Predictors of Suicidal Ideation in People with Epilepsy Living in Korea

Background and Purpose

The risk of suicide or suicide attempts is reported higher in people with epilepsy (PWE) than in the general population. Although epileptic, psychiatric, and psychosocial factors are known risk factors for suicide or suicide attempt, no studies have evaluated the predictors of the severity of suicidal ideation-which is a warning sign for suicide attempts-in PWE. Therefore, we measured the severity of suicidal ideation and its risk factors.

Methods

Consecutive PWE who were medicated with antiepileptic drugs (AEDs) and attended epilepsy clinic were included in the study. The subjects completed self-reported questionnaires, which included the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Symptom Checklist-90-Revised (SCL-90-R), and Scale for Suicide Ideation-Beck (SSI-Beck). We compared the patients'' demographic and clinical variables, and BDI, BAI, and SCL-90-R scores with their SSI-Beck score, and used our findings to determine the predictors for suicidal ideation.

Results

In total, 257 PWE were enrolled in the study. SSI-Beck scores correlated strongly with several seizure-related variables, duration of education, IQ, BDI and BAI scores, and nine domains of the SCL-90-R questionnaire. However, the strongest predictor for suicidal ideation was BDI score (β=0.41, p<0.001), followed by several SCL-90-R domains, such as obsessive-compulsive (β=-0.39, p<0.001), depression (β=0.38, p<0.001), hostility (β=0.22, p=0.002), paranoid ideation (β=0.17, p=0.01), and IQ (β=-0.10, p=0.017). These variables explained 59% of the variance in the SSI-Beck score. The seizure-related variables that influenced the BDI score were seizure frequency, duration of education, MRI abnormality, and number of AEDs. However, these variables explained only 18% of the variance in the BDI score.

Conclusions

Major risk factors for suicidal ideation in PWE were depressive and psychiatric symptoms rather than seizure-related variables. Therefore, clinicians should focus on screening for depression and other psychiatric problems and treat them appropriately in order to reduce suicidal behavior in PWE. Since seizure-related variables also exhibited a minor role in determining depressive symptoms, stronger seizure-related risk factors for depression should be sought, such as seizure severity or psychosocial factors, to minimize suicidal behavior.     

Effectiveness of Cognitive Behavioral Therapy for Veterans with Depression and Suicidal Ideation

The current study examined suicidal ideation (SI) and depression outcomes among Veterans receiving Cognitive Behavioral Therapy for depression (CBT–D) throughout the Department of Veterans Affairs health care system. Patient outcomes included Beck Depression Inventory–II total score and SI item. Of 902 patients, 427 (47%) had no SI, 405 (45%) had SI but no suicidal intent, 26 (3%) indicated suicidal desire, 8 (1%) indicated suicide intent if they had the chance, and 36 (4%) did not answer this question at session one. The odds of SI decreased by 64% from 1.03 at session one to 0.37 at final assessment (OR = 0.36; 95% CI: 0.31, 0.43). Findings reveal that CBT–D was associated with significant decreases in SI and depression among Veterans.     

The Differentiating Role of State and Trait Hopelessness in Suicidal Ideation and Suicide Attempt

With suicide being a leading cause of death in the United States, research must aim to increase efficacious prevention methods. The purpose of the present study was to gain greater understanding of the difference between suicidal ideation and suicide attempt. Previous research emphasizes the role of hopelessness in attempts and ideation (Bagge, Lamis, Nadorff, &; Osman, 2014 Bagge, C. L., Lamis, D. A., Nadorff, M., &; Osman, A. (2014). Relations between hopelessness, depressive symptoms and suicidality: Mediation by reasons for living. Journal of Clinical Psychology, 70(1), 18–31. doi:10.1002/jclp.22005[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Yet while hopelessness offers predictive value to suicide attempt, it fails in discriminating between suicide attempters and suicide ideators. Thus the goal was to examine the possible influence of different types of hopelessness on suicidal ideation and attempt. The experience of hopelessness as a temporary feeling, or state, versus as an enduring emotion, or trait, was examined in this study. The State-Trait Hopelessness Scale and 4 suicidal thought and suicidal behavior questions were assessed. Results of logistic regression analysis supported the hypothesis that state and trait hopelessness were differentially associated with ideation and attempt. While trait hopelessness was significantly positively associated with responses to all 4 suicidality questions (p’s?相似文献   

The Associations between Suicidal Ideation and Attempt and Anxiety Symptoms and the Demographic,Psychological, and Social Moderators in Taiwanese Adolescents

The objectives of this study were to examine the associations between suicidal ideation and attempt and anxiety symptoms and the moderators in 5,027 Taiwanese adolescents. The associations between suicidal ideation and attempt and anxiety symptoms on the Taiwanese version of the Multidimensional Anxiety Scale for Children (MASC-T) were examined using logistic regression analysis. The moderating effects of demographic (gender and age), psychological (problematic alcohol use, severe depressive symptoms, and low self-esteem), and social factors (bullying victimization, and low family function) on the associations were examined. Adolescents who had anxiety symptoms were more likely to have suicidal ideation and attempt than those who did not have anxiety symptoms. Bullying victimization had a moderating effect on the association between suicidal ideation and anxiety symptoms. Assessment of suicidal ideation and attempt should be routine practice among adolescents who present with anxiety symptoms.     

