A proposed model of the development of suicidal ideations

BackgroundSuicidal ideations may precede suicide attempts. They are of particular concern in psychiatric populations because psychopathology is a major risk factor for suicide. The factors affecting the development of suicide ideations may differ among psychiatric patients with and without a previous suicide attempt and individuals without a psychiatric diagnosis.ObjectivesThe aim of this study is to develop a model of suicide ideation in psychiatric patients and the general population.MethodThe study included 196 participants: 92 psychiatric patients with a previous suicide attempt (“attempters”); 47 psychiatric patients who had never attempted suicide (“non-attempters”); and 57 healthy control subjects. Data were collected on socio-demographic parameters, clinical history, and details of the suicide attempts. Participants completed a battery of psychological instruments assessing aggression–impulsivity, mental pain (including depression and hopelessness) and communication difficulties, in addition to negative life events. Findings were correlated with suicidal ideation by group.ResultsThe correlations of the different variables with suicidal ideation differed between suicide attempters and non-attempters; therefore, the model was analyzed separately for each group. The study yielded three major findings: negative life events had a significant effect on both anger-in and impulsivity in non-attempters but not in attempters; hopelessness moderately contributed to suicidal ideations in attempters but not in non-attempters; loneliness contributed significantly to depression in non-attempters but was less distressing in attempters.ConclusionThe mechanism underlying suicidal ideation appears to differ between psychiatric patients who have previously attempted suicide and those who have not, supporting a dual model of suicidal ideation. Although this is only a preliminary study, these findings are important for furthering our understanding of the process of transition of suicidal thoughts to completion of suicide. These results need further replication with a larger cohort of subjects.     

Stress Response in Suicide Attempters with Borderline Personality Disorder: The Role of Behavioral Problems in Childhood

Objective: Suicidal individuals are a heterogeneous population and may differ in systematic ways in their responsiveness to stress. The primary aim of the present study was to identify whether a different pattern of physiological stress response exists among adult suicide attempters with a history of behavioral problems during childhood and adolescence, which earlier studies have related to both decreased activity of the HPA axis and to suicidal behaviors.

Method: Seventy-eight participants with Borderline Personality Disorder were assessed using the SCID-II, and completed self-report measures assessing their history of suicide attempts, history of aggressive behaviors, depressive symptoms, history of lifetime abuse and demographics. Participants’ cortisol reactivity was assessed using the Trier Social Stress Test.

Results: Analyses indicated that suicide attempters with a history of behavioral problems in youth (n = 30) had a significantly lower response to stress than both suicide attempters without such a history (n = 26) and non-attempters (n = 22), when controlling for lifetime history of abuse. The groups did not differ in basal cortisol.

Conclusions: These findings suggest a unique subtype of suicide attempter among those with Borderline Personality Disorder, characterized by a blunted physiological stress response.     

Rumination and Pessimistic Certainty as Mediators of the Relation Between Lifetime Suicide Attempt History and Future Suicidal Ideation

This study examined whether rumination and certainty about pessimistic future-event predictions (P-Certainty) would mediate the relation between lifetime suicide attempt history and future suicidal ideation. Young adults, ages 18–25 (N = 143), with a suicide attempt history (n = 32) or no previous suicide attempt history (n = 111) at baseline, were followed up 2–3 years later and completed measures of rumination, depressive symptoms, hopelessness, suicidal ideation, and pessimistic future-event certainty. Lifetime suicide attempts at baseline were associated with higher suicidal ideation at follow up, and this relation was mediated by rumination and P-Certainty. Suicide attempters may be vulnerable to later ideation due to higher levels of rumination and also certainty in their pessimistic future expectations.     

The Influence of Death Exposure on Suicidal Thoughts and Behaviors

The present study investigated the relationship between exposure to both suicidal and non-suicidal deaths and current suicidal ideation and suicide attempt history among urban college students. Three hundred and ninety-six (n = 396) undergraduate students attending an urban university completed a series of questionnaires assessing their exposure to death (including suicide), suicide attempt history, and current level of suicidal ideation. Exposure to suicide and non-suicidal death were not related to current suicidal ideation; however, students who had made a suicide attempt were more likely to have been exposed to a death by suicide or acute disease. The findings of this study suggest that exposure to death by suicide or acute disease increased the likelihood a student made a past suicide attempt.     

