首次自杀未遂者和重复自杀未遂者的对照研究

目的探讨首次自杀未遂者和重复自杀未遂者的区别.方法检查126名因自杀未遂而入院的患者,分为首次自杀未遂组和重复自杀未遂组,获得有关的临床资料并进行自杀意图及自杀企图冲动性和致死性的测定,将有关项目作对比分析.结果有51(40.5%)名重复自杀未遂者,与首次自杀未遂者比较,重复自杀未遂者已婚居多、文化程度较低、缺乏固定的经济收入、有较多的既往精神科治疗史、常饮酒、企图自杀前与他人交流少,自杀意图较低,冲动性较高(P均＜0.05).结论对伴有某些危险因素的自杀未遂者应积极进行医学干预,以期减少自杀行为的再次发生.     

Clinical predictors of suicidal acts after major depression in bipolar disorder: a prospective study

Objective:  This study determined the clinical predictors of suicidal behavior during a 2-year follow-up of patients with bipolar disorder presenting with a major depressive episode (MDE).
Method:  Sixty four patients with DSM-III-R bipolar disorder were assessed at presentation for treatment of an MDE. Correlates of past suicidal behavior were determined by comparing patients with and without a history of suicide attempts using a t -test, Wilcoxon test or chi-squared test of independence on individual explanatory variables. Putative predictors of attempts during the follow-up period were tested separately using Cox proportional hazards regression analysis.
Results:  Twelve of 64 patients had at least one suicide attempt in the follow-up period, five of them attempted in the first 2 months and seven around or shortly after the 1-year follow-up visit. All attempters had a history of past suicide attempts. Most predictors of future suicidal behavior were correlates of past suicidal behavior. Family history of suicide acts and comorbid borderline personality disorder predicted early attempts, while younger age, high hostility scores, number of past attempts, subjective pessimism as reflected in depression and suicidal ideation, and few reported reasons for living predicted suicidal acts during the whole period.
Conclusion:  In this data set of bipolar patients we noted an intriguing picture of two clusters of suicide attempts. Hostility was the strongest risk factor. These findings may have implications in both the identification of at-risk patients and the timing of clinical interventions including aggressive pharmacotherapeutic prophylaxis to prevent relapse or recurrence of depressive symptomatology.     

Depression Scale (DEPS) among suicide attempters

The Depression Scale (DEPS), a new screening instrument for detecting depression in primary health care, was compared with the Hamilton Depression Scale (HDS) among 50 suicide attempters. Using the HDS as a gold standard, the positive and negative predictive values of the DEPS for the diagnosis of depression were 98% and 20%, respectively. The correlation between the total HDS scores and the total DEPS scores was 0.60. The DEPS may help general practitioners to detect depression among suicide attempters, but it should not be used to exclude depression.     

Adolescents who make suicide attempts repeatedly

Four hundred and six consecutive suicide attempts made by 15-19 year-old adolescents in 1973-1982 were examined. Two hundred and twenty-six cases were first, 180 repeated suicide attempts. Repeaters came from poorer social situations and less well integrated families than first-timers. Repeaters had many adapting problems typical of personality disorders and had previously been in psychiatric treatment. Their level of adaptive functioning (GAS) and overall functioning (DSM III: s axis V) were poorer than within first-timers. They were not psychotic more often than first-timers and did not make more difficult suicide attempts. Their psychiatric after-care was more intensive and prognosis with regard to subsequent suicide was poorer than within first-timers. At the end of follow-up time (approx. 5 years) 1% of first-timers and 4% of repeaters had committed suicide. Observed-expected ratio for first-timers was 0.58 and for repeaters 1.73.     

Santé mentale des adolescents selon leur attirance sexuelle : enquête en milieu scolaire