Characteristics of schizophrenic patients with a history of suicide attempt

OBJECTIVE The aim of this study was to evaluate the suicide attempt history among schizophrenic patients and compare their sociodemographic and clinical characteristics with schizophrenic patients without a history of suicide attempt.

METHOD Sixty schizophrenic patients according to DSM-IV criteria were included in the study. Half of the patients were in acute phase and receiving inpatient treatment, while the other half were in stable phase and outpatients. The sample was subdivided into two subsamples according to the presence/absence of lifetime suicidal attempts.

RESULTS History of suicide attempt was found in 27 (45%) of the patients. The rate of having suicidal ideation, depression, paranoid type schizophrenia and first-degree relatives with psychiatric disorder was high among the group with suicide attempt history. Depression and insight scores were high and PANSS Negative symptoms subscale score was low among the patients with suicide attempt history. There were no significant differences between the two groups according to the scores of PANSS Positive symptoms and General Psychopathology subscales.

CONCLUSION The high rate of suicide attempt history in our sample suggests that risk of suicide has to be determined and protective measures have to be taken while planning inpatient and outpatient treatment of these patients. Suicide attempt history is a risk factor for suicide ideation and is also related to depressive symptoms and high insight score and low negative symptoms score.     

Depressive Symptoms and Perceived Burdensomeness Mediate the Association between Anxiety and Suicidal Ideation in Adolescents

A relationship between anxiety disorders and suicide-related behaviors has been demonstrated in adolescents, with a paucity of research examining mediators of this association. The present study hypothesized that anxiety would be associated with suicidal ideation via a serial mediation pathway through depressive symptoms and perceived burdensomeness and/or thwarted belongingness. A sample of 80 adolescents (68.8% female, 65.8% Hispanic), 13–19 years of age (mean?=?16.93, SD?=?1.66), completed 3 interviews as part of a randomized controlled trial. Results indicated a significant serial mediation from anxiety to suicidal ideation via depressive symptoms and perceived burdensomeness, but not thwarted belongingness. Clinicians and mental health service providers working with adolescents experiencing elevated anxiety should regularly assess for perceived burdensomeness and suicidal ideation.     

Suicidal changes in patients with first episode psychosis: clinical predictors of increasing suicidal tendency in the early treatment phase

Aim: To identify predictors for developing a higher suicidal tendency during treatment of first‐episode psychosis. Methods: In a prospective follow‐up study, we examined clinical factors collected at treatment initiation as predictors for developing a higher suicidal tendency among patients in the first year of treatment of psychosis. Patients were grouped and ranked according to their highest suicidal tendency in the year before treatment: not suicidal, suicidal thoughts, suicidal plans or suicide attempt(s). Predictors for becoming more suicidal in the first year of treatment were examined on group level in multivariate logistic regression analyses. We assessed patients' suicidal tendency and clinical factors using validated interviews and rating scales. Analysis included 386 patients. Results: Among patients with some suicidal tendency a one‐point increase score on hallucinations significantly predicted developing a higher suicidal tendency, whereas a one‐point increase score on delusions was preventive of this. Feeling hopeless was highly associated with suicide attempt in those with earlier suicide attempt. Conclusion: The risk of suicide attempt did not differ between patient groups with suicidal thoughts, plans or suicide attempt. In first year of treatment of psychosis, hallucinations increased the risk for becoming more suicidal, whereas delusions reduced this risk in already suicidal patients.     

The Influence of Death Exposure on Suicidal Thoughts and Behaviors

The present study investigated the relationship between exposure to both suicidal and non-suicidal deaths and current suicidal ideation and suicide attempt history among urban college students. Three hundred and ninety-six (n = 396) undergraduate students attending an urban university completed a series of questionnaires assessing their exposure to death (including suicide), suicide attempt history, and current level of suicidal ideation. Exposure to suicide and non-suicidal death were not related to current suicidal ideation; however, students who had made a suicide attempt were more likely to have been exposed to a death by suicide or acute disease. The findings of this study suggest that exposure to death by suicide or acute disease increased the likelihood a student made a past suicide attempt.     

Familial Factors Related to Suicidal Ideation of Latina Adolescents in the United States

The purpose of this study was to examine whether a Latina adolescent's perception of mother connectedness, father connectedness, parental caring, autonomy granting from parents, and parental interest in their child's school life predicts suicidal ideation above and beyond known risk factors of adolescent depression and acculturation. Using the National Longitudinal Study of Adolescent Health (Add Health) Wave 1, 2 secondary logistic regression data analyses were conducted on a sample of 345 Latina adolescents. Results of correlational analyses indicated that perceived mother connectedness, father connectedness, parental caring, and academic interest were positively related; depression and nativity were negatively related to reports of suicidal ideation. Additionally, in a model with adolescents who reported having both a mother and father figure present in their life, depression and academic interest were significant predictors of suicidal ideation. In a second model, which included all Latinas regardless of the presence of both parents, depression, nativity, perceived academic interest, and caring were significant predictors. Implications are discussed for suicide prevention and intervention with Latina adolescents.     

