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.     

Correlates of Recent Suicide Attempts in a Triethnic Group of Adolescents

Purpose: To describe recent self-reported suicide attempts in a triethnic group of adolescents, to analyze differences in the correlates of attempts by ethnicity and gender, and to explore theoretical correlates of recent suicide attempts using a resilience framework.
Methods: Quantitative data were collected from 10,059 students in 7th, 9th, and 11th grades in Connecticut in 1996. Secondary analysis was done to compare respondents of African American, Hispanic Latino, and Caucasian ethnicities. Data were analyzed using bivariate and multivariate procedures. Logistic regression was used to identify the best set of explanatory variables for recent suicide attempts.
Results: The percentage of suicide attempts was significantly higher among Hispanic Latina girls (19.3%) than in any other ethnic-gender group. Significant relationships were found between recent suicide attempts and (a) family history of suicide attempt, (b) friend's history of suicide attempt, (c) history of sexual abuse, (d) history of physical abuse, and (e) environmental stress. The significant set of explanatory variables for recent suicide attempts for the three ethnic groups combined were stress, internalizing and externalizing behaviors, physical and sexual abuse, family and friend attempted suicide, social connectedness, and religious influence.
Conclusions: Findings support use of a resilience model for suicide attempts among three ethnic groups. The finding of a significantly higher percentage of recent suicide attempts by Hispanic girls compared to girls in other ethnic-gender groups warrants further investigation along with development and testing of culturally sensitive preventive interventions.     

Grit and Perseverance in Suicidal Behavior and Non-Suicidal Self-Injury

Data indicate persistence facilitates suicidal behavior. Non-suicidal self-injury (NSSI) is characterized by difficulty persisting while upset. The relationship between NSSI and suicidal behavior thus may hinge upon persistence. Participants were 604 undergraduates (79.5% women; 42.4% African American; 6.1% with 1 + prior suicide attempt). Data were collected online via self-report and analyzed using hierarchical multiple regression. As expected, higher levels of grit and perseverance predicted more frequent suicide attempts. Furthermore, grit and perseverance moderated the relationship between NSSI and suicide attempts, which increased in magnitude as individuals reported greater persistence. Findings depict suicidal behavior as a deliberate pursuit of death.     

National differences between ED and ambulatory visits for suicidal ideation and attempts and depression

Background

Many suicidal and depressed patients are seen in emergency departments (EDs), whereas outpatient visits for depression remain high.

Study objective

The primary objective of the study is to determine a relationship between the incidence of suicidal and depressed patients presenting to EDs and the incidence of depressed patients presenting to outpatient clinics. The secondary objective is to analyze trends among suicidal patients.

Methods

The National Hospital Ambulatory Medical Care Survey and the National Ambulatory Medical Care Survey were screened to provide a sampling of ED and outpatient visits, respectively. Suicidal and depressed patients presenting to EDs were compared with depressed patients presenting to outpatient clinics. Subgroup analyses included age, sex, race/ethnicity, method of payment, regional variation, and urban verses rural distribution.

Results

Emergency department visits for depression (1.16% of visits in 2002) and suicide attempts (0.51% of visits in 2002) remained stable over the years. Office visits for depression decreased from 3.14% of visits in 2002 to 2.65% of visits in 2008. Non-Latino whites had a higher percentage of ED visits for depression and suicide attempt and office visits for depression than other groups. The percentage of ED visits for suicide attempt resulting in hospital admission decreased by 2.06% per year.

Conclusion

From 2002 to 2008, the percentage of outpatient visits for depression decreased, whereas ED visits for depression and suicide remained stable. When examined in the context of a decreasing prevalence of depression among adults, we conclude that an increasing percentage of the total patients with depression are being evaluated in the ED, vs outpatient clinics.     

