Suicidal behavior in psychiatric emergency room patients

BACKGROUND: Psychiatric emergency room (ER) patients are thought to be at increased risk of suicide. The prevalence and characteristics of suicidal behavior in a recent sample of patients who came to the ER for psychiatric evaluation were examined. METHODS: Charts of 311 consecutive psychiatric ER patients were reviewed. Suicidal behavior was considered present if current suicidal ideation or attempts within 24 hours of or during the emergency evaluation were noted in the chart. RESULTS: Suicidal behavior was present in 38% of the psychiatric ER patients. Younger age, white race, affective disorders in female patients, and substance abuse disorders in male patients were features of the suicidal group. Sex of the patient was not associated with suicidal behavior. CONCLUSIONS: Suicidal behavior is prevalent in the psychiatric ER. Effective suicide prevention in this setting will hinge on finding more specific risk factors.     

抑郁症患者自杀行为与自杀意念及领悟社会支持相关性研究

目的：探讨抑郁症患者自杀行为与自杀意念、领悟社会支持的相关性。方法选取59例惠爱医院住院的抑郁症患者为研究对象。根据近3个月是否有自杀行为,将患者归入自杀行为组（n＝28）和非自杀行为组（n＝31）;采用自杀意念自评量表、领悟社会支持量表及自编一般资料调查表对两组患者进行评估。结果伴自杀行为组自杀意念较未伴自杀行为组强烈（t＝3．03,P＜0．05）,领悟社会支持度低于未伴自杀行为组（t＝2．99,P＜0．05）。中介效应分析表明,领悟社会支持在自杀意念与自杀行为间发挥完全中介作用,自杀意念会削弱抑郁症患者的领悟社会支持,导致自杀风险增加。结论领悟社会支持在自杀意念与自杀行为间发挥重要中介作用,故在自杀干预中既要丰富社会支持资源和支持方式,又要引导患者主动利用,减少自杀行为的发生。     

单相抑郁症患者自杀行为遗传效应及其遗传方式的研究

背景遗传因素在抑郁症自杀行为的发生中占有一定的地位,以往的关注的重点主要为双相抑郁自杀的遗传效应,单相抑郁症自杀行为的遗传方式和遗传效应有何特征?目的探讨单相抑郁症自杀行为的遗传效应及遗传方式.设计回顾性调查.单位一所市级精神卫生中心.对象单相抑郁症组(n=115)为1983-06-01/2002-05-31无锡市精神卫生中心门诊和住院诊断为抑郁症的患者.诊断均符合中国精神障碍分类与诊断标准第3版抑郁发作及美国精神障碍诊断与统计手册第4版重性抑郁发作标准,且抑郁发作次数≥3次或发作一两次已缓解≥8年者.方法以符合入组标准的单相抑郁症患者为先证者,由2名主治医师及其以上医师对每一家系进行调查,填写自行编制的精神病家系调查表,内容主要包括患者及一级亲属所有成员社会人口学资料、疾病发作特点及次数、以往治疗及自杀情况.由2名主治医师或以上医师对每一患者进行再诊断,并由1名主任医师核查,一致确诊的病例则予入组.对所有现存活的先症者(107例)及一级亲属中有自杀行为者(14例)进行面检;对无自杀行为的一级亲属(337名)进行面检和信函调查(380名);死亡者(患者8例,一级亲属5例)的资料由一两名一级亲属提供有关情况填写调查表.对照组由2名研究者进行面检,同时询问一级亲属情况并填写家系调查表.对所得资料行单因素分析,用多基因阈值理论Falconer模式估算自杀行为的遗传率和标准误,用医学遗传数学方法中分离分析法和多基因阈值理论进行遗传方式的探讨.主要观察指标单相抑郁症患者自杀行为的遗传效应和遗传方式.结果单相抑郁症患者自杀危险性51.30%(59/115)较其一级亲属2.58%(19/736)高(x2=283.16,P＜0.01),单相抑郁症患者一级亲属自杀危险性2.58%(19/736)较对照组0.12%(3/2469)高(x2=50.36,P＜0.01),有自杀行为患者的一级亲属自杀危险性3.8%(14/372)较无自杀行为患者的一级亲属自杀危险性1.4%(5/363)高(x2=4.14,P＜0.05).单相抑郁症自杀行为的加权平均遗传率及标准误为(70.16±0.79)%;多基因遗传方式验证显示,多基因遗传方式验证显示一级亲属自杀行为预期发病率为3.1%,实际发病率为2.6%,两者差异无显著性意义(u=0.766,P＞0.05).结论单相抑郁症自杀行为有明显的遗传效应,其遗传方式符合多基因遗传.     

