Alexithymia,suicide ideation,affective temperaments and homocysteine levels in drug naïve patients with post-traumatic stress disorder: an exploratory study in the everyday ‘real world’ clinical practice

Objective: The present exploratory study aimed to investigate relationships between alexithymia, suicide ideation, affective temperaments and homocysteine levels among drug-naïve adult outpatients with Post-Traumatic Stress Disorder (PTSD) in an everyday ‘real world’ clinical setting.

Method: Sixty-four adult outpatients with PTSD were evaluated using the Davidson Trauma Scale (DTS), the Toronto Alexithymia Scale (TAS–20), the Scale of Suicide Ideation (SSI), the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego-Autoquestionnaire. As well, homocysteine levels were measured.

Results: Alexithymic subjects showed higher values on all scales but not homocysteine levels. Partial correlations showed that almost all studied variables were correlated with each other, except homocysteine levels. Regression analysis showed that higher disorder severity as measured by DTS and TAS-20 ‘Difficulty in Identifying Feelings’ dimension was associated with higher SSI scores.

Conclusions: In conclusion, alexithymic PTSD outpatients may be characterised by higher disorder severity and difficulty in identifying feelings that may be linked to increased suicide ideation, regardless of affective temperaments or homocysteine levels. Homocysteine levels were not related to any studied variable. However, study limitations are discussed and must be considered.

• Keypoints

• Patients with alexithymia showed increased PTSD severity, a higher score on TEMPS-A subscales, and more severe suicide ideation.

• The Difficulty in Identifying Feelings (DIF) dimension of TAS-20 was associated with suicide ideation in patients with PTSD.

• Homocysteine did not correlate with any studied variables.

• This study was exploratory and cross-sectional: further larger and prospective studies are needed.

     

The association between leptin receptor polymorphism and suicidal behaviour in depressed adolescents

Abstract

Objective: Suicide is the second leading cause of death in adolescence. Genetic studies implicate the genetic component of suicide independent from associated psychiatric disorder. Although genetics is an important factor that might be associated with suicide, limited progress is achieved to identify the candidate genes in adolescents.

Methods: The study included 97 patients and 106 controls. Five leptin receptor single nucleotide polymorphism (SNP) region examined. Depressive scores were measured with Children Depression Inventory and suicidal behaviour was measured by Suicide Probability Scale. Logistic and linear regression analysis used for determining to predictors.

Results: In linear regression analysis (R²: 0.786) both previous suicide attempt (B:5.553, t:2.613 p: .035) and having a mutant allele in rs1171276 SNP region (B:4.346 t:2.220 p: .048) have been associated with suicidal behaviour. In logistic regression analysis, family history of depression (p?<?.0001, OR: 4.2 [1.7–9.6]) and number of stressful life events (p: .001, OR: 1.7 [1.3–2.1]) predicted depression significantly.

Conclusion: Leptin receptor polymorphism could result in an increase in impulsive behaviour and suicide scores with leptin resistance. Our research is the first study to investigate the relationship between depression, suicidal behaviour and leptin receptor polymorphism in adolescent sample. Similar studies could be carried out on a community basis.

• KEY POINTS

• An association has been found between rs1171276 single nucleotide polymorphism of leptin receptor and the suicide probability scores in depressed adolescents.

• Family history of depression and number of stressful life events predict depressive scores significantly.

• Leptin receptor single nucleotide polymorphism may be a risk factor for adolescent suicide by increasing impulsive behaviour.

     

Suicidal ideation in patients with obsessive–compulsive disorder

The risk factors for suicidal behaviour in obsessive-compulsive disorder (OCD) have been less studied compared than in other anxiety disorders. In the present study, we examined the demographic and clinical correlates of current suicidal ideation (SI) in patients with OCD. Forty-four patients were grouped into those with (n = 23) and without current SI (n = 21) as assessed by the Scale for Suicidal Ideation. The Yale-Brown Obsessive–Compulsive Scale (Y-BOCS) was used to assess the obsessive–compulsive (OC) symptomatology. Following Bonferroni correction, only the severity of depression differed significantly between the two groups. The presence of major depression and aggressive obsessions, the level of hopelessness, and the severity of OC symptomatology were significant predictors of current SI in patients with OCD. The relatively low frequency of some comorbid Axis I disorders is based on small sample size and therefore may be vulnerable to type II error. We did not examine the relationship between the recent suicidal attempts and OCD. Also, we did not assess the effect of impulsivity in the occurrence of SI in patients with OCD. Associated depression, hopelessness, and aggressive obsessions might play an important role in the occurrence of SI in patients with OCD. However, future studies with a psychological autopsy design are required to systematically determine the presence for OCD among those who have completed suicide.     