Climatic and diurnal variation in suicide attempts in the ED

The aim of this study was to determine whether there is a relationship between climatic factors and suicidal behavior. A total of 1,119 suicide attempts were collected from hospital records between 1996 and 2001. A clear seasonal variation was seen in suicide attempts in the 15-24, 25-34, and over 65 age groups in men and in the 15-24, 25-34, and 35-44 age groups in women with peaks in the spring and summer. Suicide attempts were more frequent between the hours of 6:00-9:00 pm in males and 3:00-6:00 pm in females. People attempting suicide who have depression, anxiety, or a psychotic disorder usually attempt suicide in the summer. Whereas the monthly averages of humidity, ambient temperature, duration and intensity of sunlight were positively correlated with the number of monthly suicide attempts, cloudiness and atmospheric pressure were negatively correlated. In conclusion, we must keep in mind that suicides and suicide attempts are not only the effect of climatic changes and that the most important component is the individual's ability to deal with conflicts.     

Depression in children after recovery from severe burns.

This outcome study of children and adolescents with severe burns (ages 7 to 19 years) reports that unrecognized depression is common during their lifetimes. Thirty children who had severe burns (range, 5% to 95% body surface area) were assessed for depression at a mean of 9 years after burn injury. This article presents an analysis of depression items from the Diagnostic Interview for Children and Adolescents, which was used in face-to-face interviews to assess child psychiatric disorders with diagnostic criteria from the American Psychiatric Association's Diagnostic and Statistical Manual--Third Edition. At the time that the interviews took place, only one child had symptoms of major depression and only three children had symptoms of dysthymic disorder. However, eight children had a lifetime history of major depression; two of them had been abused by burning and two had been physically or sexually abused. Four had made suicide attempts: one suicide attempt was the cause of the burn injury and three attempts were made after burn injury. Thirteen children had had suicidal thoughts, and their parents were often unaware of this. Other types of affective disorders were prevalent. There was no statistically significant association between depression and burn size or disfigurement. Although burn-related factors were associated with some depressive episodes, other biologic and social risk factors were also very important. The authors conclude that referral for diagnostic services and psychotherapy, and for some, treatment with antidepressant medication, is often a necessary part of medical services for children with burns.     

Hopelessness as Mediator of the Link Between Reports of a History of Child Maltreatment and Suicidality in African American Women

Findings from a study comparing reports of a history of child maltreatment and hopelessness in a sample of economically, socially, and educationally disadvantaged young urban African American women suicide attempters (n = 176) and demographically similar nonattempters (n = 185) revealed higher rates of child maltreatment and hopelessness among attempters than those among their nonsuicidal counterparts. Using a mediational model involving both linear and logistic regressions, results indicated that hopelessness partially mediated the link between reports of certain forms of child maltreatment (i.e., physical/emotional abuse and emotional neglect) and suicide attempts, and hopelessness fully mediated the link between child sexual abuse and suicide attempts. Of equal importance, reports of a history of childhood maltreatment significantly predicted the presence of hopelessness in those women who later attempted suicide. These results emphasize the clinical importance of screening for hopelessness in women who report a history of childhood maltreatment and/or current or previous suicidal behavior, as well as the need to target negative views of the future in clinical interventions with African American women abused as children.     

How Illegal Drug Use,Alcohol Use,Tobacco Use,and Depressive Symptoms Affect Adolescent Suicidal Ideation: A Secondary Analysis of the 2011 Youth Risk Behavior Survey

The purpose of this study was to identify the major risk factors among adolescents who have either contemplated or attempted suicide. Along with successful suicides, suicide attempts and contemplation are coexisting factors that are prominent in the adolescent population and therefore warrant major concern. A secondary data analysis of the Youth Risk Behavior Survey (YRBS) was completed to explore the factors that may influence adolescents’ thoughts or actions about suicidal behavior. The YRBS represents high-school students throughout 50 states. Nine questions from the YRBS were used to elicit information about the relationships among the risk factors: (1) Suicidal thoughts and attempts; (2) illegal drug use; (3) alcohol use; (4) tobacco use; and (5) depressive symptoms. Statistically significant relationships among the risk factors were found for adolescents. Adolescents considered suicide (15.8%); attempted suicide at least once (7.8%); were injured while attempting suicide (n = 2.7%). Our findings support the idea that illegal substance use can lead to suicidal thoughts and actions. Depression had a positive relationship with suicidal ideations, supporting similar studies suggesting that depression leads to suicidal action.     

