Identifying correlates of suicide attempts in suicidal ideators: a population-based study

BACKGROUND: Identification of factors that distinguish between ideators who act on their suicidal thoughts from those who do not is an important clinical and research objective. METHOD: We examined correlates of suicide attempts in suicidal ideators, members of a French-Canadian, school-based cohort. Suicidal thoughts were evaluated in adolescence and early adulthood in the total sample of suicidal ideators, who were then stratified into subgroups consisting of persistent ideators, male ideators and female ideators. RESULTS: In addition to persistent suicidal ideas [odds ratios (ORs) 2.1-2.8], Axis I psychopathology, female gender and childhood sexual abuse (CSA) were the most consistent correlates of suicide attempts. Externalizing disorders were significant contributors in persistent ideators [drug misuse: OR 2.8, 95% confidence interval (CI) 1.1-6.9] and in male ideators in particular (disruptive disorders: OR 5.9, 95% CI 2.2-16.0). In women, psychiatric co-morbidity also had a significant effect (OR 1.6, 95% CI 1.1-2.1). CSA was of relevance in both women (OR 1.2, 95% CI 1.1-1.4) and persistent ideators (OR 1.3, 95% CI 1.1-1.5). Personality traits showed gender-specific contribution with affective instability (OR 1.1, 95% CI 1.01-1.1) and anxiousness (OR 1.3, 95% CI 1.1-1.7) contributing in men and disruptive aggression (OR 1.1, 95% CI 1.03-1.3) in women. CONCLUSIONS: Correlates of suicide attempts in suicidal ideators vary as a function of the persistence of suicidal ideas and gender. This heterogeneity across subgroups of suicidal ideators may be attributed, at least in part, to differences between the sexes, early environmental adversity, maladaptive personality, and psychiatric symptoms. Further exploration and continued prospective follow-up is necessary to examine these possibilities.     

Personality traits as correlates of suicide attempts and suicidal ideation in young adults

BACKGROUND: Adults in their twenties appear to be at high risk for suicidal behaviors (SBs) and there is substantial evidence suggesting that certain personality traits may increase individual vulnerability to suicide. METHOD: We investigated relationships of personality traits with two SBs in a cohort (n=1140) of 21- to 24-year-old adults, representative of the general population of Quebec. Subjects were assessed using a series of structured diagnostic and personality trait questionnaires. Multivariate logistic regression analyses were employed to identify personality trait correlates of suicide-attempt history and serious suicidal ideation in the context of other known risk factors, such as psychopathology and experiences of childhood sexual and physical abuse. RESULTS: Traits of conduct problems contributed to both suicide attempts [odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01-1.06] and suicidal ideation (OR 1.04, 95% CI 1.02-1.07), while identity problems (OR 1.10, 95% CI 1.07-1.13) and gender-moderated impulsivity contributed exclusively to suicidal ideation. CONCLUSIONS: Personality traits may make independent contributions to current suicidal ideation and previous suicide attempts in certain subgroups of suicidal individuals. In order to further explore their utility as markers of suicide risk and targets of intervention further investigation in clinical samples and other cultural and age groups is necessary.     

Impulsive-aggressive behaviours and completed suicide across the life cycle: a predisposition for younger age of suicide

BACKGROUND: It is unclear whether the association between impulsive-aggressive behaviours and suicide exists across different ages. METHOD: Via psychological autopsy, we examined a total of 645 subjects aged 11-87 years who died by suicide. Proxy-based interviews were conducted using the SCID-I & SCID-II or K-SADS interviews and a series of behavioural and personality-trait assessments. Secondarily, 246 living controls were similarly assessed. RESULTS: Higher levels of impulsivity, lifetime history of aggression, and novelty seeking were associated with younger age of death by suicide, while increasing levels of harm avoidance were associated with increasing age of suicide. This effect was observed after accounting for age-related psychopathology (current and lifetime depressive disorders, lifetime anxiety disorders, current and lifetime substance abuse disorders, psychotic disorders and cluster B personality disorders). Age effects were not due to the characteristics of informants, and such effects were not observed among living controls. When directly controlling for major psychopathology, the interaction between age, levels of impulsivity, aggression and novelty seeking predicted suicide status while controlling for the independent contributions of age and these traits. CONCLUSIONS: Higher levels of impulsive-aggressive traits play a greater role in suicide occurring among younger individuals, with decreasing importance with increasing age.     

