Assessment Of Suicidal Behavior Research Articles

Clinical features of suicidal behaviouг in youth with borderline personality disorder

IntroductionBorderline personality disorder (BPD) in youth has the greatest spectrum of psychopathology and is strictly associated with nonsuicidal self-injury (NSSI) and suicidal behaviour [Guile et al. Adolesc Health Med Ther 2018; 9 199-210; Paris Med. 2019; 55(6):223]. The formation of autoaggressive behaviour and suicidal activity is due to the psychopathological features of BPD, which include affective instability, impulsivity and impaired self-identity.ObjectivesThe aim of the study was to investigate the psychopathological features of suicidal behaviour in BPD in youth.MethodsClinical and psychopathological examination with assessment of suicidal behaviour at the time of, 6 and 12 months later. For additional psychometric examination of patients we used: SCID-II questionnaires, Barratt Impulsiveness Scale (BIS-11), Toronto Alexithymic Scale (TAS), Columbia Suicide Severity Rating Scale (C-SSRS). Sample: N=62 male and female youth males and females in two equal groups of 31, respectively, with an established diagnosis of BPD and the presence of suicidal behaviour. The mean age of first referral in both groups was 19.1±2.2 years.ResultsThis study defined 2 variants of suicidal behaviour in patients with BPD in youth: 1) Expansive - with predominance of impulsiveness (BIS-11 70±3), affective instability, associated with psychosocial factors as a trigger of suicidal activity. Suicidal attempts were made at the height of psychoemotional stress. These patients were characterised by moderately high scores of the C-SSRS scale 2±1, in which patients noted the absence of a plan and specific intentions before the attempt, and a lower incidence of repeated attempts after 6 ((N=6 (19.4%) and 12 months N=10 (32.2%). 2) Rationalistic variant of suicidal behaviour was found in patients with predominance of self-identification disorders, dissociative disorders and high level of alexithymia TAS 81±4.2 in the clinical picture. Suicidal ideation was revealed in all patients, often throughout the entire youth period, and attempts were characterised by thoughtfulness and led to severe consequences, including fatal outcome. Patients with rationalistic variant of suicidal activity had higher C-SSRS scale scores of 4±1, with the presence of suicidal intentions and high frequency of attempt recurrence after 6 (N=11 (35.5%) and 12 months (N=17 (54.8%)).ConclusionsThe variant of suicidal behaviour depended on the degree of severity and correlation of the psychopathological structure of BPD in youth. Less favourable prognosis was characteristic of the rationalistic variant due to the high frequency of repeated attempts. The results obtained require further analysis and contribute to the development of differentiated therapeutic strategies.Disclosure of InterestNone Declared

Elaboração de diretrizes para atendimento hospitalar de tentativas de suicídio na adolescência

Abstract This article aims to describe a qualitative and quantitative study of the construction and validation of guidelines for hospital care of adolescents with suicide attempts. The methodological approach involved an integrative literature review with thematic content analysis of 27 articles, which generated 3 categories: assessment of suicidal behavior in the context of the emergency department; intervention in suicidal behavior, and hospital multidisciplinary team. The content of these categories was the basis for the construction of an instrument with 15 statements about the performance of adolescents in suicidal crisis assisted in the hospital setting. This instrument was applied with 20 healthcare professionals selected from two hospital institutions in southern Brazil, who acted as judges/evaluators of the proposed statements. The content of the 15 statements was validated as guidelines through the Percentage of Concordance Calculation and the Score Calculation. The constructed guidelines may help multidisciplinary hospital teams when facing adolescents with suicide attempts, to base their conduct on criteria that guide actions of reception, assessment, intervention, and referral.

Screening and Assessment of Suicidal Behavior in Transition-Age Youth with Foster Care Involvement.

