Suicidality in the prospective Zurich study: prevalence,risk factors and gender

Our prospective Zurich study (1978–2008) found that suicidal ideation had occurred in 40.5 % and suicide attempts in 6.6 % of the population by age 50. Important gender differences were found in both suicidality and its risk factors. Suicide attempts were earlier and more frequent among women than among men: 70 versus 44 % reported their first suicide attempt before 20. For women, the relative risk of suicide attempts was 1.6, but the relative risk of suicidal ideation was about equal (1.1 for women). The main risk factors for suicidal ideation in women were low social support (OR 4.0) and frequent punishment in childhood (OR 3.7), and in men, a depressive (OR 6.5) and an anxious personality (OR 4.6). The main risk factors for suicide attempts in women were a broken home (OR 10.2) and sexual abuse/violence (OR 7.9) in childhood; in men, no multivariate analyses of suicide attempt were conducted because of insufficient statistical power.     

Prevalence and sociodemographic characteristics of self-reported suicidal behaviours in Latvia in 2010: A population-based study

Background: The fact that Latvia is among the countries with the highest suicide mortality rates in the European Union highlights the importance of research in this field. Aims: The aims of the study were to determine the 2010 prevalence of self-reported suicidal behaviours in Latvia, to identify sociodemographic risk factors and to examine sequences for reporting of suicidal behaviours. Methods: Computer assisted personal interviews were carried out to gather information on a representative sample of the Latvian population aged 18 to 64 (n?=?2816). The study sample was selected using a combination of stratified random sampling and quota methods. Results: Last year prevalence of any type of suicidal behaviour was 18.5% – nearly threefold lower than observed in 2000 (52.6%). Middle age, non-cohabitation status and lower level of education were significant risk factors for serious types of suicidal behaviour (suicidal ideation, suicidal plans, suicide attempts) among men, but only lower level of education was for women. Risk factors regarding mild types of suicidal behaviour (life-weariness, death wishes) were the same for men and women: older and middle aged, non-cohabitation status, and lower level of education. A total of 79.6% reported a continuous pattern of suicidal behaviours. Conclusions: Several sociodemographic risk factors for suicidal behaviours have been found. Further research is needed to clarify additional risk factors, especially in the high-risk groups studied and specific determinants contributing to reduction in prevalence of suicidal behaviours and suicide mortality in Latvia.     

Self-reported life-weariness, death-wishes, suicidal ideation, suicidal plans and suicide attempts in general population surveys in the north of Sweden 1986 and 1996

Background: The aims of present study were to assess the prevalence of suicidal expression in the general population, to compare prevalences over time, to identify risk groups and to examine the evidence regarding the proposition that there is a continuous sequence of suicidal expressions with an underlying gradient of severity. Method: Two postal questionnaire studies were conducted, in 1986 and in 1996, involving representative samples of about 700 and 1000 persons respectively, in the age range 18–65 years. Response rates of 76 % and 64 %, respectively, were obtained. Results: A higher proportion (34 %) reported some degree of suicidal expression during the past year in the 1996 survey, compared to 1986 (23 %). This was mainly attributed to higher reporting of life-weariness and death-wishes, since there was a simultaneous lower reporting of suicidal ideation (12.5 % vs 8.6 %). The total lifetime incidence of suicidal expression was identical (52 %) in both studies. Respective proportions of 0.6 % and 0.2 % reported that they had made a suicide attempt during the last year, and 2.6 % and 2.7 %, respectively, during their lifetime. Higher prevalences of combined suicidal expression during the previous year were reported by women, younger persons, those living alone and women living in urban areas. Concerning suicidal ideation during last year, no gender differences were found. For a total of 21 % of those reporting some degree of suicidal expressions during the past year, no simple cumulative relationship between the different types of suicidal expression was found. Conclusions: It is possible to use a postal questionnaire approach for studies on suicidal expression in the general population, and the study indicates that such suicidal expression is fairly prevalent. The pronounced gender differences concerning most types of suicidal behaviours and expression are not valid for suicidal ideation, which is important to consider in a preventional context. Accepted: 4 May 2001     

