Columbia-Suicide Severity Rating Scale Research Articles

A Pilot Randomized Control Trial of a Dyadic Safety Planning Intervention: Safe Actions for Families to Encourage Recovery (SAFER).

A recent systematic review on family and suicide prevention efforts identified a lack of family-based safety planning interventions for adults. To address this gap, The Safe Actions for Families to Encourage Recovery (SAFER) intervention was created. SAFER is a novel, manualized, 4- session, family-based treatment intervention that provides the tools and structure to support family involvement in Safety Planning Intervention (SPI) for Veterans at moderate risk for suicide. The SAFER intervention includes the use of psychoeducation, communication skills training, and development of a Veteran, and a complementary supporting partner, SPI. This Stage II (2aii) randomized clinical trial (RCT) evaluated the preliminary efficacy of this innovative and much-needed approach. Thirty-nine Veterans and an associated supporting partner were randomized to receive either SAFER or currently mandated (i.e., standard) individual Safety Planning Intervention (I-SPI). Veterans in the SAFER condition as compared to I-SPI exhibited significant monthly decrements in suicide ideation as measured by the Columbia Suicide Severity Rating Scale (B=-0.37; p=.032). Moreover, a treatment-by-time interaction emerged when predicting improvements in Veteran suicide-related coping (B=0.08; p=.028) and supporting partner support of Veteran's coping efforts (B=0.17; p=.032). However, the treatment effect for Veteran coping was not significant in dyadic analyses (B=0.07; p=.151) after controlling for the partner's support (B=0.16; p=.009). Self-reported appraisals of relational factors and self-efficacy were not impacted by condition for either Veterans or supporting partners. This initial efficacy pilot trial suggests that a brief dyad-based SPI has the potential to improve Veteran suicide symptoms and help family members support the Veteran's coping efforts. However more intensive family work may be required for changes in self-perceptions of burdensomeness, belongingness, and caregiver perceptions of the Veteran as a burden. Nonetheless, SAFER's discussion and disclosure about suicide symptoms facilitated more robust development of SPI for the Veteran and their accompanying supporting partner.

Suicidal Behavior Among Elderly Inpatients: its Relation to Functional Disability and Pain.

BackgroundSuicidal behavior (SB) among elderly inpatients has exhibited a growing global drift. This study aimed to establish the prevalence of SB among elderly inpatients and identify the relationship between SB and depression and functional disability.MethodsThis cross-sectional study included 136 randomly selected elderly inpatients aged 60 years and older who were hospitalized in a tertiary referral center in Kuala Lumpur, Malaysia. The study utilized the following scales as the assessment tools: The Columbia Suicide Severity Rating Scale (CSSRS), Geriatric Depression Scale (GDS-15), Mini International Neuropsychiatric Interview (M.I.N.I.), the Modified Barthel Index (Shah version) (MBI), and visual analog scale.ResultsThe rates of current major depressive disorder (MDD), recurrent MDD, passive suicidal ideation (SI), and active SI were 24.3%, 8.8%, 27.9%, and 5.9%, respectively. Depressed elderly had 6 to 17 times higher risk of developing passive or active SI. “Wish to be dead,” ie, passive SI was associated with admission to oncology or surgical ward and the presence of current MDD. The findings of the study revealed that active SI was associated with being over 80 years old (p = 0.027), being single (p = 0.042), admission to the oncology ward (p = 0.012) or orthopedic ward (p = 0.032), having positive GDS (p = 0.049), and the presence of current MDD (p = 0.019) or recurrent MDD (p = 0.010). According to the study findings, no association has been observed between passive and active SI and level of independence and acute pain.ConclusionThe risk of depressed elderly inpatients having passive and active SI is high. Hence, screening for depression and SI is crucial for prompt treatment and management.

