Factors That Affect Suicidal Attempt Risk Among Korean Elderly Adults: A Path Analysis

Objectives:

Among the Korean elderly (those 65 years of age and older), the suicide rate is 80.3/100 000 people, which is ten times higher than the Organization for Economic Cooperation and Development average. Because South Korea is rapidly becoming an aging population, this high elderly suicidal rate will only get worse. Although the size of the elderly suicide problem is quite large, previous research in South Korea has surveyed restricted areas and not the entire country. Even though the factors that affect elderly suicide are complicated, there has been little research into these influencing factors. Thus, this research uses the national survey data (Community Health Survey) that was obtained in 2009. Additionally, we analyze factors affecting elderly suicidal ideation and attempts as well as the paths of these effects.

Methods:

Community Health Survey data obtained by the Korea Centers for Disease Control and Prevention in 2009 was used for this study. We additionally examined the factors that affect suicide with chi-squared tests, t-tests, Pearson’s correlation test, and path analysis.

Results:

Depressive symptoms and suicidal ideation are the only factors that directly affect suicidal attempts. Demographic, behavioral, and physical activity factors have indirect effects on suicidal attempts.

Conclusions:

Depression has the strongest influence on suicidal ideation and attempts. Demographic, behavioral, and physical activity factors affect suicidal attempts mostly through depressive symptoms. In addition, there is a path that suggests that demographic, behavioral, and physical activity factors affect suicidal attempts not through depression symptoms but only through suicidal ideation. This means that the elderly who do not have depression symptoms attempt suicide according to their own situations and characteristics.     

成都市区中学生自杀未遂的现况调查

目的：探讨中学生自杀未遂的出现率及其相关因素。方法：采用多级整群抽样法，从成都市区中学中抽取重点中学2所，普通中学1所，职业中学2所，共1393名中学生，用自编调查问卷、Beck抑郁问卷、青少年生活事件量表、父母教养方式问卷进行调查。筛选出自杀未遂者后再调查其原因及方式。采用SPSS8．0软件进行统计分析。结果：1393名青春期中学生中，曾有自杀未遂者36例（2．6％），男女之比1:2. 遂者中33．3％为反复自杀未遂。中学阶段自杀未遂原因以家庭矛盾居多（34．4％），方式以过量服药或服毒居多（50．0％）。青春期自杀未遂危险因素有可疑幻听、吸烟、受同伴欺侮、想成为异性、父母再婚、女性、父亲的拒绝、否认、过度保护、生活事件等。保护因素有家庭和睦。结论：自杀未遂在中学生中并不罕见，临床医生与教育工作者应认识其危险因素并积极干预。     

Epidemiology of suicide and suicide attempts in Belgium: results from the sentinel network of general practitioners

OBJECTIVES: To estimate the evolution of incidence of (attempted) suicide between 1993 and 2001 in Belgium and to examine trends in methods, first caretaker and aspects of seasonality. METHODS: In 1993-1995 and 2000-2001, the national sentinel network of general practitioners registered, for each case of (attempted) suicide, age, sex, date, place of the event, first caretaker, method, and survival. RESULTS: Between 1993-1995 and 2000-2001, the incidence of suicide increased among men from 29/ 100,000 to 35/ 100,000, and decreased among women from 14/ 100,000 to 11/ 100,000. The incidence of attempted suicide increased among men (from 67/ 100,000 to 71/ 100,000) and women (from 131/ 100,000 to 141/ 100,000). None of the above mentioned changes were statistically significant however. The use of violent methods as opposed to non-violent methods remained unchanged in women (OR: 0.95 [0.63-1.41]). CONCLUSIONS: No statistically significant trends were observed in the incidence of suicide, the fraction of cases with fatal outcome and the use of violent methods.     