Sleep and adolescent suicidal behavior

STUDY OBJECTIVES: Suicide risk begins to increase during adolescence. Adolescents do not get enough sleep and are also at risk for many sleep disturbances. This study examined the association between sleep patterns and sleep problems and adolescent suicidal behavior. DESIGN AND SETTING: A questionnaire survey of adolescents attending school was conducted in one prefecture of Shandong Province, People's Republic of China. PARTICIPANTS: A total of 1,362 adolescents attending school (mean age 14.6 years, 60% males) participated in the survey. MEASUREMENTS: Respondents completed a self-administered questionnaire that asked about sleep patterns, sleep problems, suicidal behavior, depressive symptoms, and demographic characteristics of the family and adolescent. RESULTS: Overall, 19.3% of the sample reported having suicidal ideation, 10.5% having suicide attempts in the past 6 months, 16.9% having insomnia symptoms, 2.3% having taken hypnotic medication, and 48.9% having experience of nightmares in the past month. Mean night sleep duration was 7.6 hours (SD = 0.8). Logistic regression analyses showed that sleeping less than 8 hours at night (OR = 2.89, 95% confidence interval [CI] = 1.07-7.81) and frequent nightmares (OR = 2.43, 95% CI = 1.76-3.35) were significantly associated with increased risk for suicide attempts after adjustment for age, sex, father's occupation, and depressive symptoms and that nightmares (OR = 1.69, 95% CI = 1.20-2.38) were also significantly related to suicidal ideation. CONCLUSION: These findings demonstrate the association between short sleep duration and nightmares and suicidal behavior and highlight the potential role of sleep intervention in the prevention of adolescent suicide.     

Non-consensual sex experienced by men who have sex with men: prevalence and association with mental health

Little is known about the psychosocial factors associated with sexual assault experienced by males. Men (N=358), 19-35 years of age, recruited by community outreach, completed questionnaires. Eligibility criteria included: being HIV-negative and self-identifying as gay or bisexual. Lifetime prevalence rates of childhood sexual abuse, juvenile prostitution, and adult sexual assault were determined. The mental health of this population was explored including associations between sexual victimization and mental health disorders (alcohol abuse, suicidal ideation and attempts, mood disorders, and poor self-esteem). Almost 1 in 10 of the men had engaged in juvenile prostitution, 14% were forced into sexual activity before 14 years of age, and 14% were sexually victimized after the age of 14. Those exposed to non-consensual sex were 2.9 (95% CI: 1.8-4.7) times more likely to abuse alcohol than those free of victimization. Those who reported childhood sexual abuse were 3.3 (95% CI: 1.7-6.4) times more likely to have attempted suicide. Juvenile prostitution was associated with current depression (OR=6.4; 95% CI: 2.8-14.9). Health professionals have the responsibility to respond competently and sensitively to victims of sexual violence. To do this, many need to recognize the prevalence of male sexual trauma, to deconstruct their personal beliefs about same-sex sexual violence, and to learn to ask sensitive questions in their assessment interviews.     

Personality disorders and health problems distinguish suicide attempters from completers in a direct comparison

Background

Whether suicide attempters and completers represent the same population evaluated at different points along a progression towards suicide death, overlapping populations, or completely different populations is a problem still unresolved.

Methods

446 Adult suicide attempters and knowledgeable collateral informants for 190 adult suicide probands were interviewed. Sociodemographic and clinical data was collected for both groups using semi-structured interviews and structured assessments. Univariate analyses and logistic regression models were conducted to explore the similarities and differences between suicide attempters and completers.

Results

Univariate analyses yielded significant differences in sociodemographics, recent life events, impulsivity, suicide intent, and distribution of Axis I and II disorders. A logistic regression model aimed at distinguishing suicide completers from attempters properly classified 90% of subjects. The most significant variables that distinguished suicide from attempted suicide were the presence of narcissistic personality disorder (OR=21.4; 95% CI=6.8–67.7), health problems (OR=20.6; 95% CI=5.6–75.9), male sex (OR=9.6; 95% CI=4.42–20.9), and alcohol abuse (OR=5.5; 95% CI=2.3–14.2).

Limitations

Our study shares the limitations of studies comparing suicide attempters and completers, namely that information from attempters can be obtained from the subject himself, whereas the assessment of completers depends on information from close family or friends. Furthermore, different semi-structured instruments assessed Axis I and Axis II disorders in suicide attempters and completers. Finally, we have no data on inter-rater reliability data.