Regional Brain Glucose Uptake Distinguishes Suicide Attempters from Non-Attempters in Major Depression

This study compared regional cerebral metabolic rates of glucose (rCMRglu) determined by [¹⁸F]-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) in suicide attempters and non-attempters. Medication-free patients with major depression (n = 29) had FDG-PET after single-blind administration of placebo (day 1) and fenfluramine (day 2). Suicide attempt history was obtained before scanning and at assessments over 2 subsequent years. Statistical parametric mapping evaluated associations between attempt status and rCMRglu, controlling for age. The study included 13 patients with and 16 without a history of suicide attempt within 2 years before or after scanning. After placebo, rCMRglu in attempters was lower in right dorsolateral prefrontal regions and higher in ventromedial regions than in non-attempters. After fenfluramine, relatively hypometabolic areas enlarged, and no hypermetabolic areas were detected. Distinct rCMRglu patterns may be serotonin-sensitive biomarkers of suicide risk.     

Suicidality in eating disorders: clinical and psychological correlates

Although many authors have described eating disorders as often being associated with suicidal feelings and behaviour, few studies to date have evaluated the prevalence and characteristics of suicidal behaviour in eating disordered patients. In the present study, in which a consecutive series of 495 out-patients was studied, 13% of the patients reported at least one suicide attempt and 29% reported current suicidal ideation; 26% of attempters reported multiple attempts. A history of suicide attempt was more prevalent among binge-eating/purging anorexics and among purging bulimics than in the other subgroups. In cases with anorexia nervosa, suicide attempters were older, had a longer illness duration, weighed less, had more often used drugs and/or alcohol and tended to be more obsessive than non-attempters. In cases with bulimia nervosa, attempters presented with more psychiatric symptoms and had more frequently been sexually abused.     

The Relationship of Self-reported Executive Functioning to Suicide Ideation and Attempts: Findings from a Large U.S.-based Online Sample

An increasing number of studies demonstrate that individuals with a history of suicidality exhibit impaired executive functioning abilities. The current study examines whether these differences are linked to suicidal thoughts or suicidal acts—a crucial distinction given that most people who think about suicide will not act on their thoughts. A large online sample of U.S. participants with a history of suicide ideation (n = 197), suicide attempts (n = 166), and no suicidality (n = 180) completed self-report measures assessing executive functioning, suicide ideation and attempts; in addition, depression, self-efficacy, and history of drug abuse and brain injury were assessed as potential covariates. Individuals with recent suicide attempts reported significantly worse executive functioning than ideators. This difference was not accounted for by depression, self-efficacy, history of drug abuse or brain injury. Self-reported executive functioning may represent an important short-term risk factor for suicide attempts.     

Comparisons of Prisoners Who Make or Do Not Make Suicide Attempts and Further Who Make One or Multiple Attempts

Suicidal behavior among prisoners is a major problem. The objective of this study was to compare prisoners who have made an attempt at suicide vs non-attempters and further to compare single vs multiple suicide attempts. Among 1,537 prisoners, 200 (13%) had a lifetime history of attempting suicide and 92 (6%) had made multiple attempts. Those who had made multiple or single attempts were compared on socio-demographic, developmental, personality, forensic, and psychiatric variables. In a re-analysis we also compared non-attempters with attempters in this larger sample. The comparison showed that prisoners who had made multiple attempts had experienced significantly more childhood trauma, were more introverted, less resilient, had a history of self-mutilation, and had more suicidal ideation. Anger and hostility scores and criminal and violence histories significantly differentiated prisoners who had attempted from those who had never attempted but they did not differentiate multiple from single attempters. Having a history of multiple attempts may be indicative of more severe psychopathology in prisoners, as found in other populations. These findings may be helpful in predicting which prisoner is at increased risk of exhibiting suicidal behavior while incarcerated and after release.     

Are structural brain abnormalities associated with suicidal behavior in patients with psychotic disorders?

