Actual Suicide Attempts Research Articles

Clinical features, impulsivity, temperament and functioning and their role in suicidality in patients with bipolar disorder.

Our aim was to analyse sociodemographic and clinical differences between non-suicidal (NS) bipolar patients (BP), BP reporting only suicidal ideation (SI) and BP suicide attempters according to Columbia-Suicide Severity Rating Scale (C-SRSS) criteria. Secondarily, we also investigated whether the C-SRSS Intensity Scale was associated with emergence of suicidal behaviour (SB). A total of 215 euthymic bipolar out-patients were recruited. Semistructured interviews including the C-SRSS were used to assess sociodemographic and clinical data. Patients were grouped according to C-SRSS criteria: patients who scored ≤1 on the Severity Scale were classified as NS. The remaining patients were grouped into two groups: 'patients with history of SI' and 'patients with history of SI and SB' according to whether they did or did not have a past actual suicide attempt respectively. Patients from the three groups differed in illness onset, diagnosis, number of episodes and admissions, family history, comorbidities, rapid cycling and medication, as well as level of education, functioning, impulsivity and temperamental profile. Our results suggest that increased impulsivity, higher rates of psychiatric admissions and a reported poor controllability of SI significantly increased the risk for suicidal acts among patients presenting SI.

Tedium vitae, death wishes, suicidal ideation and attempts in Kenya-prevalence and risk factors.

BackgroundThere has been no previous household population study of suicidal ideation and attempts in Kenya. Therefore this study aimed to establish the prevalence of suicidal ideation and attempts in a rural population in Kenya, and to assess risk factors.MethodsAn epidemiological survey of a household population, using standardised structured interviews. We examined the prevalence of suicidal ideation and suicide attempts and the predictors of suicidal thoughts and attempts, using STATA to calculate unadjusted and adjusted odds ratios.ResultsA quarter of the sample (24.1 %) had thought that life was not worth living (tedium vitae) at some point in their lives, while a fifth had experienced death wishes at some stage. About 7.9 % reported suicidal thoughts and 1.9 % had made actual suicide attempts at some point in their lives. It can be seen that the prevalence of suicidal thoughts was 0.7 %, 4.2 %, 3.7 % and 7.9 % for last week, last year, at some other time, and lifetime respectively, while the prevalence of suicidal attempts was 0.5 %, 1.2 %, 0.7 and 1.9 % respectively.In the adjusted analysis of factors associated with suicidal thoughts, being female (OR 1.8, p = 0.017), having CMD (OR 2.7, p = 0.001), having a number of recent life events (OR 2.3, p = 0.001 for 2–3 life events and OR 2.6, p = 0.004 for 4 or more life events), and having a large social group size (OR 7.7, p = 0.006 for social group size of 4–8 and OR 9.1, p = 0.003 for social group size of 9 or more) were all associated with increased rates of life time suicidal thoughts, but psychotic symptoms were no longer significant after adjustment for the other variables. In the adjusted analysis of suicide attempts, having any psychotic symptoms (OR 5.1, p = 0.001) was the only factor associated with suicide attempts after adjustment for other factors significant at the bivariate level.ConclusionSuicidal ideation and attempts pose a significant public health burden in this poor rural area of Kenya. The findings are relevant for mental health promotion and prevention programmes, public education and professional training programmes in relevant sectors, especially in front line health workers and social workers.

Self-reported sexual and psychosocial health among non-heterosexual Danes.

Little is known about the sexual and psychosocial health of non-heterosexual Danes. Based on a large population study, the aim of this article was to compare quality-of-life-related key variables of heterosexual and non-heterosexual men and women, aged 16-66. Cross-sectional data from the nationwide, representative Health and Morbidity Survey (n = 8496) were used to compare variables concerning both general and sexual well-being of self-identified heterosexual and non-heterosexual respondents. Nearly twice as many non-heterosexual than heterosexual men rated their sexual life as bad or very bad (22.5% versus 12.8%), while no statistical difference was seen among women (13.6% versus 10.6%). For both genders, significantly more non-heterosexuals than heterosexuals stated that their sexual needs were not met (17.9% versus 7.7% for men and 14.8% versus 6.9% for women), and significantly more non-heterosexuals reported acts of sexual violence (8.3% versus 2.1% for men and 35.8% versus 13.0% for women). Finally, non-heterosexual respondents had contemplated suicide more than twice as often as heterosexuals (15.9% versus 7.4% for men and 19.7% versus 8.3% for women). Actual suicide attempts were roughly three times more frequent in the non-heterosexual groups (8.3% versus 2.6 % for men and 11.8% versus 4.2% for women). Overall, non-heterosexual Danes reported higher degrees of sexual and/or psychosocial distress than heterosexuals further research is needed; but scientists, clinicians and public health workers should be aware that non-heterosexuals may pose specific health-related challenges and requirements.

