A preventive approach to the suicidal patient

Physicians may have the opportunity to prevent suicide. An awareness of suicide risk factors, such as depression, alcoholism, drug abuse, schizophrenia, and chronic pain or disease, may facilitate suicide prevention. Recognition of acute and chronic suicidal vulnerability occurs through direct questioning. Psychiatric consultation is indicated for patients exhibiting clear self-injury risk, as exemplified by expressed suicide intent, an overt plan for death, or a "gesture." Hospitalization is usually recommended for socially isolated patients presenting with overt suicidal ideation, complicated by injurious self-harm, encephalopathy, or substance abuse. Family involvement and a "no-suicide" contract with the patient, coupled with close outpatient follow-up appointments, should suffice for those exhibiting milder or transient thoughts of suicide without manifest intent to die.     

家庭环境和应对方式对大学生自杀意念影响

目的 探讨家庭环境因素及应对方式对大学生自杀意念的影响.方法 采用随机抽样方法对某城市3所高校不同年级585名学生进行自杀意念、自伤行为、抑郁自评量表以及家庭环境和简明应对方式调查.结果 被调查者中有过自杀意念的占20.9%,5.7%有过≥1次自杀行为;11.6%的大学生有过自伤行为;自杀意念组的女生比例明显高于男生,曾经有过自杀和自伤行为的比例明显高于正常组(P<0.001);多因素逻辑回归分析表明,女生(OR=2.391)、消极应对方式(OR=2.796)、抑郁状态(OR=1.071)、存在自伤行为(OR=4.003)以及有过≥1次自杀行为(OR=5.492)是大学生自杀意念的危险因素,而家庭环境亲密度(OR=0.879)可能是自杀意念的保护性因素;未发现童年时期父母的关系以及童年时期是否受到成年人虐待与大学生自杀意念相关.结论 大学生自杀意念较高,受性别、抑郁状态、家庭环境、消极应对以及曾经的自杀和自伤行为经验影响.     

Suicide attempt, smoking, comorbid depression, and platelet serotonin in alcohol dependence

The risk of suicide in patients with alcoholism increases if alcoholism is related to comorbid depression. Both alcoholism and suicidal behavior are associated with reduced serotonin (5-hydroxytryptamine [5-HT]) function. Because suicide is enormous public health problem worldwide, to prevent suicide attempts, it is important to find peripheral marker of suicidal behavior. The aim of this study was to assess whether platelet 5-HT concentration is altered in alcoholic patients with or without suicide attempt. Platelet 5-HT concentration was evaluated in 397 male and 108 female ethnically homogenous medication-free patients with alcoholism, subdivided according to smoking status, comorbid depression, and a history of suicide attempt and in 450 male and 139 female healthy control (nonsuicidal) subjects. Suicide attempt was assessed by two measures: according to the score 4 on the item 3 from the Hamilton Rating Scale for Depression and according to the Structured Clinical Interview regarding suicidal attempt during lifetime. Both male and female patients with alcoholism who were nonsmokers had significantly lower platelet 5-HT concentration than the corresponding healthy subjects. Multifactor analyses of variance revealed the significant effects of alcoholism and smoking, but the lack of significant effects of suicide attempt, sex, or comorbid depression, and no interactions between variables, on platelet 5-HT concentration. Platelet 5-HT concentration did not differ significantly between suicidal patients compared with nonsuicidal patients with alcoholism. Because the results from the present study showed similar platelet 5-HT values between patients with or without a history of suicide attempt, our data did not support the hypothesis that platelet 5-HT concentration might be used as a peripheral marker of the pronounced suicidal behavior in alcoholism.     