Predictors of Suicide and Suicide Attempt in Subway Stations: A Population-based Ecological Study

Suicidal behavior on the subway often involves young people and has a considerable impact on public life, but little is known about factors associated with suicides and suicide attempts in specific subway stations. Between 1979 and 2009, 185 suicides and 107 suicide attempts occurred on the subway in Vienna, Austria. Station-specific suicide and suicide attempt rates (defined as the frequency of suicidal incidents per time period) were modeled as the outcome variables in bivariate and multivariate Poisson regression models. Structural station characteristics (presence of a surveillance unit, train types used, and construction on street level versus other construction), contextual station characteristics (neighborhood to historical sites, size of the catchment area, and in operation during time period of extensive media reporting on subway suicides), and passenger-based characteristics (number of passengers getting on the trains per day, use as meeting point by drug users, and socioeconomic status of the population in the catchment area) were used as the explanatory variables. In the multivariate analyses, subway suicides increased when stations were served by the faster train type. Subway suicide attempts increased with the daily number of passengers getting on the trains and with the stations’ use as meeting points by drug users. The findings indicate that there are some differences between subway suicides and suicide attempts. Completed suicides seem to vary most with train type used. Suicide attempts seem to depend mostly on passenger-based characteristics, specifically on the station’s crowdedness and on its use as meeting point by drug users. Suicide-preventive interventions should concentrate on crowded stations and on stations frequented by risk groups.     

自杀未遂危险因素的配对病例对照研究

目的了解汉族人群自杀未遂的环境危险因素、儿茶酚胺-氧位-甲基转移酶(COMT)158／108基因多态性与自杀未遂有无关联。方法采用配对的病例对照研究，对205例自杀未遂者(男性89例、女性116例)与相应对照(与病例同性别、年龄相差3岁以内、同地区)进行COMT158／108基因型测定、环境因素与自杀未遂的关系研究。结果病例组与对照组在COMT基因型、基因频率上差别无统计学意义；多因素条件logistic回归模型分析显示，COMT158／108Val／Val、文化程度低、吸烟、情感冲突、精神障碍、抑郁皆为自杀未遂的危险因素，OR值分别为2．43(95％CI：1．10～5．40)、5．70(95％CI：1．88～17．27)、3．54(95％CI：1．02～12．36)、10．96(95％CI：4．74～25．34)、6．35(95％CI：1．68～24．05)、11．30(95％Ci：4．58～27．89)；且因素间无相乘模型一级交互作用。结论研究表明，文化程度低、吸烟、情感冲突、精神障碍、抑郁为自杀未遂的危险因素；支持COMT158／108Val／val为自杀未遂的易感基因型。并提示基因图谱上116bp片段可能与COMT高活性相关。     

220例自杀未遂者流行病学特点研究

目的 了解自杀未遂者的流行病学特点，为制订自杀行为的预防措施提供科学依据。方法 在山东省随机选取7个市县级综合医院急诊科或内科病房作为调查点，对2003年1月～2003年12月31日新发生的220例自杀未遂者进行调查。结果 自杀未遂者中，居住在农村、年轻人、文化程度低、已婚、低人均月收入、具有情感冲突者所占比例较高；大多数采用农药方式自杀(89．7％)；中、重度抑郁者所占比例近60％，抑郁者中以内疚感所占比例最大(67．1％)，以形象糟所占比例最小(40．8％)。从自杀想法到自杀行为间隔时间5min内的占29．9％，半小时内的约占61．7％。结论 加强农药管理、改善周围不良环境条件对自杀未遂的预防具有重要作用。     

The geography of self-injury: spatial patterns in attempted and completed suicide

This study uses hospital discharge data, death certificates and medical examiner data for New Jersey for 1999-2001 to investigate whether fatal and non-fatal self-injury exhibit similar geographic patterns. Findings show that the demographic characteristics of individuals committing fatal and non-fatal self-injury are quite different. Furthermore, attempted and completed suicides have a somewhat different geographical pattern. Municipality-level determinants of suicide and non-fatal self-injury were estimated in two separate models. While measures of isolation such as low population density and high proportions of households with only one member were predictive of completed suicides, non-fatal self-injury was related to unemployment and median age. Both types of self-injury were more common in municipalities which lost population between 1990 and 2000, and where divorce rates were high. Population-based suicide prevention efforts should be aided by the knowledge that although there are some similarities in the spatial pattern of completed and attempted suicides, there are some important differences in significant determinants.     

