Adolescent suicide attempts 1973-1982 in the Helsinki area

Four hundred and twenty-two adolescent suicide attempts were examined. The intent to die was weaker than in adult persons. Within lethality no difference was found. Adolescents came mostly from the lowest social classes and their educational status was low. Their mental health was often unsatisfactory. The psychiatric treatment, which was arranged after the suicide attempt, was not more intensive than that arranged for adult suicide attempters.     

A 5-year follow-up study of suicide attempts

Johnsson Fridell E, Öjehagen A, Träskman-Bendz L. A 5-year follow-up study of suicide attempts. Acta Psychiatr Scand 1996: 93: 151–157. Q Munksgaard 1996. Seventy-five patients were admitted to the ward of the Lund Suicide Research Center following a suicide attempt. After 5 years, the patients were followed up by a personal semistructured interview covering sociodemographic, psychosocial and psychiatric areas. Ten patients (13%) had committed suicide during the follow-up period, the majority within 2 years. They tended to be older at the index attempt admission, and most of them had a mood disorder in comparison with the others. Two patients had died from somatic diseases. Forty-two patients were interviewed, of whom 17 (40%) had reattempted during the follow-up period, most of them within 3 years. Predictors for reattempt were young age, personality disorder, parents having received treatment for psychiatric disorder, and a poor social network. At the index attempt, none of the reattempters had diagnoses of adjustment disorders or anxiety disorders. At follow-up, reattempters had more psychiatric symptoms (SCL-90), and their overall functioning (GAF) was poor compared to those who did not reattempt. All of the reattempters had had long-lasting treatment (> 3 years) as compared to 56% of the others. It is of great clinical importance to focus on treatment strategies for the vulnerable subgroup of self-destructive reattempters.     

Adolescent suicide attempts: sex differences predicting suicide

Four hundred and twenty-two consecutive hospitalized suicide attempts made by 15-19 year old girls and boys in Helsinki area were investigated. One hundred and twenty suicide attempts were made by 115 boys and 302 by 247 girls. Differences between sex were analyzed. Boys had more severe adaptive problems. Their overall level of functioning was poorer than was that of the girls. Their physical health was not as good as that of the girls. Boys did not carry out more severe suicide attempts as concerns the estimated lethality and intent of the attempt, but their suicide attempts seemed to be connected with more severe physical, mental and social problems. Boys were more susceptible to alcohol provoked suicidal behaviour than girls, and they presented less appealing motives. The outcome of the boys was much worse than the outcome of the girls. Risk ratio for suicide during the 5-year follow-up was 2.0 for boys and 0.55 for girls. Risk ratio concerning violent death was 2.43 for boys and 0.33 for girls. Young male adolescents attempting suicide should be taken very seriously as a risk group for subsequent suicide.     

The outcome of adolescent suicide attempts

A sample of 265 adolescents hospitalized between 1971 and 1980 in a psychiatric unit following a suicide attempt was studied to evaluate outcome. After an average of 11.5 years, 48% of the original sample, or 127 subjects, could be traced. Thirty-nine per cent of these subjects showed signs of improvement, 22% appeared to be unchanged and 33% were worse. Substantial dropout rates were found in postdischarge care, only 32% of the patients having been followed up for a sufficient amount of time. Fifteen subjects had died, only one of whom from a natural cause. Of the remaining 14, 5 had committed suicide and 9 had died from unnatural or violent causes other than suicide, the cause of death appearing in all cases to be closely linked to the subject's adolescent disorders. The implications of these findings for suicide prevention are discussed.     