Conclusions

Suicide completers are more likely to be male and suffer from alcohol abuse, health problems (e.g. somatic illness), and narcissistic personality disorder. The findings emphasize the importance of implementing suicide prevention programs tailored to suicide attempters and completers.     

A case-control study of 92 cases of in-patient suicides

BACKGROUND: A significant number of patients committed suicide while receiving in-patient treatment in psychiatric hospitals. Most previous studies on psychiatric in-patient suicides were conducted in the West. This study aimed to describe the characteristics and identify risk factors of suicides occurring during psychiatric in-patient care in Hong Kong. METHOD: The case record data of suicide cases (Coroner's verdicts of suicides and undetermined deaths) from all public psychiatric hospitals in the entire region within a 3 years' period (N=93) were compared with matched controls. RESULTS: In-patient suicide rate was 269/100,000 admissions. Majority had schizophrenia. Suicide usually occurred after the first month of admission, during leave, and by jump from heights. There were little case-control differences in treatment received. Multiple conditional logistic regression found 5 risk factors: previous history of deliberate self-harm (OR=4.60, 95% CI=1.57-13.5); admitted because of suicidal behaviour (OR=3.92, 95% CI=1.3-11.9); depressive symptoms at time of suicide (OR=8.53, 95% CI=1.4-52); away without leave at anytime during index admission (OR=17, 95% CI=1.76-163); and extrapyramidal side effects/akathisia at time of suicide (OR=10.8, 95% CI=1.75-66.7). LIMITATIONS: Retrospective case record review depended on non-standardized and variable quality of case notes entry. Matching for hospitals in this study would make the comparison between hospitals impossible. Although this is the second largest case-control study of psychiatric in-patient suicide, the estimated power suggested subtle risk factors would be missed. CONCLUSION: Majority of in-patient suicides occurred at a time of perceived low risk. A high sensitivity to the risk of suicide and vigorous treatment of depressive symptoms were indicated. The care processes during the index admission could bear strong influences on the risk of in-patient suicides.     

Pain, Mood, and Substance Abuse in HIV: Implications for Clinic Visit Utilization, Antiretroviral Therapy Adherence, and Virologic Failure

BACKGROUND:: Cooccurring pain, mood disorders, and substance abuse are common in HIV-infected patients. Our objective was to investigate the relationship between pain, alone and in the context of mood disorders and substance abuse, on clinic utilization, antiretroviral therapy adherence, and virologic suppression. METHODS:: Pain, mood disorders, and substance abuse were assessed at the first visit. No-show and urgent visits were measured over a 1-year period. Models were adjusted for age, race, sex, insurance status, CD4 T-lymphocyte count, and HIV risk factor. RESULTS:: Among 1521 participants, 509 (34%) reported pain, 239 (16%) had pain alone, 189 (13%) had pain and a mood disorder, and 30 (2%) had pain and substance abuse. In univariate models, participants with pain, mood disorders, and substance abuse had higher odds of a no-show visit than those without these conditions [odds ratio (OR), 1.4; 95% confidence interval (CI), 1.1-1.8; OR, 1.5; 95% CI, 1.2-1.9; OR, 2.0; 95% CI, 1.4-2.8, respectively]. In the multivariable model, pain increased the odds of a no-show visit only in participants without substance abuse (OR, 1.5; 95% CI, 1.1-1.9) and pain reduced the odds of a no-show visit in participants with substance abuse (OR, 0.5; 95% CI, 0.2-0.9; P for interaction = 0.0022). CONCLUSIONS:: In this study, pain increased the odds of no-show visits but only for participants without substance abuse. Because pain, mood disorders, and substance abuse are highly prevalent in HIV-infected patients, our findings have implications for HIV treatment success. Interventions that incorporate pain management may be important for improving health outcomes in patients living with HIV infection.     