Evaluation of official procedures for suicide prevention in hospital from a forensic psychiatric and a risk management perspective

Abstract

Background: Suicide is a severe public health problem, in 2008 the Italian ministerial recommendation n° 4 on the management of suicide defined key areas for the identification of suicidal risk in hospital wards. The guidelines are important in defining professional liability issues, in line with Law 24 of 8/3/2017 ‘Gelli-Bianco’. Our study aimed to investigate the appropriateness of the official documents on suicide prevention delivered by Italian hospitals and their compliance with the ministerial recommendation.

Methods: The Italian hospitals’ public procedures on suicide prevention issued between 2008 and 2019 (n?=?33) were retrieved thorough web search and further evaluated according to their compliance with the 2008 Italian ministerial recommendations.

Results: The guidelines documents were generally in line with the ministerial recommendation. However, we found a lack of implementation in the specific training of health professionals. Most guidelines provided no risk stratification, nor specific procedures for different risk degrees or diagnoses. More than half of the documents did not report standardised tools for the assessment of suicidal risk.

Conclusions: The public procedures on suicide prevention in Italian hospitals present general indications, leaving room for interpretation. Public procedures should be implemented with greater attention to the elements of judgement in the assessment of suicidal risk.

• KEY POINTS

• Procedures for suicide prevention are of uttermost importance for psychiatrist working in hospital.

• Standards in suicide risk evaluations are needed.

• Comparison between procedures can improve risk assessment and evaluation

     

A comparison of the medical lethality of suicide attempts in bipolar and major depressive disorders

Objectives:  Among mood disorders, bipolar disorder (BPD) is often noted to involve the highest rates of suicide attempts and possibly of completion. This study sought to determine whether suicide attempters with BPD exhibit suicide attempts with higher lethality than attempters with major depressive disorder (MDD) and to explore differences in clinical features associated with suicidal acts.
Methods:  Mood disordered suicide attempters were interviewed about Axis I and II diagnoses, lifetime history of suicide attempts, suicidal intent, suicidal ideation, the medical lethality of their most severe suicide attempt, severity of depression, hopelessness, lifetime aggression, and impulsivity.
Results:  The maximum lethality of suicidal acts tended to be higher among BPD attempters compared with those with MDD. However, there were no differences in the number of suicide attempts, intent to die or suicidal ideation. Suicide attempters with BPD reported higher levels of aggression and impulsivity but less hopelessness compared with MDD attempters. These differences could not be explained by Cluster B personality disorder comorbidity. Of note, within the BPD group, but not the MDD group, males reported suicidal acts with higher lethality. Multivariate analyses suggested that risk for more lethal suicide attempts is associated with BPD and male sex and that bipolar males appear to be especially vulnerable to these behaviors.
Conclusions:  Males with BPD make more lethal suicide attempts than females with BPD, an effect not observed among the MDD sample. Our findings suggest that higher rates of suicidal behavior in BPD may be due to a specific effect of BPD on males, leading to more dangerous suicidal behaviors. This effect, together with the larger proportion of males in the BPD group compared with the MDD group may lead to higher rates of reported attempted and completed suicide.     

Exploring the association between depression,suicidality and serum neurotrophin levels in adolescents

Abstract

Objective: The aim of this study was to identify potential differences in serum brain-derived neurotrophic factor (BDNF), glial-derived neurotrophic factor (GDNF), nerve growth factor (NGF) and neurotrophin-3 (NTF3) levels in adolescents with major depressive disorder (MDD) compared to healthy controls. The possible relationship between serum neurotrophin levels and suicidality in adolescents with MDD was also addressed.

Methods: A total of 70 treatment-free adolescents with MDD and 40 healthy controls aged 11 to 19?years were enrolled. The severity of suicidality was determined using the Columbia-Suicide Severity Rating Scale, and the severity of depression and anxiety symptoms were evaluated by self-report inventories. Serum levels of neurotrophins were measured using an enzyme-linked immunosorbent assay.