Predictors of high rates of suicidal ideation among drug users

Several studies have attempted to understand the link among substance abuse, depression, and suicidal ideation (SI). Assessment of this link is important to develop specific interventions for persons in substance abuse treatment. This association was tested among 990 drug users in and out of treatment with significant criminal justice histories from two National Institute on Drug Abuse studies. The Diagnostic Interview Schedule and Substance Abuse Module assessed DSM-III-R depression, number of depression criteria met, antisocial personality disorder (ASPD), and substance use disorders. Compared with men, women were twice as likely to report depression (24% vs. 12%), whereas men were nearly twice as likely to report ASPD (42% vs. 24%). High rates of SI were found, with women more likely than men to report thoughts of death (50% vs. 31%), wanting to die (39% vs. 21%), thoughts of committing suicide (47% vs. 33%), or attempting suicide (33% vs. 11%); 63% of women and 47% of men reported at least one of these suicidal thoughts or behaviors. Male and female ideators were more likely than nonideators to report depressed mood and to meet criteria for depression, ASPD, and alcohol use disorders. Male ideators were more likely than male nonideators to meet criteria for cocaine use disorders. Using logistic regression, SI among men was predicted by alcohol use disorder (OR = 1.60), ASPD (OR = 1.59), and number of depression criteria (OR = 9.38 for five criteria). Among women, SI was predicted by older age, marital status, alcohol use disorder (OR = 2.77), and number of depression criteria (OR = 9.12 for five criteria). These original findings point out the need to discuss suicidal thoughts among depressed drug users for early treatment and prevention.     

Beck's Depression Inventory as a screening instrument for adolescent depression in Sweden: gender differences

Beck's Depression Inventory was administered in a study of all students aged 16–17 years in the first year of high school in a Swedish town, and was completed by 93% of them (n=2270). Cronbach's reliability coefficient alpha was 0.89, and there were strong correlations between item scores and total scores. A diagnostic interview focused on depressive diagnosis during the last year was conducted with 88% (n=199) of all students with high scores (≥16), and with the same number of controls with low scores. A depressive diagnosis was confirmed in 73% of high scorers and 13% of low scorers. The questionnaire performed better with girls than with boys. The mean score was significantly higher for girls, and the proposed limit for moderate depression (a score of 16) was reached by 14.2% of girls and 4.8% of boys. All symptoms were significantly more frequent and more severe in girls. It was found that 20% of girls and 6% of boys reported suicidal ideation. In a factor analysis the strongest factor that emerged differed between the sexes. For boys it included sadness, crying and suicidal ideation, and for girls it included failure, guilt, self-dislike and feeling unattractive, combined with suicidal ideation. The gender differences are discussed.     

Suicidal ideation and behaviour in patients with persecutory delusions: Prevalence,symptom associations,and psychological correlates

BackgroundTo determine the prevalence of suicidal ideation and behaviour - and their correlates - in patients with persecutory delusions.Methods110 patients with persecutory delusions in the context of non-affective psychosis were assessed for suicidal thoughts and behaviours over the past month. Symptom and psychological assessments were also completed.ResultsThe severity of suicidal ideation was: no suicidal ideation (n = 26, 23.6%); wish to be dead (n = 21, 19.1%); nonspecific active suicidal thoughts (n = 14, 12.7%); suicidal thoughts with methods but no intent (n = 29, 26.4%); suicidal thoughts with intent but no specific plan (n = 13, 11.8%); and suicidal intent with plan (n = 7, 6.4%). In the past month, five patients (4.5%) had made an actual, interrupted, or aborted suicide attempt. The severity of suicidal ideation was associated with higher levels of depression, paranoia, hallucinations, anger, insomnia, negative beliefs about the self and others, pessimism, worry, and delusion safety-seeking behaviours and lower levels of psychological well-being and reward responsiveness. Severity of ideation was not associated with cannabis or alcohol use, working memory, pain, or meaningful activity levels.ConclusionsPatients with persecutory delusions are typically in a severe state of psychological stress, and at risk of suicide, as indicated by very high levels of suicidal ideation. This exploratory study also identifies correlates of suicidal ideation that could be investigated in causal research designs.     

Risk factors for suicidal ideation in psychiatric patients

Sociodemographic and clinical risk factors for suicidal ideation have been less studied than risk factors for parasuicide and suicide. No reports on associations between therapy satisfaction and suicidal ideation among psychiatric patients have been published. In this study we compared a group of patients with suicidal ideation (n= 84) with a randomly selected group of nonsuicidal patients (n = 166) in community-based psychiatric services. Patients with suicidal ideation felt a need for psychiatric treatment more often than nonsuicidal patients. They were also more likely to receive antidepressive medication, and weekly therapy sessions were more common among them. A wish to change therapist (OR 15.6, 95% CI 3.6–67.8), hopeless future orientation (OR 14.8, 95% CI 4.5–48.9), severe depression as evaluated by the Beck Depression Inventory (OR 14.0, 95% CI 4.3–45.2) and dysthymia (OR 12.8, 95% CI 1.7–97.3) were the factors most strongly associated with suicidal ideation in multivariate analysis. A wish to change therapist is an expression of therapy dissatisfaction, which may therefore be among the factors most strongly associated with suicidal ideation in psychiatric patients. To help prevent suicidality among psychiatric patients special attention to therapy factors is needed. Accepted: 15 September 1997     

