Lifetime risk of suicide ideation and attempts in an Australian community: prevalence, suicidal process, and help-seeking behaviour

BACKGROUND: The World Health Organisation SUicide PREvention-Multisite Intervention Study on Suicide (WHO/SUPRE-MISS) investigates suicidal behaviours in a number of nations. The feasibility of the different branches of the study was piloted in Queensland, Australia. This paper reports on the community survey component. METHOD: Randomised telephone interviews (n=11,572) were conducted to determine the lifetime prevalence of suicidal ideation and attempts, and corresponding socio-demographic and cultural characteristics. A subsequent postal survey sent to consenting individuals reporting lifetime suicide ideation/attempt (n=1311) was meant to ascertain the possible development of that behaviour along a continuum, psychiatric and psychological factors, suicidal transmission, help-seeking, and service utilisation. RESULTS: Suicide ideation and attempts prevailed in individuals aged 25-44 years, and declined with increasing age. In most cases, suicidal experience/s did not develop over time with progressively increasing severity. Knowledge of someone else's suicidal behaviour significantly increased the risk of similar acts. Almost half of the subjects contended with their suicidal crisis by over-drinking alcohol, and 1/3 through other forms of reckless behaviour. The ratio completed/attempted suicide was 1 to 23. Less than 30% of subjects went to the hospital after their suicidal behaviour, and treatment received and staff attitudes were rated less favourably than that of General Practitioners. CONCLUSIONS: This survey provides a reliable picture of suicide ideation and behaviour in the general population. Information on the development of suicidal process, recklessness, and help-seeking attitudes may be valuable for future prevention strategies.     

北京地区40家综合医院住院病人自杀意念和自杀未遂的调查

目的:了解北京地区综合医院住院病人自杀意念、自杀未遂的出现率及其危险因素。方法:采用自制抑郁筛选量表在随机抽取的北京40家各级综合医院中调查了2914例年龄>15岁的住院病人,了解他们自杀意念、自杀未遂发生情况及相关因素,并通过多因素logistic模型发现其危险因素。结果:2914例患者中,187人(6·42%;95%CI为5·58%~7·64%)有过自杀意念,其危险因素排列为:近一年感到绝望的频率高(OR=9·2,95%CI为6·5~12·9)、亲属有过自杀行为(4·3,2·3~8·3)、调查当时有重性抑郁发作(2·7,1·7~4·3)、熟人有过自杀行为(2·0,1·3~2·9)、年龄<55岁(1·7,1·2~2·3)、女性(1·5,1·1~2·1)。2914例患者中,25人(0·86%;95%CI为0·56%~1·26%)有过自杀未遂,其危险因素排列为:目前有重性抑郁发作(OR=5·6,95%CI为2·1~15·1)、亲属有过自杀行为(5·1,1·4~18·9)、近一年感到绝望频率高(4·7,1·9~11·9)、年龄<55岁(3·6,1·4~9·3)、女性(3·6,1·4~9·3)。结论:伴有抑郁症状的综合医院住院病人应视为自杀高危人群,需投入更多的关注。根据其自杀意念、自杀未遂的危险因素,应在综合医院制定和执行有针对性的自杀预防计划。     

Suicidal behaviour in adolescence and subsequent mental health outcomes in young adulthood

BACKGROUND: The aim of this study was to examine the linkages between suicidal ideation and attempt in adolescence and subsequent suicidal behaviours and mental health in young adulthood. METHOD: Data were gathered during the course of a 25-year longitudinal study of a birth cohort of 1265 New Zealand children. The information collected included: (a) measures of suicidal thoughts and attempts in adolescence (< 18 years); (b) measures of suicidal ideation, suicide attempt, major depression, anxiety disorders, and substance use disorders in young adulthood (18-25 years); and (c) measures of childhood and family background, individual characteristics, and mental disorders in adolescence. RESULTS: After statistical adjustment for confounding factors, suicide attempt in adolescence was associated with increased risks of subsequent suicidal ideation (OR 5.7) suicide attempt (OR 17.8) and major depression (OR 1.5). Those reporting suicidal ideation without suicide attempt showed moderate increases in risks of later suicidal ideation (OR 2.5), suicide attempt (OR 2.0) and major depression (OR 1.6). In addition, there was evidence of an interactive relationship in which suicidal behaviour in adolescence was associated with increased risks of later substance use disorders in females but not males. CONCLUSIONS: Young people reporting suicidal ideation or making a suicide attempt are an at-risk population for subsequent suicidal behaviour and depression. Further research is needed into the reasons for suicidal adolescent females being at greater risk of later substance use disorder.     