Transition-age youth with foster care involvement (TAY, ages 17-22) are at heightened risk for suicidal behavior. Despite this, mental health screenings are not standardized across child welfare (CW) systems and existing assessment tools are not designed for use with this specific population. As such, TAY are unlikely to be adequately screened for suicide risk and connected with needed services. In this paper, we sought to identify screening and assessment tools that could be effective for use with TAY in CW settings. Using PubMed and PsycINFO, we conducted a search of the current literature to identify some of the most commonly used screening and assessment tools for youth. We then narrowed our focus to those tools that met predefined inclusion criteria indicating appropriateness of use for TAY in CW settings. As a result of this process, we identified one brief screening tool (the ASQ) and four assessments (the SIQ-JR, the C-SSRS, the SHBQ, and the SPS) that demonstrated specific promise for use with TAY. The strengths and limitations of the tools are discussed in detail, as well as the ways that each could be used most effectively in CW settings. We highlight three key points intended to guide social work practice and policy: (1) systematic, routine assessment of mental health and suicide risk across CW settings is critical; (2) the protocol for assessing suicidal behavior in TAY must account for the wide variations in context and service provision; and (3) CW workers administering assessments must be thoughtfully trained on risk identification and the protocol implementation.

Assessment of Post-Traumatic Stress Disorders and its Associations with Suicidal Behaviour among Adults Following Movement Control Order During COVID-19 Pandemic in Malaysia

A rapid review of previous outbreaks shows that a quarantine policy had greater effects on one’s psychological state including post-traumatic stress disorder (PTSD), confusion and anger caused by various stressors. This study aimed to assess the levels of Post-Traumatic Stress Disorder (PTSD) and its associations with suicidal behavior among Malaysian adults following Movement Control Order (MCO) during the COVID-19 pandemic in Malaysia. This cross-sectional study was distributed using an online standardized questionnaire composed of three parts, the socio-demographic characteristics, PTSD assessment using PTSD Checklist for DSM-5 and the suicidal behavior assessment using Suicidal Behaviors Questionnaire-Revised (SBQ-R). Almost half of the respondents had high PTSD symptoms (41.7 %) and low PTSD was 58.3 % among Malaysian adults. Furthermore, 69.6 % of participants had no suicidal behavior but, 30.4 % from the participants has suicidal behavior. This study found single status with highest PTSD (83.3 %) and marital status had significant correlation with PTSD which p-value was < 0.05. Malay was high percentage in high PTSD (74.6 %) and significant correlation between race and PTSD (p < 0.05). Employment status also had significant correlation with PTSD with p-value was 0.002 and students was counted highest PTSD (65.7 %). This study identified some socio-demographic factors and suicidal behavior associated with PTSD among Malaysian adults, which may lay ground for further interventions.

A panorama of the medicolegal aspects of suicide assessments: integrating multiple vantage points in improving quality, safety, and risk management.

Epidemiological trends in global suicides have been of serious concern in the last decade. The burden of higher expectations in the assessment of suicidal behaviors on mental health professionals is mounting. However, the suicidal risk assessment has many evolving and moving parts, and is one of the most heavily researched fields in psychiatry. Although it is clear from current empirical research that suicide cannot accurately be predicted, the standard of care from regulatory bodies and professional organizations dictates the use of established measures and following consensus guidelines. However, the legal system has different parameters to assess for the deviation from these standards and views it from a different vantage point. Therefore, it is imperative to know these critical multifaceted panoramas of suicide assessment. Considering the gaps within suicide risk assessment tools, we propose that appropriate documentation and thorough treatment planning are key to navigating the complex medicolegal risks. These approaches are useful for risk management and improve clinical outcomes, quality of care, and overall patient safety.

Comorbidities Increase Suicide Risk in People With Autism

Comorbidities Increase Suicide Risk in People With Autism

Assessment of Suicidal Behaviors Among Individuals With Autism Spectrum Disorder in Denmark