Transgression and Gender

Human activity is determined to a great extent by not only biological sex but also gender. The aim of the study was to examine relationships between transgression and types of gender. A population of 558 individuals (399 women and 159 men) aged 19–25 (mean age: 22.6) were studied. The age of the women ranged from 19 to 24 (mean age: 22.4) and of the men—from 19 to 25 (mean age: 22.8). In order to examine the intensity of transgression, the Polish version of the chronic self-destructiveness scale was applied. The gender was studied by means of the Polish version of the Bem sex role inventory. Androgynous women achieved the highest and feminine men—the lowest scores on the transgression scale. In women, the masculinity scale positively correlated with the transgression scale, whereas the femininity scale did not significantly correlate with transgression, although the coefficient was negative. No statistically significant correlations were found in men (although the coefficients were positive). Biological sex and gender were qualitative variables that differentiated the intensity of transgression. Equilibrium between the psychological dimension of femininity and the psychological dimension of masculinity was vital for transgressive tendencies, particularly in women. Androgynous women showed rather the adaptive aspect of transgression.     

The Role of Masculinity and Depressive Symptoms in Predicting Suicidal Ideation in Homeless Men

Men’s suicide rates may be influenced by difficulties recognizing externalizing depressive symptoms in men that adhere to hegemonic masculine gender role norms. The purpose of this study was to investigate the ability of externalizing depressive symptoms, internalizing depressive symptoms, and hegemonic masculinity in predicting the existence and severity of suicidal ideation. Homeless men (n?=?94) completed questionnaires at a resource center in the Rocky Mountain Western United States. Internalizing symptoms predicted the existence of suicidal ideation, and both externalizing and internalizing symptoms predicted increased severity of suicidal ideation. The masculine norms violence and playboy were correlated with men’s suicidal ideation. An externalizing-internalizing model of predicting suicide in men and men’s adherence to certain masculine gender role norms may be valuable to further efforts in suicide assessment and prevention.     

The relationship of gender,gender identity,and coping strategies in late adolescents

The relationships among gender, gender identity, and coping in late adolescents were examined. One hundred sixty-nine late adolescents completed measures assessing their masculinity and femininity, as well as their use of coping strategies. Females endorsed greater use of emotion-focused coping strategies than males. Late adolescents who were high in masculinity endorsed higher levels of problem-focused coping strategies than those who were low in masculinity. In contrast, late adolescents who were high in femininity endorsed higher levels of emotion-focused coping strategies than those who were low in femininity. Neither the gender nor the masculinity and femininity of late adolescents were predictive of the use of avoidant coping strategies. Overall, gender identity made an important and independent contribution to the endorsement of coping strategy use. These results emphasize the importance of assessing both gender and gender identity with regard to coping in late adolescents.     

Suicidal ideation in the Finnish general population. A 12-month follow-up study

Background The epidemiology of suicidal ideation has remained a relatively unstudied area. The aim of this study was to investigate the incidence, prevalence and persistence of and recovery from suicidal ideation in a sample of the Finnish general population. Methods Postal questionnaires including the Beck Depression Inventory (BDI) were mailed to the study subjects (n = 1,593) at baseline and on follow-up after 12 months. The suicidality item of BDI was used to screen suicidal ideation. Results The 12-month incidence (4.6 %) and prevalence of suicidal ideation (14.7 %) were higher in men than in women (3.1 % and 9.2 %, respectively). Sixty-nine per cent of those men and 59 % of those women who had suicidal ideation at baseline continued to have suicidal thoughts on follow-up. Suicidal ideation and the severity of depression associated strongly. Over half of the men and women who had persistent suicidal ideation had not visited any health services for help with psychological distress during the 12-month follow-up period. Daily smoking associated with a decreased probability of recovery from suicidal ideation. Conclusions Suicidal ideation is common and persistent at the population level. Seeking professional help for depression with suicidal tendencies is disproportionately low in relation to the high prevalence of suicidal ideation. Accepted: 19 September 2001     

Traditional Masculinity as a Risk Factor for Suicidal Ideation: Cross-Sectional and Prospective Evidence from a Study of Young Adults

Traditional masculinity is hypothesized to be associated with suicidal ideation, and traditional masculinity is predicted to interact with stressors, intensifying suicidal ideation. Cross-sectional and prospective data from a study of 2,431 young adults was analyzed using hierarchical regression main effects and interaction models. Traditional masculinity was associated with suicidal ideation, second only in strength to depression, including when controlling for other risk factors. Prospective effects were substantially weaker. There was mixed evidence for traditional masculinity by stress interactions. The results provide preliminary support for the role of traditional masculinity in suicidal ideation, but the relationship should be tested in studies of suicide attempts and mortality. Implications for prevention and intervention are explored.     