深圳市中学生自杀状况调查

目的探讨深圳市中学生自杀意念和自杀未遂的发生率及其分布情况,为制定深圳市精神卫生规划提供客观依据。方法采用分层整群抽样法抽取深圳市4177名中学生应用自杀行为问卷～修订版进行调查。结果深圳市中学生自杀意念发生率为42．40％,1a内自杀意念发生率为34．04％,自杀计划发生率为7．92％,自杀未遂发生率为1．46％,自杀威胁性发生率为7．25％,自杀可能性发生率为5．03％;男生和女生自杀的各项因子无显著性差异（P〉0．05）;随着年龄的增长、年级的增高,自杀各项因子发生率明显升高。结论深圳市中学生自杀倾向发生率高,特别是在高年级的学生中更为显著。     

Parasuicide among youth in a general hospital in South Africa

Parasuicide cases among youth (15-24 years) referred to the clinical psychology section of a regional hospital from 1995 to 1998 were reviewed. In all 100 cases (37 males and 63 females) were identified being about 10% of the caseload. As part of the clinical psychological assessment sociodemographic, clinical characteristics, trigger factors, employed methods and suicide intentions were analysed. Most patients were students (79%) or unemployed (16%). The major method employed to attempt suicide was ingestion of harmful substances (like paraffin, pesticides or battery acid)(73%). Acute social conflicts (38%), socio-economic deprivation (17%), AIDS phobia (17%), academic failure (14%), teenage pregnancy (10%) and mental illness (5%) triggered suicide attempts. Fifty-eight percent of the attempts were categorised as demonstrative and 27% as genuine. The psychodynamics of parasuicides are discussed in case studies and with reference to other studies.     

Drug use and reported suicide ideation and attempt among Kosovar adolescents

Abstract

Suicide among adolescents continues to be a serious problem. Studies have found that substance use of tobacco, alcohol and illicit drugs is associated with suicide ideation and attempts. An article also analyzed gender differences in terms of suicide ideation and suicide attempts by considering substance use factors separately for males and females. The article is based on the data collected for the 2011 European School Survey Project on Alcohol and other Drugs (ESPAD), which was carried out in 42 secondary schools in Kosovo. A total of 4709 students born in 1995 and 1996 were surveyed according to ESPAD methodology. Logistic regression results indicate that cannabis use during the last 30 days was strongly associated with suicide attempts for both males and females. Frequency of alcohol consumption over the last 30 days was also associated with suicide ideation and attempts. The lifetime use of illegal drugs (amphetamines, ecstasy or hallucinogenic) was highly associated with suicide ideation for males but not for females. Findings show gender differences in suicide ideation; females reported higher rates of suicidal thoughts (9%) than males (6.3%). On the other hand, there were no gender differences for lifetime self-reported suicide attempt rates (3.4%). Findings from this article have a major relevance for youth suicide prevention strategies and action plans, emphasizing that not only the illegal drugs but also legal drugs such as, tranquilizers and alcohol are strongly associated with suicide ideation and attempts.     

Interpersonal Violence,Alcohol Use,and Acquired Capability for Suicide

Acquired capability for suicide (ACS), defined as pain tolerance and fearlessness about death, is theorized as necessary to enact suicide. This study examined the associations of interpersonal violence and alcohol use with ACS in 502 college students. General fearlessness/pain tolerance was positively associated with male gender and alcohol use. Fearlessness about death was positively associated with male gender and general physical violence perpetration. However, these risk factors did not explain variance in ACS beyond male gender and history of suicide attempts/nonsuicidal self-injury. These findings add to the understanding of ACS correlates.     