Results: The mean serum BDNF levels were significantly higher in adolescents with MDD than in control subjects; no significant difference was found between the groups for serum GDNF, NGF and NTF3 levels. No correlations were found between the levels of serum neurotrophins and the severity of depression or suicidality.

Conclusions: The study results suggest that elevated serum BDNF levels may be related to MDD in adolescents. However, our findings did not support a role for neurotrophins in suicidality.

• Key points

• Serum BDNF levels were higher in adolescents with MDD than in controls.

• No significant alterations of serum levels of GDNF, NGF and NTF3 were evident in adolescents with MDD.

• Neurotrophin levels were not associated with suicidal ideation and behaviours.

     

A proposed model of the development of suicidal ideations

BackgroundSuicidal ideations may precede suicide attempts. They are of particular concern in psychiatric populations because psychopathology is a major risk factor for suicide. The factors affecting the development of suicide ideations may differ among psychiatric patients with and without a previous suicide attempt and individuals without a psychiatric diagnosis.ObjectivesThe aim of this study is to develop a model of suicide ideation in psychiatric patients and the general population.MethodThe study included 196 participants: 92 psychiatric patients with a previous suicide attempt (“attempters”); 47 psychiatric patients who had never attempted suicide (“non-attempters”); and 57 healthy control subjects. Data were collected on socio-demographic parameters, clinical history, and details of the suicide attempts. Participants completed a battery of psychological instruments assessing aggression–impulsivity, mental pain (including depression and hopelessness) and communication difficulties, in addition to negative life events. Findings were correlated with suicidal ideation by group.ResultsThe correlations of the different variables with suicidal ideation differed between suicide attempters and non-attempters; therefore, the model was analyzed separately for each group. The study yielded three major findings: negative life events had a significant effect on both anger-in and impulsivity in non-attempters but not in attempters; hopelessness moderately contributed to suicidal ideations in attempters but not in non-attempters; loneliness contributed significantly to depression in non-attempters but was less distressing in attempters.ConclusionThe mechanism underlying suicidal ideation appears to differ between psychiatric patients who have previously attempted suicide and those who have not, supporting a dual model of suicidal ideation. Although this is only a preliminary study, these findings are important for furthering our understanding of the process of transition of suicidal thoughts to completion of suicide. These results need further replication with a larger cohort of subjects.     

High rates of depression anxiety and suicidal ideation among inpatients in general hospital in China

Objective: To investigate the prevalence rates of depression anxiety and suicidal ideation among Chinese general hospital inpatients and to identify the potential associations with sociodemographics.

Method: A cross-sectional survey was applied in a Chinese general hospital. A questionnaire set, including sociodemographic variables, Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder Scale-7 (GAD-7), was completed by the participants. Clinically significant depression (CSD) and clinically significant anxiety (CSA) were defined as a score above 10 on the two scales. CSD and CSA are proxy measures but not specific diagnoses of mental disorders.

Results: Data from 1329 patients were included in the final analysis. 422 (31.8%) reported clinically significant depressive symptoms, 83 (6.3%) reported frequent suicidal ideation, and 204 (15.3%) reported clinically significant anxiety. Household income was negatively associated with CSD. Inpatients with lower household incomes and educational levels had higher rates of CSA. Middle-aged inpatients were more prone to suicidal ideation, and stable marital status was related to less suicidal ideation.

Conclusion: Depression, anxiety, and suicidal ideation were determined to be common psychological problems in Chinese inpatients. Chinese medical personnel must pay attention to the mental health conditions of inpatients, particularly inpatients with lower income, educational levels, and poor marital status.

• Key Points

• This is one of the first studies focusing on the prevalence of depression and anxiety in Chinese hospitalized inpatients in non-psychiatric departments of a general hospital.

• The PHQ-9 and GAD-7 were determined to be potential screening tools to aid Chinese medical workers in recognizing depression and anxiety in nonpsychiatric departments.

• The prevalence of depression, anxiety and suicidal ideation was observed to be relatively high in inpatients, which requires more attention from Chinese clinicians.