Exposure to suicide and suicidal behaviors among Hong Kong adolescents

Suicidal behaviors (deliberate self-injury with the intent to hurt or kill oneself) have been little examined outside the West. The aims of this study were to (a) determine the correlates of suicidal behaviors, and (b) examine whether depression and suicide ideation moderated the effects of exposure to completed and attempted suicide on suicidal behaviors among a community sample of Hong Kong youth ages 12-17. Adolescents responded to questions regarding self-injurious behaviors, and also indicated presence of intention to hurt or kill themselves in the past 12 months. Based on their responses, two groups of interest were formed: 96 youths reported both self-injurious behaviors and the intent to hurt or kill themselves, and formed the "suicidal behaviors" group; and, 1213 adolescents reported neither self-injurious behaviors nor intent to hurt self or die, and formed the control group. The participants also responded to questions about depressive symptoms, anxiety, suicidal ideation and attempt, alcohol/drug use, stressful life events, and family relationships. They indicated whether anyone they knew had attempted or completed suicide in the previous 12 months. Logistic regression indicated that depressive symptoms, stressful life events, suicidal ideation and exposure to suicide attempt (but not completed suicide) contributed unique variance to the presence of suicidal behaviors, after controlling for demographic variables. Depression (and at trend levels, suicidal ideation) moderated the effect of exposure to suicide attempt by others on suicidal behaviors. Our results indicate that completed suicide in the social network increases risk for suicidal behaviors, but not when other risk factors are controlled. By contrast, a suicide attempt independently increases risk for suicidal behaviors. Furthermore, those youths who experience depressive symptoms or suicidal ideation are at particularly high risk for engaging in suicidal behaviors when an exposure to suicide attempt occurs.     

Factors That Affect Suicidal Attempt Risk Among Korean Elderly Adults: A Path Analysis

Objectives:

Among the Korean elderly (those 65 years of age and older), the suicide rate is 80.3/100 000 people, which is ten times higher than the Organization for Economic Cooperation and Development average. Because South Korea is rapidly becoming an aging population, this high elderly suicidal rate will only get worse. Although the size of the elderly suicide problem is quite large, previous research in South Korea has surveyed restricted areas and not the entire country. Even though the factors that affect elderly suicide are complicated, there has been little research into these influencing factors. Thus, this research uses the national survey data (Community Health Survey) that was obtained in 2009. Additionally, we analyze factors affecting elderly suicidal ideation and attempts as well as the paths of these effects.

Methods:

Community Health Survey data obtained by the Korea Centers for Disease Control and Prevention in 2009 was used for this study. We additionally examined the factors that affect suicide with chi-squared tests, t-tests, Pearson’s correlation test, and path analysis.

Results:

Depressive symptoms and suicidal ideation are the only factors that directly affect suicidal attempts. Demographic, behavioral, and physical activity factors have indirect effects on suicidal attempts.

Conclusions:

Depression has the strongest influence on suicidal ideation and attempts. Demographic, behavioral, and physical activity factors affect suicidal attempts mostly through depressive symptoms. In addition, there is a path that suggests that demographic, behavioral, and physical activity factors affect suicidal attempts not through depression symptoms but only through suicidal ideation. This means that the elderly who do not have depression symptoms attempt suicide according to their own situations and characteristics.     

自杀行为的现状及其应对策略

  目的  探索艾滋病毒感染者/艾滋病（HIV/AIDS）患者自杀的影响因素,为预防HIV/AIDS患者自杀提供针对性地干预依据。  方法  2013年3 — 6月,在广东省广州市第八人民医院对408位HIV/AIDS患者进行横断面调查,采用分类树模型筛选自杀危险因素。  结果  本次调查发放问卷450份,有效问卷为408份（90.7 %）。其中,男性占69.6 %（284/408）,同性恋/双性恋者占31.9 %（130/408）,处于抑郁状态者占36.8 %（150/408）。有32.8 %（134/408）的患者有过自杀意念或发生过自杀行为;分类树模型结果显示,有抑郁症状、文化程度、性取向以及歧视为重要的危险因素,其中,高危人群为：（有抑郁症状 + 文化程度高）、（无抑郁症状 + 非异性恋）、（无抑郁症状 + 异性恋 + 受到歧视）。利用预测概率绘制的ROC曲线下面积为0.763,与0.5比较差异有统计学意义,模型拟合效果较好。  结论  应重视所筛选出的主要自杀危险因素,降低HIV/AIDS患者自杀的发生率。同时应关注HIV/AIDS患者中未发现抑郁症状者的自杀状况,及时采取相应干预措施,减少自杀的发生。     

