Risk factors for suicide attempts among African American women

The aim of this study was to examine psychological and interpersonal risk factors for suicidal behavior in low income, African American women; 285 African American women who reported being in a relationship with a partner in the past year were studied, 148 presented to the hospital following a suicide attempt, and 137 presented for general medical care. Cases were compared to controls with respect to psychological symptoms, alcohol and drug abuse, family violence (intimate partner abuse, childhood trauma), relationship discord, and social support. Psychological risk factors for suicide attempts at the univariate level included psychological distress [Crude Odds Ratio (COR) = 6.5], post traumatic stress disorder (PTSD) symptoms (COR = 3.8), hopelessness (COR = 7.7), and drug abuse (COR = 4.2). Interpersonal risk factors at the univariate level included relationship discord (COR = 4.0), physical partner abuse (COR = 2.5), nonphysical partner abuse (COR = 2.8), childhood maltreatment (COR = 3.2), and low levels of social support (COR = 2.6). A multivariate logistic regression model identified four variables that were strongly and independently associated with an increased risk for suicide attempts: psychological distress, hopelessness, drug abuse, and relationship discord. The model predicted suicide attempt status correctly 77% of the time. The results reveal that African American women who report high levels of psychological distress, hopelessness, drug use, and relationship discord should be assessed carefully for suicidal ideation and referred for appropriate mental health care.     

Risk factors for suicide among patients with schizophrenia

In order to assess risk factors for suicide among patients with schizophrenia, we compared 32 patients with schizophrenia who committed suicide during an 11 year follow-up with a control group of 64 schizophrenics who did not commit suicide. A history of previous suicide attempts was the factor most strongly related to suicide. In females we found an increased risk for suicide among unmarried, divorced or widowed and among those living alone. In males we found an increased risk among those with a history of alcohol abuse. In contrast to findings in other studies, distribution of age and sex and a history of depressive episodes were factors not associated with an increased risk for suicide. We conclude that suicidal acts among schizophrenics are often impulsive and difficult to predict. Traditional risk scales are of limited value in the clinical assessment of suicidal risk.     

Risk for suicide attempts among adolescents who engage in non-suicidal self-injury.

The current study examined whether common indicators of suicide risk differ between adolescents engaging in non-suicidal self-injury (NSSI) who have and have not attempted suicide in an effort to enhance clinicians' ability to evaluate risk for suicide within this group. Data were collected from 540 high school students in the Midwest who completed the RADS, RFL-A, SIQ, and SHBQ as part of a larger adolescent risk project. Results suggest that adolescents engaging in NSSI who also attempt suicide can be differentiated from adolescents who only engage in NSSI on measures of suicidal ideation, reasons for living, and depression. Clinical implications of the findings are discussed.     

Risk and protective factors predicting multiple suicide attempts

This study compared demographical and clinical variables between first and multiple suicide attempters and investigated risk and protective factors predicting multiple attempts. 228 patients visiting emergency department after attempting suicide were divided into two groups: first attempter (n=148, 64.9%) and multiple attempter (n=80, 35.1%). Demographic variables, clinical characteristics, factors related with suicide behavior, and psychiatric resources between two groups were compared. Multivariate logistic regression analysis was conducted to investigate risk and protective factors predicting multiple attempts. The results showed that multiple attempters were younger, not married, more severe in psychopathology (e.g., psychiatric disorder, personality disorder, lower function, and suicide family history) and suicidality (e.g., repetitive/severe/continuous suicide ideation), and lower in psychiatric resources (e.g., interpersonal stress/conflict, conflicting interpersonal relationship, socially isolated, lower personal achievement, and lower ability to control emotion) than first attempters. Suicide ideation severity and conflicting interpersonal relationships predicted multiple suicide attempts, whereas past year's highest global functioning score and age over 45 protected against multiple suicide attempts. This study demonstrated that multiple suicide attempters have more severe clinical profile than first suicide attempters. Moreover, decreasing severity of suicide ideation, improving interpersonal relationships, and enhancing functioning level of suicide attempters might be important in preventing them from re-attempting suicide.     

