Sleep and Suicide in Psychiatric Patients

Suicidal patients often report problems with their sleep. Although sleep-related complaints and EEG (electroencephalographic) changes have been seen widely across the spectrum of psychiatric disorders, sleep complaints such as insomnia, hypersomnia, nightmares, and sleep panic attacks are more common in suicidal patients. The subjective quality of sleep as measured by self-rated questionnaires also appears to be more disturbed in suicidal depressive patients. Sleep studies have reported various polysomnographic findings including increased REM (rapid eye movement) time and REM activity in suicidal patients with depression, schizoaffective disorder, and schizophrenia. One mechanism responsible for this possible association between suicide and sleep could be the role of serotonin (5HT). Serotonergic function has been found to be low in patients who attempted and/or completed suicide, particularly those who used violent methods. Aggression dyscontrol appears to be an intervening factor between serotonin and suicide. Additionally, agents that enhance serotonergic transmission decrease suicidal behavior. Serotonin has also been documented to play an important role in onset and maintenance of slow wave sleep and in REM sleep. CSF 5-HIAA levels have been correlated with slow wave sleep in patients with depression as well as schizophrenia. Moreover, 5HT2 receptor antagonists have improved slow wave sleep. Further studies are needed to investigate the possible role of sleep disturbance in suicidal behavior.     

Suicide mortality in mental retardation:a 35-year follow-up study

OBJECTIVE: We investigated suicide mortality among people with mental retardation (MR) over a period of 35 years. METHOD: The nationwide, population-based cohort of 2369 people with MR was followed-up from a representative sample of 9.4% of the population in Finland in 1962. The standardized mortality ratio of suicides was calculated and case studies of all MR suicides based on all available data were performed. RESULTS: Women with MR had an equal suicide risk to Finnish women in general, while men had only one-third of the population risk. Risk factors for suicide were similar to those in the general population. Most suicide victims had mild MR and were hospitalized for comorbid mental disorders. Suicide methods were passive and alcohol was involved in only one case. CONCLUSION: Suicide mortality in MR is significantly lowered among males. Suicide prevention in MR should be focused on people with comorbid mental disorders. Problems in adjustment to new circumstances need to be recognized. Appropriate and adequate treatment of comorbid depression is emphasized.     

Correlates of Nonsuicidal Self-Injury and Suicide Attempts Among Tertiary Care,Emergency Department Patients

Objective:

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the distinction between nonsuicidal self-injury (NSSI) and suicidal behaviour disorder is highlighted in the section Conditions for Further Study. Diagnostic criteria classify NSSI and suicidal behaviour disorder as distinct disorders, with the latter including suicide attempt (SA). This study examined the prevalence and correlates of NSSI in emergency department (ED) settings and compared them to SA.

Methods:

Data came from adult referrals to psychiatric services in 2 EDs between January 2009 and June 2011 (n = 5336). NSSI was compared with SA, as well as no suicidal behaviour, across a broad range of demographic and diagnostic correlates.

Results:

NSSI was more highly associated with female sex, childhood abuse, anxiety disorders, major depressive disorder (MDD), aggression and impulsivity, age under 45, and substance use disorders (SUDs), compared with presentations without suicidal behaviour. Comparing NSSI and SA, no differences were observed on sex, age, history of child abuse, or presence of anxiety or SUDs. Recent life stressors (OR 1.44; 95% CI 1.05 to 1.99), active suicidal ideation (OR 8.84; 95% CI 5.26 to 14.85), MDD (OR 3.05; 95% CI 2.23 to 4.17), previous psychiatric care or SA (OR 1.89; 95% CI 1.36 to 2.64), and single marital status (OR 1.63; 95% CI 1.20 to 2.22) contributed to a higher SA rate. Among people with NSSI, 83.7% presented only once to an ED. Among people who presented multiple times, only 18.2% re-presented with NSSI.

Conclusions:

NSSI is associated with early life adversity and psychiatric comorbidity. Most people present only once to ED services, and self-harm presentations seemed to change over time. Future studies should continue to clarify whether NSSI and SA have distinct risk profiles.     

精神障碍研究状况的文献计量学分析

目的：探讨国内外精神障碍的研究现状和发展趋势。方法：应用美国生物医学信息检索系统（PubMed）和中国生物医学文献数据库（CBMWeb）,采用主题词检索的方法对国内外发表有关精神障碍的论文进行文献计量学分析。结果：国内外精神障碍的研究构成相似,但国际偏向于治疗而国内更偏向于病因学研究。近10年国际文献呈逐年增长趋势而国内文献增长不稳定。医学研究与社会干预研究对比,国际文献差异无显著性,而国内文献差异显著。结论：我国精神障碍研究应加强对治疗、心理和康复方面的研究,并且需要专业精神障碍研究人员、心理学家和社会学家的共同努力。     