“You feel like you can’t live anymore”: Suicide from the perspectives of Canadian men who experience depression

Severe depression is a known risk factor for suicide, yet worldwide men’s suicide rates continue to outnumber reported rates of men’s depression. While acknowledging that the pathways to suicide are diverse, and being mindful of the complex challenges inherent to studying suicide, we interviewed men who experienced depression as a means to better understanding the processes they used to counter and contemplate suicide. This novel qualitative study provides insights on how masculine roles, identities and relations mediate depression-related suicidal ideation in a cohort of 38 men in Canada, ranging in age from 24 to 50 years-old. Constant comparative analyses yielded the core category of reconciling despair in which men responded to severe depression and suicidal ideation by following two pathways. To counter suicide actions, connecting with family, peers and health care professionals and/or drawing on religious and moral beliefs were important interim steps for quelling thoughts about suicide and eventually dislocating depression from self-harm. This pathway revealed how connecting with family through masculine protector and father roles enabled men to avoid suicide while positioning help-seeking as a wise, rational action in re-establishing self-control. The other pathway, contemplating escape, rendered men socially isolated and the overuse of alcohol and other drugs were often employed to relieve emotional, mental and physical pain. Rather than providing respite, these risky practices were the gateway to men’s heightened vulnerability for nonfatal suicidal behaviour. Men on this pathway embodied solitary and/or risk taker identities synonymous with masculine ideals but juxtaposed nonfatal suicidal behaviours as feminine terrain.     

Repeated suicide attempts: a need for continued care

Prevention of deliberate self-harm, especially suicide attempts, remains difficult and this puts a great burden on the family as well as on the health-care professionals. The risk of a subsequent suicide attempt or a successful suicide is high while the behaviour is often met with antipathy, a feeling of helplessness and anger. This is in conflict with the needs of the patient; every suicide attempt requires the health-care professionals involved to exhibit a emphatic, patient and serious attitude, even when patients refuse to cooperate, are restless, aggressive or unwilling to communicate. Prevention of the suicidal behaviour can only be achieved this way.     

Suicide attempts and physical fighting among high school students--United States, 2001

Violence is a major cause of morbidity and mortality, particularly among youths. In the United States, homicide and suicide are the second and third leading causes of death, respectively, for persons aged 13-19 years. Although suicide commonly is associated with anxiety, depression, and social withdrawal, research suggests a link between violent behaviors directed at oneself (i.e., suicidal behaviors) and violent behaviors directed at others among adolescents. Certain students who engage in extreme forms of violence, such as school shootings, exhibit suicidal ideation or behavior before or during the attack. However, suicidal behavior also might be associated with involvement in less extreme forms of violent behaviors, such as physical fighting, which might be a risk factor for more severe forms of violence. To characterize any potential association between suicide attempts and fighting, CDC analyzed self-reported 2001 data from a nationally representative sample of high school students in the United States. The results of that analysis indicated that students who reported attempting suicide during the preceding 12 months were nearly four times more likely also to have reported fighting than those who reported not attempting suicide. Prevention programs that seek to reduce both suicidal and violent behaviors are needed. Because prevalence of this association was determined to be highest in the 9th grade, these efforts might be most effective if implemented before students reach high school.     

