Characteristics of drug addicts who attempt suicide

The aim of the study was to further describe the characteristics of drug-dependent patients who attempt suicide. Thus, 449 drug-dependent patients were interviewed about whether or not they had ever attempted suicide and about their family history of suicidal behavior. Patients completed the Childhood Trauma Questionnaire and the Eysenck Personality Questionnaire, and were interviewed with the Addiction Severity Index (ASI). It was found that patients who had attempted suicide (N=175) were significantly younger than patients who had never attempted suicide (N=274). Significantly more of the patients who had attempted suicide were female; had a family history of suicide; and had a lifetime history of major depression, of having received antidepressant medication, and of alcoholism. Also, patients who had attempted suicide had significantly higher scores for childhood trauma, psychoticism, neuroticism and introversion, as well as higher ASI psychiatric composite scores. These results suggest that social, personality, family, developmental and psychiatric risk factors may predispose to suicidal behavior in drug-dependent individuals.     

Characteristics of cocaine-dependent patients who attempt suicide

OBJECTIVE: Although suicidal behavior is frequent among cocaine-dependent patients, it has been little studied. Therefore, the author examined the characteristics of cocaine-dependent patients who had attempted suicide. METHOD: Cocaine-dependent patients who had attempted suicide (N=84) were compared with cocaine-dependent patients who had never attempted suicide (N=130) on clinical, personality, psychiatric, and physical variables. RESULTS: Significantly more of the patients who had attempted suicide were female and had a family history of suicidal behavior; they reported significantly more childhood trauma and were significantly more introverted, neurotic, and hostile. They had also had significantly more comorbidity with alcohol and/or opiate dependence, major depression, and physical disorders. CONCLUSIONS: The clinical implications are that family, childhood, personality, psychiatric, and physical risk factors contribute to suicidal behavior in cocaine-dependent patients. Comorbidity appears to be an important determinant of suicidal behavior.     

Suicidal behavior in depression: relationship to platelet serotonin transporter

OBJECTIVE: Suicidal behavior in depressed patients is associated with low central serotonin. Thus, platelet serotonin uptake in relation to suicidal behavior in depression was examined. METHODS: Depressed patients who had never attempted suicide (n = 23) were compared with depressed patients who had never attempted suicide (n = 26) and normal controls (n = 71) for platelet serotonin uptake. RESULTS: Depressed patients who had a lifetime history of a suicide attempt had a significantly greater apparent Michaelis constant (Km) of platelet serotonin uptake than either depressed patients who had never attempted suicide or controls. Patients rated high for current suicidal ideation at the index admission had significantly higher Km values than patients rated low. Also, patients who reattempted or committed suicide during a 5-year follow-up period had significantly higher Km values than controls. Among women patients who had attempted suicide there was a significant correlation between extrapunitive hostility scores and Km values. CONCLUSION: The serotonin transporter warrants further study in relation to suicidal behavior in depression.     

Marked reduction in indexes of dopamine metabolism among patients with depression who attempt suicide.

Cerebrospinal fluid studies have reported that low concentrations of the dopamine metabolite homovanillic acid are associated with suicidal behavior in depression. Although only a small proportion of homovanillic acid in the urine derives from the brain, we decided to examine 24-hour urinary outputs of homovanillic acid in relation to suicidal behavior in depression. Patients with depression who had attempted suicide had significantly smaller urinary outputs of homovanillic acid, dihydroxyphenylacetic acid, and total body output of dopamine (sum dopamine) than did patients with depression who had not attempted suicide. Patients with depression who reattempted suicide during 5-year follow-up had significantly smaller urinary outputs of homovanillic acid and sum dopamine than did patients who did not reattempt suicide, patients who never attempted suicide, and normal control subjects, and had significantly smaller outputs of dihydroxyphenylacetic acid than patients who never attempted suicide or control subjects. These data suggest that urinary outputs of homovanillic acid may be peripheral correlates of suicidality in depression. These data add to data on the low levels of homovanillic acid in cerebrospinal fluid in suggesting that diminished dopaminergic neurotransmission may play a part in suicidal behavior in depression.     

