Suicide among psychiatric patients in Fukuoka Prefecture]

To investigate suicide among psychiatric patients in Japan (mainly Fukuoka prefecture), a questionnaire survey was submitted to psychiatrists from departments of psychiatry of university hospitals in Japan, departments of psychiatry of Rosai Hospitals in Japan, psychiatric hospitals in Fukuoka prefecture, psychiatric clinics in Fukuoka prefecture, and departments of psychiatry of general hospitals in Fukuoka prefecture regarding their psychiatric patients who died from suicide (266 females and 267 males). A large proportion of the patients at completed suicide was aged within the thirties to fifties. The majority of patients suffered from either F3 (mood disorders) or F2 (schizophrenia, schizotypal and delusional disorders) categories of the ICD-10 classification. Approximately one-fifth of the patients in Fukuoka prefecture had jobs at the time of completed suicide. The main "occupational risk factors" that were found to be risks for suicide were "failure or overloaded responsibilities in their jobs" and "worsening business situation". The main "other risk factors", i.e., risk factors other than "occupational risk factors" were "worsening psychiatric conditions", "personal life events (e.g., somatic illness or marital discord)" and "life events in other family members (e.g., familial discord or familial problems)". Over 50% of all cases had both "occupational risk factors" and "other risk factors", suggestive of the necessity for multidimensional evaluation and care in the treatment of suicidal patients. Given that numerous males that suffer from psychiatric disorders commit suicide without seeing a psychiatrist, it is important to establish a system to treat them appropriately in order to prevent unnecessary deaths.     

Risk factors for suicide in epilepsy: a case control study

PURPOSE: Suicide is considered to be one of the most important causes of death contributing to the increased mortality of persons with epilepsy. We investigated the association between the risk of suicide in persons with epilepsy and clinical factors that might increase or have been suggested to increase the risk of suicide. METHODS: A case-control study was nested within a cohort of 6,880 patients registered in the Stockholm County In-Patient Register with a diagnosis of epilepsy. The study population was followed up through the National Cause of Death Register. Twenty-six cases of suicide, 23 cases of suspected but not proven suicide, and 171 controls, living epilepsy patients, were selected from the cohort. Clinical data were collected through medical record review. RESULTS: There was a ninefold increase in risk of suicide with mental illness and a 10-fold increase in relative risk (RR) with the use of antipsychotic drugs. The estimated RR of suicide was 16.0 [95% confidence interval (CI), 4.4-58.3] for onset of epilepsy at younger than 18 years, compared with onset after 29 years. The risk of suicide seemed to increase with high seizure frequency and antiepileptic drug (AED) polytherapy, although the estimates were imprecise and the associations not statistically significant. Insufficient data on seizure frequency and changes in AED dosage due to incomplete case records were associated with high RRs. We found no association between risk of suicide and any particular AED, with type of epilepsy, or localization or lateralization of epileptogenic focus on EEG [RR = 0.3 (95% CI, 0.1-1.7)]. CONCLUSIONS: The profile of the epilepsy patient who commits suicide that emerges from our study is a patient with early onset (particularly onset during adolescence) but not necessarily severe epilepsy, psychiatric illness, and perhaps inadequate neurologic follow-up. Previous reports of an association with temporal lobe epilepsy could not be confirmed.     

Tourette syndrome in Japan: A nationwide questionnaire survey of psychiatrists and pediatricians

In order to shed light on the clinical picture of patients with Tourette syndrome (TS) treated at medical institutions in Japan, a nationwide survey covering both pediatric patients and psychiatric patients was conducted. We mailed 316 questionnaires on experience in treating TS cases and the patients' present conditions etc. to specialists such as psychiatrists and pediatricians. A total of 164 responded. The survey found 154 TS patients being treated at the time of survey, 45 (29.2%) had obsessive–compulsive symptoms (OCS), and 10 (6.5%) had family histories of TS. It was suggested that TS is often associated with OCS and that familial cases of TS are slightly less common in Japan than they are in the USA. Of the 116 respondents who described their experiences, 85 (73.2%) said that they had treated one or more patients displaying the symptoms of frequent coprolalia, and 42 (36.2%) said that they had treated one or more patients suffering from developmental disorders. Based on these findings, we speculated that the rate of coprolalia in Japan is a little higher than the previously reported 4% and that TS is often associated with developmental disorders.     