"The WHO/EURO Multicenter Study of Suicidal Behavior": results of the Austrian research center (in Tyrol) compared with Europe

The article presents findings from the Austrian research center (Hall/the Tyrol) participating in the WHO/EURO Multicentre Study of Suicidal Behaviour compared to the other participating European countries. Between October 1997 and March 1999 a total number of 137 interviews were conducted (70 interviews from the defined catchment area, the city and county of Innsbruck, 67 interviews from other parts of the Tyrol) with psychiatric inpatients admitted due to a parasuicidal act (a non-habitual deliberate self-harm episode). Comparison with the total number of psychiatrically treated parasuicides in Tyrol during the same period of time showed the interviewed sample to be representative of the whole clinical population. It was found that the Austrian sample revealed significantly higher proportions of "hard methods" than the pooled sample from the other participating European centres. A relatively high proportion of deliberate self-harm episodes was found in males. The repetition rate of parasuicides within the first 6 months after the initial parasuicide was very high (14% of the interviewed persons) compared to similar studies. An analysis of psychiatric diagnoses according to ICD-10 showed that more than 50% concerned either affective disorders or psychiatric disorders associated with substance abuse and dependence. The results indicate that the sample constitutes a high risk group for completed suicide.     

Suicidal ideation in outpatients with chronic musculoskeletal pain: an exploratory study of the role of sleep onset insomnia and pain intensity

OBJECTIVES: Sleep disturbance, depression, and heightened risk of suicide are among the most clinically significant sequelae of chronic pain. While sleep disturbance is associated with suicidality in patients with major depression and is a significant independent predictor of completed suicide in psychiatric patients, it is not known whether sleep disturbance is associated with suicidal behavior in chronic pain. This exploratory study evaluates the importance of insomnia in discriminating suicidal ideation in chronic pain relative to depression severity and other pain-related factors. METHODS: Fifty-one outpatients with non-cancer chronic pain were recruited. Subjects completed a pain and sleep survey, the Pittsburgh Sleep Quality Index, the Beck Depression Inventory, and the Multidimensional Pain Inventory. Subjects were classified as "suicidal ideators" or "non-ideators" based on their responses to BDI-Item 9 (Suicide). Bivariate analyses and multivariate discriminant function analyses were conducted. RESULTS: Twenty-four percent reported suicidal ideation (without intent). Suicidal ideators endorsed higher levels of: sleep onset insomnia, pain intensity, medication usage, pain-related interference, affective distress, and depressive symptoms (P < 0.03). These 6 variables were entered into stepwise discriminant function analyses. Two variables predicted group membership: Sleep Onset Insomnia Severity and Pain Intensity, respectively. The discriminant function correctly classified 84.3% of the cases (P < 0.0001). DISCUSSION: Chronic pain patients who self-reported severe and frequent initial insomnia with concomitant daytime dysfunction and high pain intensity were more likely to report passive suicidal ideation, independent from the effects of depression severity. Future research aimed at determining whether sleep disturbance is a modifiable risk factor for suicidal ideation in chronic pain is warranted.     

Stress and knowledge of suicidal others as factors in suicidal behavior of high school adolescents.

The purpose of this study was to explore adolescent beliefs concerning the causes of adolescent suicide and to examine the influence that suicidal others have on adolescents' behavior. The researcher asked the following questions: Do students reporting suicidal behavior and those reporting no suicidal behavior give different causes for suicide? Do males and females give different causes for suicide? Does knowing someone who attempted or committed suicide affect an adolescent's suicidal behavior? The population sample was 473 eleventh- and twelfth-grade students from a suburban public school district near a large metropolitan area in the northeastern United States who completed self-report measures including an open-ended question measuring suicidal causality and a background questionnaire. Data were analyzed using cross-tabulations to compare suicidal and nonsuicidal adolescents. Specific tests included the Fisher's Exact Test (two-tailed) and chi-square. The findings showed that, of the high school students studied, 23% reported self-hurt behavior and 6.7% reported suicide attempts. A theme of "too much pressure" was reported by 40% of the adolescents as a cause of suicide. Males and females reported statistically significant divergent views regarding the causes of adolescent suicide. Other findings showed highly significant differences between the suicidal and nonsuicidal adolescents when they knew someone who attempted or committed suicide. This information suggests that approximately one in three adolescents who report self-hurt behavior may attempt suicide and that counseling needs to address the findings that males and females perceive the causes of suicide differently and therefore may respond to treatment programs differently. The importance of peer identification with others who attempt or commit suicidal acts cannot be underestimated.     

