Hopelessness,depression, substance disorder,and suicidality

Abstract. Background: Most earlier studies of hopelessness as a risk factor for suicidal behavior were based on either clinical or restricted samples. Using a longitudinal study design with a community sample of more than 3,000 participants, we aimed to examine if hopelessness was a long-term predictor of suicidal behaviors. Methods: Using longitudinal data from the Baltimore Epidemiologic Catchment Area (ECA) Program, we assessed the association of hopelessness at baseline and incident suicidal behaviors in the 13-year follow-up period, adjusting for the presence of depression and substance use disorders. Suicide behaviors studied included completed suicide, self-reported attempted suicide, and suicide ideation. Results: Hopelessness was predictive of all three types of suicidal behaviors in the follow-up period, even after adjustment. Persons who expressed hopelessness in 1981 were 11.2 times as likely to have completed suicide over the 13-year follow-up interval (95% confidence interval [1.8, 69.1]). The association between suicidality and hopelessness was stronger and more stable than the association of suicidality with the presence of depression and substance use disorders. Conclusion: Hopelessness was an independent risk factor for completed suicide, suicide attempts, and suicidal ideation. Intervention strategies that lower hopelessness may be effective for suicide prevention.Dr. Kuo is currently with Medical and Health Research Association (MHRA) and National Development and Research Institute, Inc (NDRI), New York, NY, USA. Dr. Gallo is currently with the Department of Family Practice and Community Medicine, University of Pennsylvania, Philadelphia, PA, USA.     

Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review

Objective: Involvement of personality traits in susceptibility to suicidality has been the subject of research since the 1950s. Because of the diversity of conceptual and methodological approaches, the extent of their independent contribution has been difficult to establish. Here, we review conceptual background and empirical evidence investigating roles of traits in suicidal behaviors. Method: We selected original studies published in English in MEDLINE and PsycINFO databases, focusing on suicidal ideation, suicide attempts, or suicide completions, and using standardized personality measures. Results: Most studies focused on investigating risk for suicide attempts. Hopelessness, neuroticism, and extroversion hold the most promise in relation to risk screening across all three suicidal behaviors. More research is needed regarding aggression, impulsivity, anger, irritability, hostility, and anxiety. Conclusion: Selected personality traits may be useful markers of suicide risk. Future research needs to establish their contributions in relation to environmental and genetic variation in different gender, age, and ethnocultural groups.     

Suicide rate,prevalence of diagnosed depression and prevalence of working physicians in Hungary

Based on the well-known relationship between depression and suicide, we investigated the regional distribution of the suicide rate, rate of diagnosed depression and prevalence of working physicians in Hungary. A strong significant positive correlation was found between the rate of working physicians and rate of diagnosed depression, and both parameters showed a strong significant negative correlation with the suicide rate. The more physicians per 100,000 inhabitants, the better is the recognition of depression and the lower is the suicide rate in the given region. The rate of working doctors was significantly higher in the counties located in western Hungary, which may have a role in the lower suicide mortality in this area of the country.     

Prevention of late life suicide: When, where, why and how

Abstract Suicide in late life is discussed from the perspective of four guidelines derived from preventive medicine; preventive efforts (1) are beneficial in proportion both to the prevalence and severity of a disease, (2) must consider how the outcome might affect individuals and society as a whole, (3) should take into account biological, psychological and social dimensions, (4) can only be effective if important and 'alterable' risk factors are identified. Possible risk factors for late life suicide which may be altered include social isolation, stressful circumstances, and affective disorder. Primary prevention may involve outreach programs to decrease social isolation, secondary prevention may include education of primary care physicians, and tertiary prevention may, in patients with severe affective disorder, include hospitalization and aggressive somatic therapies.     

Timing of completed suicides among residents of Olmsted County,Minnesota, 1951–1985

Previous studies of suicide timing may have been biased by incomplete ascertainment of suicides and by delays between the suicidal act and subsequent death. Those potential biases were assessed and minimized in this population-based study by using the unique resources of the Rochester Epidemiology Project in Olmsted County, Minnesota. Using these more accurate data, we confirmed previous reports of no excess suicides on birthdays (± 3 days), or during 3 United States national holidays. While most prior reports found excess post-holiday suicides and suicide peaks on Mondays, those findings were not observed in Olmsted County. Because 93% of deaths occurred on the date of the suicidal act, using date of death instead of the actual date of suicide is sufficient for most research purposes.     

