONCLUSIONS The current findings suggest that Canadian nurses are substantially exposed to traumatic events, which vary by several sociodemographic categories. PPTE exposures were significantly associated with mental disorders; that is, if PPTEs were eliminated among Canadian nurses in the sample, symptoms would be reduced between 42.0% and 58.0%.
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Affiliation(s)
- Andrea M Stelnicki
- Canadian Institute for Public Safety Research and Treatment, University of Regina, Regina, SK, Canada
| | - Laleh Jamshidi
- Canadian Institute for Public Safety Research and Treatment, University of Regina, Regina, SK, Canada
| | | | - R Nicholas Carleton
- Canadian Institute for Public Safety Research and Treatment, University of Regina, Regina, SK, Canada
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15
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Direct and Indirect Associations Between Loneliness and Thoughts of Self-Harm Among a Clinical Sample of Older Adults With Serious Mental Illness. J Nerv Ment Dis 2020; 208:828-832. [PMID: 33002939 DOI: 10.1097/nmd.0000000000001213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This cross-sectional study examines the relationships of loneliness and depressive symptoms to thoughts of self-harm among a clinical sample (n = 150) of older adults (M = 58.42 years, SD = 5.86 years; male, 55.3%; African American, 61.3%) with serious mental illness (SMI) receiving publicly funded, community-based psychiatric rehabilitation services. Participants completed the De Jong Gierveld Loneliness Scale, Multidimensional Scale of Perceived Social Support, Patient Health Questionnaire 9, and Geriatric Depression Scale-Short Form. Mediation analyses tested the association of loneliness with thoughts of self-harm through depressive symptoms and were adjusted for social support and demographic variables. The direct association of loneliness with thoughts of self-harm was mediated by depressive symptoms; indirect associations of overall and emotional loneliness to thoughts of self-harm were significant. Findings suggest the need for clinicians to reduce feelings of loneliness among older adults with SMI as a means of partially ameliorating depressive symptoms and thoughts of self-harm.
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16
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Jahangard L, Shayganfard M, Ghiasi F, Salehi I, Haghighi M, Ahmadpanah M, Sadeghi Bahmani D, Brand S. Serum oxytocin concentrations in current and recent suicide survivors are lower than in healthy controls. J Psychiatr Res 2020; 128:75-82. [PMID: 32535343 DOI: 10.1016/j.jpsychires.2020.05.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/28/2020] [Accepted: 05/17/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Suicide and suicide attempts are dramatic events both for the individuals concerned and for their social circles. From a psychopathological perspective, suicidal behavior could be understood as a severe breakdown in relations with their social worlds. Oxytocin is a neuropeptide highly involved in the perception of facets of social relationship such as their quality feelings of belongingness, and mutual trust. Given this, we expected that serum oxytocin concentrations would be lower in current and recent suicide survivors than in healthy controls. METHODS A total of 48 participants (mean age: 27 years; 62.5% females) took part in the study. Of these, 16 (62.5% females) survived a suicide attempt 12-24 h ago; 16 (62.5% females) had made a suicide attempt about 12 weeks ago, and 16 (62.5% females) were healthy age- and gender-matched controls. Blood samples were taken in the morning to assess serum oxytocin concentrations. Participants also completed questionnaires covering sociodemographic information and a scale assessing suicidal ideation. RESULTS Compared to healthy controls, suicide survivors had significantly lower serum oxytocin concentrations, but these levels did not differ between current and recent suicide survivors. Compared to healthy controls and recent suicide attempters, current suicide attempters recorded significantly higher scores on the Beck scale for suicidal ideation. Across the sample as a whole, higher scores for suicidal ideation were associated with lower serum oxytocin concentrations. Serum oxytocin concentrations and scores on the Beck scale for suicidal ideation did not differ between females and males. CONCLUSIONS Given that oxytocin is a neurobiological correlate of subjectively perceived quality of social interaction and social relationships, the results support the notion that suicide attempts are closely linked to suicide survivors' perceptions of the quality of their social lives. Speculatively, and based on the serum oxytocin concentrations, it also appears that 12 weeks after a suicide attempt, the survivor's perceived quality of social life has not significantly improved.
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Affiliation(s)
- Leila Jahangard
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehran Shayganfard
- Department of Psychiatry, Arak University of Medical Sciences, Arak, Markazi, Iran
| | - Farahnaz Ghiasi
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Iraj Salehi
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Haghighi
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Ahmadpanah
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Dena Sadeghi Bahmani
- Departments of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA; University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland; Kermanshah University of Medical Sciences (KUMS), Sleep Disorders Research Center, Kermanshah, Iran; Kermanshah University of Medical Sciences (KUMS), Psychiatry Department, Substance Abuse Prevention Research Center, Health Institute, Kermanshah, Iran
| | - Serge Brand
- University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland; Kermanshah University of Medical Sciences (KUMS), Sleep Disorders Research Center, Kermanshah, Iran; Kermanshah University of Medical Sciences (KUMS), Psychiatry Department, Substance Abuse Prevention Research Center, Health Institute, Kermanshah, Iran; University of Basel, Department of Sport, Exercise, and Health, Division of Sport and Psychosocial Health, Basel, Switzerland; Tehran University of Medical Sciences (TUMS), School of Medicine, Tehran, Iran.
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17
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The Suicidal Patient. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_34-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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de Beurs D, ten Have M, Cuijpers P, de Graaf R. The longitudinal association between lifetime mental disorders and first onset or recurrent suicide ideation. BMC Psychiatry 2019; 19:345. [PMID: 31694603 PMCID: PMC6836643 DOI: 10.1186/s12888-019-2328-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/17/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although the cross-sectional association between mental disorders and suicide ideation is well studied, less is known about the prospective association. In this paper, we estimated among those without 12-month suicide ideation at baseline, the association between a wide variety of common mental disorders at baseline and suicide ideation within the 6-year follow-up period, after controlling for history of other mental disorders and demographic variables. METHODS Data were used from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a prospective representative adult cohort study with baseline (n = 6646) with a 6-year follow-up period. Lifetime mental disorders were assessed at baseline with the Composite International Diagnostic Interview 3.0. Within the longitudinal design, participants with first time or recurrent suicide ideation were defined follows: having no suicide ideation in the 12 months before the baseline assessment, and reporting to have had seriously thought about suicide between baseline and the 6-year follow-up period. Multiple logistical regression was used to estimate the longitudinal association between suicide ideation and a specific mental disorder while controlling for comorbidity and baseline variables. To account for the prevalence of a disorder in the population, for each disorder, the population attributable risk proportion (PARP) was calculated. RESULTS 2.9% (n = 132) of the participants that did not report suicide ideation in the past 12 months at baseline reported suicide ideation at follow-up. Of these 132 cases, 81 (61%) experienced suicide ideation for the first time in their lives and could be viewed as first onset cases. 51 (39%) reported recurrent suicide ideation. After controlling for comorbidity, the only two disorders that were significantly related to suicide ideation at follow-up were lifetime major depressive disorder (MDD) and generalized anxiety disorder (GAD). PARP for MDD was 47.8 and 16.6% for GAD. CONCLUSIONS After controlling for all other mental disorders, a lifetime history of MDD and GAD were related to suicide ideation at follow-up. For clinical practice, this indicates that patients with a history of MDD or GAD stay vulnerable for suicide ideation, even though they did not report suicide ideation in the past year.
