Attempted suicide and suicide in functional psychoses.

A total of 2,243 first admissions to Gaustad Hospital between 1938 and 1961 diagnosed as functional psychotics were either followed up to the time of their death within 5 years, or observed over a period of 5 years, and then reexamined. Of these patients, 325 had attempted suicide prior to their admission. The frequency of attempted suicide was equal in both sexes. Men appeared to use more dangerous methods, and to have more serious intentions. The psychosis appears to have been of importance when considering whether, but not how the suicide should be attempted. The greatest risk of attempted suicide was to be found amongst patients with psychoses of a depressive nature. Twenty-eight of the 2,243 patients in this study committed suicide within 5 years following their discharge, and a further 20 took their own lives prior to the reexamination. A certain connection can be seen between attempted suicide and psychotic symptoms.     

Attempted suicide predicts suicide risk in mood disorders

Suicide risk was studied in a sample of 346 mood disorder inpatients, 92 of whom were admitted after a current suicide attempt. The overall suicide mortality after a mean observation period of 6 years was 8%. The potential of attempted suicide to predict suicide risk in hospitalized patients with mood disorders was studied by survival analysis after subgrouping on the basis of whether a current suicide attempt had occurred or not. The suicide risk the first year after attempting suicide was 12% (11/92), compared with 2% (4/254) in the mood disorder subgroup with no current suicide attempt. The long-range suicide risk after a current suicide attempt in depression was 15% (14/92) as compared with 5% (13/254) among those without a current suicide attempt. It is concluded that a current suicide attempt in mood disorder inpatients predicts suicide risk particularly within the first year and should be taken very seriously.     

Attempted suicide predicts suicide risk in schizophrenia spectrum psychosis

Background: People with schizophrenia have an increased risk of suicide and attempted suicide is suggested to be an important risk factor. Aim: Our objective was to assess the cumulative survival, predictive values and odds ratios of attempted suicide for suicide in a long-term cohort of patients with schizophrenia spectrum psychosis with and without previous attempted suicide. Method: Inpatients (n=224) hospitalized with schizophrenia spectrum psychosis were followed for a mean of 25 years. All patients were followed up for causes of death. Information on suicide attempt before the end of the observation period was retrieved from medical records. Results: Eight percent died by suicide during the follow-up. Eighteen percent of suicide attempters died by suicide. Two percent of non-attempters died by suicide. There was a strong association between previous suicide attempt and suicide in men and women. Odds ratio for attempters vs. non-attempters was 10. Suicide risk was almost three times higher in male than female suicide attempters. Conclusion: Previous attempted suicide is an important risk factor for suicide in both men and women with schizophrenia spectrum psychosis, particularly in male suicide attempters. The suicide risk remains high over a long period. Continuous assessment of risk factors and appropriate treatment are crucial for this patient group to prevent suicide.     

Adolescent suicide and suicide contagion in three secondary schools

This study investigated crisis intervention in three secondary schools after the suicides of five students, focusing on the relation between crisis intervention and suicide contagion. The contagion hypothesis was supported. Following a suicide, the number of suicides that occurred in secondary schools in one year were markedly increased beyond chance. No new suicides took place at schools where adequate first talk-throughs and psychological debriefing were conducted by a mental health professional. Proper crisis intervention is recommended to prevent suicide contagion in schools.     

大连地区居民自杀意念、自杀计划和自杀未遂的调查分析

目的调查大连地区居民自杀意念、自杀计划、自杀未遂情况,为制定自杀预防和干预策略提供科学依据。方法采取分层整群随机抽样的方法,从大连市11个区县共调查5062人。应用复合性国际诊断交谈量表(CIDI3.0)及美国精神障碍诊断标准(DSM-IV),计算不同人群自杀意念、自杀计划、自杀未遂的检出率。结果1自杀意念、自杀计划和自杀未遂的检出率分别为3.93%、1.10%和0.50%。2共病者自杀意念和自杀计划的检出率分别为42.42%和21.21%,单一疾病患者检出率分别为24.32%和13.51%,精神分裂症患者自杀未遂检出率为10.61%。不同精神疾病自杀意念和自杀未遂检出率差异有统计学意义(P0.05)。结论大连地区自杀问题检出率相对较高,其中患两种以上精神疾病者和单一精神分裂症患者更容易出现自杀意念。     

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.     

双相情感障碍中的自杀及自杀企图研究进展

自杀行为是一种异质性的现象，是患者的素质因素和环境因素交互作用的结果。目前双 相情感障碍的自杀行为越来越受到关注。已有的研究致力于探索双相情感障碍患者自杀及自杀企图的 预测因素及干预手段。现从流行病学、风险因素、预防、神经影像学及分子生物机制 4 个方面对双相情 感障碍患者的自杀及自杀企图进行综述。     

DST non-suppression predicts suicide after attempted suicide

Most prospective studies of HPA axis have found that non-suppressors in the dexamethasone suppression test (DST) are more likely to commit suicide during the follow-up. Attempted suicide is a strong clinical predictor of suicide. The aim of this study was to assess the predictive value of DST for suicide in a group of depressed inpatients with and without an index suicide attempt. Historical cohort of 382 psychiatric inpatients with mood disorder admitted to the department of Psychiatry at the Karolinska University Hospital between 1980 and 2000 were submitted to the DST and followed up for causes of death. During the follow-up (mean 18 years), 36 suicides (9.4%) occurred, 20 of these were non-suppressors and 16 were suppressors. There was no statistically significant difference in suicide risk between the suppressors and non-suppressors for the sample as a whole. An index suicide attempt predicted suicide. In suicide attempters with mood disorder, the non-suppressor status was significantly associated with suicide indicating that HPA axis hyperactivity is a risk factor for suicide in this group. The dexamethasone suppression test may be a useful predictor within this population.     

