Suicidal ideation and suicide attempts in homeless mentally ill persons

BACKGROUND: Despite reports of high rates of suicidal behavior among mentally ill homeless persons, it remains unknown whether the well-established suicide risks of increased age and comorbid psychiatric and substance abuse disorders ("dual diagnosis") documented in the general population are also markers for increased suicide risk among homeless persons. METHODS: Data from a multi-site outreach program (ACCESS) (N = 7,224) were used to investigate whether rates of serious suicidal ideation and recent suicide attempts varied with the age and substance abuse diagnosis(es) (drug abuse and/or alcohol abuse disorders) among homeless mentally ill clients. RESULTS: The prevalence of 30-day suicidal ideation and suicide attempts (37.5 % and 7.9 %, respectively) was extremely high. Although the risk of serious suicidal ideation and suicide attempts was greater among the younger compared with the older homeless mentally ill clients, risks were not significantly increased by co-morbid alcohol and/or drug abuse. However, a significant interaction between age and co-morbid substance abuse was observed showing that among older clients but not younger clients, those with drug and alcohol abuse were at significantly greater risk of suicidal ideation than those without substance use problems, controlling for confounding factors. CONCLUSION: Efforts to prevent suicide should recognize that among homeless people with mental illness, young-middle-aged (30- to 39-year-old) clients are at greatest risk of suicidal behavior. Among older clients the presence of both drug and alcohol abuse significantly increases suicide risk. These patterns are of special importance because they are quite different from those that are well documented in non-homeless populations.     

The association of early adolescent problem behavior with adult psychopathology

OBJECTIVE: The authors investigated whether the association between adolescent problem behavior and adult substance use and mental health disorders was general, such that adolescent problem behavior elevates the risk for a variety of adult disorders, or outcome-specific, such that each problem behavior is associated specifically with an increased risk for disorders clinically linked to that behavior (e.g., early alcohol use with adult alcohol abuse). METHOD: A population-based group of 578 male and 674 female twins reported whether they had ever engaged in, and the age of initiation of, five adolescent problem behaviors: smoking, alcohol use, illicit drug use, police trouble, and sexual intercourse. Participants also completed a structured clinical interview at both ages 17 and 20 covering substance use disorders, major depressive disorder, and antisocial personality disorder. Data were analyzed with simple bivariate methods, survival analysis, and structural equation analysis. RESULTS: Each problem behavior was significantly related with each clinical diagnosis. The association was especially marked for those who had engaged in multiple problem behaviors before age 15. Among those with four or more problem behaviors before age 15, the lifetime rates of substance use disorders, antisocial personality disorder, and major depressive disorder exceeded 90%, 90%, and 30% in males and 60%, 35%, and 55% in females, respectively. The association between the clinical diagnoses and adolescent problem behavior was largely accounted for by two highly correlated factors. CONCLUSIONS: Early adolescent problem behavior identifies a subset of youth who are at an especially high and generalized risk for developing adult psychopathology.     

The association between harmful alcohol use and Internet addiction among college students: Comparison of personality

Aims:  This study aimed to (i) evaluate the association between Internet addiction and harmful alcohol use, and (ii) evaluate the associated personality characteristics of Internet addiction as well as harmful alcohol use.
Methods:  A total of 2453 college students were invited to complete the Chen Internet Addiction Scale, Behavior Inhibition System and Behavior Approach System Scale(BIS/BAS scale), and the Alcohol Use Disorders Identification Test from May 2005 to May 2006.
Results:  The results demonstrated Internet addiction was associated with harmful alcohol use among college students. College students with Internet addiction had higher scores on the BIS and BAS fun-seeking subscales. However, college students with harmful alcohol use had higher scores on the BAS drive and fun-seeking subscales, and lower scores on the BIS subscale.
Conclusions:  Internet addiction is associated with harmful alcohol use. Furthermore, fun seeking was the shared characteristic of these two problem behaviors and might contribute to the association. However, further studies are necessary to evaluate the underlying mechanisms accounting for the association between Internet addiction and harmful alcohol use.     

