Prospective predictors of suicide and suicide attempts in 1,556 patients with bipolar disorders followed for up to 2 years

Objectives:  Bipolar disorders are associated with high rates of suicide attempts (SAs) and completions. Several factors have been reported to be associated with suicide in persons with bipolar disorder, but most studies to date have been retrospective and have not utilized multivariate statistics to account for the redundant prediction among variables submitted for analysis.
Methods:  This study examined the association between baseline clinical and demographic variables and subsequent SAs and completions through 2 years of follow-up of participants in the Systematic Treatment Enhancement Program for Bipolar Disorder using a pattern-mixture model.
Results:  Of the sample with complete data (n = 1,556), 57 patients (3.66%) experienced an SA or completion (CS). Several variables predicted suicidality (SA + CS) in this data set when considered alone, but after controlling for redundant prediction from other baseline characteristics, only history of suicide [odds ratio (OR) = 4.52, p < 0.0001] and percent days depressed in the past year (OR = 1.16, p = 0.036) were significantly associated with SAs and completions. A secondary analysis included a greater number of variables but a smaller sample size (n = 1,014). In the secondary analyses, only prior SAs predicted prospective suicidality (OR = 3.87, p = 0.0029).
Conclusions:  These results indicate that patients with bipolar disorder who present with a history of SAs are over four times as likely to have a subsequent SA or completion. Further studies are needed to evaluate and prevent future attempts in this high-risk cohort.     

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.     

Gender differences in depression risk and coping factors in a clinical sample

OBJECTIVE: To examine gender differences in depression risk and coping factors in a clinical sample of patients with a diagnosis of DSM-IV major depression. METHOD: Patients were assessed for substance use and abuse, family history of psychiatric disorder, interpersonal depressogenic factors and lifetime history of anxiety disorders. Trait anxiety, coping styles when depressed, parental bonding, marital features and personality style were also measured. Patients were reassessed at 12-month follow-up. RESULTS: There were few gender differences in experience of depression (either in duration, type or severity prior to treatment) in a group with established episodes of major depression but women reported more emotional arousability when depressed. Women reported higher rates of dysfunctional parenting and childhood sexual abuse, and rated their partners as less caring and as more likely to be a depressogenic stressor. Men were more likely to have a generalized anxiety disorder at assessment, to use recreational drugs prior to presentation. Men were rated as having a more rigid personality style and 'Cluster A' personality traits both at assessment and follow-up. CONCLUSION: There were few gender differences in severity or course of established episodes of major depression. Gender differences were related to levels of arousal, anxiety disorders, and repertoires for dealing with depression, rather than depressive symptoms per se.     

抑郁症患者自杀的危险因素研究

目的:探讨抑郁症患者自杀的危险因素及生物学指标.方法:以抑郁症患者入院时有无自杀行为分为自杀组和无自杀组.用汉密尔顿抑郁量表(HAMD,24项)、生活事件量表(LES)及自行编制的自杀行为调查表对入组患者进行调查;酶法测定两组患者的总胆固醇(CHO)、三酰甘油(TG)、高密度脂蛋白(HDL-C)和低密度脂蛋白(LDL-C)水平.结果:共107例.多因素Logistic回归分析发现,自杀与既往自杀行为、内向性格、生活事件、严重的抑郁(尤其是绝望感明显,存在严重的认识障碍)有关;两组的血脂水平差异无显著.结论:既往自杀行为、内向性格、生活事件、严重的抑郁是抑郁症患者自杀的主要危险因素;抑郁症患者的自杀可能与血脂水平无关.     

Early insight predicts depression and attempted suicide after 4 years in first-episode schizophrenia and schizophreniform disorder

OBJECTIVE: To map the development of insight in the 4 years after presentation with first-episode schizophrenia and schizophreniform disorder and to determine the effects of evolving insight on depression and the likelihood of attempted suicide. METHOD: We assessed 101 individuals at presentation, 6 months and 4 years. We measured insight, including recognition of mental illness, recognition of need for treatment and ability to relabel psychotic symptoms. We measured depression and recorded all suicide attempts. RESULTS: Insight improved with time. Recognition of mental illness at 6 months predicted depression and attempted suicide at 4 years. CONCLUSION: Six months after presentation, the greater the acknowledgement by people that they had a mental illness, the more depressed they were at 4 years and the greater the likelihood that they would attempt suicide by 4 years. This may have implications for disclosure of diagnosis.     

