The suicide assessment scale: an instrument assessing suicide risk of suicide attempters.

The Suicide Assessment Scale (SUAS), a scale constructed to measure suicidality over time, was administered to 191 suicide attempters. Its predictive validity was tested. SUAS ratings were compared to ratings from other scales, and related to age and psychiatric diagnoses including co-morbidity. Eight patients committed suicide within 12 months after the SUAS assessment. Apart from advanced age, high scores in the SUAS were significant predictors of suicide. From a receiver operating characteristic (ROC) analysis, we identified cutoff SUAS scores which alone and in combination with certain diagnostic and demographic factors are of apparent value in the clinical evaluation of suicide risk after a suicide attempt.     

The neuroscience of suicide

Various postmortem brain studies have provided evidence that reduced serotonin (5-HT) transmission in the ventrolateral prefrontal cortex (vlPFC) is associated with depression-related suicide. Suicide victims have fewer 5-HT transporter sites and a large number of postsynaptic 5-HT1A and 5-HT receptors in the vlPFC, which are implicated in behavioral inhibition and impulsivity. These could be compensatory changes in response to 5-HT hypofunction in depression and suicide. Selective serotonin reuptake inhibitors (SSRIs) are commonly used for the treatment of depression and suicidal ideation. 5-HT innervation of the PFC arises predominantly from 5-HT neurons in the brainstem dorsal raphe nucleus (DRN). In the DRN of suicide cases, 5-HT1A autoreceptors are increased and the levels of 5-HT biosynthetic enzyme, tryptophan hydroxylase (TPH), are reduced. Reduced 5-HT1A feedback inhibition and increased TPH may reflect compensatory changes in response to 5-HT hypofunction in depression-related suicide. Genetic polymorphisms in TPH, 5-HT transporter (5-HTTLPR allele), and 5-HT2A receptor were examined for their association with depression-related suicide, but no consistent associations were found. Stress is a risk factor for depression and is linked to hyperactivity of the hypothalamo-pituitary-adrenal axis and suicide. Corticotropin-releasing factor (CRF)-immunoreactive varicose fibers were detected in the DRN of suicide victims, suggesting that CRF neurons in the paraventricular nucleus of the hypothalamus and 5-HT neurons in the DRN may form a circuit in stress-induced depression. Alcoholics are at a significantly greater risk of suicide than the general population. Alcoholism is associated with alterations in the 5-HT system.     

The context of suicide

An analysis of eight cases of female suicide, drawn from Terman's Genetic Study of Genius sample, found little foreshadowing of suicide in the subjects' childhood and adolescence, absence of paternal involvement and concomitantly strong maternal influence, somatization of problems, perceived lack of accomplishment, and diminished sense of self-esteem in adulthood. Comparisons with male suicides in the Terman sample are discussed.     

The epidemiology of suicide

This paper focuses on the clinical importance of affective mixed states with special attention given to agitated depression, which has lost its status as a mixed state in the DSM and ICD systems. Following a historical review of the topic, the psychopathological elements are examined. Psychic and motor agitation are considered equally important for the definition of agitated depression and the concept of latent agitated depression is introduced for those major depressive episodes that become agitated following antidepressant treatment. The thesis is advanced that the erroneous nosologic position of agitated depression and its treatment as simple, unipolar depression is at least partly responsible for the problematic issues of the unfavourable treatment outcome and high suicide rates among depressive patients.

Sometimes it is more ‘inward anxiety and trembling’, a painful tension?…?sometimes it is an anxious restlessness, which finds an outlet in the most varied gestures, in states of violent excitement, and in heedless attempts at suicide. These moods are most frequently found in the periods of transition between states of depression and mania; they are, therefore, probably most correctly regarded as mixed states of depression and manic excitability.

Emil Kraepelin, 1913     

The statistics of suicide

1.Why is suicide so important to study?Worldwide,there are about one million suicides annually.In the United States (USA) approximately 750,000 people died by suicide over the last 25 years.Suicides outnumber homicides by at least a 3:2 ratio in the USA.Deaths from suicide exceeded deaths from AIDS by 200000 in the past 20 years.Four times as many Americans died by suicide during the Vietnam War than from wartime fatalities.     

The epidemiology of suicide and attempted suicide among young Australians

OBJECTIVE: This paper summarises a report to the NHMRC the objectives of which were to review research into the epidemiology of youth suicide in Australia and identify gaps in research. METHOD: Literature searches were conducted. A limited amount of new data analysis was included to shed light on reliability issues of official Australian suicide data. RESULTS: The review examined suicide data systems, including issues to do with coroners, the Australian Bureau of Statistics and alternative systems. The epidemiological areas reviewed included: all ages, youth, age and gender, geographical, socioeconomic, marital, indigenous, migrants, suicides in custody and gay and lesbian suicides. CONCLUSION: While much is known about the epidemiology of youth suicide, much remains to be clarified. Study of indigenous issues is perhaps the most neglected area; study of family issues may be potentially be the most productive.