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Sadath A, Troya MI, Nicholson S, Cully G, Leahy D, Ramos Costa AP, Benson R, Corcoran P, Griffin E, Phillip E, Cassidy E, Jeffers A, Shiely F, Alberdi-Páramo Í, Kavalidou K, Arensman E. Physical and mental illness comorbidity among individuals with frequent self-harm episodes: A mixed-methods study. Front Psychiatry 2023; 14:1121313. [PMID: 36970268 PMCID: PMC10033892 DOI: 10.3389/fpsyt.2023.1121313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
BackgroundResearch has indicated an increased risk of self-harm repetition and suicide among individuals with frequent self-harm episodes. Co-occurring physical and mental illness further increases the risk of self-harm and suicide. However, the association between this co-occurrence and frequent self-harm episodes is not well understood. The objectives of the study were (a) to examine the sociodemographic and clinical profile of individuals with frequent self-harm (regardless of suicidal intent) episodes and, (b) the association between physical and mental illness comorbidity, self-harm repetition, highly lethal self-harm methods, and suicide intent.MethodsThe study included consecutive patients with five or more self-harm presentations to Emergency Departments across three general hospitals in the Republic of Ireland. The study included file reviews (n = 183) and semi-structured interviews (n = 36). Multivariate logistic regression models and independent samples t-tests were used to test the association between the sociodemographic and physical and mental disorders comorbidity on highly lethal self-harm methods and suicidal intent, respectively. Thematic analysis was applied to identify themes related to physical and mental illness comorbidity and frequent self-harm repetition.FindingsThe majority of individuals with frequent self-harm episodes were female (59.6%), single (56.1%), and unemployed (57.4%). The predominant current self-harm method was drug overdose (60%). Almost 90% of the participants had history of a mental or behavioral disorder, and 56.8% had recent physical illness. The most common psychiatric diagnoses were alcohol use disorders (51.1%), borderline personality disorder (44.0%), and major depressive disorder (37.8%). Male gender (OR = 2.89) and alcohol abuse (OR = 2.64) predicted the risk of a highly lethal self-harm method. Suicide intent was significantly higher among those with a diagnosis of major depressive disorder (t = 2.43; p = 0.020). Major qualitative themes were (a) the functional meaning of self-harm (b) self-harm comorbidity (c) family psychiatric history and (d) contacts with mental health services. Participants described experiencing an uncontrollable self-harm urge, and self-harm was referred to as a way to get relief from emotional pain or self-punishment to cope with anger and stressors.ConclusionPhysical and mental illness comorbidity was high among individuals with frequent self-harm episodes. Male gender and alcohol abuse were associated with highly lethal self-harm methods. The mental and physical illness comorbidity of individuals with frequent self-harm episodes should be addressed via a biopsychosocial assessment and subsequent indicated treatment interventions.
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Affiliation(s)
- Anvar Sadath
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
- *Correspondence: Anvar Sadath,
| | - M. Isabela Troya
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Sarah Nicholson
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Grace Cully
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Dorothy Leahy
- Kerry Primary Care Child, Adolescent and Family Psychology Service, Cork Kerry Community Healthcare, Health Service Executive, Kerry, Ireland
| | - Ana Paula Ramos Costa
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Ruth Benson
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Paul Corcoran
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Eve Griffin
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Eunice Phillip
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Eugene Cassidy
- Liaison Psychiatry Services, Cork University Hospital, Cork, Ireland
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | | | - Frances Shiely
- School of Public Health, University College Cork, Cork, Ireland
- Health Research Board (HRB), Clinical Research Facility, University College Cork, Cork, Ireland
| | | | - Katerina Kavalidou
- National Suicide Research Foundation, University College Cork, Cork, Ireland
- National Clinical Programme for Self-Harm and Suicide-Related Ideation (NCPSHI), Health Service Executive, Dublin, Ireland
| | - Ella Arensman
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
- School of Applied Psychology, Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, QLD, Australia
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Tachikawa H, Takahashi S, Nemoto K, Yonemoto N, Oda H, Miyake Y, Hirayasu Y, Arai T, Kawanishi C. Predictive factors for recurrent suicide attempts: Evidence from the ACTION-J study. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2022; 1:e7. [PMID: 38868638 PMCID: PMC11114385 DOI: 10.1002/pcn5.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/29/2022] [Accepted: 03/14/2022] [Indexed: 06/14/2024]
