Suicidal ideation and suicide attempts: Comorbidity with depression,anxiety disorders,and substance abuse disorder

The effect of comorbidity on rates of suicidal ideation and suicide attempts from an adult general population of former West Germany is investigated. The assessment instrument is a modified German version of the Diagnostic Interview Schedule (DIS), a fully standardized interview for the assessment of selected DSM-III lifetime diagnoses as well as suicidal ideation and suicide attempts. Of the general population 4.1% (2.2% male and 4.1% female) made suicide attempts during their lifetime. Only 2 of 18 people who attempted suicide did not meet criteria for a DSM-III-R diagnosis. Cases with pure major depression did not have an odds ratio for suicide attempts significantly higher than subjects with no DSM-III diagnosis. However, cases with both a major depression and a lifetime-anxiety-disorder diagnosis showed significantly elevated odds ratios. Therefore, it is suggested that comorbidity of anxiety and depression, and not depression itself, seems to be a risk factor for suicide attempts.     

Self-compassion and family cohesion moderate the association between suicide ideation and suicide attempts in Chinese adolescents

BackgroundIn recent years, many studies have examined risks factors that facilitated the transition from suicide ideation to suicide attempts. Few studies, however, have examined protective factors against this transition. The current study thus assessed two protective factors, self-compassion and family cohesion, in buffering the transition from suicide ideation to suicide attempts.MethodA number of 520 Chinese adolescents (43.46% females, mean age = 12.96 years) completed questionnaires assessing self-compassion, family cohesion, suicide ideation, and suicide attempts two times with a 12-month interval.ResultsSelf-compassion significantly moderated the association between Wave 1 SI and later SA. The positive dimension of self-compassion thwarted the transition from SI and SA, and the negative dimension of self-compassion strengthened the associations. In addition, family cohesion also significantly moderated the transition from SI to SA.ConclusionIncreasing the levels of self-compassion and family cohesion may be the targets for treating adolescents with suicide ideation to prevent them from attempting suicide.     

农村未遂自杀者的再自杀意念及相关因素研究

目的探讨农村未遂自杀者再自杀意念的发生率及其相关因素。方法以乡镇卫生院近2年的抢救记录为调查线索,共完成74例自杀未遂者的调查,对其再自杀意念进行评定,并用SDS和FES对其抑郁症状和家庭环境进行评估,收集其一般资料。结果74例自杀未遂者中有48例(64.86%)有不同程度的再自杀意念,48例有再自杀意念者的SDS得分(42.42±7.64)明显高于26例无再自杀意念者(33.58±9.52)(t=4.35,P<0.001),有再自杀意念组的家庭亲密度、成功性、文化性、娱乐性和组织性均较无再自杀意念组差,家庭矛盾性较对照组突出。多元逐步回归分析显示,影响自杀未遂者再自杀意念的主要危险因素为:家庭成功性、SDS总分和家庭矛盾性。结论64.86%的自杀未遂者在其后的一段时期内仍存在不同程度的再自杀意念,而且再自杀意念主要与患者的家庭环境和患者的抑郁症状有关。     

Comorbidity of borderline personality disorder and posttraumatic stress disorder in the U.S. population

While placed on different axes of the DSM classification system, borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) have important relationships with trauma, and overlap between these disorders has long been recognized. The current study is the first to examine comorbidity of PTSD and BPD in a large nationally representative sample using a reliable and valid method of assessing Axis I and II mental disorders. Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Wave II (N = 34,653; response rate 70.2%). Multiple regression models were used to examine differences in psychopathology, traumatic events and health-related quality of life across individuals with PTSD alone (n = 1820), BPD alone (n = 1290) and those with comorbid PTSD–BPD (n = 643). The lifetime prevalence of PTSD and BPD were 6.6% and 5.9%, respectively. Of individuals with BPD, 30.2% were also diagnosed with PTSD, whereas 24.2% of individuals with PTSD were also diagnosed with BPD. Individuals with comorbid PTSD–BPD had a poorer quality of life, more comorbidity with other Axis I conditions, increased odds of a lifetime suicide attempt, and a higher prevalence of repeated childhood traumatic events than individuals with either condition alone. These results show that PTSD and BPD have a high degree of lifetime co-occurrence but are not entirely overlapping. Their concurrence is associated with poorer functioning compared to either diagnosis alone, emphasizing the clinical utility of diagnosing both conditions. Future research should explore the determinants of having either or both diagnoses with an aim toward improved identification, prevention, and intervention.     