Adolescent problem behaviours predicting DSM-IV diagnoses of multiple substance use disorder

Background Whether there is an independent association between problem behaviours and substance use disorders (SUD) needs further investigation. This study examined prospective associations of adolescent psychopathology and problem behaviours with SUD in early adulthood, and whether these associations are confounded by other factors. Method Data were from a prospective study of 2,429 young Australian adults from birth to the age of 21 when data on SUD were collected. Adolescent psychopathology and behaviour were assessed at 14 years via the Youth Self Report instrument on eight sub-scales of emotional and behavioural problems. Results In multivariate analyses, attention problems, delinquency, and aggression were associated with both single and multiple SUD in early adulthood, with delinquent behaviour being the strongest predictor (OR = 2.0, 95% CI 1.4–2.9 for one SUD and OR = 3.6, 95% CI 2.4–5.0 for multiple SUDs). Conclusions Problem behaviours, in particular delinquency and aggression in early adolescence predict long-term SUD. The results suggest that substance use prevention programs should target adolescents with early symptoms of psychopathology and problem behaviour.     

Does cannabis use lead to depression and suicidal behaviours? A population‐based longitudinal study

Objective: This study investigates the relationship between cannabis use and later depression, suicidal ideation and suicide attempts in a cohort of young Norwegians. Method: Data were gathered through the Young in Norway longitudinal study, in which a population‐based sample of 2033 Norwegians were followed up over a 13‐year period, from their early teens to their late twenties. Data were gathered on: (a) exposure to cannabis use; and (b) depression, suicide ideation and suicide attempts. In addition, information about possible confounding factors was included. Results: In early adolescence, no associations with later depression or suicidal behaviours were observed. In the sample’s twenties, we observed highly significant associations with suicide ideation and suicide attempts. When adjusting for confounders, the OR was 2.9 (95% CI 1.3–6.1) for later suicide attempts in the group who had used cannabis 11+ times during the past 12 months. Conclusion: The findings suggest that exposure to cannabis by itself does not lead to depression but that it may be associated with later suicidal thoughts and attempts.     

Is the bipolar spectrum the psychopathological substrate of suicidality in heroin addicts?

BACKGROUND: To describe the prevalence and the risk factors of suicidal ideation in a cohort of Italian opioid addicts presenting for treatment. METHOD: Systematic cross-sectional clinical data on suicidal ideation, socio-demographic variables, psychiatric status, social adjustment, status and history of addiction in 616 patients were gathered. RESULTS: Suicidal thoughts during the past week were reported by 29.1%. Suicidal thoughts were more frequent in patients with bipolar spectrum diagnoses (OR = 1.42) and in patients with depressive and aggressive symptoms (multiple R = 0.47). The odds of having suicidal thoughts were also higher for subjects receiving public welfare benefits (OR = 1.69), unemployed patients (OR = 1.37), those with early onset of heroin dependence (OR = 1.36), living alone (OR = 1.33), and experiencing problems in organizing social contacts and leisure time (OR = 1.28). CONCLUSION: Current suicidal ideation was a common feature of patients with opioid addiction. Depression and hostility as part of the bipolar spectrum - in the context of early-onset drug dependence, work and social/leisure problems - appear independently associated with suicidal ideation. Given the elevated rates of completed suicide in heroin addiction, these data have implications for preventing suicide in patients with this type of addiction. Prospective data are needed to further address this important clinical and public health agenda.     

Social support and suicidal ideation in Japan: are home visits by commissioned welfare volunteers associated with a lower risk of suicidal ideation among elderly people in the community?

Aims

Social support has consistently been reported to be effective in reducing suicidal ideation. This cross-sectional study was performed to determine whether home visits by commissioned welfare volunteers (i.e., organizations of community residents appointed by national or prefectural governments) are associated with a lower risk of suicidal ideation among the elderly.

