Psychiatric effects of exposure to suicide among the friends and acquaintances of adolescent suicide victims.

The friends and acquaintances (N = 58) of 10 adolescent suicide victims were interviewed 6 months after the death of the victims, and the rates of psychiatric disorders that had onset after the death were compared with the 6-month incidence of psychopathology in 58 demographically and psychiatrically matched unexposed controls. The exposed group showed higher rates of any new onset major depressive disorder, but the rate of incident suicide attempts was the same in both groups. The median onset of incident depression among the exposed group was within the first month after exposure, and the majority of those exposed youth with incident depression were still depressed at interview 6 months after the death. Adolescent friends and acquaintances of suicide victims experience considerable psychiatric morbidity subsequent to exposure to suicide, most consistent with pathological grief.     

Stability of diagnosis: a 20-year retrospective cohort study of Israeli psychiatric adolescent inpatients.

Outcome according to diagnosis and stability of diagnosis were investigated in a follow-back study of 351 adolescents with various psychiatric disorders hospitalized in a closed psychiatric ward. The duration of follow-back was 15-19 years. All diagnoses were based on the ICD-9. Data were collected from the Health Ministry registry and, in the patients who could be located, by structured telephone interview. Special attention was directed at the diagnosis of transient adolescent psychosis (TAP) vs. schizophrenia and prognostic indicators of suicide. The results showed that the most stable diagnosis was anxiety disorder. The stability of the different diagnoses over time was greater between the second and last admission than between the first and last (for patients with three or more admissions). Number of hospitalizations correlated negatively with prognosis. TAP at second admission was an unstable diagnosis; 66% of these patients had a final diagnosis of schizophrenia. However, patients with a diagnosis of TAP at first admission had a higher predictive index score and a higher outcome score than schizophrenic patients. TAP appeared to be a valid diagnostic entity, distinguishable from schizophrenia in course, frequency of suicidal behaviour and social-occupational outcome. Suicide victims had a higher cumulative length of stay than age- and sex-matched non-suicidal patients. Fifty per cent of the suicide victims had a final diagnosis of schizophrenia, compared to 30 per cent for the whole sample. In conclusion, these findings indicate that TAP is associated with a relatively good prognosis and should probably be differentiated from schizophrenia. Further retrospective and prospective studies of adolescent psychiatric inpatients may help delineate the nature and course of psychosis and other psychopathology in this age group.     

Behaviour Management Problems as Predictors of Psychotropic Medication and Use of Psychiatric Services in Adults with Autism

We examined behaviour management problems as predictors of psychotropic medication, use of psychiatric consultation and in-patient admission in a group of 66 adults with pervasive developmental disorder (PDD) and intellectual disability (ID) and 99 controls matched in age, gender and level of ID. Overall, people with PDD had higher rates of most DAS behaviour problems and more frequent use of anti-psychotics than matched controls. Logistic regression analyses showed that physical aggression and problems such as pestering staff independently predicted use of anti-psychotics. Physical aggression and overactivity predicted further involvement of psychiatric services. PDD diagnosis predicted admission to an in-patient unit. The results suggest that externalizing problem behaviours in adults with autism can predict type of treatment intervention.     

Suicide and hospitalization for mental disorders in Sweden: A population-based case-control study

The aim of this study was to estimate suicide risk during hospitalization and in the year following discharge for patients with mental disorders.All suicide cases in Sweden 18 years and older, between 1991 and 2003 (N = 20,675; 70% male), were individually matched to 10 controls from the general Swedish population. Discharge diagnoses in the year before suicide of any mental disorder, mood disorder, schizophrenia spectrum disorder, and alcohol use disorder were identified from the Swedish Patient Register.Highest suicide risk during hospitalization and in the year following discharge was found for mood disorder [odds ratio (OR) 55 (95% CI, 47-65) for men and 86 (95% CI, 70-107) for women], with the risk peaking in the first week following discharge [OR 177 (95% CI, 78-401) for men and OR 268 (95% CI, 85-846) for women]. Compared to that for mood disorder, the suicide risk for schizophrenia spectrum disorder and alcohol use disorder was about half and more constant over time. The majority of suicide victims with a psychiatric diagnosis had been discharged from psychiatric treatment more than a month before the suicide. Over time, a constant proportion of 25% of the suicide victims had been hospitalized with a mental disorder in the year before suicide (23% of males and 31% of females), despite a significant decrease in psychiatric hospitalizations in the population.In conclusion, suicide risk was found to vary by type of mental disorder, time since discharge, and sex. This should be taken into account when planning suicide preventive efforts.     