There is limited evidence supporting an association of autism spectrum disorder (ASD) with suicidality and the risk factors for suicide attempt and suicide among people with ASD. Existing research highlights the need for national cohort studies. To analyze whether people with ASD have higher rates of suicide attempt and suicide compared with people without ASD using national register data, identify potential risk factors for suicide attempt and suicide among those with ASD, and examine associations with comorbid disorders. In this cohort study, nationwide register data from January 1, 1995, to December 31, 2016, were gathered on 6 559 266 individuals in Denmark aged 10 years or older. Statistical analysis was performed from November 20, 2018, to November 21, 2020. Rates of suicide attempt and suicide among persons with ASD were compared with rates among persons without ASD, using Poisson regression models to calculate incidence rate ratios adjusted for sex, age, and time period. Of the total study population of 6 559 266 individuals, 35 020 individuals (25 718 male [73.4%]; mean [SD] age at diagnosis, 13.4 [9.3] years) received a diagnosis of ASD. A total of 64 109 incidents of suicide attempts (587 [0.9%] among individuals with ASD) and 14 197 suicides (53 [0.4%] among individuals with ASD) were recorded. Persons with ASD had a more than 3-fold higher rate of suicide attempt (adjusted incidence rate ratio [aIRR], 3.19; 95% CI, 2.93-3.46) and suicide (aIRR, 3.75; 95% CI, 2.85-4.92) than those without ASD. For individuals with ASD, the aIRR for suicide attempt among female individuals was 4.41-fold (95% CI, 3.74-5.19) higher compared with male individuals; for individuals without ASD, the aIRR for female individuals was 1.41-fold (95% CI, 1.39-1.43) higher compared with male individuals. Higher rates of suicide attempt were noted across all age groups for those with ASD. Persons with a diagnosis of ASD only had an aIRR of 1.33 (95% CI, 0.99-1.78) for suicide attempt, whereas those with other comorbid disorders had an aIRR of 9.27 (95% CI, 8.51-10.10) for suicide attempt compared with those without any psychiatric disorders. A total of 542 of 587 individuals with ASD (92.3%) who attempted suicide had at least 1 other comorbid condition and 48 of 53 individuals with ASD (90.6%) who died by suicide had at least 1 other comorbid condition. This nationwide retrospective cohort study found a higher rate of suicide attempt and suicide among persons with ASD. Psychiatric comorbidity was found to be a major risk factor, with more than 90% of those with ASD who attempted or died by suicide having another comorbid condition. Several risk factors are different from the risk factors in the general population, which suggests the need for tailored suicide prevention strategies.

The Magnitude of Suicidal Behavior among People Living with Diabetes Mellitus Attending an Outpatient Department of Alamata General Hospital, Mekelle, Tigray, Ethiopia 2019: A Cross-Sectional Study

Background: Globally, suicide accounts for 75% in low and middle-income countries (LMICs). Though the magnitude of suicidal behavior in High-income Countries (HIC) is higher relative to the general population, limited studies had explored suicidal behavior among medical outpatients in LMICs including this locality. Suicidal behaviors among people with the chronic medical illness are one of the commonest psychiatric emergencies that demand a major health concern by researchers and mental health task forces. People with chronic medical illnesses show suicidal ideation and attempt which are fatal problems to end life. Therefore, this study will address the gaps by determining the magnitude of suicidal behavior among Diabetes Mellitus (DM) patients in an outpatient setting of Alamata General Hospital (AGH). Methods: Institutional based cross-sectional study was conducted among medical patients attending a chronic care clinic in Alamata general Hospital from May to June 2019. A sample of 146 DM patients who were attending an outpatient chronic care clinic was included in the study. Suicidal behavior was assessed by the World Health Organization (WHO) suicidal behavior assessment through software called Statistical Package for Social Science (SPSS) Version 25. Results: The magnitude of suicidal behavior among Diabetes Mellitus patients at AGH was 30.8%, 15.8% had suicidal ideation, 14.4% had a suicidal attempt and 15.1% of them had the plan to commit suicide. Conclusion: The prevalence of suicidal behavior was found to be significantly high in Diabetes Mellitus patients. Hence, it is important to conduct more interventions to assess the suicidal behavior symptoms among Diabetes Mellitus patients.