自杀未遂者出院后再次出现自杀行为的6年随访

目的 了解自杀未遂者再自杀情况及其影响因素.方法 对115例住院自杀未遂者出院后18个月、3年、5年、6年进行4次随访.结果 115例自杀未遂者中6年内21例再次出现自杀行为(18.3%),其中自杀死亡5例(4.3%).21例再次自杀者平均年龄(44.2±14.3)岁,13例有精神障碍(61.9%),8例既往(入院前)有自杀未遂史(38.1%),与94例无再次自杀行为者比较,两组在年龄(t=3.42)、精神疾病(χ2=11.20)、既往自杀未遂史(χ2=24.18) 方面的差异有统计学意义(均P<0.05).Logistic回归分析,仅既往自杀未遂史(P＜0.01,OR=10.21,β=2.32)进入回归方程.115例自杀未遂人群总的随访时间为723.55人年,以此推算6年内该组自杀未遂者群体年人均自杀死亡率为0.7%,年人均自杀未遂率为2.2%,年人均自杀行为率为2.9%.结论 部分自杀未遂者会再次出现自杀行为,而既往有自杀未遂史和有精神障碍的自杀未遂者更易再次发生自杀行为.     

Social,toxicological and meteorological data on suicide attempts

Summary A sample of 151 patients, admitted to an Intensive Care Unit after attempted suicide by poisoning was analysed with regard to age, drugs consumed, possible causal factors and influence of weather. The German Weather Service provided the meteorological data. Mean age of the patients was 37.6 years. The patients had taken barbiturates, aggressive chemicals, tranquillizers or a combination of drugs (47%). Alcohol had been taken in addition to the drugs in 24%, which might indicate a trigger function. The main provoking causes for the suicide attempts were conflicts in partnerships and occupational problems. Some 15% of the patients had previously diagnosed psychiatric disorders. There was a significant positive correlation between the time of attempted suicide and the weather parameters stable upslide, labile upslide, fog, thunderstorm, warm air, upslide and weather drier than on the 2 preceding days. Significantly fewer attempts than expected occurred with low pressure and trough situation, labile ground layer-upslide above, subsidence or downslide motion. Apart from individual provoking factors, such as the reaction to conflicts and the spectrum of reactions, exogenous factors like weather must be considered as important for the timing of suicide attempts. These results may be of relevance for suicide prevention.     

A population-based longitudinal study of risk factors for suicide attempts in major depressive disorder

No longitudinal study has examined risk factors for future suicide attempts in major depressive disorder in a nationally representative sample. The objective of this study was to investigate baseline sociodemographic characteristics, comorbid mental disorders, specific depressive symptoms, and previous suicidal behavior as potential risk factors for suicide attempts at 3 years follow-up. Data came from the national epidemiologic survey on alcohol and related conditions (NESARC), a large nationally representative longitudinal survey of mental illness in adults [Wave 1 (2001-2002); Wave 2 (2004-2005) n = 34,653]. Logistic regression examined associations between risk factors present at Wave 1 and suicide attempts at Wave 2 (n = 169) among individuals with major depressive disorder at baseline assessment (n = 6004). Risk factors for incident suicide attempts at Wave 2 (n = 63) were identified among those with major depressive disorder at Wave 1 and no lifetime history of suicide attempts (n = 5170). Results revealed specific comorbid anxiety, personality, and substance use disorders to be associated with incident suicide attempts at Wave 2. Comorbid borderline personality disorder was strongly associated with suicide attempts in all models. Several comorbid disorders were strongly associated with suicide attempts at Wave 2 even after adjusting for previous suicidal behavior, notably posttraumatic stress disorder (adjusted odds ratio (AOR) = 2.20; 95% confidence interval (95% CI) 1.27-3.83) and dependent personality disorder (AOR = 4.43; 95% CI 1.93-10.18). These findings suggest that mental illness comorbidity confers an increased risk of future suicide attempts in major depressive disorder that is not solely accounted for by past suicidal behavior.     

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。     

Revisiting the immigrant paradox: Suicidal ideations and suicide attempts among immigrant and non-immigrant adolescents

The current study examined the immigrant paradox in suicidal ideations and attempts, whether rates and correlates varied across immigrant/non-immigrant youth in a nationally representative sample of 7,287 Swiss adolescents (10.2% 1st generation immigrants, 10.3% 2nd generation, and 16.1% mixed parentage; M_age = 17.45, SD = 1.85, 46.6% females). Known risk and protective factors for suicidal ideations and attempts (depressive symptoms, family and peer connectedness, and demographics) were used as correlates, and their effects were compared across groups. About 27% of youth thought about suicide in past 12 months, while 5.5% reported attempting suicide once in their lifetime. After controlling for known predictors and nationality, being an immigrant adolescent (1st, 2nd generation, or mixed parentage) lowered the risk for suicidal ideations as compared to native Swiss youth; immigrant status was unrelated to attempts. Findings provide mixed support for the immigrant paradox; both immigrant and native youth would benefit from effective intervention strategies.     

