Combined PTSD and depressive symptoms interact with post-deployment social support to predict suicidal ideation in Operation Enduring Freedom and Operation Iraqi Freedom veterans

Rates of suicide are alarmingly high in military and veteran samples. Suicide rates are particularly elevated among those with post-traumatic stress disorder (PTSD) and depression, which share overlapping symptoms and frequently co-occur. Identifying and confirming factors that reduce, suicide risk among veterans with PTSD and depression is imperative. The proposed study evaluated, whether post-deployment social support moderated the influence of PTSD–depression symptoms on, suicidal ideation among Veterans returning from Iraq and Afghanistan using state of the art clinical, diagnostic interviews and self-report measures. Operations Enduring and Iraqi Freedom (OEF/OIF) Veterans (n=145) were invited to, participate in a study evaluating returning Veterans? experiences. As predicted, PTSD–depression, symptoms had almost no effect on suicidal ideation (SI) when post-deployment social support was high; however, when, post-deployment social support was low, PTSD–depression symptoms were positively associated with, SI. Thus, social support may be an important factor for clinicians to assess in the context of PTSD and, depressive symptoms. Future research is needed to prospectively examine the inter-relationship, between PTSD/depression and social support on suicidal risk, as well as whether interventions to, improve social support result in decreased suicidality.     

Method of assessment determines prevalence of suicidal ideation among patients with depression

BackgroundHow different ways of assessing suicidal ideation influence its prevalence, correlates and predictive validity among patients with major depressive disorder (MDD) remains unclear.MethodsWithin the Vantaa Primary Care Depression Study (PC-VDS, 91 patients) and the Vantaa Depression Study (VDS, 153 psychiatric out-and 41 inpatients), suicidal ideation was assessed with the Scale for Suicidal Ideation (SSI), Hamilton Depression Scale (HAM-D) item 3 and Beck Depression Inventory (BDI) item 9, and by asking whether patients had seriously considered suicide during the episode. The positive and negative predictive values (PPV, NPV) for suicide attempts during a six-month follow-up were investigated.ResultsDepending on the setting, 56–88% of patients had suicidal ideation in some of the assessments, but only 8–44% in all of them. Agreement ranged from negligible to moderate (kappa 0.06–0.64), being lowest among primary care patients. The correlates of suicidal ideation overlapped. No assessment had optimal sensitivity, specificity, PPV and NPV. Nevertheless, PPVs ranged up to 43%.ConclusionsWhich MDD patient is classified as having suicidal ideation depends strongly on the method of assessment, with the greatest variation likely in primary care. Differences in assessments may cause inconsistency in risk factors. Predicting suicide attempts is difficult, but not futile.     

中国北方城乡两地居民自杀意念、自杀未遂的调查

目的:了解中国北方城乡两地居民自杀意念、自杀未遂的发生率,以及性别之间、城乡之间的差异。方法:采用分层抽样的方法随机抽取北京市区10个居委会和河北武安农村10个村、年龄≥18岁人群共1 000人(城市和农村各500人),实际调查1 007人(城市503人,农村504人);采用自制"公众对自杀的态度问卷"对被试逐项进行调查。结果:被调查的1 007人中,有36人近1年出现过自杀意念,在性别、城乡之间差异无统计学意义(χ2=0.07,χ2=0.11;P均0.05);92人曾经有过自杀意念,在性别之间差异无统计学意义(χ2=0.11,P0.05),但农村显著多于城市(χ2=7.88,P0.05);有6人近1年出现过自杀未遂,18人曾经有过自杀未遂,在性别(χ2=0.72,χ2=0.27)、城乡之间(χ2=0.00,χ2=2.20)差异无统计学意义(P均0.05)。1 007人中有49人的亲属在过去任何时候有过自杀意念,城市显著多于农村(χ2=6.24,P0.05);20人的亲属有过自杀未遂,25人的亲属自杀死亡,城乡之间差异无统计学意义(χ2=0.82,χ2=0.38;P均0.05)。结论:中国北方城乡两地居民自杀意念、自杀未遂的发生率均相对较高,制定相应的自杀预防计划是亟待解决的问题。     

不同性别抑郁症患者自杀意念的相关危险因素比较

目的 研究抑郁症患者自杀意念相关因素的性别差异,为自杀的干预和预防提供更多的证据.方法 依据DSM-IV抑郁症诊断标准入组122例有自杀意念的抑郁症患者和129例无自杀意念的抑郁症患者,进行不同性别间各项目的比较分析.结果 男女抑郁症患者在婚姻、文化程度、职业、收入水平和生活事件、艾森克人格测验的内外倾向、神经质和掩饰性方面差异有统计学意义.结论 男性与女性抑郁症患者的自杀意念危险因素存在一定差异,健全的人格,积极的应对方式,良好的家庭环境,在自杀预防中有重要意义.     

Risk Factors for Suicidal Ideation among Patients with Complex Regional Pain Syndrome

Objective

Chronic pain frequently coexists with psychiatric symptoms in patients diagnosed with complex regional pain syndrome (CRPS). Previous studies have shown a relationship between CRPS and the risk of suicide. The purpose of this study was to assess risk factors for suicidal ideation in patients with CRPS.

