银杏内酯 K 通过 PI3K/Akt/mTOR 通路促进 血管生成改善缺血性卒中

目的 描述综合医院具有自杀倾向患者的特征,并分析此类患者发生自杀行为的危险因 素。方法 回顾性连续纳入南方医科大学南方医院 2012 年 10 月至 2017 年 10 月的住院患者中具有自杀 倾向的病例共 680 例,根据是否发生自杀行为分为自杀倾向组（有自杀倾向无自杀行为,527 例）和自杀 行为组（有自杀倾向亦有自杀行为,153 例）。收集他们的性别、年龄、婚姻状况、户籍、入院科室、自杀诱 因、自杀方式、精神疾患、躯体疾患及显著的精神症状等资料。采用单因素分析比较两组间的社会人口 学和临床特征差异,采用二分类 Logistic 回归分析研究自杀行为的危险因素。结果 自杀倾向组主要为 女性［66.6%（351例）］、已婚［77.4%（458例）］、心理科［74.4%（392例）］、抑郁症［66.2%（349例）］。自杀行为 组中,男性和女性的自杀方式差异有统计学意义（χ2 =12.489,P=0.014）,选择跳楼方式的男性较多,药物 及割脉方式的女性更多。Logistic回归分析结果表明,入住重症医学科（OR=7.844,95%CI：2.240～27.475, P=0.001）、婚恋受挫（OR=3.646,95%CI：1.217～10.917,P=0.021）,肿瘤（OR=4.620,95%CI：1.552～13.755, P=0.006）,双相情感障碍（OR=3.734,95%CI：1.157～12.052,P=0.028）是自杀行为的危险因素。结论 具 有自杀倾向的患者中,入住重症医学科、双相情感障碍、肿瘤、婚恋挫折是发生自杀行为的危险因素,而 且两性的自杀方式有所不同,需要临床高度重视,并采取针对性预防措施。     

住院成年早期双相情感障碍患者自杀相关因素研究

目的 探索分析成年早期双相情感障碍住院患者自杀行为的相关因素。方法 选取 2018 年 1— 12 月在首都医科大学附属北京安定医院住院的 521 例成年早期（18～25 岁）双相情感障碍 患者为研究对象,按照是否曾有过自杀,分为自杀组（n=140）与无自杀组（n=381）,比较两组患者的 一般资料及疾病亚型。通过二分类 Logistic 回归分析探讨成年早期双相情感障碍患者自杀危险因素。 结果 与无自杀组比较,自杀组女性［70.0%（98/140）比 47.8%（182/381）］、冲动性格者［29.3%（41/140） 比 19.2%（73/381）］、有重大精神创伤史者［14.3%（20/140）比 4.5%（17/381）］占比更高,差异均有统计 学意义（χ2 =20.350、6.141、16.941;P＜ 0.05）。二分类 Logistic 回归分析显示,女性［OR=0.375,95%CI （0.226～0.564）,P＜ 0.001］、冲动性格［OR=0.603,95%CI（0.377～0.963）,P=0.034］、有重大精神创伤史 ［OR=0.295,95%CI（0.144～0.604）,P=0.001］是成年早期双相情感障碍患者发生自杀的独立危险因素。 结论 女性、性格冲动、有重大精神创伤史的成年早期双相情感障碍患者发生自杀的风险更高。     

重庆市大学生自杀未遂及相关因素分析

目的了解重庆市大学生自杀未遂的特征、发生率及其危险因素。方法采用北京回龙观医院北京心理危机研究与干预中心提供的《自杀态度与心理健康状况问卷(大学版-Ⅳ)》在重庆市随机抽取的11所大学中调查了9808名大学生,了解自杀未遂发生情况及相关因素,并通过多因素logistic模型分析其危险因素。结果大学生自杀未遂报告率为1.7%(169/9808),男女性别构成比为1∶1.8;多因素logistic回归分析显示,其危险因素排列为:近一年感到绝望的频率高(OR=4.2,95%CI:3.1～5.9)、一级亲属有过自杀行为(OR=2.8,95%CI:1.7～4.7)、认识的人有过自杀行为(OR=2.8,95%CI:2.1～3.9)、已发生性行为(OR=2.7,95%CI:1.9～3.9)、近1个月心理问题对学习及日常生活的影响(OR=2.5,95%CI:1.8～3.6)、女性(OR=2.5,95%CI:1.8～3.5)、其他血缘关系亲属有自杀行为(OR=2.4,95%CI:1.6～3.4),P值均小于0.001。结论大学生自杀现象并不罕见,应在高校制定和执行有针对性的自杀预防计划。     