Suicide rates, life satisfaction and happiness as markers for population mental health

Objective To examine the association of variables from survey data on well-being with suicide rates and other markers of population mental health in Europe. Design Ecological study correlating (Spearman’s rank correlation) life satisfaction and happiness (European Values Survey 1999/2000) in 32 countries with suicide rates (WHO Mortality Database), rates of hospital discharge for mental and behavioural disorders and prevalence of mental disorders based on registered mental patients (WHO Regional Office for Europe) and Mental Health Index (MHI)-5 survey data (European Opinion Research Group). Results An inverse association exists between suicide rates and life satisfaction (r=−0.44; 95% CI: −0.68, −0.11) and happiness (r=−0.42; 95% CI: −0.67, −0.08). Similar though weaker associations were seen with hospital discharge data and MHI−5 data but not with the prevalence of mental disorders. The association between suicide rates and life satisfaction was weaker amongst 15–44 year olds (r=−0.31; 95% CI: −0.59, 0.04) than amongst 45–64 year olds (r=−0.47; 95% CI: −0.70, −0.14). It was strongest in the 65+ age group (r=−0.54; 95% CI: −0.75, −0.23). A similar pattern was observed for the association with happiness. In a subgroup analysis, the association between suicide and life satisfaction in Eastern Europe was similar to that in the whole dataset (r=−0.35) but a positive association was seen in Western Europe (r=0.47). Conclusions Life satisfaction and happiness were modestly associated with other indicators of population mental health. Since all such markers have their limitations, surveys of well-being may be useful indicators of population mental health.     

Language of publication of journal articles on suicide and mental disorders

English as the language of publication for articles on suicide in the medical literature increased from 58% of articles in 1966 to 79% in 1986. This increase occurred at the expense of all languages. These changes parallel those for the language of publication of articles on mental disorders and all medical subjects.     

威海市精神疾病流行病学调查

目的：了解威海市≥15岁人群各类精神疾病的患病率和分布特点。方法：2006年9月至2007年2月随机抽取≥15岁人群共50174人,使用心理卫生筛选表、神经症筛选表、精神现状检查（PSE）140题等工具进行调查,以中国精神疾病分类方案与诊断标准第3版为诊断依据。结果：各类精神障碍的时点患病率为70．34‰,终生患病率为89．51‰。排在前3位的为抑郁症（37．49‰）、神经症（30．06‰）和酒依赖（11．38‰）。农村患病率（93．22‰）高于城市（84．30‰）,女性（95．27‰）高于男性（83．82‰）。3种精神疾病均存在较高的未识别率,且农村高于城市。结论：山东威海市精神疾病的患病率以女性和农村较高;抑郁症是威海市患病率最高的精神疾病。     

Suicide and suicide attempts in general hospital psychiatry: Clinical and statistical study

Abstract Thirty-six psychiatric patients with completed suicide, 162 with attempted suicide and 154 patients referred for suicidal behavior, four of whom died, were investigated and classified according to the ICD-10. Thirty-six patients with completed suicide among 9085 new psychiatric patients (1969-92) gave a suicide rate of 82.6/100 000 per year. Schizoaffective and depressive disorder in psychiatric patients with completed suicide and schizophrenia, depressive disorder and adjustment disorders in patients with attempted suicide were significantly more frequent than in 312 controls. Intrafamilial conflicts, divorce or loss of love and death or severe disease of family member were the most common precipitants. Loneliness from living alone in males, losing a spouse and intrafamilial conflicts within a large family of three generations in females were supposed to be risk factors. A high referral rate of 48% in attempted suicide indicated the important role of consultation-liaison psychiatry in emergency medicine.     

Suicide attempts among patients with psychosis in a Chinese rural community

OBJECTIVE: To explore the characteristics of psychotic patients with suicide attempts in a Chinese rural community. METHOD: An epidemiological investigation of psychotic patients with suicide attempts among 123,572 population (over 15 years of age) was conducted in Xinjin County, Chengdu. RESULTS: The rate of suicide attempts was found to be 8.17% among all the psychotic patients (906 cases). Patients with affective psychosis showed a significantly higher rate of suicidal attempts (15.3%) than those with schizophrenia (7.5%) (P < 0.005). Suicide attempts were significantly associated with depression and hopelessness in both schizophrenia and affective psychosis (P < 0.001). Patients with suicide attempts were younger and had an earlier age of onset than those without suicide attempts (P < 0.05). Patients with schizophrenia and affective disorders were the major patients with suicide attempts. CONCLUSION: The rate of suicide attempts in psychotic patients may be largely influenced by the illness itself. Community-based services should be necessary for these patients.     