Suicidal ideation and suicide attempts among child and adolescent psychiatric inpatients in Finland

BACKGROUND: The aim was to study the prevalence of, and factors associated with, suicidal ideation and suicide attempts among child and adolescent inpatients during hospital treatment. METHODS: The target group included all the child and adolescent psychiatric inpatients (n=504) in Finland on a chosen day. Suicidality was determined by the psychiatrist responsible for the inpatient treatment, using a questionnaire also exploring demographic, diagnostic, and treatment characteristics, as well as traumatic events of the patient. RESULTS: The rate of suicidal ideation was 37.6%, and suicide attempts 10.8%. The factors independently associated with suicidal ideation in multivariate analysis were the following: being affected by open adult sexual behaviour (OR 3.2), having depression (OR 2.5) or conduct disorder (OR 2.4) diagnosis, and manifesting violent acts (OR 2.4). The factors independently associated with suicide attempts were: manifesting violent acts (OR 8.1), having depression diagnosis (OR 5.3), being affected by open adult sexual behaviour (OR 4.9), involuntary treatment (OR 4.7), and being of the female sex (OR 3.7). Suicidal ideation was particularly prevalent among boy patients having conduct disorders, manifesting violent acts, and belonging to the age group under 13 years old. Suicide attempts were particularly prevalent among depressive adolescent girl patients. LIMITATIONS: Suicidality was based solely on the clinician's evaluation. CONCLUSIONS: Suicidal ideation and suicide attempts are common among child and adolescent psychiatric inpatients. Particular attention should be directed to inpatients who manifest violent acts or have depressive disorder.     

Comorbidity of mental disorders in the post-mortem diagnosis of completed suicide in children and adolescents

In a psychological autopsy of 21 children and adolescents aged 11-19 years who committed suicide as compared with a matched-pair control group, 95% of the suicide victims and 48% of the controls had at least one serious diagnosable mental disorder (P less than 0.02). The presence of two or more mental disorders (comorbidity) was the rule occurring in 81% of the suicide victims and 29% of the controls (P less than 0.001). Mood disorders such as major depression, major depression superimposed on dysthymic disorder and dysthymic disorder coexisted with either alcohol and drug abuse, conduct disorder or other mental disorders in 76% of the victims and 24% of the controls (P less than 0.025). The suicide victims experienced significantly more psychosocial stressors and the poorest level of adaptive functioning. This study suggests that suicide in children and adolescents very frequently is the outcome of serious psychiatric disorders, particularly when associated with drug and alcohol abuse.     

Suicide in female nurses in England and Wales

BACKGROUND: Female nurses appear to have an increased risk of suicide but the reasons are unknown. METHOD: We have concluded a study of nurse suicides (N = 106) in England and Wales, including a psychological autopsy study (N = 42) and case-control comparison with living nurses (N = 84). RESULTS: Nearly three-quarters of the nurse suicides had previous contact with psychiatric services and almost half had been psychiatric in-patients in the past. There were particularly marked differences between the cases and controls for current psychiatric disorder (90.5% v. 7.1%, OR = 68.5), personality disorder (38.1% v. 12%, OR = 32), and history of deliberate self-harm (71.4% v. 2.4%, OR = 58.5). Family background and social factors (especially concerning interpersonal relationships) also distinguished the two groups. Smoking and serious alcohol abuse were much more frequent in the suicides. There was some indication that while many of the suicides were in contact with psychiatric services, care may not have been optimal in some cases. CONCLUSIONS: The most important strategies for suicide prevention in nurses are in prevention, detection and management of psychiatric disorders. In assessing suicide risk a history of DSH and the presence of comorbid psychiatric and personality disorders are particularly important.     

Risk factors for pneumonia in urban-dwelling HIV-infected women: a case-control study in Nairobi,Kenya

In sub-Saharan Africa, respiratory tract infections (RTI) are the leading cause of serious morbidity and mortality in HIV-infected persons. This study sought to investigate demographic, socioeconomic, and environmental risk factors for pneumonia in a cohort of HIV-infected women. The authors performed a nested case-control study in a cohort of HIV-1-infected adults followed in Nairobi, Kenya. Thirty-nine women who developed pneumonia during the follow-up period were selected as cases, and 66 women who did not develop pneumonia were randomly chosen to serve as control subjects. A questionnaire was administered in subjects' homes that assessed demographics, home environment, and socioeconomic status. Women were followed in the cohort for a median of 36.8 months (range, 27.3-39.3). Adjusting for length of follow-up period, factors associated with lower socioeconomic status (lower monthly spending [OR = 3.2; 95% CI, 1.2-8.4 per 10,000 Kenyan shilling decrease], having no savings [OR = 4.1; 95% CI, 1.4-11.9], less sturdy home construction material such as mud or cement walls [OR = 2.6; 95% CI, 1.1-5.9] or dirt floors [OR = 2.8; 95% CI, 1.0-7.6], and lack of a window in the home [OR = 5.5; 95% CI, 0.9-32.2]) and being widowed (OR = 4.3; 95% CI, 1.2-15.1) or single (OR = 3.3; 95% CI, 1.0-11.2) were associated with an increased risk of pneumonia. In multivariate analysis, widowed (AOR = 5.9; 95% CI, 1.3-26.3), single (AOR = 7.7; 95% CI, 1.6-36.4), and divorced (AOR = 4.5; 95% CI, 1.0-20.1) women, those without savings (AOR = 3.7; 95% CI, 1.2-11.7), and those living in more crowded and contagious conditions (AOR = 1.5; 95% CI, 1.1-2.1) remained at increased risk of pneumonia. If confirmed by prospective investigation, these findings could help identify persons and subpopulations of HIV-infected women with the greatest risk of pneumonia.     