Physical health and mental disorder in elderly suicide: a case-control study

The psychological autopsy method was used to study 95 cases of suicide. Ninety-five comparison subjects matched for gender, age, region, and date of death were selected from the death register. This study showed that suicide cases did not differ from controls with regard to the number of chronic health problems and, compared to the suicide cases, the controls had less functional autonomy six months prior to death. If minor and sub-threshold depression cases were included, 74.7% of the suicide cases would have been considered as having a mental health disorder compared to 12.6% in the control group. When the effect of other co-variables were controlled for, multivariate analysis showed that suicide cases and controls did not differ according to marital status, education, income, and living arrangement. Furthermore, suicide cases were no more likely than controls to seldom meet with family members or friends or to have been isolated during the six-month period preceding their death. Our findings suggest that detection of psychiatric disorders, mainly depression, must be included in late life suicide prevention strategies.     

Brain gamma-aminobutyrate transaminase and monoamine oxidase activities in suicide victims

Summary The activity of gamma-aminobutyrate aminotransferase (GABA-T) and monoamine oxidase (MAOA and-B) was measured in 42 postmortem human brains. Three brain regions (frontal cortex, cingulate cortex and hypothalamus) from 23 controls without known neurological or psychiatric disorder and from 19 suicide victims were analysed. The suicide victims were classified according to the use of violent and non-violent methods and to the presence or absence of a known history of depressive disorder. No difference was found between the series of suicide victims and the control subjects with regard to GABA-T activity. Carbon monoxide poisoning and death by drug overdose, however, were found to reduce the activity. The MAO-B activity did not differ between the groups. With MAO-A, however, a significant elevation (t=2.01;P<0.05) was found in the hypothalamic region of the suicide victims. The difference seemed to be confined to the subgroup of suicides with a record of depressive disorder.     

Increased tryptophan hydroxylase immunoreactivity in the dorsal raphe nucleus of alcohol-dependent, depressed suicide subjects is restricted to the dorsal subnucleus

Considerable evidence suggests that alcoholics with co-occurring depressive disorder are at greater risk for developing psychosocial problems particularly suicidal behavior. Moreover, dysfunction in serotonin (5-HT) neurotransmission has been implicated in depression, suicide and alcoholism. In the present study, we measured the levels of tryptophan hydroxylase (TPH), the main synthetic enzyme of 5-HT synthesis, in specific nuclei of the dorsal raphe (DR) in depressed suicide victims with alcohol dependence and matched psychiatrically normal controls. TPH immunoreactivity (IR) was quantified in frozen tissue sections containing the DR from 8 suicide victims with a diagnosis of major depression and alcohol dependence, and 8 psychiatrically normal control subjects by using immunoautoradiographic methods. We found that the levels of TPH-IR were significantly increased by 46% in the dorsal subnucleus of the DR in depressed suicide victims with alcohol dependence when compared with controls. In contrast, TPH-IR levels did not significantly differ in the other DR subnuclei between depressed, alcoholic suicide subjects, and controls. Our results indicate that abnormalities in 5-HT biosynthesis in the brain of depressed alcoholic suicide subjects are restricted within distinct regions of the DR.     

Suicide among adolescents

BACKGROUND: The suicide rate among young males in Belgium has doubled over the last decade. As more knowledge about risk factors is required to develop national prevention strategies, we investigated adolescent suicides using the psychological autopsy method. METHODS: A total of 32 informants were interviewed regarding 19 suicide cases (aged 15-19). A semi-structured interview schedule, constructed by Houston et al. (J Affect Disord 63:159-170, 2001), was used. RESULTS: All adolescents were suffering from one or more mental disorder(s) at the time of their death, and almost half of them were diagnosed with personality disorders. Adjustment disorders were diagnosed in one fifth of the sample, which appears to be relevant in view of the multiple life events and other psychosocial problems which adolescents were facing shortly before death. This suggests that difficulties in coping with stressful psychosocial problems are important in the course of the suicidal process. Only a small minority was receiving treatment for their disorders. CONCLUSIONS: Mental disorders, commonly untreated and combined with personality disorders and psychosocial problems, are frequently found in young suicide victims. This study suggests that education in the diagnosis and treatment of depression, adjustment disorders and suicide is important in the prevention of suicide.     