Sortir des addictions : à l’alcool,par l’alcool ou vers l’alcool

Pathways from alcoholism to recovery are documented; less often are those from drug addiction to alcoholism. Biographical approaches allow analyzing how people change their uses and talk about their trajectories of recovery.

Multigenerational and transgenerational effects of paternal exposure to drugs of abuse on behavioral and neural function

Addictions are highly heritable disorders, with heritability estimates ranging from 39% to 72%. Multiple studies suggest a link between paternal drug abuse and addiction in their children. However, patterns of inheritance cannot be explained purely by Mendelian genetic mechanisms. Exposure to drugs of abuse results in epigenetic changes that may be passed on through the germline. This mechanism of epigenetic transgenerational inheritance may provide a link between paternal drug exposure and addiction susceptibility in the offspring. Recent studies have begun to investigate the effect of paternal drug exposure on behavioral and neurobiological phenotypes in offspring of drug‐exposed fathers in rodent models. This review aims to discuss behavioral and neural effects of paternal exposure to alcohol, cocaine, opioids, and nicotine. Although a special focus will be on addiction‐relevant behaviors, additional behavioral effects including cognition, anxiety, and depressive‐like behaviors will be discussed.     

Alcohol and drug addiction in northern Nigeria

This paper shows that the major psychiatric syndromes encountered in the West with the exception of personality disorder and sexual deviation are represented among patients in northern Nigeria. It draws attention to the increasing problem of alcohol and drug (Indian hemp) addiction in a predominantly Moslem society. 17% of the male cases were treated for alcohol or drug addiction.     

When Problem Gambling is the Primary Reason for Seeking Addiction Treatment

An existing database was used to compare problem gamblers (N = 138) who presented for treatment of their gambling problem to two other groups: alcohol and/or drug addiction clients who also had a gambling problem (N = 280) or who did not have a gambling problem (N = 2178). Clients with gambling as their primary problem were more likely to be female; employed or retired; more highly educated; married, divorced, or widowed; without legal problems; and older than the other groups. They also had different patterns of recent mental health diagnoses and problematic substance use. The other problem gambling clients were more similar to the substance only clients. These findings indicate that those who present for treatment of problem gambling are a distinct subset of addiction clients who have gambling problems, and emphasize the importance of considering the reasons for seeking treatment, not just the presence of a gambling problem.     

Multi-dimensional discriminative factors for Internet addiction among adolescents regarding gender and age

Aims:  The aim of the present study was to examine the discriminative effects of sociodemographic, individual, family, peers, and school life factors on Internet addiction in Taiwanese adolescents.
Methods:  A total of 8941 adolescents were recruited and completed the questionnaires. Multi-dimensional discriminative factors for Internet addiction were examined using chi-squared automatic interaction detection for gender and sex.
Results:  Depression and low family monitoring were the discriminative factors for Internet addiction in all four gender- and age-specified groups of adolescents. Low connectedness to school, high family conflict, having friends with habitual alcohol drinking, and living in rural areas also had discriminative effects on adolescent Internet addiction in adolescents of different gender and age.
Conclusions:  Multi-dimensional factors were able to discriminate between those adolescents with and without Internet addiction. It is suggested that parents and health and educational professionals monitor the Internet-using behaviors of adolescents who have the factors discriminating for Internet addiction identified in the present study.     

Co-Occurring Non-Suicidal Self-Injury and Firesetting Among At-Risk Adolescents: Experiences of Negative Life Events,Mental Health Problems,Substance Use,and Suicidality

Co-occurring internalizing and externalizing problem behaviors in adolescence typically marks more severe psychopathology and poorer psychosocial functioning than engagement in a single problem behavior. We examined the negative life events, emotional and behavioral problems, substance use, and suicidality of school-based adolescents reporting both non-suicidal self-injury (NSSI) and repetitive firesetting, compared to those engaging in either behavior alone. Differences in NSSI characteristics among self-injurers who set fires, compared to those who did not, were also assessed. A total of 384 at-risk adolescents aged 12–18 years (58.8% female) completed self-report questionnaires measuring NSSI, firesetting, and key variables of interest. Results suggest that adolescents who both self-injure and deliberately set fires represent a low-prevalence but distinct high-risk subgroup, characterized by increased rates of interpersonal difficulties, mental health problems and substance use, more severe self-injury, and suicidal behavior. Implications for prevention and early intervention initiatives are discussed.     

