Suicidal ideation and suicidal attempts in a population-based study of Chinese people: risk attributable to hopelessness, depression, and social factors

BACKGROUND: The population attributable fraction of hopelessness, depression and other risk factors for suicidal ideation and suicidal attempts in Asian population is unknown. Social support is often said to be a buffer against the effect of hopelessness and depression. METHODS: Suicidal ideation, suicidal attempts as well as demographic and psychometric data were delineated in a random and representative population sample of 2,219 Chinese people in Hong Kong. The population attributable fraction was used to determine the contribution of hopelessness, depression and other risk factors to suicidal ideation and attempts. RESULTS: Multivariate modelling shows that about 40% of suicidal ideation and attempts was attributable to depression and about 20% was attributable to hopelessness. Drug abuse and marital dissolution were also significant contributors to suicidality. The impact of hopelessness and depression was not affected by social support. LIMITATIONS: Suicidality was self-reported. CONCLUSIONS: Suicidal ideation and suicidal attempts were to a large extent attributable to depression and hopelessness, and, to a lesser extent, drug abuse and marital dissolution. Social support appeared to play little role as a buffer.     

A comparison of specific positive future expectancies and global hopelessness as predictors of suicidal ideation in a prospective study of repeat self-harmers

BACKGROUND: Hopelessness and the lack of positive future expectancies have been related to suicidality. This is the first study to compare the power of positive future expectancies and global hopelessness in the prediction of suicidal ideation. In short, are specific positive expectancies or global hopelessness attitudes more closely related to suicidality? METHOD: One hundred and forty four adults hospitalized following a suicidal self-harm episode completed a range of clinical and psychological measures in hospital and were followed up approximately 2.5 months after discharge. All participants reported at least one other self-harm episode in addition to the index episode. RESULTS: Hierarchical regression analyses confirmed that specific positive future expectancies were better predictors of Time 2 suicidal ideation than global hopelessness. In addition, as hypothesized, negative future thinking was not independently associated with suicidal ideation. LIMITATIONS: Short-term follow-up. CONCLUSIONS: Specific, idiographic expectancies for positive events (i.e., positive future thinking) are more important predictors of suicidal ideation than global attitudes of hopelessness. Unlike global hopelessness, they provide more options for intervention (e.g., identifying life goals and plans). These findings are particularly noteworthy given the widespread use of measures of global hopelessness. The theoretical and clinical implications are discussed.     

To know or not to know: a review of behaviour and suicidal ideation in preclinical Huntington's disease

OBJECTIVE: At present, the problems associated with suicidal ideation and suicide in Huntington's disease (HD), worldwide, are much the same as 2 decades ago. This study seeks to investigate the psychological complications of predictive testing in HD at risk populations. METHODS: The key problems of predictive testing, fear of acquiring carrier status, psychological consequences, autonomy, and rights to know are discussed. RESULTS: This review (1) describes psychological affect and problems of persons facing the decision to test for HD, (2) discusses suicidal ideation, behaviour, and catastrophic events associated with predictive testing, (3) assesses ethical questions raised in the genetic counselling, (4) questions whether counsellors should promote or advocate predictive testing, and finally (5) discusses what professionalism actually is in genetic counselling. CONCLUSION: The need for professional counselling, using a well designed protocol, and the importance of focusing on the suicide risk of participants in predictive testing programs are emphasized. PRACTICE IMPLICATIONS: The counsellor has an obligation to provide adequate information. The professionals should not promote nor advocate presymptomatic DNA-testing. Depression, hopelessness, anxiety, emotional distress, suicidal tendencies, and social dysfunction grading should be considered in predictive testing of HD.     

Risk behaviors,suicidal ideation and suicide attempts in a nationally representative French sample

Background

Data from large nationally representative samples are needed to provide the empirical foundation to inform health policies for the prevention of suicide risk and risk behaviors in men and women.

Methods

Data were extracted from the 2010 Health Barometer, a large telephone survey on a representative sample of the general population aged 15–85 years living in France (n=27,653), carried out by the National Institute for Health Promotion and Health Education. Data were collected between October 2009 and July 2010. A computer-assisted telephone interview (CATI) system was used.