Risk factors for suicide attempts among African American women

The aim of this study was to examine psychological and interpersonal risk factors for suicidal behavior in low income, African American women; 285 African American women who reported being in a relationship with a partner in the past year were studied, 148 presented to the hospital following a suicide attempt, and 137 presented for general medical care. Cases were compared to controls with respect to psychological symptoms, alcohol and drug abuse, family violence (intimate partner abuse, childhood trauma), relationship discord, and social support. Psychological risk factors for suicide attempts at the univariate level included psychological distress [Crude Odds Ratio (COR) = 6.5], post traumatic stress disorder (PTSD) symptoms (COR = 3.8), hopelessness (COR = 7.7), and drug abuse (COR = 4.2). Interpersonal risk factors at the univariate level included relationship discord (COR = 4.0), physical partner abuse (COR = 2.5), nonphysical partner abuse (COR = 2.8), childhood maltreatment (COR = 3.2), and low levels of social support (COR = 2.6). A multivariate logistic regression model identified four variables that were strongly and independently associated with an increased risk for suicide attempts: psychological distress, hopelessness, drug abuse, and relationship discord. The model predicted suicide attempt status correctly 77% of the time. The results reveal that African American women who report high levels of psychological distress, hopelessness, drug use, and relationship discord should be assessed carefully for suicidal ideation and referred for appropriate mental health care.     

Risk factors for postpartum depression in Japan

Abstract We conducted a longitudinal study to identify risk factors for postpartum depression. At the late phase of pregnancy, 627 pregnant women agreed to take the State-Trait Anxiety Inventory Trait (STAIT) test and to remain in the study until 4 months postpartum. At 1, 3 and 4 months postpartum, they took the Edinburgh Postnatal Depression Scale (EPDS) test and the State-Trait Anxiety Inventory State (STAIS) test. At 3 months postpartum, they were asked about socio-psychological and obstetric factors. High scores in the EPDS and STAIS tests were correlated with primiparity, premature delivery, difficult labor, experience of life events and worries about baby care. Furthermore, high scores in the STAIT test in late pregnancy were strongly correlated with high scores in the EPDS and STAIS tests in the postpartum period.     

抑郁障碍患者自杀未遂的危险因素分析

目的:分析抑郁障碍(MDD)患者自杀未遂的危险因素。方法:入组332例MDD患者,分为自杀未遂组(95例)和非自杀未遂组(237例);对入组者进行人口学与临床资料调查、汉密尔顿抑郁量表(HAMD-24)及汉密尔顿焦虑量表(HAMA-14)评估及血清甲状腺功能检测,并进行组间比较;分析自杀未遂的危险因素。结果:自杀未遂组年龄、首次发病年龄明显小于非自杀未遂组,病程、既往住院次数明显多于非自杀未遂组;单身、无业、受教育程度低、家族史阳性、伴有精神病性症状、共病焦虑障碍比率明显高于非自杀未遂组(P<0.05或P<0.01)。HAMD总分与焦虑躯体化、认知障碍、阻滞、绝望感、体质量、日夜变化因子分及HAMA评分明显高于非自杀未遂组(P<0.05或P<0.01)。血清游离三碘甲状腺原氨酸(FT3)水平明显高于非自杀未遂组(P<0.05)。多因素Logistic回归分析显示,伴有精神病性症状、既往住院次数、HAMD评分中认知障碍、绝望感因子是影响抑郁症患者自杀未遂的主要危险因素。结论:伴有精神病性症状、既往住院次数、HAMD评分中的认知障碍、绝望感因子可能为MDD患者...