Prevalence and impact of patient suicide in psychiatrists: Results from a national French web-based survey

BackgroundPatient suicide (PS) is known to be a frequent and challenging occupational hazard for mental health professionals. No study previously explored the prevalence and impact of PS in a large sample of French psychiatrists.MethodA national web-based survey was performed between September and December 2019 to assess (a) the prevalence of the exposure to PS, (b) the emotional, traumatic and professional impacts of PS, and (c) the perceived support in the aftermath of PS in French psychiatrists. Participants were contacted through email to answer the online 62-item questionnaire, including a measure of traumatic impact through the Impact of Event Scale-Revised. Emotional and professional impacts and perceived support were assessed through dedicated items.ResultsA total of 764 psychiatrists fully completed the survey. Of them, 87.3% reported an exposure to PS and 13.7% reported PTSD symptoms afterward. Guilt, sadness and shock were the most frequent emotions. Among the exposed psychiatrists, 15.1% have temporarily considered changing their career path. The most emotionally distressing PS occurred during their ten first years of practice or during residency. A total of 37.1% of respondents felt unsupported and 50.4% reported that no team meeting had been organized in the aftermath. The feeling of responsibility for the death was strongly associated with negative impacts.ConclusionOur results entail considerations to prevent negative mental health outcomes in psychiatrists after PS. Notably, our results advocate for the implementation of educational programs during psychiatric residency and postvention programs in healthcare settings to effectively help psychiatrists in dealing with PS.     

Risk factors for completed suicide in schizophrenia

OBJECTIVE: Schizophrenic patients in Taiwan have lower comorbidity of substance use disorders than do those in Western countries, and most of them live with their families. This study investigated the risk factors for completed suicide in this population with inherently lower rates of the confounding variables of substance abuse and social isolation. METHOD: 4237 acute inpatients with DSM-III, DSM-III-R, or DSM-IV schizophrenia admitted from January 1, 1985, to December 31, 2000, were followed through 2001 by record linkage to the Death Certification System. Seventy-eight subjects who died from suicide during this period were matched with living controls randomly for age (+/- 5 years), sex, and the same year of index admission. Demographic and clinical variables were collected from medical records and formally confirmed at every admission and outpatient follow-up. RESULTS: Among 78 case-control pairs, the lifetime prevalence of substance use disorders was 7.1%, and 93.6% of the subjects lived with their families. Approximately half of the completed suicides occurred within 4 years after the first admission. Conditional logistic regression analysis revealed a strong association with the following 3 variables: depressive syndrome in residual phase (adjusted odds ratio [OR] = 23.07, p < .005), higher suicide intensity (adjusted OR = 2.78, p < .05), and later age at onset (increase per year, adjusted OR = 1.07, p < .05). Fasting cholesterol level and clozapine use had no association with completed suicide. CONCLUSIONS: The peak period for completed suicide was early years after the first admission. The target population for additional measures to prevent suicide should include patients with depressive syndrome in residual phase, higher suicide intensity, and later onset of illness.     

Risk factors for late-life suicide: a prospective, community-based study.

Despite the fact that people age 65 and older have the highest rates of suicide of any age-group, late-life suicide has a low prevalence, making it difficult to conduct prospective studies. The authors examined risk factors for late-life suicide on the basis of general information collected directly from older subjects participating in a community-based prospective study of aging, the Established Populations for Epidemiologic Studies of the Elderly. Demographic variables, presence of a relative or friend to confide in, alcohol use, and sleep quality were assessed at baseline interview. Baseline and follow-up data were used to determine physical, cognitive, and affective functioning, as well as medical status. Of 14,456 people, 21 committed suicide over the 10-year observation period. Depressive symptoms, perceived health status, sleep quality, and absence of a relative or friend to confide in predicted late-life suicide. Suicide victims did not have greater alcohol use and did not report more medical illness or physical impairment. This study provided additional information about the context of late-life depression that also contributes to suicidal behavior: poor perceived health, poor sleep quality, and limited presence of a relative or friend to confide in.     

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.     

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.     