Results

Overall, 3.9% of respondents aged 15 to 85 reported past year suicidal ideation, and 0.5% reported a suicide attempt in that time period. Increased rates of risky sexual behavior are associated with ideation and attempt in both men and women, after controlling for sociodemographic variables. Homosexuality or bisexuality are associated with suicidal ideation for both men and women, but not with attempts. Substance misuse, physical and sexual assaults are strongly associated with suicidal symptoms for both men and women. Early first experiences with sex, tobacco, and alcohol are associated with suicidal symptoms though somewhat differentially for men and women.

Limitations

Cross-sectional survey.

Conclusion

The findings underscore associations between suicidal thoughts and behaviors and risk behaviors such as unprotected sex and substance use in men and women throughout the lifespan. These associations highlight the need for preventive strategies such as screening for risk behaviors in order to identify men and women particularly at risk for suicidal behavior.     

Psychological factors associated with the incidence and persistence of suicidal ideation

Background

Suicidal ideation has been identified as both a common antecedent and a significant risk factor for suicide attempt and completed suicide. However, little is known about the incidence and persistence of suicidal ideation in the general population and the associated risk factors.

Methods

A 12-month follow-up survey investigated 997 of the respondents who participated in the baseline territory-wide survey of adult population in Hong Kong. A set of baseline psychological factors was considered as predictors of first onset and persistence of suicidal ideation.

Results

Twelve-month incidence (1.9%) and persistence (6.2%) rates were estimated. Respondents with anxiety and lack of reasons for living were more likely to report a development of suicidal thoughts in the follow-up assessment, while respondents with higher level of average life distress and lower level of hope were at increased risk of continuing to have suicidal thoughts. Depression was found to partially mediate the effect of average life distress on persistent suicidality.

Limitations

Retention rate of the follow-up sample was about 50% only. Assessments of suicidal ideation were based on retrospective reports.

Conclusions

Psychological factors differentially predict first onset and persistence of suicidal ideation. It is of clinical value that depression partially mediated the effect of life distress on persistence of suicidality.     

Protective associations of importance of religion and frequency of service attendance with depression risk, suicidal behaviours and substance use in adolescents in Nova Scotia, Canada

Purpose

We examined relationships of measures of personal importance of religion and frequency of attendance at religious services with risk of depression and risk behaviours in high school students in Cape Breton, Canada. We examined the impact of confounding and explanatory factors on these relationships.

Methods

Data were drawn from self-report surveys of adolescents aged 15-19 (N = 1615) at three high schools in May, 2006. We used logistic regression to assess associations of religious importance and religious service attendance with risk of depression, suicidal behaviour, binge drinking and frequent marijuana use, controlling in multivariate models for sociodemographic factors, family structure and social capital.

Results

Among females, higher personal importance of religion was associated with decreased odds of depression, suicidal ideation, drinking and marijuana use, while more religious attendance was protective for substance use behaviours and suicidal ideation. In males, both measures of religiosity were associated with decreased substance use. In multivariate models, religious importance had weak protective effects for depression and suicidal thinking in females, which were respectively modified by social trust and substance use. Attendance was protective for suicidal thinking in females, and was modified by depression. These associations were not seen in males. Attendance was consistently associated with less substance use in females, while importance was not. Importance was consistently protective for marijuana use and attendance was protective for binge drinking in males.

Limitations

This was a cross-sectional self-report survey and causality cannot be inferred.

Conclusion

Protective associations of measures of religiosity are seen in Canadian adolescents, as they are elsewhere.     

医学生的绝望感与自杀意念:心理韧性的作用机制

目的:探讨医学生的绝望感与心理韧性和自杀意念的关系,以及心理韧性在医学生的绝望感与自杀意念之间是否具有补偿、调节及中介效应。方法:采用贝克绝望量表(BHS)、自杀意念自评量表(SIOSS)和青少年心理韧性量表(RSCA)对1120名医学生进行施测。结果:绝望感各因子及总分与自杀意念呈显著正相关(r=0.443,0.472,0.493,0.608;P0.01),心理韧性总分与绝望感总分及各因子呈显著负相关(r=-0.555,-0.300,-0.500,-0.470;P0.01),心理韧性总分与自杀意念总分呈显著负相关(r=-0.528,P0.01)。医学生的心理韧性在其绝望感与自杀意念之间同时具有补偿(β=-0.275,-0.247,-0.199;P0.001)、中介(β=0.455,0.481,0.515;P0.001)和调节效应(B=-1.096,-1.013,-1.105;P0.001)。结论:心理韧性是抑制医学生自杀意念的重要保护因素,它可以补偿、缓冲和调节绝望感对自杀意念的促进作用,同时这一保护因素也会受到绝望感的削弱。     