Service Use and Unmet Needs in Youth Suicide: A Study of Trajectories

Objective:

While 90% of suicide victims have suffered from mental health disorders, less than one-half are in contact with a mental health professional in the year preceding their death. Service use in the last year of life of young suicide victims and control subjects was studied in Quebec. We wanted to determine what kinds of health care services were needed and if they were actually received by suicide victims.

Method:

We recruited 67 consecutive suicide victims and 56 matched living control subjects (aged 25 years and younger). We evaluated subjects’ psychopathological profile and determined which services would have been indicated by conducting a needs assessment. We then compared this with what services were actually received.

Results:

Suicide victims were more likely than living control subjects to have a psychiatric diagnosis. They were most in need of services to address substance use disorder, depression, interpersonal distress, and suicide-related problems. There were significant deficits in the domains of coordination and continuity of care, mental health promotion and training, and governance.

Conclusions:

Our results show that we need to urgently take action to address these identified deficits to prevent further loss of life in our young people.     

What happens to medical patients with psychiatric disorder?

Medical, psychiatric and social outcome were examined in medical in-patients previously identified as suffering from psychiatric disorder. One third of patients with an affective (emotional) disorder on admission were still psychiatrically ill four months after discharge. Persistent disorder was associated with continuing physical illness. During the year following admission those with affective disorder on admission continued to make greater demands on medical, social and psychiatric services than matched controls and had double the mortality rate (not significant). Patients with organic mental states on admission had a high mortality and morbidity, and made considerable continuing use of general hospital social and psychiatric services. Improved recognition of psychiatric disorder during hospital admission could result in better overall care of medical patients' psychiatric and social difficulties and more effective use of medical resources.     

Risk factors for suicide: a questionnaire survey by psychiatrists in Fukuoka Prefecture]

In our previous study, we demonstrated a preliminary questionnaire survey to psychiatrists from university hospitals, psychiatric hospitals, psychiatric clinics, and departments of psychiatry in general hospitals in Fukuoka Prefecture. In that study, 324 psychiatric patients who committed suicide between January 1, 1998 and December 31, 2001 were ascertained. In the present study, we have recruited matched control patients from the same clinics/hospitals and further demonstrated a secondary questionnaire survey to the psychiatrists in order to reveal the various risk factors for suicide suggested by the literature. Associations between completed suicide and possible risk factors were examined in 192 completed suicide psychiatric patients and 356 non-suicidal psychiatric patients (controls). Significant association was found for history of admission to psychiatric hospitals, history of suicide attempts, history of substance abuse, cluster B personality disorders, and hopelessness in our sample. In male samples, history of suicide attempts, cluster B personality disorders, recent loss, and hopelessness were significantly associated with suicide. In females, history of admission to psychiatric hospitals, history of suicide attempts, and hopelessness were significant.     

A case control study on psychopharmacotherapy before suicide committed by 61 psychiatric inpatients

OBJECTIVE AND METHOD: The pharmacotherapy of 61 suicide victims (0.24 % of 27,078 admissions from January 1, 1980 to December 31, 1999) was compared to that of a control group matched for age, gender and diagnosis at the time of discharge. RESULTS: Both groups were also comparable regarding stay in hospital, history of psychiatric disease, and frequency of hospitalisations during the year preceding the index evaluation. Multiple but not single suicide attempts were significantly more frequent in patients who were later to complete the suicide than in controls. Schizophrenia (ICD-9, ICD-10) was the most frequent diagnosis among suicide victims (44.3 %). Affective psychosis (ICD-9, ICD-10) bore the highest relative risk (0.8 %). 50 % of the schizophrenic patients in the suicide group had been continuously treated with full-dose tricyclic antidepressants. The CPZ-equivalents in the patients treated with antipsychotics were not of discriminating value. Four of 27 schizophrenic patients in the suicide group had been off neuroleptics for ten days or more; this was never observed among the controls. Lorazepam applied in 40% of the schizophrenic and in 25 % of the affective psychosis suicide victims had more often been withdrawn or reduced during the ten days preceding suicide than among controls. No schizophrenic suicide victims but five controls had been on mood stabilisers. The use of antipsychotics (classical and atypical) and a recent change in tricyclic drug or drug dose were more frequent in suicide victims with affective psychosis. Lithium had been given to one patient, but it had also been administered to six controls; this difference is significant. CONCLUSION: Mood stabilisers, especially lithium, should be considered more often in patients with previous suicide attempt(s). When changing antidepressants in affective psychosis, benzodiazepines might be given more deliberate consideration. Patients in all diagnostic categories should be closely guided by means of intensified psychotherapeutic interventions while undergoing a benzodiazepine reduction. The treatment of patients suffering from schizophrenia with full-dose tricyclic regimens should be considered as possibly enhancing the acute suicide risk in some individuals.     