探究与大学生抑郁症自杀未遂行为相关的社会心理因素

目的:探究与大学生抑郁障碍患者自杀未遂行为相关的童年创伤、家庭功能及社会支持。方法:招募大学生抑郁障碍患者156例,根据既往是否存在自杀行为分为自杀未遂组(n=78)和非自杀未遂组(n=78)。采用儿童创伤问卷中文版(CTQ)、家庭功能量表(FAD)、社会支持量表(SSRS)对2组进行评估。结果:与非自杀未遂组相比,自杀未遂组的情感虐待(P0.001)、情感忽视(P=0.001)、性虐待(P=0.002)、躯体虐待(P0.001)、躯体忽视(P=0.001)因子评分及总分(P0.001)更高;角色(P=0.039)、情感介入(P=0.023)、家庭总功能(P=0.010)及总分(P=0.018)更高;主观支持(P=0.007)、支持利用率(P=0.005)因子评分及总分(P=0.011)更高。情感虐待、性虐待、支持利用率是导致自杀行为发生的独立危险和保护因素。结论:伴自杀未遂行为的大学生抑郁障碍患者存在更严重的童年创伤、更差的家庭功能以及更少的社会支持。     

The Association of Pain Intensity and Suicide Attempts Among Patients Initiating Pain Specialty Services

Using Veterans Health Administration data, we assessed the extent to which mean past-year (365 days) pain intensity scores were associated with suicide attempts in the year after the initiation of pain specialty services in fiscal years 2012 to 2014 (N = 221,817). Suicide attempts in the year after initiating Veterans Health Administration pain specialty services (ie, index visit) were identified using medical records and a suicide surveillance sources. Adjusted hazard models accounted for key covariates (eg, demographics, comorbidities). Subgroup analyses were also conducted on veterans without and with a suicide attempt in the year before the index visit to examine risk for first attempt and reattempts. Adjusted analyses revealed that pain intensity scores were significantly associated suicide attempts after the index visit. Specifically, veterans with severe and moderate pain had a hazards ratio of 1.41 (95% confidence interval = 1.21-1.63) and 1.29 (95% confidence interval = 1.13-1.47), respectively. These results were consistent for those without a past-year attempt and for those with a past-year attempt. The results suggest that moderate to severe pain intensity in the year before initiating pain specialty services may be a useful indicator of suicide risk, even when considered in the context of key factors.PerspectiveThis study used national administrative and suicide surveillance data to assess the relationship between pain intensity and suicide attempts after an initial visit for pain specialty services among veterans. These findings highlight the potential usefulness of assessing pain intensity as an indicator for suicide risk.     

Sense of coherence and suicidality in suicide attempters: a prospective study

The usefulness of the Sense of Coherence (SOC) scale in the nursing setting is well-established, and an association between SOC and suicidality has been suggested. The aim was to test whether low SOC at index attempt is an independent predictor of suicidality at 2-month follow-up and of risk for repeat attempt. The study, which had a prospective cross-sectional design, included patients admitted to hospital after a suicide attempt. They were interviewed by means of Structured Clinical Interview for DSM-IV. Participants (n=155) completed the SOC scale and the Comprehensive Psychopathological Self-rating Scale for Affective Syndromes. Suicidality was rated with the Suicide Assessment Scale. Instruments were employed again at follow-up. Non-fatal/fatal repetition within 3 years was determined by review of hospital records. Low SOC at baseline predicted high suicidality at follow-up. The association remained after adjustment for major depression and affective symptom burden. Repeat attempts were made by 54 persons. Low baseline SOC was associated with repeat attempt, but the association did not remain after adjustment for major depression and symptom burden. Low SOC ratings could be a marker of risk for high suicidality in the aftermath of a suicide attempt. The SOC scale could be incorporated in nursing assessments of suicide attempters.     

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.     