726名一、四年级大学生自杀意念及其影响因素的研究

目的探讨一、四年级大学生自杀意念受相关因素的影响程度。方法采用问卷调查大连市高校726名一、四年级大学生,数据统计采用SPSS10．0统计软件进行数据管理与分析处理,统计方法主要采用t、F、与χ^2检验进行单因素分析、多元logistic回归进行多因素分析。结果通过Logistic回归分析：神经质、精神质、自杀行为、生命的价值观、人际关系等因子进入方程．均为自杀意念的影响因素。结论自杀意念影响因素的筛查,对易感因子和易感人群的早期发现,起到预警信号的作用。     

An evaluation of large group CBT psycho-education for anxiety disorders delivered in routine practice

OBJECTIVE: To determine the clinical utility and acceptability of a brief CBT psycho-educational course delivered in an NHS psychotherapy service. METHODS: All patients referred, found suitable for CBT, and who had an anxiety disorder, were invited to enrol in a psycho-education course, delivered in an outpatient mental health clinic by two mental health nurses with post-registration training in CBT. There were up to 24 patients in each course. Outcome measures used were CORE-OM and Fear Questionnaire administered pre-course and at 12-week follow-up and Client Satisfaction Questionnaire administered post-course. RESULTS: One-hundred and ninety one patients were referred. Of these 120 remained in contact with the service to the follow-up meeting. Ninety-seven patients were discharged at the follow-up point and 92 requested further individual psychotherapy. A number of patients made a clinical and reliable change as measured by CORE-OM and Fear Questionnaire. One-hundred and two patients completed the CSQ-8 reporting high satisfaction with the intervention. CONCLUSIONS: The intervention appears to be helpful for a number of patients and largely acceptable for most patients that attend. PRACTICE IMPLICATIONS: Large group psycho-educational interventions for anxiety disorders could be increasingly used as a method of delivering low intensity treatments within a stepped care model of the treatment of anxiety disorders. The intervention is relatively simple to deliver and potentially could be delivered by primary care clinicians.     

医学院学生自杀意念与希望特质、抑郁情绪的关系以及希望特质的调节作用

目的:探讨医学院学生的自杀意念与希望特质和抑郁情绪的关系,以及在其中希望特质的调节作用。方法:选择某医学院各年级学生按比例进行分层整群随机抽样调查,发放自杀意念自评量表(SIOSS)、希望特质量表(DHS)和抑郁自评量表(SDS)。回收有效问卷148份。结果:样本中自杀意念检出率为8.1%,其中有自杀意念组抑郁得分高于无自杀意念组(t=8.699,P0.001),希望特质评分低于无自杀意念组(t=-6.077,P0.001);抑郁得分与自杀意念得分成正相关(t=0.681,P0.01),希望特质得分与自杀意念得分成负相关(t=-0.328,P0.01)。并且分层回归显示,抑郁自评量表得分与希望特质的交互作用显著(t=-4.727,P0.01),即希望特质在抑郁情绪与自杀意念之间有显著的调节作用。结论:自杀意念与抑郁情绪消极相关,与希望特质积极相关。关注大学生抑郁情绪,提高大学生希望特质水平,可以增强危机因素的抵抗作用,有助于对大学生自杀危机干预工作提供科学参考。     

The effects of physical and psychological well-being on suicidal ideation

This study examines a theoretical model of suicidal ideation with physical symptoms (physical well-being) and self-esteem (psychological well-being) as two competitive predicting variables. The national sample of 1,433 cases was drawn in the People's Republic of China in March 1995. Results indicate that both suicidal ideation and attempt rates are lower in the Chinese population than in other populations studied, and as found in the West, Chinese women are more likely to think about and to attempt suicide than Chinese men. LISREL analysis of the model shows that psychological well-being (self-esteem) is a much stronger predictor of suicidal ideation than physical well-being (physical symptoms), especially when depression is introduced as an intervening variable in the model. © 1998 John Wiley & Sons, Inc. J Clin Psychol 54: 401–413, 1998.     

