Psychosocial predictors of suicidal ideation in patients diagnosed with chronic illnesses in Jordan

Correlates for the severity of suicidal risk in participants with common mental disorders with comorbid chronic medical conditions in rural primary healthcare settings in India

Context

Suicide is on the rise in low- and middle-income countries (LMICs), including India. There are limited studies assessing factors linked to the severity of suicidal risk in patients with depression and comorbid chronic medical disorders in primary healthcare (PHC) settings.

Aim

This study examines factors linked to suicidal risk among participants in a cluster randomized controlled trial of collaborative care intervention (Healthier Options through Empowerment (HOPE Study)).

Settings and Design

The setting was at 49 PHC in the rural Ramanagara District of Karnataka State in southern India. Study eligibility criteria included being ≥30 years with at least mild depression or generalized anxiety disorder and at least one medical condition (cardiovascular disorder or type 2 diabetes mellitus).

Methods and Material

The severity of suicidal risk at baseline was assessed using the Mini International Neuropsychiatric Interview (MINI), and other measures included the severity of depression (Patient Health Questionnaire-9-items (PHQ-9)), the severity of anxiety (Generalized Anxiety Disorder Scale-7-items (GAD-7)), disability, social support, quality of life, number of comorbid chronic medical illnesses, and body mass index (BMI).

Statistical Analysis Used

Chi-square tests and independent-samples t-tests were used to compare the demographic and clinical characteristics of the no-low and mod-high suicidal risk groups. Logistic regression analysis was used to identify correlates associated with the mod-high suicidal risk group.

Results

Mod-high suicidal risk was significantly positively associated with the severity of depression and disability and significantly negatively associated with social support.

Conclusion

The severity of depression, higher disability scores, and lower social support were found to be independent correlates of mod-high suicidal risk. Screening, managing depression, and facilitating social support for patients with chronic medical illness in PHC settings may reduce suicidal risk.

Prevalence and Factors Associated With Suicidal Ideation Among Adult Eritrean Refugees in Northern Ethiopia

Background

The present study assessed the prevalence of and factor associated with suicidal ideations among adult Eritrean refugees in Tigray, Ethiopia.

Methods

A community-based cross-sectional study was carried out among 400 adult refugees living in the Mai-Aini refugee camp in Tigray, Northern Ethiopia from September 2019 to May 2020. The response variable was suicidal ideation and was measured using World Mental Health (WMH) Survey Initiative Version of the World Health Organization Composite International Diagnostic Interview. We applied bivariate and multivariate logistic regression to determine predictors for suicide ideations. Odds ratios and p-values were determined to check the associations between variables, and a p-value <0.05 was considered as a cut-off for statistical significance.

Results

The prevalence of suicidal ideations was 20.5% (95% CI: 16.4%, 24.5%). Having previous history of trauma [AOR = 2.3, 95% CI: 1.4, 4.5], a history of chronic illness [AOR = 2.9, 95% CI: 1.3, 6.5], a family history of mental disorder [AOR = 3.08, 95% CI: 1.3, 7.06], and history of post-traumatic stress disorder [AOR = 5.7, 95% CI: 2.8, 11.5] were significantly associated with suicidal ideations.

Conclusions

This study showed that during the stay in the refugee camp, there was a high prevalence of suicide ideations compared to the prevalence of suicide ideations among the general populations of Ethiopia, Europe, and China, and the lifetime pooled prevalence across 17 countries. Having previous history of trauma, a history of chronic illness, a family history of mental disorder, and history of post-traumatic stress disorder were the factors statistically associated with the suicidal ideation.