Suicide represents a major health problem world-wide. Nevertheless, the understanding of the neurobiological underpinnings of suicidal behavior remains far from complete. We compared suicide attempters to non-attempters, and high vs. low lethality attempters, to identify brain regions associated with suicidal behavior in patients with psychotic disorders. 489 individuals with schizophrenia, schizoaffective disorder, or psychotic bipolar disorder I and 262 healthy controls enrolled in the B-SNIP study were studied. Groups were compared by attempt history and the highest medical lethality of previous suicide attempts. 97 patients had a history of a high lethality attempt, 51 of a low lethality attempt and 341 had no attempt history. Gray matter volumes were obtained from 3T structural MRI scans using FreeSurfer. ANCOVAs were used to examine differences between groups, followed by Hochberg multiple comparison correction. Compared to non-attempters, attempters had significantly less gray matter volume in bilateral inferior temporal and superior temporal cortices, left superior parietal, thalamus and supramarginal regions, right insula, superior frontal and rostral middle frontal regions. Among attempters, a history of high lethality attempts was associated with significantly smaller volumes in the left lingual gyrus and right cuneus. Compared to non-attempters, low lethality attempters had significant decreases in the left supramarginal gyrus, thalamus and the right insula. Structural brain abnormalities may distinguish suicide attempters from non-attempters and high from low lethality attempters among individuals with psychotic disorders. Regions in which differences were observed are part of neural circuitries that mediate inhibition, impulsivity and emotion, visceral, visual and auditory perception.     

Past suicidal ideation as an independent risk factor for suicide behaviours in patients with depression

Objectives: As South Korea has the highest incidence of completed suicides, the present study aimed to investigate the predictive power of the variables that have been associated with suicide attempts in Korean patients diagnosed with depression.

Methods: Hundred participants were divided into two groups: suicide attempters (31%) and suicide non-attempters (69%). Participants with a history of more than one suicidal attempt were assigned to the suicide attempter group. A hierarchical logistic regression analysis was performed to determine the predictive strengths of the variables that were likely to be associated with suicide attempts.

Results: After controlling for the effects of such variables as the severity of depressive symptoms, life stress events and impulsivity, the severity of past suicidal ideation was the most important predictive factor for discriminating suicide attempters from suicide non-attempters. The odds ratio for attempting suicide relative to not attempting suicide increased by a factor of 4.408 for each unit of increase in suicidal ideation.

Conclusions: The present study suggests that the most severe suicidal ideation throughout one’s entire life should not be overlooked and may be a major predictor of the risk of suicide.     

Suicidal behaviour and the co-occurrence of behavioural,emotional and cognitive problems among adolescents

Abstract

The co-occurrence of addiction-risk behaviour. Aggressive/criminal behaviour, emotional problems and cognitive problems was investigated in a population-based sample of 477 secondary school students with a history of suicidal behaviour and a similar matched sample of 477 students without such a history. More non-attempters than attempters had problems in a 'single' problem category, whereas more attempters than non-attempters had problems in 'multiple' categories. The number or accumulation of emotional, behavioural and/or cognitive problems seems of more importance in relation to a history of suicidal behaviour than the specific type of problem. Within the subgroup of suicide attempters. the co-occurrence of symptoms of different disorders was rather the rule than the exception, which raises doubts upon the validity of the prevailing diagnostic and classification systems, such as DSM or ICD.     

Parental Mental Disorders and Suicidal Behavior in the Nigerian Survey of Mental Health and Well-Being

The objective of this study was to determine which parental mental disorders predict offspring suicidal behavior in a general adult population sample of a sub-Saharan African country. The World Health Organization Composite International Diagnostic Interview, version 3 was used to assess respondents' suicidal behaviors as well as psychopathology in their parents. The effects of parental disorders in predicting offspring suicide ideation and attempts were examined in a series of bivariate and multivariate models. Sections on suicidality were administered to the entire sample (n = 6752), but associations with parental psychopathology were examined in a subsample of respondents (n = 2143). Lifetime prevalence (95% confidence interval) of suicide ideation, plans, and attempts was 3.2% (1.4–6.5), 1.0% (0.4–7.5), and 0.7% (0.5–1.0) respectively. Parental panic disorder and substance abuse were associated with suicide ideation in offspring, but only parental panic disorder was linked to suicide attempts. Parental panic disorder predicted the onset and persistence of suicide ideation and attempts and also which persons with suicide ideation go on to make a suicide attempt. This study further affirms findings from previous studies of the role of disorders characterized by anxiety and impulse control in suicide attempts and as being a probable link in the transmission of suicidal behavior to offspring.     