Methods

Based on criteria established by the International Association for the Study of Pain, 39 patients diagnosed with CRPS Type 1 or Type 2 were enrolled in this study. Suicidal ideation was assessed using item 3 of the Hamilton Depression Rating Scale (HAMD), and symptoms of pain were evaluated using the short form of the McGill Pain Questionnaire (SF-MPQ). Psychiatric symptoms were assessed in using the Structured Clinical Interview for DSM-IV Disorders (SCID-I, SCID-II), the HAMD, the Hamilton Anxiety Rating Scale (HAMA), the Global Assessment of Functioning Scale (GAF), and the Pittsburgh Sleep Quality Index (PSQI).

Results

Twenty-nine patients (74.4%) were at high risk and 10 (25.6%) were at low risk for suicidal ideation. Risk factors significantly associated with suicidal ideation included depression (p=0.002), severity of pain (p=0.024), and low scores on the GAF (p=0.027). No significant correlations were found between suicidal ideation and anxiety or quality of sleep.

Conclusion

Significant risk factors for suicidal ideation in patients with CRPS include severity of pain, depressive symptoms, and decreased functioning. These results suggest that psychiatric evaluation and intervention should be included in the treatment of CRPS.     

Unique relations among anxiety sensitivity factors and anxiety,depression, and suicidal ideation

Anxiety sensitivity (AS) is composed of three lower-order dimensions, cognitive concerns, physical concerns, and social concerns. We examined the relations between AS dimensions using a more adequate assessment of subscales (ASI-3) than has previously been used, and measures of anxiety and mood disorders as well as suicidal ideation in a sample of 256 (M age = 37.10 years, SD = 16.40) treatment-seeking individuals using structural equation modeling. AS cognitive concerns was uniquely associated with generalized anxiety disorder (GAD), obsessive–compulsive disorder (OCD), major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and suicidal ideation. AS physical concerns was uniquely associated with OCD, social anxiety disorder (SAD), panic disorder (PD), and specific phobia. AS social concerns was uniquely associated with SAD, GAD, OCD, and MDD. These results highlight the importance of considering the lower-order AS dimensions when examining the relations between AS and psychopathology.     

Crise suicidaire et maladie d’Alzheimer débutante : intérêt d’une analyse neuropsychologique détaillée

IntroductionThe role of Alzheimer's disease as a risk factor for suicide is unclear. The aim of this study was to understand neuropsychological component of the suicidal crisis in Alzheimer's disease.MethodUsing an extensive neuropsychological battery, different aspects of cognitive inhibition were particularly examined: Access to relevant information (using the Reading with distraction task), suppression of no longer relevant information (Trail Making Test, Rule Shift Cards), and restraint of cognitive resources to relevant information (Stroop test, Hayling Sentence Completion test, Go/No-Go). One female Alzheimer depressed case was assessed before and after a suicide attempt.ResultsTen days after the patient's suicide attempt, dementia was still moderate with a MMSE score at 21/30 but with a worsening of executive functions (FAB at 8/18) in the context of depression and suicide. The Hamilton-Depression Rating Scale was at 24 (maximal score at 52), and the Cornell Scale for Depression was at 21 (maximal score at 38). Suicidal intent was moderate with a score of 9 on the Beck Suicide Intent Scale (maximal score at 25). The patient did not present a delirium, psychotic symptoms, or anosognosia. Her episodic memory was altered as shown by her semantic performance on verbal fluency (naming 12 animals in 120 seconds) and on lexical fluency (naming 8 words beginning with the letter P). Initially preserved, executive function declined during a suicidal crisis in a context of depression in Alzheimer's disease case. Neuropsychological testing confirmed a dysexecutive syndrome (FAS at 8/18), with an impairment in her conceptualization capacity (MCST) and a deficit in cognitive inhibition and its access (reading task in the presence of distractors), deletion (TMT) and restraint (Stroop, Go/No-Go, Hayling) functions. Computed tomography has shown no signs of intracranial expansive process.ConclusionAssessing predictors of suicide and means of completion in patients with dementia may help the development of interventions to reduce risk of suicide among the growing population of individuals with dementia. Because of Alzheimer's-related cognitive inhibition impairment, identification and intervention addressing the complex issues of depression, executive dysfunction and dementia may help clinicians to mitigate the risk of suicide in patients with Alzheimer's disease.     

Relationships between suicidal ideation and psychosocial factors among residents living in Nagano Prefecture of Japan

Objectives

Feeling ashamed for seeking help when distressed is known to be a critical factor promoting suicidal behaviors. The objective of this study was to examine the relationship between suicidal ideation and psychosocial factors, including worries or anxieties, having a person to confide in, feeling ashamed for seeking help when distressed, and K6 score.

Methods

Fourteen out of 77 municipalities from Nagano Prefecture participated in this questionnaire survey. Participants of both sexes over 20 years of age were randomly selected according to age distribution in each municipality. Association between suicidal ideation and sociodemographic and psychosocial factors, including “feeling ashamed for seeking help”, were determined by multiple logistic regression analysis.

Results

Among a total of 11,100 participants, 7394 (66.6 %) returned the questionnaire. 2147 participants responded properly to essential study parameters and were submitted to the final analyses. The adjusted odds ratio of suicidal ideation was 2.09 (95 % CI 1.49–2.94) among participants feeling ashamed for seeking help, compared to those not feeling ashamed. Although the rate of “no person to confide in” was 4.4 %, participants who responded with “no person to confide in” had significantly increased odds ratio of suicidal ideation compared with those who responded with “having a person to confide in” (OR 1.97, 95 % CI 1.12–3.47).

Conclusions

Our findings suggest a need for tailored intervention targeting individuals at risk by gatekeepers to encourage individuals at risk to overcome feeling ashamed for seeking help and to cultivate an appropriate person to confide in.