     

Effectiveness of intensive treatment services for obsessive compulsive disorder: outcomes from the first Canadian residential treatment program

Abstract

Background: Obsessive–Compulsive Disorder (OCD) is a psychiatric illness that can result in debilitating symptoms and functional impairment. Until recently, individuals with severe OCD symptoms have not received appropriate services within the Canadian healthcare system. The Frederick W. Thompson Anxiety Disorders Centre launched an Intensive Services Residential treatment programme for OCD in July 2017 to meet the needs of the Canadian population. This paper sets out to demonstrate the effectiveness of this programme.

Methods: This study incorporated quantitative and qualitative data collection. Quantitative data were analysed using paired sample t-tests while qualitative data was transcribed and coded for emerging themes.

Results: Beneficial changes in symptomatology were found. Client narrative emphasised the importance of exposure response prevention (ERP), creation of an OCD community as well as enhanced functionality in clients’ lives. Clients also commented on why they believed the treatment worked and points of potential improvement for discharge planning and programme organisation.

Conclusions: This study adds to the growing body of evidence regarding the importance of intensive services for individuals experiencing severe symptoms of OCD. Enhancing accessibility to services and ensuring ongoing maintenance of gains will be important next steps in ensuring long-term recovery for individuals with severe symptoms of OCD.

• Key points

• Intensive services treatment for OCD has been found to be beneficial for clients and this paper demonstrates the first time this has been seen within a Canadian programme.

• Treatment provided decreased OCD severity and increased functionality and quality of life.

• Clients cited exposure and response prevention work as a key ingredient in their recovery.

• Our programme is always in an ongoing state of quality improvement, ensuring client engagement and satisfaction.

     

Past suicidal ideation as an independent risk factor for suicide behaviours in patients with depression

Objectives: As South Korea has the highest incidence of completed suicides, the present study aimed to investigate the predictive power of the variables that have been associated with suicide attempts in Korean patients diagnosed with depression.

Methods: Hundred participants were divided into two groups: suicide attempters (31%) and suicide non-attempters (69%). Participants with a history of more than one suicidal attempt were assigned to the suicide attempter group. A hierarchical logistic regression analysis was performed to determine the predictive strengths of the variables that were likely to be associated with suicide attempts.

Results: After controlling for the effects of such variables as the severity of depressive symptoms, life stress events and impulsivity, the severity of past suicidal ideation was the most important predictive factor for discriminating suicide attempters from suicide non-attempters. The odds ratio for attempting suicide relative to not attempting suicide increased by a factor of 4.408 for each unit of increase in suicidal ideation.

Conclusions: The present study suggests that the most severe suicidal ideation throughout one’s entire life should not be overlooked and may be a major predictor of the risk of suicide.     

Neurocognitive findings in young adults with binge eating disorder

Abstract

Objectives: Binge-eating disorder (BED) has been associated with cognitive impairment, including on measures of impulsivity, but it is not clear in prior literature whether these deficits may have been associated with obesity, rather than BED per se. Impulsivity may play a role in predisposing people towards BED as well as in the chronicity of symptoms. The aim of this study was to examine cognitive functions between BED and healthy controls matched for age, gender, and body mass indices.

Methods: Individuals with BED and healthy controls were recruited from the general community using media advertisements. After providing informed consent, study participants completed a clinical interview and computerised neuropsychological testing. Group differences were analysed.

Results: Groups did not differ significantly on age, gender, education levels, or body mass indices. The BED group (N?=?17) exhibited significantly impaired stop-signal response inhibition (Stop-Signal Task) and executive planning (Stockings of Cambridge Task) compared to healthy controls (N?=?17). Spatial working memory and set-shifting were intact.

Discussion: BED appears to be associated with motor disinhibition and impaired executive planning even controlling for obesity. Longitudinal work is needed to clarify whether motor impulsivity predisposes people to BED, and/or contributes to persistence of symptoms over time.

• Key points

• Binge-eating disorder is common, under-recognised, and associated with untoward physical and health sequelae.

• The neurobiological basis of binge-eating disorder is unclear; cognitive testing may offer insights.

• Many prior cognitive studies have not controlled for potential confounds, especially group differences in body mass indices (BMI). Obesity in itself has been linked with cognitive dysfunction.