Epidemiological link between low cholesterol and suicidality: A puzzle never finished

Abstract

A substantial body of evidence shows an association between an increased risk of suicide and naturally low or therapeutically lowered serum cholesterol. The nature of the association, however, remains unclear. The interrelationships of cholesterol, cholesterol-lowering medications, depressive disorders, and the risk of suicide are more likely to be multi-directional. On the one hand, low cholesterol may have direct effects on mood and suicidal behaviors. On the other hand, psychological conditions and the medications for treatment may influence eating and exercise habits, and subsequently cholesterol levels. There is also likelihood that cholesterol might be a bystander of the association between suicide and other factors. Overall, the association not only represents a public health concern, is indeed a scientific challenge. The aim of this contribution is to comprehensively update and critically review the epidemiological evidences. Efforts have been made to explain the discrepant results from previous studies. This paper is concluded with discussions of the direction and methodological challenges for future investigations.     

Psychosocial influences on prisoner suicide: a case-control study of near-lethal self-harm in women prisoners

We examined the psychosocial influences on female prisoner suicide by carrying out a study of near-lethal self-harm. We interviewed 60 women prisoners who had recently engaged in near-lethal self-harm (cases) and 60 others who had never carried out near-lethal acts in prison (controls) from all closed female prison establishments in England and Wales, using mixed quantitative and qualitative methods. We gathered information on socio-demographic and criminological variables, life events and childhood trauma, exposure to suicidal behaviour, contributory and precipitating factors for near-lethal self-harm, social support and psychological characteristics. While socio-demographic factors were only modestly associated with near-lethal self-harm, being on remand, in single cell accommodation, and reporting negative experiences of imprisonment were strong correlates. Recent life events and past trauma, including different forms of childhood abuse, were also significantly associated with near-lethal self-harm, as were a family history of suicide and high scores on measures of depression, aggression, impulsivity and hostility, and low levels of self-esteem and social support. Our findings underline the importance of both individual and prison-related factors for suicide in custody, and hence the need for a comprehensive approach to suicide prevention in women's prisons. Given the multiple needs of female prisoners at-risk of self-harm and suicide, complex psychosocial interventions are likely to be required, including interventions for abused and bereaved women, and initiatives to improve staff-prisoner relationships and reduce bullying. The findings of this research may provide insights into factors leading to suicidal behaviour in other forensic and institutional settings, such as detention centres and psychiatric hospitals, and may assist in developing suicide prevention policies for prisoners and other at-risk populations.     

自杀未遂危险因素的病例对照研究

目的：探讨自杀未遂的独立危险因素以及精神疾病在自杀行为危险因素中的相对重要性。方法：对就诊于综合医院的152例自杀遂者和按1：1匹配的对照组用自制问卷进行调查。结果：自杀未遂组患精神病的比例显著高于对照组（37．7％比4．0，配对X2．45．45，P＜0．001），条件logistic回归分析结果显示自杀未遂有三个独立的危险因素，急性应激强度大（OR＝67．47，95％，CI8．85－514．56），患有精神疾病（OR＝13．85，95％，CI 2．01－95．55），和负性生活事件在近一年对心理的影响程度大（OR＝5．40，95％CI 1．12－26．08），结论：精神疾病是导致自杀未遂的一个重要因素但不是必然因素，有必要制定出具有中国特色的全国性自杀干预计划。     