误诊为抑郁症的双相障碍Ⅱ型患者自杀风险的危险因素分析

目的探讨误诊为抑郁症的双相障碍Ⅱ型患者自杀风险的社会人口学及临床特征方面的危险因素。方法通过简明国际神经精神访谈(the Mini International Neuropsychiatric Interview,MINI)5.0中文版,对来自全国13个中心的1478例最初诊断为抑郁症的患者进行重新诊断,其中190例被诊断为双相障碍Ⅱ型,将这190例误诊患者按照有无自杀风险进行分组,从性别、年龄等社会人口学资料及起病年龄、是否伴有自杀观念等临床特征方面探讨被误诊患者自杀风险可能的危险因素。结果有自杀风险组共74例患者,无自杀风险组共116例。有自杀风险组与无自杀风险组相比,年龄更小[(34.45±11.18)vs.(37.23±13.22)],起病年龄更早[(26.20±9.16)vs.(30.37±11.59)],更常伴有自杀观念(82.4%vs.53.4%),差异均具有统计学意义(P<0.05)。Logistic回归分析显示,年龄(OR=0.969,95%CI:0.945~0.993)、伴有自杀观念(OR=4.129,95%CI:2.030~8.397)与误诊为抑郁症的双相障碍Ⅱ型患者发生自杀风险相关联(均P<0.05)。结论年龄小、伴有自杀观念可能是误诊为抑郁症的双相障碍Ⅱ型患者自杀风险的独立危险因素。     

伴精神病性症状的双相障碍患者自杀未遂的危险因素分析

目的:探讨伴有精神病性症状的双相障碍(BD)患者自杀未遂的危险因素。方法:对2010~2011年"中国BD患者诊断评估服务"项目的数据进行二次分析;对306例BD患者中伴有精神病性症状的99例(32.4%)患者应用简明国际神经精神访谈(MINI)中自杀模块分为自杀未遂组和对照组,比较两组的人口学及临床资料,Logistic回归分析伴有精神病性症状的BD患者自杀未遂的危险因素。结果:分别有36例(36.5%)及63例患者入自杀未遂组和对照组;自杀未遂组年龄明显高于对照组(t=-2.37,P=0.020);发作频繁(χ~2=8.526)、伴有不典型特征(χ~2=6.673)、有自杀观念(χ~2=6.314)、有季节性特征(χ~2=4.956)及有精神障碍家族史(χ~2=6.189)比率明显高于对照组(P0.05或P0.01)。Logistic回归分析显示,年龄及自杀观念与伴有精神病性症状BD患者的自杀未遂相关(OR=1.055,P=0.008,95%CI:1.014~1.098;OR=4.467,P=0.002,95%CI:1.750~11.403)。结论:年龄大及有自杀观念是伴有精神病性症状BD患者自杀未遂的主要危险因素。     

社区精神分裂症患者自杀行为的危险因素分析

目的:探讨社区精神分裂症患者自杀行为的相关危险因素。方法:通过自制调查问卷对成都市青羊区358例登记在册的精神分裂症患者进行调查。根据患者既往是否有自杀行为,分为有自杀行为组和无自杀行为组。采用单因素分析、多因素Logistic回归分析,探讨社区精神分裂症患者自杀行为相关的危险因素。结果:社区精神分裂症患者中发生过自杀行为的占23.5%;有幻觉及妄想(OR=1.857,P0.05)、服药不依从(OR=2.320,P0.01)、照护者对疾病知识完全不了解(OR=2.816,P0.05)是患者发生自杀行为的危险因素。结论:社区精神分裂症患者自杀风险高,患者有幻觉妄想症状及治疗不依从、患者照料者对该病不了解是患者自杀行为的危险因素。     