• Here, we compared cognition between people with binge-eating disorder and controls, matched for BMI and other measures.

• Binge-eating disorder was associated with impaired response inhibition and executive planning.

• These results inform neurobiological models of binge-eating disorder and may suggest new treatment targets for this condition.

     

Relationship between impulsivity and obsession types in obsessive-compulsive disorder

Objective: Impulsivity is an important aspect of obsessive-compulsive disorder (OCD) which is classified under a new heading in DSM-5 with other impulsivity related disorders like trichotillomania. Due to its heterogeneous nature, different obsessions may be linked to varying impulsivity profiles. Aim of this study was to investigate the impulsivity traits and their relationship with obsession types by comparing OCD subjects who display sexual, religious and aggressive obsessions or other obsessions to healthy controls.

Methods: Outpatients with OCD (n?=?146) and healthy controls (n?=?80) were evaluated with Sociodemographic Data Form, SCID-I, SCID non-patient version, Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Barratt Impulsiveness Scale (BIS-11).

Results: BIS-11 attention scores of the OCD group were significantly higher than healthy subjects. In patients with sexual, aggressive, religious obsessions, BIS-11 attention scores were significantly higher than those who have other obsession types and that of controls.

Conclusions: Higher levels of attentional impulsivity, particularly in patients suffering from sexual, aggressive or religious obsessions suggest a common diathesis for a dysfunction in neural correlates corresponding to these symptoms. The results of our study may promote further studies conducted with more advanced and objective neuropsychometric tests evaluating features of the clinical course, neurobiology and the response to OCD treatment.     

Alcohol use predicts emergency psychiatric unit admission for non-fatal suicidal behaviour in the Western Cape (South Africa): a case–control study

Abstract

Objective: We aimed to describe patterns of substance use among patients admitted to an emergency psychiatric unit for non-fatal suicidal behaviour (NFSB) or another psychiatric reason and establish whether there were significant differences in patterns of substance use between the two groups.

Methods: We employed a case–control design (N?=?50) and collected data about participants' substance use in Cape Town, South Africa. Data were analysed using Chi-square and Mann–Whitney tests, factor analysis, and logistic regressions.

Results: Prevalence of lifetime Alcohol Use Disorder (AUD) was 60% in the NFSB group and 28% in the control group. 12% of the NFSB group and 20% of the control group had a lifetime Tobacco Use Disorder. Prevalence of lifetime illicit Substance Use Disorder was 44% in the NFSB group and 60% in the control group. Hospital admission for NFSB was associated with: any past 24-hour alcohol use; quantity of past 24-hour alcohol use; quantity of past-month alcohol use; lifetime AUD; past 12-month AUD; and current AUD; and was not associated with the use of any other substances (p<.05). Past 12-month AUD was the best predictor of hospital admission for NFSB, controlling for, respectively, any past 24-hour alcohol use (aOR = 13.33, p?=?.023) and quantity of past 24-hour alcohol use (aOR = 9.01, p?=?.022)

Conclusions: Patients admitted to emergency psychiatric units for NFSB have increased needs for the treatment of AUDs compared to patients admitted for another psychiatric emergency. Findings support calls for interventions to prevent NFSB among psychiatric patients with a history of AUD.

• Key points

• Rates of substance use among patients admitted to emergency psychiatric units in South Africa were high compared to the general population.

• Hazardous alcohol use was uniquely associated with hospital admission for non-fatal suicidal behaviour compared to another psychiatric emergency.

• Tobacco use and illicit substance use were not associated with hospital admission for non-fatal suicidal behaviour compared to another psychiatric emergency.

• The association between hazardous alcohol use and hospital admission for non-fatal suicidal behaviour did not appear to be affected by demographic variables.

• Patients admitted to hospital for non-fatal suicidal behaviour have increased needs for the treatment of alcohol use disorders compared to other psychiatric patients.