Help-seeking behaviors among a sample of urban adolescents with a history of dating violence and suicide ideations

Using data from the 2011 New York City Youth Risk Behavior Survey, this study examined professional help-seeking behaviors among an urban sample of adolescent youth with a history of dating violence and suicidal ideations. Adolescents of both genders who reported a history of dating violence (physical and sexual abuse) as well as a history of suicidal ideations (thoughts of and actual suicide attempts) were selected for this study (N = 1923). Multivariate regression analyses were conducted to examine the relationship between the variables. Results indicated that approximately 17% of the sample reported seeking professional help in the past 12 months, with females being more likely to seek help. Nine percent of the sample reported that they were hit or slapped by boyfriend or girlfriend in the past 12 months, and almost 7% of the sample reported sexual abuse. Implications for future research are also addressed.

Kathleen O'Neill vs. Eugene G. O'Neill

Yale University Press's publication of Eugene O'Neill's lost play Exorcism last February (2012) astonished O'Neill scholars with the uncanny timing of its appearance—within a month of the one-hundredth anniversary of the play's setting, mid-March 1912. This was also within a few months of the actual events that inspired the play the previous December 1911, when O'Neill attempted suicide at Jimmy the Priest's.To many of us, the twist of fate seemed almost mystical. Here's another one:This past June I contacted the Westchester County Clerk's Office in New York State to inquire whether the file for O'Neill and Kathleen Jenkins's divorce proceedings were available to the public. The file clerk expressed some doubt, but after consulting with his superior, he informed me that it would be legally considered public information on July 9, 2012, exactly one hundred years and a day after the filing date of July 8, 1912.The legal testimonies found in Kathleen O'Neill vs. Eugene G. O'Neill are, like Exorcism, a blend of fact and fiction. But unlike the actors who performed Exorcism in good faith as drama (while at the same time understanding that it was based on O'Neill's actual suicide attempt), these divorce proceedings reveal evidence of perjury on the part of at least two witnesses, Kathleen's mother Kate Jenkins's legal aide James C. Warren and Kathleen herself. At one point, referring to O'Neill's hiring a prostitute to prove adultery, the presiding judge Joseph Morschauser asks Warren, “This was not pre-arranged with the plaintiff?” “No, sir,” he replied. “It was not.” Of course we now know it was. “You know the law in New York,” O'Neill's autobiographical protagonist Ned Malloy says in Exorcism, “There's only one ground that goes” (31). Earlier in the proceedings, Kathleen informs the court that O'Neill and she were married at Trinity Church in New Jersey on July 26, 1909, instead of the actual date, October 2, thus concealing the fact that their son, Eugene Jr., born on May 5, 1910, was conceived out of wedlock.More scholarship on these proceedings will come with time, of course, and Arthur and Barbara Gelb and Doris Alexander have already cited them in their most recent work. But whatever value future scholars assign them, one thing is sure: These testimonies, combined with Exorcism, provide the only first-hand accounts of those awful nights in late December 1911, nights that unalterably affected Eugene O'Neill's life, and, I think it can be said without hyperbole, over one hundred years of American theater history.What follows is a facsimile of the first page of the proceedings and a transcription of the rest. I have regularized the format to some degree, but tried to preserve the rawness of the court record. I have also silently corrected minor spelling errors, but left the occasional misspellings of names intact and followed by “[sic].”[Stamped]: filed / July 8, 1912 / Frank M. Buck / ClerkSupreme Court, Westchester County,kathleen o'neill, Plaintiff,vs.eugene j. [sic] o'neill, Defendant.Tried at White Plains, N.Y., June 10, 1912.Before: hon. joseph morschauser, Justice of the Supreme Court.Appearances: van schaich & brice, for the plaintiff.No appearance for the defendant.mrs. kathleen o'neill, being duly sworn as a witness on he[r] behalf, testified as follows:examined by mr. bricejames c. warren, being duly sworn as a witness on behalf of the plaintiff, testified as follows:examined by mr. bricethe courtedward ireland, being duly sworn as a witness on behalf of the plaintiff, testified as follows:examined by mr. brice [sic]the courtmr. briceedward mullen, being duly sworn as a witness on behalf of the plaintiff, testified as follows:examined by mr. bricefrank archibold, being duly sworn as a witness on behalf of the plaintiff, testified as follows:examined by mr. briceo'neill vs. o'neillAppearances: Mr. Walter C. NeisFor the Plaintiff.kate c. jenkins called as a witness on behalf of the plaintiff being duly sworn testified as follows:by mr. neis

