Cocaine and alcohol use preceding suicide in African American and white adolescents

The goal of this investigation was to determine whether cocaine and ethanol use was a differentiating factor between African American and white teenage suicide victims. This is a retrospective analysis of medical examiner's records of all completed suicides in Fulton County, GA from 01/1989 to 12/2003, and included 1296 cases. There were 79 suicide victims aged 19 and younger during the study interval, and of this group, 49 (62%) were African American, 26 (33%) were white, and 4 (5%) other race, compared to adults (20 years) where 28.5% were African American, 68.6% white and 2.9% other race (chi(2)=42.678, d.f.=2, p<0.0001). Of the black teenaged victims, 82.2% had no cocaine or alcohol detected at autopsy, while 41.7% of the white victims were positive for one or both substance (chi(2)=4.633, d.f.=1, p=0.04). Only 8.9% of the black teenage suicide victims had used cocaine prior to death compared to 28% of the whites (chi(2)=4.432; d.f.=1; p<0.04). The suicide rate (suicide/100,000/year) for black teens was 5.48 compared to 4.16 for whites, but the rate of cocaine positive teen suicides was 1.12 for whites and 0.45 for blacks. The pattern of cocaine use changes dramatically in the adult group, with 27% of African American suicide victims compared to 7.7% of whites being positive (chi(2)=73.272; d.f.=1; p<0.001). Use of intoxicating substances does differentiate teenage suicide victims, as only a small proportion of black teenagers had used cocaine or alcohol prior to death compared to almost half of all whites.     

中山市流动人口与户籍人口自杀率和自杀方式特征分析

目的分析2015年-2017年中山市流动人口和户籍人口自杀率变化趋势和自杀案例特征,为中山市制定自杀干预策略提供参考。方法抽取中山市死因登记报告信息系统中死亡时间为2015年1月1日-2017年12月31日的死亡案例,按照是否具有中山市户籍分为户籍组和流动组,计算并比较两组自杀率和自杀方式的差异。结果中山市2015年-2017年自杀率为4. 03/10万。户籍组和流动组年自杀率分别为3. 61/10万、4. 46/10万。两组自杀率均随年龄增长呈上升趋势,流动组60岁以上人群自杀率高于户籍组(34. 94/10万vs. 6. 83/10万)。前三位的自杀方式,户籍组分别为自缢[95例(53. 67%)]、服用农药[27例(15. 25%)]和高坠[22例(12. 43%)];流动组分别为自缢[65例(30. 37%)]、高坠[48例(22. 43%)]和服用农药[30例(14. 02%)],两组自杀方式分布的差异有统计学意义(χ~2=32. 99,P<0. 01)。结论中山市流动人口与户籍人口自杀死亡的案例均以自缢、服用农药和高坠为主。流动人口自杀率略高于户籍人口,老年流动人口可能是高自杀风险人群。     

Alcohol,cannabis and other drugs and subsequent suicide ideation and attempt among young Mexicans

ObjectiveTo report results from a follow-up study of alcohol, cannabis and other drugs on suicidal behavior.MethodWe estimated prospective associations of substance use as a risk factor for incident suicide ideation and attempt, from a follow-up conducted in 2013 (n = 1071) of the original Mexican Adolescent Mental Health Survey conducted in 2005.ResultsCannabis use before age 15 (ideation risk ratio (RR) = 3.97; 95% confidence interval (CI) = 1.43–11.03; attempt RR = 5.23; 95% CI = 1.17–23.32), early onset of DSM-IV drug use disorder (DUD) among cannabis users (ideation RR = 3.30; 95% CI = 1.11–9.84; attempt RR = 4.14; 95% CI = 1.28–13.36), high frequency of cannabis use (RR for attempts = 4.60; 1.03–20.60) and recent DSM-IV-DUD among cannabis users (RR for attempts = 4.74; 1.09–20.57) increased the RR. For “other drug use”, significant results were found among those with high frequency use of other drugs such that they had a higher RR of suicide attempt (5.04; 1.03–24.64). For alcohol, only those who initiated alcohol before age 15 had higher RRs of suicide attempt (1.79; 1.00–3.20).DiscussionThose who used cannabis at an early age, early onset of DSM-IV-DUD, and those with heavy cannabis use and recent DSM-IV-DUD among cannabis users in the last 12-months had increased risk of suicide ideation and attempt. Drugs other than cannabis showed some of these associations, but to a lesser degree. Prevention of substance use and treatment of those already engaged in drug use, by decreasing suicide ideation and attempt, may help to prevent suicide in Mexico.     