     

Hopelessness,depression, substance disorder,and suicidality

Abstract. Background: Most earlier studies of hopelessness as a risk factor for suicidal behavior were based on either clinical or restricted samples. Using a longitudinal study design with a community sample of more than 3,000 participants, we aimed to examine if hopelessness was a long-term predictor of suicidal behaviors. Methods: Using longitudinal data from the Baltimore Epidemiologic Catchment Area (ECA) Program, we assessed the association of hopelessness at baseline and incident suicidal behaviors in the 13-year follow-up period, adjusting for the presence of depression and substance use disorders. Suicide behaviors studied included completed suicide, self-reported attempted suicide, and suicide ideation. Results: Hopelessness was predictive of all three types of suicidal behaviors in the follow-up period, even after adjustment. Persons who expressed hopelessness in 1981 were 11.2 times as likely to have completed suicide over the 13-year follow-up interval (95% confidence interval [1.8, 69.1]). The association between suicidality and hopelessness was stronger and more stable than the association of suicidality with the presence of depression and substance use disorders. Conclusion: Hopelessness was an independent risk factor for completed suicide, suicide attempts, and suicidal ideation. Intervention strategies that lower hopelessness may be effective for suicide prevention.Dr. Kuo is currently with Medical and Health Research Association (MHRA) and National Development and Research Institute, Inc (NDRI), New York, NY, USA. Dr. Gallo is currently with the Department of Family Practice and Community Medicine, University of Pennsylvania, Philadelphia, PA, USA.     

Suicidality among South Brazilian tobacco growers

ObjectiveTo assess prevalence of suicidal ideation and suicide attempt among South Brazilian tobacco growers and to analyze the associated factors related to the suicidal ideation.MethodsA cross-sectional study was conducted in 2011 with a random sample of 2469 tobacco growers in São Lourenço do Sul/RS. Suicidal ideation was characterized by the question “Has the thought of ending your life been on your mind?”. Suicide attempt was assessed by the question “Have you ever tried to kill yourself?”. Investigation of factors associated with suicidal ideation was done by means of Poisson regression.ResultsPrevalence of suicidal ideation and suicide attempt was 2.5 % and 1.2 % respectively. In the adjusted analysis, suicidal ideation was associated with being female, older age, moderate participation in religious activities and difficulty in paying debts. Those who worked in activities that required inadequate postures (hunched over or other forced positions), as well as farmers who performed 6–9 pesticide-related tasks demonstrated greater risk of suicidal ideation. Regarding health conditions, medical diagnosis of asthma, chronic low back pain, number of lifetime green tobacco sickness episodes and lifetime pesticide poisoning were positively associated with suicidal ideation.ConclusionSuicidal thoughts and attempts are relevant mental health problems among tobacco growers. Reducing pesticide use, as well as exposure to nicotine and improving socio-economic conditions, can reduce suicidal ideation and improve the mental health of exposed workers.     

Suicidality in the "prodromal" phase of schizophrenia

Objectives

Patients with schizophrenia are at high risk for suicide ideation, attempts, and completed suicide. However, suicidal behavior during the prodromal phase of schizophrenia and a possible association between prodromal suicidal behavior and suicidality after the onset of overt psychosis are not studied.

Methods

One hundred six consecutively admitted schizophrenia patients with recent onset were evaluated retrospectively for prodromal symptoms and suicidality during the prodromal phase and after the onset of frank psychosis. In addition, 106 matched control subjects from the general population were evaluated for suicidality during the same age period of the prodromal phase of the corresponding patient.

Results

Suicide ideation and attempt during the prodromal period were reported in 25.5% and 7.5% of the patients, which are 3.8- and 8-fold greater than in the controls, respectively. Patients with suicidal behavior experienced a greater number of prodromal symptoms than those without. Prodromal depressive mood, marked impairment in role functioning, and tobacco smoking exerted an independent effect on suicide ideation, whereas depressive mood was the symptom significantly more frequent in patients with suicide attempt. Suicide attempts were associated with an earlier onset of prodromal symptoms and frank psychosis. All patients with prodromal suicide attempts were cigarette smokers. Suicide ideation during the prodromal phase was strongly associated with lifetime suicidality after the onset of frank psychosis.

Conclusions

Suicidal behavior is quite common during the prodromal period. The association of smoking, depressive mood, impaired functioning, and a large number of prodromal symptoms, particularly in patients with an early onset of symptomatology, carries a substantially increased risk for suicide ideation. Particular care is needed in patients with prodromal suicide ideation after the onset of frank psychosis because the risk to attempt suicide is high.     

