农村未遂自杀者的再自杀意念及相关因素研究

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

Substance use disorders and suicide attempts in bipolar subtypes

Bipolar disorder (BD) is associated with high rates of suicide attempt and completion. Substance use disorders (SUD) have been identified as potent risk factors for suicidal behavior in BD. However, little is known concerning differences between BD subtypes with regard to SUD as a risk factor for suicidal behavior. We studied previous suicidal behavior in adults with a major depressive episode in context of BD type I (BD-I; N = 96) or BD type II (BD-II; N = 42), with and without history of SUD. Logistic regressions assessed the association between SUD and suicide attempt history by BD type, and exploratory analyses examined the effects of other clinical characteristics on these relationships. SUD were associated with suicide attempt in BD-I but not BD-II, an effect not attributable to sample size differences. The higher suicide attempt rate associated with alcoholism in BD-I was mostly explained by higher aggression scores, and earlier age of BD onset increased the likelihood that alcohol use disorder would be associated with suicide attempt(s). The higher suicide attempt rate associated with other drug use disorders in BD-I was collectively explained by higher impulsivity, hostility, and aggression scores. The presence of both alcohol and drug use disorders increased odds of a history of suicide attempt in a multiplicative fashion: 97% of BD-I who had both co-morbid drug and alcohol use disorders had made a suicide attempt. A critical next question is how to target SUD and aggressive traits for prevention of suicidal behavior in BD-I.     

Cannabis use disorder and suicide attempts in Iraq/Afghanistan-era veterans

The objective of the present research was to examine the association between lifetime cannabis use disorder (CUD), current suicidal ideation, and lifetime history of suicide attempts in a large and diverse sample of Iraq/Afghanistan-era veterans (N = 3233) using a battery of well-validated instruments. As expected, CUD was associated with both current suicidal ideation (OR = 1.683, p = 0.008) and lifetime suicide attempts (OR = 2.306, p < 0.0001), even after accounting for the effects of sex, posttraumatic stress disorder, depression, alcohol use disorder, non-cannabis drug use disorder, history of childhood sexual abuse, and combat exposure. Thus, the findings from the present study suggest that CUD may be a unique predictor of suicide attempts among Iraq/Afghanistan-era veterans; however, a significant limitation of the present study was its cross-sectional design. Prospective research aimed at understanding the complex relationship between CUD, mental health problems, and suicidal behavior among veterans is clearly needed at the present time.     

Association between anxiety disorders and substance use disorders among young persons: results of a 21-year longitudinal study

OBJECTIVE: To examine the linkages between anxiety disorders and the development of substance use disorders in a birth cohort of young people studied to young adulthood. METHOD: Data were gathered over the course of a longitudinal study of a birth cohort of over 1000 New Zealand born young people. Over the course of the study, data were gathered on: (a) anxiety disorders and substance use disorders at ages 16-18 and 18-21; (b) a range of potential confounding factors including measures of childhood, social, and family factors. RESULTS: Young people with anxiety disorders had odds of substance dependence that were between 1.3 and 3.9 times higher than young people without anxiety disorders. These associations were largely explained by a series of covariate factors relating to: (a) childhood and family factors; (b) prior substance dependence; (c) comorbid depression; (d) peer affiliations. After adjustment for these factors, anxiety disorder was unrelated to all measures of substance use. CONCLUSIONS: Young people with anxiety disorders are at increased risk of substance dependence. However, this association appears to be largely or wholly non causal and reflects the associations between childhood factors, prior substance dependence, comorbid depression, peer affiliations and the development of anxiety disorders.     

自杀未遂者出院后再次出现自杀行为的6年随访

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

自杀未遂者的临床及心理特征

目的 探讨自杀未遂者的临床特征及心理特征.方法 采用自编一般情况调查表、自杀行为调查表、抑郁症调查表收集人口学资料和病史资料,艾森克个性测验、汉密尔顿抑郁量表、自杀意念自评量表、自杀态度问卷进行调查评分,分析临床特征及心理特征.结果 (1)自杀未遂者主要自杀方式依次为过量服药、割腕、溺水、自缢;(2)两自杀组内外向标准分低于正常对照组(F=22.673,P＜0.001),神经质标准分高于正常对照组(F=6.276,P＜0.05),神经质维度与自杀意念呈正相关(rB=0.517,PB =0.012;rD =0.551,PD =0.002);(3)两自杀组自杀意念总分(F=42.987,P＜0.001)、绝望因子(F=45.647,P＜0.001)高于两对照组;(4)两自杀组自杀态度的四个维度(F1、F2、F3、F4)均分低于正常对照组(F1 =28.149,F2=32.191,F3=16.467,F4=40.412,P＜0.001).结论 神经质维度、绝望感、自杀意念、自杀态度是自杀的重要预测因子,自杀行为可以独立于抑郁症而存在,或者伴有显著的抑郁.     

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.     