Comparison of suicide notes and parasuicide notes

This archival research, a comparison of suicide notes written by individuals who killed themselves and notes—called parasuicide notes—by individuals who attempted suicide, involved two studies. The first study involved a comparison of eight patterns (comprised of individual protocol sentences): unbearable pain, interpersonal relations, rejection-aggression, inability to adjust, indirect expressions, identification-egression, ego, and cognitive constriction. The second study involved a protocol analysis based on previous reviews that compared completers and attempters. Independent judges scored the notes. No differences in the eight patterns were found. However, protocol differences were noted, namely that attempters see themselves more often as too weak to cope with life's difficulties; attempters see their attempt as a style of life; attempters express greater lack of social integration; and completers see themselves as more immature, passive/aggressive, and/or antisocial. There may be important commonalities between attempters, whose attempts are of moderate to high lethality, and completers. A number of significant limitations exist in the current study warranting some caution in generalizing to all suicides and parasuicides.     

Adult Attachment Orientations,Depressive Symptoms,Anger, and Self-Directed Aggression by Psychiatric Patients

This study applied adult attachment theory to better understand self-directed aggression, defined as suicide attempts and nonsuicidal self-injury, reported by 109 hospitalized psychiatric patients. As expected, patients with higher levels of adult attachment anxiety were more likely to report suicide attempts and self-injury. We tested depressive symptoms and anger as mediators of the relationship between attachment orientations and self-directed aggression. As hypothesized, depressive symptoms partially mediated the relationship between attachment anxiety and self-directed aggression, but unexpectedly, anger did not. The results support that levels of depression partially explain the associations between attachment anxiety and self-directed aggression. Subsidiary analyses suggested that patients with higher levels of adult attachment avoidance were more likely to report histories of nonsuicidal self-injury but not suicide attempts. Implications for research and practice are discussed.     

Situational analysis of attitudes toward suicide behavior

The purpose of the present study was to discern whether there were differences in the attitudes of suicidal ideators and nonideators toward suicide victims in different situations (cancer, AIDS, schizophrenia, and depression). Two hundred twenty-eight college students completed a suicide ideation questionnaire and read one of four scenarios. People in the cancer and AIDS scenarios were viewed as the most physically unhealthy and the most justified in committing suicide. Suicide ideatars saw the people in the scenarios as justified in committing suicide more often than did nonideators.     

Older adults' attitudes toward suicide: are there race and gender differences?

Suicide among older persons in the United States is a major problem that has increased dramatically during the past decade. Little is known about older nonsuicidal adults' attitudes toward suicide. The purpose of this study was to identify attitudes of older persons toward suicide and to explore the relationship of race and gender to attitudes toward suicide. The Suicide Attitude Vignette Experiences for the Elderly (SAVE-L) scale, which consists of 16 vignettes, was used to measure empathy toward suicidal people and agreement with suicidal actions as portrayed in 16 vignettes. The sample consisted of 54 low-income, inner city residents, aged 65 or older. Participants reported a moderate level of empathy with suicidal behavior (M =2.82 on a 5-point scale) and a low level of agreement with suicidal actions (M =1.31 on a 5-point scale). There were no differences in empathy toward suicidal people nor in agreement with suicidal people's actions based on race (African American or White) or gender; nor was there a significant interactional effect of race and gender on attitudes toward suicide.     

双相情感障碍伴自杀行为的流行病学分析

目的分析双相情感障碍伴自杀行为患者的流行病学特征,提高对其诊治水平。方法选取2016年5月至2018年5月洛阳市第五人民医院(太康路院区)精神科收治的186例双相情感障碍患者,年龄(43.15±5.66)岁,年龄范围为23~55岁,对患者流行病学特征进行统计,并通过logistic回归分析与各种危险因素之间的关系。结果根据有无自杀行为将患者分为有自杀行为组(n=96)和无自杀行为组(n=90),两组患者性别、婚姻状况、人际关系、是否为独生子女方面比较,差异无统计学意义(P>0.05);两组患者年龄、吸烟史、精神异常史、饮酒史方面比较,差异有统计学意义(P<0.05)。男性有自杀行为组与男性无自杀行为组患者年龄、婚姻状况、吸烟史、人际关系、是否为独生子方面比较,差异无统计学意义(P>0.05);男性有自杀行为组与男性无自杀行为组患者精神异常史、是否饮酒、家族自杀史、既往自杀史比较,差异有统计学意义(P<0.05)。女性有自杀行为组与女性无自杀行为组患者婚姻状况、人际关系、是否为独生子女方面比较,差异无统计学意义(P>0.05);女性有自杀行为组与女性无自杀行为组患者年龄、吸烟史、精神异常史、饮酒史、家族自杀史、既往自杀史方面比较,差异有统计学意义(P<0.05)。logistic回归分析显示,女性、年龄大、重大精神创伤、既往自杀史与双相情感障碍伴自杀行为均呈正相关。结论女性、年龄大、有重大精神创伤、有自杀家族史、既往自杀史等都可能是双相情感障碍伴自杀行为患者的危险因素临床上应给予高度重视并及早采取干预措施,以免延误最佳治疗时机。     