Postcards in Persia: A Twelve to Twenty-four Month Follow-up of a Randomized Controlled Trial for Hospital-Treated Deliberate Self-Poisoning

This study reports the outcomes, during follow-up, of a low-cost postcard intervention in a Randomized Control Trial of hospital-treated self-poisoning (n = 2300). The intervention was 9 postcards over 12 months (plus usual treatment) versus usual treatment. Three binary endpoints at 12–24 months (n = 2001) were: any suicidal ideation, suicide attempt, or self-cutting. There was a significant reduction in any suicidal ideation (RRR 0.20 CI 95% 0.13–0.27), (NNT 8, 6–13), and any suicide attempt (RRR 0.31, 0.06–0.50), (NNT 35, 19–195), in this non-western population. However, there was no effect on self-cutting (RRR -0.01, -1.05–0.51). Sustained, brief contact by mail may reduce some forms of suicidal behavior in self-poisoning patients during the post intervention phase.     

Increased Suicidal Ideation in Patients with Co-Occurring Bipolar Disorder and Post-Traumatic Stress Disorder

Suicide risk increases for those with Bipolar Disorder or PTSD, however little research has focused on risk for co-occurring Bipolar Disorder and PTSD. The aim of this article was to evaluate increased suicide risk in co-occurring disorders, and differences in suicide risk for patients with Bipolar I versus Bipolar II. This study evaluated suicide risk in patients with co-occurring PTSD and Bipolar Disorder (n = 3,158), using the MADRS and Suicide Questionnaire. Those with history of PTSD had significantly higher suicidal ideation than those without (U = 1063375.00, p < .0001). Those with Bipolar I had higher risk than those with Bipolar II. Patients with Bipolar I and PTSD were at higher risk for suicidal ideation, implying the importance of diagnosis and risk assessment.     

Characteristics of Recent Suicide Attempters with and without Borderline Personality Disorder

The present research compared recent suicide attempters with and without a diagnosis of Borderline Personality Disorder (BPD). One hundred and eighty recent suicide attempters, recruited in the Emergency Department, participated in extensive research interviews. Results showed that suicide attempters with BPD displayed greater severity of overall psychopathology, depression, hopelessness, suicidal ideation, past suicide attempts, and had poorer social problem solving skills than those without a BPD diagnosis. No differences were found between the groups regarding the intent to die or lethality associated with the index suicide attempt. These findings highlight the seriousness of BPD and the risk that individuals diagnosed with this disorder will attempt suicide.     

Characteristics of recent suicide attempters with and without Borderline Personality Disorder.

The present research compared recent suicide attempters with and without a diagnosis of Borderline Personality Disorder (BPD). One hundred and eighty recent suicide attempters, recruited in the Emergency Department, participated in extensive research interviews. Results showed that suicide attempters with BPD displayed greater severity of overall psychopathology, depression, hopelessness, suicidal ideation, past suicide attempts, and had poorer social problem solving skills than those without a BPD diagnosis. No differences were found between the groups regarding the intent to die or lethality associated with the index suicide attempt. These findings highlight the seriousness of BPD and the risk that individuals diagnosed with this disorder will attempt suicide.     

Suicidal Ideation among Attendees of a West African HIV Clinic

The paucity of information on suicide and its related issues among people living with HIV/AIDS (PLWHA) can impair evidence guided intervention. This study was set to determine the prevalence of suicidal ideation and the associated risk factors among PLWHA. A total of 295 participants made up of HIV positive individuals were subjected to a sociodemographic/clinical profile questionnaire. This was followed by the 28-item General Health Questionnaire (GHQ-28), suicidal intention item from the Beck Depression Inventory (BDI) and World Health Organisation Quality of Life (WHOQOL)—Bref scale to assess emotional distress, suicidal ideation, and quality of life respectively. The prevalence of suicidal ideation among PLWHA was 13.6%; and being unmarried, poor medication adherence, and poorer quality of life were significantly associated (p < 0.05) with suicidal ideation; while unemployment (odds ratio [OR] = 0.200; 95% Confidence Interval [CI] = 0.084–0.476; P < 0.001), emotional distress (OR = 5.734; 95% CI = 2.119–15.519; P—0.001), religion (OR = 4.829; 95% CI = 1.639–14.231; P—0.004), HIV status non-disclosure (OR = 2.630; 95% CI = 1.015–6.809; P—0.046) and previous suicidal attempt (OR = 0.172, 95% CI = 0.042–0.705; P—0.014) were not only associated but predictive of suicidal ideation in PLWHA. These findings indicate a significant burden of suicidal ideation, and psychosocial with clinical factors constitute identifiable risk factors among PLWHA. The development of evidence guided preventive and treatment measures against suicide among PLWHA are implied.     