The Incidence of Suicide in Pakistan Day by Day, Especially the Educated Youth Trying to Commit Suicide in 2022 - 2023

The focus of this study the Incidence of Suicide in Pakistan Day by Day, Especially the Educated Youth Trying to Commit Suicide in 2022 2023 is to provide understanding for human nature, the societal impact of suicides, to explore the trend and causes of suicide, and to create awareness about this sensitive and unlawful act. The main theme is a try to stop this inhuman act by helping the needed people by approaching the related authorities. This report is an effort to stop this sinful act by explaining the bad effects because this act can never eliminate the problems but on the other hand give rise to them. This whole effort can only bring about change, if everyone really wants to help others and contribute to get rid of this evil and unlawful act. This study discovers that suicide is an indication of the problems in the lives of many people such as financial, social or medical. The most common underlying disorder is depression, 30% to 70% of suicide victims suffer from major depression, no matter which strata of society they belong to. A suicide attempt is often a cry for help that ends in tragedy. The research paper is an analytical study of adverse effect of criminalization of Attempt to Suicide in Pakistan in Section 325 of PPC 1860. Criminalization of attempted suicide is one of the major reasons that have made people reluctant to get help for the psychological problem that causes such act. This study aims to provide significant reasons for decriminalizing attempted suicide in Pakistan. Quantitative and Qualitative research method was used to gather, analyse and abridge the data. This paper focuses on the problem of criminalization of attempted suicide and tends to provide a new framework in the replacement of existing one. It is pertinent to mention that committing suicide is an illness not a crime, so the one who attempts to commit suicide must be treated as a „patient‟ not as a „culprit‟. The existing law provides punishment for the person who attempted suicide but failed, this represents the harshness of the state as it prescribes „punishment‟ for the person suffering from mental disorder, instead of „treatment‟. The analysis includes problems of criminalizing attempted suicide and challenges of the applicability of relevant law as well as negative impacts of it. Moreover, this paper deliberates upon the introduction of new practice in law. According to this practice, state institutions will provide rehabilitation/treatment to those persons who attempted suicide but failed under the law. Suicidal behavior is one of the serious consequences of depression. Depression disrupts the daily life functioning including ability to think properly, planning, problem solving and decision-making. This happens because of excessively experiencing the negative emotions. Dialectical behavior therapy sessions were planned including skills training for emotional stability, obsessions and impulse control. Evaluation of the behavior at the end of this intervention had fruitful outcomes and better change in the patient’s condition. Columbia Suicide Severity Rating Scale was used to measure the change after ten sessions, once a week of one hour each.

Identifying Suicide Risk in Adolescents and Young Adults With Type 1 Diabetes: Are Depression Screeners Sufficient?

Examine the utility of suicide-risk items embedded within depression screeners for identifying the presence of suicide risk in adolescents and young adults (AYA) with type 1 diabetes. Sensitivity, specificity, and predictive value of self-report of suicide risk on the Patient Health Questionniaire-9 (PHQ-9) were compared with the pediatric psychologist-administered Columbia-Suicide Severity Rating Scale (C-SSRS) as the reference standard for AYA with type 1 diabetes seen in a multidisciplinary AYA Diabetes Program clinic. Of 133 participants, 9.8% and 11.3% reported suicide risk on the PHQ-9 and C-SSRS, respectively. Sensitivity of the PHQ-9 risk item was 53.3% (95% CI 27.4%-77.7%), specificity was 95.7% (95% CI 89.9%-98.4%), positive predictive value was 61.5% (95% CI 32.3%-84.9%), and negative predictive value was 94.2% (95% CI 87.9-97.4%). Depression screeners appear to under-identify AYA with type 1 diabetes who may otherwise be at risk for suicide.

The Role of Emotion Regulation Difficulties in the Relation Between Suicide Risk and the Quality of Life in Depressive Patients

This research is based on existing research in the literature referring to the relationship amongst emotion regulation difficulties, quality of life, depression and suicide risk in depressed patient. The main goal of this research is to identify the role of emotion regulation difficulties in the relationship between suicide risk and quality of life in depressed patients. Data were collected using a general demographic questionnaire plus specific psychometric tests: Difficulties in emotional regulation scale (DERS-SF), Quality of life inventory (Qoli), Columbia suicide severity rating scale (C-SSRS), and Depression Anxiety Stress Scales (DASS21-R). The study included 109 participants, aged 18 – 60 years ((M= 36, SD=12.75), 37 (33.9%) men and 72 (66.1%) women, 49 from a rural background (45%) and 60 from urban background (55%), 43 in the clinical group - patients with depression (39.4%) and 66 in the non-clinical group - controls (60.6%). The results reinforce all the hypotheses of the research and point out the role of emotion regulation difficulties in the relation between suicide risk and the quality of life in depressive patients. Thus, the level of depression, severity of suicide risk and emotion regulation difficulties negatively influence the quality of life. The research findings point out that emotion regulation difficulties should be taken into account when designing psychotherapy programs and protocols aiming at increasing the quality of life and reducing the risk of suicide in depressive patients.