Incidence of suicide ideation and attempts in adults: the 13-year follow-up of a community sample in Baltimore, Maryland.

BACKGROUND: Utilizing a prospectively designed community sample, we set out to estimate the rate of newly-incident suicidal ideation and attempts (non-fatal suicide behaviour) in a community sample, to evaluate antecedent sociodemographic characteristics and psychiatric disorders, and to assess use of mental health services in relation to non-fatal suicide behaviour. METHOD: Prospectively-gathered data was utilized from 3481 continuing participants in the 13-year follow-up of the Baltimore sample of the NIMH Epidemiologic Catchment Area survey interviewed in 1981, 1982 and 1993/6. RESULTS: The incidence of suicide attempts was estimated at 148.8 per 100,000 person-years and ideation at 419.9 per 100,000 person-years. Persons in the youngest age group, in the lowest socioeconomic status, and previously married persons were at increased risk for non-fatal suicide behaviour during the follow-up interval. Persons who reported suicidal ideation at baseline were more likely to report having attempted suicide at follow-up (RR = 6.09, 95% CI 2.58-14.36). Psychiatric disorders, especially depression and substance abuse, were associated with new-onset of non-fatal suicidal behaviour. While persons who reported newly-incident suicidal behaviour were more likely to report use of mental health services, few said that suicidal ideation or attempts were the reason for the visits. CONCLUSIONS: Suicidal ideation is a common and important antecedent to suicide attempts and deserves more attention in community and general medical settings.     

Natural history of suicidal behaviors in a population-based sample of young adults

BACKGROUND: Suicidal behaviors in young individuals represent an important public health problem. Understanding their natural history and relationships would therefore be of clinical and research value. In this study, we examined the natural histories of several suicidal behaviors and investigated two conceptual models of suicidality (dimensional and categorical) in the context of adolescent and adult-onset suicide attempts. METHOD: Participants were members of a prospectively studied, representative, population-based school cohort followed since age 6 (n = 3017) through mid-adolescence (n = 1715) to their early twenties (n = 1684). Outcome measures included suicidal ideation, attempts and completions. RESULTS: Approximately one in 500 individuals died by suicide. About 33% had suicidal ideas and 9.3% made at least one suicide attempt. Over half (4.9%) of the self-reported attempters made their first attempt before age 18. With the exception of current suicidal ideas, non-fatal suicidal behaviors were more prevalent in females. In general, parental and cross-sectional self-reports underestimated suicidality rates. Aikaike (AIC) and Bayesian (BIC) information criteria suggested the ordinal model, and dimensional conceptualization of suicide attempts of different onset age, to be more optimal than its multinomial/categorical counterpart (ordinal: AIC 567.55, BIC 635.67; multinomial: AIC 616.59, BIC 723.83). Both models, nevertheless, identified five common factors of relevance to suicidal diathesis: gender, disruptive disorders, childhood anxiousness and abuse, and suicidal thoughts. CONCLUSIONS: Non-fatal suicidal behaviors in adolescents and young adults are more common than suggested by cross-sectional studies and parental reports. The dimensional model may be more useful in explaining the relationship of suicide attempts of different age of onset.     