Abstract
Aim Risk factors for attempted suicide have been widely studied. However, there is limited evidence on predictive factors for suicide reattempts. We aimed to identify these in suicide attempters admitted to emergency departments. Methods This is the second analysis from a randomized controlled multicenter trial, ACTION-J. Patient characteristics were extracted from baseline demographic data and clinical data of participants. Predictive factors for a recurrent suicide attempt in each gender were examined using Cox proportional hazards regression analysis. Dependent variables were months from trial entry to the first reattempt. Independent variables were characteristics regarded as potential predictive factors. Results The study included 914 adults (400 men and 514 women). A visit to a psychiatrist within a month of the suicide attempt was significantly associated with reattempts in men (hazard ratio [HR] 2.49, 95% confidence interval [CI] 1.21-5.25). Substance-related disorders (HR 3.65, 95% CI 1.16-7.9.60), drinking alcohol less than once per month (HR 0.42, 95% CI 0.17-0.88), previous suicide attempts (HR 2.28, 95% CI 1.40-3.87), and taking a drug overdose for the first suicide attempt (HR 1.82, 95% CI 1.14-3.01) were significantly associated with reattempts in women. Conclusion Our data highlight the importance of visits to a psychiatrist a short time before the first suicide attempt in men and substance-related disorder, previous suicide attempts, and drug overdose in the first suicide attempt in women as predictive factors for future suicide reattempts.
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Affiliation(s)
- Hirokazu Tachikawa
- Department of Disaster and Community Psychiatry, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Sho Takahashi
- Department of Disaster and Community Psychiatry, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Kiyotaka Nemoto
- Department of Psychiatry, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Naohiro Yonemoto
- Department of Neuropsychopharmacology, National Institute of Mental HealthNational Center of Neurology and PsychiatryKodairaJapan
| | - Hiroyuki Oda
- Department of NeuropsychiatryKansai Medical UniversityHirakataJapan
| | - Yasufumi Miyake
- Department of Emergency MedicineTeikyo University HospitalItabashi‐kuJapan
| | | | - Tetsuaki Arai
- Department of Psychiatry, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Chiaki Kawanishi
- Department of NeuropsychiatrySapporo Medical University Graduate School of MedicineSapporoJapan
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Association between anger and suicidal ideation. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-021-02577-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Troya MI, Cully G, Leahy D, Cassidy E, Sadath A, Nicholson S, Ramos Costa AP, Alberdi-Páramo Í, Jeffers A, Shiely F, Arensman E. Investigating the relationship between childhood sexual abuse, self-harm repetition and suicidal intent: mixed-methods study. BJPsych Open 2021; 7:e125. [PMID: 34236021 PMCID: PMC8281309 DOI: 10.1192/bjo.2021.962] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Research into the association between childhood sexual abuse (CSA) and self-harm repetition is limited. AIMS We aimed to examine the association between self-harm repetition, mental health conditions, suicidal intent and CSA experiences among people who frequently self-harm. METHOD A mixed-methods study was conducted including consecutive patients aged ≥18 years, with five or more self-harm presentations, in three Irish hospitals. Information was extracted from psychiatric records and patients were invited to participate in a semi-structured interview. Data was collected and analysed with a mixed-methods, convergent parallel design. In tandem, the association between CSA and self-harm repetition, suicidal intent and mental health conditions was examined with logistic regression models and independent sample t-test, with psychiatric records data. Thematic analysis was conducted with interview data, to explore CSA experiences and self-harm repetition. RESULTS Between March 2016 and July 2019, information was obtained on 188 consecutive participants, with 36 participants completing an interview. CSA was recorded in 42% of the total sample and 72.2% of those interviewed. CSA was positively associated with self-harm repetition (odds ratio 6.26, 95% CI 3.94-9.94, P = 0.00). Three themes emerged when exploring participants' CSA experiences: CSA as a precipitating factor for self-harm, secrecy of CSA accentuating shame, and loss experiences linked to CSA and self-harm. CONCLUSIONS CSA was frequently reported among people who frequently self-harm, and associated with self-harm repetition. Identification of patients at risk of repetition is key for suicide prevention. This is an at-risk group with particular characteristics that must be considered; comprehensive patient histories can help inform and tailor treatment pathways.