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Affiliation(s)
- Derek de Beurs
- Netherlands Institute of Health Services Research, Utrecht, Netherlands. .,Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Margreet ten Have
- 0000 0001 0835 8259grid.416017.5Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Pim Cuijpers
- 0000 0004 1754 9227grid.12380.38Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ron de Graaf
- 0000 0001 0835 8259grid.416017.5Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
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19
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Covert D, Fraire MG. The role of anxiety for youth experiencing suicide-related behaviors. CHILDRENS HEALTH CARE 2019. [DOI: 10.1080/02739615.2019.1630284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Maria G Fraire
- Franciscan Children’s, Brighton, MA, USA
- McLean Hospital, Harvard Medical School, Brighton, MA, USA
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20
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Holma KM, Holma I, Ketokivi M, Oquendo MA, Isometsä E. The Relationship Between Smoking and Suicidal Behavior in Psychiatric Patients with Major Depressive Disorder. Arch Suicide Res 2019; 23:590-604. [PMID: 29883280 DOI: 10.1080/13811118.2018.1480986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Smoking is frequently associated with suicidal behavior, but also with confounding other risk factors. We investigated whether smoking independently predicts suicidal ideation, attempts (SAs), or modifies risk of SAs during major depressive episodes (MDEs). In the Vantaa Depression Study (VDS), a 5-year prospective study of psychiatric patients (N = 269) with major depressive disorder (MDD), we investigated the association of suicidal ideation and smoking, and smoking as an independent risk factor for SAs in 2-level analyses of risk during MDEs. Smoking was not significantly associated with suicidal ideation, nor SAs after controlling for confounding factors, and no evidence of a significant effect during MDEs was found. Smoking was neither significantly associated with suicidal ideation, nor predicted suicide attempts.
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Affiliation(s)
- K Mikael Holma
- Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland.,Department of Mental Health and Substance Abuse, City of Helsinki, Social Services and Health Care , Helsinki , Finland
| | - Irina Holma
- Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland.,Department of Psychiatry, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Mikko Ketokivi
- Operations and Technology Department, IE Business School , Madrid , Spain
| | - Maria A Oquendo
- Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
| | - Erkki Isometsä
- Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland.,Department of Psychiatry, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
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21
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Antisocial and Borderline Personality Disorders in the Emergency Department: Conceptualizing and Managing “Malingered” or “Exaggerated” Symptoms. Curr Behav Neurosci Rep 2019. [DOI: 10.1007/s40473-019-00183-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Recent Suicidal Ideation and Behavior in the General Population: The Role of Depression, Posttraumatic Stress, and Reactive Avoidance. J Nerv Ment Dis 2019; 207:320-325. [PMID: 30958420 DOI: 10.1097/nmd.0000000000000976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The multivariate relationship between suicidality and three potential etiologic variables (depression, posttraumatic stress, and reactive avoidance) was examined in a stratified sample of 679 individuals from the general population. Lifetime exposure to a trauma or another very upsetting event was prevalent among those reporting suicidal behavior in the previous 6 months (58%) and those reporting recent suicidal ideation alone (40%), relative to those with no recent suicidal thoughts or behaviors (26%). Canonical correlation analysis indicated two independent sources of variance: the first loading on both suicidal ideation and behavior, predicted by depression, posttraumatic stress, and reactive avoidance, and the second indicating a unique relationship between suicidal behavior and reactive avoidance alone. Results indicate that the etiology of suicidality is likely multidimensional, and point to a significant variant of suicidal behavior that is unrelated to depression or posttraumatic stress, but may reflect emotional dysregulation and subsequent distress reduction behaviors.
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23
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Campbell-Sills L, Kessler RC, Ursano RJ, Sun X, Heeringa SG, Nock MK, Jain S, Stein MB. Nicotine Dependence and Pre-Enlistment Suicidal Behavior Among U.S. Army Soldiers. Am J Prev Med 2019; 56:420-428. [PMID: 30777160 PMCID: PMC6383784 DOI: 10.1016/j.amepre.2018.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Identification of modifiable risk factors for suicidal behaviors is a priority for the U.S. Army. This study investigated associations of nicotine dependence with suicidal behaviors among incoming soldiers. METHODS Lifetime DSM-IV nicotine dependence, mental disorders, suicidal behaviors, and their ages of onset were retrospectively assessed in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) New Soldier Study. Discrete-time survival analysis of person-year data from 30,436 soldiers was performed to evaluate associations of nicotine dependence with subsequent suicidal ideation, plans, and attempts. Among respondents with lifetime ideation (n=4,060), models tested associations of nicotine dependence with progression from ideation to first onset of plan, from plan to first attempt, and, among ideators without plans, from ideation to first unplanned attempt. A hierarchy of models incorporated increasing controls for other risk factors. Data were collected in 2011-2012 and analyzed in 2017-2018. RESULTS In models controlling for sociodemographic characteristics, nicotine dependence was associated with onset of all suicidal behaviors (AORs, 2.07-4.08, p<0.001) and with each type of progression of suicidal behavior (AORs, 1.48-2.44, p<0.005). After adjusting for childhood adversities and mental disorders, nicotine dependence remained associated with onset of ideation (AOR=1.27, 95% CI=1.10, 1.46, p=0.001) and attempt (AOR=1.83, 95% CI=1.41, 2.37, p<0.001); and with progression from ideation to unplanned attempt (AOR=2.03, 95% CI=1.17, 1.74, p<0.001). CONCLUSIONS Nicotine dependence exhibited associations with onset of suicidal ideation and suicide attempt-and with progression from ideation to unplanned attempt-that were independent of other measured risk factors. Awareness of associations of nicotine dependence with suicidal behaviors may inform risk assessment, facilitate targeting of prevention efforts, and provide further impetus for reducing nicotine dependence.
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Affiliation(s)
- Laura Campbell-Sills
- Department of Psychiatry, University of California, San Diego, La Jolla, California.
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Steven G Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Murray B Stein
- Department of Psychiatry, University of California, San Diego, La Jolla, California; Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California; VA San Diego Healthcare System, San Diego, California
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24
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Chireh B, Li M, D'Arcy C. Diabetes increases the risk of depression: A systematic review, meta-analysis and estimates of population attributable fractions based on prospective studies. Prev Med Rep 2019; 14:100822. [PMID: 30815337 PMCID: PMC6378921 DOI: 10.1016/j.pmedr.2019.100822] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/25/2019] [Accepted: 02/06/2019] [Indexed: 12/27/2022] Open
Abstract
We aim to examine the relationship between diabetes and depression risk in longitudinal cohort studies and by how much the incidence of depression in a population would be reduced if diabetes was reduced. Medline/PubMed, EMBASE, PsycINFO, and Cochrane Library databases were searched for English-language published literature from January 1990 to December 2017. Longitudinal studies with criteria for depression and self-report doctors' diagnoses or diagnostic blood test measurement of diabetes were assessed. Systematic review with meta-analysis synthesized the results. Study quality, heterogeneity, and publication bias were examined. Pooled odds ratios were calculated using random effects models. Population attributable fractions (PAFs) were used to estimate potential preventive impact. Twenty high-quality articles met inclusion criteria and were analyzed. The pooled odds ratio (OR) between diabetes and depression was 1.33 (95% CI, 1.18–1.51). For the various study types the ORs were as follows: prospective studies (OR 1.34, 95% CI 1.14–1.57); retrospective studies (OR 1.30, 95% CI 1.05–1.62); self-reported diagnosis of diabetes (OR 1.37, 95% CI 1.17–1.60); and diagnostic diabetes blood test (OR 1.25, 95% CI 1.04–1.52). PAFs suggest that over 9.5 million of global depression cases are potentially attributable to diabetes. A 10–25% reduction in diabetes could potentially prevent 930,000 to 2.34 million depression cases worldwide. Our systematic review provides fairly robust evidence to support the hypothesis that diabetes is an independent risk factor for depression while also acknowledging the impact of risk factor reduction, study design and diagnostic measurement of exposure which may inform preventive interventions. Depression risk is 1.33 times higher in people with diabetes. Prospective studies likely to report depression incidence Self-reported diabetes diagnoses likely to report depression A 10–25% diabetes reduction could prevent 930,000–2.34 million depression.
