Do antidepressants precipitate youth suicide?

The association between treatment with Selective serotonin reuptake inhibitors (SSRIs) and suicide in children and adolescents on the individual and ecological level were examined in a nationwide Danish pharmacoepidemiological register-linkage study including all persons aged 10–17 years treated with antidepressants during the period 1995–1999 (n=2,569) and a randomly selected control population (n=50,000). A tripartite approach was used. In Part 1, changes in youth suicide and use of antidepressants were examined. In Part 2, we made an assessment of youth suicide characteristics. In Part 3, we analysed the relative risk (RR) of suicide according to antidepressant treatment corrected for psychiatric hospital contact to minimize the problem of confounding by indication. The use of SSRIs among children and adolescents increased substantially during the study period, but the suicide rate remained stable (Part 1). Among 42 suicides nationally aged 10–17 years at death, none was treated with SSRIs within 2 weeks prior to suicide (Part 2). There was an increased rate of suicide associated with SSRIs (RR=4.47), however, not quite significant (95% CI: 0.95–20.96), when adjusted for severity of illness (Part 3). Conclusively, we were not able to identify an association between treatment with SSRIs and completed suicide among children and adolescents.     

Is COPD associated with suicide behavior?

Background

The goal of this study is to examine the relationship between chronic obstructive pulmonary disease (COPD) and suicidal ideation and suicide attempt among adults in the United States.

Methods

Data were drawn from the National Comorbidity Study-Replication (NCS-R), a household probability sample of adults ages 18 and older in the United States.

Results

COPD is associated with significantly increased odds of suicidal ideation and suicide attempt, compared with those without COPD. The association between COPD and suicide attempt remained statistically significant after adjusting for demographics, depression, panic disorder, substance use and nicotine dependence. The association between COPD and suicidal ideation was no longer significant after adjusting for nicotine dependence.

Conclusions

Our findings provide initial evidence that there is a relationship between COPD and suicidal behavior among adults in the community. Future studies that can examine the relationship between COPD and completed suicide, as well as replication of these results, would improve our understanding of whether and to what degree COPD confers an increased vulnerability for suicide behavior.     

Do theories of suicide play well together? Integrating components of the hopelessness and interpersonal psychological theories of suicide

Given that suicide is a leading cause of death worldwide, there has been considerable research on theories of suicide risk. Despite the volume of such research, each theory is largely investigated in isolation and there has been little attempt to integrate them. Thus, the goal of the present study is to integrate two theories of suicide risk, Alloy and Abramson’s hopelessness theory of suicide (HT) and Joiner’s interpersonal psychological theory of suicide (IPTS), into one mediational model where the effects of the risk associated with the HT variables (i.e., a negative cognitive style) on suicidal ideation are transmitted by the IPTS (i.e., perceived burdensomeness and thwarted belonging) variables. Participants were 245 young adults with elevated levels of depressive symptoms who completed self-report measures of suicide risk at baseline and a measure of suicidal ideation eight weeks later. The results of a mediated model supported our hypothesis. The effects of the HT variables on suicidal ideation were mediated by the IPTS variables. Furthermore, results did not support the reverse model, suggesting specificity of the direction of our hypotheses. These findings imply that there may be merit in attempting to integrate theories of suicide risk rather than studying them in isolation.     

Are suicide attempters who self-mutilate a unique population?