Reduced dopamine function in depressed patients is related to suicidal behavior but not its lethality

Several lines of evidence suggest a role for dopamine in the control of suicidal behaviour. Previously, we suggested an involvement of D2-dopaminergic function in the biology of suicide by demonstrating a smaller growth hormone (GH) response to apomorphine, a dopaminergic agonist, in depressed patients who later died by suicide. The purpose of the present study was to assess GH response to apomorphine in major depressed in-patients with a history of highly lethal suicide attempt compared to depressed patients with a low lethal lifetime suicide attempt history and non-attempters. The study was performed in a sample of 26 male depressed in-patients with a history of suicide attempt compared to 26 male depressed non-attempters. We observed a significant difference between suicide attempters and non-attempters (for GH peak, 6.3+/-5.1 ng/ml vs 15.8+/-14.2 ng/ml, F=10.3, df=1, 50, P=0.002). Moreover, GH peak responses to apomorphine did not differ between depressed patients with a high lethal lifetime suicide attempt history and patients who made low lethal lifetime suicide attempt. In conclusion, the results of the present study support a role for dopamine in the biology of suicidal behaviour. More specifically, an impaired GH response to apomorphine could be a marker of suicide risk.     

Psychosocial profile of suicide ideators, attempters and completers in India

The study aims to determine the psychological profile of suicide ideators, attempters and completers in a tertiary care teaching hospital. A total of 260 suicidal ideators, 58 attempters and 55 completers were studied. The majority of ideators, attempters and completers were 26-35 years of age, males (except attempters who were predominantly females), married, literate up to high school, employed (ideators) or housewives (attempters and completers). The suicide ideators, attempters and completers who had a past history of attempt were 6.9%, 24.1% and 18.2% respectively. Family history of attempted suicide or completed suicide was also common among patients suffering from depression. In suicidal ideators, mixed anxiety and depressive disorder was the most common psychiatric diagnosis followed by major depression and schizophrenia. Among suicide attempters, adjustment disorder with depression was the most common diagnosis. The most common method of suicide attempt was organophosphorus compound intake whereas in suicide completers, the most common method in use was hanging. The patients with suicidal ideation or attempt need careful evaluation, early intervention and long term follow up.     

Change of suicidal ideation induced by suicide attempt

Some studies have reported that a suicide attempt has a cathartic effect. We studied a change of suicidal ideation just before and after a suicide attempt to test whether a cathartic effect exists and, if a cathartic effect does exist, to identify factors that may affect it. Subjects consisted of 88 suicide attempters (29 males, 59 females, mean age=35.5 years) who attended the emergency medical center of Kobe City General Hospital, Kobe, Japan. Strength of suicidal ideation just before and after a suicide attempt was evaluated by 11 steps from 0 to 10, where 0 indicates no suicidal ideation and 10 indicates the strongest suicidal ideation. Subjects were also interviewed about any clinical backgrounds related to suicide attempts. Diagnoses were made by psychiatrists based on ICD-10. Scores of suicidal ideation decreased significantly after the suicide attempt in comparison with those just before the suicide attempt (P<0.0001). In suicide attempters of each generation under 60 years of age, there were significant decreases in scores of suicidal ideation after the suicide attempt, but not in those of over 60 years of age. Scores of suicidal ideation after the suicide attempt were significantly higher in the group of F4 classified by ICD-10 than that of F2. Our results indicate that the cathartic effect induced by suicide attempt is different among generations and psychiatric disorders.