Adolescent depression and suicide risk: association with sex and drug behavior

BACKGROUND: Depression is common among adolescents, and suicide is the third leading cause of death among 15- to 19-year-olds. Although both health problems have been associated with drug use and early sexual intercourse, the relationship has not been systematically studied in a nationally representative sample. METHODS: Sixteen patterns of combined sex and drug use behaviors were obtained using cluster analysis of responses to Wave I of the National Longitudinal Study of Adolescent Health conducted from September 1994 through December 1995. Bivariate and multivariate analyses tested correlations between behavior patterns and current depression, serious suicidal ideation, and previous suicide attempt, controlling for gender, race/ethnicity, Hispanic ethnicity, family structure, and parent education. RESULTS: Compared to youth who abstain from risk behaviors, involvement in any drinking, smoking, and/or sexual activity was associated with significantly increased odds of depression, suicidal ideation, and suicide attempts. Odds ratios were highest among youth who engaged in illegal drug use. There were few differences between boys and girls who abstain from sex and drug behaviors. Girls were less likely than boys to engage in high-risk behaviors, but those who did tended to be more vulnerable to depression, suicidal ideation, and suicide attempt. CONCLUSIONS: Teens engaging in risk behaviors are at increased odds for depression, suicidal ideation, and suicide attempts. Although causal direction has not been established, involvement in any sex or drug use is cause for concern, and should be a clinical indication for mental health screening for girls; both boys and girls should be screened if engaging in any marijuana or illegal drug use.     

北京50家综合医院门诊患者自杀意念及自杀未遂调查

目的 了解北京市综合医院门诊患者的自杀意念和自杀未遂出现率及其危险因素.方法 采用自制量表对随机抽取的北京市50家各级综合医院2877例门诊患者进行调查,通过logistic分析筛选出其危险因素.结果 自杀意念和自杀未遂终生发生率分别为6.08%和1.18%;多因素分析显示两者的共同危险因素为近一年有绝望感、年纪轻、熟人有过自杀行为、女性.结论 北京市综合医院门诊就诊患者经常有自杀危险、抑郁等心理问题;应培养普通门诊医务人员识别、评估和处理这类问题的技能.     

Suicidal behaviour and aggression in psychiatric inpatients

OBJECTIVE: Theoretically, suicidal behaviour and aggression are usually said to be correlated. Such relationship is, however, not reliably supported by clinical and experimental evidence. It has been more frequently found when suicidal psychiatric patients are compared with healthy non-suicidal controls rather than when the comparison is done within the group of the psychiatric patients. Therefore we decided to investigate whether such relationship exists in a group with a high risk of suicidal behaviour--psychiatric male inpatients. MATERIAL AND METHODS: 113 male inpatients, mostly with schizophrenia and other psychotic disorders and mood disorders were studied in the first five days after their admission. Using a structured clinical interview and formal rating scales data were collected about the number of suicide attempts and aggressive acts committed throughout their lives, current suicide ideation and suicide planning behaviour, alcohol use, depression and outwardly directed aggression. Correlation analysis and chi-square test were used to analyze the data. RESULTS: There is no significant relation between current aggressivity and current suicide risk, as well as between the lifetime aggression and the lifetime suicide behaviour. The current suicide ideation and suicide planning behaviour are related to previous suicidal behaviour and to the current depression level. The lifetime aggression is related to the alcohol use. CONCLUSIONS: The results of our study do not define aggression as a suicide risk factor within the group of psychiatric inpatients. This findings could benefit the evaluation of the suicidal risk in psychiatric clinic.     

Modeling the Distinct Pathways of Influence of Coping Strategies on Youth Suicidal Ideation: A National Longitudinal Study