Association of Overweight with the Prevalence of Lifetime Psychiatric Disorders and Suicidality: General Population-based Study in Korea

Many epidemiological studies suggest that overweight is associated with an elevated risk of psychiatric disorders and suicidal tendency. However, findings vary across studies, and some have contradictory results. We investigated the relationship of overweight with a range of psychiatric disorders and suicidality in the Korean general population. A multistage cluster sampling design was adopted. A total of 6,022 participants aged 18–74 years completed face-to-face interviews (response rate: 78.7%) including assessment of psychiatric disorders, suicidality, and height and weight. Overweight (defined as body mass index of ≥ 25) was associated with an increase in the lifetime prevalence of depressive disorders (adjusted odds ratio [AOR] 1.38; 95% confidence interval [CI], 1.07–1.77), suicidal ideation (AOR, 1.42; 95% CI, 1.20–1.68), and suicidal plans (AOR, 1.44; 95% CI, 1.02–2.03), controlling for sociodemographic variables. Subgroup analysis found that the association between overweight and depressive disorders exists only in women aged 18–44 years (AOR, 1.75; 95% CI, 1.07–2.89) while the association of overweight with suicidal ideation (AOR, 2.08; 95% CI, 1.53–2.82) and suicide plans (AOR, 2.59; 95% CI, 1.25–5.37) existed only in men aged 18–44 years. Overweight was associated with increased odds of nicotine use disorders in women aged 18–44 years (AOR, 2.35; 95% CI, 1.02–5.43), but the association was in the opposite direction in men aged 45–74 years (AOR, 0.64; 95% CI, 0.43–0.94). In conclusion, overweight is related to various psychiatric disorders and suicidality in Korea. Policy makers and clinicians should pay more attention to the mental health of overweight individuals.     

Vulnerability and resiliency to suicidal behaviours in young people

BACKGROUND: We aimed to examine factors that influence vulnerability/resiliency of depressed young people to suicidal ideation and suicide attempt. METHOD: Data were gathered during a 21-year longitudinal study of a birth cohort of 1,265 New Zealand young people. Measures included: suicide attempt; suicidal ideation; major depression; childhood, family, individual and peer factors. RESULTS: Young people who developed major depression had increased rates of suicidal ideation (OR = 54: 95% CI 4.5-6.6) and suicide attempt (OR = 12.1; 95% CI 7.9-18.5). However, the majority of depressed young people did not develop suicidal ideation or make suicide attempts, suggesting that additional factors influence vulnerability or resiliency to suicidal responses. Factors influencing resiliency/vulnerability to suicidal responses included: family history of suicide; childhood sexual abuse; neuroticism; novelty seeking; self-esteem; peer affiliations; and school achievement. These factors operated in the same way to influence vulnerability/resiliency among those depressed and those not depressed. CONCLUSIONS: Vulnerability/resiliency to suicidal responses among those depressed (and those not depressed) is influenced by an accumulation of factors including: family history of suicide, childhood sexual abuse, personality factors, peer affiliations and school success. Positive configurations of these factors confer increased resiliency, whereas negative configurations increase vulnerability.     