The Association of Persistent Symptoms of Depression and Anxiety with Recurrent Acute Coronary Syndrome Events: A Prospective Observational Study

The purpose of this study was to examine the role of persistent symptoms of depression and anxiety in a second acute coronary syndrome (ACS) event. Data presented in this study were from an RCT study. A follow-up for 24 months after baseline to detect a second ACS event among 1162 patients from five hospitals. Hierarchal Cox regression analyses were used. The results showed that persistent depression only (HR 2.27; 95% CI: 1.35–3.81; p = 0.002), and comorbid persistent depression and anxiety (HR 2.03; 95% CI: 1.03–3.98; p = 0.040) were the significant predictors of a second ACS event. Secondary education level compared to primary educational level (HR 0.63; 95% CI: 0.43–0.93; p = 0.020) and college or more education level compared to primary educational level (HR 0.47; 95% CI: 0.27–0.84; p = 0.011) were the only demographic variables that were significant predictors of a second event. The study reveals that attention must be paid by healthcare providers to assess and manage persistent depression; particularly when it is co-morbid with anxiety.

Suicide Attempts Among Adult Eritrean Refugees in Tigray, Ethiopia: Prevalence and Associated Factors

Purpose

The present study assessed the prevalence of and factors associated with suicide attempts among adult Eritrean refugees in Tigray, Ethiopia.

Methods

A community-based cross-sectional study was carried out among adult refugees from February 2020 to April 2020. The exposure variables included socio-demographic, clinically related, and psychosocial characteristics, and substance use-related factors. We included 400 participants and recruited them via a systematic random sampling technique. The study participants were between 18 and 60 years old. Data were collected using a structured interviewer-administered questionnaire. We applied bivariable and multivariable logistic regression to determine predictors for suicide attempts. Multicollinearity was checked to test correlations among predictor variables, and the Hosmer and Lemeshow test (p>0.2) was conducted to check the fitness of the model. Odds ratios and p-values were determined to check the associations between variables, and a p-value <0.05 was considered as a cut-off for statistical significance.

Results

The prevalence of suicide attempts was 7.3% (95% CI: 4.8%, 9.8%). Having current symptoms of trauma (AOR=5.6, 95% CI: 2.1, 14.9), a family history of mental disorder (AOR=3.02, 95% CI: 1.01, 9.07), a history of post-traumatic stress disorder (PTSD) (AOR=2.7, 95% CI: 1.01, 7.4), and severe hopelessness (AOR=3.9, 95% CI: 1.3, 12.7) were significantly associated with suicide attempts.

Conclusion

This study showed that during the stay in the refugee camp, there was a high prevalence of suicide attempts compared to the prevalence of suicide attempts among the general populations of Ethiopia, Europe, and China, and the lifetime pooled prevalence across 17 countries. Current symptoms of trauma, PTSD, a family history of mental illness, and hopelessness were the factors statistically associated with the suicide attempt. Early screening, detection, and management of suicidal behavior, as well as appropriate mental healthcare, are warranted in refugee camps to reduce the number of suicide attempts.

Association between social support and suicidal ideation in patients with cancer: A systematic review and meta-analysis

OBJECTIVE

To quantitatively examine the relationship between social support and suicidal ideation (SI) among patients with cancer and identify the moderators that influence the magnitude of this association.

METHODS

Publications were searched in PubMed, PsycINFO, EMBASE, Cochrane Library and Chinese National Knowledge Infrastructure from database inception to May, 2020. Correlation coefficients (r) were chosen as the effect size with a random model to evaluate the overall effect size between social support and SI in patients with cancer. To assess statistical heterogeneity, we examined potential moderator variables on the social support and SI.

RESULTS

A total of 881 studies were identified in initial search, and twelve studies were eligible. A negative, small but significant correlation (r = -0.22, 95% CIs: -0.30,-0.14, p < 0.001) was observed between social support and SI in patients with cancer, with a significant heterogeneity (I²  = 95.24%, Q = 231.27, p < 0.001). Moderator analyses indicated that race/ethnicity (Q(1) = 8.4, p < 0.05) and measurements of social support (Q(3) = 9.78, p < 0.05) and SI (Q(3) = 9.69, p < 0.05) significantly moderate the effect size between social support and SI.