Psychiatric symptoms in adolescents with Internet addiction: Comparison with substance use

Aims:  The aim of the present study was to compare psychiatric symptoms between adolescents with and without Internet addiction, as well as between analogs with and without substance use.
Methods:  A total of 3662 students (2328 male and 1334 female) were recruited for the study. Self-report scales were utilized to assess psychiatric symptoms, Internet addiction, and substance use.
Results:  It was found that Internet addiction or substance use in adolescents was associated with more severe psychiatric symptoms. Hostility and depression were associated with Internet addiction and substance use after controlling for other symptoms.
Conclusions:  This result partially supports the hypothesis that Internet addiction should be included in the organization of problem behavior theory, and it is suggested that prevention and intervention can best be carried out when grouped with other problem behaviors. Moreover, more attention should be devoted to hostile and depressed adolescents in the design of preventive strategies and the related therapeutic interventions for Internet addiction.     

Sex differences in addictive disorders

Gender-dependent differences in the rate of initiation and frequency of misuse of addicting drugs have been widely described. Yet, men and women also differ in their propensity to become addicted to other rewarding stimuli (e.g., sex, food) or activities (e.g., gambling, exercising). The goal of the present review is to summarize current evidence for gender differences not only in drug addiction, but also in other forms of addictive behaviours. Thus, we first reviewed studies showing gender-dependent differences in drug addiction, food addiction, compulsive sexual activity, pathological gambling, Internet addiction and physical exercise addiction. Potential risk factors and underlying brain mechanisms are also examined, with particular emphasis given to the role of sex hormones in modulating addictive behaviours. Investigations on factors allowing the pursuit of non-drug rewards to become pathological in men and women are crucial for designing gender-appropriate treatments of both substance and non-substance addictions.     

Factors associated with receipt of behavioral health services among persons with substance dependence

OBJECTIVE: This study sought to identify demographic and clinical variables that predict use of behavioral health services among persons with substance dependence. METHODS: Interviews were conducted with 1,893 adults who endorsed items on the National Household Survey on Drug Abuse in 1995 and 1996 that were consistent with a DSM-IV-TR diagnosis of dependence on at least one substance, excluding cigarettes. Logistic regression analyses were conducted to identify significant predictor variables. RESULTS: Among persons with substance dependence, only 18.3 percent had sought substance abuse or mental health treatment, or both, in the previous year. Female sex, high family income, a history of being arrested or booked, concurrent psychiatric comorbidity, self-perception of having a drug or alcohol problem, and the number of substances involved all predicted treatment use. One-third of substance-dependent individuals who used services reported receiving mental health care that did not include any substance use component. Persons with higher education levels were more likely to use mental health care only. In contrast, persons who used public insurance or were uninsured, had been booked or arrested, or perceived themselves as having a drug or alcohol problem were less likely to obtain mental health care only. CONCLUSIONS: Several clinical and demographic variables were predictive of some type of treatment use by substance-dependent individuals. Persons who used mental health care only were more likely to be female, to be of higher socioeconomic status, not to have a history of involvement with the legal system, and to have problems with alcohol or marijuana but not to perceive themselves as needing addiction treatment.     

Do Addictive Behaviors Matter for College Students’ Depression and Suicidal Ideation?