Prevalence of suicide ideation among adolescents and young adults in rural Bangladesh

Suicide is a leading cause of death world-wide. However, adolescent suicidal behavior is a neglected public health issue, especially in low-income countries such as Bangladesh. The study was conducted to estimate the prevalence of suicidal ideation among adolescents in a rural community and to examine factors associated with suicidal ideation. A cross-sectional survey was carried out in 2013 among 2,476 adolescents aged 14–19 years, selected randomly from a rural community of Bangladesh. An adapted version of the WHO/SUPRE-MISS questionnaire was used to collect data in the Raiganj sub-district. A two stage screening was performed to identify the suicidal ideation cases. It was found that the life-time prevalence for suicidal ideation was 5 percent among adolescents. The majority of the adolescents with suicidal ideation were females 66 (52.8%), unmarried 103 (82.4%), and students 92 (73%). Suicidal ideation was statistically significantly associated with age, education, occupation, living with parents or others, and house ownership. Respondents who were aged 18–19 years, had secondary school certificate (SSC) and secondary school certificate (HSC) or higher education, were day laborers, had own house, and do not lived with parents had odds ratios of 2.31 (CI 1.46–3.65), 2.38 (CI 1.51–3.77), 4.15 (CI 2.41–7.14), 0.28 (CI 0.13–0.60), 0.14(CI 0.05–0.35), and 1.80 (CI 1.07–3.03), respectively. Among adolescents, the prevalence of life-time suicidal ideation was moderately high. Age, education, occupation, house ownership, and living with parents were statistically significantly associated with suicidal ideation. It is important to design and implement effective community based suicide prevention programs for adolescents in Bangladesh.     

Prevalence of suicide attempts in pathological gamblers in a nationwide Austrian treatment sample

Background

For pathological gambling (PG), a 12-month prevalence rate of up to 0.66% has been reported. Multiple financial, occupational and relationship problems and losses, humiliation of the person and the environment are possible side effects and may lead to hopelessness, suicidal ideation and suicidal behavior. Suicide attempt rates among pathological gamblers of between 4% and 40% and suicidal ideation of between 12% and 92% have been reported.

Aim

This study aims at assessing the prevalence of suicide attempts in PG and at elucidating differences between the patients with and without suicide attempt history (SAH) in a large nationwide Austrian sample.

Methods

Between 2002 and 2011, the Austrian Society for the Research of Non-Substance Related Addiction collected 862 questionnaires of pathological gamblers undergoing outpatient and inpatient treatment for PG in Austria.

Results

(a) Of all pathological gamblers, 9.7% had an SAH. (b) The SAH group suffered significantly more from a comorbid disorder and was more often in previous inpatient treatments. (c) The SAH patients had a longer time of an abstinence period in their PG career.

Discussion

One in 10 pathological gamblers has an SAH, demonstrating the relevance of suicidality in this population. Significant differences for several parameters were found for PG with and without SAH. However, a regression analysis only explained 15% of the variance. This suggests that suicidality must be considered in pathological gamblers in general.     

Variables associated with familial suicide attempts in a sample of suicide attempters

Attempted suicide appears to be a familial behavior. This study aims to determine the variables associated with family history of attempted suicide in a large sample of suicide attempters. The sample included 539 suicide attempters 18 years or older recruited in an emergency room. The two dichotomous dependent variables were family history of suicide attempt (10%, 51/539) and of completed suicide (4%, 23/539). Independent variables were 101 clinical variables studied with two data mining techniques: Random Forest and Forward Selection. A model for family history of completed suicide could not be developed. A classificatory model for family history of attempted suicide included the use of alcohol in the intent and family history of completed suicide (sensitivity, specificity, 98.7%; and accuracy, 96.6%). This is the first study that uses a powerful new statistical methodology, data mining, in the field of familial suicidal behaviors and suggests that it may be important to study familial variables associated with alcohol use to better understand the familiality of suicide attempts.     