CONCLUSION

Taken together, we found a negative yet significant association between social support and SI in patients with cancer, which supported the importance of social support for the prevention of SI in patients with cancer.

Characteristics associated with later self-harm hospitalization and/or suicide: A follow-up study of the HUNT-2 cohort, Norway

BACKGROUND

To improve suicide and self-harm prevention in adults, better knowledge on preexisting characteristics and risk factors is of great importance.

METHODS

This is a population-based case-control study; baseline measures were collected in the second wave of the North-Trøndelag Health Study (HUNT-2, 1995-1997) in Norway, and outcomes were observed for up to 19 years. Average follow up time was 4.9 years for self-harm and 6.8 years for suicides. Out of 93,898 eligible adult inhabitants aged 20 and above, a total of 65,229 (70%) participated in the study. The data were linked to the National Mortality Registry and hospital patient records in the three hospitals covering the HUNT-2 catchment area.

RESULTS

Among the participants, 332 patients (68% women) were hospitalized because of self-harm (HSH), and 91 patients (32% women) were died by suicide (SU). A total of 10% of those who died by SU had previously been HSH. People in the HSH and SU groups were younger, reported more depression and anxiety symptoms, sleeping problems, higher use of alcohol and tobacco, poorer social network and more economic problems, compared to the rest of the HUNT-2 population. In addition, the HSH group reported more somatic health problems, higher use of health services, higher sick leave, and lower work participation than the SU group.

LIMITATIONS

Younger adults (20-40 years) were under-represented in HUNT-2. Younger adults (20-40 years) were constituted 31.7% in HUNT-2, 50% in HSH and 33% in SU. Further, we did not identify less severe self-harm, not requiring hospitalization. Life changes, adverse events, and other possible triggers to self-harming behavior were not recorded.

CONCLUSION

Psychological problems were long-term predictors of both HSH and SU. Somatic health problems and lower functional performance were more present in HSH-group compared to the SU-group.

Predicting Suicidal Ideation in Adolescent Boys and Girls: The Role of Psychological Maturity, Personality Traits, Depression and Life Satisfaction

In recent years, suicide rates have increased in adolescents and the young population, so these age groups are considered as populations at risk. Considering that suicidal ideation is the first sign of possible future suicide behavior, the objective of this study is to determine the relative importance of psychological maturity, personality, depression and life satisfaction in predicting suicidal ideation in adolescents. Results show that depressive symptoms is the variable that best predicts suicidal ideation, but psychological maturity, life satisfaction and emotional stability are predictors as well (R2 = .51, p < .001). However, the Multigroup Structural Equation Models analyses carried out show that emotional stability has an indirect relationship with suicidal ideation, through its relationship with depressive symptoms, life satisfaction and identity. Two Multigroup Structural Equation Models were proposed to better understand the relationships between these variables for each sex. The results show that the fit of the model that includes the variable Self-reliance is better for boys than for girls (chi-square contributions of 8.175 for girls and 1.978 for boys) unlike the other model (chi-square contributions of 0.288 for girls and 1.650 for boys). These results suggest that the psychological maturity subscale Self-reliance play a role in suicidal ideation in males but not in females. Although there have been no previous studies on the role of psychological maturity as a predictor of suicidal phenomena, the current study suggests that it is a feature to be considered in the prediction of adolescent suicidal ideation.

Depression and anxiety disorders in people with diabetes

Introduction: As the global number of diabetes and the burden of depression together with other mental disorders increases, there is a need for better understanding of the connection between these diseases. In patients with diabetes, mental disorders are more common than in the general population, especially anxiety disorders and depression, which are often difficult to detect by health professionals.