Rumination and Pessimistic Certainty as Mediators of the Relation Between Lifetime Suicide Attempt History and Future Suicidal Ideation

This study examined whether rumination and certainty about pessimistic future-event predictions (P-Certainty) would mediate the relation between lifetime suicide attempt history and future suicidal ideation. Young adults, ages 18–25 (N = 143), with a suicide attempt history (n = 32) or no previous suicide attempt history (n = 111) at baseline, were followed up 2–3 years later and completed measures of rumination, depressive symptoms, hopelessness, suicidal ideation, and pessimistic future-event certainty. Lifetime suicide attempts at baseline were associated with higher suicidal ideation at follow up, and this relation was mediated by rumination and P-Certainty. Suicide attempters may be vulnerable to later ideation due to higher levels of rumination and also certainty in their pessimistic future expectations.     

Suicide attempt and suicidal ideation and their associations with demographic and clinical correlates and quality of life in Chinese schizophrenia patients

Objectives

This study aimed to examine the prevalence and correlates of lifetime suicide attempts and current suicidal ideation in community-dwelling schizophrenia patients in China.

Method

A sample of 540 schizophrenia patients was randomly selected in Beijing, China. All subjects were interviewed using standardized assessment instruments and their basic socio-demographic and clinical data including history of suicide attempts were collected.

Results

The prevalence of lifetime suicide attempts and the point prevalence of suicidal ideation were 12.0 %, and 21.1 %, respectively. In multiple logistic regression analyses, the presence of lifetime suicide attempt was independently associated with rural residence, having major medical conditions and better social functioning, while higher likelihood of current suicidal ideation was associated with past suicide attempt, the severity of overall psychopathology and depressive symptoms and lower psychological quality of life (QOL).

Conclusion

Among Chinese outpatients with schizophrenia, increased current symptoms and poorer QOL were correlated with current suicidal ideation, while demographic factors and indicators of greater social support were mostly correlated with lifetime suicide attempts. This study may help to identify important subgroups of patients with schizophrenia at particularly high risk of suicidal behavior.     

Depression and sleep quality in psoriatic patients: impact of psoriasis severity

Abstract

Background: Psoriatic patients often display depression and sleep disturbances. In previous research, we found high rates of depression and poor sleep quality among psoriatic patients, unrelated to psoriasis severity. However, these results referred to a sample mainly composed of patients under remission.

Aim: To compared the prevalence of depression and sleep disturbances in patients suffering from mild versus moderate-tosevere plaque psoriasis, also investigating the association between psoriasis severity and psychopathological variables.

• Keypoints

• Psoriasis affects the patients’ psychophysical health.

• Depressive symptoms and/or sleep disturbances are frequent among psoriatic patients.

• This study investigates these issues comparing the sub-populations of mild and moderate-to-severe psoriatic patients, with special attention to the association between sleep and pruritus.

• In clinical practice, the link between psychopathological disturbances and psoriasis should not be underestimated.

     

Suicidality in Subjects With Anxiety or Obsessive-Compulsive and Related Disorders: Recent Advances

Purpose of Review

Historically, anxiety disorders have not been considered as important determinants of suicide, but in the last years, many works have challenged this assumption. Here, we will review the available evidence on the relationship between suicide and anxiety disorders (e.g., obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, panic disorder, and body dysmorphic disorder), with special emphasis on findings published in the last years.

Recent Findings

Overall, anxiety disorders increase the risk of suicide. Specifically, 16% of patients with social anxiety disorder reported suicidal ideation in the previous month, and 18% of them had a history of suicide attempts. Similarly, in patients with panic disorder, suicidal ideation prevalence ranged between 17 and 32%, and 33% of them had a history of suicide attempts. Generalized anxiety disorder (GAD) was the most frequent anxiety disorder in completed suicides (present in 3% of people who committed suicide) and also subthreshold GAD was clearly linked to suicide ideation. Post-traumatic stress disorder was positively associated with suicidal ideation, and in patients with obsessive-compulsive disorder, suicide ideation rates ranged from 10 to 53% and suicide attempts from 1 to 46%. Body dysmorphic disorders presented a suicide ideation prevalence of about 80%.

Summary

Suicide risk is increased in subjects with anxiety disorder. This risk is higher in the presence of comorbidities, but it is not clear whether it is independent from such comorbidities in some disorders.