Childhood trauma and psychiatric comorbidities in patients with depressive disorder in primary care in Chile

Childhood trauma is associated with different psychiatric disorders during adulthood. These disorders are often presented in comorbidity with depression. Objective: To establish the relationship between psychiatric comorbidities and childhood traumatic events in patients with depression in Chile. Methods: Three hundred and ninety-four patients with major depression were assessed using the MINI International Neuropsychiatric Interview and a screening for childhood trauma. Results: Social anxiety disorder was associated with having witnessed domestic violence during childhood (OR = 2.2, CI 1.2 - 3.8), childhood physical abuse (OR = 2.7, CI 1.6 - 4.4), physical injury associated with physical abuse (OR = 2.3, CI 1.3 - 4.7) and sexual abuse by a non-relative (OR = 2.7, CI 1.3 - 4.2). Posttraumatic stress disorder was associated with physical injury associated with physical abuse (OR = 1.9, CI 1.1 - 3.6), sexual abuse by a relative (OR = 3.2, IC 1.8 - 5.9) and sexual abuse by a non-relative (OR = 2.2, CI 1.2 - 4.1). Antisocial personality disorder was associated with traumatic separation from a caregiver (OR = 3.2, CI 1.2 - 8.5), alcohol abuse by a family member (OR = 3.1, CI 1.1 - 8.1), physical abuse (OR = 2.8, CI 1.1 - 6.9) and sexual abuse by a non-relative (OR = 4.8, CI 1.2 – 11.5). Panic disorder was associated with sexual abuse by a relative (OR = 1.9, CI 1.1 - 3.1). Generalized anxiety disorder was associated with sexual abuse by a non-relative (OR = 1.9, CI 1.1- 3.3). Conclusions: Further clinical recognition is required in patients seeking help for depression in primary care. This recognition must take into account the patient’s current psychiatric comorbidities and adverse childhood experiences.     

Risk factors for suicide in China's youth: a case-control study

BACKGROUND: Suicide is the most common cause of death among youth in China. METHOD: A case-control psychological autopsy study in 23 geographically representative disease surveillance points around China collected information from family members and close associates of 114 persons aged 15-24 years who died by suicide (cases) and 91 who died of other injuries (controls). RESULTS: Among the 114 suicides 61% were female, 88% lived in rural villages, 70% died by ingesting pesticides (most commonly stored in the home), 24% previously attempted suicide, and 45% met criteria of a mental illness at the time of death. Multivariate logistic regression identified several independent risk factors: severe life events within 2 days before death (OR 31.8, 95% CI 2.6-390.6), presence of any depressive symptoms within 2 weeks of death (OR 21.1, 95% CI 4.6-97.2), low quality of life in the month before death (OR 9.7, 95% CI 2.8-34.1), and acute stress at time of death (moderate: OR 3.1, 95% CI 0.8-11.9; high: OR 9.1, 95% CI 1.2-66.8). A significant interaction between mental illness at time of death and gender indicated that diagnosis was an important predictor of suicide in males (OR 14.0, 95% CI 2.6-76.5) but not in females (OR 0.3, 95% CI 0.0-3.6). Prior suicide attempt was related to suicide in the univariate analysis (OR 57.5) but could not be included in the multivariate model because no controls had made prior attempts. CONCLUSIONS: Suicide prevention efforts for youth in China must focus on restricting access to pesticides, early recognition and management of depressive symptoms and mental illnesses, improving resiliency, and enhancing quality of life.     

Suicide in depressive disorders: a retrospective case-control study of 127 suicides

BACKGROUND: Depressive disorders are associated with a significant risk of suicide. Inpatient status and recent discharge from hospital have been identified as times of high risk of suicide within the course of illness. METHOD: A matched retrospective case control study of 127 patients with depression requiring inpatient care who died by suicide as inpatients or in the 12 months following discharge from hospital. Single and multivariable conditional logistic regression identified independent risk and protective factors for suicide. RESULTS: A history of deliberate self harm is a significant risk factor for suicide in patients with depression (OR 6.96; 95% CI 3.41-14.19), as is living alone (OR 2.11; 95% CI 1.15-3.87) and paid employment (OR 2.80; 95% CI 1.48-5.32). Admission to hospital during social crisis is associated with a reduction in suicide risk (OR 0.43; 95% CI 0.24-0.75). LIMITATIONS: This is a retrospective case-control study, using clinical data not originally collected for research purposes. CONCLUSIONS: General population risk factors for suicide are less predictive of suicide in patients with depression requiring inpatient treatment. Clinicians need to be aware of factors which increase or reduce the risk of suicide in this group.     

