The impact of migration and culture on suicide attempts of children and adolescents living in Istanbul

Abstract

Background. Suicidal attempts are steadily increasing in societies with rapid urbanisation and dramatic social changes in places like Istanbul. Stress related to internal migration may increase suicidal behaviour. Aim. We investigated the impact of internal migration and culture on suicide attempts among youth in Istanbul. Methods. We retrospectively analysed the records of 210 children and adolescents, aged 6–18 years, who presented at the Emergency Outpatient Clinic of the Department of Pediatrics at Cerrahpa?a Medical School in Istanbul because of suicide attempts between January 2008 and December 2010. Results. The majority of patients (78.95%, N = 165) had a background of internal migration, mostly (65%, N = 136) originating from regions with large cultural differences compared with that of Istanbul. Noticeably, more migrants than non-migrants (18.8% vs. 6.8%) and more patients originating from regions with large cultural differences chose high-risk methods for suicide attempts (20.7% vs. 8.1%). Conclusion. Internal migration can be considered a serious risk factor for suicidal behaviour. Furthermore, the degree of cultural differences between the area of origin and the new environment can be of vital importance. Healthcare measures should, therefore, focus on internal migration as a risk factor for youth suicidal behaviour and provide assistance for appropriate resettlement and integration in countries with increased mobility.     

Suicidal attempts by prescription drug overdose in the elderly: a study of 44 cases

A series of 44 consecutive elderly, admitted to a busy general hospital following deliberate self-poisoning, is reviewed for associated medical and psychosocial factors. In all but 3 cases the act involved an overdose of drugs prescribed for the treatment of a chronic medical and/or psychiatric disorder. Women outnumbered men by 2.7 to 1. There was high proportion of chronic psychiatric (80%, mostly depressive) and medical (60%) conditions. Chronic stress from the physical illness, social isolation, or tacit family conflict were common and seemed instrumental in the self-poisoning act. Most attempts were carried out around the weekend and during winter. One man succumbed to complications of the overdose but the rest of the patients recovered. Psychosocial (especially depressive) and medical vulnerability, plus availability of prescribed drugs, were the most important determinants of suicidal behavior among these elderly attempters.     

Self-compassion and family cohesion moderate the association between suicide ideation and suicide attempts in Chinese adolescents

BackgroundIn recent years, many studies have examined risks factors that facilitated the transition from suicide ideation to suicide attempts. Few studies, however, have examined protective factors against this transition. The current study thus assessed two protective factors, self-compassion and family cohesion, in buffering the transition from suicide ideation to suicide attempts.MethodA number of 520 Chinese adolescents (43.46% females, mean age = 12.96 years) completed questionnaires assessing self-compassion, family cohesion, suicide ideation, and suicide attempts two times with a 12-month interval.ResultsSelf-compassion significantly moderated the association between Wave 1 SI and later SA. The positive dimension of self-compassion thwarted the transition from SI and SA, and the negative dimension of self-compassion strengthened the associations. In addition, family cohesion also significantly moderated the transition from SI to SA.ConclusionIncreasing the levels of self-compassion and family cohesion may be the targets for treating adolescents with suicide ideation to prevent them from attempting suicide.     

Suicide attempts among adolescents in Switzerland: prevalence,associated factors and comorbidity

Switzerland has one of the highest rates of adolescent suicide in Europe, but the prevalence of suicidal thoughts and attempts is unknown. The objective of this paper is to assess the prevalence of suicidal ideation and behaviour among Swiss teenagers and to identify the factors associated with suicide attempts. A self-administered anonymous questionnaire was distributed to a representative sample of 9268 15- to 20-year-old adolescents attending school or college. Six items focused on suicidal ideation and conduct. Multivariate analyses were performed to identify the health variables associated with suicide attempts. About 55% of the adolescents had no suicidal concerns; 26% reported suicidal thoughts, 15% reported suicidal plans and 3% reported suicide attempts. Suicide attempters reported significantly more problems in four areas, namely health behaviour, life events, social relationships and mental health. In conclusion, many factors associated with suicide attempts represent detectable behaviours. Thus health professionals could use this knowledge to be more effective in suicide prevention among adolescents.     