Increased Risk of Attempted and Completed Suicide in Obsessive Compulsive Disorder: A Systematic Review of Follow-up Studies

Obsessive compulsive disorder (OCD) is a severe, often long-term mental disorder. It may be independent from, or comorbid with other mental disorders, especially depression and anxiety disorders. Suicidal thoughts, ideations and ruminations are prevalent in subjects with OCD, but it is not yet clear if the incidences of attempted and completed suicides have increased in comparison with the general population and with other psychiatric disorders. Methods We conducted a systematic literature search on the incidence of suicide attempts and completed suicides in subjects with OCD. Search terms for Pubmed and Medline were OCD and suicide. We selected papers providing follow-up data on the incidence of attempted and completed suicide in OCD. Results 404 papers were initially identified. Only 8 papers covering six studies provided prospective data on attempted or completed suicide over a defined period in subjects with OCD, four studies included control subjects. Two studies providing follow-up data were limited to high-risk samples and did not provide enough data on the incidence of suicide in comparison with the general population. The conclusion that there is an increased risk of attempted and completed suicides in OCD can only be based on one large Swedish National Registry sample with an up to 44 year follow up. Psychiatric comorbidity is the most relevant risk factor for suicide. Conclusions Even though some studies report an increased incidence of attempted and completed suicides in OCD patients from selected high risk samples, the evidence from population based studies is mostly based on one large Swedish study. More long-term studies in the general population with a reduced risk of subject attrition are needed. Using a clear definition and assessment of suicidal behaviour and a common time-frame would improve the comparability of future studies.

Validation of the Suicidal Behaviors Questionnaire-Revised in adolescents in Ghana

Background According to the World Health Organization, 85% of global suicides occur in low- and middle-income countries (LMICs). A major factor contributing to the alarming rates of suicides in LMIC is the unavailability of standardized and validated screening measures to screen and identify individuals at heightened risk of suicidal tendencies for early intervention. Aim To investigate the factorial validity, construct validity and gender invariance of the Suicidal Behavior Questionnaire-Revised (SBQ-R). Methods A cross-sectional self-report methodology was employed to gather data from 553 adolescents (average age = 16.85; girls = 322) in Ghana. Results The result of a multi-group confirmatory factor analysis supported a unidimensional structure of the SBQ-R that did not differ for boys and girls. The SBQ-R demonstrated construct validity for boys and girls by correlating significantly although moderately with measures of depression, anxiety and mental wellbeing. Conclusion The findings of this preliminary study suggest that the SBQ-R can be administered as a valid screening measure for adolescents at high risk for suicide for further assessment and intervention planning in Ghana, regardless of gender. Additionally, the study contributes to the literature on the universality and assessment of suicidal behaviors using SBQ-R.

Suicide-Specific Cognitions, Attentional Fixation, and Worst-Point Suicidal Ideation.

The fluid vulnerability theory of suicide posits that each person has a baseline risk for suicide, which is comprised of both stable and dynamic factors. The current study investigated the unique involvement of suicide-specific cognitions and attentional fixation on recent suicidal ideation (SI) and SI at its worst. Data were analyzed from a sample of N=126 undergraduate students with a history of SI. Path analyses were used to analyze the relationship between suicide-specific cognitions, attentional fixation, and SI (current and worst point). Results revealed that suicide-specific cognitions were directly related to both recent SI and worst-point SI. Suicide-specific cognitions had a significant, indirect effect with worst-point SI through attentional fixation, but this effect was not significant when using recent SI. These data support the need for interventions to target cognitive contents and contexts (e.g., fixation) to reduce escalation of SI. Future work would benefit from replicating and extending results in studies that include prospective designs and the assessment of suicidal behaviors.

Assessment of suicidal behavior in dermatology (Review)

Many diseases that affect physical health can also affect mental health. Many of these diseases are studied in terms of quality of life, depression and suicidal behavior. Dermatological disorders, although having a strong impact on the individual's life, are less studied with regard to suicidal behavior. There is a need to approach several dermatological diseases from the perspective of suicidal behavior in order to intervene early with specific treatment or to prevent suicide. Psoriasis, acne, melanoma, atopic dermatitis and urticaria are scarcely studied from the point of view of suicidal behavior. In addition to these diseases, there are others that require attention in terms of suicidal behavior, such as vitiligo or oculocutaneous albinism, most probably due to a small number of people suffering from these diseases, research is almost non-existent in these cases. We want to draw attention to the importance of early detection of suicidal behavior in dermatological practice and to highlight the need for several studies on this subject.