Cigarette smoking and suicidal behaviour: results from a 25-year longitudinal study

BACKGROUND: This study examined the associations between cigarette smoking and suicidal ideation and suicide attempts, both before and after control for potentially confounding using fixed effects regression models. METHOD: Data were gathered during the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of New Zealand children (635 males, 630 females). The analysis was based on a sample of 1041 participants with available data on cigarette smoking and suicidal behaviour from ages 16 to 25 years. The main outcome measures were suicidal ideation and suicide attempts, ages 16-18, 18-21, and 21-25. RESULTS: There were significant bivariate associations between the frequency of cigarette smoking and both suicidal ideation and suicide attempts. Cohort members who smoked 20 or more cigarettes per day had odds of suicidal ideation that were 3.39 times (95% CI 2.06-5.59) those of non-smokers, and odds of suicide attempt that were 4.39 (95% CI 2.18-8.85) times those of non-smokers. Control for non-observed fixed confounding factors reduced the association between cigarette smoking and suicidal ideation and suicide attempts to statistical non-significance. After adjustment, those smoking more than 20 cigarettes per day had odds of suicidal ideation that were 1.00 times (95% CI 0.46-2.18) those of non-smokers, and odds of suicide attempt that were 1.84 (95% CI 0.81-4.18) times those of non-smokers. CONCLUSIONS: The findings suggest that the associations between frequency of cigarette smoking and suicidal behaviour may largely be explained by the non-observed background factors and life circumstances that are associated with both cigarette smoking and suicidal behaviour.     

Suicidal ideation among medical students and young physicians: a nationwide and prospective study of prevalence and predictors

BACKGROUND: Despite an increased risk of suicide among physicians we lack studies on prevalence and predictors of suicidal ideation among medical students and young doctors. METHOD: A prospective study of Norwegian medical students (n=522) re-examined after the first postgraduate year, comprising suicidal thoughts and attempts, perceived study stress, job stress, and personality. RESULTS: The previous year prevalence of suicidal thoughts was 14% at both points of time. The lifetime prevalence was 43%, while 8% had planned suicide, and 1.4% had attempted suicide. Suicidal ideation in medical school was predicted by lack of control, personality trait, single marital status, negative life events and mental distress (anxiety and depression). In the first postgraduate year, mental distress was the most important predictor, but before controlling for this variable, job stress, vulnerability (neuroticism), single status, and less working hours were independent predictors. Prospectively, suicidal thoughts and vulnerability as student predicted postgraduate suicidal ideation. CONCLUSIONS: The level of suicidal thoughts was high, but the level of attempts was low. Clinical implications: Preventive efforts should be directed both at the students' abilities to cope with stress and at mental health services for young doctors. LIMITATIONS OF STUDY: The lower response rate at follow-up (57%) may reduce external validity.     

Association of psychosis with suicidality in pediatric bipolar I, II and bipolar NOS patients

BACKGROUND: Psychosis in pediatric mood disorder patients may be related to suicidal ideation. Bipolar (BP) adolescents are at high risk of completed suicide. We examined whether pediatric BP patients with psychosis have a higher prevalence of suicidality than non-psychotic BP patients. Based on previous findings in adult BP patients, we predicted that pediatric BP patients with psychotic symptoms would have higher prevalence of suicidality, higher occurrence of lifetime psychiatric hospitalizations and worse current Global Assessment of Functioning Scale (GAF) scores compared to non-psychotic BP patients. METHODS: We studied 43 BP children and adolescents (mean age +/- S.D = 11.2 +/- 2.8 y, range = 8-17) who did (n = 17) or did not have (n = 26) a lifetime history of psychotic symptoms. Indicators of suicidality (thoughts of death and suicidal ideation, plans, and attempts), psychiatric diagnoses, psychotic symptoms, psychiatric hospitalizations and GAF scores were assessed with the K-SADS-PL interview. LIMITATIONS: Small sample size, cross-sectional study and exclusion of substance abuse comorbidity. RESULTS: Pediatric BP patients with a lifetime history of psychotic symptoms compared to BP patients without psychosis were more likely to have thoughts of death (100% versus 69.2%, p = 0.01), suicidal ideation (94.1% versus 42.3%, p = 0.001) and suicidal plans (64.7% versus 15.4%, p = 0.002). Occurrence of psychiatric hospitalization was higher in psychotic BP patients compared to non-psychotic BP patients (82.4% versus 46.2%, p = 0.018). CONCLUSIONS: Psychotic symptoms in pediatric BP patients are associated with suicidal ideation and plans, and psychiatric hospitalizations. Psychotic symptoms are a risk factor for suicidality amongst pediatric BP patients.     