Previous research has shown that depression is an important predictor for suicidal ideation and that depression, addictive behaviors, and suicidal ideations are highly associated with each other. However, no studies have specifically investigated the role of addictive behaviors (i.e., alcohol use, gambling) as moderators on the association between depression and suicidal ideation among Korean college students. This study examined (1) the association between depression and suicidal ideation using Depression, Anxiety and Stress Scale (DASS-21) and five selected items from the Youth Risk Behavior Surveillance System (YRBSS), and (2) the moderating roles of alcohol use and problem gambling using Alcohol Use Disorder Identification Test (AUDIT) and Problem Gambling Severity Index (PGSI). We collected data from full-time students (n?=?870) enrolled at 14 universities throughout South Korea using a self-reported paper-pencil survey conducted on college campuses. More than half of the total sample (52.3%, n?=?450) reported either alcohol use or gambling, and findings revealed that depression, alcohol use, and gambling are associated with suicidal ideation. We found a significant moderating effect of alcohol use on the relationship between depression and suicidal ideation (ß?=?.151, p?<?.001); whereas, gambling had no significant moderating effect on the relationship (ß?=?.054, p?<?.276). The influence of depression on suicidal ideation was greater for Korean college students who used high levels of alcohol compared to those who used low levels of alcohol. The results suggest that alcohol use is an important modifiable factor for suicidal ideation especially in students with depression, and provide a foundation for future research aimed at understanding complex and nuanced mechanisms linking depression, addictive behaviors, and suicidal ideation.     

强制戒毒者自杀意念及影响因素的调查分析

目的探讨吸毒人群自杀意念产生原因及影响因素,为该特殊人群的自杀干预提供依据。方法对甘肃省兰州市榆中县强制戒毒所中的强制戒毒人员,采用分层随机抽样,使用阿片成瘾严重程度量表及自杀意念自评量表和自编的访谈提纲,采取各大队各班抽测、单独访谈方式进行调查。结果共173名调查对象的问卷有效,对自杀意念的多因素logistic回归分析结果显示有无职业、成瘾史、成瘾程度、自杀史和曾经用药这5个因子都被纳入了回归方程。结论强制戒毒者的自杀未遂率和自杀意念发生率远高于普通人群。失业、较长的成瘾史、严重的成瘾程度和以往的自杀经历都是影响强制戒毒人员自杀意念发生的重要影响因素。     

The role of fibroblast growth factor 2 in drug addiction

Fibroblast growth factor 2 (FGF2) is a member of the FGF‐family, which consists of 22 members, with four known FGF receptors (five in humans). Over the last 30 years, FGF2 has been extensively studied for its role in cell proliferation, differentiation, growth, survival and angiogenesis during development, as well as for its role in adult neurogenesis and regenerative plasticity. Over the past decade, FGF2 has been implicated in learning and memory, as well as in several neuropsychiatric disorders, including anxiety, stress, depression and drug addiction. In this review, we present accumulating evidence indicating the involvement of FGF2 in neuroadaptations caused by drugs of abuse, namely, amphetamine, cocaine, nicotine and alcohol. Moreover, evidence suggests that FGF2 is a positive regulator of alcohol and drug‐related behaviors. Thus, although additional studies are yet required, we suggest that reducing FGF2 activity may provide a novel therapeutic approach for substance use disorders.     

Population-based Studies of Childhood Disability in Developing Countries

This article reports the main health status differences between a representative sample of homeless people and an at-risk for homelessness group consisting of people who use services for the homeless such as soup kitchens and public baths but have and maintain a home. The variables analyzed include health problems by system, risk habits and behaviors, substance use, alcohol problems, general health status, suicidal thoughts and perceived health status. Because of the gender differences between groups, the data were analyzed independently for men and women. The results show that the homeless have worse health status compared with the at-risk group. Homeless men had significantly more risk habits and behaviors, substance use, and mental health problems. Homeless women had similar tendencies, although they also had significantly more general health illnesses (by systems and over the past year). Almost no differences were found in drug use (especially alcohol use) or in mental health—except for depression, which was significant. These results shed light on new data regarding the correlation between homelessness and health issues.     

男女海洛因依赖者成瘾严重程度的比较

目的：了解男女海洛因依赖者成瘾严重程度的差异,为针对不同性别海洛因依赖者制定干预措施提供依据。方法：采用自制个案调查表和成瘾行为严重度指数量表（addiction severity index,ASI）对199例男性和239例女性海洛因依赖者进行评估,比较不同性别海洛因依赖者ASI量表中各维度分值的差异。结果：女性依赖者ASI中因子4（药物使用）评分平均为（0.52±0.28）分和因子7（精神健康状况）平均（0.15±0.24）分显著高于男性的（0.43±0.34）分和（0.08±0.19）分（P〈0.05或P〈0.01）;男性依赖者因子5（法律状况）评分平均（0.07±0.13）分高于女性的（0.03±0.10）分（P〈0.01）。将年龄、首次吸毒年龄及吸毒时间与ASI分量表进行偏相关分析发现,年龄（r=-0.182）、吸毒时间（r=0.158）与因子4（药物使用）分数存在显著相关;进一步相关分析发现,年龄与吸毒时间存在显著相关（r=0.364,P〈0.01）。结论：男女海洛因依赖者在成瘾行为严重程度方面存在差异,临床治疗与康复过程中应针对不同性别特征制定个体化的治疗方案以满足不同性别患者的需求。     