Material and methods: Using the keywords searched in the international bibliographic databases: Embase, Medline, Science Direct, Web of Science. We analyzed clinical trials published in English and international journals

Results: Patients with diabetes are exposed to serious physical and mental complications. The occurence of depression and psychiatric disorders among people with diabetes was twice as frequent as in the general population. There are also studies showing a higher risk of suicide among people with diabetes. In addition, patients with both diseases, diabetes and depression, had an increased risk of cardiovascular complications and increased mortality and higher costs of health care. Diabetic patients have increased incidence of anxiety disorders in relation to non-diabetic patients by 20%.

Conclusion: Further researches and integration of medical and psychological treatment are needed. Cooperation between psychiatrists and diabetologists can reduce mental and physical harm in patients with diabetes.

Clinical Characteristics of Diabetes Mellitus and Suicide Risk

BACKGROUND

Diabetes mellitus (DM) is a chronic illness with impaired health-related quality of life and a high risk of psychiatric disorders. We carried out a systematic review analyzing the relationship between DM and suicide by providing a qualitative data synthesis of the studies.

METHODS

We conducted, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of the literature in PubMed, Scopus, ISI Web of Science, PsycINFO, Google Scholar, and ScienceDirect. Search terms were "suicid*" combined with the Boolean "AND" operator with "diabetes."

RESULTS

The initial search identified 568 citations. A total of 17 research reports met the predefined inclusion criteria and were analyzed. DM was found to be significantly associated with a marked increase in suicidal behaviors and suicidal ideation (SI), especially in patients with depressive symptoms. Insulin therapy, DM of long duration, and unsatisfactory glycemic control were identified as risk factors for SI in Type 1 (T1DM) and Type 2 (T2DM).

CONCLUSION

Health-care professionals need to be aware of the higher suicidal risk in patient subgroups based on the clinical characteristics of DM; thus, patients with these characteristics warrant special attention. In this regard, clinical management should include efforts to manage emotional distress in DM care.

Relationship of optimism and suicidal ideation in three groups of patients at varying levels of suicide risk

Optimism has been associated with reduced suicidal ideation, but there have been few studies in patients at high suicide risk. We analyzed data from three study populations (total N = 319) with elevated risk of suicide: (1) patients with a recent acute cardiovascular event, (2) patients hospitalized for heart disease who had depression or an anxiety disorder, and (3) patients psychiatrically hospitalized for suicidal ideation or following a suicide attempt. For each study we analyzed the association between optimism (measured by the Life-Orientation Test-Revised) and suicidal ideation, and then completed an exploratory random effects meta-analysis of the findings to synthesize this data. The meta-analysis of the three studies showed that higher levels of self-reported optimism were associated with a lower likelihood of suicidal ideation (odds ratio [OR] = .89, 95% confidence interval [CI] = .85-.95, z = 3.94, p < .001), independent of age, gender, and depressive symptoms. This association held when using the subscales of the Life Orientation Test-Revised scale that measured higher optimism (OR = .84, 95% CI = .76-.92, z = 3.57, p < .001) and lower pessimism (OR = .83, 95% CI = .75-.92], z = 3.61, p < .001). These results also held when suicidal ideation was analyzed as an ordinal variable. Our findings suggest that optimism may be associated with a lower risk of suicidal ideation, above and beyond the effects of depressive symptoms, for a wide range of patients with clinical conditions that place them at elevated risk for suicide.

'Everything's from the inside out with PCOS': Exploring women's experiences of living with polycystic ovary syndrome and co-morbidities through Skype™ interviews

Polycystic ovary syndrome is an endocrine disorder affecting 1 in 10 women. Women with polycystic ovary syndrome can experience co-morbidities, including depressive symptoms. This research explores the experience of living with polycystic ovary syndrome and co-morbidities. Totally, 10 participants with polycystic ovary syndrome took part in Skype™ interviews and analysed using thematic analysis. Four themes emerged from the data: change (to life plans and changing nature of condition); support (healthcare professionals, education and relationships); co-morbidities (living with other conditions and depression, self-harm and suicidal ideation) and identity (feminine identity and us and them). The findings highlight the need for screening of women with polycystic ovary syndrome for depressive disorders.