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

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

Socio-demographic and clinical correlates of lifetime suicide attempts and their impact on quality of life in Chinese schizophrenia patients

This study determines the socio-demographic and clinical correlates of suicide attempts in Chinese schizophrenia outpatients and their impact on patients' quality of life (QOL). Two hundred and fifty-five clinically stable schizophrenia outpatients were randomly selected in Hong Kong (HK) and their counterparts matched according to sex, age, age at onset and length of illness were recruited in Beijing (BJ). All subjects at both sites were interviewed by the same investigator using standardized assessment instruments. Basic socio-demographic and clinical data and history of suicide attempts were collected. The lifetime prevalence of suicide attempts was 26.7% in the whole sample and 20% and 33.6% in the HK and BJ samples, respectively. Patients with a history of suicide attempts were less likely to receive depot antipsychotic (AP) medication, more likely to receive clozapine, benzodiazepines (BZD) and higher doses of APs; were younger at onset, had more hospitalizations; had more severe positive, depressive, anxiety and extrapyramidal (EPS) symptoms; were poorer QOL in the physical, psychological, social and environmental domains; and were more likely to be BJ residents. In multiple logistic regression analysis, early age at onset, poor physical QOL, use of clozapine and BZDs, and study site (HK vs BJ) were significant contributors to lifetime suicide attempts. Significant difference was found between matched samples in HK and BJ with respect to suicide attempts. HK is a cosmopolitan city with a Western social structure and mental health system, whereas in BJ more traditional Chinese cultural values predominate, with a mental health policy radically different from that of HK. These differences suggest that socio-cultural factors play a significant role in determining suicide attempts in schizophrenia.     

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

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

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.     

Risk factors for suicide in epilepsy: a case control study

PURPOSE: Suicide is considered to be one of the most important causes of death contributing to the increased mortality of persons with epilepsy. We investigated the association between the risk of suicide in persons with epilepsy and clinical factors that might increase or have been suggested to increase the risk of suicide. METHODS: A case-control study was nested within a cohort of 6,880 patients registered in the Stockholm County In-Patient Register with a diagnosis of epilepsy. The study population was followed up through the National Cause of Death Register. Twenty-six cases of suicide, 23 cases of suspected but not proven suicide, and 171 controls, living epilepsy patients, were selected from the cohort. Clinical data were collected through medical record review. RESULTS: There was a ninefold increase in risk of suicide with mental illness and a 10-fold increase in relative risk (RR) with the use of antipsychotic drugs. The estimated RR of suicide was 16.0 [95% confidence interval (CI), 4.4-58.3] for onset of epilepsy at younger than 18 years, compared with onset after 29 years. The risk of suicide seemed to increase with high seizure frequency and antiepileptic drug (AED) polytherapy, although the estimates were imprecise and the associations not statistically significant. Insufficient data on seizure frequency and changes in AED dosage due to incomplete case records were associated with high RRs. We found no association between risk of suicide and any particular AED, with type of epilepsy, or localization or lateralization of epileptogenic focus on EEG [RR = 0.3 (95% CI, 0.1-1.7)]. CONCLUSIONS: The profile of the epilepsy patient who commits suicide that emerges from our study is a patient with early onset (particularly onset during adolescence) but not necessarily severe epilepsy, psychiatric illness, and perhaps inadequate neurologic follow-up. Previous reports of an association with temporal lobe epilepsy could not be confirmed.     

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

Background

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

Aim

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

Methods

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

Results

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

Discussion

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

一所综合医院七年间因自杀急诊者的临床特征分析

目的　探讨在北京大型综合医院急诊科抢救自杀者的特征及其动态分布。方法　对 1995～ 2 0 0 1年一所综合医院急诊室登记表中诊断为自杀的患者 ,按自编回顾性调查表进行筛查并记录其特征。结果　 7年间共有15 34例自杀患者 ,占急诊室就诊人数的 2 94‰ ,未见逐年上升或下降的趋势 ;女性明显多于男性 (男∶女 =1∶2 6 ) ;年龄以青壮年为主 ,平均 ( 33 3± 15 1)岁 ;90 3%的自杀方式是服毒 ( 75 6 %使用治疗性药 ) ;17例 ( 1 1% )自杀死亡 ;春、夏季自杀患者高于秋、冬季 ;多数在晚 6～ 12时急诊 ,80 4 %在院抢救治疗时间少于 1天。结论　自杀已成为综合医院急诊患者中常见的致命问题 ,在急诊工作中应采取相应的治疗及心理干预措施     

抑郁症未遂自杀及相关因素研究

对１４０例抑郁症患者的未遂自杀及相关因素进行研究，发现未遂自杀发生率为３４．２９％。与对照组相比，发生未遂自杀的４８例有以下特点：年龄较大、多有阳性家族史、个人经济收入较低，发病多有诱因、多为急性起病、ＨＡＭＤ睡眠障碍和绝望感因子分较高、迟缓因子分较低、多为单相抑郁症。逐步回归分析发现，影响未遂自杀的因素主要为ＨＡＭＤ睡眠障碍、绝望感、迟缓因子分。     