Suicidal ideation,suicide attempts,and psychological distress among intoxicated adolescents in the pediatric emergency department

Background: Studies have emphasized screening for psychiatric disorders, especially suicide risk in emergency departments. Psychiatric disorders and experimentation with alcohol increase in adolescence and intoxications among patients challenge the staff in emergency departments.

Aims: This study examined the degree of suicidal ideation (SI) and suicidal behavior in adolescents, and the extent to which they differed from non-suicidal patients in terms of alcohol use, psychological distress, self-esteem, and perceived social support.

Methods: The study comprised 120 adolescents, a mean age of 14.2 years. Of them 60% were females. We collected data on the clinical characteristics and assessed the patient’s psychiatric status using self-report scales and analyzed blood samples for alcohol. A consulting psychiatrist interviewed each patient before discharge to evaluate potential SI or suicide attempt (SA) using structured and semi-structured scales.

Results: Of the 120 patients 20% had SI or had made a SA. High psychological distress in girls, low blood alcohol levels (BALs), as well as low scores on self-esteem, on social support and on familial support were associated with patients with SI/SA. Logistic regression showed that the most significant variables with suicidal patients included low BAL and low self-esteem and high alcohol consumption. Psychological distress had a direct and mediational role in the suicidal patients.

Conclusions: Adolescents referred to the pediatric emergency department with intoxication displaying high psychological distress and low self-esteem represent a high-risk group of teens. In this group, careful assessment of mental health status, screening for suicidal ideation, and SAs seems warranted.     

青少年睡眠问题与自杀的相关性研究现状

本文目的是对青少年睡眠问题与自杀的相关性研究现状进行综述,以期为青少年自杀的早期临床干预提供新的方向。研究表明,睡眠问题与青少年自杀密切相关,睡眠可能成为自杀干预的潜在靶点。本文对青少年睡眠问题与自杀的相关性研究进行综述,并从改善睡眠问题着手,寻找可能的自杀干预措施。     

Distinguishing the relevant features of frequent suicide attempters

Background

In spite of the high prevalence of suicide behaviours and the magnitude of the resultant burden, little is known about why individuals reattempt. We aim to investigate the relationships between clinical risk factors and the repetition of suicidal attempts.

Methods

1349 suicide attempters were consecutively recruited in the Emergency Room (ER) of two academic hospitals in France and Spain. Patients were extensively assessed and demographic and clinical data obtained. Data mining was used to determine the minimal number of variables that blinded the rest in relation to the number of suicide attempts. Using this set, a probabilistic graph ranking relationships with the target variable was constructed.

Results

The most common diagnoses among suicide attempters were affective disorders, followed by anxiety disorders. Risk of frequent suicide attempt was highest among middle-aged subjects, and diminished progressively with advancing age of onset at first attempt. Anxiety disorders significantly increased the risk of presenting frequent suicide attempts. Pathway analysis also indicated that frequent suicide attempts were linked to greater odds for alcohol and substance abuse disorders and more intensive treatment.

Conclusions

Novel statistical methods found several clinical features that were associated with a history of frequent suicide attempts. The identified pathways may promote new hypothesis-driven studies of suicide attempts and preventive strategies.     

Male-specific association between the 5-HTTLPR S allele and suicide attempts in alcohol-dependent subjects

Changes in serotoninergic neurotransmission have been implicated in the pathogenesis of suicidal behavior and alcohol dependence. Previous studies have demonstrated an association between suicide attempts and the 5-HTTLPR S allele in alcohol-dependent subjects. We investigated the frequency of the S allele of 5-HTTLPR in a sample of 100 French Caucasian alcohol-dependent inpatients (48 men and 52 women) with and without a history of suicide attempts. The frequencies of 5-HTTLPR genotypes did not differ significantly between men and women. A history of at least one suicide attempt was more frequent in women than in men (57.5% versus 31.3%, respectively, p=0.008). Logistic regression analysis showed that the presence of the S allele of 5-HTTLPR was related to a life-time risk of suicide attempts, but only in male subjects (p=0.05). There seems to be an allelic association between the 5-HTTLPR S allele and suicidal behavior in alcohol-dependent subjects, but this relationship is restricted to male subjects.     