Family history of suicide among suicide victims

OBJECTIVE: The aim was to compare the rates of suicide in family members of suicide victims and comparison subjects who died of other causes. METHOD: The Swedish cause of death register identified all suicides in subjects born between 1949 and 1969 (N=8,396). The comparison group comprised persons of the same age who died of other causes (N=7,568). First-degree relatives of the suicide victims (N=33,173) and comparison subjects (N=28,945) were identified. RESULTS: Among families of the suicide victims there were 287 suicides, representing 9.4% of all deaths in family members. Among comparison families there were 120 suicides, 4.6% of all deaths. The difference was significant. Previous psychiatric care and suicide in a family member predicted suicide in the logistic regression model. CONCLUSIONS: The rate of suicide was twice as high in families of suicide victims as in comparison families. A family history of suicide predicted suicide independent of severe mental disorder.     

Ulcer, attempted suicide and suicide.

Attempted suicide and suicide have been investigated among 2,619 patients suffering from duodenal ulcer, gastric ulcer and ulcer dyspepsia without ulcer demonstrable by x-ray. There was no difference in the percentage of attempted suicides and suicides among the three ulcer groups or between the sexes. Within well-defined periods, there was a statistically significant greater excess of attempted suicides among patients operated on than among unoperated patients. The distribution according to psychiatric diagnosis was very similar to the one observed among persons in general in Copenhagen attempting suicide. The number of patients committing suicide exceeded the expected number significantly, for men as well as for women, but there was no difference between patients operated on and unoperated patients. The psychiatric diagnoses of those committing suicide were predominantly neuroses and psychopathy.     

CSF 5-HIAA, suicide intent and hopelessness in the prediction of early suicide in male high-risk suicide attempters

OBJECTIVE: To study the predictive value of the Beck Suicide Intent Scale (SIS), the Beck Hopelessness Scale (BHS) and of 5-hydroxyindoleacetic acid (5-HIAA) in the cerebrospinal fluid for future early suicide in a group of high-risk male suicide attempters. METHOD: Fifteen consecutive male suicide attempters admitted to a psychiatric ward at the Karolinska Hospital, who were not receiving any treatment with antidepressants were diagnosed according to DSM-III, assessed with SIS and BHS and submitted to lumbar puncture. All patients were followed up for cause of death. RESULTS: Five early suicides (within 2 years) were identified. Mean cerebrospinal fluid (CSF) 5-HIAA differed between suicides and survivors. Low CSF 5-HIAA was identified in those who committed early suicide. Neither the Suicide Intent Score nor the Hopelessness Score distinguished suicides from survivors. CONCLUSION: In high suicide risk hospitalized male psychiatric patients CSF 5-HIAA may be a better predictor of early suicide after attempted suicide than SIS or BHS.     

Elderly suicide in Finland

Suicide mortality among the elderly is high in most Western countries. We investigated the characteristics of suicide victims 65 years or older in a nationwide psychological autopsy study, the research phase of the National Suicide Prevention Project in Finland. This study population included all completed suicides (N = 1,397, of whom 211 were 65 years or older) that occurred in Finland during a 12-month research period in 1987-1988. The elderly suicide victims were found to have used violent suicide methods more often than the young. Although almost 70% of the elderly persons who had committed suicide had been in contact with health care services during the month before their death, their suicidal intentions were rarely communicated in these contacts. They had been referred to psychiatric services less often than the young, and only 8% had received adequate antidepressive medication. The fact that most elderly suicides have contact with health care services during their final month suggests a potential for suicide prevention. However, the major obstacle to this is the poor recognition of mental disorders and suicidal ideation among the elderly.     

Alexithymia in suicide attempters

Taiminen TJ, Saarijärvi S, Helenius H, Keskinen A, Korpilahti T. Alexithymia in suicide attempters. Acta Psychiatr Scand 1996: 93: 195–198. © Munksgaard 1996. Alexithymia seems to share some common features with psychological constriction, a phenomenon described in suicidal individuals. Fifty suicide attempters were interviewed within 24 h after arrival at a hospital, and measures of lethality of the attempt, suicidal intent, depression and alexithymia were carried out with structured instruments. Almost all the attempters were depressive, and about half of them were also alexithymic. However, alexithymia was not more prevalent in this population than in non-suicidal depressive patients. Depression and alexithymia correlated significantly with each other, but there was no correlation between alexithymia and lethality of the suicide attempt or suicidal intent. The authors conclude that alexithymia in suicide attempters seems to be associated with depression, but not with suicidality per se. Therefore, measurement of alexithymia may not yield extra information in suicide risk assessment.