IntroductionAlthough homosexuality is a subject often addressed by the media, little is said about homosexuality in adolescents who are particularly affected by the question of sexual orientation. This work aims to study the mental health of adolescents who report being exclusively attracted to members of the same sex. We explore the evidence for an association between homosexuality and depression, suicide attempts, and consulting a psychiatrist or a psychologist.MethodsWe used data from the cross-sectional study “Adolescent Portraits – A Multicenter Epidemiological Survey in Schools in 2013” (CHU Fondation Vallée, Inserm CESP U1018). Data were gathered through the use of an anonymous, self-administered questionnaire (348 questions) given to students between the “4^e” and “terminale school” years (comparable to the 8th and 12th grade in the U.S. education system) in three contrasting French geographical areas. The risk of depression was measured using the Adolescent Depression Rating Scale (ADRS).ResultsThe results reflect the survey responses provided by 15,235 young people. Of these, 1.5 % reported only being attracted to members of the same sex (homosexual group). This group contained twice as many girls as boys. Students who did not report sexual attraction, who reported bisexual attraction, or who did not answer the question were excluded from the results (830 students). In the homosexual group, 24 % presented with depression versus 11.5 % of those attracted exclusively to members of the opposite sex (heterosexual group). There is also a significant difference between sexes: 13.2 % of boys in the homosexual group were depressed compared to 29.3 % of girls in the same group; 6.7 % of boys in the heterosexual group reported being depressed versus 16.1 % of girls in the same group. In the heterosexual group, 10.7 % of respondents reported having already made at least one suicide attempt versus 20.7 % of those in the homosexual group. There was a difference according to sex, since 6.3 % of boys in the heterosexual group had a history of attempted suicide versus 14.9 % of girls in the same group. This gap disappeared completely within the homosexual group, as 21.4 % of boys and 20.4 % of girls had already made at least one suicide attempt at the time of the survey. Depressed adolescents in the homosexual group also reported a higher number of previous suicide attempts than those in the heterosexual group (46.9 % versus 31.6 %). In terms of sex, 25.3 % of depressed boys in the heterosexual group made at least one suicide attempt versus 34.1 % of girls. In the homosexual group, 44.4 % of depressed boys reported having made at least one suicide attempt versus 47.5 % of depressed girls. Adolescents in the homosexual group were significantly more likely to report having consulted a psychiatrist or psychologist than those in the heterosexual group (14.6 % versus 6.5 %), regardless of sex (16.7 % versus 4.7 % for boys; 13.5 % versus 8.2 % for girls). This difference was also found among depressed subjects (26.0 % in the homosexual group versus 15.4 % in the heterosexual group). Sexual activity (having already had sex) was higher in the homosexual group than in the heterosexual group (53.7 % versus 37.5 %), and this difference remained significant after adjusting for age. Fifty percent of the sexually active homosexual respondents reported having engaged in sexual activity of a homosexual nature versus 0.7 % of sexually active heterosexual respondents. In the homosexual group, mental suffering appeared to be more severe among sexually active subjects, in terms of dark thoughts (64 % versus 46 %) and a prior history of attempted suicide (29.3 % versus 10 %), but not in terms of depression (27.9 % versus 18.9 %; NS).ConclusionYoung people who reported being exclusively attracted to members of the same sex presented a higher level of mental distress compared to those who reported being attracted to members of the opposite sex. This was especially the case for boys. These findings led to the identification of risk and protective factors that can inform the development of appropriate preventive measures.     

Association of deferring a quit attempt with smoking cessation success: A secondary analysis

Several smoking cessation treatments ask smokers to wait to quit to obtain treatment. We report a secondary analysis of whether a later quit attempt is associated with less success. In a placebo-controlled trial of varenicline that allowed smokers to set their quit date within 5 weeks after starting medication, 24% had their first quit attempt during week 1, and 27%, 19%, 18% and 12% in subsequent weeks. Continuous abstinence between 9 and 24 weeks declined over time; that is, from 36% to 37%, 35%, 29%, and 18% across the 5 weeks (p < 0.001). The only statistically significant difference was between the last week and prior weeks. Whether a later quit attempt actually causes less success or is a marker for other variables (e.g., low motivation) is unclear.     

Improving Understanding of the Quitting Process: Psychological Predictors of Quit Attempts Versus Smoking Cessation Maintenance among College Students

This study examined motivation, positive and negative outcome expectations of quitting, and self-efficacy as predictors of quit attempts and cessation maintenance in a smoking cessation intervention for college students (N = 303). Psychological measures assessed at baseline were used to predict smoking behavior outcomes. Analysis of variance (ANOVA) and logistic regression analysis revealed that motivation and self-efficacy were strong, differential predictors of quit attempts and cessation maintenance, respectively. This study extends the previous findings regarding psychological predictors of quitting processes to college students, and suggests the need for interventions tailored according to phases of quitting processes.     

Feelings,thoughts and experiences of nurses working in a mental health clinic about individuals with suicidal behaviors and suicide attempts

Background

It is of the utmost importance to determine the views of nurses about patients with suicidal behavior and who attempt suicide so that they can help such individuals.