Family history of mood disorders may weaken the link between adverse childhood experience and suicidality in patients with depression

To study the impact of family history of mood disorders (FHMD), comprising genetic factors associated with depression, on the association between adverse childhood experience (ACE) and suicidality in depression. This multicenter cross-sectional study included 200 in- and outpatients (64% (n=128) women, mean age - (M (SD)) 36.21 (15.09) yrs.) with depression. Self-reports about FHMD and lifetime suicide attempts were obtained in clinical interview. The lifetime intensity of suicidal ideas and behavior was assessed by the Columbia-Suicide Severity Rating Scale (C-SSRS), ACE - by the Adverse Childhood Experience International Questionnaire (ACE-IQ). FHMD did not affect the prevalence of ACE, suicide attempts and C-SSRS scores. We found that FHMD weakens the link between ACE and the risk of suicide attempt. The emotional neglect itself increased the risk of suicide attempt (p=0.001, OR=4.428, CI 95% [1.797-10.911]), but reduced it in patients with FHMD (p=0.03, OR=0.128, CI 95% [0.018-0.893]). GLM analysis revealed that FHMD significantly affected the association between suicidal ideas and domestic violence (p=0.045) and between suicidal behavior and emotional neglect (p=0.015) and abuse (p=0.044). FHMD may weaken the link between ACE and suicidality in patients with depression. Suicidality in these patients may be underlined by mechanisms not involved in the response to ACE although more studies are needed.

Assessment of lethality and its clinical correlates in suicide attempters with mood disorders.

Relatively limited literature is available on lethality assessment for suicide attempts in affective disorders from the Indian subcontinent. To assess the lethality and its clinical correlates in lifetime suicide attempters with mood disorders. A total of 100 lifetime suicide attempters, aged ≥18 years, with a DSM-5 diagnosis of bipolar disorder (BD) or major depressive disorder-recurrent (MDD-R) were recruited. Current euthymia was ascertained (Hamilton Depression Rating Scale (HAM-D) ≤7; Young Mania Rating Scale (YMRS) ≤4). Assessments were conducted using clinical pro forma, Risk-Rescue Rating Scale (RRRS), Columbia Suicide Severity Rating Scale (C-SSRS) and Barratt's Impulsiveness Scale (BIS). Average age of the sample was 36.32 ± 11.76 years (48% males, 52% females). The mean duration of affective illness was 10.59 ± 8.32 years. Risk-rescue scores for lethality were significantly higher in males (vs females), bipolar disorder (vs unipolar), multiple attempters (vs single) and planned (vs unplanned) attempters. Risk-rescue score also showed a significant positive correlation with lifetime total and depressive episodes, and intensity of ideations, and a significant negative correlation with BIS-attention impulsiveness. Regression analysis [F (3,96) = 12.196, P < 0.001, adjusted R2 = 0.253] found that lifetime lithium prescription, intensity of suicidal ideations and attention impulsiveness explained 25.3% variance in lethality. Absence of lifetime lithium, higher intensity of suicidal ideations and lower attentional impulsiveness predicted higher lethality of suicide attempts. Lethality of suicide attempts was found to be associated with a multitude of clinical factors, notably male gender, bipolarity, multiple attempts, planned attempts and number of total and depressive episodes. Assessment of lethality and its correlates can help to plan strategies towards risk prevention in mood disorders.

Course and outcome of bipolar I disorder among Indian patients: A retrospective life-chart study.