Religiousness and non-hopeless suicide ideation

Individuals who think about suicide but do not feel suicidally hopeless tend to be less religious and can therefore entertain thoughts of suicide unabated by religiousness. Religiousness, suicide ideation, and hopelessness were surveyed among 279 Idaho college students, 37 (13%) of whom were non-hopeless suicide ideators. A total of only 21 (7%) qualified as ideator/hopeless or non-ideator/hopeless with the remaining 221 (79%) qualifying as non-ideator/non-hopeless. Lower religiousness coinciding with greater ideation supports Durkheim's position that religious social affiliation protects against suicide. The fact that non-hopeless ideators were less religious than all others suggests that religion may provide hope that buffers against suicidal ideas.     

Religiousness and Non-Hopeless Suicide Ideation

Individuals who think about suicide but do not feel suicidally hopeless tend to be less religious and can therefore entertain thoughts of suicide unabated by religiousness. Religiousness, suicide ideation, and hopelessness were surveyed among 279 Idaho college students, 37 (13%) of whom were non-hopeless suicide ideators. A total of only 21 (7%) qualified as ideator/hopeless or non-ideator/hopeless with the remaining 221 (79%) qualifying as non-ideator/non-hopeless. Lower religiousness coinciding with greater ideation supports Durkheim's position that religious social affiliation protects against suicide. The fact that non-hopeless ideators were less religious than all others suggests that religion may provide hope that buffers against suicidal ideas.     

Tolerance for physical pain in suicidal subjects

This study investigated the tolerance for physical pain in suicidal subjects. Suicidal, psychiatric nonsuicidal, and normal young males and females were administered pain measures including electric shocks, appraisal of shocks, and a measure of thermal pain. Additional study variables included diagnosis, past suicide attempts, severity of suicidal intent, and length of hospitalization. Suicidal individuals showed higher tolerance for pain and appraised the pain as less intense than the other groups, regardless of diagnosis, length of hospitalization, and motivation to participate in the study. These findings were explained as a result of dissociative processes inherent in the development of suicidal tendencies and in terms of pain management strategies.     

Brain-derived neurotrophic factor and suicidal behavior

Studies of the neurobiology of suicidal behavior have become an important and integral part of psychiatric research. Over the past several years, studies of the role of brain-derived neurotrophic factor (BDNF) in the pathophysiology of suicidality have attracted significant interest of researchers. Multiple lines of evidence including studies of levels of BDNF in blood cells and plasma of suicidal patients, postmortem brain studies in suicidal subjects with or without depression, and genetic association studies linking BDNF to suicide suggest that suicidal behavior may be associated with a decrease in BDNF functioning. Studies of the BDNF function are important for suicide research and prevention because of the multiple reasons including the following: (i) BDNF plays a role in the pathophysiology of depression, post-traumatic stress disorder, substance use disorders and other conditions associated with suicidal behavior. Treatment-induced enhancements of BDNF can facilitate neural integrity and recovery of function in psychiatric disorders, and consequently prevent suicidal behavior; (ii) abnormal BDNF function may be associated with elevated suicidality independently of psychiatric diagnoses. It is possible that treatment-induced improvement in the BDNF function prevents suicidal behavior independently of improvement in psychiatric disorders; (iii) BDNF may be a biological marker of suicidal behavior in certain patient populations. It is to be hoped that the studies of the neurobiology of suicidal behavior will lead to the development of new methods of suicide prevention.     