OBJECTIVE: Individuals who mutilate themselves are at greater risk for suicidal behavior. Clinically, however, there is a perception that the suicide attempts of self-mutilators are motivated by the desire for attention rather than by a genuine wish to die. The purpose of this study was to determine differences between suicide attempters with and without a history of self-mutilation. METHOD: The authors examined demographic characteristics, psychopathology, objective and perceived lethality of suicide attempts, and perceptions of their suicidal behavior in 30 suicide attempters with cluster B personality disorders who had a history of self-mutilation and a matched group of 23 suicide attempters with cluster B personality disorders who had no history of self-mutilation. RESULTS: The two groups did not differ in the objective lethality of their attempts, but their perceptions of the attempts differed. Self-mutilators perceived their suicide attempts as less lethal, with a greater likelihood of rescue and with less certainty of death. In addition, suicide attempters with a history of self-mutilation had significantly higher levels of depression, hopelessness, aggression, anxiety, impulsivity, and suicide ideation. They exhibited more behaviors consistent with borderline personality disorder and were more likely to have a history of childhood abuse. Self-mutilators had more persistent suicide ideation, and their pattern for suicide was similar to their pattern for self-mutilation, which was characterized by chronic urges to injure themselves. CONCLUSIONS: Suicide attempters with cluster B personality disorders who have a history of self-mutilation tend to be more depressed, anxious, and impulsive, and they also tend to underestimate the lethality of their suicide attempts. Therefore, clinicians may be unintentionally misled in assessing the suicide risk of self-mutilators as less serious than it is.     

Is attempted suicide different in adolescent and adults?

Attempted suicide may be a different phenomenon in adolescents than in adults. To our knowledge, direct comparisons between these two populations are very scarce. The aim of this study is to analyze the differences between adolescents and adults in methods of attempted suicide, accompanying certainty of death, and intentionality. All cases admitted to one adult (n=173) and one adolescent (n=104) inpatient unit who attempted suicide in the period from January 2003 through October 2005 were included in a prospective, common, national register, with data on methods, circumstances, and intentionality. The methodology followed that of the WHO/Euro Multicenter Study on Parasuicide. A stratified analysis was performed using the Mantel-Haenszel procedure in order to control for the effects of gender and diagnosis. Adolescents used significantly more over-the-counter medicines. Adults were significantly more certain of the possible fatal outcome of their attempt and had a significantly more severe intention when harming themselves. Individuals appear to use the methods that are available to them to attempt suicide. Adolescents may display more impulsive and less lethal directed behavior than adults or, alternatively, they are more frequently admitted for less severe attempts.     

Imagery about suicide in depression—“Flash-forwards”?

Suicide is a significant world health problem, with more deaths by suicide globally than by war. We need to better understand the cognitive processes underlying suicidal thinking for improved treatment development. Cognitive psychology indicates that mental imagery can be causal in determining future behavior, yet the occurrence of suicide-related imagery has not previously been investigated. Interviews with 15 depressed and formerly suicidal patients in remission found that all patients reported experiencing detailed mental imagery in addition to verbal thoughts when at their most despairing, for example images of making a future suicide attempt. A clinical measure of the severity of suicidal ideation was associated with both preoccupation with suicide-related imagery and perceived imagery realness. Echoing flashbacks in posttraumatic stress disorder, the current images appeared like “flash-forwards” to suicide. These results provide the first data to our knowledge on the existence of mental imagery in suicidality, opening a promising new avenue for research.     

Attempted suicide. Do we understand the patients' reasons?

This explorative study compared the patients', doctors', and nurses' views regarding their attribution of reasons for attempting suicide and the patients' emotional state immediately preceding their suicide attempts. A sample of 30 out of 94 consecutive patients seen in the emergency room of University Hospital were examined shortly after they had attempted suicide. Immediately after the routine clinical interview, conducted by a psychiatric resident and a nurse, patients filled in a questionnaire giving 14 possible reasons for attempting suicide as well as 8 feelings characterizing the emotional state preceding the suicide attempt. In the meantime, and without prior discussion of the case, the resident and the nurse independently completed the same questionnaire. In addition, sociodemographic and clinical data were obtained. Intrapersonal reasons such as to get relief from a terrible state of mind or from an unbearable situation were most frequently chosen by patients, nurses, and doctors alike. The most striking difference was found for "loss of control": this item was chosen significantly more often by patients than by nurses and doctors. Accordingly, patients reported significantly more often feelings of anxiety/panic and emptiness (mental vacuum), whereas feelings of despair and powerlessness/hopelessness were mentioned most frequently by nurses and doctors. Mental health professionals should bear in mind that many suicide attempters experience feelings of anxiety/panic prior to their suicidal act, and that a majority report having lost control over themselves, thus indicating a state of emotional crisis.