Gender differences in adolescents and young adults with suicidal behaviour.

OBJECTIVE: Gender differences in prevalence rates of suicide attempts and suicidal thoughts as well as in risk factors for suicide attempts such as traumatic events and mental disorders were investigated in a random sample of 3021 adolescents aged 14-24 years. METHOD: The M-CIDI (Composite International Diagnostic Interview) was used to survey suicidal behaviour, DSM-IV lifetime diagnoses and traumatic events. RESULTS: The female suicide attempters showed suicidal thoughts and suicide attempts significantly more often, and suicide attempts at a much younger age than the males. Furthermore, the females experienced sexual abuse much more often, and suffered significantly more often from anxiety disorders. The male suicide attempters showed higher rates of alcohol disorders and financial problems. CONCLUSION: A higher rate of anxiety in female suicide attempters results probably as a consequence of sexual abuse, which in turn makes them more vulnerable than males for attempting suicide between the age of 14-17.     

Gender differences in psychiatric symptoms related to suicidal ideation in Japanese patients with depression

Recent figures show that more than 30,000 people suicide each year in Japan, and that many of them are considered to suffer from depression. In addition, the suicide rate among Japanese women has been shown to be higher than in other countries. However, it is not clear whether the psychiatric symptoms leading to suicide differ by gender. The authors examined gender differences in psychiatric symptoms related to suicidal ideation (SI) in Japanese patients with depression. Study subjects were 199 new patients (66 men and 133 women) who were diagnosed with a major depressive disorder. SI and psychiatric symptoms were assessed by several psychological tests using questionnaires. Logistic regression analysis was used to calculate the odds ratio (OR) and 95% confidence interval (CI) with an adjustment for all relevant factors simultaneously. The stepwise method was also used for selecting variables. In univariate analysis, several psychosocial factors such as self-reproach, derealization, depressive moods, depersonalization, and anxiety traits were statistically significantly associated with SI in both men and women. However, multivariate analysis using the stepwise method distinguished gender differences. Low social/family support and depersonalization were statistically significantly associated with SI in men, while depressive moods and an anxiety state were significantly associated with SI in women. The relation between derealization and SI was statistically significant in women but not significant in men.     

Suicidal changes in patients with first episode psychosis: clinical predictors of increasing suicidal tendency in the early treatment phase

Aim: To identify predictors for developing a higher suicidal tendency during treatment of first‐episode psychosis. Methods: In a prospective follow‐up study, we examined clinical factors collected at treatment initiation as predictors for developing a higher suicidal tendency among patients in the first year of treatment of psychosis. Patients were grouped and ranked according to their highest suicidal tendency in the year before treatment: not suicidal, suicidal thoughts, suicidal plans or suicide attempt(s). Predictors for becoming more suicidal in the first year of treatment were examined on group level in multivariate logistic regression analyses. We assessed patients' suicidal tendency and clinical factors using validated interviews and rating scales. Analysis included 386 patients. Results: Among patients with some suicidal tendency a one‐point increase score on hallucinations significantly predicted developing a higher suicidal tendency, whereas a one‐point increase score on delusions was preventive of this. Feeling hopeless was highly associated with suicide attempt in those with earlier suicide attempt. Conclusion: The risk of suicide attempt did not differ between patient groups with suicidal thoughts, plans or suicide attempt. In first year of treatment of psychosis, hallucinations increased the risk for becoming more suicidal, whereas delusions reduced this risk in already suicidal patients.     

Attention‐deficit/hyperactivity disorder symptoms and suicidal behavior in adult psychiatric outpatients

Aim

We aimed to examine the association between attention‐deficit/hyperactivity disorder (ADHD) symptoms and suicidal behavior in psychiatric outpatients and whether this association differs among patients with different psychiatric disorders.

Methods

Cross‐sectional data came from the Japan Prevalence Study of Adult ADHD at Psychiatric Outpatient Care, which included psychiatric outpatients aged 18–65 years recruited from one university hospital and three general psychiatric outpatient clinics in Kitakyushu City, Fukuoka, Japan from April 2014 to January 2015 (N = 864). The Adult ADHD Self‐Report Scale (ASRS) Screener was used to collect information on ADHD symptoms. Reports of current and lifetime suicidal behavior were also obtained. A multivariable Poisson regression analysis was used to examine the association between ADHD symptoms and suicidal behavior.