Associations between non‐restorative sleep, short sleep duration and suicidality: Findings from a representative sample of Korean adolescents

This study clarifies the associations among sleep duration, non-restorative sleep, suicidal ideation and suicide attempts in a representative sample of Korean adolescents. Analyses are based on data from the 2007 Korean Youth Risk Behavior Web-based Survey. The survey used a cross-sectional, national and representative sample consisting of 78 843 students (grades 7-12) who were selected using a stratified, clustered, multistage sampling method. Logistic regression analysis was conducted to test the association between sleep and suicide variables while controlling for demographic characteristics and other potential risk factors of suicide. Fewer than 4 h of sleep and a lack of feeling refreshed after sleeping increased the likelihood of suicidal ideation but not of suicide attempts. Non-restorative sleep as well as short sleep duration are significantly associated with suicidal ideation in adolescents. This finding highlights the need to assess for both non-restorative sleep and short sleep duration when screening suicide risk in adolescents. Future research should examine the moderating or mediating effects of individual and environmental characteristics on the association between sleep and actual suicide attempt.

Victimization and Suicidality Among Dutch Lesbian, Gay, and Bisexual Youths

We examined Netherlands Institute for Social Research data, collected between May and August 2009, on 274 Dutch lesbian, gay, and bisexual youths. The data showed that victimization at school was associated with suicidal ideation and actual suicide attempts. Homophobic rejection by parents was also associated with actual suicide attempts. Suicidality in this population could be reduced by supporting coping strategies of lesbian, gay, and bisexual youths who are confronted with stigmatization by peers and parents, and by schools actively promoting acceptance of same-sex sexuality.

Love and suicide: the structure of the Affective Intensity Rating Scale (AIRS) and its relation to suicidal behavior.

BackgroundSuicide has been linked to intense negative affect. However, little is known about the range of affects experienced by suicidal persons, or the separate effects of affect valence and intensity. We examine a novel self-report scale, the 17-item Affective Intensity Rating Scale (AIRS), and its relation to suicidality in a high-risk sample.Methodology/Principal FindingsPatients presenting with suicidality were recruited from the Emergency Department in a large urban hospital, and completed a battery of assessments there. Structure of the AIRS was assessed using Maximum Likelihood Factor Analysis with Oblimin rotation. Convergent and divergent validity were assessed by regressing AIRS subscales against Brief Symptom Inventory subscales. Relation to suicidality was assessed by regression of suicide attempt status against scale and subscale scores, and individual items and two-way item interactions, along with significant clinical and demographic factors. 176 subjects were included in analyses. Three reliable subscales were identified within the AIRS measure: positive feelings towards self, negative feelings towards self, and negative feelings towards other. Only individual AIRS items associated significantly with suicide attempt status; strong ‘feelings of love’ associated positively with actual suicide attempt, while ‘feelings of calm’ and ‘positive feelings towards self’ associated negatively. Interaction analyses suggest ‘calm’ moderates the association of ‘love’ with suicide attempt.Conclusions/SignificanceFactor analysis of the AIRS is consistent with a circumplex model of affect. Affective dimensions did not predict suicidal behavior, but intense feelings of love, particularly in the absence of protective feelings of calm or positive self-view associated with current attempt.