Seasonality of self-destructive behaviour: Seasonal variations in demographic and suicidal characteristics in Van,Turkey

Abstract

Objective. Seasonality is one of the most interesting but still elusive issue in suicide research. Linkages of seasonality in suicides to possible contributors such as gender, type of method used, and climatic factors have received attention in different cultures. We aimed at evaluating seasonal trends in suicidal behaviour according to demographic characteristics, reasons for self-destructive behaviour and means preferred in suicide. Methods. Our aim was to assess the seasonal variation in self-destructive behaviour in terms of completed and attempted suicides in a 3-year time period from 2008 to 2010 in Van, Turkey. A total of 1448 cases were registered over a 3-year time period in the city. Seasonal deviations in demographic characteristics, reasons for suicide, and methods of suicide were evaluated. Results. Seasonal distribution of both completed and attempted suicides by gender did not significantly deviate. On the other hand, we found a significant decline in self-destructive behaviours among those who were single and student in the spring. We found a peak in self-destructive behaviours in the autumn among Individuals who suffer from psychological problems. Conclusions. Subjects with psychological difficulties were more prone to commit suicide in autumn. Seasonal differences in methods of suicide used by suicidal subjects were not significant.     

The acquired capability for suicide: A comparison of suicide attempters,suicide ideators,and non‐suicidal controls

Background: The Interpersonal Theory of Suicide states that to make a serious or lethal suicide attempt, a person must experience reductions in fear and pain sensitivity sufficient to overcome self preservation reflexes (i.e., the acquired capability for suicide). The purpose of this study was to examine the fearlessness component of the acquired capability for suicide using self‐report assessment instruments and an objective measure of aversion (the affectively modulated startle reflex task). Methods: Depressed suicide ideators (n=15), depressed suicide attempters (n=15), and a group of control participants (n=14) were compared on their self‐report of acquired capability and painful and provocative life events, and completed the affectively modulated startle reflex task. This task compared electromyography recordings of participants' eye‐blink response to a startle probe while viewing pictures of varying hedonic valence (neutral, positive, negative, and suicide‐related). Results: Suicide attempters reported the highest levels of fearlessness and pain insensitivity and a greater history of painful and provocative life events. Although no group differences were found on the psychophysiology data, participants reacted to suicide‐related images with less aversion compared to neutral images with no differences between suicide‐related and positive images. Conclusions: Self‐reported fearlessness and pain insensitivity can differentiate suicide attempters and suicide ideators. Results suggest that one's self‐perception (i.e., cognitions regarding fear and pain tolerance) are more functionally related to suicide attempts than psychophysiological reactivity to suicide‐related stimuli. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Isolating the Association of Sleep,Depressive State,and Other Independent Indicators for Suicide Ideation in United States Teenagers

According to the Centers for Disease Control and Prevention, suicide is the second leading cause of death in American teenagers, and is a growing public health concern. This study uses multivariable logistic regression to investigate the independent relationship between suicide ideation and sleep duration in teenagers using the 2015 Youth Behavior Risk Surveillance Study, controlling for demographic, behavioral, and other factors found to be associated. Sleep durations of 4–5 hours and 6–7 hours per night were associated with approximately 75–80% and 20–40% increased adjusted odds of suicide ideation, as compared to teens sleeping the recommended 8 hours or more, and should be considered as a potential important indicator for adolescent suicidal ideation in primary-care screens.     

Suicide and attempted suicide reported by general practitioners in Belgium, 1990–1991

In 1990–1991 the Belgian sentinel network of general practitioners recorded suicide and suicide attempts within their practices. The annual attempted suicide rate is estimated at 13.0 cases per 10,000 inhabitants. The highest incidence rates are found among women and young people. The annual suicide rate is estimated at 2.3 cases per 10,000 inhabitants, with the highest rates in men and in elderly people. The highest incidence rates of suicide attempts as well as of suicide are found among divorced people. About 30% of the attempters and committers made at least one earlier attempt. Drug overdose and hanging are the most frequently used methods, respectively when attempting and committing suicide. About 60% of both committers and attempters contacted their general practitioner within a period of 1 month preceding the attempt. Nearly half of the attempters and of the committers were treated for a mental disorder in the year preceding the attempt.     