Symptoms of depression,suicidal behaviour and use of substances in Greece: a nationwide general population survey

This study aimed at investigating the relationship between the use of unprescribed licit and illicit drugs and problematic drinking with reported depressive symptoms and suicidal behaviour in a nationwide general population sample of 4291 respondents aged 12 to 64. Depressive symptoms were detected by the use of the Center for Epidemiological Studies Depression Scale (CES-D). A higher proportion of respondents who have reported illicit drug use in their lifetime were found to be depressed with a > 16 score in the CES-D in all age groups and both sexes, than of the other categories of substance use. A multiple range test revealed 3 groups of substance users. The more frequent illicit drug users together with the problematic drinkers exhibited the higher average depressive symptoms scores. The 12-month prevalence of suicidal ideation and suicide attempts was found to be in accordance with the severity and frequency of substance consumption.     

Recreational gamblers with and without parental addiction

Research has found that children who have parents with an addiction may be more vulnerable to developing psychopathology compared to children without parental addiction. We compared young adult, recreational gamblers with and without parental addiction on measures of gambling behavior and impulsivity. A total of 286 recreational gamblers (defined as having gambled at least five times in the past 12 months) between the ages of 18 and 29 participated in an initial intake of a longitudinal study assessing susceptibility to pathological gambling. Trained staff members interviewed subjects, and subjects completed cognitive testing and self-report measures. Fifty-three subjects (18.53%) reported at least one parent with an addiction (including alcohol and substance dependence and pathological gambling). Subjects with at least one addicted parent were significantly more likely to report problems resulting from gambling, have significantly greater rates of psychiatric comorbidity, and report significantly more current marijuana and tobacco use. Subjects with an addicted parent were not significantly different on measures of impulsivity. These findings suggest that even at a stage of low-risk gambling, before what has been considered a psychopathology arises, those with a possible environmental and/or genetic risk of addiction exhibit a range of problematic behaviors.     

Adolescent suicidal ideation as predictive of psychopathology, suicidal behavior, and compromised functioning at age 30

OBJECTIVE: The purpose of this study was to examine whether suicidal ideation in a community population of adolescents represents normative adolescent angst or is predictive of psychopathology, suicidal and problem behaviors, and compromised functioning 15 years after onset. METHOD: Participants were 346 largely Caucasian individuals who were part of a single-age cohort from a working class community and whose development had been traced prospectively from ages 5 to 30. Those with suicidal ideation at age 15 were compared to those without suicidal ideation at age 15 on measures of psychopathology, suicidal ideation and behavior, problem behaviors, and adult functioning at age 30. Gender differences were assessed across all domains. RESULTS: At age 30, there were marked differences between adolescents with suicidal ideation and adolescents without suicidal ideation of both genders in most domains examined. Subjects with suicidal ideation were twice as likely to have an axis I disorder, nearly 12 times more likely to have attempted suicide by age 30, and 15 times more likely to have expressed suicidal thoughts in the past 4 years. Subjects with suicidal ideation had more problem behaviors and poorer overall functioning as assessed by multiple informants. Their self-perceptions of coping ability, self-esteem, and interpersonal relations were also lower. Although subjects with suicidal ideation among both genders had higher levels of psychopathology, suicidal ideation and behavior, and problem behaviors at age 30, male subjects with suicidal ideation had lower salaries and socioeconomic status and were less likely to have achieved residential independence. CONCLUSIONS: Findings underscore the importance of considering suicidal ideation in adolescence as a marker of severe distress and a predictor of compromised functioning, indicating the need for early identification and continued intervention.