Hypothalamic-pituitary-adrenal axis function and suicidal behavior in depression.

Hypothalamic-pituitary-adrenal (HPA) axis function was examined in relation to suicidal behavior in depression. There were no significant differences between depressed patients who had or had not attempted suicide for either cerebrospinal fluid concentrations of corticotropin-releasing hormone, plasma cortisol levels predexamethasone or postdexamethasone, or for urinary-free cortisol outputs. However, depressed patients who had made a violent suicide attempt had significantly higher 4 PM and maximum postdexamethasone plasma cortisol levels, and significantly more of them were cortisol nonsuppressors than patients who had made nonviolent suicide attempts. A 5-year follow-up was carried out. There were no significant differences on indices of HPA function between depressed patients who did or did not reattempt suicide during the follow-up or who had never attempted suicide. These results suggest the possibility that dysregulation of the HPA axis may be a determinant of violent suicidal behavior in depression.     

Cigarette smoking,suicidal behavior,and serotonin function in major psychiatric disorders

OBJECTIVE: Cigarette smoking is associated with a higher risk for suicide and attempted suicide, but psychopathological or biological explanations for this association have not been explored. Lower serotonin function and impulsive/aggressive traits are associated with suicidal acts, including completed suicide. The authors hypothesized that the relationship that may exist between cigarette smoking and suicidal behavior may be associated with lower serotonin function and the presence of impulsive/aggressive traits. METHOD: Study subjects were 347 patients with a psychiatric disorder (175 with depression, 127 with schizophrenia, and 45 with other disorders). Fifty-three percent of the subjects (N=184) had a lifetime history of suicide attempt, and 47% (N=163) had never attempted suicide. Smoking behavior, lifetime suicidal behavior, and psychopathology were assessed. Serotonin function was assessed in a subgroup of patients with depression (N=162) by using a fenfluramine challenge test and/or measurement of CSF levels of 5-hydroxyindoleacetic acid. RESULTS: Among all patients, smokers were more likely to have made a suicide attempt (adjusted odds ratio=2.60, 95% confidence interval=1.60-4.23) and had higher suicidal ideation and lifetime aggression scores, compared with nonsmokers. An inverse relationship was observed between amount of cigarette smoking and both indices of serotonin function. CONCLUSIONS: The association between cigarette smoking and the presence and severity of suicidal behavior across major psychiatric disorders may be related to lower brain serotonin function in smokers with depression. Further investigation is required to replicate these findings, to measure serotonin function in patients with disorders other than depression, and to test potential therapeutic effects of serotonin-enhancing treatments on both smoking behavior and suicide risk.     

Risk factors for suicide attempts among alcohol dependent patients.

Suicidal behavior is a common and important problem among alcohol dependent patients. The study was designed to examine risk factors for attempting suicide in 499 alcohol dependent patients. Those who had attempted suicide (N = 198) were more likely to be female, report a family history of suicidal behavior, report more childhood trauma, report greater levels of aggressive behavior, began heavy drinking earlier, and were more likely to have received antidepressant medication. Logistic regression analysis showed that gender, family history, and childhood sexual abuse history made significant and independent contributions to the risk of a suicide attempt. Thus, developmental, personality, family history, social, and comorbidity risk factors may differentiate alcohol dependent patients who have attempted suicide from those who have not.     

Attitudes of Japanese nursing personnel toward patients who have attempted suicide

Objective

The aim of this study was to examine the attitudes among Japanese nurses together with their perceived need for training in relation to understanding the nature of suicidal behavior and preventive strategies.

Methods

The Understanding Suicidal Patients scale together with additional questions reflecting training and the psychiatric treatment of suicide attempters were administered.

Results

A total of 323 nurses attended this study. Overall, the nurses thought patients who attempted suicide were not treated well. The nurses who worked in the psychiatric unit or had the experience in psychiatric nursing had more favorable attitudes toward suicidal patients and viewed themselves as having more relevant skill training in dealing with suicidal patients than those who did not. The nurses who worked at emergency care/intensive care unit were less likely to understand suicidal patients, and were less inclined to be sympathetic and to verbally interact with suicidal patients concerning their problems. The nurses who have confidence in the psychiatric care of suicidal patients, confidence in their own skills, and have a need for more training had the more positive attitudes.