Political Beliefs,Region of Residence,and Openness to Firearm Means Safety Measures to Prevent Suicide

Firearms account for approximately half of all suicides in the United States and are highly lethal, widely available, and popular; thus, are an ideal candidate for targeted means safety interventions. However, despite their value as a suicide prevention tool, firearm means safety strategies are not widely utilized, possibly due to factors which impede openness to their use. This study examines the relationship between region, political beliefs, and openness to firearm means safety in a sample of 300 American firearm owners. Overall, firearm owners were more willing to engage in means safety for others than for themselves and to store firearms safely than temporarily remove them from the home. Social policy views and region were significantly associated with openness to firearm means safety measures, however, economic policy views were not. This study provides further context for the development and implementation of efficacious means safety measures capable of overcoming potential barriers to their use.     

Attempted-suicide trends in Stockholm County, Sweden, 1975-1985

A total of 22,961 admissions, representing 19,127 individuals, diagnosed as certain or undetermined attempted suicide were registered in the computer medical information system in Stockholm County for the study period 1975-1985. Two different statistical regression models were used to describe the trends of attempted suicide and undetermined attempted suicide. A simple linear ordinary least squares model generally performed better at describing the observed rates in sex- and age-specific rates of attempted suicide when the diagnosis of attempted suicide was certain. Significantly increasing attempted-suicide trends for men over 35 and women over 45 as well as for all ages pooled for both men and women were found. Undetermined attempted suicides were described better by a quadratic model than by the linear model. Women 35-44 and 65-85 years old and men 25-54 years old were found to have an increasing initial phase followed by a leveling out in the rates around 1980-1982, with weak evidence that the rate might even be slowly decreasing. Comparing earlier findings of decreasing rates in completed suicides for all ages, and findings in this study of increasing attempted-suicide trends during the same period, we believe that improved somatic and psychiatric treatment of attempted-suicide patients may partly account for the decreased rates of completed suicides.     

Suicide and attempted suicide in general practice, 1979-1986

Using data from the Continuous Morbidity Registration Sentinel Stations over the period 1979-1986, the authors tried to determine the incidence and the characteristics of patients in general practice who attempted or committed suicide. Almost half of the suicide attempts and suicides had contacted their general practitioner (GP) shortly before the suicidal act. A minority of these cases were recognized by the GP as having a high suicide risk. In almost 70% of the suicides and 58% of the suicide attempters the GPs reported the existence, currently or previously, of a depressive episode. About half of both the suicides and the suicide attempters had been treated or seen by mental health professionals or social workers. Given the fact that suicide and suicide attempt are relatively rare events in general practice, and given the fact that for the patients who contact their GP shortly before the suicidal act, it is not at all certain whether they present clearly recognizable signs of suicide risk at that time, the authors conclude that GPs cannot play an important role in the prevention of suicidal behaviour.     

Trends in suicide rates of the elderly in Austria, 1970-2004: an analysis of changes in terms of age groups, suicide methods and gender

BACKGROUND: Suicides of the elderly (persons aged 65 and older) make up a large proportion of total suicides. Since suicide rates of the elderly are highest in western populations, addressing them as a risk group in prevention plans has been recommended. In order to assess possible approaches to prevention strategies, this study examines high-risk groups of the elderly. METHODS: We examined official statistics on suicides that occurred in Austria between 1970-2004 (18,101 Suicides of the elderly). We analyzed time trends and differences in suicide methods as well as in age groups and both genders of the elderly. RESULTS: Three major high-risk groups were identified: elderly male suicides by firearms; elderly female suicides by poisoning, which occur more often with increasing age; and suicides of both genders by jumping from heights. CONCLUSION: Besides conducting treatment of psychiatric disorders of the elderly, restricting the means to commit suicide may help to prevent it among the elderly. Such specific prevention strategies should be implemented in national suicide prevention plans for the high-risk groups identified in this study.     

Suicide in the Canary Islands, 1977-1983.

We studied suicide in the Canary Islands between 1977 and 1983 and found 775 cases, twice the official number of 381. This indicates the lack of validity and reliability of official figures for suicide in Spain today. The figures reveal an upward trend in the Canary Islands, with the annual rate of 6.81 per 100,000 in 1977 having increased to 10.64 per 100,000 in 1983. There were no significant differences in the frequency of suicide according to season, month or day of the week.     