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Affiliation(s)
- Maria Isabela Troya
- School of Public Health, College of Medicine and Health, University College Cork, Ireland; and National Suicide Research Foundation, University College Cork, Ireland
| | - Grace Cully
- School of Public Health, College of Medicine and Health, University College Cork, Ireland; and National Suicide Research Foundation, University College Cork, Ireland
| | - Dorothy Leahy
- School of Public Health, College of Medicine and Health, University College Cork, Ireland; and National Suicide Research Foundation, University College Cork, Ireland
| | - Eugene Cassidy
- Cork University Hospital Group, Liaison Psychiatry Service, Ireland
| | - Anvar Sadath
- School of Public Health, College of Medicine and Health, University College Cork, Ireland; and National Suicide Research Foundation, University College Cork, Ireland
| | - Sarah Nicholson
- School of Public Health, College of Medicine and Health, University College Cork, Ireland; and National Suicide Research Foundation, University College Cork, Ireland
| | - Ana Paula Ramos Costa
- School of Public Health, College of Medicine and Health, University College Cork, Ireland; and National Suicide Research Foundation, University College Cork, Ireland
| | - Íñigo Alberdi-Páramo
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Spain; and Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, Spain
| | - Anne Jeffers
- National Clinical Programme for the Assessment and Management of Patients presenting to the Emergency Department following Self-Harm, Office of the National Clinical Advisor and Group Lead - Mental Health, Dr. Steeven's Hospital, Ireland
| | - Frances Shiely
- School of Public Health, College of Medicine and Health, University College Cork, Ireland
| | - Ella Arensman
- School of Public Health, College of Medicine and Health, University College Cork, Ireland; National Suicide Research Foundation, University College Cork, Ireland; and Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Australia
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Trajectories in suicide attempt method lethality over a five-year period: Associations with suicide attempt repetition, all-cause, and suicide mortality. PLoS One 2021; 16:e0245780. [PMID: 33481936 PMCID: PMC7822301 DOI: 10.1371/journal.pone.0245780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022] Open
Abstract
It is not known if there are discernible patterns in method lethality over successive episodes of self–harm and, if so, how these may be differentially associated with risks of self–harm repetition and suicide. Latent trajectory modelling estimated variation in patterns of suicide attempt lethality in 1,719 individuals attended by ambulance services on at least three occasions between 2012 and 2016. Cox regression modelling investigated hazards of suicide attempt repetition, all–cause, and suicide mortality as a function of these patterns. Two distinct trajectories provided optimal fit (BIC: –39,464.92). The first (Low/Moderate to Low/Moderate Lethality group; 92.5%) consisted of those consistently using methods associated with low to moderate potential lethality throughout the observation period. The second (High to Low/Moderate Lethality group; 7.5%) consisted of those who initially used methods with higher potential lethality but who switched to methods characterised by lower lethality. There were no significant differences between groups in the hazards of reattempting suicide (Hazard Ratio [HR] = 1.41, 95% CI 0.76 to 2.59) or all–cause mortality (HR = 1.21, 95% CI 0.63 to 2.32). However, those assigned to the High to Low/Moderate Lethality trajectory group may be at greater risk of suicide (Sub–Hazard Ratio [SHR] = 2.82, 95% CI 1.16 to 6.86). There may be discernible sub–groups of patients with important differences in clinical treatment needs and suicide risk profiles. These differences should be considered when undertaking psychosocial risk/needs assessments with those presenting to clinical services following self-harm.