Assessment of suicidal behavior in bipolar disorder

Amaç: Bu çalışmada düzenli olarak Bipolar Bozukluk tanısıyla izlenen hastalarda özkıyım davranışının, hastaların sosyodemografik ve klinik özellikleri, dürtüsellik ve çocukluk çağı travmaları ile ilişkisi araştırılmıştır.Gereç ve Yöntem: Çalışmaya polikliniğimize başvuran Bipolar Bozukluk tanısıyla izlenen 91 hasta dahil edilmiştir. Çalışma verileri tarafımızca oluşturulan Duygudurum Bozuklukları Hasta Kayıt Formu, SCID-I, SCID-II, Young Mani Değerlendirme Ölçeği, Hamilton Depresyon Değerlendirme Ölçeği, Özkıyım Davranışı Ölçeği, Çocukluk Çağı Travmaları Ölçeği ve Barratt Dürtüsellik Ölçeği kullanılarak toplanmıştır. Tüm tanısal işlemler ve görüşmeler aynı psikiyatrist tarafından yapılmıştır.Bulgular:Çalışmaya dahil edilen 91 hastanın 52’si kadın, 39’u erkekti. Çalışmamızda 91 bipolar bozukluk hastasının 40’ında özkıyım girişimi öyküsü vardı. Özkıyım girişiminde bulunan grupta hastalık sürecinin daha çok depresif ve karma ataklarla seyrettiği, ataklar arası dönemde işlevselliğin kısmi etkilenmiş olduğunu ve psikotik özellikli daha ağır atak sıklığının daha fazla olduğunu bulduk. Bunun yanında iki grup arasında çocukluk çağı travmaları ve dürtüsellik için istatiksel olarak anlamlı ilişki bulamadık.Sonuç:Bipolar Bozukluk yaşam boyu süren ve işlevselliği büyük oranda bozan bir hastalıktır. Bipolar bozukluk yüksek oranlarda özkıyım girişimi ve tamamlanmış özkıyım ile ilişkilidir. Bu açıdan özkıyım davranışında bulunan hastalarla bulunmayan hastalar arasındaki sosyodemografik, klinik ve diğer değişkenlerin araştırılması ve olası risk faktörlerinin tespiti hastalarda gelişebilecek olası özkıyım davranışını önlemede etkili olacaktır.

Increased Risk of Attempted and Completed Suicide in Obsessive Compulsive Disorder: A Systematic Review of Follow-up Studies

Abstract Obsessive compulsive disorder (OCD) is a severe, often long-term mental disorder. It may be independent from, or comorbid with other mental disorders, especially depression and anxiety disorders. Suicidal thoughts, ideations and ruminations are prevalent in subjects with OCD, but it is not yet clear if the incidences of attempted and completed suicides have increased in comparison with the general population and with other psychiatric disorders. Methods We conducted a systematic literature search on the incidence of suicide attempts and completed suicides in subjects with OCD. Search terms for Pubmed and Medline were OCD and suicide. We selected papers providing follow-up data on the incidence of attempted and completed suicide in OCD. Results 404 papers were initially identified. Only 8 papers covering six studies provided prospective data on attempted or completed suicide over a defined period in subjects with OCD, four studies included control subjects. Two studies providing follow-up data were limited to high-risk samples and did not provide enough data on the incidence of suicide in comparison with the general population. The conclusion that there is an increased risk of attempted and completed suicides in OCD can only be based on one large Swedish National Registry sample with an up to 44 year follow up. Psychiatric comorbidity is the most relevant risk factor for suicide. Conclusions Even though some studies report an increased incidence of attempted and completed suicides in OCD patients from selected high risk samples, the evidence from population based studies is mostly based on one large Swedish study. More long-term studies in the general population with a reduced risk of subject attrition are needed. Using a clear definition and assessment of suicidal behaviour and a common time-frame would improve the comparability of future studies.