Young Adults Show Highest Rate of Suicidal Thoughts

Back to table of contents Previous article Next article Professional NewsFull AccessYoung Adults Show Highest Rate of Suicidal ThoughtsJonathan WolfeJonathan WolfeSearch for more papers by this authorPublished Online:20 Jan 2012https://doi.org/10.1176/pn.47.2.psychnews_47_2_7-aAbstractApproximately 8.3 million U.S. adults, or 3.7 percent of the population, contemplated suicide in the prior year, according to a study from the Centers for Disease Control and Prevention (CDC).Published October 21, 2011, in the CDC’s Morbidity and Mortality Weekly Report, the study also found that 1 percent of adults made plans to commit suicide in the prior year, while 0.5 percent attempted suicide.For the study, Alex Crosby, M.D., of the CDC’s National Center for Injury Prevention and Control led a team of researchers from the CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA) in analyzing data on 92,264 individuals over age 18 who participated in SAMHSA’s National Survey on Drug Use and Health (NSDUH) during 2008 and 2009.All respondents to the NSDUH were asked during in-person interviews whether they had thought seriously about trying to kill themselves at any time during the preceding 12 months. Those who reported having had serious suicidal thoughts were then asked if they had made any plans or attempts to kill themselves in the past year.The CDC’s new report summarizes both national and state-level data on suicide-related issues by age, sex, and race/ethnicity. The agency noted that this is the first report to present state-specific findings on suicidal thoughts and behaviors.According to the CDC, the prevalence of suicidal thoughts and behaviors was significantly higher among adults aged 18 to 29 than for respondents aged 30 and older. Of those in the younger age group, 5.7 percent reported having suicidal thoughts in the prior year, 1.6 percent reported planning suicide, and 1 percent said they attempted suicide. This compares with 3.1 percent, 0.8 percent, and 0.3 percent, respectively, for the older cohort.Suicide plans and attempts did not differ significantly by gender; 3.9 percent of women reported having serious suicidal thoughts in the prior year, compared with 3.5 percent of men.Suicidal ideation was higher among non-Hispanic white adults (3.9 percent) than any other race/ethnicity, while non-Hispanic black adults reported the greatest number of suicide attempts (0.7 percent). Suicidal thoughts and planning were consistently lowest among Asians.When considering geographic region as a factor, the survey showed that suicidal thoughts were greater among adults living in the Midwest and West (4.3 percent and 4.1 percent, respectively) than those in the Northeast and South (3.5 percent and 3.2 percent, respectively). Suicidal plans followed the same regional trends as thoughts, though with less variation, while there was no difference in actual suicide attempts by region.Residents of Georgia reported the least number of suicidal thoughts, plans, and attempts (2.1 percent, 0.1 percent, and 0.1 percent, respectively), while 6.8 percent of those living in Utah reported thoughts of suicide, and Rhode Islanders had the greatest number of suicide attempts and plans (1.5 percent and 2.8 percent, respectively).“This research underscores the importance of collecting and using local information for prevention purposes,” said the CDC in a press release announcing the new report. The agency recommended the implementation of suicide-prevention strategies such as education campaigns for the general public and intensive cognitive-behavioral therapy for those at heightened risk.According to psychiatrist Paula Clayton, M.D., medical director of the American Foundation for Suicide Prevention, the study confirms much of the existing data on suicidal thoughts and behaviors, though the finding that there is no significant difference in suicide attempts between men and women is “startling.”“The results of this study are more useful on a global basis than an individual one,” said Clayton, pointing out that 90 percent of those who die by suicide suffer from a mental illness. “Psychiatrists should continue to focus on treating and keeping in treatment those with psychiatric disorders.”“Suicidal Thoughts and Behaviors Among Adults Aged ≥ 18 Years — United States, 2008–2009” is posted at www.cdc.gov/mmwr/pdf/ss/ss6013.pdf. ISSUES NewArchived

Gender-Specific Risk Factors for Suicidality Among High School Students

This study examined differences in three major risk areas associated with suicidality (suicidal ideation and suicide attempts) separately by gender: 1) substance use, 2) aggression/victimization, and 3) risky sexual behaviors. This study is a secondary data analysis of the Youth Risk Behavior Surveillance (YRBS) survey, consisting of data collected from a nationally representative sample of high school students. Early alcohol onset, having had sex before age 13, injection drug use, and being forced to have sex were associated with suicidality across gender. Smoking in girls was associated with making a plan to attempt suicide and actual suicide attempts. Fighting was related to suicidality for girls, while fighting in school was related to suicidality for boys. The importance of examining risk factors for suicidality separately for boys and girls is discussed.