Conners父母问卷对少年儿童行为问题的研究

目的:探讨少年儿童的行为状况. 方法:用Conners父母问卷调查表(PSQ),对182例3～17岁淮安市少年儿童的行为等问题进行调查,并与Conners常模比较. 结果:独生子女的冲动-多动行为问题显著多于多子女家庭的男性少年儿童(P＜0.01).6～11岁儿童的品行问题、冲动-多动、焦虑及多动指数因子分显著低于Conners常模(P＜0.05～0.01),而12～17岁少年的PSQ各因子分均显著低于Conners常模(P＜0.05～0.01),仅学习问题显著多于Conners常模(P＜0.05),且男生冲动-多动行为问题显著多于女生(P＜0.01).6～11岁女性儿童的冲动-多动因子分显著高于12～17岁少年. 结论:独生子的冲动-多动行为问题多于多子女家庭的男性少年儿童.淮安市区少年儿童行为问题少于美国,但青少年学习问题较多.随年龄增长,少年儿童行为问题有所改善.     

The Zurich Study: XV. Suicide attempts in a cohort from age 20 to 30

Summary The life-time prevalence of suicide attempts in a Swiss population, interviewed four times between the ages of 20 and 30 years, was 3.8% (females 5.4%, males 2.1%). One fifth of the 30-year-olds reported persistent suicidal ideation. In comparison with controls, attempters reported a more disturbed childhood, and subjects with multiple attempts reported more sexual abuse. Over 10 years attempters persistently showed more negative affectivity, more feelings of helplessness and lower selfesteem. At age 30 they were higher on the scales neuroticism, masculinity and aggressivity in a personality test. Over ten years, a higher than expected comorbidity appeared of suicide attempts with depressive and anxiety disorders, with substance abuse, and with sociopathic features.     

Prevalence and Risk Factors Associated with Suicide Ideation and Attempts in Korean College Students

Objective

Suicide is a leading cause of death in college age students. Identification of the associated risk factors has important implications for how to prevent and respond to this population; however, few studies have been performed on this topic in this age group. The purpose of this study was to evaluate the prevalence and risk factors associated with suicide ideation and attempts in college students.

Methods

Three hundred sixty-eight college students participated in this cross-sectional observational study. The recent (over two weeks) suicide ideation and lifetime suicide attempts were defined according to Moscicki''s suicide behavior index. Sociodemographic variables were assessed and psychopathology measured using the Beck Depression Inventory, the Bipolar Spectrum Diagnostic Scale and the Alcohol Use Disorders Identification Test. A hierarchical multiple logistic regression analysis was used to identify the significant risk factors related to suicide ideation and attempts.

Results

The two-week prevalence of suicidal ideation was 9.8%, and the lifetime prevalence of suicide attempts was 3.3%. The univariate analysis showed that students who had more severe depression (p<0.001), a higher probability for bipolar disorder (p<0.001) and decrement of academic achievement (p<0.005) were more likely to have suicide ideation. Those with factors such as severe depression (p<0.05), a higher probability of bipolar disorder (p<0.001), a low socioeconomic status (p<0.001), who lived alone (p<0.01), and were female (p<0.05) had a higher risk for suicide attempts. The most important predictors of suicide ideation, by the logistic regression analysis, were depression, probability for bipolar disorder and academic achievement, and the risks identified for suicide attempts were socioeconomic status and probability of bipolar disorder.

Conclusion

Suicide ideation and attempts were common in college students. The results of this study suggest that early identification and management of mood disorders and other sociodemographic risk factors may have implications for intervention and prevention.     

Evaluation and treatment of rage in children and adolescents

Rage is characterized by an unpredictable and primitive display of violence that is out of proportion to the provoking event and often threatens serious self-injury or harm to others. New insight into the pathogenesis of unpredictable violent behavior has been gained largely as a result of neurochemical, neuropsychological and brain imaging studies. This article examines episodic rage from a neuropsychiatric perspective. Three cases illustrating the evaluation and treatment of rage in childhood and adolescence are presented.     