La psychiatrie de liaison au Centre Hospitalier Universitaire Mohammed VI d’Oujda, Maroc : étude transversale sur dix mois

In Morocco, liaison psychiatry is a relatively new activity and is not currently recognized as a psychiatric sub-specialty. However, several university psychiatric teams have started this activity in a more or less structured manner (Fès, Casablanca, Rabat and Oujda). ObjectivesThe objective of this study is to describe the development and organization of the psychiatric liaison activity in the psychiatry department of the Mohamed VI University Hospital Center in Oujda and to evaluate it from a preliminary study. Through this study, we evaluated the reasons for psychiatric consults, requesting services and the most frequent psychiatric disorders. MethodsThis is a cross-sectional descriptive and analytical primary study over a period of 10 months between May 2016 and February 2017. The study recruited 60 patients requiring psychiatric consultation from different medical and surgical departments at the University Hospital in Fès. The psychiatric assessment was based on a psychiatric interview using DSM-5 diagnostic criteria. The data were collected by a certified psychiatrist using a medical psychiatric record. ResultsDuring this study, 17 medical and surgical departments of our University Hospital had requested a psychiatric assessment for their patients. Most demands were respectively emitted by the Department of Dermatology (28%), gastroenterology (13%), and nephrology (11%). Depressive symptoms (54%) and assessment of suicidal behavior (19%) were the most common motivations for psychiatric consultations. Depressive disorder (58%) and adjustment disorder (18.7%) were the most frequent psychiatric diagnoses in patients from medical and surgical departments. ConclusionPsychiatry liaison is an activity in full evolution in Morocco, the structuring and organization of this activity is paramount, given its clinical, pedagogical, research and even economic interest.

Assessment of suicidal behavior and factors associated with a diagnosis of prostate cancer

OBJECTIVES:To determine the incidence of suicide risk in a group of patients who have been diagnosed with localized prostate cancer (PC) and to identify the factors that affect suicidal behavior.METHODS:Patients from a tertiary care oncology center in São Paulo, Brazil participated in this study and were interviewed after being diagnosed with low-risk or intermediate-risk PC, per the D'Amico risk classification, between September 2015 and March 2016. Patients underwent suicide risk assessment sessions using the Mini International Neuropsychiatric Interview (MINI), the Hospital Anxiety and Depression Scale (HADS), and the CAGE substance abuse screening tool before they started treatment and surveillance. Psychiatric treatment history, family history of suicidal behavior, and the use of psychotropic drugs were also examined.RESULTS:The prevalence of suicide risk among 250 patients who were recently diagnosed with low-risk or intermediate-risk PC was 4.8%. According to the HADS, 10.8% and 6.8% of patients had a positive score anxiety and for depression, respectively. Alcoholism was suspected in 2.8% of the group. Suicide risk was associated with anxiety (p=0.001); depression (p=0.005); being divorced, separated, widowed, or single (p=0.045); living alone (p=0.028); and prior psychological treatment (p=0.003).CONCLUSIONS:After being diagnosed with PC, patients who display risk factors for suicide should be monitored by a mental health team.

Evaluation of Suicide Risk Levels in Hospitals: Validity and Reliability Tests

Examination of in-hospital suicide risk levels concerning their validity and their reliability. The internal suicide risk levels were evaluated in a cross sectional study of in 163 inpatients. A reliability check was performed via determining interrater-reliability of senior physician, therapist and the responsible nurse. Within the scope of the validity check, we conducted analyses of criterion validity and construct validity. For the total sample an "acceptable" to "good" interrater-reliability (Kendalls W = .77) of suicide risk levels were obtained. Schizophrenic disorders showed the lowest values, for personality disorders we found the highest level of interrater-reliability. When examining the criterion validity, Item-9 of the BDI-II is substantial correlated to our suicide risk levels (ρm = .54, p < .01). Within the scope of construct validity check, affective disorders showed the highest correlation (ρ = .77), compatible also with "convergent validity". They differed with schizophrenic disorders which showed the least concordance (ρ = .43). In-hospital suicide risk levels may represent an important contribution to the assessment of suicidal behavior of inpatients experiencing psychiatric treatment due to their overall good validity and reliability.