抑郁症未遂自杀及相关因素研究

对１４０例抑郁症患者的未遂自杀及相关因素进行研究，发现未遂自杀发生率为３４．２９％。与对照组相比，发生未遂自杀的４８例有以下特点：年龄较大、多有阳性家族史、个人经济收入较低，发病多有诱因、多为急性起病、ＨＡＭＤ睡眠障碍和绝望感因子分较高、迟缓因子分较低、多为单相抑郁症。逐步回归分析发现，影响未遂自杀的因素主要为ＨＡＭＤ睡眠障碍、绝望感、迟缓因子分。     

Risk factors for suicide and attempted suicide among young people

OBJECTIVE: Suicide rates in young people have increased during the past three decades, particularly among young males, and there is increasing public and policy concern about the issue of youth suicide in Australia and New Zealand. This paper summarises current knowledge about risk factors for suicide and suicide attempts in young people. METHOD: Evidence about risk factors for suicidal behaviour in young people was gathered by review of relevant English language articles and other papers, published since the mid-1980s. RESULTS: The international literature yields a generally consistent account of the risk factors and life processes that lead to youth suicide and suicide attempts. Risk factor domains which may contribute to suicidal behaviour include: social and educational disadvantage; childhood and family adversity; psychopathology; individual and personal vulnerabilities; exposure to stressful life events and circumstances; and social, cultural and contextual factors. Frequently, suicidal behaviours in young people appear to be a consequence of adverse life sequences in which multiple risk factors from these domains combine to increase risk of suicidal behaviour. CONCLUSIONS: Current research evidence suggests that the strongest risk factors for youth suicide are mental disorders (in particular, affective disorders, substance use disorders and antisocial behaviours) and a history of psychopathology, indicating that priorities for intervening to reduce youth suicidal behaviours lie with interventions focused upon the improved recognition, treatment and management of young people with mental disorders.     

Characteristics of suicide attempts preceded by alcohol consumption.

Acute alcohol ingestion and alcohol dependence are known to increase the risk of impulsive suicide attempt even in non-depressed patients. The relation between alcohol and suicide risk needs, however, to be clarified. We assessed for this purpose prevalence of recent alcohol intake among suicide attempters and compared suicide attempts preceded ("Alcohol + ") or not by alcohol intake. We included 160 patients examined in the emergency service of a French general hospital after a suicide attempt. Psychiatric disorders were identified according to the DSM-IV criteria. Patients were rated for depression and alcohol use disorder (MAST). Prevalence of alcohol consumption was 40%. Patients from the "Alcohol + " group were significantly older (40 versus 34.8 years, p = 0.03). Alcohol abuse was more frequent among suicide attempters with prior alcohol ingestion (49% versus 12%,). Alcohol dependence was also more frequent in the "Alcohol + " group (43% versus 9%). Patients from the "Alcohol + " group drank more alcohol each day (6.1 versus 1.3 drinks) and more often during the week (3.6 days per week versus 1.4). They had a higher number of alcohol intoxications each week (0.9 versus 0.3). They drank more often alone (41% versus 12%, p < 0.005) and in the morning (21% versus 3%). They had higher scores on the Michigan Alcohol Screening test (14.8 versus 2.9). Prevalence of drug dependence was higher in the "Alcohol + " group (21% versus 3%, respectively). Suicide attempts must be asked about their recent alcohol intake. This alcohol intake is often the symptom of an alcohol abuse or dependence disorder.     

Risk factors of suicide among schizophrenics

This case control study included 74 Chinese schizophrenics (DSM-III criteria) who died of suicide and 74 age- and sex-matched nonsuicide schizophrenics. Sociodemographic variables were unrelated with suicide. Associations were found between suicide and severity of illness (more frequent admissions, higher dose of medication and earlier appointments), history of major depressive episodes and suicidal attempts, last admission for reasons other than schizophrenic symptoms alone, and suicidal ideas on mental state examination. The last 2 factors, together with the maintenance dose of medication, were identified as the most important risk factors by logistic regression analysis.     

Serious suicide attempts among adolescents in custody.

The Royal Commission into Aboriginal Deaths in Custody has focused attention on people who are held in custody in police cells, prisons, remand centres and detention centres. A series of research papers has been released by the Royal Commission which delineates some important aspects of the needs of these people. Nearly half of the deaths which occur in these custodial settings appear to be self-inflicted. Suicide seems to be particularly common among younger age groups of those in custody [1,2]. This pattern parallels suicide levels among young people in the Australian community generally, so that suicide is now a leading cause of death among young Australians [3,4].     

Impulsivity and borderline personality as risk factors for suicide attempts among opioid-dependent individuals

The study aimed to examine the association of impulsivity and screening positively for borderline personality disorder (BPD+) as risk factors for suicide attempts among opioid-dependent individuals. The study used a case-control design with 775 opioid-dependent cases and 306 non-opioid-dependent controls. Cases were more likely than controls to screen BPD+ and to be classed as highly impulsive. Significant risk for lifetime suicide attempt was associated with screening BPD+ and also with high impulsivity. A number of risk factors were identified for suicide attempts among those with either high impulsivity or among those who screened BPD+: being female, a diagnosis of an anxiety disorder and a diagnosis of illicit drug dependence (other than opioid dependence). Opioid dependence was not a unique risk factor for suicide attempts among either the BPD+ group or the high impulsivity group. Although opioid dependence was not a unique risk factor for suicide attempts among those who screened BPD+, cases presented with multiple risk factors at substantially higher rates than controls. This research also highlights the importance of assessing impulsivity, in both clinical settings and research, particularly among those with a history of suicidal behaviour.     