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Arensman E, Troya MI, Nicholson S, Sadath A, Cully G, Ramos Costa AP, Benson R, Corcoran P, Griffin E, Williamson E, Eustace J, Shiely F, Browne J, Rigby J, Jeffers A, Cassidy E. Study protocol for the implementation and evaluation of the Self-harm Assessment and Management for General Hospitals programme in Ireland (SAMAGH). BMC Health Serv Res 2020; 20:590. [PMID: 32600390 PMCID: PMC7322837 DOI: 10.1186/s12913-020-05254-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/26/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Previous self-harm is one of the strongest predictors of future self-harm and suicide. Increased risk of repeated self-harm and suicide exists amongst patients presenting to hospital with high-risk self-harm and major self-harm repeaters. However, so far evidence-based training in the management of self-harm for mental health professionals is limited. Within this context, we aim to develop, implement and evaluate a training programme, SAMAGH, Self-harm Assessment and Management Programme for General Hospitals in Ireland. SAMAGH aims to (a) reduce hospital-based self-harm repetition rates and (b) increase rates of mental health assessments being conducted with self-harm patients. We also aim to evaluate the training on self-harm knowledge, attitudes, and skills related outcomes of healthcare professionals involved in the training. METHODS/DESIGN The study will be conducted in three phases. First, the SAMAGH Training Programme has been developed, which comprises two parts: 1) E-learning Programme and 2) Simulation Training. Second, SAMAGH will be delivered to healthcare professionals from general hospitals in Ireland. Third, an outcome and process evaluation will be conducted using a pre-post design. The outcome evaluation will be conducted using aggregated data from the National Self-Harm Registry Ireland (NSHRI) on self-harm repetition rates from all 27 public hospitals in Ireland. Aggregated data based on the 3-year average (2016, 2017, 2018) self-harm repetition rates prior to the implementation of the SAMAGH will be used as baseline data, and NSHRI data from 6 and 12 months after the implementation of SAMAGH will be used as follow-up. For the process evaluation, questionnaires and focus groups will be administered and conducted with healthcare professionals who completed the training. DISCUSSION This study will contribute to the evidence base regarding the effectiveness of an evidence informed training programme that aims to reduce repeated hospital self-harm presentations and to improve compliance with self-harm assessment and management. This study is also expected to contribute to self-harm and suicide training with the possibility of being translated to other settings. Its feasibility will be evaluated through a process evaluation.
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Affiliation(s)
- Ella Arensman
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland.
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland.
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia.
| | - M Isabela Troya
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Sarah Nicholson
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Anvar Sadath
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Grace Cully
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Ana Paula Ramos Costa
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Ruth Benson
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Paul Corcoran
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Eve Griffin
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Eileen Williamson
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Joe Eustace
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- Health Research Board Clinical Research Facility-Cork, University College Cork, Cork, Ireland
| | - Frances Shiely
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- Health Research Board Clinical Research Facility-Cork, University College Cork, Cork, Ireland
| | - John Browne
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - Jan Rigby
- Centre for Health Geoinformatics & Department of Geography, Maynooth University, Maynooth, Ireland
| | - Anne Jeffers
- National Clinical Programme for the Assessment and Management of Patients presenting to the Emergency Department following Self-Harm, Office of the National Clinical Advisor and Group Lead, Dr. Steeven's Hospital, Dublin, Ireland
| | - Eugene Cassidy
- Department of Psychiatry and Neurobehavioral Science, University College Cork, Acute Mental Health Unit, Cork University Hospital, Wilton, Ireland
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Berardelli I, Forte A, Innamorati M, Imbastaro B, Montalbani B, Sarubbi S, De Luca GP, Mastrangelo M, Anibaldi G, Rogante E, Lester D, Erbuto D, Serafini G, Amore M, Pompili M. Clinical Differences Between Single and Multiple Suicide Attempters, Suicide Ideators, and Non-suicidal Inpatients. Front Psychiatry 2020; 11:605140. [PMID: 33384631 PMCID: PMC7769945 DOI: 10.3389/fpsyt.2020.605140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/18/2020] [Indexed: 12/23/2022] Open
Abstract
Single suicide attempters (SSAs) and multiple suicide attempters (MSAs) represent distinct subgroups of individuals with specific risk factors and clinical characteristics. This retrospective study on a sample of 397 adult psychiatric inpatients analyzed the main sociodemographic and clinical differences between SSAs and MSAs and the possible differences between SSAs, MSAs, and psychiatric patients with and without suicidal ideation (SI). Clinical variables collected included psychiatric diagnoses (Mini International Neuropsychiatric Interview), presence of substance use, current suicide risk status (Columbia Suicide Severity Rating Scale), Clinical Global Impression at admission, Global Assessment of Functioning improvement between admission and discharge, age at onset of psychiatric illness, duration of untreated illness in years, number of hospitalizations in psychiatric settings, and lethality of the most severe suicide attempt. A multinomial logistic regression model with groups showed that MSAs had a higher lethality of their last suicide attempt as compared to SSAs. In addition, MSAs had distinct sociodemographic characteristics compared to both SSAs and patients with SI. Although the study was limited by the relatively small sample size and retrospective nature, the present results suggest that identifying MSAs could be useful in predicting suicide risk and designing ad hoc prevention strategies.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Alberto Forte
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Benedetta Imbastaro
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Benedetta Montalbani