Effect of acute alcohol use on the lethality of suicide attempts in patients with mood disorders

Acute alcohol use is an important risk factor for attempted and completed suicide. We evaluated the effect of acute alcohol intake on the lethality of suicide attempts to test the hypothesis that acute alcohol intoxication is associated with more lethal suicide attempts. This retrospective study included 317 suicide attempters enrolled in mood disorders protocols. Demographic and clinical parameters were assessed. The use of alcohol at the time of the most lethal suicide attempt was determined. On the basis of their responses participants were classified into three groups: participants who reported “Enough alcohol intake to impair judgment, reality testing and diminish responsibility” or “Intentional intake of alcohol in order to facilitate implementation of attempt” were included in the group “Alcohol” (A); participants who reported “Some alcohol intake prior to but not related to attempt, reportedly not enough to impair judgment, reality testing” were included in the group “Some Alcohol” (SA); and participants who reported “No alcohol intake immediately prior to attempt” were included in the group “No Alcohol” (NA). Lethality of the most lethal suicide attempts was higher in the A group compared to the SA and NA groups. Prevalence of patients with alcohol use disorders was higher in the A group compared to the SA and NA groups. SA participants reported more reasons for living and lower suicide intent scores at the time of their most lethal suicide attempt compared to the A and NA groups. Acute alcohol use increases the lethality of suicide attempts in individuals with mood disorders.     

抑郁症的自杀未遂及其危险因素分析

为了获得抑郁症病人的自杀未遂发生率及其危险因素，采用自制的抑郁症与自杀的关系登记表和Ｈａｍｉｌｔｏｎ抑郁量表，分别对符合中国精神疾病分类方案与诊断标准第２版修订本的２１２例住院的抑郁症病人进行调查评分，然后用ＳＰＳＳ和ＰＥＭＳ软件包进行统计分析。结果：在２１２例抑郁症病人中发生自杀观念１５８例（７４．５％），自杀未遂６７例（３１．６％）。在自杀未遂组中的自杀方式以过量服药为主（４７．８％），自杀地点多在室内（７７．６％）。自杀未遂组的抑郁症状评分高于无自杀行为组（ｔ＝７．２７，Ｐ＜０．０１）。自杀与绝望感、抑郁情绪、自卑感、自知力等呈正相关。逐步回归分析发现，绝望感对自杀的影响最大，其次是抑郁情绪，再次是自卑感和自知力。提示抑郁症与自杀的关系密切，频繁出现≥３次自杀观念的抑郁症病人发生自杀行为的可能性较大。     

伴非典型特征的抑郁症患者自杀未遂的危险因素分析

目的探讨伴非典型特征抑郁症患者自杀未遂的社会人口学及临床特征方面危险因素。方法来自全国13个中心的1172例抑郁症患者,纳入其中179例伴非典型特征患者,依据简明国际神经精神访谈(the Mini International Neuropsychiatric Interview,MINI)5.0中文版自杀模块的访谈结果,分为自杀未遂组和无自杀未遂组,通过多因素logistic回归分析伴非典型特征的抑郁症患者在性别、年龄等社会人口学资料及伴焦虑症状、伴精神病性症状等临床特征方面可能与自杀未遂相关的危险因素。结果伴非典型特征抑郁症患者自杀未遂的发生率为23.5%(42/179)。与无自杀未遂组患者相比,自杀未遂组患者更多伴有自杀观念、产后起病,更常使用抗抑郁剂以外的其他药物治疗(如抗精神病药、情感稳定剂及苯二氮类药)(均P0.05)。多因素logistic回归分析显示,既往住院次数(OR=1.730,95%CI:1.093~2.740)和自杀观念(OR=3.899,95%CI:1.506~10.092)与伴非典型特征的抑郁症患者发生自杀未遂相关(均P0.05)。结论既往住院次数多及伴有自杀观念是伴非典型特征抑郁症患者自杀未遂的主要危险因素。     

自杀未遂者相关因素及其临床特点对照研究

目的研究自杀未遂者的相关因素及临床特点,并与正常对照者比较。方法本研究对70名自杀未遂者进行了调查及心理量表和家庭环境量表评定,以70名正常人为对照。结果(1)自杀未遂者中年轻女性多见；自杀方式绝大多数为服药或服毒。(2)两组的家庭环境和邻里关系明显不同,自杀未遂组存在问题较多。(3)自杀未遂组具有焦虑、病态人格和疑心等性格特点。结论与对照组相比,自杀未遂者存在问题较多,但个体素质因素是自杀未遂发生的主要原因。     

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.     

