The InterSePT suicide scale for prediction of imminent suicidal behaviors

The present study examined the ability of the International Suicide Prevention Trial (InterSePT) Scale for Suicidal Thinking (ISST) and the Calgary Depression Scale (CDS) to predict suicide attempts or hospitalizations to prevent attempts (referred to as Type 1 events) during the InterSePT trial [Meltzer, H.Y., Alphs, L., Green, A.I., Altamura, A.C., Anand, R., Bertoldi, A., Bourgeois, M., Chouinard, G., Islam, M.Z., Kane, J., Krishman, R., Lindenmayer, J.P., Potkin, S., 2003. Clozapine treatment for suicidality in schizophrenia. Archive of General Psychiatry 60, 82-91]. The primary goal of this analysis was to determine if the ISST and CDS ratings indicated that the raters, an unblinded (UP) and a blinded psychiatrist (BP) using the ISST, and a blinded rater using the CDS, were able to identify those patients who had a Type 1 event. The ratings of patients adjudged to have experienced a Type 1 event (Group 1) were compared with patients who did not (Group 2). The ISST and the CDS ratings obtained 2-8 weeks prior to a Type 1 event (Pre-1) and Pre-2, the rating immediately prior to Pre-1, obtained 2-12 weeks before Pre-1, were analyzed to test the hypothesis that the difference between Pre-2 and Pre-1 ratings for the Group 1 patients was significantly greater than the difference in the comparable ratings for Group 2 patients. The prediction that patients with Type 1 events would show greater worsening in ISST and CDS ratings between Pre-2 and Pre-1 than the Group 2 patients was confirmed. However, the sensitivity and specificity of a worsening in ratings was not sufficient to provide definitive warning of an impending Type 1 event. Other characteristics of the patients with Type 1 events provide additional warning: e.g. overall higher ratings on these scales, slower improvement in suicidality during treatment, and previous number of suicide attempts. These results indicate that the ISST and CDS may provide some additional information that can assist clinical decision making regarding suicidal risk in patients with schizophrenia or schizoaffective disorder.     

The role of psychopathology and suicidal intention in predicting suicide risk: a longitudinal study

OBJECTIVE: In this study, we describe psychological symptoms, any relationship with suicidal intention in a sample of subjects recently attempting suicide and the predictive value of this association in later completed suicide. METHODS: An assessment was made of 467 suicidological consultations carried out by the Suicidology Unit of the Department of Neurology and Psychiatry, University of Padua, on 421 patients admitted to hospital following attempted suicide in the 5-year period 1990-1994. Suicidal intention was appraised by the Intent Score Scale (ISS). Suicide mortality was assessed after a mean follow-up period of 3.5 years. RESULTS: Psychiatric evaluation was completely negative in only 8% of cases. The most commonly identified symptom was depressed mood (79% of cases, 22% severe depression), followed by anxiety (43% of cases, 32% severe anxiety). From the study, it emerged that psychopathology seemed to influence suicidal intent, where this was characterized by severe depression. Anxiety and other symptoms appeared to have a secondary role. Assessments of suicidal intent showed that intention heightened as the number of symptoms increased. The symptom 'anxiety' did not prove to have a significant bearing on assessment of the seriousness of suicidal intention, whereas severely depressed mood did. The total number of subsequent suicide victims was 5.5%. During consultation relating to the index parasuicide, these subjects did not manifest a discriminate psychopathological profile (the only distinguishing characteristic was anxiety, which was less frequently identified in suicide victims), but did present a more positive personal and family psychiatric history. CONCLUSIONS: In subjects who had recently attempted suicide, the psychopathological profile appeared to be related to suicidal intent, where this was characterized by severe depression. Anxiety and other symptoms seemed to have a secondary role. Nonetheless, both total scores and subscores should be taken into consideration when assessing suicidal intention through the ISS. The psychopathological profile and ISS score following attempted suicide do not appear to permit prediction, in the medium to long term, of subsequent completed suicide.     