Pain persistence and lethality of suicide attempts

The interpersonal–psychological theory of suicide posits that elevated pain tolerance is necessary to engage in suicidal behaviour. It is assumed that suicidal intent only leads to lethal (or near lethal) suicide attempts when an individual has the capability to persist the pain involved in dying. The aim of this study was to assess whether objective pain persistence moderates the association between suicide intent and lethality of a recent suicide attempt. Ninety‐seven inpatients, who were hospitalized due to a recent suicide attempt, were interviewed regarding lifetime suicide attempts as well as their most recent suicide attempt: Method of attempt, intention to die, medical risk of death, probability of an intervention, and physical condition following the attempt were inquired. Pain persistence was examined using a pressure algometer. Contrary to the expectation, pain persistence did not moderate the association between suicide intent and lethality of a recent suicide attempt, that is, medical risk of death, probability of an intervention, or physical condition following the attempt. Future studies are needed to examine method specific pain persistence for suicidal behaviour in a longitudinal study design.     

Suicidal behaviours in South East London: Prevalence,risk factors and the role of socio-economic status

Background

Low socio-economic status (SES) is an established risk factor of suicidal behaviours, but it is unknown to what extent its association is direct, indirect or confounded, given its strong association to mental health. We aimed to (I) estimate the prevalence of suicidal behaviours; (II) describe relevant risk factors; and (III) investigate direct and indirect effects of SES on suicidal behaviours.

Methods

We used cross-sectional community survey data of adults from randomly selected South East London households (SELCoH). Suicidal outcome measures replicated the 2007 Adult Psychiatric Morbidity Survey in England (APMS). Lifetime prevalence was described by socio-demographics, SES, mental health indicators, and life events. Structured symptom screens and a drug use questionnaire measured mental health. Structural equation models estimated direct and indirect effects of a latent SES variable on suicidal ideation and suicide attempts, adjusting for covariates.

Results

20.5% (95% CI: 18.4–22.7) reported suicidal ideation and 8.1% (95% CI: 6.8–9.7) reported suicide attempts (higher than APMS estimates: 13.7%, 4.8%, respectively). Unadjusted risk factors included poor mental health, low SES, and non-married/non-cohabitating relationship status. Black African ethnicity was protective, and women reported more suicide attempts. SES was directly associated to suicide attempts, but not suicidal ideation. SES had indirect effects on suicidal outcomes via mental health and life events.

Limitations

The cross-sectional design and application of measures for different time periods did not allow for causal inferences.

Conclusions

Suicidal behaviours were more prevalent than in the general UK population. Interventions targeting low SES individuals may prove effective in preventing suicide attempts.     

Childhood adversities and risk for suicidal ideation and attempts: a longitudinal population-based study

BACKGROUND: Developmental adversities may be risk factors for adult suicidal behavior, but this relationship has rarely been studied prospectively. The present study examined the association between childhood adversities and new onset suicidal ideation and attempts in an adult population-based sample. METHOD: The study used a large community mental health survey (the Netherlands Mental Health Survey and Incidence Study; n=7076, age range 18-64 years). Logistic regression analyses were used to evaluate the relationship between childhood adversities and new onset of suicidal ideation and attempts over 3 years of longitudinal follow-up. RESULTS: During the study period 85 new cases of suicidal ideation and 39 new onset suicide attempts were observed. The incidence rate for new suicide ideation was 0.67% per year and the incidence rate for new suicide attempts was 0.28% per year. Childhood neglect, psychological abuse and physical abuse were strongly associated with new onset suicidal ideation and suicide attempts. Odds ratios (ORs) ranged from 2.80 to 4.66 for new onset suicidal ideation and from 3.60 to 5.43 for new onset suicide attempts. The total number of adversities reported had a strong graded relationship to new onset suicidal ideation and attempts. These associations remained significant after controlling for the effects of mental disorders. CONCLUSIONS: Childhood abuse and multiple adversities are strongly associated with future suicidal behavior and the mental disorders assessed in the present study do not fully account for this effect. A comprehensive understanding of suicidal behavior must take childhood adversities into account.     