Understanding PTSD comorbidity and suicidal behavior: Associations among histories of alcohol dependence,major depressive disorder,and suicidal ideation and attempts

Individuals with posttraumatic stress disorder (PTSD) are at an elevated risk for experiencing suicidal thoughts and actions. However, a relative dearth of research has examined factors that may impact this relation, such as common co-occurring disorders. Utilizing the National Comorbidity Survey-Replication data, the current study examined comparisons between comorbid PTSD and major depressive disorder (MDD) and comorbid PTSD and alcohol dependence (AD) in relation to suicidal ideation and suicide attempts. It was hypothesized that comorbid MDD would be associated with an elevated likelihood of suicidal ideation, while comorbid AD would be associated with an elevated likelihood of suicide attempt history. Results indicated that only PTSD-AD was significantly associated with an elevated likelihood of endorsing histories of both suicidal ideation and suicide attempts. These findings suggest that AD may be a critical risk factor for acquiring the capability for suicide attempts.     

Mental-Physical Comorbidity in Korean Adults: Results from a Nationwide General Population Survey in Korea

ObjectiveThe aims of this study were to estimate the prevalence of mental-physical comorbidity and health-threatening risk factors in subjects with mental disorders, and the risks of mental disorders in those with physical diseases for the last 12 months in the general Korean population.MethodsKorean Epidemiologic Catchment Area study replication (KECA-R) was conducted for 6,510 adults between August 2006 and April 2007. The Korean version of Composite International Diagnostic Interview 2.1 (K-CIDI) was used in the survey. Prevalence of mental and physical disorders, and risk factors for physical health were calculated, and their associations were evaluated with adjustment for age and sex.ResultsSubjects with any mental disorder showed significantly higher prevalence of chronic physical conditions (adjusted odds ratio, AOR=1.5 to 2.8, p<0.001) and medical risk factors including smoking, heavy drinking, overweight, and hypertension (AOR=1.5 to 4.0, p<0.001). Of those with chronic physical conditions, 21.6% had one or more comorbid mental disorder compared with 10.5% of the subjects without chronic physical disorders (AOR=2.6, p<0.001). Contrary to expectations, depressive disorders did not show significant association with hypertension and prevalence of obesity was not influenced by presence of mental disorders. Further studies should assess these findings.ConclusionThis is the first identification of significant mental-physical comorbidity in the general Korean population. Clinicians and health care officials should keep in mind of its potential adverse effects on treatment outcome and aggravated disease-related socioeconomic burden.     

Attempted suicide predicts suicide risk in schizophrenia spectrum psychosis

Background: People with schizophrenia have an increased risk of suicide and attempted suicide is suggested to be an important risk factor. Aim: Our objective was to assess the cumulative survival, predictive values and odds ratios of attempted suicide for suicide in a long-term cohort of patients with schizophrenia spectrum psychosis with and without previous attempted suicide. Method: Inpatients (n=224) hospitalized with schizophrenia spectrum psychosis were followed for a mean of 25 years. All patients were followed up for causes of death. Information on suicide attempt before the end of the observation period was retrieved from medical records. Results: Eight percent died by suicide during the follow-up. Eighteen percent of suicide attempters died by suicide. Two percent of non-attempters died by suicide. There was a strong association between previous suicide attempt and suicide in men and women. Odds ratio for attempters vs. non-attempters was 10. Suicide risk was almost three times higher in male than female suicide attempters. Conclusion: Previous attempted suicide is an important risk factor for suicide in both men and women with schizophrenia spectrum psychosis, particularly in male suicide attempters. The suicide risk remains high over a long period. Continuous assessment of risk factors and appropriate treatment are crucial for this patient group to prevent suicide.     

Psychosocial functioning and psychiatric comorbidity among substance-abusing Icelandic adolescents

Abstract

Background: Physical inactivity is an independent risk factor for cardiovascular diseases and Type 2 diabetes, both being highly prevalent in patients with severe mental illness. Though physical activity has become an important issue in psychiatric treatment and rehabilitation in the past decade, systematic evaluations of physical activity level in psychiatric populations could be more disseminated. Aim: The primary aim of the study was to investigate the physical activity level of psychiatric patients in comparison with healthy controls. Methods: Patients with severe mental illness (n =47) and a group of healthy controls (n =28) matched on sex and age reported their physical activity level using the Physical Activity Scale (PAS). PAS was administered as an interview in relation to patients and as a questionnaire in relation to healthy controls. Results: Patients had statistically significant lower levels of physical activity compared with healthy controls (P <0.0001) and the level of physical activity among patients was hazardously low. Conclusion: The study confirmed previous studies and clinical experience that patients with severe mental illness are physically inactive and emphasize the importance of physical activity in psychiatric treatment and rehabilitation. The PAS is an applicable and relevant method for evaluating physical activity levels in psychiatric patients.