Indian studies on the course and outcome of bipolar disorder (BD) are scarce and their methodologies vary. Nevertheless, differences from Western ones have been noted. A systematic random sample of 200 patients with BD attending a general hospital psychiatric unit was chosen. They were assessed using the clinician and self-rated versions of the National Institute of Mental Health-Retrospective Life Charts, the lifetime version of the Columbia Suicide Severity Rating Scale, the Medication Adherence Questionnaire, the Indian Disability Evaluation and Assessment Scale, and the Presumptive Stressful Life Events Scale. The mean age of onset of BD was 26 years. About 11%-13% of the illness was spent in acute episodes, mostly in depression (60%). Episode frequency was 0.4-0.6 annually. The first episode was more likely to be manic, and manic episodes outnumbered depressive episodes. The average duration of episodes was 3 months. Depressive episodes were longer and the time spent in depression was greater than mania. Psychotic symptoms (48%), a mania-depression-interval pattern (61%), and recurrent mania (19%) were common while rapid cycling and seasonal patterns were uncommon. Comorbidity (40%), functional impairment (77%), and lifetime nonadherence (58%) were high, whereas lifetime suicide attempts (16%) were low. Stressful life events were very common prior to episodes (80%), particularly early in the illness. This study suggests differences between Indian and Western patients in the demographic profile and the course and outcome of BD. A more benign presentation in the current study including Indian studies is indicated by their later age of presentation and illness onset, higher rates of marriage, education, and employment, a mania predominant course, lower rates of rapid cycling, comorbidity, and suicidal attempts. Factors associated with better outcomes such as longer time to recurrence, Manic Depressive pattern of illness, and low rates of hospitalizations also appear to be commoner in our study and also in other Indian studies.

Retrospective data analysis to determine the effectiveness of intravenous ketamine therapy on patients suffering from depression with suicidal ideation.

Depression is often a debilitating and recurrent psychiatric disorder. Depression with suicidal ideation, being a psychiatric emergency, often needs intensive intervention such as Electro-Convulsive Therapy (ECT). ECT may be refused because of stigma and perceived risk. Intravenous ketamine therapy, being an alternative to ECT for quick response compared to routine pharmaco-therapy, is analyzed to determine its effectiveness. Among patients suffering from depression with suicidal ideation, intravenous ketamine therapy is routinely offered as an alternative to ECT to the needy in the Department of Psychiatry affiliated with a teaching institute. There is a standard operative procedure laid down for ketamine therapy. Baseline and periodical assessment of depression by Hamilton Depression Rating Scale and suicidality by Columbia Suicide Severity Rating Scale is a part of it. Taking advantage of it, retrospective data analysis was done to determine the effectiveness of the therapy. Significant improvement of depression and suicidality found at all the evaluation points after intravenous ketamine therapy. Intravenous ketamine therapy is an effective alternative to ECT among patients suffering from depression with suicidal ideation.

Suicidal behaviour: What's the brain up to?

BackgroundIndividuals with suicidal behaviours are increasingly recognized as having impairments in brain metabolism. However, these are not well delineated. AimTo evaluate regional cerebral glucose metabolism (rCMglu) in subjects with suicidal behaviours and assess differences in rCMglu between depressed and non-depressed suicidal subjects. MethodsThirty-three subjects with suicidal behaviours were assessed using Columbia Suicide Severity Rating scale (CSSRS) and Beck's Depression Inventory (BDI). Brain metabolism was assessed using [18F]Fluoro,Deoxy-Glucose Positron Emission Tomography (FDG-PET). ResultsOf 33 subjects, eighteen had depression. FDG-PET findings revealed that in comparison to mean asymptomatic controls, subjects had decreased rCMglu in right inferior frontal, left Broca's, left inferiolateral andsuperiolateral temporal, right inferior parietal and left posterior cingulate cortex. Increased rCMglu was seen in bilateral superior and medial frontal, right inferiolateral and posteriomedial temporal cortex, and midbrain. CSSRS total intensity inversely correlated with rCMglu in medial frontal cortex, left Broca's and superiolateral temporal cortex and directly correlated with rCMglu in right cerebellum. There was no significant difference in rCMglu between depressed and non depressed group. ConclusionsSignificant differences exist in rCMglu of suicidal individuals, chiefly in frontal and temporal regions. Understanding these would help us identify individuals more at risk for suicidal behaviours.