History of suicide attempts in pediatric bipolar disorder: factors associated with increased risk

BACKGROUND: Despite evidence indicating high morbidity associated with pediatric bipolar disorder (BP), little is known about the prevalence and clinical correlates of suicidal behavior among this population. OBJECTIVE: To investigate the prevalence of suicidal behavior among children and adolescents with BP, and to compare subjects with a history of suicide attempt to those without on demographic, clinical, and familial risk factors. METHODS: Subjects were 405 children and adolescents aged 7-17 years, who fulfilled DSM-IV criteria for BPI (n = 236) or BPII (n = 29), or operationalized criteria for BP not otherwise specified (BP NOS; n = 140) via the Schedule for Affective Disorders and Schizophrenia for School-Aged Children. As part of a multi-site longitudinal study of pediatric BP (Course and Outcome of Bipolar Youth), demographic, clinical, and family history variables were measured at intake via clinical interview with the subject and a parent/guardian. RESULTS: Nearly one-third of BP patients had a lifetime history of suicide attempt. Attempters, compared with non-attempters, were older, and more likely to have a lifetime history of mixed episodes, psychotic features, and BPI. Attempters were more likely to have a lifetime history of comorbid substance use disorder, panic disorder, non-suicidal self-injurious behavior, family history of suicide attempt, history of hospitalization, and history of physical and/or sexual abuse. Multivariate analysis found that the following were the most robust set of predictors for suicide attempt: mixed episodes, psychosis, hospitalization, self-injurious behavior, panic disorder, and substance use disorder. CONCLUSIONS: These findings indicate that children and adolescents with BP exhibit high rates of suicidal behavior, with more severe features of BP illness and comorbidity increasing the risk for suicide attempt. Multiple clinical factors emerged distinguishing suicide attempters from non-attempters. These clinical factors should be considered in both assessment and treatment of pediatric BP.     

Characteristics of HIV patients who attempt suicide

OBJECTIVE: To examine the risk factors for suicidal behaviour in human immunodeficiency virus (HIV) positive patients. METHOD: HIV substance dependent positive patients who had attempted suicide were compared with HIV substance dependent positive patients who had never attempted suicide for suicide risk factors. RESULTS: Among the 149 HIV positive patients examined almost half had attempted suicide. Significantly more HIV positive patients who had attempted suicide were female. Attempters were significantly younger than non-attempters. Significantly more of the attempters had a family history of suicidal behaviour. Attempters also reported significantly more childhood trauma, scored significantly higher for neuroticism, had experienced significantly more comorbidity with depression, and more of them had received antidepressant medication. CONCLUSION: These data suggest that both distal and proximal risk factors are involved in suicidal behaviour in HIV positive substance dependent patients.     

The familial aggregation of adolescent suicide attempts

The objective of this study was to determine whether the familial aggregation of suicidal behaviour is explained by the familial aggregation of personality disorder and aggression. The relatives of 62 clinically referred adolescent suicide attempters were compared with 70 never-suicidal psychiatric controls. The first-degree relatives of the suicide attempters had a higher rate of suicide attempts/completion than those of the psychiatric controls. This rate remained significantly higher after controlling for Axis I and II differences in the probands and the relatives, but familial personality disorder was significantly associated with suicidal risk in probands. Among the adolescent attempters, high scores on a measure of assaultiveness were associated with significantly higher familial rates of suicide attempts/completion. Our results support the hypothesis that suicidal behaviour may be transmitted as a trait independent of Axis I and II psychopathology but that, in addition, personality disorder has a role in the transmission of suicidal behaviour. An interrelationship between proband assaultiveness and the familial aggregation of suicidality was noted.     

Comparison of depressed patients with and without suicide attempts in their past history

Forty-eight inpatients with the diagnosis of a Brief or Prolonged Depressive Reaction according to ICD-9 who had attempted suicide just before the admission were compared to 24 inpatients with the same diagnosis but no history of previous suicide attempts. The variables investigated included sociodemographic characteristics, family history, life events within the year prior to admission, social functioning, social support, and personality factors. The comparison of these two groups revealed that alcoholism and suicide attempts in first degree relatives, and divorce or separation of the patients' parents predispose for a depressive reaction associated with the suicidal behavior. No differences between the two patient groups were found for personality factors, number and quality of life events in the year before index admission, social functioning, and social support during the last 4 weeks. Due to the small number of patients in both groups the conclusions drawn are preliminary.     