Risk factors for suicide among older adults with cancer

Objective: To determine whether the increased risk of suicide for individuals with cancer may be explained by functional limitations, lack of social support, or other factors.Method: In this population-based case-control study, interviews of primary informants for suicides in the state of North Carolina were compared to interviews with participants in the Piedmont Health Study of the Elderly to estimate adjusted odds ratios for suicide and self-reported, physician diagnosed cancer, heart attack, stroke, and hip fracture.Results: Adjusting for all other factors, there was a statistically significant association of suicide and cancer (odds ratio [OR] 2.62, 95% confidence interval [CI] CI 1.84–3.73), but not heart attack, hip fracture, or stroke. The risk of suicide was also elevated for men vs. women (OR 17.15, CI 10.88–27.02), whites vs. blacks (OR 9.70, CI 6.07–15.50), and individuals with stressful life events (OR 2.75, CI 1.97–3.86) or limitations of instrumental (OR 2.93, CI 2.03–4.22) but not physical activities of daily living. Suicide cases were not more likely to be short of breath or poor sleep quality. Suicide was statistically significantly less likely for study participants who were married with spouse living vs. other (OR 0.61, CI 0.43–0.88) or who had one or more indicators of social support (OR 0.27, CI 0.19–0.39).Conclusion: After adjustment for other risk factors, suicide was strongly associated with cancer but not with other disabling, potentially fatal conditions.     

Predictors of serious suicide attempts among patients with panic disorder

Of 74 panic disorder subjects followed up after 7 years, five reported serious suicide attempts and three had completed suicide. Compared with subjects who had not made serious attempts, the serious suicide attempters (including the three suicides) were younger, and fewer of them were married. Also, the serious attempt group had an earlier, more gradual onset of illness. More of the serious attempters had personality disorders and coexisting major depression. At the time of original assessment, the serious attempters had more severe symptoms. These data suggest that among patients with panic disorder, serious suicidal behavior is associated with more severe psychopathology.     

Psychosocial risk factors associated with suicide attempts and violence among psychiatric inpatients

OBJECTIVES: To better understand the relationship between suicidal behavior and violence directed toward others among patients with major psychiatric disorders, this study examined how suicide attempts and violent behaviors were associated with various psychosocial problems. METHODS: Participants were inpatients in two psychiatric state hospitals. They included 216 inpatients who had physically assaulted another patient or a staff member and a comparison group of 81 inpatients who had not assaulted anyone. History of suicide attempts and historical information about various risk factors for violence and suicide were obtained through chart review and patient interviews. RESULTS: Patients in the violent group did not differ from those in the nonviolent group in whether they had attempted suicide. Suicide attempts and violence were associated with different historical variables. Suicide attempts were associated with a history of head trauma, harsh parental discipline, and parental psychopathology. Violence against others was associated with having a history of school truancy and foster home placement. CONCLUSIONS: Among inpatients with major psychiatric disorders, violence and suicide attempts were not related to each other and were associated with dissimilar psychosocial risk factors.     

Causative factors for suicide attempts by overdose in epileptics

We investigated possible causative factors for the high epileptic suicide rate by reviewing the cases of 22 patients with idiopathic epilepsy found among 711 patients hospitalized for a suicide attempt by overdose. Suicide attempts occurred with increased seizure activity in one epileptic; otherwise, no relationships were found with seizure-related variables. When matched by age, sex, and race with 44 nonepileptic controls from the same population, the epileptics had more borderline personality disorders with multiple impulsive suicide attempts (45.5% vs 13.6%), more psychotic disturbances, including command hallucinations (31.8% vs 9.1%), fewer adjustment disorders (18.2% vs 45.5%), and a comparable frequency of depression (13.6% vs 25%). We conclude that suicide attempts in epileptics are primarily associated with interictal psychopathologic factors, such as borderline personality disorder and psychosis, rather than with specific psychosocial stressors, seizure variables, or anticonvulsant medications.     