氟西汀治疗儿童少年抑郁症临床观察

目的:了解氟西汀治疗儿童少年抑郁症的疗效和不良反应。方法:以氟西汀开放式治疗10～18岁抑郁症患者22例。用临床疗效总评量表(CGI)、Beck抑郁量表(BDI)、Beck焦虑量表(BAI)和不良反应量表(SERS)评估。结果:治疗结束时显著进步8例,进步9例;轻度不良反应5例,中度2例。结论:氟西汀治疗儿童少年抑郁症有效,不良反应较轻。     

伴自杀未遂双相障碍患者的血清脑源性神经营养因子水平

目的 分析伴自杀未遂的双相障碍（BD）患者与不伴自杀未遂患者及健康人群间血清BDNF水平的差异,探讨BDNF在预防BD患者自杀中的作用.方法 采用DSM-IV轴Ⅰ障碍用临床定式检查（患者版）（SCID-I/P）对临床诊断为心境障碍的患者进行评佑.纳入111例BD患者（26例有自杀未遂史）及41例健康对照.使用汉密尔顿抑郁量表（HAMD-17）及杨氏躁狂量表（YMRS）评估患者症状严重程度;使用酶联免疫吸附测定法测定所有研究对象的血清BDNF水平.结果 伴自杀未遂的BD患者血清BDNF水平（13.8±7.4） ng/ml显著低于无自杀未遂患者（18.7±11.9） ng/ml及健康对照组（26.0±12.9）ng/ml（F=9.371,P＜0.01）;伴自杀未遂的BD患者抑郁发作次数显著多于不伴自杀未遂患者,在控制抑郁发作次数后,两组间血清BDNF水平差异消失（P=0.236）;伴自杀未遂的BD患者血清BDNF水平和抑郁发作次数有相关性的倾向（r=-0.388,P=0.068）,与HAMD-17得分呈负相关（r=-0.585,P＜0.01）.结论 本研究提示BDNF在BD及BD患者自杀未遂的病理生理机制中起重要作用;伴自杀未遂的BD患者血清BDNF水平可能与抑郁发作次数、抑郁严重程度相关;通过有效治疗来提高BDNF水平可能通过减少抑郁发作次数,降低抑郁严重程度来降低自杀风险.     

儿童青少年与老年抑郁症患者自杀危险因素比较

目的 比较精神科儿童青少年和老年抑郁症患者的自杀危险因素,认识两类人群自杀危险的特点,有针对性地预防自杀.方法 采用自制的自杀危险评估表对210例儿童青少年和老年抑郁症患者进行评估.结果 在健康状况、焦虑程度、药物副反应、自杀史、人际关系、性格特征方面儿童青少年和老年患者存在明显差异.结论 儿童青少年和老年抑郁症患者自杀意念具有不同的特点,需根据不同特点针对性地采取不同的预防措施.     

Social predictors of suicidal behaviour in adolescents in Trinidad and Tobago

Abstract Background Previous research in Trinidad and Tobago has been limited in examining suicidal behaviours through psychological autopsy, secondary data and psychiatric populations. To date, there has been no community survey with an emphasis on causation and prevention. Methods A total of 1,845 respondents aged 14–20 were selected in 24 schools across the country. Data were collected on socio-demographic variables and suicidal behaviour. Results Gender differences existed for both suicidal ideation and attempts (p<0.001). Respondents from reconstituted families had higher suicidal ideation compared to other family structures (p<0.001), while intact families had the lowest rate for suicide attempts (p<0.01). Attendance to a religious institution lowered only suicidal ideation (p<0.05), while prayer with the family lowered both suicidal ideation (p<0.01) and suicide attempts (p<0.001). Individuals with alcohol abuse in the family had higher suicidal ideation (p<0.001) and attempts (p<0.001). Conclusions Significant social predictors of suicidal behaviour in Trinidad and Tobago are gender, attendance to a religious institution, prayer with the family, family structure and alcohol abuse in the family. It is essential to consider these predictors in planning public health policies.     

Suicide and suicide attempts in adolescent-onset psychotic disorders

Eighty-eight subjects with adolescent-onset psychotic disorders (mean age±standard deviation 15.7±1.5?years), mainly schizophrenia and affective disorders, were followed up 10.6±3.6?years later, rediagnosed (DSM-IV) and assessed with the Positive and Negative Symptom Scale, abuse of drugs including nicotine, the Lancashire Quality of Life Profile and occurrence of suicide or suicide attempts. Four males (4.5% of subjects) had died from suicide while another 25% of the subjects had attempted suicide. Suicide attempts were associated to more depressive symptoms but fewer negative symptoms at first episode, and to number of admissions and to dependence on nicotine at follow-up in a logistic regression. Satisfaction with religion, health, family relations and safety at follow-up were inversely associated to attempting suicide but only satisfaction with religious belief remained after controlling for concurrent symptoms of anxiety and depression.     

