Suicidality and its associated factors among mood disorder patients in emergency department in China: a comparative study using propensity score matching approach

Suicidality in mood disorder patients is common, especially in emergency department (ED), but the patterns and associated factors of suicidality are not clear. This study compared biomarkers and mental health symptoms (i.e., depression, anxiety, and psychiatric symptoms) between mood disorder patients with and without the whole range of suicidality comprising suicidal ideation (SI), suicide plan (SP), and suicide attempt (SA). This cross-sectional, comparative, convenient-sampling study was conducted between January 2021 and March 2022, in emergency department of Beijing Anding Hospital, China. Patients with mood disorders at a psychiatric emergency department were assessed, with measurements of suicidality, biomarkers, depressive, anxiety, and psychiatric symptoms were assessed using the 24 items-Hamilton Depression Rating Scale (HAMD-24), Hamilton Anxiety Rating Scale (HAMA), Young Manic Rating Scale (YMRS) and Brief Psychiatric Rating Scale (BPRS), respectively. The propensity score matching (PSM) method was used to identify patients in mood disorder with and without SI, SP, and SA. A generalized linear model (GLM) was used to assess the differences in biomarkers, depressive, anxiety, and psychiatric symptoms between patients in mood disorder with and without SI, SP, and SA. In total, 898 participated in this survey and completed the assessment. Illness duration was significantly negatively associated with SA (OR = 0.969, 95%CI = 0.939-0.999, P = 0.046). HAMD-24 total score was significantly positively associated with the SI (OR = 1.167, 95%CI = 1.134-1.201, p < 0.001), SP (OR = 1.159, 95%CI = 1.126-1.192, p < 0.001) and SA (OR = 1.189, 95%CI = 1.144-1.235, p < 0.001) of the matched samptched sample. However, YMRS total score was significantly negatively associated with the SI (OR = 0.928, 95%CI = 0.905-0.951, p < 0.001), SP (OR = 0.920, 95%CI = 0.897-0.944, p < 0.001) and SA (OR = 0.914, 95%CI = 0.890-0.938, p < 0.001) of the matched sample after adjusting for age, gender, marital status, and occupation. The duration of illness, severity of depressive symptoms and severity of manic symptoms appeared to be more likely to influence suicidality. Considering the significant risk of suicide in mood disorders on psychiatric emergency care, timely treatment and effective management of suicidality in this population group need to be developed.

Evidence for a Positive Ecological Correlation of Regional Intelligence and Suicide Mortality in the United States during the Early 20th Century

Several contemporary cross-national and intranational geographic studies have reported positive ecological (group-level) associations of intelligence and suicide mortality. These findings are consistent with facts from suicide research and with an evolutionary view of suicidal behavior. The present research extended these accounts cross-temporally. Analysis of E. L. Thorndike's state-level personal quality scores and standardized birth rates of eminent persons, taken as proxy variables for regional intelligence, along with historical state suicide rates (1913–1924 and 1928–1932) showed that intelligence and suicide mortality across the USA were already clearly positively related during the early 20th century, suggesting time stability of the effect. Within the USA, the effect is possibly due to state differences in the ethnic composition, which correspond to both suicide rates and intelligence proxies. It is argued that the most parsimonious interpretation of these ecological findings remains that they indeed reflect individual-level effects, that a positive link between intelligence and suicide is entirely compatible with positive overall links between intelligence and health and longevity, and that the ultimate explanative background for the positive link between intelligence and suicide may be provided through the framework of Rushton's differential K theory.

National Intelligence and Suicide Rate across Europe: An Alternative Test Using Educational Attainment Data

National mean scores on a historical knowledge test (taken as a proxy for intelligence), stemming from representative samples of male (and female) 9th-grade school students from 26 European countries in a 1999 report by Wilberg and Lynn, were significantly positively associated with the national male (and female) suicide rates, independent of the general quality-of-living conditions in these countries. This finding replicates previous evidence from cross-national studies (by Lester and by Voracek), of a correspondence of higher national IQ to higher suicide rates, with an alternative measure of national IQ that is independent of the national IQ estimates recently published by Lynn and Vanhanen which have been used in prior studies.

National intelligence estimates and the Failed State Index

Across 177 countries around the world, the Failed State Index, a measure of state vulnerability, was reliably negatively associated with the estimates of national intelligence. Psychometric analysis of the Failed State Index, compounded of 12 social, economic, and political indicators, suggested factorial unidimensionality of this index. The observed correspondence of higher national intelligence figures to lower state vulnerability might arise through these two macro-level variables possibly being proxies of even more pervasive historical and societal background variables that affect both.

Cross-National Social Ecology of Intelligence and Suicide Prevalence: Integration, Refinement, and Update of Studies

This study integrates, refines, and updates previous findings pertaining to positive ecologic (population-level) associations between intelligence and suicide prevalence across nations by using corrected and revised national IQ estimates and, further, a quality-of-human-conditions index, both recently published by Lynn and Vanhanen. Across a global 85-nation sample of sex-specific total suicide rates and a Eurasian 48-nation sample of sex-specific elderly suicide rates, these were positively associated with updated national IQ estimates. The associations were stronger for the general population than for elderly persons, independent of the quality of human conditions, and notedly stronger in exponential fitting of suicide rates with national IQ than in linear fitting, thereby indicating that shifts or differences in national IQ correspond to proportional, not absolute, changes in suicide rates. Implications of these findings and the question of generalizability of such associations to the individual level are discussed.