Conclusions

The results suggest that less favorable attitudes may to some extent be the result of lack of knowledge regarding suicidal patients. Future studies should focus on the evaluation of educational experiences on attitudes and skill acquisition of nurses.     

Serum cholesterol, suicidal behavior and impulsivity in cocaine-dependent patients

Relationships between serum cholesterol and suicidal behavior have been reported. As suicidal behavior is common in cocaine dependence, we looked for a relationship with serum cholesterol. To do this, we compared 57 cocaine-dependent patients who had attempted suicide with 111 cocaine-dependent patients who had never attempted suicide for their admission total serum cholesterol levels. We found that there were no significant differences between cocaine-dependent patients who had or had not attempted suicide in their total serum cholesterol levels. Also, there were no significant correlations between total serum cholesterol levels and scores on the Barratt Impulsivity Scale. Thus, admission total serum cholesterol does not appear to be clinically useful in the assessment of suicidal behavior in cocaine-dependent patients.     

Family History of Suicide and Impulsivity

A family history of suicide indicates a raised risk for suicidal behavior; this liability might be familially transmitted as an impulsive-aggression trait. To examine the impulsivity factor, data from 258 abstinent drug dependent patients who were interviewed about their family history of suicidal behavior and who completed the Barratt Impulsivity Scale (BIS) were examined. The results showed that patients with a family history of suicidal behavior had significantly higher BIS scores for risk taking than patients without a family history of suicidal behavior. Also, patients with a family history of suicidal behavior who had themselves attempted suicide had significantly higher BIS scores for both impulsivity and risk taking than patients with a family history of suicidal behavior who had never attempted suicide.     

Family history of suicide and impulsivity.

A family history of suicide indicates a raised risk for suicidal behavior; this liability might be familially transmitted as an impulsive-aggression trait. To examine the impulsivity factor, data from 258 abstinent drug dependent patients who were interviewed about their family history of suicidal behavior and who completed the Barratt Impulsivity Scale (BIS) were examined. The results showed that patients with a family history of suicidal behavior had significantly higher BIS scores for risk taking than patients without a family history of suicidal behavior. Also, patients with a family history of suicidal behavior who had themselves attempted suicide had significantly higher BIS scores for both impulsivity and risk taking than patients with a family history of suicidal behavior who had never attempted suicide.     

Neuroactive steroids and suicidality in posttraumatic stress disorder

OBJECTIVE: Recent studies suggest that neuroactive steroids may be altered in posttraumatic stress disorder (PTSD). Since high rates of suicidality accompany PTSD, the authors investigated neuroactive steroid levels and correlations to suicide attempts in veterans with this disorder. METHOD: Male veterans with PTSD enrolled in a larger study during inpatient hospitalization (N=130) were assessed for suicidal ideation or suicide attempt in the last 6 months. Serum levels of dehydroepiandrosterone (DHEA), androstenedione, testosterone, and estradiol were determined. The authors investigated associations between neuroactive steroids and suicidality. RESULTS: High rates of suicidality were observed. Close to 70% of these patients had suicidal thoughts, and 25% had attempted suicide in the last 6 months. Patients who had attempted suicide demonstrated significantly higher median DHEA levels than those who had not attempted suicide (15.6 versus 8.3 ng/ml), an association that persisted after adjustment for age. CONCLUSIONS: These findings suggest that higher DHEA levels may be linked to suicidality in veterans with PTSD and may be associated with the risk of self-harm.     