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Gabriele Pasquale De Luca
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Martina Mastrangelo
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Gaia Anibaldi
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Elena Rogante
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - David Lester
- Psychology Program, Stockton University, Galloway, NJ, United States
| | - Denise Erbuto
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, Psychiatry Section, University of Genoa, IRCCS San Martino, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, Psychiatry Section, University of Genoa, IRCCS San Martino, Genoa, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Berrouiguet S, Billot R, Larsen ME, Lopez-Castroman J, Jaussent I, Walter M, Lenca P, Baca-García E, Courtet P. An Approach for Data Mining of Electronic Health Record Data for Suicide Risk Management: Database Analysis for Clinical Decision Support. JMIR Ment Health 2019; 6:e9766. [PMID: 31066693 PMCID: PMC6707587 DOI: 10.2196/mental.9766] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 06/30/2018] [Accepted: 07/26/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In an electronic health context, combining traditional structured clinical assessment methods and routine electronic health-based data capture may be a reliable method to build a dynamic clinical decision-support system (CDSS) for suicide prevention. OBJECTIVE The aim of this study was to describe the data mining module of a Web-based CDSS and to identify suicide repetition risk in a sample of suicide attempters. METHODS We analyzed a database of 2802 suicide attempters. Clustering methods were used to identify groups of similar patients, and regression trees were applied to estimate the number of suicide attempts among these patients. RESULTS We identified 3 groups of patients using clustering methods. In addition, relevant risk factors explaining the number of suicide attempts were highlighted by regression trees. CONCLUSIONS Data mining techniques can help to identify different groups of patients at risk of suicide reattempt. The findings of this study can be combined with Web-based and smartphone-based data to improve dynamic decision making for clinicians.
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Affiliation(s)
- Sofian Berrouiguet
- Adult Psychiatry, Brest Medical University Hospital at Bohars, Brest, France.,EA 7479 Soins Primaires, Santé Publique, Registre des Cancers de Bretagne Occidentale, Université de Bretagne Occidentale, Brest, France.,Mental Health Department, University Hospital of Brest, Brest, France.,F-29238, Laboratoire des Sciences et Techniques de l'information de la Communication et de la Connaissance, IMT Atlantique, Brest, France
| | - Romain Billot
- F-29238, Laboratoire des Sciences et Techniques de l'information de la Communication et de la Connaissance, IMT Atlantique, Brest, France
| | - Mark Erik Larsen
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | | | - Isabelle Jaussent
- Inserm U1061, La Colombières Hospital, University of Montpellier, Montpellier, France
| | - Michel Walter
- Adult Psychiatry, Brest Medical University Hospital at Bohars, Brest, France
| | - Philippe Lenca
- F-29238, Laboratoire des Sciences et Techniques de l'information de la Communication et de la Connaissance, IMT Atlantique, Brest, France
| | - Enrique Baca-García
- Carlos III Institute Of Health, Centro de Investigation en Salud Mental, Madrid, Spain.,Department of Psychiatry, Universitad Catolica del Maule, Talca, Chile.,Department of Psychiatry, General Hospital of Villaba, Madrid, Spain.,Department of Psychiatry, University Hospital Rey Juan Carlos, Mostoles, Spain.,Department of Psychiatry, University Hospital Infanta Elena, Valdemoro, Spain.,Psychiatry Department, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Psychiatry, Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
| | - Philippe Courtet
- Inserm U1061, La Colombières Hospital, University of Montpellier, Montpellier, France.,Department of Psychiatry, General Hospital of Villaba, Madrid, Spain.,Department of Psychiatry, University Hospital Rey Juan Carlos, Mostoles, Spain.,Department of Emergency Psychiatry and Acute Care, Centre Hospitalier Universitaire de Montpellier, Université Montpellier, Montpellier, France.,Fondamental Foundation, Créteil, France
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Liu Y, Zhang J, Sun L. Who are likely to attempt suicide again? A comparative study between the first and multiple timers. Compr Psychiatry 2017; 78:54-60. [PMID: 28803042 PMCID: PMC5600866 DOI: 10.1016/j.comppsych.2017.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 06/30/2017] [Accepted: 07/17/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Various explanations account for suicide incidents, and some patients continue to attempt afterwards and others never again. The suicide mortality rate increases with the number of serious attempts. The prevention of secondary attempt of suicide should be an important approach to reduce suicide mortality. However, the characteristics of the targeted population of repeated suicide attempters are understudied. METHODS This was a cross-sectional data collection from hospital emergency room from patients who had either attempted suicide for the first time (n=721) or for two or more times (n=70). The subjects were between 14 and 53years old and comprised 293 males and 498 females. In-depth interview was conducted for each suicide attempter with a semi-structural protocol. Demographic and social-psychological characteristics were compared between the two groups of suicide attempters. Logistic regression was used to identify independent predictors of multiple attempts. FINDINGS The two groups only differed in religion factor among demographic characteristics and multiple suicide attempters group have a higher percentage of subjects who reported to have a religion affiliation than first time suicide attempters. Multiple attempters were more likely to have family suicide history, physical illness, mental disorder, higher scores on Beck Hopelessness Scale (BHS) and Suicide Intent Scale (SIS) and lower scores on Duke Social Support Scale (DSSI). In the final regression model, family history of suicide, mental disorder, hopelessness and social support emerged as significant predictors of multiple suicide attempts. CONCLUSION Suicide attempters that have mental disorder, family history of suicide, higher level of hopelessness and lower level of social support are more likely to re-attempt suicide again. Social and clinical interventions may have to also focus on this sub-group of patients with these characteristics to effectively reduce suicide mortality rate.