Risk factors related to lifetime suicide attempts in acutely admitted bipolar disorder inpatients

Finseth PI, Morken G, Andreassen OA, Malt UF, Vaaler AE. Risk factors related to lifetime suicide attempts in acutely admitted bipolar disorder inpatients.
Bipolar Disord 2012: 14: 727–734. © 2012 The Authors.
Journal compilation © 2012 John Wiley & Sons A/S. Objective: The main aim of this study was to assess possible clinical characteristics of acutely admitted bipolar I disorder (BD‐I) and bipolar II disorder (BD‐II) inpatients at high risk of suicide by comparing patients who had made one or several serious suicide attempts with patients who had not. Methods: A total of 206 consecutive patients (mean age 42 ± 15 years; 54.9% women) with DSM–IV diagnosed BD‐I (n = 140) and BD‐II (n = 66) acutely admitted to a single psychiatric hospital department from November 2002 through June 2009 were included. Using a detailed retrospective questionnaire, patients with a history of a serious suicide attempt were compared to those with no history of a suicide attempt. Results: Ninety‐three patients (45.1%) had a history of one or more serious suicide attempts. These constituted 60 (42.9%) of the BD‐I patients and 33 (50%) of the BD‐II patients (no significant difference). Lifetime suicide attempt was associated with a higher number of hospitalizations due to depression (p < 0.0001), antidepressant (AD)‐induced hypomania/mania (p = 0.033), AD‐ and/or alcohol‐induced affective episodes (p = 0.009), alcohol and/or substance use (p = 0.002), and a family history of alcohol abuse and/or affective disorder (p = 0.01). Suicide attempt was negatively associated with a higher Positive and Negative Syndrome Scale for Schizophrenia (PANSS) Positive Subscale score (p = 0.022) and more hospitalizations due to mania (p = 0.006). Conclusions: The lifetime suicide attempt rate in BD inpatients is high. Risk factors of suicide attempts were: (i) a predominant depressive course of illness, (ii) comorbid alcohol and substance use disorders, and (iii) a history of AD‐ and/or alcohol‐induced affective episodes. Risk‐reducing factors were a preponderant manic or psychotic course of the illness. These risk factors may be signs of a clinical subgroup at risk of suicidal behaviour, and seem to be important for suicide risk assessment in acutely admitted BD patients.     

Risk factors for suicide in later life.

Suicide rates are higher in later life than in any other age group. The design of effective suicide prevention strategies hinges on the identification of specific, quantifiable risk factors. Methodological challenges include the lack of systematically applied terminology in suicide and risk factor research, the low base rate of suicide, and its complex, multidetermined nature.Although variables in mental, physical, and social domains have been correlated with completed suicide in older adults, controlled studies are necessary to test hypothesized risk factors. Prospective cohort and retrospective case control studies indicate that affective disorder is a powerful independent risk factor for suicide in elders. Other mental illnesses play less of a role. Physical illness and functional impairment increase risk, but their influence appears to be mediated by depression. Social ties and their disruption are significantly and independently associated with risk for suicide in later life, relationships between which may be moderated by a rigid, anxious, and obsessional personality style.Affective illness is a highly potent risk factor for suicide in later life with clear implications for the design of prevention strategies. Additional research is needed to define more precisely the interactions between emotional, physical, and social factors that determine risk for suicide in the older adult.     

An epidemiologic investigation of potential risk factors for suicide attempts

Summary This is a report of new research on suicide attempts, based on an analysis of data from the Epidemiologic Catchment Area surveys in the United States. Risk of making a suicide attempt during a 1–2 year observation interval in the early 1980s was estimated in relation to selected personal and behavioral atributes of 13,673 study participants who completed baseline and follow-up interviews for these surveys. Being an active case of Major Depression was associated with increased risk of suicide attempt (estimated relative odds, RO=41; 95% CL=6.46–262), as was active alcoholism (RO=18; 95% CL=2.75–118) and being separated or divorced (RO=11; 95% CL=1.64–77). Being a user of cocaine was associated with increased risk of making a suicide attempt (RO=62; 95% CL=2.51–1528), but illicit use of marijuana, sedative-hypnotics, or sympathomimetic stimulants was not (P>0.30). Educational achievement was inversely associated with risk of suicide attempt at a marginal level of statistical significance (P=0.068). These multivariable conditional logistic regression results were obtained by applying a conventional epidemiologic strategy with poststratification of subjects into homogeneous risk sets. Limitations of the study data and the analytic strategy are discussed in relation to directions for future epidemiologic field surveys.     

Risk factors associated with lifetime suicide attempts in bipolar I patients: findings from a French National Cohort

Risk factors that may be associated with suicide attempts in bipolar disorder are still a matter of debate. We compared demographic, illness course, clinical, and temperamental features of suicide attempters vs those of nonattempters in a large sample of bipolar I patients admitted for an index manic episode. One thousand ninety patients (attempters = 382, nonattempters = 708) were included in the study. Multivariate analysis evidenced 8 risk factors associated with lifetime suicide attempts as follows: multiple hospitalizations, depressive or mixed polarity of first episode, presence of stressful life events before illness onset, younger age at onset, no free intervals between episodes, female sex, higher number of previous episodes, and cyclothymic temperament. These characteristics may help identify subjects at risk for suicide attempt throughout the course of bipolar disorder. We finally propose to integrate such characteristics into a stress-diathesis model of suicidal behavior, adapted to bipolar patients.