山东农村居民自杀意念的发生率及其危险因素研究

目的 了解农村居民自杀意念的发生率及其危险因素,为自杀干预提供依据.方法 采用包括一般健康状况问卷、冲动性和攻击性量表、社会支持量表、家庭亲密度与适应性量表等对山东滕州市东郭镇19个村≥15岁的5039例农村居民进行自杀意念及其相关因素的调查,以多因素logistic模型分析自杀意念的危险因素.结果 在农村居民中,9.33%(470/5039)在过去任何时候有过自杀意念(95%CI:8.52%～10.13%),5.39%(299/5039,95%CI:5.28%～6.59%)近1年有过自杀意念.近1年自杀意念的危险因素排列为:近1年慢性压力大(OR=5.61,95%CI:4.04～7.78),攻击性高(OR=2.54,95%CI:1.93～3.35),非现婚状态(OR=2.04,95%CI:1.52～2.76),生命质量低(OR=1.86,95%CI:1.40～2.48),女性(OR=1.76,95%CI:1.34～2.32),自我感觉经济状况差(OR=1.70,95%CI:1.29～2.25),认识的人中有自杀(OR=1.53,95%CI:1.17～1.99),家庭亲密度低(OR=1.38,95%CI:1.06～1.80).结论 农村居民自杀意念发生率处于较高水平.慢性压力大、攻击性高、非现婚状态是近1年自杀意念最主要的危险因素.应根据其危险因素制订有针对性的干预计划.     

未治疗抑郁障碍患者自杀风险与认知情绪调节策略的关系

目的探讨具有自杀风险的抑郁障碍患者在认知情绪调节策略方面的特征及其影响因素,以早期识别具有自杀风险的患者,有针对性地给予干预。方法选取117例来自北京回龙观医院门诊、经简明国际神经精神访谈(MINI)5. 0中文版筛查符合抑郁障碍诊断标准的未治疗抑郁障碍患者,根据MINI 5. 0中文版自杀模块的访谈结果,将患者分为自杀风险组(n=52)和无自杀风险组(n=65)。采用认知情绪调节问卷(CERQ-C)进行认知调节策略的测评,采用汉密尔顿抑郁量表17项版(HAMD-17)评定抑郁症状的严重程度。结果抑郁障碍患者自杀风险发生率为44. 4%(52/117)。与无自杀风险组相比,自杀风险组患者更多见于女性、未婚、平均年龄更小、发病年龄更早、HAMD-17总评分更高、伴精神病性症状率较高,自杀风险组自我责难、接受、沉思、灾难化4个认知调节策略维度及消极认知情绪调节评分均高于无自杀风险组(P均<0. 05)。Logistic回归分析显示,女性(OR=3. 539,95%CI:1. 383~9. 057)、发病年龄(OR=0. 931,95%CI:0. 895~0. 968)、HAMD-17总评分(OR=1. 207,95%CI:1. 063~1. 370)和灾难化(OR=1. 143,95%CI:1. 002~1. 305)与抑郁障碍患者自杀风险相关(P均<0. 05)。结论女性、发病年龄早、抑郁症状严重和灾难化可能为未治疗抑郁障碍患者自杀风险的危险因素。     