Rumination and Pessimistic Certainty as Mediators of the Relation Between Lifetime Suicide Attempt History and Future Suicidal Ideation

This study examined whether rumination and certainty about pessimistic future-event predictions (P-Certainty) would mediate the relation between lifetime suicide attempt history and future suicidal ideation. Young adults, ages 18–25 (N = 143), with a suicide attempt history (n = 32) or no previous suicide attempt history (n = 111) at baseline, were followed up 2–3 years later and completed measures of rumination, depressive symptoms, hopelessness, suicidal ideation, and pessimistic future-event certainty. Lifetime suicide attempts at baseline were associated with higher suicidal ideation at follow up, and this relation was mediated by rumination and P-Certainty. Suicide attempters may be vulnerable to later ideation due to higher levels of rumination and also certainty in their pessimistic future expectations.     

Suicidal ideation,suicide attempts,and psychological distress among intoxicated adolescents in the pediatric emergency department

Background: Studies have emphasized screening for psychiatric disorders, especially suicide risk in emergency departments. Psychiatric disorders and experimentation with alcohol increase in adolescence and intoxications among patients challenge the staff in emergency departments.

Aims: This study examined the degree of suicidal ideation (SI) and suicidal behavior in adolescents, and the extent to which they differed from non-suicidal patients in terms of alcohol use, psychological distress, self-esteem, and perceived social support.

Methods: The study comprised 120 adolescents, a mean age of 14.2 years. Of them 60% were females. We collected data on the clinical characteristics and assessed the patient’s psychiatric status using self-report scales and analyzed blood samples for alcohol. A consulting psychiatrist interviewed each patient before discharge to evaluate potential SI or suicide attempt (SA) using structured and semi-structured scales.

Results: Of the 120 patients 20% had SI or had made a SA. High psychological distress in girls, low blood alcohol levels (BALs), as well as low scores on self-esteem, on social support and on familial support were associated with patients with SI/SA. Logistic regression showed that the most significant variables with suicidal patients included low BAL and low self-esteem and high alcohol consumption. Psychological distress had a direct and mediational role in the suicidal patients.

Conclusions: Adolescents referred to the pediatric emergency department with intoxication displaying high psychological distress and low self-esteem represent a high-risk group of teens. In this group, careful assessment of mental health status, screening for suicidal ideation, and SAs seems warranted.     

Cognitive-Affective Correlates of Suicide Ideation and Attempt: Mindfulness is Negatively Associated with Suicide Attempt History but not State Suicidality

The objective of this study was to test whether 3 cognitive-affective correlates,--mindfulness, emotion reactivity, and depressive symptom severity—have different associations with current suicidal ideation (SI), a history of suicide attempt (SA) and SA?+?SI among emerging adults. Whether impulsive-aggression (IA) moderated associations between cognitive-affective correlates of suicidal behavior and suicidality was also tested. Survey data on current SI, SA history, mindfulness, emotion reactivity, depressive symptom severity, and IA were collected from 780 emerging adults. Results from multinomial logistic regression analysis showed greater depressive symptom severity among emerging adults with current SI, regardless of SA history. Those with a history of SA reported greater depressive symptom severity and less mindfulness than controls. IA did not moderate relationships of SI and/or SA and mindfulness, emotion reactivity, or depressive symptom severity. Mindfulness is a marker of SA, and depressive symptom severity is associated with current SI and SA history in emerging adults. IA does not moderate these associations. To the extent that a history of SA is indicative of elevated trait-like suicide risk and SI indicates state suicidality, our findings suggest that mindfulness protects against longer-term vulnerability to suicide while depressive symptom severity is associated with suicide state-trait risk.     

Agency is Associated with Decreased Emotional Distress and Suicidal Ideation in Military Personnel

Suicides in the U.S. military continue to rise at a rapid rate. Identification of protective factors that reduce risk for suicidal thoughts and behaviors among military personnel are therefore needed. Agency—the sense that one is competent, effective, and in control of one's life—has shown to reduce the effects of hopelessness and emotional distress on suicidal thoughts and attempts in non-military populations. The current study explores the association of agency with suicidal ideation in a sample (n = 273) of active duty Air Force Security Forces personnel. Results of generalized regression modeling suggest that agency is directly associated with decreased emotional distress and severity of suicidal ideation, but does not moderate the effect of emotional distress on suicidal ideation.     

History of suicidal behaviour in the families of young suicides

The prevalence of attempted or completed suicide was studied in the families of a consecutive sample of young suicide victims aged 15–29 years. In 17 of 42 (40%) of the men and 5 of 16 (31%) of the women suicidal behaviour was found to be present in first-degree relatives. Male suicide victims with a family history of suicidal behaviour had an earlier debut of their own suicidal behaviour, longer suicidal processes, and had made more previous suicide attempts. Families in which suicidal behaviour was displayed by the victim's parents or siblings also had more frequent early separations between parent and victim and more substance abuse. Taking into account suicide by a friend or second-degree family member, it was found that 72% of suicide victims had a history of suicidal behaviour in close relationships.