The prevalence of suicidal ideation and attempts among individuals attending an adult psychiatry out-patient clinic in Gondar, Ethiopia

Background

Suicide is a common problem worldwide and the magnitude is high especially in countries where mental illnesses are prevalent and psychiatric services are poor.

Objective

To determine the prevalence of suicidal ideation and attempts among patients who attended the Psychiatry clinic of Gondar University Hospital.

Methods

A cross sectional study was conducted from March–December 2006 involving a total of 474 patients. Data was collected using a pre tested structured questionnaire containing basic socio-demographic variables, psychiatric diagnosis, suicidal ideation, suicidal attempt, the methods of suicide attempt and ways of survival from the attempted suicide. It was administered by psychiatry nurses working in the clinic. The data was analyzed anonymously using SPSS software.

Results

The commonest mental illness was Major Depressive Disorder (51.3%) followed by Psychosis (38%). Ninety one (19.2 %) patients attempted suicide at least once after the onset of the current mental illness and 307(64.8%) have suicidal ideation. The common method of suicidal attempt was hanging (45.1%) and 69.2% were at home. An association was found between suicidal ideation and attempt (OR=33.7; CI=8.2–138.8, p-value <0.01).

Conclusion

Suicidal ideation was common in psychiatric patients. It was also associated with suicidal attempt.     

抑郁症患者自杀态度与自杀意念的关系研究

目的探讨抑郁症患者自杀态度与自杀意念的关系。方法采用自杀态度问卷(Q SA)和B eck自杀意念量表中文版(BS I-CV)对334名抑郁症住院患者进行调查。结果抑郁症患者自杀态度的4个因子均分都在2.5~3.5之间;其与自杀意念强度、自杀危险程度呈一定负相关关系(P<0.05);结构方程模型拟合表明,自杀态度通过自杀意念强度影响自杀危险程度(近1周:χ2=2870.04,P<0.05,NNF I=0.88,CF I=0.89;最消沉抑郁时:χ2=1599.41,P<0.05,NNF I=0.94,CF I=0.95);在"近1周"和"最消沉"2个时间段,自杀态度对自杀危险程度的间接影响作用分别为0.308和0.410,P<0.05。结论自杀态度通过自杀意念强度对自杀危险产生影响。     

Personality and reports of suicide ideation among depressed adults 50 years of age or older

BACKGROUND: Accuracy in patient reports of suicide ideation is a concern in clinical assessment, given that some patients deny suicide ideation even when suicidal. Despite this concern, there is little research on the psychological processes driving reported suicide ideation in at-risk patients. METHODS: A cross-sectional design was used to examine the association of personality and suicide ideation in a clinical sample of 134 depressed adults 50 years and older. Patients completed a structured diagnostic interview, an interviewer-rated measure of current suicide ideation and self-report measures of personality (NEO-Personality Inventory Revised; NEO-PI-R) and hopelessness. The main outcome variable in logistic regression analyses was suicide ideator status; covariates included comorbid psychopathology, hopelessness and physical illness burden. Predictors were Neuroticism and Openness to Experience (OTE) scores on the NEO-PI-R. RESULTS: Elevated OTE and neuroticism were associated with suicide ideation in unadjusted analyses; OTE was also associated with suicide ideation in adjusted regression analyses. LIMITATIONS: This study used a cross-sectional methodology with depressed patients 50 years or older; it is possible that patients' depression severity may have influenced their responses to personality measures. Prospective studies of personality vulnerability to future suicide ideation are warranted. CONCLUSIONS: Elevated neuroticism increases the likelihood of reporting suicide ideation, just as it may enhance risk for suicidal behavior and death by suicide. The pattern for openness is markedly different. Although elevated openness increases the likelihood of reporting suicide ideation, previous research has shown that it may decrease risk of death by suicide, suggesting that the personality-mediated expression of suicide ideation may be adaptive in certain contexts. In contrast, low levels of openness may mute reports of suicide ideation in at-risk patients and confer risk for poor outcomes by potentially undermining clinician vigilance.