Selective Serotonin Reuptake Inhibitors and Suicidality: A Guide for the Perplexed

Can J Psychiatry. 2009;54(2):72-74. The rate of suicidal adverse events is elevated around 2-fold in drugs, relative to placeboes, in clinical trials of antidepressants in children, adolescents, and young adults.1,2 Since the FDA's black box warning in 2003-2004, there has been a decline in the prescription rate of antidepressants, with no compensatory increase in referrals for psychotherapy in the United States.3 Families, patients, and clinicians are uncertain about how to balance the benefits and risks of antidepressants. In this brief review, the clinical significance of suicidal events is discussed along with the factors that may increase or attenuate the risk, possible explanations for this phenomenom, the benefits and risks of antidepressants, the public health implications of a decline in the use of SSRIs, and recommendations for clinicians. Suicidal adverse events are treatment-emergent increases in suicidal ideation or an actual suicide attempt. In more than 4300 participants in pediatric antidepressant clinical trials, there have been no deaths by suicide, and most of these events were increases in suicidal ideation, rather than actual suicide attempts. The actual risk difference for the occurrence of an event is not large. While the FDA initially reported a risk difference of 2%, a more recent re-analysis included more recently conducted trials found a risk difference of only 0.9%, which translates to a NNH of 121.1,2 Moreover, during the period of time when the rate of SSRI prescriptions was increasing, youth suicide rates were declining.4 One cannot necessarily infer a causal relation between the increase in the use of SSRIs in adolescents and a decline in the adolescent suicide rate. However, if antidepressants were associated with an increased risk for suicide, one would have expected an increase in adolescent suicide, which clearly was not the case. The nature of assessment for suicidal events has also been questioned. In most clinical trials, suicidal events are not surveyed systematically, but are reported spontaneously. In fact, in the subset of clinical trials that had systematic assessment, there was no difference between medication and placebo regarding systematically assessed suicidal ideation.2 However, other reports have shown similar rates of events, whether using usual adverse event reporting methods or by deriving the occurrence of events from systematically assessed measures of self-reported suicidal ideation. 5'6 Predictors of suicidal adverse events include previous suicidal behaviour and higher baseline levels of suicidal ideation, anger, and irritability.5 In the Treatment of Adolescent Depression Study,6 the rate of suicidal events was lower in the combination of antidepressant and CBT than in medication alone; however, in other clinical trials of more severely or chronically depressed youth, no protective effect was found for combination treatment.6,7 No relation has been established among dosage, adherence pattern, medication type, and risk for events, and while some promising pharmacogenetic findings have been reported, there is currently no clinical applicability of these findings. Several hypotheses, all unproven, have been advanced to explain the increased rate of suicidal events in antidepressant-treated patients, compared with those on placebo. These have included induction of akathisia, disinhibition, increasing energy of the patient to the point where he or she can actually make an attempt, induction of mania or a mixed state, or withdrawal from medication as a result of nonadherence, with induction of dysphoria and suicidality. The adage of suicidal behaviour coming as a consequence of improvement in mood is not consistent with data showing a high correlation between severity of suicidal ideation and severity of depression; further, most reported suicidal events were not attempts, but were increases in suicidal ideation. The induction of a mixed state can certainly lead to suicidal ideation and behaviour; however, while the risk of a suicidal event is higher in adolescents than in children, the risk of mania after treatment with an antidepressant is higher in younger children. …

How Can We Know Whether Antidepressants Increase Suicide Risk?

How Can We Know Whether Antidepressants Increase Suicide Risk?

Suicide Attempts Among Substance Use Disorder Patients: An Initial Step Toward a Decision Tree for Suicide Management

Little empirical data are available to develop profiles of patients who attempt suicide or to formulate a decision tree for suicide management. This study identifies profiles of patients who have a high risk of suicide attempt and takes a first step toward developing a decision tree to classify high-risk patients. Based on a cross-sectional, nationwide cohort of substance use disorder patients (N=34,251) in 150 Veterans Affairs (VA) facilities, a total of 5,671 patients who reported suicidal ideation in the 30 days before intake assessment were included in receiver operating characteristic (ROC) analyses to identify the 30-day risk of an actual suicide attempt. Clinical diagnostic and Addiction Severity Index interview data were used. Results provide an initial decision tree to classify high-risk patients with sensitivity ranging from 0.33 to 0.89, and specificity, from 0.42 to 0.87. The factors included in the decision tree encompass history of prior suicide attempts, current drinking to intoxication, current cocaine use, first occasion of suicidal ideation, and difficulty controlling violent behavior. To our knowledge, this is the first attempt to use empirical data to provide information to eventually establish a decision tree for clinical management of patients with suicidal ideation. The findings show that profiles of patients who are at high risk of suicide attempts can be effectively identified using ROC, with relatively good sensitivity and specificity.