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Affiliation(s)
- Yanzheng Liu
- Shandong University Center for Suicide Prevention Research, China
| | - Jie Zhang
- Shandong University Center for Suicide Prevention Research, China; State University of New York Buffalo State, USA.
| | - Long Sun
- Shandong University Center for Suicide Prevention Research, China
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Sher L, Grunebaum MF, Burke AK, Chaudhury S, Mann JJ, Oquendo MA. Depressed Multiple-SuicideAttempters – A High-Risk Phenotype. CRISIS 2017; 38:367-375. [DOI: 10.1027/0227-5910/a000475] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abstract. Background: There is compelling evidence that suicide attempts are among the strongest predictors of suicide and future suicide attempts. Aim: This study aimed to examine psychopathology in multiple-suicide attempters. Method: We compared the demographic and clinical features of three groups: depressed patients without a history of suicide attempts (non-attempters), depressed patients with a history of one to three suicide attempts (attempters), and depressed patients with a history of four or more suicide attempts (multiple attempters). Results: We found that attempters and multiple attempters had higher levels of depression, hopelessness, aggression, hostility, and impulsivity and were more likely to have borderline personality disorder and family history of major depression or alcohol use disorder compared with non-attempters, but did not differ between each other on these measures. Multiple attempters had greater suicidal ideation at study entry and were more likely to have family history of suicide attempt compared with attempters. Importantly, multiple attempters had greater suicide intent at the time of the most medically serious suicide attempt and more serious medical consequences during their most medically serious suicide attempt compared with attempters. Limitations: The cross-sectional design of the study. Conclusion: Our data suggest that multiple-suicide attempters require careful evaluation as their behavior can have serious medical consequences.
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Affiliation(s)
- Leo Sher
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
- James J. Peters Veterans' Administration Medical Center and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael F. Grunebaum
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ainsley K. Burke
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Sadia Chaudhury
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - J. John Mann
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Maria A. Oquendo
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Brovelli S, Dorogi Y, Feiner AS, Golay P, Stiefel F, Bonsack C, Michaud L. Multicomponent Intervention for Patients Admitted to an Emergency Unit for Suicide Attempt: An Exploratory Study. Front Psychiatry 2017; 8:188. [PMID: 29021764 PMCID: PMC5623851 DOI: 10.3389/fpsyt.2017.00188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/14/2017] [Indexed: 11/13/2022] Open
Abstract
Suicide is a major cause of premature deaths worldwide and belongs to the top priority public health issues. While suicide attempt is the most important risk factor for completed suicide, intervention for suicide attempters (SA) have produced mixed results. Since an important proportion of SA request medical care, emergency units (EU) are an opportune setting to implement such interventions. This exploratory study evaluated the feasibility and acceptability of a multicomponent intervention for SA admitted to an EU. The intervention consisted of coordination by a case manager of a joint crisis plan (JCP), an early meeting with relatives and the existing care network, as well as phone contacts during 3 months after suicide attempt. Among 107 SA admitted to the emergency unit during the study period, 51 could not be included for logistical reason, 22 were excluded, and intervention was offered to 34. Of these, 15 refused the intervention, which was thus piloted with 19 SA. First-time attempters most frequently declined the intervention. Feasibility and acceptability of phone contacts and case manager were good, while JCPs and meetings were difficult to implement and perceived as less acceptable. Refusal pattern questions the global acceptability and is discussed: JCPs and meetings will have to be modified in order to improve their feasibility and acceptability, especially among first-time attempters.