National surveys indicate high rates of suicidal ideation in youth, especially among females. Coping skill training programs hold promise as a potential intervention that can help young people better manage stress and not consider suicide as a solution to life??s problems. To assess the promise of this strategy, the present research examined which coping strategies (if any) predicted reduction in youth suicidal ideation over a 1-year follow-up, and explored the potential pathways through which their influence was channeled. Two waves of panel data from a nationally representative sample of youth, assessed 1?year apart (N?=?710; Mean age?=?18?years) were analyzed separately by gender using multiple group path analytic procedures. Four coping strategies, namely problem solving, emotional regulation, support seeking and acceptance were found to predict reduction in suicidal ideation among both males and females. However, the influence of these strategies (at baseline) was channeled through distinct pathways. The effect of emotional regulation (and acceptance) was channeled through its use at follow-up and was mediated by reductions in perceived stress and depressive symptoms, leading to reduction in suicidal ideation. The influence of support seeking was also channeled through its more recent use at follow-up, but directly predicted reduction in suicidal ideation, with no effect on perceived stress or depressive symptoms. The effect of problem solving on suicidal ideation was mediated by reduction in depressive symptoms, but was not channeled through its use at follow-up, suggesting a longer time course for the protective influence of this strategy. Finally, acceptance had a direct risk-enhancing effect on suicidal ideation. Coping strategies commonly used by youth can be effective in reducing suicidal ideation and therefore universal training in the effective use of these strategies should be considered. An understanding of the distinct pathways through which their effect on suicidal ideation is transmitted can better inform the design of youth suicide prevention interventions.     

Brief Intervention and Follow-Up for Suicidal Patients With Repeat Emergency Department Visits Enhances Treatment Engagement

We implemented an innovative, brief, easy-to-administer 2-part intervention to enhance coping and treatment engagement. The intervention consisted of safety planning and structured telephone follow-up postdischarge with 95 veterans who had 2 or more emergency department (ED) visits within 6 months for suicide-related concerns (i.e., suicide ideation or behavior). The intervention significantly increased behavioral health treatment attendance 3 months after intervention, compared with treatment attendance in the 3 months after a previous ED visit without intervention. The trend was for a decreasing hospitalization rate.Approximately 400 000 to 500 000 US emergency department (ED) visits occur annually for suicide attempts.1,2 The ED is a primary site for the treatment of suicide attempts, and for many patients, ED interventions are the only treatment they receive.3 As many as 60% of suicidal ED patients are stabilized and discharged directly to outpatient care.1,2 Unfortunately, only 50% of these patients follow up on their referrals and attend 1 or more outpatient behavioral health sessions.3 Consequently, costly repeat ED visits and additional suicidal behavior are frequent. As many as 30% of patients presenting to the ED for a suicide-related concern return to the ED for another suicide-related concern within 1 year,4 and 2-year follow-up suicide mortality rates among suicide attempters are estimated at 2%.5 Recurrent suicidal behavior and limited outpatient treatment engagement are similarly significant problems among veterans,6–8 who may be at greater risk for suicide than civilians despite more recent reductions.9,10 Given that the ED is the only place where many suicidal individuals receive care, it could be an important intervention site to increase outpatient treatment engagement and reduce repeat suicidal behavior, ED visits, and hospitalizations.11     

Preventing suicide in adolescents with alcohol use disorders

Adolescent suicide is an escalating crisis that needs to be addressed by clinicians and researchers. Alcohol use has consistently been implicated in adolescent suicide and it is generally assumed that alcohol use leads to an increased risk in suicidality, suicide attempts and completed suicides. It can lead to adolescent suicidality through alcohol myopia, disinhibition, and impaired judgment. Multiple genetically related intermediate phenotypes might contribute to the risk of alcohol misuse and suicidal behavior in adolescents. Genetic variations that enhance the risk for mood and anxiety symptoms or susceptibility to stress might increase risk through different mechanisms. Comorbid disorders such as depression are frequently exhibited in adolescents who misuse alcohol, therefore any adolescent who appears to be at risk for alcoholism or depression should always be screened for all other psychiatric disorders and for suicidality; some signs suicidal adolescents may exhibit include withdrawal, personality change, and a loss of interest in pleasurable activities. While assessment is important, prevention is crucial in any attempt to decrease the incidence of adolescent suicide. The US Center for Disease Control and Prevention (CDC) has established a set of seven guidelines that can be implemented from kindergarten through high school in order to establish alcohol prevention efforts in schools. Through beginning prevention efforts at a young age, it is hopeful that both alcohol misuse and adolescent suicide can be reduced.     