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Affiliation(s)
- Batholomew Chireh
- University of Saskatchewan School of Public Health, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada
| | - Muzi Li
- The Douglas Hospital Research Centre, 6875 boulevard LaSalle, Montreal H4H 1R3, Canada
| | - Carl D'Arcy
- University of Saskatchewan, Department of Psychiatry and, School of Public Health, 103 Hospital drive, Ellis Hall, Room 107, Saskatoon, SK S7N 0W8, Canada
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25
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Shepardson RL, Kosiba JD, Bernstein LI, Funderburk JS. Suicide risk among Veteran primary care patients with current anxiety symptoms. Fam Pract 2019; 36:91-95. [PMID: 30219849 DOI: 10.1093/fampra/cmy088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although anxiety is prevalent in primary care, the association between anxiety symptoms and suicide risk remains understudied. OBJECTIVES This cross-sectional study aimed to (i) assess the prevalence of suicide risk among Veteran primary care patients with anxiety symptoms and (ii) compare suicide risk between patients with a positive (versus negative) depression screen. METHODS Participants were 182 adult primary care patients (84.6% male, Mage = 58.3 years) with current anxiety symptoms, but no psychotherapy in specialty care in the past year, at a Veterans Health Administration medical center in New York. Participants completed self-report measures of anxiety, depression and suicide risk via telephone. RESULTS Forty percent endorsed ≥1 suicide risk item. Suicide risk was more common among those screening positive (versus negative) for depression (50.5% versus 26.5%, χ2 (1) = 10.88; P = 0.001). Participants with a negative depression screen constituted 31% of all those with any suicide risk. Logistic regression revealed that anxiety symptom severity was not associated with suicide risk (P = 0.14) after controlling for age, sex and depression screen status (P = 0.01). CONCLUSIONS A substantial proportion of primary care patients with anxiety was classified as at risk for suicide, even in the absence of a positive depression screen. Primary care providers should assess suicide risk among patients with anxiety symptoms, even if the patients are not seeking specialty mental health treatment, the anxiety symptoms are not severe or do not rise to the level of an anxiety disorder, and comorbid depressive symptoms are not present.
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Affiliation(s)
- Robyn L Shepardson
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Jesse D Kosiba
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Lee I Bernstein
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Jennifer S Funderburk
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychology, Syracuse University, Syracuse, NY, USA.,Department of Psychiatry, University of Rochester, Rochester, NY, USA
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26
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Lewis KL, Fanaian M, Kotze B, Grenyer BFS. Mental health presentations to acute psychiatric services: 3-year study of prevalence and readmission risk for personality disorders compared with psychotic, affective, substance or other disorders. BJPsych Open 2019; 5:e1. [PMID: 30575497 PMCID: PMC6343119 DOI: 10.1192/bjo.2018.72] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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
BACKGROUND The relative burden and risk of readmission for people with personality disorders in hospital settings is unknown.AimsTo compare hospital use of people with personality disorder with that of people with other mental health diagnoses, such as psychoses and affective disorders. METHOD Naturalistic study of hospital presentations for mental health in a large community catchment. Mixed-effects Cox regression and survival curves were generated to examine risk of readmission for each group. RESULTS Of 2894 people presenting to hospital, patients with personality disorder represented 20.5% of emergency and 26.6% of in-patients. Patients with personality disorder or psychoses were 2.3 times (95% CI 1.79-2.99) more likely than others to re-present within 28 days. Personality disorder diagnosis increases rate of readmission by a factor of 8.7 (s.e. = 0.31), marginally lower than psychotic disorders (10.02, s.e. = 0.31). CONCLUSIONS Personality disorders place significant demands on in-patient and emergency departments, similar to that of psychoses in terms of presentation and risk of readmission.Declaration of interestNone.
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Affiliation(s)
- Kate L Lewis
- Associate Research Fellow,School of Psychology,University of Wollongong,Australia
| | - Mahnaz Fanaian
- Lecturer, School of Nursing,University of Wollongong,Australia
| | - Beth Kotze
- Director, Mental Health,Cumberland Hospital,Australia
| | - Brin F S Grenyer
- Professor of Psychology,School of Psychology,University of Wollongong,Australia
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27
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Baranyi G, Cassidy M, Fazel S, Priebe S, Mundt AP. Prevalence of Posttraumatic Stress Disorder in Prisoners. Epidemiol Rev 2018; 40:134-145. [PMID: 29596582 PMCID: PMC5982805 DOI: 10.1093/epirev/mxx015] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 10/25/2017] [Indexed: 12/13/2022] Open
Abstract
People involved with criminal justice frequently are exposed to violence and traumatic experiences. This may lead to posttraumatic stress disorder (PTSD); however, no review, to our knowledge, has synthetized findings in this setting. We conducted a systematic review and meta-analysis to estimate prevalence rates of PTSD in prison populations. Original studies in which prevalence rates of PTSD in unselected samples of incarcerated people were reported were systematically searched between 1980 and June 2017. Data were pooled using random-effects meta-analysis, and sources of heterogeneity for prespecified characteristics were assessed by meta-regression. We identified 56 samples comprising 21,099 imprisoned men and women from 20 countries. Point prevalence of PTSD ranged from 0.1% to 27% for male, and from 12% to 38% for female prisoner populations. The random-effects pooled point prevalence was 6.2% (95% confidence interval: 3.9, 9.0) in male prisoners and 21.1% (95% confidence interval: 16.9, 25.6) in female prisoners. The heterogeneity between the included studies was very high. Higher prevalence was reported in samples of female prisoners, smaller studies (n < 100), and for investigations based in high-income countries. Existing evidence shows high levels of PTSD among imprisoned people, especially women. Psychosocial interventions to prevent violence, especially against children and women, and to mitigate its consequences in marginalized communities must be improved. Trauma-informed approaches for correctional programs and scalable PTSD treatments in prisons require further consideration.
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Affiliation(s)
- Gergõ Baranyi
- Center for Research on Environment Society and Health, School of GeoSciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Megan Cassidy
- Unit for Social and Community Psychiatry, WHO Collaborating Center for Mental Health Services Development, Queen Mary University of London, London, United Kingdom
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Center for Mental Health Services Development, Queen Mary University of London, London, United Kingdom
| | - Adrian P Mundt
- Medical Faculty, Universidad Diego Portales, Santiago, Chile.,Medical School, Universidad San Sebastián, Puerto Montt, Chile
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28
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Ahmadpanah M, Rahighi AH, Haghighi M. Female Gender, Marital and Family Problems, and Feelings of Guilt Are Related to Self-Immolation Suicide Attempts. Neuropsychobiology 2018; 76:51-58. [PMID: 29649810 DOI: 10.1159/000487859] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/21/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Self-immolation (SI) is considered one of the most painful, dramatic, and at the same time most inexplicable methods of suicide, with a high social impact. Prevalence rates are particularly high in Iran, and in north-western Iran specifically. Here, we report sociodemographic, psychological, and psychiatric characteristics of patients attempting self-immolation (PSIs), compared to patients with accident burns (PABs). METHOD Patients referred to the Burns Emergency Unit of the Besat Hospital (Hamadan, Iran) were enrolled in the present study between winter 2015 and summer 2016. After burn-related treatments and surgery, a thorough interview was undertaken covering sociodemographic characteristics, burn-related information, and psychiatric background. RESULTS A total of 79 patients were enrolled. Among these, 19 (31.7%) had attempted suicide via SI. Compared to the PABs, the PSIs were predominantly females; they reported family and marital problems as the main triggers for SI. The psychiatric interviews indicated that PSIs often suffered from major depressive disorders, adjustment disorders, and bipolar disorders. The prevailing feelings reported were guilt and shame. A binary logistic regression showed that feelings of guilt and marital and family problems predicted SI. CONCLUSIONS The prevalence of SI was surprisingly high. Marital and family conflicts as a proxy for highly distressing social interactions, along with female gender and feelings of guilt and shame were strongly associated with SI. Family and couple counseling specifically tailored to difficulties experienced by women might reduce the risk of SI.