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Affiliation(s)
- Sebastien Brovelli
- Service of Liaison Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Yves Dorogi
- Service of Liaison Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Adam-Scott Feiner
- Department of Emergency Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Philippe Golay
- Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Friedrich Stiefel
- Service of Liaison Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Charles Bonsack
- Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Laurent Michaud
- Service of Liaison Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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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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Abstract
Between 10 and 20 million people attempt suicide every year worldwide, and suicide attempts represent a major economic burden. Suicide attempters suffer from high rates of comorbidity, and comorbidity is the rule in suicide re-attempters. Comorbidity complicates treatment and prognosis and causes a more protracted course. In the present narrative review, we included these patterns of comorbidity: intra-Axis I disorders, intra-Axis II disorders, Axis I with Axis II disorders, and psychiatric with physical illnesses. We also briefly reviewed the patterns of comorbidity in suicide re-attempters. We concluded that comorbidity at different levels appears to be the rule in suicide attempters, particularly in those who re-attempt. However, several issues deserve further research regarding the patterns of comorbidity in suicide attempters.
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Blasco-Fontecilla H, Fernández-Fernández R, Colino L, Fajardo L, Perteguer-Barrio R, de Leon J. The Addictive Model of Self-Harming (Non-suicidal and Suicidal) Behavior. Front Psychiatry 2016; 7:8. [PMID: 26869941 PMCID: PMC4734209 DOI: 10.3389/fpsyt.2016.00008] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/14/2016] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Behavioral addictions such as gambling, sun-tanning, shopping, Internet use, work, exercise, or even love and sex are frequent, and share many characteristics and common neurobiological and genetic underpinnings with substance addictions (i.e., tolerance, withdrawal, and relapse). Recent literature suggests that both non-suicidal self-injury (NSSI) and suicidal behavior (SB) can also be conceptualized as addictions. The major aim of this mini review is to review the literature and explore the neurobiological and psychological mechanisms underlying the addiction to self-harming behaviors. METHOD This is a narrative review. The authors performed literature searches in PubMed and Google for suicidal behavior, self-harming, addiction, and "major repeaters." Given the scarce literature on the topic, a subset of the most closely related studies was selected. The authors also focused on three empirical studies testing the hypothesis that major repeaters (individuals with ≥5 lifetime suicide attempts) represent a distinctive suicidal phenotype and are the individuals at risk of developing an addiction to SB. RESULTS The authors reviewed the concept of behavioral addictions and major repeaters, current empirical evidence testing concerning whether or not NSSI and SB can be understood as "addictions," and the putative mechanisms underlying them. CONCLUSION Our review suggests that both NSSI and SB can be conceptualized as addictions. This is relevant because if some individual's self-harming behaviors are better conceptualized as an addiction, treatment approaches could be tailored to this addiction.
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Affiliation(s)
- Hilario Blasco-Fontecilla
- Department of Psychiatry, Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Puerta de Hierro University Hospital, Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain; Consulting Asistencial Sociosanitario (CAS), Madrid, Spain
| | - Roberto Fernández-Fernández
- Department of Psychiatry, Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Puerta de Hierro University Hospital , Madrid , Spain
| | - Laura Colino
- Department of Psychiatry, Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Puerta de Hierro University Hospital , Madrid , Spain
| | - Lourdes Fajardo
- Department of Psychiatry, Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Puerta de Hierro University Hospital , Madrid , Spain
| | - Rosa Perteguer-Barrio
- Department of Psychiatry, Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Puerta de Hierro University Hospital , Madrid , Spain
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital , Lexington, KY , USA
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Blasco-Fontecilla H, Baca-García E, Courtet P, García Nieto R, de Leon J. Horror Vacui: Emptiness Might Distinguish between Major Suicide Repeaters and Nonmajor Suicide Repeaters: A Pilot Study. PSYCHOTHERAPY AND PSYCHOSOMATICS 2015; 84:117-119. [PMID: 25720355 DOI: 10.1159/000369937] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 11/05/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Hilario Blasco-Fontecilla
- Department of Psychiatry, Puerta de Hierro University Hospital, IDIPHIM, CIBERSAM, Autonomous University of Madrid, Madrid, Spain
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