Early separation and suicidal behaviour in the parental homes of 40 consecutive suicide attempters

Forty suicide-attempt patients who were consecutively admitted to an intensive-care unit, their significant others and treatment personnel were investigated by semistructured interviews. The patients were divided into neurosis (n = 14), abuse (n = 19) and psychosis (n = 7) groups. Twenty-one of the patients (52%) had lost contact with one or both parents before the age of 18, in 25% of cases owing to death and in 27% because of the parents' divorce or separation. Parents and/or siblings of 19 patients (47%) had shown suicidal behaviour in the form of attempted suicide and/or suicide. Differences between the groups were not significant. Alcohol abuse in the parental home was overrepresented in the abuse group compared with the other groups. The role of identification with the dead and suicidal parent in prompting suicidal actions in adulthood is discussed, as well as that of the impeded evolution of stable external object relations owing to parental losses.     

Passive euthanasia in response to attempted suicide: one form of aggressiveness by relatives

A total of 88 interviews were conducted with 40 people attempting suicide who were receiving care in an intensive-care unit, and 129 interviews were carried out with their relatives and friends. The subjects were divided into 3 diagnostic groups: neurosis (n = 14), abuse (n = 19) and psychosis (n = 7). The incidence of relatives' failure to provide care after the suicide attempt--turning-away reactions as well as do not resuscitate orders, a form of passive euthanasia--was investigated. In 8 cases, partners of patients in the abuse and neurosis groups showed turning-away reactions. In 2 cases, relatives of elderly patients in the neurosis group said to the doctor that life-preserving measures should not be taken. Relatives explained their behaviour by saying that they had the best interests of the suicidal individual at heart. In-depth interviews, however, revealed that these reactions were a manifestation of the relatives own psychic conflicts, brought forth by the confrontation with the depressed and suicidal patient. Turning-away reactions and do not resuscitate orders might be interpreted as expressing the relatives' aggressiveness towards the suicidal individual and attempts to escape from a difficult situation. It is important that doctors stand up for the interests of suicidal people, which at times may conflict with relatives' interests, and help the relatives to sort out their problems and wishes with respect to the problem areas of passive euthanasia.     

A global view of suicidal behaviour

Suicidal behaviour is a major public health problem. There is no one explanatory theory of suicidal behaviour, and various combinations of sociological and biological/medical interventions are required to reduce associated mortality and morbidity. The importance of primary prevention varies from community to community, and may have an impact at the population level. However, individual suicidal persons always require optimum assessment and management and that is usually provided by primary care and emergency physicians. This paper provides an overview of issues to be addressed in the assessment and management of suicidal patients. See Commentary, page 8.     

Biological correlates of deliberate self-harm behaviour: a study of electroencephalographic,biochemical and psychological variables in parasuicide

Clinical, electroencephalographic and biochemical variables were measured in 40 patients who attempted suicide and 27 age-matched controls. Patients had significantly higher scores for depression, hopelessness, neuroticism and psychoticism and lower scores for extraversion than controls. They also had significantly lower contingent negative variation (CNV), higher postimperative negative variation and lower whole blood serotonin values than controls. Within the patient group, vulnerability to parasuicide, as determined by previous or repeated acts of deliberate self-harm, was associated with higher scores for hopelessness and suicide intent, lower scores for extraversion and decreased CNV. Factor analysis revealed significant correlations between psychological variables and auditory evoked potential amplitudes for the vulnerable group. A profile of variables associated with increased risk of self-harm in patients presenting with attempted suicide is proposed from our data.     

Attempted suicide in bipolar disorder pedigrees: evidence for linkage to 2p12.

BACKGROUND: We are interested in identifying susceptibility genes that predispose subjects to attempted suicide. METHODS: We conducted a secondary analysis of genome-wide linkage data from 162 bipolar pedigrees that incorporated attempted suicide as a clinical covariate. RESULTS: The strongest covariate-based linkage signal was seen on 2p12 at marker D2S1777. The logarithm of odds (LOD) score at marker D2S1777 rose from 1.56 to 3.82 after inclusion of the suicide covariate, resulting in significant chromosome-wide empirically derived p-values for the overall linkage finding (p = .01) and for the change in LOD score after the inclusion of the covariate (p = .02). CONCLUSIONS: The finding on chromosome 2 replicates results from two previous studies of attempted suicide in pedigrees with alcohol dependence and in pedigrees with recurrent early-onset depression. Combined, these three studies provide compelling evidence for a locus influencing attempted suicide on 2p12.     

Prevalence and predictors of parasuicide in chronic psychosis. UK700 group

OBJECTIVE: This study estimates the prevalence of and risk factors for parasuicide in a large community-based sample of patients with chronic psychosis. METHOD: A total of 704 subjects with chronic psychosis were interviewed using a battery of instruments. The 2-year prevalence of parasuicide was estimated and a comparison was made between attempters and nonattempters on a wide range of sociodemographic and clinical variables. RESULTS: The 2-year prevalence of parasuicide was 18.8%. Attempters were significantly more likely to be younger, of white ethnic origin, to have a diagnosis of affective disorder, to be currently depressed, to have experienced more auditory hallucinations and to have received treatment with antipsychotic drugs for a longer period. CONCLUSION: Parasuicide was found to present a considerable clinical problem in this group. Continual risk assessment is essential to reduce this unacceptably high rate.     

COMT基因多态性与自杀未遂关系研究

目的 探讨儿茶酚胺氧位甲基转移酶(COMT)基因多态性与自杀未遂的相关性，并了解影响COMT Val／Val型自杀未遂者的相关因素。方法 从山东省7个市、县级综合医院中收集2003年一年内自杀未遂者共220例，分别调查其一般信息和抽取1ml肘静脉血；采用聚合酶链反应(PCR)和限制性片段长度多态性(RFLP)分析方法，检测COMT基因多态性。采用病例一病例研究分析COMT Val／Val型与其他因素的相关性。结果 自杀未遂者中女性：男性=1，23：1，年龄均集中于20岁到49岁(70．1％)，多集中小学及以下(60．9％)，睡眠与以前有变化(占60．0％)，多为抑郁(69，5％)和多有情感冲突(81．0％)。自杀未遂者中COMT基因型以Val／Met为主(54．5％)，Met／Met仅占0．3％。只发现自杀未遂者中精神障碍与COMT Val／Val型具有相关关系(χ^2=6．110，P=0．013)。结论 自杀未遂者中女性与年轻人、文化程度低、具有睡眠问题、抑郁和情感冲突所占比例较高；自杀未遂者中存在COMT基因多态性与精神障碍的相互作用。     

Suicidal behaviour in HIV infection: A case-control study of deliberate self-harm in people with HIV infection

A group of 22 individuals with HIV infection who had made acts of self-harm were compared with a sex and age-matched control group of individuals without known HIV infection who had also being involved in acts of deliberate self-harm (DSH). Compared with all DSH individuals referred to the deliberate self-harm service during the same period. men were over-represented amongst HIV subjects. Compared with matched controls, HIV subjects were more likely to include gay/bisexual men, and not be employed. Individuals with HIV infection were more likely to be receiving outpatient psychiatric care at the time of DSH. and to have received it in the past A diagnosis of depression was given mom frequently to HIV subjects, while alcohol misuses was more often diagnosed in controls. Concerns about their physical health were prominent amongst HIV seropositives. Psychiatric follow-up was offered to HIV subjects more often than to controls. The results indicate that HIV disease is a potential contributing factor to deliberate self-harm. and highlight the need for efforts to identify individuals with HIV infection at risk of deliberate self-harm, ant to develop effective interventions to prevent suicidal behaviour in this group of individuals.