Victimization and Suicidality Among Dutch Lesbian,Gay, and Bisexual Youths

We examined Netherlands Institute for Social Research data, collected between May and August 2009, on 274 Dutch lesbian, gay, and bisexual youths. The data showed that victimization at school was associated with suicidal ideation and actual suicide attempts. Homophobic rejection by parents was also associated with actual suicide attempts. Suicidality in this population could be reduced by supporting coping strategies of lesbian, gay, and bisexual youths who are confronted with stigmatization by peers and parents, and by schools actively promoting acceptance of same-sex sexuality.Studies have shown that rates of suicidal ideation and suicide attempts among lesbian, gay, and bisexual (LGB) youths are higher than among heterosexually identified youths.1 Also, suicide attempts in LGB adolescents are positively associated with the parents’ negative responses to their offspring’s sexual orientation.2 Furthermore, victimization at school is positively related to lifetime suicide attempts and to suicidal ideation in the previous year.3,4 Although LGB adolescents experience victimization in various social contexts, it is not clear which social context (parents, family members outside the nuclear family, school, or neighborhood) is most crucial in determining suicidality. The present study is one of the first studies to examine this issue.     

Suicide prevention by limiting access to methods: A review of theory and practice

This review discusses the limitation of access to suicide methods as a way to prevent suicide, an approach which forms a major component of many national suicide prevention strategies. An important distinction is made between efforts that attempt to limit physical access to suicide methods and those that attempt to reduce the cognitive availability of suicide. Physical imitations will be reviewed with reference to restricting access to domestic gas, catalytic converters, firearms, pesticides, jumping, paracetamol and methods used in prisons. Impacts of cognitive availability will be discussed mainly with regard to the media in terms of providing access to technical information and sensational or inaccurate portrayals of suicide. Drawing on psychological models of suicidal ideation and behaviour, this review explores how processes leading to suicidal behaviour and issues around method choice may relate to the effectiveness of limiting access to methods. Potential problems surrounding method limitations are explored, in particular the factors contributing to substitution, the risk that alternative methods of suicide may be used if one is restricted. It is concluded that in appropriate contexts, where substitution is less likely to occur, and in conjunction with psychosocial prevention efforts, limitation of both physical and cognitive access to suicide can be an effective suicide prevention strategy.     

抑郁在青少年核心自我评价与自杀意念间的中介作用:基于Bootstrap法和MCMC法的实证研究

目的了解高中生自杀意念的发生状况和相关因素。方法采用自编问卷,以自填方式对上海市长宁区高中学生进行调查。结果被调查的高中生中曾有过不同程度自杀意念的占33.75%。认为自杀是一种疯狂行为的占42.82%,认为自杀是对家庭和社会的不负责任的占66.39%,26.32%的高中生在一般情况下,不愿意和有过自杀行为的人交往,且不同性别高中生对上述提及的自杀态度差异有统计学意义(χ²分别为38.33、9.19及9.84,P均＜0.05)。多因素logistics回归分析发现,女生比男生更易出现自杀意念(OR=1.371)。就读普通高中的学生比就读职业高中的学生更易出现自杀意念(OR=1.515)。检出有抑郁倾向的学生更易出现自杀意念(OR=9.195)。经历过人际关系、家庭及健康适应因子方面的压力性生活事件的学生更容易出现自杀意念,OR值分别为2.651、1.372及1.643。结论上海市长宁区高中生中有一部分学生曾经有过自杀意念,且女生、就读普高、检出抑郁、经历人际关系、家庭及健康适应生活事件是自杀意念的相关因素。应关注女生的心理情况,尽早发现学生的抑郁倾向,减少自杀行为的发生。