残留症状对缓解期双相情感障碍患者心理社会功能的影响

目的探讨残留症状对缓解期双相情感障碍患者心理社会功能的影响。方法采用横断面研究,选取2019年11月至2020年12月就诊于河北医科大学第一医院门诊的81例纳入符合ICD-10诊断的缓解期双相情感障碍患者,对其进行人口统计学调查,采用24项汉密尔顿抑郁量表(HAMD)、轻躁狂量表(HCL-32)、汉密尔顿焦虑量表(HAMA)测量双相情感障碍患者的残留情绪症状,采用霍普金斯词汇学习测验-修订版(HVLT-R)、简易视觉空间记忆测验-修订版(BVMT-R)、连线测试A(TMT-A)部分实验、数字广度测试评估残留的认知症状,使用功能大体评定量表(GAF)评估心理社会功能。根据功能大体评定量表评分将患者分为GAF=9组(27例)和GAF<9组(54例)。采用SPSS 22.0统计软件对数据进行分析。结果GAF<9组的女性[40.7%(22/54)]明显多于GAF=9组[33.3%(9/27)],受教育年限[12.00(9.00,13.00)年]明显少于GAF<9组[16.00(12.00,16.00)年],无职业者[40.7%(22/54)]明显多于GAF=9组[18.5%(5/27)],抗精神病药物使用剂量[(10.48±5.40)mg]明显高于GAF=9组[(7.99±5.65)mg],HAMD评分[6.00(3.75,10.00)分]明显高于GAF=9组[3.00(0,6.00)分],BVMT-RT1评分[4.00(1.00,8.00)分]明显低于GAF=9组[6.00(3.00,10.00)分],BVMT-RDR评分[7.50(3.00,11.25)分]明显低于GAF=9组[11.00(8.00,12.00)分],DST评分[14.00(12.00,16.00)分]低于GAF=9组[15.00(13.00,18.00)分]。两组患者的性别、受教育年限、婚姻、职业、吸烟、饮酒、既往史、心境稳定剂、抗抑郁药、苯二氮䓬类药物的使用、HAMD评分、DST评分、BVMT-RT1评分、BVMT-RDR评分比较,差异均有统计学意义(P<0.05)。双相情感障碍患者缓解期的整体功能与受教育年限(r=-0.34,95%CI:-0.53~-0.12,P<0.01)、HAMD评分(r=0.37,95%CI:0.16~0.56,P<0.01)、BVMT-RT1评分(r=-0.23,95%CI:-0.41~-0.02,P=0.04)、BVMT-RDR评分(r=-0.24,95%CI:-0.45~-0.02,P=0.03)、数字广度测验总分(r=-0.23,95%CI:-0.42~-0.01,P=0.04)、抗精神病药物(r=0.23,95%CI:0.02~0.44,P=0.04)之间存在显著的相关性。缓解期的双相情感障碍患者残留抑郁症状(χ^(2)=5.33,OR=1.58,95%CI:1.07~2.33,P=0.02)、使用抗精神药物(χ^(2)=4.77,OR=1.37,95%CI:1.03~1.82,P=0.03)是其心理社会功能损害的危险因素;受教育年限长是其保持良好心理社会功能的保护因素(χ^(2)=5.31,OR=0.34,95%CI:0.14~0.85,P=0.02)。结论缓解期双相情感障碍患者心理社会功能的损害危险因素包括残留抑郁症状、使用抗精神病药物,保护因素包括受教育年限长。     

女性双相情感障碍住院患者高自杀风险的相关因素 分析

目的 分析女性双相情感障碍（BD）住院患者高自杀风险的相关因素。方法 收集 2010 年 4 月至 2019 年 6 月首都医科大学附属北京安定医院 378 例女性 BD 住院患者的病历资料。根据患者 自杀风险,分为低自杀风险组（n=220）和高自杀风险组（n=158）。比较两组患者的一般人口学资料及 临床特征差异,采用二项 Logistic 回归分析女性 BD 住院患者高自杀风险的相关因素。结果 与低自 杀风险组相比,高自杀风险组患者的本次住院天数少、首发年龄及首次抑郁发作年龄小、总发作次 数及抑郁发作次数多、躁狂发作次数少、首发症状为抑郁者和双相Ⅱ型障碍者（BD-Ⅱ）比例高、有精 神病性症状者比例少,差异均有统计学意义（均P＜ 0.05）。二项Logistic回归分析显示,抑郁发作次数 （OR=1.56,95%CI=1.32～1.83）、BD类型（OR=2.30,95%CI=1.16～4.58）以及是否伴精神病性症状（OR=0.56, 95%CI=0.35～0.90）是女性 BD 患者高自杀风险的相关因素（P＜ 0.05）。结论 抑郁发作次数频繁、 BD-Ⅱ、不伴精神病性症状是影响女性 BD 患者高自杀风险的因素。     

Anxiety disorders in suicidal youth.