One-year prevalence of death thoughts,suicide ideation and behaviours in an elderly population

BACKGROUND: Suicidality is constituted by all those phenomena that are apparently positioned along a continuum, with the two extremes represented by death wishes and completed suicide. OBJECTIVES: The aim of this paper is to show the one-year prevalence of the phenomena constituting this possible continuum in the elderly population (aged 65 years and over) of a northern Italian city and to evaluate the relationship between some of these phenomena with psychological suffering. METHOD: Emotional feelings and suicidal thoughts have been investigated by an epidemiological survey conducted in a central quarter of that city. Data on attempted and completed suicide derived from the data bank of the Padua's WHO Collaborating Centre for Research and Training in Suicide Prevention that monitors these phenomena since 1989. RESULTS AND CONCLUSIONS: Results suggest the existence of some continuity in suicidal phenomena, where prevalence decreases from those of emotional/ideational nature to most extreme behaviour. Subjects presenting with more severe suicidal ideation were those also obtaining highest scores in a number of sub-scales of the Brief Symptom Inventory.     

Epilepsy and suicide: pathogenesis, risk factors, and prevention

Depression and suicide tendencies are common in chronic diseases, especially in epilepsy and diabetes. Suicide is one of the most important causes of death, and is usually underestimated. We have analyzed several studies that compare mortality as a result of suicide in epileptic patients and in the general population. All the studies show that epileptic patients have a stronger tendency toward suicide than healthy controls. Moreover it seems that some kinds of epilepsy have a higher risk for suicide (temporal-lobe epilepsy). Among the risk factors are surgery therapy (suicide tendency five times higher than patients in pharmacological therapy), absence of seizures for a long time, especially after being very frequent, and psychiatric comorbidity (major depression, anxiety-depression disorders, personality disorders, substance abuse, psychoses). The aim of the review was to analyze the relationship between suicide and epilepsy, to identify the major risk factors, and to analyze effective treatment options.     

Hopelessness,impulsiveness and intent among suicide attempters with major depression,alcohol dependence,or both

The present study examined differences in hopelessness, impulsiveness and suicide intent between suicide attempters with either major depression or alcohol dependence, comorbid major depression and alcohol dependence, and those without these disorders. A sample of 114 patients from consecutive cases of attempted suicide referred to a general hospital in Helsinki was interviewed and diagnosed according to DSM-III-R. Suicide intent was measured by the Beck Suicide Intent Scale (SIS) and hopelessness was assessed by the Beck Hopelessness Scale (HS). Impulsiveness of the suicide attempt was measured by two items of the SIS. Suicide attempters with major depression without comorbid alcohol dependence had higher suicide intent and lower impulsiveness than attempters with non-depressive alcohol dependence. Suicide attempts may differ between subjects with major depression, alcoholism or both disorders in terms of impulsiveness and suicide intent.     

Correlates of Nonsuicidal Self-Injury and Suicide Attempts Among Tertiary Care,Emergency Department Patients

Objective:

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the distinction between nonsuicidal self-injury (NSSI) and suicidal behaviour disorder is highlighted in the section Conditions for Further Study. Diagnostic criteria classify NSSI and suicidal behaviour disorder as distinct disorders, with the latter including suicide attempt (SA). This study examined the prevalence and correlates of NSSI in emergency department (ED) settings and compared them to SA.

Methods:

Data came from adult referrals to psychiatric services in 2 EDs between January 2009 and June 2011 (n = 5336). NSSI was compared with SA, as well as no suicidal behaviour, across a broad range of demographic and diagnostic correlates.

Results:

NSSI was more highly associated with female sex, childhood abuse, anxiety disorders, major depressive disorder (MDD), aggression and impulsivity, age under 45, and substance use disorders (SUDs), compared with presentations without suicidal behaviour. Comparing NSSI and SA, no differences were observed on sex, age, history of child abuse, or presence of anxiety or SUDs. Recent life stressors (OR 1.44; 95% CI 1.05 to 1.99), active suicidal ideation (OR 8.84; 95% CI 5.26 to 14.85), MDD (OR 3.05; 95% CI 2.23 to 4.17), previous psychiatric care or SA (OR 1.89; 95% CI 1.36 to 2.64), and single marital status (OR 1.63; 95% CI 1.20 to 2.22) contributed to a higher SA rate. Among people with NSSI, 83.7% presented only once to an ED. Among people who presented multiple times, only 18.2% re-presented with NSSI.

Conclusions:

NSSI is associated with early life adversity and psychiatric comorbidity. Most people present only once to ED services, and self-harm presentations seemed to change over time. Future studies should continue to clarify whether NSSI and SA have distinct risk profiles.