Identifying correlates of suicide attempts in suicidal ideators: a population-based study

BACKGROUND: Identification of factors that distinguish between ideators who act on their suicidal thoughts from those who do not is an important clinical and research objective. METHOD: We examined correlates of suicide attempts in suicidal ideators, members of a French-Canadian, school-based cohort. Suicidal thoughts were evaluated in adolescence and early adulthood in the total sample of suicidal ideators, who were then stratified into subgroups consisting of persistent ideators, male ideators and female ideators. RESULTS: In addition to persistent suicidal ideas [odds ratios (ORs) 2.1-2.8], Axis I psychopathology, female gender and childhood sexual abuse (CSA) were the most consistent correlates of suicide attempts. Externalizing disorders were significant contributors in persistent ideators [drug misuse: OR 2.8, 95% confidence interval (CI) 1.1-6.9] and in male ideators in particular (disruptive disorders: OR 5.9, 95% CI 2.2-16.0). In women, psychiatric co-morbidity also had a significant effect (OR 1.6, 95% CI 1.1-2.1). CSA was of relevance in both women (OR 1.2, 95% CI 1.1-1.4) and persistent ideators (OR 1.3, 95% CI 1.1-1.5). Personality traits showed gender-specific contribution with affective instability (OR 1.1, 95% CI 1.01-1.1) and anxiousness (OR 1.3, 95% CI 1.1-1.7) contributing in men and disruptive aggression (OR 1.1, 95% CI 1.03-1.3) in women. CONCLUSIONS: Correlates of suicide attempts in suicidal ideators vary as a function of the persistence of suicidal ideas and gender. This heterogeneity across subgroups of suicidal ideators may be attributed, at least in part, to differences between the sexes, early environmental adversity, maladaptive personality, and psychiatric symptoms. Further exploration and continued prospective follow-up is necessary to examine these possibilities.     

The influence of media reporting of a celebrity suicide on suicidal behavior in patients with a history of depressive disorder

BACKGROUND: Few studies have directly assessed the impact of a specific media report in vulnerable people. This study investigates possible influences of media reporting of a celebrity suicide on subsequent suicidal behaviors and associated risk factors among depressive patients. METHODS: Depressive patients (N=461) were assessed through a structured interview soon after extensive media reporting of a celebrity suicide. RESULTS: Among 438 depressive patients exposed to the media report, 38.8% reported an influence on subsequent suicidal behaviors, including 24 (5.5%) with a suicide attempt. The risk of such influence was highest among patients in a severe depressive state just prior to the media report (adjusted OR 7.81, 95% CI 3.28-18.59). Such influence on a subsequent suicide attempt was highest in patients with a most recent suicide attempt within one month prior to the media reports (adjusted hazard ratio 11.91, 95% CI 3.76-37.72). LIMITATIONS: Our finding of the significant media influence may reflect adverse thoughts among more suicidal and depressed individuals. The possible influence of other factors on the findings cannot be ruled out. CONCLUSIONS: This study has provided more convincing evidence suggesting negative influences of media reporting of a celebrity suicide on subsequent suicidal behaviors among depressive patients. Particular attention in terms of potential negative media influences should be paid to patients who are younger and currently depressed and have made a recent suicide attempt.     

Kindling and behavioral sensitization: are they relevant to recurrent suicide attempts?

BACKGROUND: Data from a sample of suicidal young adults were used to examine the relevance of the kindling and behavioral sensitization models to suicide attempts. Three predictions derived from the kindling and sensitization models were tested: a higher number of suicide attempts would be associated with (a) lower levels of pre-attempt stress; (b) higher suicidal intent; and (c) greater lethality of the current attempt. METHODS: Measures of life stress and suicidal intent were collected among 123 young adults who attempted suicide just prior to entering treatment. Data on the total number of suicide attempts and the lethality of the current attempt were also collected. RESULTS: Number of suicide attempts was significantly and positively associated with pre-suicidal crisis life stress and suicidal ideation, but was not significantly associated with lethality of the most recent attempt. LIMITATIONS: The young sample drawn from a military medical setting may not accurately represent suicide attempters in the general population. Only total negative life events in the year preceding suicide attempt were examined, not the increase in negative life events immediately prior to suicide attempt. CONCLUSIONS: The kindling and sensitization models may not accurately describe the progression of recurrent suicide attempts.     