Association Between Migraine Comorbidity and Psychiatric Symptoms Among People With Newly Diagnosed Focal Epilepsy.

Little is known about psychiatric symptoms among patients with migraine and newly diagnosed focal epilepsy. The investigators compared symptoms of depression, anxiety, and suicidality among people with newly diagnosed focal epilepsy with migraine versus without migraine. The Human Epilepsy Project is a prospective multicenter study of patients with newly diagnosed focal epilepsy. Depression (measured with the Center for Epidemiologic Studies Depression Scale), anxiety (measured with the 7-item Generalized Anxiety Disorder scale), and suicidality scores (measured with the Columbia-Suicide Severity Rating Scale [C-SSRS]) were compared between participants with versus without migraine. Data analysis was performed with the Kolmogorov-Smirnov test for normality assessment, the Mann-Whitney U test, chi-square test, and linear regression. Of 349 patients with new-onset focal epilepsy, 74 (21.2%) had migraine. There were no differences between the patients without migraine versus those with migraine in terms of age, race, and level of education. There were more women in the group with migraine than in the group without migraine (75.7% vs. 55.6%, p=0.0018). The patients with epilepsy and comorbid migraine had more depressive symptoms than the patients with epilepsy without migraine (35.2% vs. 22.7%, p=0.031). Patients with epilepsy with comorbid migraine had more anxiety symptoms than patients with epilepsy without migraine, but this relation was mediated by age in logistic regression, with younger age being associated with anxiety. Comorbid migraine was not associated with C-SSRS ideation or behavior. Among a sample of patients with newly diagnosed focal epilepsy, 21.2% had migraine. Migraine comorbidity was associated with higher incidence of depressive symptoms. Future studies should be performed to better assess these relationships and possible treatment implications.

Evaluating the Validity of the Columbia-Suicide Severity Rating Scale for Lonely Older Adults

Social support exchanges are an integral part of older adults’ well-being. Yet, we know little about how older adults' marital status may influence their support exchanges with different social partners in everyday life, and whether the effect of support exchanges on daily well-being vary by marital status. Adults aged 65+ (N = 278) completed an initial interview about their background and close social networks; then, participants reported whether they provided or received support from their close social partners and rated their psychological well-being for 5 to 6 days. Multilevel logistic models revealed that married older adults were more likely to provide or receive daily support from their close partners than widowed or divorced older adults. However, with respect to specific non-spousal ties, married older adults were less likely to provide support to siblings, friends or others (acquaintances, neighbors) compared to divorced older adults. Although married older adults were more likely to receive support from children than divorced older adults, they were less likely to receive support from siblings and friends compared to widowed or divorced older adults. Furthermore, receiving support from other familial ties (grandchild, other relatives) was associated with reduced daily well-being for widowed older adults whereas married older adults were able to maintain their daily well-being in such situation. Findings highlight the central role siblings and friends play in unmarried older adults' daily support networks and suggest that receiving support could have differential impact on daily well-being depending on older adults’ marital status.

ADHD symptoms and suicide attempts in adults with mood disorders: An observational naturalistic study

• In a sample of adults, ADHD symptoms were significantly associated with suicide attempt (lifetime and in the last 3 months) only among participants with mood disorders. • Our study suggests that ADHD symptoms among adults with mood disorders might have a role in increasing the risk of suicide attempt only when the two conditions are comorbid. • The present findings stress the importance of evaluating the co-occurrence of ADHD symptoms and mood disorders among adults, and also to carefully assess the risk of suicide in the presence of such comorbidity. • Further research on the mechanisms underlying the moderating role of mood disorders in the association between ADHD symptoms and suicide attempts may lead to a better understanding of preventing suicide in this at-risk group. Although several studies explored the association between ADHD and suicidality in the pediatric population, there is a lack of studies focusing on adults. It is particularly unclear whether comorbid mood disorders confer an increased risk of suicidal ideation and attempt among individuals with high ADHD symptoms. Participants were 111 inpatients admitted to the Department of Psychiatry of Sant'Andrea Hospital between July 2017 and July 2018. Data were collected using self-report questionnaires and semi-structured interviews. Lifetime and last-month suicidal ideation and attempts were rated with The Columbia-Suicide Severity Rating Scale (C-SSRS). Symptoms of ADHD were rated using The Adult ADHD Self-Report Scale Version 1.1 (ASRS-V1.1). Of the 111 participants, 40.6% had a history of suicide attempts. No associations were found between ADHD symptoms and suicide attempt/ideation as well as mood disorder diagnosis and suicide attempt, while an association between mood disorder diagnosis and suicidal ideation was found. ADHD symptoms were significantly associated with suicide attempt (lifetime and in the last 3 months) only among participants with mood disorders (lifetime, OR 2.30; 95% CI: 0.97–3.64; 3-months OR 2.34; 95% CI: 0.19–4.49) Given the cross-sectional nature of the study, the directions of the associations described are uncertain. Conclusions: ADHD symptoms were significantly associated with lifetime and recent suicide attempts, only when a mood disorder diagnosis was comorbid. The co-occurrence of ADHD symptoms and a mood disorders diagnosis might confer a higher risk of suicide attempt among adults.