Suicide attempts and personality disorder

OBJECTIVE: The purpose of the present study was to compare clinical characteristics of suicide attempters with or without personality disorders. METHOD: A systematic sample (n = 114) of patients from consecutive cases of attempted suicide referred to general hospitals in Helsinki was interviewed and diagnosed according to DSM-III-R. Forty-six subjects with DSM-III-R personality disorders were identified and divided into clusters A (n = 4), B (n = 34) and C (n = 8). These subjects were compared with 65 suicide attempters without personality disorders in terms of clinical characteristics and treatment received. RESULTS: Suicide attempters with personality disorders more often had a history of previous suicide attempts and lifetime psychiatric treatment than comparison subjects. However, suicide attempts did not differ in terms of suicide intent, hopelessness, lethality or impulsiveness between subjects with or without personality disorders. CONCLUSION: Although suicidal behaviour is a more persistent feature among those with personality disorders, their clinical characteristics at the time of a suicide attempt may not differ from those without personality disorders.     

Suicide and seasonality

Christodoulou C, Douzenis A, Papadopoulos FC, Papadopoulou A, Bouras G, Gournellis R, Lykouras L. Suicide and seasonality. Objective: Seasonal variation of deaths by suicide offers an important pathway in the study of possible suicide determinants of suicide and consequently suicide prevention. Method: We conducted a review of the literature on suicide seasonality, assessing articles published between 1979 and 2009. Results: The majority of the studies confirm a peak in spring, mainly for men, older individuals, and violent methods of suicide. A secondary peak during autumn is observed. There is no common seasonality pattern for suicide methods. However, there are also certain studies that did not confirm seasonal variation. Inconsistent results with reduced, unchanged, and even increased suicide seasonality have been reported. Aspects on the association between seasonality and suicides are discussed. Except sex, age, and method of suicide, other parameters were taken into account to find more specific characteristics of seasonality in suicides as well. The influence of clinical, bioclimatic, sociodemographic as well as biological factors seems to affect the seasonal variation. Conclusion: Studies from both the Northern and the Southern hemisphere report a seasonal pattern for suicides. These studies are not only an important source of epidemiological data for suicides but also represent a global effort to uncover hidden parameters of this self‐destructive behaviour.     

Prevalence of mental disorders and mental health service use in Japan

A high disease burden of mental disorders has been noted worldwide, including Japan. It is important to monitor mental disorder prevalence trends and the use of mental health services over time using epidemiological data and to plan appropriate policies and measures that consider mental health in each country. This review outlines the prevalence trends of common mental disorders (CMD) and the use of mental health services in Japan from the 2000s to the 2010s and compares them with those in other countries. This review clarifies that the prevalence of CMD in Japan has been relatively stable in the past decade. The 12‐month prevalence of mental health service use has increased about 1.2 times to 1.6 times in the past 10–15 years. Thus, it is very likely that the rise in mental health service use contributes to increased patient numbers. Regarding cross‐national comparison, the prevalence rate of CMD in Japan is much lower compared to rates in the USA and Europe. The 12‐month prevalence of mental health service use was also lower in Japan compared to prevalence rates in other high‐income countries. Mental health epidemiology has clarified that the prevalence of CMD worldwide has remained unchanged, even though mental health service use has increased in high‐income countries. Thus, the gap in treatment quality and prevention should be addressed in the future.     

Universal Adolescent Suicide Screening in a Pediatric Urgent Care Center

The aim of this article is to describe the implementation of a 2-question suicide screening tool in a pediatric urgent care center to identify patients at risk of suicide. Adolescents presenting during a 12-month period completed the screening tool. Positive response to either question triggered further social work evaluation, including a Columbia-Suicide Severity Rating Scale (C-SSRS). Of 4,786 patients screened, 95 (2%) responded positively. Of these, 75 (79%) also had a positive C-SSRS. Only 7 (7%) had chief complaints related to mental health. A group of 78 patients (82%) were discharged with outpatient mental health referral, and 10 (10%) were admitted to a psychiatric facility. Universal adolescent suicide screening in an acute care setting did not significantly affect flow in our pediatric urgent care and was able to detect patients at risk of suicide, especially those with chief complaints unrelated to mental health.     

Satisfaction with primary and specialized mental health care among patients with mental disorders

The purpose of this article is to assess the satisfaction of patients who received primary or specialized mental health care, and to identify variables associated with each level of care. This cross-sectional study included 325 patients with mental disorders (MDs). We used a conceptual framework based on Andersen’s behavioral model, comprising predisposing factors, enabling factors, and needs; socio-demographic, clinical, needs-related, service-use, and quality-of-life variables were integrated into the model. We performed adjusted multiple linear regression models. The mean score on patient satisfaction for primary and specialized care was approximately 4 (range: 3.67–5.0). Regarding enabling factors, better continuity of care and having a case manager were associated with patient satisfaction for both types of care; help received from services and relatives was positively associated with patient satisfaction in primary care, whereas patients on welfare were more likely to be dissatisfied with specialized care. Number of needs was negatively associated with patient satisfaction in primary care and, marginally so, in specialized care. Suicidal ideation was marginally associated with patient dissatisfaction for specialized care only.