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。     

Adolescent Suicide Risk Screening in the Emergency Department

Objectives: Many adolescents who die by suicide have never obtained mental health services. In response to this, the National Strategy for Suicide Prevention recommends screening for elevated suicide risk in emergency departments (EDs). This cross‐sectional study was designed to examine 1) the concurrent validity and utility of an adolescent suicide risk screen for use in general medical EDs and 2) the prevalence of positive screens for adolescent males and females using two different sets of screening criteria. Methods: Participants were 298 adolescents seeking pediatric or psychiatric emergency services (50% male; 83% white, 16% black or African American, 5.4% Hispanic). The inclusion criterion was age 13 to 17 years. Exclusion criteria were severe cognitive impairment, no parent or legal guardian present to provide consent, or abnormal vital signs. Parent or guardian consent and adolescent assent were obtained for 61% of consecutively eligible adolescents. Elevated risk was defined as 1) Suicidal Ideation Questionnaire‐Junior [SIQ‐JR] score of ≥31 or suicide attempt in the past 3 months or 2) alcohol abuse plus depression (Alcohol Use Disorders Identification Test‐3 [AUDIT‐3] score of ≥3, Reynolds Adolescent Depression Scale‐2 [RADS‐2] score of ≥76). The Beck Hopelessness Scale (BHS) and Problem Oriented Screening Instrument for Teenagers (POSIT) were used to ascertain concurrent validity. Results: Sixteen percent (n = 48) of adolescents screened positive for elevated suicide risk. Within this group, 98% reported severe suicide ideation or a recent suicide attempt (46% attempt and ideation, 10% attempt only, 42% ideation only) and 27% reported alcohol abuse and depression. Nineteen percent of adolescents who screened positive presented for nonpsychiatric reasons. One‐third of adolescents with positive screens were not receiving any mental health or substance use treatment. Demonstrating concurrent validity, the BHS scores of adolescents with positive screens and the POSIT scores of those with positive screens due to alcohol abuse and depression indicated substantial impairment. The addition of alcohol abuse with co‐occurring depression as a positive screen criterion did not result in improved case identification. Among the subgroup screening positive due to depression plus alcohol abuse, all but one (>90%) also reported severe suicide ideation and/or a recent suicide attempt. This subgroup (approximately 17% of adolescents who screened positive) also reported significantly more impulsivity than other adolescents who screened positive. Conclusions: The suicide risk screen showed evidence of concurrent validity. It also demonstrated utility in identifying 1) adolescents at elevated risk for suicide who presented to the ED with unrelated medical concerns and 2) a subgroup of adolescents who may be at highly elevated risk for suicide due to the combination of depression, alcohol abuse, suicidality, and impulsivity.     

Suicidal ideation, plans, and attempts in chronic pain patients: factors associated with increased risk

This study describes suicidal behavior in a cross-sectional sample of chronic pain patients and evaluates factors associated with increased risk for suicidal ideation. One hundred-fifty-three adults with nonmalignant pain (42% back pain) who were consecutively referred to a tertiary care pain center completed a Structured Clinical Interview for Suicide History, the McGill Pain Questionnaire, and the Beck Depression Inventory. Nineteen-percent reported current passive suicidal ideation (PSI), 13% had active thoughts of committing suicide (ASI), 5% had a current suicide plan, and 5% reported a previous suicide attempt. Drug overdose was the most commonly reported plan and method of attempt (75%). Thirteen-percent reported a family history of suicide attempt/completion. Pain-specific and traditional suicide risk factors were evaluated as predictors of current PSI and ASI. Logistic regression analyses revealed that a family history of suicide attempts/completions was associated with a 7.5 fold increase in risk of PSI (P=0.001) and a 6.6 fold increase in ASI (P=0.003), after adjusting for significant covariates. Having abdominal pain was associated with an adjusted 5.5 fold increase in PSI (P=0.05) and a 4.2 fold increase in ASI (P=0.10). Neuropathic pain significantly reduced risk for both PSI (P=0.002) and ASI (P=0.01). Demographics, pain severity, and depression severity were not associated with suicidal ideation in multivariate analyses. These findings highlight the need for routine evaluation and monitoring of suicidal behavior in chronic pain, especially for patients with family histories of suicide, those taking potentially lethal medications, and patients with abdominal pain.