自杀未遂者出院后再次出现自杀行为的6年随访

目的 了解自杀未遂者再自杀情况及其影响因素.方法 对115例住院自杀未遂者出院后18个月、3年、5年、6年进行4次随访.结果 115例自杀未遂者中6年内21例再次出现自杀行为(18.3%),其中自杀死亡5例(4.3%).21例再次自杀者平均年龄(44.2±14.3)岁,13例有精神障碍(61.9%),8例既往(入院前)有自杀未遂史(38.1%),与94例无再次自杀行为者比较,两组在年龄(t=3.42)、精神疾病(χ2=11.20)、既往自杀未遂史(χ2=24.18) 方面的差异有统计学意义(均P<0.05).Logistic回归分析,仅既往自杀未遂史(P＜0.01,OR=10.21,β=2.32)进入回归方程.115例自杀未遂人群总的随访时间为723.55人年,以此推算6年内该组自杀未遂者群体年人均自杀死亡率为0.7%,年人均自杀未遂率为2.2%,年人均自杀行为率为2.9%.结论 部分自杀未遂者会再次出现自杀行为,而既往有自杀未遂史和有精神障碍的自杀未遂者更易再次发生自杀行为.     

The possible factors affecting suicide attempts in the different phases of the menstrual cycle

This study was designed to investigate whether there is a relationship between the menstrual cycle and suicide attempts, and to determine the factors affecting suicide attempts in different phases of the menstrual cycle. The study sample included 52 women who were admitted to the emergency room because of a suicide attempt. The incidence of suicide attempts in menstrual follicular phase (MFP) was significantly higher than in other phases. No significant difference of socio-demographic and clinical characteristics was observed between MFP and the other phases. Also, hormone levels of patients who attempted suicide were not different from those of healthy control subjects. In spite of the fact that suicide attempts were often made in MFP, there was substantial difficulty in explaining why this frequency was different than other phases. Furthermore, the event may be linked to low estrogen and progesterone levels in this phase. It has, however, been thought that hormonal effects cannot be responsible alone for suicide attempts.     

Impulsivity and aggression as predictors of suicide attempts in alcoholics

Introduction: The aim of this study was to assess the potential role of impulsive and aggressive behavior in the pathogenesis of suicide attempts in alcoholics. Impulsive and aggressive behavior as well as a psychiatric comorbidity with depressive conditions and personality disorders have been reported to be significant risk factors for suicide attempts in alcoholics. We hypothesized that alcoholics with a history of violent suicide attempts show an increased level of impulsive and aggressive behavior. Furthermore, the potential influence of concurrent personality disorders and depressive conditions were assessed. Material and methods: 182 detoxified alcohol-dependent subjects were enrolled into the study. Impulsive and aggressive traits were assessed using the Buss-Durkee Hostility Inventory and the Brown-Goodwin Assessment for Lifetime History of Aggression, personality disorders using the SCID II. Characteristics of alcohol dependence and suicide attempts were evaluated using the Semi-Structured Assessment on Genetics in Alcoholism (SSAGA). Results: Alcohol-dependent subjects with a history of suicidal behavior show a profile with higher impulsive and aggressive behavior. No significant association between these traits and concurrent borderline and antisocial personality disorder was found. Subjects with suicide attempts tended to have a significantly higher rate of depressive disorders. Discussion: These results suggest that impulsive and aggressive traits might contribute significantly to the risk of suicide attempts in alcoholics. Received: 14 December 2001 / Accepted: 3 April 2002     

Sex differences in risk factors for suicide after attempted suicide

Abstract.Aim: This study aims to investigate suicide risk factors after attempted suicide and whether and how these risk factors differ between the sexes.Method: A total of 1052 suicide attempters admitted to the Medical Emergency Inpatient Unit, Lund University Hospital, Sweden were followed up concerning suicide and death from other causes after a median period of 6 years and 5 months. In all, 50 persons committed suicide during follow-up. At the index suicide attempt, socio-demographic data and information about clinical characteristics were gathered in a standardised manner. Risk factors were identified among these data using survival analyses for the whole sample and for each sex separately.Result: Men had a higher frequency of suicide and a greater overall mortality than women. Cox regressions showed that suicide attempt(s) prior to the index attempt and the use of a violent method for the index attempt were risk factors for men only, whereas older age and a high suicidal intent (Beck SIS score) were female ones. Major depression was a risk factor for both sexes.Conclusion: More attention probably needs to be paid to the importance of gender in assessment of suicide risk and treatment of suicide attempters.     