Results revealed a high level of patient satisfaction with each type of care, with significant variables related to continuity of care, case management, and needs. The study suggests the critical importance of addressing patient needs comprehensively, and of establishing long-term, individual recovery plans that promote patient satisfaction. Collaboration between relatives of patients and professionals in patient treatment is closely related to satisfaction with primary care. Accounting for the presence of suicidal ideation and patient vulnerability is fundamental to increasing patient satisfaction with specialized care. Increased patient follow-up in the community, work integration, provision of supported housing, and rapid crisis intervention may help improve patient satisfaction with mental health service (MHS) while supporting recovery.     

利培酮治疗老年器质性精神障碍对照研究

目的：比较利培酮与奋乃静治疗老年器质性精神障碍的疗效及不良反应。方法：对116例老年器质性精神障碍患者随机分为两组，分别服用利培酮或奋乃静。疗程6周，于治疗前及治疗第2、4、6周末进行简明精神病评定量表(BPRS)、临床疗效总评量表(CGI)评定疗效，用副反应量表(TESS)评定不良反应。结果：113例患者完成治疗，利培酮与奋乃静的疗效相仿，利培酮不良反应少而轻。结论：利培酮是治疗老年器质性精神障碍的安全有效药物。     

A multinational study of mental disorders, marriage, and divorce

Breslau J, Miller E, Jin R, Sampson NA, Alonso J, Andrade LH, Bromet EJ, de Girolamo G, Demyttenaere K, Fayyad J, Fukao A, Gălăon M, Gureje O, He Y, Hinkov HR, Hu C, Kovess‐Masfety V, Matschinger H, Medina‐Mora ME, Ormel J, Posada‐Villa J, Sagar R, Scott KM, Kessler RC. A multinational study of mental disorders, marriage, and divorce. Objective: Estimate predictive associations of mental disorders with marriage and divorce in a cross‐national sample. Method: Population surveys of mental disorders included assessment of age at first marriage in 19 countries (n = 46 128) and age at first divorce in a subset of 12 countries (n = 30 729). Associations between mental disorders and subsequent marriage and divorce were estimated in discrete time survival models. Results: Fourteen of 18 premarital mental disorders are associated with lower likelihood of ever marrying (odds ratios ranging from 0.6 to 0.9), but these associations vary across ages of marriage. Associations between premarital mental disorders and marriage are generally null for early marriage (age 17 or younger), but negative associations come to predominate at later ages. All 18 mental disorders are positively associated with divorce (odds ratios ranging from 1.2 to 1.8). Three disorders, specific phobia, major depression, and alcohol abuse, are associated with the largest population attributable risk proportions for both marriage and divorce. Conclusion: This evidence adds to research demonstrating adverse effects of mental disorders on life course altering events across a diverse range of socioeconomic and cultural settings. These effects should be included in considerations of public health investments in preventing and treating mental disorders.     

The wishes of outpatients with severe mental disorders to discuss spiritual and religious issues in their psychiatric care

Objective. In a previous multisite comparative study of spiritual and religious coping (S/R) among outpatients with schizophrenia; S/R were adaptive for 80% of patients; harmful for 13%; and marginal for 7%. This importance was underestimated by clinicians. We created an interfaith therapeutic group to address such topics. The aim of the study is to assess patients’ wish to address S/R issues in their psychiatric care. Method. Psychiatrists asked consecutive outpatients about their wish; with who they shared S/R concerns; and their interest to enroll in the “Spiritual and Recovery Group”. Results. Among the 147 patients included less than half shared their spiritual concerns with other people. A quarter wished to address S/R issues in their care; 24/147 already shared those issues with a religious professional; half of them wished also to share them with their psychiatrist. Among the 21 patients who participated in an in-depth spiritual assessment 16 patients were directed to the S/R group and 5 patients were directed to groups addressing other therapeutic objectives. Conclusion. For one patient out of ten, S/R issues were of a clinical significance warranting integration into psychiatric treatment. This study shows that patients’ views are in accordance with former research, putting forward psychiatrists’ stance on this issue.     

Reducing stigma and discrimination against older people with mental disorders: a technical consensus statement

This technical consensus statement is jointly produced by the Old Age Psychiatry section of the World Psychiatric Association and the World Health Organization, with the collaboration of several NGOs and the participation of experts from different Regions.It is intended to be a tool for (i) promoting debate at all levels on the stigmatisation of older people with mental disorders; (ii) outlining the nature, causes and consequences of this stigmatisation; and (iii) promoting and suggesting policies, programmes and actions to combat this stigmatisation.