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Finch EF, Brickell CM, Choi-Kain LW. General psychiatric management: An evidence-based treatment for borderline personality disorder in the college setting. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2018. [DOI: 10.1080/87568225.2018.1491361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ellen F. Finch
- McLean Hospital, Belmont, Massachusetts, USA
- Harvard University, Cambridge, Massachusetts, USA
| | | | - Lois W. Choi-Kain
- McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
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Jahangard L, Solgy R, Salehi I, Taheri SK, Holsboer-Trachsler E, Haghighi M, Brand S. Cholecystokinin (CCK) level is higher among first time suicide attempters than healthy controls, but is not associated with higher depression scores. Psychiatry Res 2018; 266:40-46. [PMID: 29803785 DOI: 10.1016/j.psychres.2018.05.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/26/2018] [Accepted: 05/11/2018] [Indexed: 11/19/2022]
Abstract
Suicide and suicide attempts are dramatic events for both the individuals concerned and for their social environments. Efforts have been made to identify reliable biological predictors of suicide and suicide attempts. In the present study, we focused on one potential marker, cholecystokinin (CCK), among first time suicide attempters. A total of 25 suicide attempters (mean age: 30 years; 80% females) and 23 healthy controls were enrolled in the present cross-sectional study. Experts rated participants' symptoms of depression (Hamilton Depression Rating Scale; HDRS). Blood levels of CCK levels were assessed. Suicide attempters had CCK levels 22.67 times higher and HDRS scores 14.33 higher than healthy controls. CCK levels were only weakly associated with HDRS scores. CCK appears to be a fairly reliable biomarker for suicide attempts. However, CCK levels were not associated with depression scores, making it difficult to match biological markers to depressive behaviour.
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Affiliation(s)
- Leila Jahangard
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rahmat Solgy
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Iraj Salehi
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Kazem Taheri
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Edith Holsboer-Trachsler
- University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland
| | - Mohammad Haghighi
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Serge Brand
- University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland; University of Basel, Department of Sport, Exercise, and Health, Division of Sport and Psychosocial Health, Basel, Switzerland; Kermanshah University of Medical Sciences (KUMS), Psychiatry Department, Substance Abuse Prevention Research Center and Sleep Disorders Research Center, Kermanshah, Iran.
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Brickell CM. Diagnosis and Treatment of Borderline Personality Disorder in the College Mental Health Setting. Curr Psychiatry Rep 2018; 20:38. [PMID: 29777413 DOI: 10.1007/s11920-018-0905-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE OF REVIEW The impact of borderline personality disorder (BPD) on college students is not well studied, and there is currently little data about its phenomenology or treatment in this population. We review the available literature regarding evidence-based treatment for BPD on college campuses, as well as best-practice guidelines for the treatment of mental illness in the college setting. Diagnostic disclosure and psychoeducation are proposed as practical first steps in improving the treatment landscape. RECENT FINDINGS Preliminary studies of targeted treatment for BPD on college campuses are promising. They suggest that even pared-down interventions have the potential to help students feel better and function better. Experts in college mental health treatment emphasize the importance of gathering data, intervening early, communicating across treatment environments, appropriately marshaling resources, and providing psycho-education. To bring the on-campus treatment of BPD in line with best-practice guidelines, improved diagnostic practices are needed. Disclosing the diagnosis of BPD and educating students about this disorder are simple yet powerful interventions that can set the stage for further treatment and provide symptom relief.
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Affiliation(s)
- Claire M Brickell
- McLean Hospital and Harvard Medical School, 115 Mill St, Belmont, MA, 02478, USA.
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McLafferty M, O'Neill S, Murphy S, Armour C, Bunting B. Population attributable fractions of psychopathology and suicidal behaviour associated with childhood adversities in Northern Ireland. CHILD ABUSE & NEGLECT 2018; 77:35-45. [PMID: 29294415 DOI: 10.1016/j.chiabu.2017.12.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 06/07/2023]
Abstract
Childhood adversities are strong predictors of psychopathology and suicidality. However, specific adversities are associated with different outcomes, with cross-national variations reported. The current study examined rates of adversities reported in Northern Ireland (NI), and associations between adverse childhood experiences and psychopathology and suicidal behaviour were explored. Data was obtained from the Northern Ireland Study of Health and Stress (NISHS), conducted as part of the World Mental Health (WMH) survey initiative (2004-2008); response rate 68.4% (n = 1,986). The on-line survey used, the WHO Composite International Diagnostic Interview (CIDI) to examine psychopathology and associated risk factors in the NI population. Prevalence rates of retrospectively reported childhood adversities were calculated, with gender and age variations explored. Females were more likely to experience sexual abuse. Individuals who grew up during the worst years of the civil conflict in NI experienced elevated levels of childhood adversities. Participants who endured childhood adversities were more likely to have mental health problems but variations in risk factors were found for different disorders. Parental mental illness was associated with all disorders however, with ORs ranging from 2.20 for mood disorders to 4.07 for anxiety disorders. Population attributable fractions (PAF) estimated the reduction in psychopathology and suicidal behaviour in the population if exposure to adverse childhood events had not occurred. The highest PAF values were revealed for parental mental illness and sexual abuse. The findings indicate that a substantial proportion of psychopathology and suicide risk in NI are attributable to childhood adversities, providing support for early intervention and prevention initiatives.
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Affiliation(s)
- Margaret McLafferty
- School of Psychology, Ulster University, Magee Campus, Northland Road, Derry, N. Ireland, United Kingdom.
| | - Siobhan O'Neill
- School of Psychology, Ulster University, Magee Campus, Northland Road, Derry, N. Ireland, United Kingdom.
| | - Sam Murphy
- School of Psychology, Ulster University, Magee Campus, Northland Road, Derry, N. Ireland, United Kingdom
| | - Cherie Armour
- School of Psychology, Ulster University, Coleraine Campus, Cromore Road, Coleraine, N. Ireland, United Kingdom
| | - Brendan Bunting
- School of Psychology, Ulster University, Magee Campus, Northland Road, Derry, N. Ireland, United Kingdom
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Mental disorders and suicide attempt in rural China. Psychiatry Res 2018; 261:190-196. [PMID: 29309959 DOI: 10.1016/j.psychres.2017.12.087] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 12/06/2017] [Accepted: 12/31/2017] [Indexed: 11/22/2022]
Abstract
The prevalence of various mental disorders and their age and gender specific characteristics among suicide attempters remains unclear in rural China. This study using 1:1 paired case-control design included 409 suicide attempters and 409 paired controls matched on age, gender and place of residence. Mental disorders were assessed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders. The prevalence of mental disorders was 32.3% for suicide attempters and 4.9% for paired controls. Mental disorder constituted a significant risk factor for suicide attempt with an adjusted odds ratio of 7.16 (95%CI: 3.65-14.04). The prevalence of mental disorders was higher among male than female suicide attempters. Major depressive disorder was most common in female suicide attempters while alcohol use disorder was most common in the males. The prevalence of mental disorders seemed to increase with age. Suicide attempters of higher ages were more prone to have mood disorders, especially a major depression. Suicide attempters with mental disorders differed from those without mental disorders on a number of socio-economic characteristics and suicidal behavior features. These insights should be taken into account in strategies and efforts to improve mental health care and ultimately to reduce suicidal behavior among residents in rural China.