抑郁症自杀行为遗传流行病学对照研究

目的　探讨遗传因素在抑郁症自杀行为中的作用。方法　采用病例对照研究方法对 10 3例抑郁症自杀行为先证者和 10 3例对照的亲属资料进行遗传流行病学研究。结果　 2 4 2 7%的先证者的Ⅰ级亲属有自杀行为 ;Ⅰ级亲属、Ⅱ级亲属发生率依次为 4 5 6 %、1 6 0 % ,显著高于对照组Ⅰ级亲属发生率 0 2 6 4 % (P <0 0 1) ,其OR值及95 %可信区间分别为 18 0 7(4 33～ 75 4 0 )、6 16 (1 4 3～ 2 6 6 3) ,且Ⅰ级亲属自杀行为发生率 >Ⅱ级亲属 >Ⅲ级亲属>群体自杀行为发生率。采用Li mantel Gart法得分离比及 95 %可信区间为 0 12 88(0 0 991～ 0 15 85 )。多基因阈值模型估计 ,抑郁症自杀行为先证者Ⅰ、Ⅱ、Ⅲ级亲属的遗传度分别为 71 5 2± 11 0 2 %、4 1 92± 11 81%、31 0 9±13 2 9% ,三者加权平均遗传度为 4 9 38± 3 99%。结论　抑郁症自杀行为具有多基因遗传的特点 ,遗传因素在决定抑郁症自杀行为的易患性上起到重要的作用。     

Outcomes of suicidal behaviors

Research issues associated with outcomes of suicidal behavior include: the appropriate length of time to follow subjects is at least two years, psychiatric controls without a history of suicide attempt are a recommended comparison group, quantitation of traits such as aggression or impulsivity is desirable. Clinical issues include the following: the diathesis for suicide is a trait, the most universal risk factor across groups is the presence of depression, yet under-treatment, such as inadequate dosing of antidepressants and high rates of drop-out from psychotherapy, is a major problem. Other issues include that treatment must take a lifelong perspective, there is an ongoing need for psychoeducation of practitioners and the public, outreach to institutions such as schools, hospitals and jails is needed, when a child or adolescent exhibits suicidal behavior, parents should be screened for psychiatric illness, there is an urgent need to remedy barriers to treatment including insurance coverage obstacles, long wait-lists, and fragmentation of mental healthcare. Improvements should include a focus on step-down treatments and the integration of primary care and mental healthcare. Establishing a national registry of serious suicidal behavior to aid research, and clinical trials of treatments for suicidal behavior is important. Subpopulations for study include children, adolescents, the elderly, institutionalized persons, community samples (as distinct from clinical samples), persons with a family history of suicide (for genetic linkage studies), attempters versus completers, single versus multiple attempters and persons who drop out of treatment.     

The association between the suicide crisis syndrome and suicidal behaviors: The moderating role of personality traits

BackgroundPersonality traits have been associated with long-term suicide risk but their relationship with short-term risk is still unknown. Therefore, to address this gap, we explored the moderating effect of personality traits on the relationship between the Suicide Crisis Syndrome (SCS) and short-term suicidal behaviors (SB).Sampling and MethodsAdult participants (N = 459) were administered the Suicide Crisis Inventory (SCI), a validated self-report questionnaire designed to measure the intensity of the Suicidal Crisis Syndrome, the Big Five Inventory for personality traits, and the Columbia Suicide Severity Rating Scale for SB at intake and at a 1-month follow-up. The PROCESS macro in SPSS was used to test the moderation model. Covariates hypothesized to influence the results were added: age, gender, ethnicity, years of education, and depressive symptomatology on the Beck Depression Inventory. This study was a secondary analysis drawn from a larger study on the SCS.ResultsSCI total score had a significant positive relationship with SB at the 1-month follow-up for patients with lower levels of extraversion, agreeableness, conscientiousness, and openness, respectively. Hence, these four traits were protective against SB. There was an association between SCI and SB for patients with high levels of neuroticism at the 1-month follow-up.ConclusionsHigh levels of neuroticism served as a risk factor, whereas high levels of the other Big Five traits were protective factors against short-term SB in the context of elevated SCS symptoms. Thus, personality traits play a role in moderating the relationship between the SCS and imminent SB.     

TPH and suicidal behavior: a study in suicide completers

An association between the gene that codes for tryptophan hydroxylase (TPH)-the rate-limiting enzyme in the synthesis of serotonin-and suicidal behavior has been investigated with some detail in samples of living subjects who attempted suicide. In this study, we investigated TPH and suicide completion, the most severe form of suicidal behavior. A relatively large sample of suicide completers (n = 101) was genotyped at three TPH loci (two polymorphisms in the promoter region, A-6526G and G-5806T, and one in intron 7, A218C) and compared to psychiatrically normal living controls (n = 129). Although no significant differences were found between groups for genetic variation at single loci, haplotype analysis revealed that one haplotype (-6526G -5806T 218C) was significantly more frequent among suicide cases than in normal controls (chi(2) = 11.30, df = 2, P = 0.0008; OR = 2.0 CI: 1.30-3.6). Further analyses suggested that this haplotype is particularly more frequent among subjects who committed suicide using violent methods. Similar results were observed in recent haplotype analyses in suicide attempters, which found that the equivalent of haplotype -6526G -5806T 218C was more frequent in impulsive attempters (Rotondo et al, Mol Psychiatry 1999; 4: 360-368). Our results replicate in suicide completers previous data observed in suicide attempters. These and other results continue to point to the substantial role that the gene that codes for TPH may play in the neurobiology of suicidal behavior.     