OBJECTIVE: To test the hypothesis that anxiety disorders are associated with suicidal ideation and suicide attempts in a child and adolescent sample referred to a clinic. METHOD: The sample comprised 1979 patients aged 5 to 19 years who were assessed using the Schedule for Affective Disorders and Schizophrenia for School Aged Children--Present Episode (K-SADS-P) at an outpatient mood and anxiety disorders clinic. Subjects were stratified by age and categorized into mutually exclusive groups as being nonsuicidal (n = 817), having suicidal ideation (n = 768), or having attempted suicide (n = 394) in the current episode. Psychiatric diagnoses based on DSM-IV criteria were compared to determine if anxiety disorders were a risk factor for suicidal ideation and suicide attempts. Logistic regression was used to control for significant demographic characteristics and comorbid disorders. RESULTS: After stratifying by age, we found no differences across the 3 groups (ideators, attempters, and nonsuicidal youth) in rates of an anxiety disorder in general or in specific rates of panic disorder, agoraphobia, social phobia, simple phobia, and obsessive-compulsive disorder. Two salient findings involving anxiety disorders were noted with regression analysis. In younger children (age < or = 15 years), attempters had a significantly lower prevalence of separation anxiety disorder (SAD), compared with ideators (OR = 0.30; 95%CI, 0.11 to 0.80; P = 0.006) and nonsuicidal youngsters (OR = 0.14; 95%CI, 0.05 to 0.39; P < 0.0001). In older children (age > 15 years), generalized anxiety disorder (GAD) was more prevalent in ideators (OR = 1.65; 95%CI, 1.03 to 2.66; P = 0.03) than in nonsuicidal patients. CONCLUSIONS: Based on this clinical sample, the relation between pediatric anxiety disorder and suicidal ideation and suicide attempts is not straightforward. However, further studies in nonreferred samples are warranted.     

DRD4 receptor gene exon III polymorphism in inpatient suicidal adolescents

Summary. Some studies have suggested possible association of the dopamine receptor subtype 4 (DRD4) gene exon III 48bp repeat polymorphism with novelty seeking behavior. As suicidal behavior in adolescents is linked to risk taking behavior, we evaluated the association of suicidality with DRD4 polymorphism in Israeli inpatient suicidal adolescents. Sixty-nine inpatient adolescents who recently attempted suicide were assessed by structured interview and rating scales for detailed clinical history, diagnoses, suicide intent and risk, impulsivity, violence, and depression. The frequency of DRD4 alleles was compared between the suicidal inpatients and 167 healthy control subjects. No significant association between the DRD4 polymorphism and suicidal behavior was found. Analysis of the suicide-related measures demonstrated a significant difference in depression severity between suicidal inpatients homozygote and heterozygote for the DRD4 alleles (p=0.003). The relevance of this finding to increased depression severity in suicidal adolescents, if replicated, is as yet unclear.     

Hyperactivity-inattention symptoms in childhood and suicidal behaviors in adolescence: the Youth Gazel Cohort

Objective: Although a link has been suggested between attention deficit/hyperactivity disorder (ADHD) and completed suicide, little is known about the association with suicidal behaviors in community settings. This study addresses the relationship between childhood hyperactivity‐inattention symptoms (HI‐s) and subsequent suicidal behaviors. Method: Nine hundred sixteen subjects aged 7–18 were recruited from the general population and surveyed in 1991 and 1999. Parent and adolescent self‐reports provided psychopathology and suicidal behavior pattern measures. Multivariate modeling was used to evaluate the effects of childhood HI‐s and other risk factors on adolescent suicidal behaviors. Results: In males, HI‐s independently accounted for the risk of lifetime suicide plans/attempts (OR=3.25, P = 0.02) and adolescent 12‐month prevalence rates of suicide plans/attempts (OR=5.46, P = 0.03). In females, HI‐s did not independently heighten the likelihood of suicidal behaviors. Conclusion: This survey suggests a possible specific link between HI‐s and suicide plans/attempts in males.     

Familial clustering of suicidal behaviour and psychopathology in young suicide attempters

Introduction Familial clustering of suicidal behaviour and psychopathology has been reported in young suicide attempters. Most of these studies were predominantly carried out in clinical treatment settings and lacked statistical power to assess the independent and modifying influences of own and familial psychopathology and suicidal behaviour. Methods We carried out a population-based record-linkage study with a nested case control design. The 14,440 individuals hospitalised due to suicide attempt (cases) and 144,400 matched controls were born in Sweden between 1968 and 1980 and followed up till December 31, 1999. Results Among the strongest independent familial risk factors for youth suicide attempt were siblings’ (OR 3.4; 2.8–4.1), maternal (OR 2.7; 2.5–3.1) and paternal (OR 1.9; 1.7–2.1) suicide attempt. Other important risk factors were familial personality and substance abuse disorders, maternal schizophrenia, non-affective psychoses and organic disorders and parental neurotic, stress-related and somatoform disorders (1.9–3.2 fold increase), and paternal (OR 1.9; 1.6–2.3) and maternal (OR 1.8; 1.3–2.4) suicide completion. Mental illnesses in index subjects, particularly substance abuse, affective and personality disorders, were the dominant determinants of suicide attempt. Strong interactions were observed between psychopathology in index subjects and familial suicidality. Familial suicide completion had a stronger effect on suicide attempt of earlier onset and on boys. Nearly half (47%) of all suicide attempts could be attributed to familial psychopathology (13%), family suicide attempt (7%) and suicide completion (1%) and own psychopathology (25%). Conclusion Early recognition and adequate treatment of individual mental illness contribute to prevent youth suicide attempts. Children of parents with psychopathology and suicidal behaviour should receive early support and attention. Evaluation of familial suicidal behaviour seems to be vital for suicide risk assessment in young psychiatric inpatients. There appears to be an independent effect of familial suicidal behaviour as well as familial psychopathology on youth suicide attempt beyond the transmission of mental illness.     