Impulsivity and borderline personality as risk factors for suicide attempts among opioid-dependent individuals

The study aimed to examine the association of impulsivity and screening positively for borderline personality disorder (BPD+) as risk factors for suicide attempts among opioid-dependent individuals. The study used a case-control design with 775 opioid-dependent cases and 306 non-opioid-dependent controls. Cases were more likely than controls to screen BPD+ and to be classed as highly impulsive. Significant risk for lifetime suicide attempt was associated with screening BPD+ and also with high impulsivity. A number of risk factors were identified for suicide attempts among those with either high impulsivity or among those who screened BPD+: being female, a diagnosis of an anxiety disorder and a diagnosis of illicit drug dependence (other than opioid dependence). Opioid dependence was not a unique risk factor for suicide attempts among either the BPD+ group or the high impulsivity group. Although opioid dependence was not a unique risk factor for suicide attempts among those who screened BPD+, cases presented with multiple risk factors at substantially higher rates than controls. This research also highlights the importance of assessing impulsivity, in both clinical settings and research, particularly among those with a history of suicidal behaviour.     

Suicide and suicide attempts in adolescent-onset psychotic disorders

Eighty-eight subjects with adolescent-onset psychotic disorders (mean age±standard deviation 15.7±1.5?years), mainly schizophrenia and affective disorders, were followed up 10.6±3.6?years later, rediagnosed (DSM-IV) and assessed with the Positive and Negative Symptom Scale, abuse of drugs including nicotine, the Lancashire Quality of Life Profile and occurrence of suicide or suicide attempts. Four males (4.5% of subjects) had died from suicide while another 25% of the subjects had attempted suicide. Suicide attempts were associated to more depressive symptoms but fewer negative symptoms at first episode, and to number of admissions and to dependence on nicotine at follow-up in a logistic regression. Satisfaction with religion, health, family relations and safety at follow-up were inversely associated to attempting suicide but only satisfaction with religious belief remained after controlling for concurrent symptoms of anxiety and depression.     

A 5-year follow-up study of suicide attempts

Johnsson Fridell E, Öjehagen A, Träskman-Bendz L. A 5-year follow-up study of suicide attempts. Acta Psychiatr Scand 1996: 93: 151–157. Q Munksgaard 1996. Seventy-five patients were admitted to the ward of the Lund Suicide Research Center following a suicide attempt. After 5 years, the patients were followed up by a personal semistructured interview covering sociodemographic, psychosocial and psychiatric areas. Ten patients (13%) had committed suicide during the follow-up period, the majority within 2 years. They tended to be older at the index attempt admission, and most of them had a mood disorder in comparison with the others. Two patients had died from somatic diseases. Forty-two patients were interviewed, of whom 17 (40%) had reattempted during the follow-up period, most of them within 3 years. Predictors for reattempt were young age, personality disorder, parents having received treatment for psychiatric disorder, and a poor social network. At the index attempt, none of the reattempters had diagnoses of adjustment disorders or anxiety disorders. At follow-up, reattempters had more psychiatric symptoms (SCL-90), and their overall functioning (GAF) was poor compared to those who did not reattempt. All of the reattempters had had long-lasting treatment (> 3 years) as compared to 56% of the others. It is of great clinical importance to focus on treatment strategies for the vulnerable subgroup of self-destructive reattempters.     

Recent medical service utilization and health conditions associated with a history of suicide attempts

Objectives

Suicide is a leading cause of death; unfortunately most individuals at risk for suicide are not identified, assessed or treated by the mental health system. Investigating medical healthcare utilization among individuals with a history of suicide attempt may identify alternative settings for case finding and brief intervention.

Methods

The study sample (n= 1422, 58% female, 72% African-American) is from a prospective cohort of adults (27–31 years) who participated in a randomized trial of school-based interventions. Logistic regression evaluated the relationship between lifetime history of suicide attempt with past year medical service utilization and selected self- reported health conditions, controlling for lifetime Major Depressive Disorder (MDD), demographic factors, health insurance status and employment.

Results

A suicide attempt history was associated with past year emergency department medical visits [aOR 1.51, 95% CI 1.04–2.18, P= .03], but not primary care visits or inpatient hospitalization, when controlling for MDD and other covariates. Severe headaches and chronic gastrointestinal conditions were also associated with lifetime suicide attempt [aOR 1.50, 95% CI 1.03–2.17 and aOR 1.67, 95% CI 1.06–2.63, respectively].

Conclusions

Suicide prevention, including universal screening and brief intervention, is indicated in emergency department settings. Restricting screening to subgroups, such as those individuals presenting with depression, may miss at-risk individuals with somatic concerns.