Les récidives suicidaires : étude comparative des caractéristiques des suicidants à répétition et des primosuicidants admis aux urgences d’un hôpital général tunisien

Repeat suicide attempts constitute a special problem in suicidology. It seems that the excess mortality by suicide is even higher among the suicide repeaters. The objectives of this study were to estimate repeat suicide attempts frequency among a sample of suicide attempters admitted in the University Hospital Emergency of Monastir (Tunisia), to compare their features to those of first-time attempters and to determine factors associated with repeat suicide. A transversal survey involves a review of all patients committing suicide attempt and who are admitted in the emergency service during the second semester of 1999. Study variables included: demographic parameters, family and personal psychiatric history, axis I psychiatric disorder and circumstances of the present suicide attempt. Also, subjects were evaluated with the following scales: Montgomery and Asberg Depression Rating Scale (MADRS) and The Social Readjustment Rating Scale of Holms and Rahe. Among the 90 suicide attempters, 42.2% (n = 38) had made at least one previous suicide attempt. More repeaters than first-time attempters were divorced or separated: 21.1% versus 5.8% (p = 0.05). Belonging to a numerous family (n > or = 4) was more frequent in the repeaters group: 73.7% versus 46.2% (p = 0.01). The two groups did not differ as to level of education but were significantly different with regard to their professional activity: 60.5% of repeaters were unemployed versus 34.6% of first-time attempters (p = 0.01). Repeaters had more loaded family psychiatric disorders: 26.3% versus 7.7% (p = 0.03). However there were practically no differences between repeaters and first-time attempters in regard of suicide in their families. Personal previous history of repeaters was characterized by frequency of psychiatric hospitalization: 50% versus 11.5% (p = 0.00005). Sexual abuse was more frequent in repeaters group but this difference was not significant. Alcohol and drug abuse were not frequent in the two groups. Concerning the actual suicide attempt, the most frequently diagnosed disorder was adjustment disorders. However depressive and psychotic disorders were significantly more frequent in the repeaters group: 34.2% versus 13.4% (p = 0.05). Repeaters had more frequently elevated scores (> 14) in MADRS: 71.1% versus 48.1% (p = 0.01), and raised intensity of stress factors lived during the six months preceding actual suicide attempt: 68.4% versus 42.3% (p = 0.04). Nevertheless we hadn't noticed any differences between the two groups regarding the methods used or the motives. Differences in the characteristics of repeaters and first-time attempters are therefore of interest when discussing future suicidal risk and should clear on preventive actions in order to face the increase of suicidal recidivism. A broad based, multidisciplinary intervention approach is recommended.

Women's Encounters With the Mental Health Establishment: Escaping the Yellow Wallpaper Voices of Hope: Conversations With Helen L. Shore Diagnosis: Schizophrenia: A Comprehensive Resource for Patients, Families, and Helping Professionals Children of Jonah: Personal Stories by Survivors of Suicide Attempts Walk With Me Nothing to Hide: Mental Illness in the Family Changing Minds: Our Lives and Mental Illness

Women's Encounters With the Mental Health Establishment: Escaping the Yellow Wallpaper Voices of Hope: Conversations With Helen L. Shore Diagnosis: Schizophrenia: A Comprehensive Resource for Patients, Families, and Helping Professionals Children of Jonah: Personal Stories by Survivors of Suicide Attempts Walk With Me Nothing to Hide: Mental Illness in the Family Changing Minds: Our Lives and Mental Illness

Family Communication, Maternal and Paternal Expectations, and College Students' Suicidality