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Mental disorders and the risk for the subsequent first suicide attempt: results of a community study on adolescents and young adults. Eur Child Adolesc Psychiatry 2018; 27:839-848. [PMID: 29027588 PMCID: PMC6013520 DOI: 10.1007/s00787-017-1060-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/25/2017] [Indexed: 10/29/2022]
Abstract
Adolescents and young adults represent the high-risk group for first onset of both DSM-IV mental disorders and lifetime suicide attempt (SA). Yet few studies have evaluated the temporal association of prior mental disorders and subsequent first SA in a young community sample. We examined (a) such associations using a broad range of specific DSM-IV mental disorders, (b) the risk of experiencing the outcome due to prior comorbidity, and (c) the proportion of SAs that could be attributed to prior disorders. During a 10-year prospective study, data were gathered from 3021 community subjects, 14-24 years of age at baseline. DSM-IV disorders and SA were assessed with the Munich-Composite International Diagnostic Interview. Cox models with time-dependent covariates were used to estimate the temporal associations of prior mental disorders with subsequent first SA. Most prior mental disorders showed elevated risk for subsequent first SA. Highest risks were associated with posttraumatic stress disorder (PTSD), dysthymia, and nicotine dependence. Comorbidity elevated the risk for subsequent first SA, and the more disorders a subject had, the higher the risk for first SA. More than 90% of SAs in the exposed group could be attributed to PTSD, and over 30% of SAs in the total sample could be attributed to specific phobia. Several DSM-IV disorders increase the risk for first SA in adolescents and young adults. Several promising early intervention targets were observed, e.g., specific phobia, nicotine dependence, dysthymia, and whether a young person is burdened with comorbid mental disorders.
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Raines AM, Capron DW, Stentz LA, Walton JL, Allan NP, McManus ES, Uddo M, True G, Franklin CL. Posttraumatic stress disorder and suicidal ideation, plans, and impulses: The mediating role of anxiety sensitivity cognitive concerns among veterans. J Affect Disord 2017; 222:57-62. [PMID: 28672180 DOI: 10.1016/j.jad.2017.06.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/10/2017] [Accepted: 06/17/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although the relationship between posttraumatic stress disorder (PTSD) and suicide has been firmly established, research on underlying mechanisms has been disproportionately low. The cognitive concerns subscale of anxiety sensitivity (AS), which reflects fears of cognitive dyscontrol, has been linked to both PTSD and suicide and thus may serve as an explanatory mechanism between these constructs. METHODS The sample consisted of 60 male veterans presenting to an outpatient Veteran Affairs (VA) clinic for psychological services. Upon intake, veterans completed a diagnostic interview and brief battery of self-report questionnaires to assist with differential diagnosis and treatment planning. RESULTS Results revealed a significant association between PTSD symptom severity and higher suicidality (i.e., ideation, plans, and impulses), even after accounting for relevant demographic and psychological constructs. Moreover, AS cognitive concerns mediated this association. LIMITATIONS Limitations include the small sample size and cross-sectional nature of the current study. CONCLUSIONS These findings add considerably to a growing body of literature examining underlying mechanisms that may help to explain the robust associations between PTSD and suicide. Considering the malleable nature of AS cognitive concerns, research is needed to determine the extent to which reductions in this cognitive risk factor are associated with reductions in suicide among at risk samples, such as those included in the present investigation.
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Affiliation(s)
- Amanda M Raines
- Southeast Louisiana Veterans Health Care System, 3500 Canal St., New Orleans, LA 70119, USA; South Central VA Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), 1601 Perdido St., New Orleans, LA 70112, USA
| | - Daniel W Capron
- Department of Psychology, University of Southern Mississippi, 118 College Dr., Hattiesburg, MS 32406, USA
| | - Lauren A Stentz
- Department of Psychology, Florida State University, 1107W. Call St., Tallahassee, FL 32306, USA
| | - Jessica L Walton
- Southeast Louisiana Veterans Health Care System, 3500 Canal St., New Orleans, LA 70119, USA; South Central VA Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), 1601 Perdido St., New Orleans, LA 70112, USA
| | - Nicholas P Allan
- Department of Psychology, Ohio University, 200 Porter Hall, Athens, OH 45701, USA
| | - Eliza S McManus
- Southeast Louisiana Veterans Health Care System, 3500 Canal St., New Orleans, LA 70119, USA
| | - Madeline Uddo
- Southeast Louisiana Veterans Health Care System, 3500 Canal St., New Orleans, LA 70119, USA; South Central VA Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), 1601 Perdido St., New Orleans, LA 70112, USA; Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA
| | - Gala True
- Southeast Louisiana Veterans Health Care System, 3500 Canal St., New Orleans, LA 70119, USA; South Central VA Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), 1601 Perdido St., New Orleans, LA 70112, USA; Division of General Internal Medicine and Geriatrics, Department of Medicine, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA
| | - C Laurel Franklin
- Southeast Louisiana Veterans Health Care System, 3500 Canal St., New Orleans, LA 70119, USA; South Central VA Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), 1601 Perdido St., New Orleans, LA 70112, USA; Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA.
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Turner BJ, Jin HM, Anestis MD, Dixon-Gordon KL, Gratz KL. Personality pathology and intentional self-harm: cross-cutting insights from categorical and dimensional models. Curr Opin Psychol 2017; 21:55-59. [PMID: 29017093 DOI: 10.1016/j.copsyc.2017.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 09/08/2017] [Accepted: 09/14/2017] [Indexed: 02/07/2023]
Abstract
This paper reviews current literature on the links between personality pathology and intentional self-harm, including nonsuicidal self-injury (NSSI) and suicidal behaviors. Specifically, this review highlights recent advances stemming from longitudinal, epidemiological, and health registry studies, as well as emerging research on pathological personality traits and intentional self-harm, and integrates current knowledge across dimensional and categorical frameworks to provide recommendations for clinical practice and future research. This review provides strong evidence that personality disorders marked by intense and unstable negative affect, detachment/low extraversion, aggression/hostility, and specific facets of impulsivity may be considered risk factors for suicidal behaviors. Further, there is some evidence of a stronger relation between maladaptive personality traits and suicidal versus non-suicidal intentional self-harm.
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Affiliation(s)
- Brianna J Turner
- Department of Psychology, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada V8W 2Y2
| | - Hyejin M Jin
- Department of Psychology, University of Southern Mississippi, 118 College Drive, Box #5025, Hattiesburg, MS 39406, USA
| | - Michael D Anestis
- Department of Psychology, University of Southern Mississippi, 118 College Drive, Box #5025, Hattiesburg, MS 39406, USA
| | - Katherine L Dixon-Gordon
- Department of Psychological and Brain Sciences, University of Massachusetts, 135 Hicks Way, Amherst, MA 01003, USA
| | - Kim L Gratz
- Department of Psychology, University of Toledo, 2801 West Bancroft Street, Toledo, OH 43606, USA.