Prevalences of lifetime histories of self-cutting and suicidal ideation in Japanese adolescents: differences by age

We examined differences in the prevalence of a lifetime history of self-cutting and suicidal ideation by age among junior and senior high-school students. Histories of self-cutting and suicidal ideation were reported by 9.9% and 40.4% of the students. Among early teens, females were more likely to report suicidal ideation than males, and among late teens, females were more likely than males to report self-cutting.     

男女儿童青少年精神分裂症患者临床特征的比较

目的:比较儿童青少年精神分裂症男性与女性患者临床特征的差异。方法:对125例男性(男性组)和133例女性(女性组)儿童青少年精神分裂症患者的年龄、发病年龄、病前诱因、阳性家族史、病程特点、住院天数、简明精神病量表(BPRS)、大体评定量表(GAS)及临床疗效总评量表(CGI)评分等临床特征进行比较。结果:男性与女性患者在年龄、发病年龄、病前诱因、阳性家族史、病程特点、住院天数方面比较差异无统计学意义(P均0.05)。BPRS评分中敌对性、动作迟缓、情感淡漠、缺乏活力因子分男性组高于女性组(t=2.164,t=3.317,t=2.096,t=2.230;P0.05或P0.01);幻觉、思维障碍因子分女性组高于男性组(t=3.682,t=2.987;P0.01或P0.001)。入院时GAS、CGI-SI评分及出院时CGI-GI评分两组间差异无统计学意义(P均0.05),出院时CGI-EI评分女性组高于男性组(t=2.466)、自知力评分男性组高于女性组(t=2.403),差异有统计学意义(P均0.05)。结论:男性儿童青少年精神分裂症患者的临床特征以情感淡漠、缺乏活力等阴性症状为主,女性则以幻觉、思维障碍等阳性症状更突出;女性临床疗效优于男性。     

Suicide and other causes of death in a five-year follow-up of patients treated for self-poisoning in Oslo

This 5-year follow-up study includes all patients (n = 934; 50% females) treated for self-poisoning in Oslo during 1 year. Seventeen percent were considered suicide attempts upon admission, 25% among the nonabusers and 8% among the abusers. At follow-up, 122 patients were dead (61% males). The mortality rate was highest among the abusers. The mortality rate was similar (13%) among those who were considered to be suicidal on admittance and those who were not. The causes of death were suicide (28%), opiate abuse (16%), heart disease (14%), accidents or wounds (11%), alcoholism (9%) and others (22%). The standard mortality rate was highly increased in all groups (8 times on average), highest among the female opiate abusers, whose rate was 63 times higher than expected. The increased suicide rates (87 times for females, 27 times for males), however, may be a more relevant measure of mental morbidity than the standard mortality rate. Logistic regression analysis demonstrated that male sex, age above 50 years and the lowest social group were factors on admission associated with death in the follow-up period. Age above 50 years and suicidal attempt on admission were associated with subsequent suicide. The study strongly supports the idea of self-destructiveness and slow suicide in substance abuse.     

Cannabis use disorder and suicide attempts in Iraq/Afghanistan-era veterans

The objective of the present research was to examine the association between lifetime cannabis use disorder (CUD), current suicidal ideation, and lifetime history of suicide attempts in a large and diverse sample of Iraq/Afghanistan-era veterans (N = 3233) using a battery of well-validated instruments. As expected, CUD was associated with both current suicidal ideation (OR = 1.683, p = 0.008) and lifetime suicide attempts (OR = 2.306, p < 0.0001), even after accounting for the effects of sex, posttraumatic stress disorder, depression, alcohol use disorder, non-cannabis drug use disorder, history of childhood sexual abuse, and combat exposure. Thus, the findings from the present study suggest that CUD may be a unique predictor of suicide attempts among Iraq/Afghanistan-era veterans; however, a significant limitation of the present study was its cross-sectional design. Prospective research aimed at understanding the complex relationship between CUD, mental health problems, and suicidal behavior among veterans is clearly needed at the present time.