Anxiety disorders and suicidal behaviours in adolescence and young adulthood: findings from a longitudinal study

BACKGROUND: The aim of this study was to estimate the extent to which anxiety disorders contribute to an increase in suicidal behaviour after controlling for both observed and non-observed sources of confounding. METHOD: Data were collected from the Christchurch Health and Development Study (CHDS), a 25-year longitudinal study of over 1000 participants. Measures of anxiety disorders [phobia, generalized anxiety disorder (GAD), panic disorder], major depression (MD), substance use disorders, conduct/antisocial personality disorder, stressful life events, unemployment, and suicidal ideation/attempts for subjects aged 16-18, 18-21 and 21-25 years were used to fit random and fixed effects regression models of the associations between anxiety disorders and suicidal behaviours. RESULTS: Anxiety disorders were strongly associated with suicidal ideation/attempts. Any single anxiety disorder increased the odds of suicidal ideation by 7.96 times [95% confidence interval (CI) 5.69-11.13] and increased the rate of suicide attempts by 5.85 times (95% CI 3.66-9.32). Control for co-occurring mental disorders, non-observed fixed confounding factors and life stress reduced these associations [suicidal ideation odds ratio (OR) 2.80, 95% CI 1.71-4.58; suicide attempts incidence rate ratio (IRR) 1.90, 95% CI 1.07-3.39]. Rates of suicidal behaviour also increased with the number of anxiety disorders. Estimates of the population attributable risk suggested that anxiety disorders accounted for 7-10% of the suicidality in the cohort. CONCLUSIONS: Anxiety disorders may be a risk factor for suicidality, even after controlling for confounding, with risks increasing with multiple anxiety disorders. Management of anxiety disorders may be an important component in strategies to reduce population rates of suicide.     

Personality disorders and depressive symptoms in late luteal phase dysphoric disorder

BACKGROUND: Although many significant studies of late luteal phase dysphoric disorder (LLPD) have been carried out, some conflicting findings on the relationships between personality disorders, depressive symptoms, hostility and LLPD deserve further investigation. METHODS: Forty-three LLPD patients and 85 control subjects, evaluated by prospective daily ratings during two symptomatic cycles, received a detailed psychiatric evaluation, including the sections for psychotic, affective and anxiety disorders of the Structured Clinical Interview for DSM-III-R nonpatient version and the section for personality disorders; the Buss Durkee Inventory for Assessing Different Kinds of Hostility and the Montgomery-Asberg Depression Rating Scale. RESULTS: The odds of suffering from LLPD are about nine-fold (crude odds ratio, OR = 9.23, 95% confidence interval, CI 3.98-21.39) among women with mild or moderate depressive symptoms. When two age strata (below and above 30) are analyzed separately, the association between LLPD and depressive symptoms is strong and positive in both strata, while the association between LLPD and avoidant personality disorder is found only among older women (adjusted OR = 8.26, p < 0.05, 95% CI 1.03-66.35). CONCLUSIONS: The major finding from this preliminary study is the association between LLPD and depressive symptoms. Conversely, the association between LLPD and avoidant personality disorder remains controversial and seems to be dependent on age. Our findings support the hypothesis that LLPD and avoidant personality disorder may be considered as part of the spectrum of recurrent mood disorder rather than as qualitatively distinct nosological entities. Future studies are needed, adopting prospective, longitudinal assessments of personality prior to the onset of LLPD.     

江苏盐城地区留守儿童抑郁状况及相关因素

目的:了解江苏盐城地区留守儿童的抑郁状况及相关的影响因素。方法:采用自制的一般资料问卷及儿童抑郁问卷(Children's Depression Inventory,CDI)对盐城地区3所农村中心小学356名留守儿童进行调查。结果:留守儿童的抑郁检出率为25.6%。Logistic回归分析显示,与父母交流频率为每半年(P0.001,OR=7.321,95%CI=2.876~15.128)、双亲缺失型留守儿童(P=0.021,OR=2.134,95%CI=1.654~6.980)、交流中谈论日常琐事(P=0.006,OR=4.321,95%CI=1.908~9.978)、家庭年收入为0~2000元(P=0.012,OR=3.223,95%CI=2.011~8.830)、5~6年级(P=0.003,OR=8.342,95%CI=2.113~19.232)、11~13岁(P=0.015,OR=5.299,95%CI=1.809~15.098)为留守儿童抑郁发生的危险因子,而交流内容为自我感受(P=0.001,OR=0.342,95%CI=0.190~0.799)、1~2年级(P0.001,OR=0.543,95%CI=0.221~0.879)、7~8岁(P0.001,OR=0.655,95%CI=0.207~0.911)为留守儿童抑郁的抗性因素。结论:盐城地区留守儿童的抑郁发生率较高,危险因素和抗性因素应当给予关注。