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Chan Chee C, Paget LM. Le Recueil d’information médicalisé en psychiatrie (RIM-P) : un outil nécessaire pour la surveillance des hospitalisations suite à une tentative de suicide. Rev Epidemiol Sante Publique 2017; 65:349-359. [DOI: 10.1016/j.respe.2017.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 02/08/2017] [Accepted: 05/10/2017] [Indexed: 11/26/2022] Open
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Bi B, Liu W, Zhou D, Fu X, Qin X, Wu J. Personality traits and suicide attempts with and without psychiatric disorders: analysis of impulsivity and neuroticism. BMC Psychiatry 2017; 17:294. [PMID: 28810846 PMCID: PMC5558700 DOI: 10.1186/s12888-017-1453-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 08/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a critical need for empirical data concerning the association of personality traits and attempted suicide with and without psychiatric disorders in mainland China. The objective of the present study is to provide such data by determining the prevalence of psychiatric disorders and analyzing the levels of impulsivity and neuroticism among people who have attempted suicide, and to examine the association between these personality traits and suicide attempt in people with or without psychiatric disorders. METHODS We administered self-reported tests and clinical interviews to 196 people who have attempted suicide who were admitted to a hospital emergency room or our psychiatric settings after a suicide attempt. RESULTS One hundred and fifty-six subjects (79.6%) met the criteria for Axis I disorders and eleven (6.6%) met the criteria Axis II personality disorders. Those who have attempted suicide who did not have psychiatric disorders exhibited a greater degree of background characteristics (e.g., high lethality, more interpersonal conflicts and more alcohol use), lower levels of suicidality (suicide risk, depressive symptoms) and differences of personality traits (e.g., more impulsive and less neuroticism) as compared to those who do have psychiatric disorders. Profile differences existed even after control for the stressful life event. CONCLUSION Our findings suggest that some personality traits differ between people who have attempted suicide depending on whether or not they have psychiatric disorders. Based on these findings, investigating the impact of personality traits on suicidal behavior in therapeutic settings would provide critical data to improve patient treatment and outcomes.
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Affiliation(s)
- Bo Bi
- The First Affiliated Hospital, China Medical University, 155 North Nanjing Street, Shenyang, 110001, Liaoning, China.
| | - Wei Liu
- 0000 0000 9678 1884grid.412449.eThe First Affiliated Hospital, China Medical University, 155 North Nanjing Street, Shenyang, 110001 Liaoning, China
| | - Die Zhou
- 0000 0000 9678 1884grid.412449.eThe First Affiliated Hospital, China Medical University, 155 North Nanjing Street, Shenyang, 110001 Liaoning, China
| | - Xu Fu
- 0000 0000 9678 1884grid.412449.eThe First Affiliated Hospital, China Medical University, 155 North Nanjing Street, Shenyang, 110001 Liaoning, China
| | - Xiaoxia Qin
- 0000 0000 9678 1884grid.412449.eThe First Affiliated Hospital, China Medical University, 155 North Nanjing Street, Shenyang, 110001 Liaoning, China
| | - Jiali Wu
- 0000 0000 9678 1884grid.412449.eThe First Affiliated Hospital, China Medical University, 155 North Nanjing Street, Shenyang, 110001 Liaoning, China
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Shah D, Shah A, Tan X, Sambamoorthi U. Trends in utilization of smoking cessation agents before and after the passage of FDA boxed warning in the United States. Drug Alcohol Depend 2017; 177:187-193. [PMID: 28605678 PMCID: PMC5568118 DOI: 10.1016/j.drugalcdep.2017.03.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 03/08/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND In 2009, the FDA required a black box warning (BBW) on bupropion and varenicline, the two commonly prescribed smoking cessation agents due to reports of adverse neuropsychiatric events. We investigated if there was a decline in use of bupropion and varenicline after the BBW by comparing the percent using these medications before and after BBW. METHODS We conducted a retrospective observational study using data from the Medical Expenditure Panel Survey from 2007 to 2014. The study sample consisted of adult smokers, who were advised by their physicians to quit smoking. We divided the time period into "pre-warning", "post-warning: immediate", and "post-warning: late." Unadjusted analysis using chi-square tests and adjusted analyses using logistic regressions were conducted to evaluate the change in bupropion and varenicline use before and after the BBW. Secondary analyses using piecewise regression were also conducted. RESULTS On an average, 49.04% of smokers were advised by their physicians to quit smoking. We observed a statistically significant decline in varenicline use from 22.1% in year 2007 to 9.23% in 2014 (p value<0.001). In the logistic (Adjusted Odds Ratio=0.36, 95% CI=0.22-0.58) and piecewise regressions (Odds Ratio=0.64, 95% CI=0.41-0.99) smokers who were advised to quit smoking by their physicians were less likely to use varenicline in the immediate post-BBW period as compared to pre-BBW period. While the use of varenicline continued to be significantly low in the late post-BBW period (AOR=0.45, 95% CI=0.31-0.64) as compared to the pre-BBW period, the trend in use as seen in piecewise regression remained stable (OR=0.90, 95% CI=0.75-1.06). We did not observe significant differences in bupropion use between the pre- and post-BBW periods. CONCLUSION The passage of the FDA boxed warning was associated with a significant decline in the use of varenicline, but not in the use of bupropion.
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Affiliation(s)
- Drishti Shah
- West Virginia University, Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA.
| | - Anuj Shah
- West Virginia University, Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA; Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Xi Tan
- West Virginia University, Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Usha Sambamoorthi
- West Virginia University, Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
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Early maladaptive schemas of emotional deprivation, social isolation, shame and abandonment are related to a history of suicide attempts among patients with major depressive disorders. Compr Psychiatry 2017. [PMID: 28636896 DOI: 10.1016/j.comppsych.2017.05.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Patients with psychiatric disorders have an exceptionally high risk of completed or attempted suicide. This holds particularly true for patients with major depressive disorders. The aim of the present study was to explore whether patients with major depressive disorders (MDD) and a history of suicide attempts differed in their early maladaptive schemas from patients with MDD but without such a history or from healthy controls. METHOD Ninety participants took part in the study. Of these, 30 were patients with MDD who had made a recent suicide attempt; 30 were patients with MDD but no suicide attempts, and 30 were gender- and age-matched healthy controls. Participants completed questionnaires covering socio-demographic characteristics and the Young Schema Questionnaire (YSQ- RE2R) to assess early maladaptive schemas. Experts rated patients' MDD with the Montgomery-Asberg Depression Rating Scale. RESULTS Patients did not differ in experts' ratings of symptoms of depression. Compared to healthy controls, patients with MDD recorded higher scores on maladaptive schemas such as recognition seeking, negativity/pessimism, and insufficient self-control. Compared to patients without suicide attempts and healthy controls, those who had made a suicide attempt had higher scores on dimensions such as failure, mistrust, emotional inhibition, social isolation, and abandonment/instability. CONCLUSION Compared to healthy controls, patients with MDD had more pronounced maladaptive schemas, but this was more marked in patients with a history of suicide attempts. The results suggest that suicide attempts and poorer psychological functioning are related.
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Lee KH, Jun JS, Kim YJ, Roh S, Moon SS, Bukonda N, Hines L. Mental Health, Substance Abuse, and Suicide Among Homeless Adults. ACTA ACUST UNITED AC 2017; 14:229-242. [DOI: 10.1080/23761407.2017.1316221] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Kyoung Hag Lee
- School of Social Work, Wichita State University, Wichita, Kansas, USA
| | - Jung Sim Jun
- School of Social Work, Wichita State University, Wichita, Kansas, USA
| | - Yi Jin Kim
- Department of Social Work, University of Mississippi, Oxford, Mississippi, USA
| | - Soonhee Roh
- Department of Social Work, University of South Dakota, Sioux Falls, South Dakota, USA
| | - Sung Seek Moon
- College of Social Work, University of South Carolina, Columbia, South Carolina, USA
| | - Ngoyi Bukonda
- Department of Public Health Sciences, Wichita State University, Wichita, Kansas, USA
| | - Lisa Hines
- School of Social Work, Wichita State University, Wichita, Kansas, USA
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Coleman D, Lawrence R, Parekh A, Galfalvy H, Blasco-Fontecilla H, Brent DA, Mann JJ, Baca-Garcia E, Oquendo MA. Narcissistic Personality Disorder and suicidal behavior in mood disorders. J Psychiatr Res 2017; 85:24-28. [PMID: 27816770 PMCID: PMC5191918 DOI: 10.1016/j.jpsychires.2016.10.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 10/18/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
Abstract
The relationship of Narcissistic Personality Disorder (NPD) to suicidal behavior is understudied. The modest body of existing research suggests that NPD is protective against low-lethality suicide attempts, but is associated with high lethality attempts. Mood-disordered patients (N = 657) received structured interviews including Axis I and II diagnosis and standardized clinical measures. Following chi-square and t-tests, a logistical regression model was constructed to identify predictors of suicide attempt. While there was no bivariate relationship of NPD on suicide attempt, in the logistic regression patients with NPD were 2.4 times less likely to make a suicide attempt (OR = 0.41; 95% CI = 0.19 - 0.88; p < 0.05), compared with non-NPD patients and controlling for possible confounding variables. NPD was not associated with attempt lethality. NPD patients were more likely to be male, to have a substance use disorder, and to have high aggression and hostility scores. Limitations include that the sample consists of only mood-disordered patients, a modest sample size of NPD, and the data are cross-sectional. The multivariate protective effect of NPD on suicide attempt is consistent with most previous research. The lower impulsivity of NPD patients and less severe personality pathology relative to other personality disorders may contribute to this effect. No relationship of NPD to attempt lethality was found, contradicting other research, but perhaps reflecting differences between study samples. Future studies should oversample NPD patients and include suicide death as an outcome. Clinical implications include discussion of individualized suicide risk assessment with NPD patients.