The Role of Oxidative Stress in Suicidal Behaviour Among Bipolar Patients: A Cross-Sectional Study in a Malaysian Sample.

Background: Oxidative stress markers are found to be linked with depression and suicide attempts in bipolar disorder (BD), although the role of DNA damage as a marker of suicidal ideation and attempt has yet to be determined. We aim to investigate the association between DNA damage and suicidal behaviour, i.e., suicidal ideation and suicide attempt, among suicidal ideators in BD patients while accounting for clinical and psychosocial risk factors.Methods: A cross-sectional study was conducted in the Universiti Kebangsaan Malaysia Medical Centre on 62 consecutive BD patients diagnosed using the M.I.N.I. Neuropsychiatric Interview and 26 healthy control participants. Socio-demographic and clinical assessments were performed using the Columbia Suicide Severity Rating Scale (C-SSRS) for lifetime suicidal ideation and attempt, Quick Inventory of Depressive Symptomatology (QIDS) for depression severity, Clinical Global Impression for Bipolar Disorder (CGI-BD) for illness severity [both mania (CGI-Mania) and major depressive episode (CGI-MDE)], Social Readjustment Rating Scale (SRRS) for change in life events, and Barratt Impulsiveness Scale (BIS) for behavioural impulsivity. The degree of DNA damage in peripheral blood samples was determined using a standard protocol of comet assay.Results: Multivariable logistic regression revealed higher scores of CGI-MDE as the sole significant factor for lifetime suicidal ideation (OR = 1.937, 95% CI = 1.799–2.076). Although initial bivariate analysis showed a significant association between DNA damage, malondialdehyde (MDA), catalase (CAT), and suicidal behaviour, the findings were not seen in multivariable logistic regression. Bivariate subgroup analysis showed that moderate and severe DNA damage (p = 0.032 and p = 0.047, respectively) was significantly associated with lifetime suicide attempts among lifetime suicidal ideators. The study is the first to look at the connexion between DNA damage and suicidal risk in bipolar patients. It is limited by the small sample size and lack of information on illicit substance use.Conclusions: More severe DNA damage was significantly associated with lifetime suicide attempts among lifetime suicidal ideators in BD. However, the severity of depression was found to be independently associated with lifetime suicidal ideation per se rather than DNA damage in BD. Larger prospective studies are required to ascertain the potential of DNA damage as a biomarker for the transition from suicidal ideation to a suicide attempt.

Symptoms of mania and anxiety do not contribute to suicidal ideation or behavior in the presence of bipolar depression