Modeling effects on suicidal behavior

Knowledge of suicidal behavior, i.e., psychiatric patients indicating that they have an acquaintance or relative who has attempted or committed suicide, has been cited as a risk factor in the assessment of suicide potential. The authors evaluated psychiatric patients hospitalized for a suicide attempt (N = 30), serious suicidal ideation (N = 26), or other non-suicide-related reasons (N = 20) and also a control group of 18 patients admitted for orthopaedic surgery. Information derived from a structured clinical interview revealed that suicide attempters have fewer suicidal models than individuals in the other patient groups, and they are more interpersonally distant from the models they do know. Depression level was not positively related to the recall and reporting of suicidal models. Measures assessing suicide-related beliefs revealed that suicide attempters rated suicide as an effective solution for problems to a greater extent that did patients in the remaining three groups. The implications of these results for social learning models of suicidal behavior are discussed.     

Family history of suicidal behavior and earlier onset of suicidal behavior

The study examined whether having a family history of suicidal behavior is associated with an earlier age of first attempting suicide. Interviews were conducted with 545 patients who had attempted suicide about their family history of suicidal behavior and about their age of first suicide attempt. The results showed that attempters with a family history of suicidal behavior, particularly attempters with two or more such family members, had first attempted suicide at an earlier age than attempters who did not have a family history of suicidal behavior. These results suggest that a family history of suicide, which is known to increase the risk of suicidal behavior, may also be associated with an earlier age of first attempting suicide.     

Peripubertal suicide attempts in offspring of suicide attempters with siblings concordant for suicidal behavior

OBJECTIVE: The authors sought to determine 1) whether the risk for familial transmission of suicidal behavior is greater with increased family loading for suicide attempts, and 2) whether the transmission of suicidal behavior is mediated by impulsive aggression. METHOD: A reanalysis of a high-risk study compared the offspring of three mood disorder proband groups: suicide attempters with a sibling who also attempted suicide (N=19), suicide attempters whose siblings never made a suicide attempt (N=73), and nonsuicidal probands whose siblings also never engaged in suicidal behavior (N=73). Probands and offspring were assessed with respect to psychopathology, suicide attempt history, impulsive aggression, and exposure to familial adversity. RESULTS: Offspring of suicide attempters with siblings concordant for suicidal behavior showed a higher risk of suicide attempt than did offspring of nonsuicidal probands and had an earlier age at onset of suicidal behavior than offspring of suicide attempters with siblings discordant for suicidal behavior. Probands from sibling pairs concordant for suicidal behavior and their offspring reported greater lifetime impulsive aggression compared with each of the other two proband/offspring groups. In the offspring, impulsive aggression was the most powerful predictor of early age at first suicide attempt. CONCLUSIONS: Familial loading for suicide attempts may affect rates of transmission as well as age at onset of suicidal behavior, and its effect may be mediated by the familial transmission of impulsive aggression.     

Suicidal ideation and attempts in bipolar I and II disorders

OBJECTIVE: Few studies have investigated the prevalence of and risk factors for suicidal ideation and attempts among representative samples of psychiatric patients with bipolar I and II disorders. METHOD: In the Jorvi Bipolar Study (JoBS), psychiatric inpatients and outpatients were screened for bipolar disorders with the Mood Disorder Questionnaire from January 1, 2002, to February 28, 2003. According to Structured Clinical Interviews for DSM-IV Axis I and II Disorders, 191 patients were diagnosed with bipolar disorders (bipolar I, N = 90; bipolar II, N = 101). Suicidal ideation was measured using the Scale for Suicidal Ideation. Prevalence of and risk factors for ideation and attempts were investigated. RESULTS: During the current episode, 39 (20%) of the patients had attempted suicide and 116 (61%) had suicidal ideation; all attempters also reported ideation. During their lifetime, 80% of patients (N = 152) had had suicidal behavior and 51% (N = 98) had attempted suicide. In nominal regression models, severity of depressive episode and hopelessness were independent risk factors for suicidal ideation, and hopelessness, comorbid personality disorder, and previous suicide attempt were independent risk factors for suicide attempts. There were no differences in prevalence of suicidal behavior between bipolar I and II disorder; the risk factors were overlapping but not identical. CONCLUSION: Over their lifetime, the vast majority (80%) of psychiatric patients with bipolar disorders have either suicidal ideation or ideation plus suicide attempts. Depression and hopelessness, comorbidity, and preceding suicidal behavior are key indicators of risk. The prevalence of suicidal behavior in bipolar I and II disorders is similar, but the risk factors for it may differ somewhat between the two.     