Comparison of psychiatric inpatient suicides with suicides completed in the surrounding community

We compared main characteristics of 58 (22 male and 36 female) psychiatric inpatients that committed suicide in the psychiatric hospital with all 1261 suicides (956 male and 305 female) that occurred outside hospitals in the same health district of Slovenia, all these in the period between 1985 and 1993. The independent t-test and cross-tabulation were used to compare the two groups on age, sex, marital status and suicide method profile. It appeared that female suicide is much more frequent in the psychiatric inpatients' group than in others. Only male psychiatric inpatients' suicides are younger than other suicide victims. Psychiatric inpatients use methods like jumping from high places and drowning more often than do others, which goes in line with the availability of methods of suicide. Apparently, the studied hospital has some wards on the third floor and majority of acute wards are located by the river. However, psychiatric inpatients do not differ from other suicide victims on marital status. Higher suicide rates in men compared with women in the population, but not in psychiatric inpatients, could be explained by the presence of so-called atypical, clinically unrecognized depression in the male population.     

Risk of suicide according to level of psychiatric treatment: a nationwide nested case–control study

Purpose

Knowledge of the epidemiology of suicide is a necessary prerequisite of suicide prevention. We aimed to conduct a nationwide study investigating suicide risk in relation to level of psychiatric treatment.

Methods

Nationwide nested case–control study comparing individuals who died from suicide between 1996 and 2009 to age-, sex-, and year-matched controls. Psychiatric treatment in the previous year was graded as “no treatment,” “medicated,” “outpatient contact,” “psychiatric emergency room contact,” or “admitted to psychiatric hospital.”

Results

There were 2,429 cases and 50,323 controls. Compared with people who had not received any psychiatric treatment in the preceding year, the adjusted rate ratio (95 % confidence interval) for suicide was 5.8 (5.2–6.6) for people receiving only psychiatric medication, 8.2 (6.1–11.0) for people with at most psychiatric outpatient contact, 27.9 (19.5–40.0) for people with at most psychiatric emergency room contacts, and 44.3 (36.1–54.4) for people who had been admitted to a psychiatric hospital. The gradient was steeper for married or cohabiting people, those with higher socioeconomic position, and possibly those without a history of attempted suicide.

Conclusions

Psychiatric admission in the preceding year was highly associated with risk of dying from suicide. Furthermore, even individuals who have been in contact with psychiatric treatment but who have not been admitted are at highly increased risk of suicide.     

Domestic Violence Victims in Shelters: What Do We Know About Their Mental Health?

In this study, the relationship between mental disorders, childhood trauma and sociodemographic characteristics was evaulated in women staying in shelters due to domestic violence. The study comprised 59 volunteers, staying in women’s shelters in Istanbul due to domestic violence. The structured clinical interview for DSM-IV TR axis 1 disorders (SCID-I), Domestic Violence Data Form, Hamilton Rating Scale for Depression, Beck Anxiety Inventory and Childhood Trauma Questionnaire were applied by a psychiatric expert in face-to-face interviews. Of the cases 76.3% were diagnosed with at least one psychiatric disorder. Post traumatic stress disorder was the most common diagnosis (50.8%). In our study 59% of women had attempted suicide at least once, and 66% of these were found to have attempted suicide after violence started. Previous psychiatric diagnosis and exposure to childhood abuse were observed to be risk factors for suicide attempts. Psychiatric disease comorbidities and suicide attempt were identified at high rates in women exposed to domestic violence.     