Methods

In August 2010, questionnaires were sent to all residents aged ≥65 years in three municipalities (n = 21,232) in Okayama prefecture, Japan, and 13,929 returned the questionnaire (response rate: 65.6 %). We finally analyzed 11,218 subjects. Both home visits by commissioned welfare volunteers and suicidal ideation within the last 30 days were assessed in the questionnaire. Odds ratios (ORs) and 95 % confidence intervals (CIs) for suicidal ideation were calculated adjusting for age, sex, educational attainment, and marital status. We then additionally adjusted for instrumental and emotional support, separately.

Results

The prevalence of suicidal ideation was 10.0 % and higher in women than in men (11.4 % vs. 8.0 %). Home visits were significantly associated with a lower risk of suicidal ideation after adjusting for instrumental and emotional support, respectively (OR: 0.60, 95 % CI: 0.53–0.69; OR: 0.67, 95 % CI: 0.59–0.78). In sex-stratified analysis, the association was clearer for women than for men: the corresponding ORs among women were 0.55 (95 % CI: 0.46–0.65) and 0.61 (95 % CI: 0.52–0.73), whereas they were 0.71 (95 % CI: 0.56–0.90) and 0.78 (95 % CI: 0.61–0.99) among men.

Conclusion

Our findings suggest that home visits by commissioned welfare volunteers are significantly associated with lower suicidal ideation among the elderly, particularly in women.     

Development of the feminine gender role stress scale. A cognitive-behavioral measure of stress, appraisal, and coping for women.

The cognitive appraisal of threats and challenges to sterotypical feminine gender role coping behavior was defined as feminine gender role stress (FGRS). This article describes the development of a self-report measure of FGRS. Situations perceived as more stressful for women than for men wer categorized by factor analysis, yielding the following constellation of maladaptive stress responses particularly salient for women: (a) fear of unemotional relationships, (b) fear of being unattractive, (c) fear of victimization, (d) fear of behaving assertively, and (e) fear of not being nurturant. Women demonstrated significantly higher FGRS appraisal scores than men, and scores among women showed good 2-week test-retest reliability. The tendency to appraise situations on the FGRS scale as stressful was associated with the tendency to consider daily hassles stressful but was not related to self-perceived femininity in women. It was predicted that women who tend to exhibit the FGRS appraisal style would have more difficulty in coping with stressors related to depression. Supporting this hypothesis, women with higher FGRS scores reported greater depression than those with lower scores. The assessment of FGRS appraisal and coping style in women provides useful information for devising treatment strategies to improve women's health through promotion of adaptive coping.     

Gender differences in psychiatric symptoms related to suicidal ideation in Japanese patients with depression

Recent figures show that more than 30,000 people suicide each year in Japan, and that many of them are considered to suffer from depression. In addition, the suicide rate among Japanese women has been shown to be higher than in other countries. However, it is not clear whether the psychiatric symptoms leading to suicide differ by gender. The authors examined gender differences in psychiatric symptoms related to suicidal ideation (SI) in Japanese patients with depression. Study subjects were 199 new patients (66 men and 133 women) who were diagnosed with a major depressive disorder. SI and psychiatric symptoms were assessed by several psychological tests using questionnaires. Logistic regression analysis was used to calculate the odds ratio (OR) and 95% confidence interval (CI) with an adjustment for all relevant factors simultaneously. The stepwise method was also used for selecting variables. In univariate analysis, several psychosocial factors such as self-reproach, derealization, depressive moods, depersonalization, and anxiety traits were statistically significantly associated with SI in both men and women. However, multivariate analysis using the stepwise method distinguished gender differences. Low social/family support and depersonalization were statistically significantly associated with SI in men, while depressive moods and an anxiety state were significantly associated with SI in women. The relation between derealization and SI was statistically significant in women but not significant in men.     

Nonsuicidal self-injury,suicide ideation and suicide attempts in the National Guard

BackgroundAmong members of the National Guard, suicide rates are higher than age and sex matched civilian counterparts. Across many civilian samples, nonsuicidal self-injury has emerged as a particularly strong correlate of suicide risk. The current study describes the prevalence and correlates of NSSI and suicidal thoughts and behaviors among National Guard members.MethodsParticipants were 897 National Guard personnel recruited online who completed study measures anonymously.ResultsApproximately 6% of males and 14% of females reported a history of NSSI. Almost one third of the sample reported suicide ideation and 3% of men and 11% of women reported a suicide attempt. NSSI was strongly associated with a history of suicide ideation and attempts. Characteristics of NSSI were similar across men and women.DiscussionReliable access to effective interventions is essential for National Guard members in light of their risk for suicidal and nonsuicidal self-injurious behavior.