Differentiating army suicide attempters from psychologically treated and untreated soldiers: A demographic,psychological and stress-reaction characterization

Background

Suicide is the leading cause of death in most armies during peace-time. The recent dramatic rise in suicides in the US Army further focuses attention on the causes of suicidal behavior in the military.

Methods

This study investigated demographic characteristics, psychological profile and stress-related risk factors associated with suicide attempts in Israelis aged 18–21 years, who served in the Army in 2009. Soldiers who attempted suicide (N=60) were compared to soldiers treated by a mental health professional, but reported no suicidal behavior (N=58), and to controls (N=50).

Results

Suicide attempters had lower socioeconomic status and less cognitive ability compared with treated soldiers and untreated control soldiers. Only 25% of the suicide attempters had received mental healthcare prior to the attempt. The majority of the attempts were non-lethal (86.2%), and only 5.2% used firearms. Attempters had more previous suicide attempts (37.9%) and deliberate selfharm incidents (19.3%), compared to almost no such behaviors in the other two groups. Following the suicide attempt, 77% were diagnosed with moderate to severe mental disorders, 44.8% personality disorders and 8.6% mood disorders. Attempters reported higher levels of general stress compared to their peers in the other two groups. Being away from home and obeying authority were especially more stressful in attempters.

Conclusions

Young soldiers are less prone to seek mental health assistance, despite suffering from higher levels of stress. Screening is required to detect soldiers at risk for suicidal behavior and preventive intervention will require active outreach.     

Suicidal Ideation and Attempted Suicide Among Women Living With HIV/AIDS

The prevalence, timing, and predictors of suicidal ideation and attempted suicide were evaluated in a sample of 207 HIV-positive women in New York City. Twenty-six percent of the women reported attempting suicide since their HIV diagnosis. Of those who made an attempt, 42% acted within the first month after diagnosis and 27% acted within the first week. AIDS diagnosis, psychiatric symptoms, and physical or sexual abuse were significant positive predictors of both suicidal ideation and attempts. Contrary to expectations, having children and being employed were also significant positive predictors. Spirituality was significantly negatively associated with suicidal ideation only. These results suggest that suicide prevention measures should be implemented for HIV-positive women immediately after diagnosis. Specifically, interventions should target those with an AIDS diagnosis, psychiatric symptoms, an abuse history, children, or employment. The encouragement of spiritual connection seems to be a deterrent to suicidal thoughts and is a possible avenue for intervention.     

Prevalence of reported suicidal behaviour in the general population and mental health-care staff

BACKGROUND: Higher rates of suicidal behaviour have been reported among staff in mental health care than in the general population. However, no studies of these two groups have been carried out simultaneously, using the same methods. This study aims to investigate whether they differ in terms of age- and sex-standardized prevalence of suicidal behaviour. METHODS: Identical questions about suicidal behaviour were addressed in the same year to a random sample of the general population and to mental health-care staff in Stockholm. Life weariness among the latter was also investigated. RESULTS: Age- and sex-standardized past year prevalences of suicidal thoughts and suicide attempts were found to be similar among mental health-care staff and the general population. Lifetime prevalence of both suicidal thoughts and suicide attempts was significantly higher among mental health-care staff than among the general population. Psychologists/social workers have a higher probability of: lifetime thoughts of life is not worth living; death wishes; and, suicidal thoughts, than nurses/assistant nurses. CONCLUSIONS: Reports on lifetime prevalence of suicidal behaviour may be biased in populations that are not reminded of these problems in everyday life. Data on past year prevalence of suicidal behaviour show clearly the similarity between the general population and the mental health-care staff.     