成年癫痫患者的自杀风险及相关危险因素研究

目的：研究成人癫痫患者自杀风险及相关危险因素。方法采用简明国际神经精神访谈（MINI）自杀风险模块和抑郁障碍模块对211例我院门诊的成年癫痫患者进行心理评估,并详细记录患者的年龄、性别、就业状况、婚姻、教育年限、发病年龄、病程、发作类型、发作频率、头颅M RI结果以及使用抗癫痫药种数,比较上述因素与自杀风险的关系。结果本组病例中有自杀风险的患者占21.3％（45/211）,伴抑郁障碍的患者占17.1％（36/211）;而伴抑郁障碍患者的自杀风险高达75.0％（27/36）,非抑郁障碍患者的自杀风险达10.3％（18/175）,差异有统计学意义（χ2＝74.525,P＜0.01）。结论伴抑郁障碍的癫痫患者自杀风险更高。     

Co-occurring aggression and suicide attempt among veterans entering residential treatment for PTSD: The role of PTSD symptom clusters and alcohol misuse

Aggression and suicidality are two serious public health concerns among U.S. veterans that can co-occur and share many overlapping risk factors. The current study aims to elucidate the contribution of posttraumatic stress disorder (PTSD) symptom clusters defined by a five-factor model and alcohol misuse in predicting aggression and suicide attempts among veterans entering residential treatment for PTSD. Participants were 2570 U.S. veterans across 35 Veterans Health Administration sites. Multinomial logistic regression models were used to identify correlates of aggression only (n = 1471; 57.2%), suicide attempts only (n = 41; 1.6%), co-occurring aggression and suicide attempts (n = 202; 7.9%), and neither behavior (n = 856; 33.3%) over the past four months. When compared to veterans endorsing neither behavior, greater PTSD re-experiencing symptoms were related to suicide attempts (odds ratio [OR] = 1.58, 95% confidence interval [CI] = 1.09–2.30), aggression (OR = 1.13, 95% CI = 1.02–1.26), and co-occurring aggression and suicide (OR = 1.38, 95% CI = 1.13–1.68), and higher PTSD dysphoric arousal symptoms and alcohol misuse symptoms were related to aggression (OR = 1.54, 95% CI = 1.38–1.71; OR = 1.30, 95% CI = 1.18–1.44, respectively) and co-occurring aggression and suicide (OR = 1.66, 95% CI = 1.35–2.04; OR = 1.50, 95% CI = 1.28–1.75, respectively). Our findings suggest that assessment of PTSD symptom clusters and alcohol misuse can potentially help to identify veterans who endorse suicide attempts, aggression, or both concurrently. These results have important implications for risk assessment and treatment planning with U.S. veterans seeking care for PTSD.     

Cognitive factors, engagement in sport, and suicide risk.

The aims of this study were to identify cognitive vulnerabilities and to examine the protective role of active engagement in sport in the development of (1) suicide ideation and (2) hopelessness. In Study 1,102 male military recruits were the participants. Scores on the Automatic Thoughts Questionnaire (ATQ-30), but not on the Dysfunctional Attitude Scale (DAS-A), predicted presence of suicide ideation three months later. The results of Study 2 with 84 university students showed that scores on the ATQ-30, but not on the DAS-A were significantly associated with hopelessness. Moreover, students actively engaged in sports exhibited less hopelessness. The findings suggest that active engagement in sports is strongly associated with negative automatic thoughts, suicidal thoughts, and hopelessness.     

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.     

深圳某企业外来劳务工抑郁焦虑情绪及自杀风险调查

目的 了解深圳某企业外来劳务工的抑郁、焦虑情绪和自杀风险的现状及与自杀相关的危险因素.方法 本研究采用横断面调查研究方法,以自编的社会人口学基本信息资料表、患者健康问卷抑郁量表、患者健康问卷焦虑量表和简明国际神经精神访谈自杀筛选问卷等量表为工具,对深圳某企业1845名外来劳务工的抑郁和焦虑情绪及自杀风险进行现况调查和多因素logistic回归分析.结果 (1) 1845名外来劳务工中,689例存在轻度及以上抑郁症状,占37.3％,其中中度以上抑郁146例,占7.9％;392例存在轻度及以上焦虑症状,占21.2％,其中中度以上焦虑67例,占3.6％.(2)男性和女性员工的抑郁评分在不同年龄、文化程度、婚姻状况的差异无统计学意义(P均＞0.05);男性和女性员工焦虑评分在未婚组(P=0.02)和高中及以上组(P=0.02)的差异有统计学意义.(3)多因素logistic回归分析显示,中度以上抑郁(OR=6.886,P＜0.01)和中度以上焦虑(OR=2.984,P ＜0.05)是自杀的重要危险因素.结论 深圳某企业部分外来劳务工存在轻度及以上抑郁或焦虑症状,中度以上抑郁和焦虑是自杀的重要危险因素.     