Risk factors for completed suicide in bipolar disorder

BACKGROUND: Because Chinese bipolar patients in Taiwan, unlike Western patients, exhibit low comorbidity of substance abuse disorders, this retrospective and controlled study of completed suicide in bipolar patients explored the risk period and other risk factors for such an outcome. METHOD: All acute inpatients with bipolar I disorder (DSM-IV) were followed from date of admission after January 1, 1985, until December 31, 1996, in regard to their death. The patients were followed by record linkage to the Death Certification System in Taiwan, which was issued throughout 1996. Nineteen female and 24 male patients died as a result of suicide within this period. Forty-one of 43 of the total number of patients were matched with 1 living bipolar individual (as a control subject) for age, sex, and date of admission. Demographic data, family history, and clinical characteristics were collected from the patients' medical records and were formally confirmed at every admission. RESULTS: The lifetime prevalence of alcohol/drug use disorders was 14.6% in suicide completers. Thirty suicide completers (69.8%) revealed duration of illness of at least 7 years at the time of death. The latency period from the presumed time of onset to completing suicide averaged 12.2 years. The mean age at the first suicide attempt was 31.1 years among 43 completers and 10 living controls who had ever attempted suicide. Conditional logistic regression revealed a strong association of suicide (p < .001) with the following factors: onset with mood-congruent psychotic feature (adjusted odds ratio [OR] = 0.18, 95% confidence interval [CI] = 0.04 to 0.74), positive first-degree family history of completed suicide (adjusted OR = 15.08, 95% CI = 1.39 to 163.50), and making a suicide attempt at least once in 7 years of illness (adjusted OR = 4.96, 95% CI = 1.03 to 23.83). There appeared to be no significant difference in fasting levels of serum cholesterol or blood sugar between the suicide completers and the living controls. CONCLUSION: The first 7 to 12 years subsequent to onset of affective illness and age less than 35 years may be the high-risk periods for suicide in bipolar disorder. Those bipolar disorder patients who have a first-degree family history of suicide and who have more suicide attempts (at least once in 7 years of illness) are likely to commit suicide. Symptomatology (e.g., mood congruence of psychotic features) at the time of presumed disease onset may potentially differentiate subgroups of bipolar patients with various levels of suicide risk.     

Risk factors for suicide in Caucasians and in African-Americans: a matched case-control study

It is known that suicide rates for Caucasians are higher than those for African-Americans. However, there has been little research examining whether risk factors associated with suicide differ by race, when the effects of age, gender, and educational-occupational status are taken into account. A matched case-control study was constructed from the 1986 National Mortality Followback Survey to address such concerns. Cases included all individuals aged between 25 and 64 years dying from suicide. Controls were those who died of natural causes, who were frequency matched to cases by age and gender. The study results for Caucasians indicate that those who had at least a high school education were more likely to commit suicide [odds ratio (OR) = 1.91; 95% confidence interval (CI) = 1.37–2.67] than those who had less than a high school education; those who were heavy drinkers were more likely to commit suicide (OR = 1.64; 95% CI = 1.16–2.33) than those who were light or moderate drinkers; those who lived alone were more likely to commit suicide (OR = 1.72; 95% CI = 1.28–2.30) than those who lived with others; those who had blue-collar occupations were more likely to commit suicide (OR = 1.79; 95% CI = 1.33–2.42) than those who had white-collar occupations; and those who had used mental health services were more likely to commit suicide (OR = 3.07; 95% CI = 2.34–4.01) than those who had not used them. For African-Americans, use of mental health services was the only factor significantly associated with suicide (OR = 4.56 95% CI = 1.69–12.29). Accepted: 23 June 1997     

Consultation-liaison training for child psychiatrists: results of a survey

As a first step toward improving the quality of training for child psychiatrists in the increasingly important area of consultation-liaison work, a survey of current educational experiences in child psychiatry programs was carried out. Sixty-four programs (61% of those sampled) responded to a questionnaire and request for information. The consultation-liaison field remains minimally emphasized, as three-fourths of the programs devote less than 11% of the fellowship training time experiences to this area. Variations in the rotations are summarized, and five reasons for the low priority of consultation-liaison training are proposed.     