Suicide and suicide attempts in general hospital psychiatry: Clinical and statistical study

Abstract Thirty-six psychiatric patients with completed suicide, 162 with attempted suicide and 154 patients referred for suicidal behavior, four of whom died, were investigated and classified according to the ICD-10. Thirty-six patients with completed suicide among 9085 new psychiatric patients (1969-92) gave a suicide rate of 82.6/100 000 per year. Schizoaffective and depressive disorder in psychiatric patients with completed suicide and schizophrenia, depressive disorder and adjustment disorders in patients with attempted suicide were significantly more frequent than in 312 controls. Intrafamilial conflicts, divorce or loss of love and death or severe disease of family member were the most common precipitants. Loneliness from living alone in males, losing a spouse and intrafamilial conflicts within a large family of three generations in females were supposed to be risk factors. A high referral rate of 48% in attempted suicide indicated the important role of consultation-liaison psychiatry in emergency medicine.     

Predictive factors of post-discharge follow-up care among adolescent suicide attempters.

OBJECTIVE: To study short-term compliance with follow-up care in a sample of adolescent suicide attempters. METHOD: One hundred and sixty-seven adolescents, aged from 13-18 years and hospitalized after a suicide attempt, completed a questionnaire that included the CES-Depression Scale and Zung Anxiety Scale. Physicians assessed the hospital care immediately after the attempt, and post-discharge care plans. Three months later, adolescents were contacted by telephone and asked about follow-up care. RESULTS: After 3 months, 91.6% of the adolescents could be contacted: 25.5% never attended any follow-up; 11.1% went only once; 31.4% missed some appointments; and 32.0% went to all their scheduled appointments. Adolescents who complied with follow-up care differed significantly from those who did not: they showed more depression, anxiety and illicit drug use at the time of the attempt; they had more often planned the attempt; they were hospitalized longer; and they met with a psychiatrist more often while hospitalized. Compliance was also better when the follow-up appointment was scheduled before discharge. CONCLUSION: Compliance with post-discharge follow-up care depends upon the adolescent's psychopathology but may also be improved by the type of hospital care and post-discharge plans.     

Near-Fatal Self-Harm Among Canadian Adolescents

ObjectiveTo evaluate the clinical features of Canadian adolescents admitted to the intensive care unit (ICU) for medically serious self-harm.Methods2700 Canadian paediatricians were surveyed monthly over two years (January 2017 to December 2018) through the Canadian Paediatric Surveillance Program to ascertain data from eligible cases.ResultsNinety-three cases (73 female; age 15.2 ± 1.5) met the case definition. Four provinces reported the majority of cases: Quebec (n = 27), Ontario (n = 26), Alberta (n = 21), and British Columbia (n = 8). There were 10 deaths, 9 by hanging. Overdose and hanging were the most frequently reported methods of self-harm (74.2% and 19.4%, respectively). Overdose was more common in females (80.8% females vs. 50% males; χ² = 7.8 (1), p = .005), whereas hanging was more common in males (35% males vs. 15.1% females, χ² = 3.9 (1), p = .04). More females than males had a past psychiatric diagnosis (79% vs. 58%; χ² = 4.1 (1), p = .06), a previous suicide attempt (55.9% vs. 29.4%, χ² = 3.8 (1), p = .05), and prior use of mental health service (69.7% vs. 27.8%, χ² = 10.4 (1), p = .001). Family conflict was the most commonly identified precipitating factor (43%) of self-harm.ConclusionsAmong Canadian adolescents admitted to the ICU with medically serious self-harm, females demonstrate a higher rate of suicide attempts and prior mental health care engagement, whereas males are more likely to die by suicide. These findings are consistent with data from other adolescent samples, as well as data from working-age and older adults. Therefore, a sex-specific approach to suicide prevention is warranted as part of a national suicide prevention strategy; family conflict may be a specific target for suicide prevention interventions among adolescents.