This study extends current research on family communication and suicide risk in 2 ways. First, it examines variables that reflect communication patterns found in generally well-functioning families, as opposed to more commonly specified pathological factors, to assess the relationship of family communication and suicidality (ideation and attempts). Second, it examines the differential effects of family communication and parental expectations across gender, analyzing mothers and fathers separately. Specifically, this study assesses the influence that maternal and paternal family communication orientation, maternal and paternal expectation of perfection, personal expectation of perfection, and emotional closeness with parents have on suicidality in both men and women. Data from a questionnaire administered to 421 introductory public speaking students at a northeastern university were analyzed using logistic regression and revealed that female suicide ideation was strongly influenced by one particular pattern of family communication-one in which the father adopted a conformity orientation and the mother communicated a strong expectation of perfection. Findings regarding actual suicide attempts were inconclusive.

Gate questions in psychiatric interviewing: the case of suicide assessment

Gate questions are commonly used to shorten structured interviews, by not probing negative responses with more detailed questions. This study quantified cases of aborted suicide attempts that would have been missed, if we had skipped detailed questions following a gate. To accomplish this, we interviewed a random sample of 135 adult psychiatric inpatients concerning their past suicidal behavior. Using our structured interview, subjects were asked a general question about aborted suicide attempts, and then asked method-specific questions regardless of their response to the general “gate” question. Of the seventy subjects who were found to have histories of aborted attempts, 44.3% answered “no” to the gate question. Comparing these “false negative” subjects to “true positives,” who had answered “yes” to the gate question and reported bona fide aborted attempts yielded no significant associations with demographics, psychiatric diagnoses, or reported histories of actual suicide attempts. Thus, a large number of subjects with aborted attempts would have been missed if a negative response to the gate question had not been probed. Clinical and reasearch implications generally, as well as implications for suicide assessment, are discussed.

Stress system alterations and mood disorders in suicidal patients. A review

Stress system alterations, in particular HPA axis hyperactivations, are fairly well documented in suicide victims and in depressed suicide attempters who subsequently complete suicide. In suicide attempters with no documented completed suicide, the results are more inconsistent. This may depend on differences in studies due to diagnostic heterogeneity among suicide attempters, and the time between the suicide attempt and the examination. Recent data suggests differences in the stress system between depressed patients with a recent suicide attempt and depressed patients in general. The field merits further examination, with thorough examinations of genotypes, actual suicide attempts and stress in combination with examinations of the stress system.

Suicide in psychiatric hospital in-patients. Risk factors and their predictive power.

Psychiatric hospital in-patients are known to be at high risk of suicide, yet there is little reliable knowledge of risk factors or their predictive power. To identify risk factors for suicide in psychiatric hospital in-patients and to evaluate their predictive power in detecting people at risk of suicide. Using a case-control design, 112 people who committed suicide while in-patients in psychiatric hospitals were compared with 112 randomly selected controls. Univariate analysis and multivariate analyses were used to estimate odds ratios and adjusted likelihood ratios. The rate of suicide in psychiatric in-patients was 13.7 (95% CI 11.7-16.1) per 10,000 admissions. There were five predictive factors with likelihood ratios > 2, following adjustment: planned suicide attempt, 4.1; actual suicide attempt, 4.9; recent bereavement, 4.0; presence of delusions, 2.3; chronic mental illness, 2.2; and family history of suicide, 4.6. On this basis, only two of the patients who committed suicide had a predicted risk of suicide above 5%. Although several factors were identified that were strongly associated with suicide, their clinical utility is limited by low sensitivity and specificity, combined with the rarity of suicide, even in this high-risk group.

Perceptions of Life and Death among Suicidal Gay Adolescents

Suicide rates among homosexuals are higher than those among hetero-sexuals. This article suggests that gay youth who attempt suicide represent a special case in which the meanings associated with life and death are worth exploration. In light of the phenomenological paradigm, we are interested in how sixteen gay men who attempted suicide perceived life and death before the actual suicide attempt and how these perceptions are linked to the attempt. Orbach's model specifies four categories of attitudes toward life and death: attraction and aversion to life and attraction and aversion to death. Only three categories of Orbach's model emerged from the interview data. “Attraction to life” was missing and the analysis attempts to account for this gap. Life and death are interdependent; they exist simultaneously, not consecutively; death whirs continuously beneath the membrane of life and exerts a vast influence upon experience and conduct (Yalom, 1980, p. 29).