研究生自杀态度的调查

目的了解研究生的自杀态度及群体间的差异,为研究生自杀的研究、预防和治疗提供依据。方法采用整群抽样方法抽取322名硕士研究生,并运用自杀态度问卷(QSA)对其进行调查。结果研究生对自杀态度的总体得分为(2.74±0.34),对自杀持矛盾或中立的态度。不同性别的研究生在对自杀者的态度(F2)上存在差异(p<0.05)。不同专业的研究生在对自杀性质的认识(F1)、自杀者的态度(F2)和安乐死的态度(F4)上均存在差异(p<0.05)。结论对研究生进行系统的自杀干预培训是很有必要的。     

父母教养方式与中学生自杀意念的相关研究

目的探索父母教养方式与中学生自杀意念之间的相关性,为青少年自杀干预研究提供依据.方法对成都市市区中学生采取多级抽样法,对抽取的中学生1 421名使用自编一般调查问卷、Beck抑郁问卷(BDI)、父母教养方式问卷(EMBU)进行评估.结果来自单亲家庭的被试有较高的自杀意念检出率.有自杀意念组被试较少地体验来自父母的情感温暖和理解,较多地受到父母惩罚、严厉、拒绝、否认、过干涉、过保护等不良教养方式影响.母亲教养方式对不同性别中学生影响较大,其中母亲情感温暖和理解作为保护因素是非常重要的.异性家长的过干涉是自杀意念的危险因素.结论不良父母教养方式是自杀意念的危险因素,家长应给予子女更多的情感温暖和理解,以减少自杀意念等心理问题的发生,增进青少年身心健康.     

研究生自杀态度的调查

目的了解研究生的自杀态度及群体间的差异，为研究生自杀的研究、预防和治疗提供依据。方法采用整群抽样方法抽取322名硕士研究生，并运用自杀态度问卷（QSA）对其进行调查。结果研究生对自杀态度的总体得分为（2．74±0．34），对自杀持矛盾或中立的态度。不同性别的研究生在对自杀者的态度（F2）上存在差异（p〈0．05）。不同专业的研究生在对自杀性质的认识（F1）、自杀者的态度（F2）和安乐死的态度（F4）上均存在差异（p〈0．05）。结论对研究生进行系统的自杀干预培训是很有必要的。     

武汉市某三甲医院136例急诊就诊自杀患者流行病学特征分析

目的：探讨2013年就诊于武汉某三级甲等综合医院急诊科自杀患者的流行病学特征,为自杀的识别和预防提供理论依据。方法自制急诊科自杀就诊患者登记表,根据急诊患者预检分诊登记的电子信息系统进行回顾性分析,资料采用SPSS 17．0软件建立数据库,运用频数和百分比进行统计描述。结果2013年医院急诊科共接诊自杀患者136例,其中女性（90例,66．18％）明显多于男性（46例,33．82％）,青年、中年患者（分别占60．30％和25．00％）人数最多;农药中毒和安眠药（43．38％和38．97％）为主要自杀方式,家庭矛盾、婚恋受挫、工作学习压力为前3位的自杀原因,自杀月份主要集中在4－10月份,时间点集中在13点至凌晨1点。结论在农村和城市,自杀已成为一个不可忽视的社会现象,应引起家庭、社会、医务人员的高度重视,多方协调做好自杀的早期识别和干预工作。     

Genetic Vulnerability as a Distal Risk Factor for Suicidal Behaviour: Historical Perspective and Current Knowledge

Introduction

Suicide is a multidimensional problem. Observations of family history of suicide suggest the existence of a genetic vulnerability to suicidal behaviour.

Aim

Starting with a historical perspective, the article reviews current knowledge of a genetic vulnerability to suicidal behaviour, distinct from the genetic vulnerability to psychiatric disorders, focused on clinical and population-based studies, and findings from recent molecular genetics association studies.

Method

The review includes peer-reviewed research articles and review papers from the professional literature in English language, retrieved from PubMed/Medline and PsycINFO.