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Affiliation(s)
- Daniel Coleman
- Graduate School of Social Service, Fordham University, New York, NY, USA.
| | - Ryan Lawrence
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Amrita Parekh
- School of Social Work, Columbia University, New York, NY, USA
| | - Hanga Galfalvy
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Hilario Blasco-Fontecilla
- Department of Psychiatry, Puerta de Hierro University Hospital, Autonoma University, CIBERSAM, Madrid, Spain
| | - David A. Brent
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - J. John Mann
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Enrique Baca-Garcia
- Department of Psychiatry, Jimenez Diaz Foundation, Autonoma University, Madrid, Spain
| | - Maria A. Oquendo
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
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Correlates of suicidality in firefighter/EMS personnel. J Affect Disord 2017; 208:177-183. [PMID: 27788381 DOI: 10.1016/j.jad.2016.08.078] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/20/2016] [Accepted: 08/24/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Firefighter and Emergency Medical Services (EMS) personnel experience higher rates of lifetime suicidal ideation and attempts than the general population and other protective service professions. Several correlates of suicidality (alcohol use, depression, posttraumatic stress) have been identified in the literature as applicable to firefighter/EMS populations; however, few studies to date have examined the specific correlates of suicidality (lifetime suicidal ideation and/or attempts) in a firefighter/EMS sample. METHODS Participants (N=3036) from a large, urban fire department completed demographic and self-report measures of alcohol dependence, depression, posttraumatic stress disorder (PTSD) symptom severity, and lifetime suicidal ideation and attempts. Participants in this sample performed both firefighter and EMS duties, were predominately male (97%), White (61.6%), and 25-34 years old (32.1%). RESULTS Through hierarchical linear regressions, depression (β=.22, p<.05) and PTSD symptom severity (β=.21, p<.05) were significantly associated with lifetime suicidal ideation (R2 =17.5). Depression (β=.15, p<.001), and PTSD symptom severity (β=.07, p<.01) were significantly associated with lifetime suicide attempts (R2=5.1). LIMITATIONS Several limitations are addressed in the current study. The survey was a self-report pre-existing dataset and lifetime suicidal ideation and attempts were measured using sum scores. Additionally, the disproportionately large sample of males and large, urban setting, may not generalize to female firefighters and members of rural community fire departments. CONCLUSIONS The current study highlights the importance of targeting depression and PTSD symptom severity in efforts to reduce suicidality in firefighter/EMS personnel.
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Tulisiak AK, Klein JA, Harris E, Luft MJ, Schroeder HK, Mossman SA, Varney ST, Keeshin BR, Cotton S, Strawn JR. Antidepressant Prescribing by Pediatricians: A Mixed-Methods Analysis. Curr Probl Pediatr Adolesc Health Care 2017; 47:15-24. [PMID: 28057447 PMCID: PMC5340594 DOI: 10.1016/j.cppeds.2016.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Among pediatricians, perceived knowledge of efficacy, tolerability, dosing, and side effects of antidepressants represent significant sources of variability in the use of these medications in youth with depressive and anxiety disorders. Importantly, the qualitative factors that relate to varying levels of comfort with antidepressants and willingness to prescribe are poorly understood. Using a mixed-methods approach, in-depth interviews were conducted with community-based and academic medical center-based pediatricians (N = 14). Interviews were audio recorded and iteratively coded; themes were then generated using inductive thematic analysis. The relationship between demographic factors, knowledge of antidepressants, dosing, and side effects, as well as prescribing likelihood scores for depressive disorders, anxiety disorders or co-morbid anxiety and depressive disorders, were evaluated using mixed models. Pediatricians reported antidepressants to be effective and well-tolerated. However, the likelihood of individual physicians initiating an antidepressant was significantly lower for anxiety disorders relative to depressive disorders with similar functional impairment. Pediatricians considered symptom severity/functional impairment, age and the availability of psychotherapy as they considered prescribing antidepressants to individual patients. Antidepressant choice was related to the physician׳s perceived knowledge and comfort with a particular antidepressant, financial factors, and the disorder-specific evidence base for that particular medication and consultation with mental health practitioners. Pediatricians noted similar efficacy and tolerability profiles for antidepressants in youth with depressive disorders and anxiety disorders, but tended to utilize "therapy first" approaches for anxiety disorders relative to depressive disorders. Parental and family factors that influenced prescribing of antidepressants by pediatricians included parental ambivalence, family-related dysfunction and impairment secondary to the child׳s psychopathology as well as the child׳s psychosocial milieu. Pediatricians consider patient- and family-specific challenges when choosing prescribing antidepressant medications and are, in general, less likely to prescribe antidepressants for youth with anxiety disorders compared to youth with depressive disorders. The lower likelihood of prescribing antidepressants for anxious youth is not related to perception of the efficacy or tolerability, but rather to a perception that anxiety disorders are less impairing and more appropriately managed with psychotherapy.
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Affiliation(s)
- Anne K Tulisiak
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Jillian A Klein
- Department of Pediatrics Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Emily Harris
- Division of Child & Adolescent Psychiatry, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH
| | - Marissa J Luft
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Heidi K Schroeder
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Sarah A Mossman
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Sara T Varney
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Brooks R Keeshin
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Sian Cotton
- Department of Family and Community Medicine, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Jeffrey R Strawn
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH; Division of Child & Adolescent Psychiatry, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH
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The Suicidal Patient. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Suicide is one of the leading causes of violent death in many countries and its prevention is included in worldwide health objectives. Currently, the DSM-5 considers suicidal behavior as an entity that requires further study. Among the three validators required for considering a psychiatric disorder, there is one based on psychological correlates, biological markers, and patterns of comorbidity. This review includes the most important and recent studies on psychological factors: cognitive, emotional, temperament, and personality correlates (unrelated to diagnostic criteria). We included classic factors related to suicidal behavior such as cognitive, inflexibility, problem-solving, coping, rumination, thought suppression, decision-making, autobiographical memory, working memory, language fluency, burdensomeness, belongingness, fearless, pain insensitivity, impulsiveness, aggressiveness, and hopelessness. The personality correlates reported are mainly based on the personality theories of Cloninger, Costa and McCrae, and Eysenck. Moreover, it explores conceptual links to other new pathways in psychological factors, emptiness, and psychological pain as a possible origin and common end path for a portion of suicidal behaviors.