Sociopsychological factors relating to suicide prevention in a Japanese rural community: coping behaviors and attitudes toward depression and suicidal ideation

In response to the rise in suicide in Japan since 1998, some suicide prevention measures in local communities have been put into action. However, in the previous suicide prevention measures, sociopsychological factors were not fully taken into consideration. In the present study, the authors surveyed sociopsychological factors relating to suicide and depression (i.e. people's coping behavior and thoughts about depression and suicidal ideation, and their attitudes toward suicide and psychiatric treatment), and their differences in gender and generations. The present study was conducted in a rural area of Japan (Town A), where the suicide rate is much higher than the national average. The authors randomly selected 10% of the residents (i.e. 532 people) aged between 40 and 79 years on the basis of resident registration. Health promotion volunteers in Town A visited these 532 people individually, distributed questionnaires, and asked them to anonymously answer the questionnaire within 4 weeks. Data from 450 residents (193 men, 257 women) were analyzed in the present study. Although there were few gender differences, some significant differences were found between the younger (40-59 years) and older (60-79 years) residents. Generally, the younger were more pessimistic about their mental health than the elderly. It was also noteworthy that about 10% of the people thought that it was natural for them to have suicidal ideation, and about 18% reported that they had experienced suicidal ideation. Some suggestions were given to provide more effective suicide prevention measures.     

Opiate addiction and suicidal behaviors.

The authors tested the hypothesis that people addicted to opiates manifest more psychopathology in areas that have been identified as predictors for high risk of suicidal behavior than do normal control subjects. They gave 278 patients in a methadone maintenance program and 207 normal control subjects the index of Potential Suicide (IPS), a scale designed to assess suicidal risk. Using discriminate function analysis, the authors found that 87% of 100 of the methadone patients and 98% of 100 of the normal control subjects were correctly identified on the basis of the IPS data.     

Exposure to suicide is associated with increased risk for suicidal thoughts and behaviors among National Guard military personnel

BackgroundResearch suggests that individuals who know someone who died by suicide are at increased risk for posttraumatic stress disorder (PTSD), depression, and recent suicidal thoughts. Studies have not yet investigated the association of suicide exposure with suicide attempts, however, especially among high-risk subgroups of military personnel such as the National Guard.ProceduresAn anonymous online survey was completed by 971 military personnel assigned to the National Guard in Utah and Idaho. Weighted analyses were conducted to ensure demographic matching to the full population. Univariate and multivariate logistic regression was used to test the association of suicide exposure with psychiatric condition, suicide ideation, and suicide attempts.Main findings65.4% of National Guard personnel reported knowing someone who had died by suicide. On average, participants knew 3.0 (SD = 2.0) suicide decedents. Total number of known suicide decedents was associated with significantly increased risk for PTSD (OR = 1.18, p = .008), depression (OR = 1.19, p = .003), and suicide ideation (OR = 2.48, p < .001), but not suicide attempt (OR = 1.34, p = .472). Perceived closeness to the suicide decedent was associated with significantly increased risk for PTSD (OR = 1.54, p < .001), depression (OR = 1.36, p = .031), suicide ideation (OR = 1.24, p = .039), and suicide attempt (OR = 1.69, p = .026). The majority of participants who experienced suicidal thoughts and attempts after the suicide exposure had a previous history of suicide ideation.ConclusionsSuicide exposure is common among National Guard personnel, and is associated with increased risk for PTSD, depression, and suicidal thoughts and behaviors. Risk is highest for those personnel who know multiple suicide decedents and were closer to the suicide decedent.     