Two generations of Slovenian suicidal adolescent inpatients

BACKGROUND: The political and socio-economic situation in Slovenia, a former Yugoslav republic, a country in transition and a country with a high suicide rate, which joined the European Union in 2004, has changed steadily since the beginning of the 1970s. Literature shows constancy in suicide statistics in Slovenia during these times. AIM: The present study examines whether the suicidal adolescent inpatient population in Slovenia reflects recent social changes and upheavals. METHOD: Data on two groups of patients admitted to a specialized adolescent psychiatry department after attempting suicide were collected. The first group (n = 74) were patients admitted from 1975 to 1977, the second group (n = 73) from 2002 to 2004. They were compared on general characteristics, family and living circumstances, risk behaviors, suicide attempts and diagnoses. RESULTS: The comparison revealed statistically significant differences between groups on educational level, number of siblings, frequency of smoking and psychoactive medication misuse as well as number of previous suicide attempts. No differences were found in other family and living circumstances, methods used in the index suicide attempt, other risk behaviors or diagnoses. CONCLUSIONS: The post-independence suicidal inpatient population in Slovenia shows a tendency towards higher morbidity, but has changed less than expected considering the vast changes in the society. These results suggest a certain constancy in adolescent suicidal behavior.     

Predictors and outcome characteristics associated with suicidal behaviour in early psychosis: a two-year follow-up of first-admitted subjects

OBJECTIVE: To assess the baseline characteristics associated with a greater risk of suicidal behaviour (suicide and parasuicide) over the 2 years following a first admission for psychosis, and the associations between suicidality and outcome. Method: First-admitted subjects with psychosis (n=65) were assessed at 6-monthly intervals over a 2-year follow-up period. RESULTS: Over this period, 11.3% of the patients displayed suicidal behaviour. Baseline predictors of suicidal behaviour were a lifetime history of parasuicide before first admission (OR=5.9, 95% CI 1.5-23.4), lower Positive And Negative Symptom Scale positive subscores (OR=0.8, 95% CI 0.6-0.97) and a longer duration of first admission (OR=1.1, 95% CI 1-1.2). Subjects with suicidal behaviour presented with a longer duration of psychotic symptoms (OR=1.1, 95% CI 1.02-1.2) and a greater risk of being readmitted (OR=4.6, 95%CI 1.1-19.1). Subjects with substance misuse over the follow-up period were seven times (95%CI 1.3-39) more likely to engage in suicidal behaviour. CONCLUSION: Subjects with a previous history of parasuicide, with a deteriorating clinical course, or with substance misuse are at increased risk of suicidal behaviour in the 2 years after the onset of a first psychotic episode.     

Sex differences in clinical predictors of suicidal acts after major depression: a prospective study

OBJECTIVE: Whether sex differences exist in clinical risk factors associated with suicidal behavior is unknown. The authors postulated that among men with a major depressive episode, aggression, hostility, and history of substance misuse increase risk for future suicidal behavior, while depressive symptoms, childhood history of abuse, fewer reasons for living, and borderline personality disorder do so in depressed women. METHOD: Patients with DSM-III-R major depression or bipolar disorder seeking treatment for a major depressive episode (N=314) were followed for 2 years. Putative predictors were tested with Cox proportional hazards regression analysis. RESULTS: During follow-up, 16.6% of the patients attempted or committed suicide. Family history of suicidal acts, past drug use, cigarette smoking, borderline personality disorder, and early parental separation each more than tripled the risk of future suicidal acts in men. For women, the risk for future suicidal acts was sixfold greater for prior suicide attempters; each past attempt increased future risk threefold. Suicidal ideation, lethality of past attempts, hostility, subjective depressive symptoms, fewer reasons for living, comorbid borderline personality disorder, and cigarette smoking also increased the risk of future suicidal acts for women. CONCLUSIONS: These findings suggest that the importance of risk factors for suicidal acts differs in depressed men and women. This knowledge may improve suicide risk evaluation and guide future research on suicide assessment and prevention.     