Results

The research literature confirms a existence of a genetic vulnerability to suicidal behaviour. Even though the results of individual studies are difficult to compare, genetic influences could explain up to half of the variance of the occurrence of suicide.

Conclusion

Genetic vulnerability could be a distal risk factor for suicide, which helps us to understand the occurrence of suicide among vulnerable people. Ethical implications of such vulnerability are highlighted.     

广州市某高校大学生自杀意念影响因素分析

目的了解社会支持、遭遇负性事件与大学生自杀意念的关系,为及时进行危机干预提供依据。方法采用统一的调查表,以便利抽样的方法调查广州市某高校大学生974名,通过单因素χ2检验和多因素Logistic回归模型筛选自杀意念的影响因素。结果在974名大学生中,138人曾有过自杀意念,发生率为14.17%。多因素Logistic回归模型分析揭示,因其貌不扬而被歧视(OR=3.365),曾遭受暴力(OR=2.988),单亲家庭(OR=2.965),有饮酒、吸烟或药物依赖(OR=1.827)是产生自杀意念的危险因素;而家庭关系融洽(OR=0.618)和大学生具有自信心(OR=0.390)是预防自杀意念发生的保护因素。结论大学生遭遇负性事件后可能产生自杀意念,应采取多种预防措施防止自杀行为的发生。     

Clinical Supervision of Counselors-in-Training Working with Suicidal Clients: A Grounded Theory Investigation

The purpose of the current study was to generate an emergent theory of the process of counselor supervision for counselor trainees who work with suicidal clients. The researchers explored perspectives of five counselor supervisors, each of whom served as director of the counseling clinic/practicum training lab at his or her respective counselor preparation program. The emergent theory was titled Supervision for Suicidal Clients as an Immediate, Versatile Collaboration Between Counselor Trainees and Counselor Supervisors and captured participants' experiences of supervision as a complex, evolving process focused on client welfare and promoting counselor trainee growth.     

大学生自杀意念的相关因素研究

目的探讨影响大学生自杀意念的因素,为采取早期干预提供依据.方法采用自拟大学生自杀意念影响因素量表,调查武汉市某高校在校大学生479人.结果大学生自杀意念发生率为13.8%;有过自杀/自伤行为、抑郁、焦虑及神经质等心理问题对大学生自杀意念的产生有显著影响.结论对有过自杀/自伤行为的大学生应给予更多的关注.加强对大学生情绪方面的辅导,防止抑郁情绪的产生;积极开展心理咨询、心理讲座等,促进大学生人格的健康发展,是预防自杀的关键.     

A proposed approach to suicide prevention in Japan: the use of self-perceived symptoms as indicators of depression and suicidal ideation

The incidence of suicide in Japan has increased markedly in recent years, making suicide a major social problem. Between 1997 and 2006, the annual number of suicides increased from 24,000 to 32,000; the most dramatic increase occurred in middle-aged men, the group showing the greatest increase in depression. Recent studies have shown that prevention campaigns are effective in reducing the total number of suicides in various areas of Japan, such as Akita Prefecture. Such interventions have been targeted at relatively urban populations, and national data from public health and clinical studies are still needed. The Japanese government has established the goal of reducing the annual number of suicides to 22,000 by 2010; toward this end, several programs have been proposed, including the Mental Barrier-Free Declaration, and the Guidelines for the Management of Depression by Health Care Professionals and Public Servants. However, the number of suicides has not declined over the past 10 years. Achieving the national goal during the remaining years will require extensive and consistent campaigns dealing with the issues and problems underlying suicide, as well as simple screening methods for detecting depression. These campaigns must reach those individuals whose high-risk status goes unrecognized. In this review paper, we propose a strategy for the early detection of suicide risk by screening for depression according to self-perceived symptoms. This approach was based on the symposium Approach to the Prevention of Suicide in Clinical and Occupational Medicine held at the 78th Conference of the Japanese Society of Hygiene, 2008.