Identifying a physical indicator of suicide risk: Non-suicidal self-injury scars predict suicidal ideation and suicide attempts

BackgroundSuicide risk is challenging to quantify due to reliance on self-report, which is limited by individuals' lack of insight and the desire to conceal such intentions. Non-suicidal self-injury (NSSI) is one of the most robust predictors of suicidal ideation (SI) and suicide attempts (SA). Although NSSI often leads to permanent scarring, which can be assessed by objective physical examination, no research has examined whether scarring denotes tangible risk for SI and SA. The present study examined whether NSSI scar presence and number predict current SI and SA history. Further, we examined whether brooding would exacerbate the effects of NSSI scarring on SI or SA.MethodsYoung adults (N = 231; M = 21.24 years; 78% female) completed self-report questionnaires assessing SA history, frequency of NSSI, presence/number of NSSI scars, brooding, current depressive symptoms, and SI.ResultsNSSI scar presence and number predicted current SI and SA history after controlling for current depressive symptoms. Moreover, scar presence and number predicted current SI over and above the effects of SA history and NSSI frequency, method, and medical severity. Further, NSSI scar presence and number predicted SI more strongly among individuals with greater levels of brooding than among individuals with lower levels of brooding.ConclusionsThe presence and number of NSSI scars are objective physical indicators of risk for SI and SAs. Brooding may further heighten the risk of SI for individuals bearing NSSI scars.     

Prevalence of specific suicidal behaviors in a high school sample

Of 380 high school students who completed an anonymous survey concerned with their experience with suicidal behavior, 60% reported that they had thought about killing themselves. These thoughts varied with respect to persistence and planfulness. Almost 9% reported that they had actually made at least one attempt to kill themselves and over half of the suicide attempters reported at least two attempts. Fewer than half of the attempters reached the attention of mental health professionals. The data on family history of suicidal behavior suggest that the suicidal ideators and the suicide attempters represent overlapping groups.     

Level of suicidal intent predicts overall mortality and suicide after attempted suicide: a 12-year follow-up study

Background  

The aim of this study was to comprehensively examine clinical risk factors, including suicide intent and hopelessness, for suicide and risk of death from all causes after attempted suicide over a 12-year follow-up period.     

具有凶杀行为的精神疾病患者自杀行为研究

目的:探讨具有凶杀行为的精神疾病患者自杀的危险因素。方法:调查1986年至2006年具有凶杀行为的精神疾病患者院内自杀身亡31例,采用多因素Logistic回归分析自杀行为危险因素。结果:具有凶杀行为精神疾病患者自杀男:女=3.43∶1,自杀行为的发生与家族自杀史、悔恨、绝望、心理社会因素及杀害对象有关。结论:悔恨、绝望、心理社会因素等是具有凶杀行为精神疾病患者自杀的危险因素,对于有凶杀行为的精神疾病患者自杀行为应加以干预。     

Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review

Objective: Involvement of personality traits in susceptibility to suicidality has been the subject of research since the 1950s. Because of the diversity of conceptual and methodological approaches, the extent of their independent contribution has been difficult to establish. Here, we review conceptual background and empirical evidence investigating roles of traits in suicidal behaviors. Method: We selected original studies published in English in MEDLINE and PsycINFO databases, focusing on suicidal ideation, suicide attempts, or suicide completions, and using standardized personality measures. Results: Most studies focused on investigating risk for suicide attempts. Hopelessness, neuroticism, and extroversion hold the most promise in relation to risk screening across all three suicidal behaviors. More research is needed regarding aggression, impulsivity, anger, irritability, hostility, and anxiety. Conclusion: Selected personality traits may be useful markers of suicide risk. Future research needs to establish their contributions in relation to environmental and genetic variation in different gender, age, and ethnocultural groups.     

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.     

The suicidal child: assessment and management of adolescents after a suicide attempt

It has been estimated that for each completed suicide, there are 15 to 20 nonfatal suicide attempts. A prior suicide attempt can create a major elevation in the risk of subsequent attempt. A prior suicide attempt also is a strong predictor for eventual completed suicide. Consequently, management of an adolescent who attempts suicide is important. In this article, the authors examine various issues related to suicide risk in adolescents. The article focuses on key issues that should be included in a thorough assessment of adolescents who are referred for an evaluation during a suicidal crisis. The empirical literature is used as a guide for identifying risk factors that should be monitored and managed as part of a comprehensive treatment plan.     

Migraine, suicidal ideation, and suicide attempts.

We examined the risk of suicide attempts and suicidal ideation separately in persons with (1) migraine with aura alone, (2) migraine with aura and coexisting major depression, (3) migraine without aura alone, and (4) migraine without aura and coexisting major depression. Persons with migraine with aura alone and migraine with aura and coexisting major depression had significantly higher rates of suicide attempts and suicidal ideation compared with persons with neither migraine nor major depression. The rates of suicide attempts and suicidal ideation in persons with migraine with aura and major depression were higher than the combined rates in persons with major depression alone and migraine with aura alone. In contrast, migraine without aura was not associated with an increased risk for suicide attempts and suicidal ideation.