Association of comorbid posttraumatic stress disorder and major depression with greater risk for suicidal behavior

OBJECTIVE: Posttraumatic stress disorder (PTSD) increases the risk of suicidal behavior; a major depressive episode also increases the risk for suicidal behavior. The authors' goal was to examine the effect of comorbid PTSD and major depressive episode on suicidal behavior. METHOD: Inpatients with a diagnosis of major depressive episode (N=156) were assessed for PTSD, suicidal behavior, and clinical risk factors for suicidal acts. RESULTS: Patients with comorbid major depressive episode and PTSD were more likely to have attempted suicide, and women with both disorders were more likely to have attempted suicide than men with both disorders. Cluster B personality disorder and PTSD were independently related to history of suicide attempts. CONCLUSIONS: The greater rate of suicide attempts among patients with comorbid PTSD and major depressive episode was not due to differences in substance use, childhood abuse, or cluster B personality disorders.     

Familial transmission of suicidal ideation and suicide attempts: evidence from a general population sample

The goals of the study were (1) to determine the association between parental and offspring suicidal ideation and suicide attempts among adult offspring in a general community sample, and (2) to examine the extent to which this association can be explained by mediating processes of mental disorders. Data were drawn from the National Comorbidity Survey (n=8098), a representative household sample of adults aged 15-54 in the United States. The relationships between suicidal ideation and suicide attempts among adult offspring and suicidal ideation and suicide attempt in their parents, compared with those in parents not characterized by suicidal ideation or suicide attempts, were calculated using multiple logistic regression analyses. Analyses were adjusted for differences in sociodemographic characteristics and for mental disorders. Results showed that parental suicidal ideation was associated with a significantly increased likelihood of suicidal ideation [OR=1.7 (1.2, 2.5)] and suicide attempt [OR=1.4 (0.9, 2.1)] among offspring. Parental suicide attempt was associated with increased odds of suicidal ideation [OR=2.0 (1.4, 2.9)] and suicide attempt [OR=2.2 (1.4, 3.4)] among offspring. Comorbid mental disorders contributed to the strength of these associations, but with the exception of the link between parental suicidal ideation and offspring suicide attempt, all remained statistically significant even after adjustment. These data provide initial evidence of familial linkages (parent-offspring) of suicidal ideation and behavior among a sample of adults representative of the US population. The data suggest that comorbid mental disorders contribute to these associations but do not completely account for them. The findings are consistent with and extend results from family, clinical, and high-risk studies suggesting that a familial risk of suicidal ideation and suicide behavior occurs in the general population. Implications for prevention and future research are discussed.     

Suicidal behavior and related traits among inpatient adolescents with first-episode schizophrenia

Purpose

Suicide is a major cause of death in adolescents with first-episode schizophrenia (FES). The aim of this pilot study was to compare suicide-related traits between subjects with FES and those with other psychopathologies to evaluate risk factors for suicidal behavior.

Method

Twenty-five inpatient adolescents with FES and a control group of 28 psychiatric inpatients matched for sex and age were assessed for depression, anger, criminal behavior, aggression, and suicidal ideation, risk, and potential.

Results

The adolescents with FES had significantly lower depression (P = .003), anger (P = .025), and criminal behavior (P = .022) than did the controls. However, although suicide ideation was greater in the subjects with FES (P = .003), suicide risk was significantly lower than that in controls (P = .004).

Conclusion

Decreased levels of both depression and anger as part of affective constriction in the group with schizophrenia could explain why the increased suicide ideation did not lead to a higher suicide risk in these inpatients. This study highlights the importance of distinguishing between suicidal ideation and actual suicide risk. We demonstrated that thoughts of suicide do not necessarily translate into an actual risk of suicidal behavior in adolescents with schizophrenia.