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Gosnell SN, Velasquez KM, Molfese DL, Molfese PJ, Madan A, Fowler JC, Christopher Frueh B, Baldwin PR, Salas R. Prefrontal cortex, temporal cortex, and hippocampus volume are affected in suicidal psychiatric patients. Psychiatry Res Neuroimaging 2016; 256:50-56. [PMID: 27685801 PMCID: PMC9694115 DOI: 10.1016/j.pscychresns.2016.09.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 11/20/2022]
Abstract
Suicide is a leading cause of death in America, with over 40,000 reported suicides per year. Mental illness is a major risk factor for suicidality. This study attempts to validate findings of volumetric differences from studies on suicidality. Psychiatric inpatients classified as having mildly severe or severe depression were separated into two groups: suicide attempted in the past two months (SA; n=20), non-suicidal control group (DA; n=20); these patients were all depressed and not significantly different for age, gender, race, marital status, education level, anxiety level, and substance abuse. Healthy controls (HC; n=20) were not significantly different from the suicidal groups for age and gender. Volunteers underwent MRI to assess volumes of cortical lobes, corpus callosum, and subcortical regions of interest, including the thalamus, insula, limbic structures, and basal ganglia. The right hippocampal volume of the SA group was significantly reduced compared to healthy controls. The frontal and temporal lobe volumes of the SA group were significantly decreased compared to the DA group. These volumetric reductions confirm previous findings and support the hypothesis that fronto-temporal function may be altered in suicidal patients.
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Affiliation(s)
- Savannah N Gosnell
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kenia M Velasquez
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; Michael E DeBakey VA Medical Center, Houston, TX 77030, USA
| | - David L Molfese
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; Michael E DeBakey VA Medical Center, Houston, TX 77030, USA
| | - Peter J Molfese
- Department of Psychological Sciences, University of Connecticut, Mansfield, CT 06269, USA
| | - Alok Madan
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; The Menninger Clinic, Houston, TX 77030, USA
| | - James C Fowler
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; The Menninger Clinic, Houston, TX 77030, USA
| | - B Christopher Frueh
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; The Menninger Clinic, Houston, TX 77030, USA; The University of Hawaii at Hilo, HI 96720, USA
| | - Philip R Baldwin
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; Michael E DeBakey VA Medical Center, Houston, TX 77030, USA
| | - Ramiro Salas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; Michael E DeBakey VA Medical Center, Houston, TX 77030, USA; Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA.
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Tong Y, Phillips MR, Conner KR. DSM-IV Axis II personality disorders and suicide and attempted suicide in China. Br J Psychiatry 2016; 209:319-326. [PMID: 26585099 PMCID: PMC6173803 DOI: 10.1192/bjp.bp.114.151076] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 03/01/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are meagre data on Axis II personality disorders and suicidal behaviour in China. AIMS To describe the prevalence of Axis II personality disorders in suicides and suicide attempts in China and to estimate risk for these outcomes associated with personality disorders. METHOD People who died by suicide (n = 151), people who attempted suicide (n = 118) and living community controls (n = 140) were randomly sampled from four Chinese counties and studied using the Structured Clinical Interviews for DSM-IV-TR Axis I Disorders (SCID-I) and Axis II Personality Disorders (SCID-II). We also determined the prevalence of subthreshold versions of ten DSM-IV personality disorders. RESULTS Axis II personality disorders were present in 7% of the suicide group, 6% of the suicide attempt group and 1% of the control group. Threshold and subthreshold personality disorders had adjusted odds ratios (point estimates) in the range of 2.7-8.0 for suicide and for suicide attempts. CONCLUSIONS Axis II personality disorders may confer increased risk for suicidal behaviour in China, but their low prevalence in the community and among people with suicidal behaviour suggests that other personality constructs such as select dimensional traits may be a more fruitful avenue for understanding and preventing suicide in China.
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Affiliation(s)
- Yongsheng Tong
- Yongsheng Tong, MD, PhD, Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA; Michael R. Phillips, MD, MA, MPH, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China, Departments of Psychiatry and Public Health, Emory University, Atlanta Georgia, USA, and Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China; Kenneth R. Conner, PsyD, MPH, Department of Psychiatry, University of Rochester Medical Center, Rochester, New York and US Department of Veterans Affairs VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
| | - Michael R. Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China, Departments of Psychiatry and Public Health, Emory University, Atlanta Georgia, USA, and Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China
| | - Kenneth R. Conner
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NewYork and US Department of Veterans Affairs VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
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Assessment of health-related quality of life, mental health status and psychological distress based on the type of pharmacotherapy used among patients with depression. Qual Life Res 2016; 26:969-980. [PMID: 27671488 DOI: 10.1007/s11136-016-1417-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Effectiveness of antidepressants is generally comparable between and within classes. However, real-world studies on antidepressant treatment and its consequences on the overall quality of life and mental health of individuals are limited. The purpose of this study was to examine the association of specific class of antidepressants with the health-related quality of life, psychological distress and self-reported mental health of individuals suffering from depression who are on monotherapy. METHODS This retrospective, longitudinal study included individuals with depression who were on antidepressant monotherapy, using data from 2008 to 2011 Medical Expenditure Panel Survey (MEPS). Changes in health-related quality of life, self-reported mental health and psychological distress over a year's time were observed. A multinomial logistic regression model was built to examine the association between the class of antidepressant medications and the dependent variables. RESULTS A total of 688 adults met the study inclusion criteria. No significant difference was observed in the change in Physical Component Summary (PCS), self-reported mental health and psychological distress based on the class of antidepressants. However, individuals on serotonin-norepinephrine reuptake inhibitors (SNRIs) (OR 0.337, 95 % CI 0.155-0.730) were significantly less likely to show improvement on Mental Component Summary (MCS) scores as compared to those on selective serotonin reuptake inhibitors (SSRIs). CONCLUSIONS The study findings suggest that practitioners should be aware of the differences in the health-related quality of life of those taking SSRIs versus other classes of antidepressants. Further research needs to be done to determine the reason for SSRIs to show greater improvement on mental health as compared to SNRIs.
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Abstract
BACKGROUND Many studies have reported a positive association between smoking and suicide, but the results are inconsistent. This meta-analysis was carried out to estimate the association between smoking and suicidal ideation, suicide plan, suicide attempt, and suicide death. METHODS Major electronic databases including PubMed, Web of Science, Scopus, and ScienceDirect were searched until May 2015. The reference lists of included studies were screened too. Epidemiological studies addressing the association between smoking and suicidal behaviors were enrolled. The heterogeneity across studies was explored by Q-test and I2 statistic. The possibility of publication bias was assessed using Begg's and Egger's tests and Trim & Fill analysis. The results were reported based on risk ratio (RR) and odds ratio (OR) with 95% confidence intervals (CI) using a random-effects model. RESULTS We identified a total of 8062 references and included 63 studies with 8,063,634 participants. Compared to nonsmokers, the current smokers were at higher risk of suicidal ideation (OR = 2.05; 95% CI: 1.53, 2.58; 8 studies; I2 = 80.8%; P<0.001), suicide plan (OR = 2.36; 95% CI: 1.69, 3.02; 6 studies; I2 = 85.2%; P<0.001), suicide attempt (OR = 2.84; 95% CI: 1.49, 4.19; 5 studies; I2 = 89.6%; (P<0.001), and suicide death (RR = 1.83; 95% CI: 1.64, 2.02; 14 studies; I2 = 49.7%; P = 0.018). CONCLUSIONS There is sufficient evidence that smoking is associated with an increased risk of suicidal behaviors. Therefore, smoking is a contributing factor for suicide. Although this association does not imply causation, however, smoking prevention and cessation should be the target of suicide prevention programs.
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Affiliation(s)
- Jalal Poorolajal
- Modeling of Noncommunicable Diseases Research Center and Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Nahid Darvishi
- Psychological Counseling Center, Hamadan University of Medical Sciences, Hamadan, Iran
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