Results

After adjusting for covariates there was a strong association between possible ADHD (ASRS ≥14) and suicidal behavior with prevalence ratios ranging from 1.17 (lifetime suicidal ideation) to 1.59 (lifetime suicide attempt) and 2.36 (current suicidal ideation). When ASRS strata were used, there was a dose–response association between increasing ADHD symptoms and suicidal ideation and suicide attempts. Analyses of individual ICD‐10 psychiatric disorders showed that associations varied across disorders and that for anxiety disorder, ADHD symptoms were significantly linked to all forms of suicidal behavior.

Conclusion

ADHD symptom severity is associated with an increased risk for suicidal behavior in general psychiatric outpatients. As ADHD symptoms are common among adult psychiatric outpatients, detecting and treating ADHD in this population may be important for preventing suicidal behavior.     

Marijuana use and suicidal behaviours among school-going adolescents in Africa: assessments of prevalence and risk factors from the Global School-Based Student Health Survey

BackgroundMarijuana use among adolescents, including high school students, has been consistently reported to be associated with a high incidence of suicidal behaviours. Little empirical research has been conducted on the propensity impact of marijuana use on suicidal behaviours in Africa.AimsTo assess factors associated with marijuana use and further quantify marijuana use as an associated factor of suicidal behaviours, including repeated attempted suicide, suicidal ideation and suicide planning, among high school students in Africa.MethodsA cross-sectional study was conducted among 32 802 school-going adolescents using the Global School-Based Student Health Survey data from 10 African countries grouped into West Africa, North Africa, South-East Africa, South Africa and East Africa subregions. Marijuana use and repeated attempted suicide were the main outcome variables. We employed double selection least absolute shrinkage and selection operator poisson regression model to assess risk factors associated with marijuana use and dominance analysis to establish ranked important and common risk factors. Inverse probability weighting poisson regression adjustment was applied to assess impact.ResultsThe prevalence of marijuana use and repeated attempted suicide were 3.7% (95% CI: 3.1 to 4.3) and 6.6% (95% CI: 5.9 to 7.4), respectively. The most important risk factor for marijuana use generally across the countries and specifically in three subregions was alcohol consumption, which constituted approximately 40% of the impact. The average treatment effect on the treated (ATT) indicated that marijuana use significantly increased the risk of suicidal ideation, suicide planning and repeated attempted suicide by 12% (ATT=0.12 (95% CI: 0.02 to 0.22)), 18% (ATT=0.18 (95% CI: 0.13 to 0.22)) and 31% (ATT=0.31 (95% CI: 0.20 to 0.41)), respectively.ConclusionsMarijuana use was significantly associated with suicidal behaviours (suicidal ideation, planning and repeated attempted suicide) among the students. To achieve Sustainable Development Goal 3.5 (to strengthen prevention and treatment of substance abuse), school-based psychosocial interventions should be streamlined to adequately assess and manage marijuana use. Targeting the most dominant risk factors in this population could translate into the reduction of suicidal behaviours in countries within Africa.     

Rates and risk factors for suicidal ideation,suicide attempts and suicide deaths in persons with HIV: a systematic review and meta-analysis