Resilience as a focus of suicide research and prevention

Suicide is a major medical and social problem. Decades of suicide research have mostly focused on risk factors for suicidal behaviour while overlooking protective factors such as resilience that may help to address this important public health issue. Resilience is the capacity and dynamic process of adaptively overcoming stress and adversity while maintaining normal psychological and physical functioning. Studies conducted over the past 10–15 years suggest that resilience is a protective factor against suicide risk. Resilience is becoming a focus of suicide research and prevention. Building resilience should be a part of universal, selective, and indicated suicide prevention interventions. Promoting resilience may reduce suicide risk in the general population, in groups at elevated suicide risk, and among high‐risk individuals. Building resilience in the general population may reduce the incidence of stress‐related disorders and, consequently, suicidal behaviour. Improving resilience should be a part of a treatment plan of every psychiatric patient. Mental health professionals will probably have the best success in reducing suicide risk in psychiatric patients if they actively concentrate on increasing stress resilience using both psychosocial and pharmacological interventions. It is critically important to move forward the development of pharmacological and psychological interventions for enhancing resilience.     

Impulsivity in Drug Dependent Patients Who Attempt Suicide

Impulsivity is a personality dimension often implicated in suicidal behavior. However, it has been little studied in drug dependent patients who attempt suicide. Therefore, 292 recently abstinent opiate or cocaine dependent patients were asked to complete the Barratt Impulsivity Scale (BIS). Those who had attempted suicide were compared with those who had never attempted suicide for their scores on the BIS. The results showed that there was no significant difference between the drug dependent patients who had attempted suicide (N = 91) and those who had never attempted suicide (N = 201) on BIS scores. The possible clinical implication may be that the high impulsivity associated with drug dependent patients may mitigate the utility of impulsivity in the suicide risk assessment of such patients.     

Attempted suicide in older depressed patients: effect of cognitive functioning.

The authors explored cognitive functioning and suicidal behavior in older depressed patients. Inpatients age 50 years or older (N=103) with major depression, 45 of whom had attempted suicide, were evaluated within 1 week of their hospital admission. Measures of suicidal behavior included suicide attempter status, the Suicide Intent Scale (SIS), ratings of method used (violent/nonviolent), and seriousness of injuries sustained (lethality). The Mini-Mental State Exam (MMSE) score measured cognitive impairment; covariates were age, gender, and living arrangement. The MMSE score was not associated with suicide attempter status, but for attempters, MMSE score showed a positive association with SIS score, but not method or lethality. Findings suggest that although cognitive disturbance may be associated with less-deliberate acts among older depressed suicide attempters, it does not appear to influence the potential lethality of their behavior.     

Relationship between attempted suicide,serum cholesterol level and novelty seeking in psychiatric in-patients

This study sought to compare the serum cholesterol levels of psychiatric in-patients, with and without recent suicidal behavior. The hypothesis was that the temperament dimension novelty seeking (NS) would be an intermediary variable, correlated with both serum cholesterol level and suicidal behavior. The study included 155 psychiatric in-patients, 21.9% (n=34) of whom had recently attempted suicide. Their cholesterol level was compared to that of patients with no suicide attempt. The NS dimension was explored with the aid of Cloninger's Temperament and Character Inventory. Significantly lower average cholesterol levels were found in women who had attempted suicide before hospitalization than for the others (4.71 mmol/l+/-0.83 vs. 5.52 mmol/l+/-1.36). Similar results were not found for men. However, the average NS scores did not differ according to suicide attempts in women or in men, and the scores of NS were not correlated with cholesterol level. This study confirms an association between low cholesterol and suicidal behavior in women only, but this association seems independent from the NS personality dimension. The absence of a correlation between serum cholesterol levels and suicidal behavior in men could be linked to the small number of men included in the study.