Feeling our way in the dark: the psychiatric nursing care of suicidal people--a literature review

Psychiatric/Mental Health nurses have a long history of being front-line carers of suicidal people, and yet the international epidemiological literature, methodological problems notwithstanding, suggests that contemporary care practices for suicidal people have much room for improvement. As a result, this paper focuses on several areas/issues of care of the suicidal person, and in so doing, critiques the extant literature, such as it is. This critique illustrates that there is a disconcerting lack of empirically induced theory to guide practice and even less empirical evidence to support-specific interventions. The paper concludes, accepting the axiomatic complexity and multi-dimensionality of suicide, and the undeniable fact that suicide is a human drama, played out in the everyday lives of people, that for Psychiatric/Mental Health nurses, caring for suicidal people must be an interpersonal endeavor; and one personified by talking and listening.     

Evaluation and treatment of patients with suicidal ideation

Suicidal ideation is more common than completed suicide. Most persons who commit suicide have a psychiatric disorder at the time of death. Because many patients with psychiatric disorders are seen by family physicians and other primary care practitioners rather than by psychiatrists, it is important that these practitioners recognize the signs and symptoms of the psychiatric disorders (particularly alcohol abuse and major depression) that are associated with suicide. Although most patients with suicidal ideation do not ultimately commit suicide, the extent of suicidal ideation must be determined, including the presence of a suicide plan and the patient's means to commit suicide.     

精神病患者自杀未遂临床分析及护理对策

目的:分析精神病患者自杀未遂的临床资料,探讨预防、护理措施。方法:对80例自杀未遂患者病历进行了回顾性分析,归纳了他们的疾病类型、自杀原因、自杀方式。结果:疾病类型:抑郁症自杀未遂者70例,占87.5%;精神分裂症、抑郁状态10例,占12.5%。自杀方式:服用过量药物32例,占40%;割腕19例,占23.8%;自伤11例,占13.8%;喝农药和自缢各7例,各占8.8%;放煤气4例,占5%。自杀原因:情感障碍72例,精神病性症状8例。结论:对有自杀未遂史、抑郁心境患者及早干预;增加家属和社会对患者的支持,激励患者提高生活信心;提高患者服药依从性;加强康复治疗与社会技能训炼,可预防和降低精神病自杀未遂者再次发生自杀行为。     

The Interactive Effects of the Capability for Suicide and Major Depressive Episodes on Suicidal Behavior in a Military Sample

Major depressive symptoms are associated with increased risk for suicidal ideation and behavior. Suicide is fearsome; as such, the interpersonal theory of suicide proposes that individuals who engage in suicidal behavior possess not only the desire to die, but also the acquired capability (AC) for suicide. This study examined whether major depressive episodes (MDEs) may be particularly relevant to suicidal behavior when considered in the context of AC. History of MDEs, AC, and suicide attempt history were examined in a large (n = 3377) sample of military members. Data were analyzed using hierarchical multiple regression. Results indicated that among individuals with high AC, the number of MDEs was significantly, positively associated with number of previous suicide attempts; MDEs were not significantly related to suicide attempt history among individuals with low AC. Findings held in the presence of robust covariates associated with suicidal behavior. Findings suggest that a history of MDEs alone may not indicate severe suicide risk—increased AC for suicide appears necessary for increased suicide risk. Implications for suicide treatment and prevention in military personnel are discussed.     

Suicidal intent in patients with chronic pain

Suicidal ideation among individuals suffering from chronically painful conditions has not been widely studied, although rates of completed suicide are believed to be elevated in this population relative to the general population. The psychiatric literature on suicide documents the importance of controlling for the severity of depression when studying factors associated with suicidal ideation, attempts, or completion. The present study examined the relationships between suicidal ideation and the experience of pain, pain-related disability, and pain coping efforts among a sample of individuals experiencing chronically painful conditions. Of 200 patients evaluated on an inpatient rehabilitation unit in a psychiatric service, 13 individuals (6.5%) reported suicidal intent on a commonly used self-report measure of symptoms of depression, the Beck Depression Inventory. This group was compared to a matched (age, sex, pain duration) group of similarly depressed individuals (N=13) and a matched group of non-depressed individuals (N=13) on measures of pain, disability, pain beliefs, and pain coping strategies. A history of a suicide attempt was associated with suicidal intent. Family history of substance abuse was significantly more prevalent among the depressed groups, regardless of suicidal thinking. The depressed/suicidal group and depressed/non-suicidal groups reported higher levels of pain, higher levels of pain-related disability, lower use of active coping, and higher use of passive coping compared to the non-depressed group. The depressed groups did not differ from one another on any of the measures of pain experience. Depression, not suicidal status, consistently predicted level of functioning. The prevalence of suicidal intent was comparable to rates observed in other studies and relatively low. When individuals with chronic pain report suicidal intent, it is imperative that measures preventing self-harm be implemented immediately and the patient's depression be treated aggressively.