BackgroundPeople living with HIV/AIDS (PLWHA) must contend with a significant burden of disease. However, current studies of this demographic have yielded wide variations in the incidence of suicidality (defined as suicidal ideation, suicide attempt and suicide deaths).AimsThis systematic review and meta-analysis aimed to assess the lifetime incidence and prevalence of suicidality in PLWHA.MethodsPublications were identified from PubMed (MEDLINE), SCOPUS, OVID (MEDLINE), Joanna Briggs Institute EBP and Cochrane Library databases (from inception to before 1 February 2020). The search strategy included a combination of Medical Subject Headings associated with suicide and HIV. Researchers independently screened records, extracted outcome measures and assessed study quality. Data were pooled using a random-effects model. Subgroup and meta-regression analyses were conducted to explore the associated risk factors and to identify the sources of heterogeneity. Main outcomes were lifetime incidence of suicide completion and lifetime incidence and prevalence of suicidal ideation and suicide attempt.ResultsA total of 185 199 PLWHA were identified from 40 studies (12 cohorts, 27 cross-sectional and 1 nested case-control). The overall incidence of suicide completion in PLWHA was 10.2/1000 persons (95%CI: 4.5 to 23.1), translating to 100-fold higher suicide deaths than the global general population rate of 0.11/1000 persons. The lifetime prevalence of suicide attempts was 158.3/1000 persons (95%CI: 106.9 to 228.2) and of suicidal ideation was 228.3/1000 persons (95%CI: 150.8 to 330.1). Meta-regression revealed that for every 10-percentage point increase in the proportion of people living with HIV with advanced disease (AIDS), the risk of suicide completion increased by 34 per 1000 persons. The quality of evidence by Grading of Recommendations, Assessment, Development and Evaluations for the suicide deaths was graded as ‘moderate’ quality.ConclusionsThe risk of suicide death is 100-fold higher in people living with HIV than in the general population. Lifetime incidence of suicidal ideation and attempts are substantially high. Suicide risk assessments should be a priority in PLWHA, especially for those with more advanced disease.     

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.     

Gender influence in suicidal behaviour of Polish adolescents

Objective: The aim of the study was to assess the prevalence and possible suicide attempts and ideation predictors in the school population of girls and boys in the city of ód.Method: A selfadministered anonymous questionnaire was distributed to a representative (random) sample of 1663 students, aged 14–21. Boys and girls reporting no suicidal behaviour (NSB) constitute the control groups; the characteristics of these groups were compared to those of the groups with suicidal behaviour (SB), with focus on the associations between different variables and gender, separately for suicidal ideation (SI) and suicide attempts (SA).Results: About 37% of girls and 25% of boys reported suicidal ideation and about 11% and 5%, respectively, suicide attempts. Boys were more likely to make multiple suicide attempts. The relation between SB and the history of psychiatric treatment was the same for both sexes. Boys with SB were significantly more often fascinated with death, and girls were significantly more often exposed to difficult family situations.Abbreviations SI Suicidal Ideation - SA Suicidal Attempt - SB Suicidal Behaviour - NSB No Suicidal Behaviour - AACAP American Academy of Child and Adolescent Psychiatry - CDC Centres for Disease Control     

The association between attitudes toward suicide and suicidal ideation in adolescents

The aims of this study were to determine whether adolescent attitudes to suicide could be grouped into distinct factors, and then to examine the relationship between these factors and the psychosocial parameters known to be associated with suicide, and between attitudes towards suicide and suicidal ideation. A questionnaire designed to assess attitudes to suicide was distributed to a total of 525 Israeli adolescents. Statistical analysis indicated that the attitude items could be grouped into four distinct factors: the right of society to prevent suicide; suicide as a symptom of mental illness; the right of the individual to talk about suicide; and taking suicidal behaviour seriously. Each factor was differentially associated with the various psychosocial parameters examined. The association between the attitude factors and subjects' suicidal ideation was significant and at least as strong as that of the psychosocial parameters normally associated with adolescent suicide, namely gender and exposure to suicide. A generally approving attitude towards suicide was correlated with a high level of suicidal ideation.     

Variability in suicidal ideation during treatment for individuals at clinical high risk for psychosis: The importance of repeated assessment

Aim

Suicide risk is elevated among individuals at clinical high risk for psychosis (CHR-P). The current study examined variability in suicidal ideation during treatment for individuals at CHR-P.

Methods

A retrospective chart review was used to examine the course of suicidal ideation during 16 sessions of individual psychotherapy for 25 individuals at CHR-P.

Results

Suicidal ideation was reported by 24% of participants at session 1 and 16% at session 16, with minimal within-subject change in the presence of suicidal ideation across the two time points. However, a more fine-grained investigation at each session indicated that 60% of individuals at CHR-P experienced suicidal ideation at least once during treatment. Additionally, there was great variability in suicidal ideation both within and between participants over the course of the 16 sessions.

Conclusions

These findings highlight the importance of repeated assessment when examining suicidal ideation as a treatment outcome for individuals at CHR-P.