Behind impulsive suicide attempts: indications from a community study

AIM: A considerable proportion of suicide attempts are made on impulse. However, knowledge of characteristics of impulsive attempters is still limited. The present study investigated some of these characteristics and aimed to identify the pattern (if any) of suicidal ideation before an impulsive attempt. METHODS: Data from a randomized and stratified population of 5130 individuals from Brisbane, Australia, were analysed. Computer-assisted telephone interviews (CATI) were adopted to recruit subjects. Those reporting previous suicidal behaviour were sent a questionnaire by mail. RESULTS: One hundred and twelve subjects reported a suicide attempt. One quarter of these described a pattern consistent with an impulsive attempt. Most impulsive attempters experienced suicidal thoughts before their attempt. They were less likely to believe that their attempt would cause death, and less likely to experience depression. Impulsive attempters did not differ significantly from non-impulsive attempters in regards to age, gender, and motivations for the attempt. Surprisingly, no differences in mean scores of trait impulsivity between impulsive and non-impulsive attempters were found. In addition, the majority of suicide attempters (whether impulsive or not) experienced the suicidal process as fluctuating and not as developing along a continuum. LIMITATIONS: The number of attempters who validly entered the study limited our ability to identify potential confounders. Due to the retrospective nature of the survey, the reliability of the information collected may have been affected by recall biases. In addition, as the surveys were administered by mail, it is possible that some questions may have been misinterpreted. CONCLUSIONS: The presence of suicidal feelings prior to an attempt constitutes an opportunity for intervention also in impulsive attempters. However, the identification of impulsiveness requires more research efforts.     

Vulnerability and resiliency to suicidal behaviours in young people

BACKGROUND: We aimed to examine factors that influence vulnerability/resiliency of depressed young people to suicidal ideation and suicide attempt. METHOD: Data were gathered during a 21-year longitudinal study of a birth cohort of 1,265 New Zealand young people. Measures included: suicide attempt; suicidal ideation; major depression; childhood, family, individual and peer factors. RESULTS: Young people who developed major depression had increased rates of suicidal ideation (OR = 54: 95% CI 4.5-6.6) and suicide attempt (OR = 12.1; 95% CI 7.9-18.5). However, the majority of depressed young people did not develop suicidal ideation or make suicide attempts, suggesting that additional factors influence vulnerability or resiliency to suicidal responses. Factors influencing resiliency/vulnerability to suicidal responses included: family history of suicide; childhood sexual abuse; neuroticism; novelty seeking; self-esteem; peer affiliations; and school achievement. These factors operated in the same way to influence vulnerability/resiliency among those depressed and those not depressed. CONCLUSIONS: Vulnerability/resiliency to suicidal responses among those depressed (and those not depressed) is influenced by an accumulation of factors including: family history of suicide, childhood sexual abuse, personality factors, peer affiliations and school success. Positive configurations of these factors confer increased resiliency, whereas negative configurations increase vulnerability.     

Suicidal ideation and attempts in adults seeking outpatient psychodynamic psychotherapy

Suicide is an important cause of death in patients with mental health disorders, but little is known about the occurrence of suicidal ideation and attempts in outpatient psychotherapy patients. The aim of this study was to identify the proportion of patients with and correlates of suicidal ideation and attempts in community-based psychotherapy practices. Using 983 applications for reimbursement of psychotherapy from individual patients, reports about suicidal thoughts and suicide attempts were extracted along with demographic, biographic and clinical data. Multivariate logistic regression analysis was used to identify correlates of suicidal ideation and attempts by calculating odds ratios (ORs). Among the patients, 19% presented with suicidal thoughts (11% currently and 8% in the past) and 6% with suicide attempts. Important correlates of suicidal thoughts were male gender (OR 1.7), lower education (OR 1.8), early retirement (OR 2.9), death of a parent when younger than 5 years old (OR 3.3), violence experienced from various people (OR 2.1), self-harm behaviour (OR 7.9) and alcohol misuse (OR 1.7). Suicide attempts were associated with male gender (OR 5.6), lower education (OR 4.2), violence experienced from partner (OR 2.5) or from various people (OR 9.5) and self-harm behaviour (OR 15.0). These results show that the proportion of suicidal patients seeking outpatient psychotherapy is high. It should therefore be a central topic in clinical training. Biographic data such as the loss of a parent at an early age or experiencing violence are associated with who is at increased risk and should be explored in detail.