Prevalence of psychiatric disorders in the first trimester of pregnancy and factors associated with current suicide risk

This study aimed to describe the prevalence of psychiatric disorders and to identify the factors associated with Current Suicide Risk (CSR) in the first trimester of pregnancy. The Mini-International Neuropsychiatric Interview (M.I.N.I.) was employed to diagnose mental disorders in 239 women enrolled in a prospective cohort in Rio de Janeiro, Brazil. Serum lipids, leptin and socio-economic status were the independent variables. CSR, the dependent variable, was entered as binary (yes/no) variable into crude and adjusted Poisson regression models with robust variances. CSR was found to be the main psychiatric syndrome (18.4%), followed by agoraphobia (17.2%), major depressive disorder (15.1%) and generalized anxiety disorder (10.5%). Women with CSR showed higher mean levels of cholesterol (169.2 vs. 159.2; p=0.017), high density lipoprotein (50.4 vs. 47.7; p=0.031) and low density lipoprotein (102.8 vs. 95.6; p=0.022) when compared to women without CSR. The adjusted regression model showed a higher prevalence ratio (PR) of CSR among pregnant women with generalized anxiety disorder (PR=2.70, 95% CI: 1.36–5.37), with ≥two parturitions (PR=2.46, 95% CI: 1.22–4.93), and with major depressive disorder (PR=2.11, 95% CI: 1.08–4.12). We have shown that generalized anxiety disorder, major depressive disorder and higher parity are associated with CSR in the first trimester of pregnancy.     

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

     

Alcoholism and depression in a Swedish female population: co-morbidity and risk factors

OBJECTIVE: Our aims were to study associations between depressive disorders and alcohol dependence/abuse (ADA) in a female population-based sample, and to identify risk indicators common to both depressive disorders and ADA. METHOD: Three hundred and sixteen women in a stratified randomized sample were interviewed face to face. They were asked about their childhood/adolescence and alcohol habits. Clinical lifetime diagnoses according to DSM-III-R were made. Depressive disorders includes different mood disorders. RESULTS: Half the women with ADA also had a depressive disorder, and 25% of the women with depressive disorders also had ADA. Alcohol intoxication before the age of 15 and psychological and/or psychiatric problems before the age of 18 years increased the risk for ADA and depressive disorders in our study. CONCLUSION: Our results support previous findings of an association between depressive disorders and ADA, beginning early in life.     

15～24岁人群自杀特征及危险因素的病例对照研究

目的了解全国15～24岁自杀死亡者的特征,并通过与其他伤害死亡案例的比较了解青年自杀的危险因素。方法由精神科医师运用心理解剖方法对全国有地理代表性的23个疾病监测点上报的15～24岁的88例自杀案例(自杀组)和76例其他伤害死亡案例(对照组)的家属和周围知情人进行深入调查。结果(1)自杀组的平均受教育年限为(6.2±3.2)年,59%为女性,88%居住在乡村,82%服毒或服药自杀,26%为现婚,76%自杀前一直在工作或学习,26%有自杀未遂既往史,14%有血缘关系的人曾有自杀行为,31%朋友或熟人有过自杀行为,50%自杀当时有精神疾病,18%曾因心理问题寻求过帮助。(2)有既往自杀未遂史(经单因素分析)、自杀前2周有抑郁症状、自杀当时急性应激强度大和自杀前1个月生命质量低(后3项经多因素logistic回归分析)是自杀的危险因素。结论15～24岁自杀死亡者中50%有精神疾病,仅极少数自杀死亡者曾因心理问题寻求帮助。自杀未遂既往史、近2周有抑郁症状、经历急性负性生活事件和近1个月生命质量低为青年自杀死亡的主要危险因素。     

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.     

老年性谵妄临床特征及相关因素分析

目的　以谵妄量表 (DSS)为工具测评老年性谵妄临床特征 ,并从社会、心理、生物学角度分析老年性谵妄发生的相关因素。方法　对研究期间的住院患者进行前瞻性观察 ,选择谵妄患者 ,收集其临床资料 ,并与对照组相对照。结果　共完成 82例 ,其中谵妄病人 41例 ,对照组 41例。谵妄的症状主要是注意力障碍 ,思维障碍 ,意识障碍 ,定向力障碍 ,睡眠 觉醒周期障碍 (DSS评分分别为 0 2± 0 5 ,0 2± 0 5 ,0 3± 0 5 ,0 3± 0 6,0 3± 0 8)等。谵妄组患者氧分压、血氧饱和度均低于对照组患者 (P <0 0 5 )。内向性格 ,人际关系紧张 ,生活事件刺激 ,男性 ,急性起病 ,白蛋白降低 ,肌酐、尿素氮水平增高 ,肺部感染 ,颅脑CT异常与谵妄发生有关。结论　年龄大、急性起病、躯体疾病、脑部器质性病变、应激与谵妄发生有关。氧分压与血氧饱和度降低是预示谵妄的敏感指标。