Suicide among psychiatric patients: a case-control study

OBJECTIVE: To examine patient- and treatment-based differences between psychiatric patients who do and do not die by suicide. METHOD: By linking databases of deaths and psychiatric service use in Victoria, we compared 597 cases who suicided over 5 years with individually matched controls. RESULTS: Cases and controls could not be distinguished on the majority of patient- or treatment-based characteristics. The exceptions were that cases were more likely to be male, less likely to be outside the labour force, more likely to have recent contact with inpatient and community services, and more likely to have a registration as their last contact. CONCLUSION: Patients who suicide 'look' similar to those who do not, suggesting prevention approaches should ensure that all psychiatric patients receive optimal care, including appropriate detection, diagnosis, assessment and treatment of mental health problems, and careful, individualised assessment of suicide risk.     

Survival time after last hospitalization among suicide victims in northern Finland

Psychiatric patients exhibit increased suicide risk shortly after hospitalization, but little is known about patients who are discharged after treatment for physical illness. Information on all suicides over a period of 13 years in northern Finland as well as information from hospital registers were used to examine the interval between the last hospitalization and the suicide. On the basis of discharge diagnoses of physical or psychiatric illnesses, three groups were distinguished. Among victims with psychiatric disorders, survival time was shorter than among those without such a history, even if the last admission was for a physical condition. Clinicians should note the putative suicide risk among somatic patients at discharge, especially among those with a psychiatric history.     

Suicide in doctors. A psychological autopsy study

OBJECTIVES: Doctors are at higher risk of suicide than many other occupational groups. This study was conducted to investigate factors associated with suicide in doctors. METHOD: Psychological autopsy study of 38 working doctors who died by suicide in England and Wales between January 1991 and December 1993. RESULTS: Psychiatric illness was present in 25 of the doctors. Depressive illness and drug or alcohol abuse were the most common diagnoses. Twenty-five doctors had significant problems related to work, 14 had relationship problems and 10 had financial problems. Multiple and interrelated problems were often present. The most common method of suicide was self-poisoning, often with drugs taken from work. CONCLUSION: Prevention of suicide in doctors requires a range of strategies, including improved management of psychiatric disorder, measures to reduce occupational stress and restriction of access to means of suicide when doctors are depressed.     

Comparison of psychiatric inpatient suicides with suicides completed in the surrounding community

We compared main characteristics of 58 (22 male and 36 female) psychiatric inpatients that committed suicide in the psychiatric hospital with all 1261 suicides (956 male and 305 female) that occurred outside hospitals in the same health district of Slovenia, all these in the period between 1985 and 1993. The independent t -test and cross-tabulation were used to compare the two groups on age, sex, marital status and suicide method profile. It appeared that female suicide is much more frequent in the psychiatric inpatients' group than in others. Only male psychiatric inpatients' suicides are younger than other suicide victims. Psychiatric inpatients use methods like jumping from high places and drowning more often than do others, which goes in line with the availability of methods of suicide. Apparently, the studied hospital has some wards on the third floor and majority of acute wards are located by the river. However, psychiatric inpatients do not differ from other suicide victims on marital status. Higher suicide rates in men compared with women in the population, but not in psychiatric inpatients, could be explained by the presence of so-called atypical, clinically unrecognized depression in the male population.     

Suicide means used by Chinese rural youths: a comparison between those with and without mental disorders

Reports on Chinese rural youth suicide indicated patterns different from those of the West. Only about 30% to 70% young victims had had diagnoses of psychiatric illnesses (Phillips et al., Lancet 359:835-840, 2002; Xiao et al., Chin J Psychiatry 36:129-131, 2003), and more than 60% of them used pesticides as suicide means (Wang et al., Lancet 372:1765-1773, 2008). To prevent suicides in rural China, it is important to know the choice of means by Chinese young suicide victims with and without mental disorders. Data on suicide cases in China's rural areas gathered from a big psychological autopsy study were studied for demographic characteristics, suicide methods, and the presence of mental disorders. The findings in the suicide victims with and without mental disorders showed significant differences in suicide method selecting. Victims with mental disorders tended to select violent methods compared with those without mental disorders (31.4% vs. 16.2%). Hanging is method more likely chosen by the mentally disordered victims (13.3%) than those without a mental disorder (7.8%). Mental status affects the means choice among the Chinese rural young suicide victims. Among them, the female victims without mental disorders tended to act on impulsivity and used nonviolent means such as pesticide consumption for suicide. This study informs suicide prevention measures in both China and rest of the world.