Kynurenine pathway metabolites and suicide attempters among psychiatric inpatients: Preliminary results

IntroductionIncreased concentrations of kynurenine (KYN) pathway metabolites have been associated to several groups of psychiatric disorders. As for suicide risk literature is still inconclusive due to the limited evidence.Objectivesto test the hypothesis of Increased concentrations of kynurenine as related to suicide attempter.AimsWe aim to investigate the association between kynurenine pathway metabolites blood levels and suicidal behaviour, in affective disorder patients, in order to explore if kynurenine pathway metabolites could be potential diagnostic biomarkers.SampleWe enrolled a sample of affective disorder patients and perform detailed diagnoses, as well as detailed assessment of suicidal behaviour using validated questionnaires. We also aim to follow-up individuals included in the current study.MethodsPlasma KYN was assayed by high performance liquid chromatography in three groups: healthy volunteers (n = 90), patients with mood disorders with a recent suicide attempt (n = 44) and without (n = 44) history of suicide attempt. Analysis of variance tested for group differences in KYN levels. Each was evaluated with psychometric scales. Patients were sampled for 10 cc of venous blood for assay. The preparation of blood samples and assay was processed by a specialist using high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS).ResultsPreliminary results will be presented as to shed light if KYN levels differed across groups. According to preliminary calculations we expect that KYN is higher in suicide attempters compared with non-attempters, who did not differ from healthy volunteers.ConclusionsOur work-in-progress study suggests that KYN and related molecular pathways may be implicated in the precipitation of suicidal behavior.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Suicidal Behavior

This issue of Focus on Suicide brings us new data about risk assessment, with 2 articles examining the utility of rating scales for assessment of suicidal behavior. Youngstrom et al conduct a careful comparison of 3 suicide rating scales: the Columbia Suicide Severity Rating Scale (C-SSRS), the Suicide Tracking Scale (STS), and the Sheehan Suicidality Tracking Scale (S-STS). While the scales did comparably in 2 broad categories, suicidal ideation and suicide attempts, the study suggests that some subtypes of suicidal behavior/ideation are not captured as well by the S-STS.

Assessment of Suicidal Behavior in a Psychiatric Emergency Room in Lisbon.

Some studies alerted for the burden of suicidal attempters at emergency rooms. In this study we characterized the suicidal patients admitted to a Portuguese emergency room. For three years, all patients assessed by the first author after suicidal behaviour were included. Suicidal intentionality was evaluated with the Pierce Suicide Intent Scale. Clinical records were searched for follow-up status and satisfaction level was assessed through telephone call. From 120 included patients 70.8% were female, with mean age of 42.35 years. Pierce Suicide Intent Scale suicidal intentionality was low in 30.1%, medium in 59.3%, and high in 10.6% of the sample. The most important predictors of Pierce Suicide Intent Scale intentionality were male gender (p < 0.001), family history of suicide (p < 0.01), divorced or widowed marital status (p < 0.013), and severe mental illness (p < 0.015). In 41.6% of the patients the follow-up status was unknown. Regarding satisfaction, only 19.5% gave a valid answer: 2.7% 'mildly satisfied', 4.4% 'moderately satisfied', and 12.5% 'very satisfied'. The Pierce Suicide Intent Scale is useful on suicidal behavior assessment at emergency rooms. Highly intentional suicidal behaviour is related to male sex, social problems and personal and familial psychiatric history. The quality of administrative records on this psychiatric emergency room setting are still unacceptable. The most important variables correlated with higher suicidal intentionality are the same described in other countries. Of the reachable patients, one fifth was satisfied with provided follow-up. We still need studies for better understanding of suicidal behaviour observed on this Portuguese emergency room.