Risk factors for suicide in the immediate post-discharge period

BACKGROUND: Suicide risk is highest in the first few months following psychiatric in-patient care. Most data on post-discharge suicides have come from Western countries. Many studies collected cases of suicide over a long post-discharge period and did not focus on this high-risk period. This study aims to describe the characteristics and examine the risk factors of suicides occurring in the immediate post-discharge period in Hong Kong. METHODS: A case-control study based on discharged patients from all psychiatric hospitals/units in Hong Kong in 1997-1999. Suicides occurring within 60 days of discharge from psychiatric hospitals (N = 97) were ascertained by record linkage with Coroner's court data. Controls were matched for age, gender, diagnoses, discharge hospitals, and dates of discharge. Possible risk factors were extracted from in- and out-patient records, and were identified by conditional logistic regression. RESULTS: The commonest diagnosis and suicide method were schizophrenia and falling from a height, respectively. There were no significant case-control differences in the drug treatment received. Risk factors for suicides were: previous deliberate self-harm (OR = 2.3, 95% CI = 1.07-5.05), admission for deliberate self-harm (OR = 3.2, 95% CI = 1.3-7.8), compulsory admission (OR = 3.1, 95% CI = 1.1-8.7), living alone (OR = 5.8, 95% CI = 1.4-23), work stresses (OR = 5.4, 95% CI = 1.5-18) and being out of contact (OR = 7.9, 95% CI = 1.87-33). The overall number of risk factors had greater screening efficacy for suicide than any single factor. CONCLUSIONS: Vulnerable (previous suicidality) and uncooperative (compulsory admission and out of contact) patients who live alone and are exposed to work stresses are prone to immediate post-discharge suicide. Thorough treatment of the circumstances leading to the index admissions, management of work stresses, improved engagement in follow-up care and systematic assessment of suicide risk are indicated.     

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 factors for suicide in young people suffering from schizophrenia: a long-term follow-up study

Ten per cent of patients with schizophrenia commit suicide, but assessment of risk is difficult. Large case-control studies with a long follow-up period are needed. These should focus on patients from one age group to give clinicians the details required to identify those at highest risk.We present a case-control study of 63 patients who committed suicide and 63 controls from a consecutive admission series of patients with a diagnosis of schizophrenia. All patients were under the age of 30 at admission.Risk factors for suicide were male gender, chronic illness with frequent relapses (OR 6.0), frequent short hospitalisation, a negative attitude towards treatment (OR non-compliance 7.0), impulsive behaviour (OR acting out 6.4, OR involuntary commitment 17), parasuicide (OR suicide attempt 4.8, OR highly lethal suicide attempt 11), high pre-morbid IQ (OR 4.3), psychosis (OR 7.0) and depression (OR 36). However, early onset of a defect state (OR 6.3) and a daily activity (OR 4.2) were protective factors. Identified risk factors could help clinicians to target high-risk patients and form the basis for interventions aimed at reducing suicide.     

The questionnaire survey to clarify correspondence of medical doctors and dentists in Fukuoka City, Japan, for warfarin therapy at the dental extraction]

PURPOSE: The questionnaire survey was performed in order to clarify correspondence of medical doctors and dentists working at hospital service for warfarin therapy at the dental extraction. METHODS: For 17 senior dentists in 17 hospitals and 142 senior physicians in 82 hospitals in Fukuoka City, we investigated using the questionnaire whether they supported dental extraction under warfarin therapy or not in patients having warfarin treatment with past history of cardioembolic stroke due to non-valvular atrial fibrillation (NVAF). Specialty and experience of stroke after withdrawal of warfarin were also asked in medical doctors. RESULT: The reply was obtained from 14 dentists (82.4%) and 66 doctors (46.5%). The number of dentists and doctors who pull out a tooth under warfarin treatment continuation were 12 persons (85.7%) and 32 persons (48.5%), respectively. The rates in doctors whose specialty was stroke, cardiovascular disease, and others were 78.6% (11/14), 36.0% (9/25), and 44.4% (12/27), respectively. The rate in stroke specialists was significantly higher than that in cardiovascular disease specialists (p = 0.019). The stroke specialists had experience of stroke after withdrawal of warfarin more frequently than the cardiovascular disease specialists (57.1% vs. 20.0%, p = 0.033). CONCLUSION: The rates of acceptance in tooth extraction under warfarin treatment continuation of the dentist were high in Fukuoka city, while that of the medical doctors were not. Rate of doctor's acceptance differed according to the specialties, and may be affected by experience of stroke after cessation of warfarin therapy.