Bipolar disorder is typified by episodes of manic/hypomanic and depressive symptoms, either distinctly or concurrently as mixed symptoms. While depressive symptoms are the major driver of risk, it is unclear whether specific combinations of manic and anxiety symptoms contribute differentially to suicidal ideation and behavior in individuals with bipolar disorder during a depressive state. This study uses a quantitative application of Rothman's theoretical framework of causation, or ‘causal pies’ model. Data were obtained from the National Network of Depression Centers Mood Outcomes Program for 1028 visits from 626 individuals with bipolar disorder with current moderate-to-severe depressive symptoms, operationalized as a Patient Health Questionnaire-8 (PHQ-8) score ≥10. Mania symptoms were captured using the Altman Self-Rating Mania scale (ASRM) and anxiety symptoms were captured using the Generalized Anxiety Disorder-7 scale (GAD-7). The outcome of suicidal ideation or behavior was captured using the Columbia Suicide Severity Rating Scale (C-SSRS). In this cohort of individuals with bipolar disorder and at least moderate depressive symptoms, we found no increased risk of suicidal ideation or behavior attributable to manic and anxiety symptom clusters in individuals with bipolar disorder during depressive state. A small amount (4%) of risk was attributable to having severe depressive symptoms. These findings, however, may be influenced by limitations in sample size and measurement instruments. Future studies would benefit from larger samples and more rigorous assessments, including clinician-rated measures.

Suicidality: Once Again, Don’t Blame the Drug Class

ImportanceMostantiseizure medications (ASMs) carry a US Food and Drug Administration–mandated class label warning of increased suicidality risk, based on a meta-analysis comparing suicidality between individuals treated with medications vs placebo in randomized clinical trials done before 2008. ASMs approved since then carry this warning although they were not similarly studied.ObjectiveTo review all placebo-controlled phase 2 and 3 studies of 10 ASMs approved since 2008 to evaluate the risk of suicidality of these drugs compared with placebo.Data SourcesPrimary publications and secondary safety analyses in PubMed of all phase 2 and 3 randomized placebo-controlled epilepsy trials of ASMs approved since 2008, using keywords epilepsy, antiepileptic drugs, seizures, suicidality, suicidal ideation, and the names of individual drugs.Study SelectionAll phase 2 and 3 randomized clinical trials of adjunctive treatment of drug-resistant epilepsy and their secondary safety analyses.Data Extraction and SynthesisArticles were reviewed for frequency of suicidality (ideation, attempts, and completed suicides). Mode of suicidality ascertainment included treatment-emergent adverse event reports, Standardized Medical Dictionary for Regulatory Activities queries for events in prespecified categories including suicidal ideation and behavior, prospective collection of suicidality data as a prespecified safety outcome using the Columbia-Suicide Severity Rating Scale, and retrospective evaluation by blinded review using the Columbia-Classification Algorithm of Suicide Assessment. A meta-analysis compared risk for drugs vs placebo of each outcome for all drugs overall and by individual drugs and trials.Main Outcomes and MeasuresSuicidality (total and by ideation), attempts, and completed suicides.ResultsExcluding studies that did not evaluate suicidality (everolimus and fenfluramine) or did not evaluate it prospectively (lacosamide, ezogabine, and clobazam), 5 drugs were analyzed: eslicarbazepine, perampanel, brivaracetam, cannabidiol, and cenobamate. Suicidality was evaluated in 17 randomized clinical trials of these drugs, involving 5996 patients, of whom 4000 patients were treated with ASMs and 1996 with placebo. There was no evidence of increased risk of suicidal ideation (drugs vs placebo overall risk ratio, .75; 95% CI, .35–1.60) or attempt (risk ratio, .75; 95% CI, .30–1.87) overall or for any individual drug. Suicidal ideation occurred in 12 of 4000 patients treated with ASMs (.30%) vs 7 of 1996 patients treated with placebo (.35%) (P = .74). Three patients treated with ASMs and no patients treated with placebo attempted suicide (P = .22). There were no completed suicides.Conclusions and RelevanceThere is no current evidence that the 5 ASMs evaluated in this study increase suicidality in epilepsy and merit a suicidality class warning

Opioid use as a proximal risk factor for suicidal behavior in young adults.

There is a concomitant rise in suicide rates with the prevalence of opioids involved in overdose deaths, especially among adolescents and young adults. However, there are limited studies on whether opioid use prospectively predicts suicidal behavior in youth. Our sample included 183psychiatric patients (18-30years) admitted for a suicide attempt (SA), have current suicidal ideation (SI), and psychiatric controls without ideation or attempt (PC). Suicidal behavior was assessed using the Columbia Suicide Severity Rating Scale. We also recruited a healthy control group (HC; n=40). Patients and controls were followed over a year. ANOVA, regression, and cox regression were used. Suicide attempt (β=0.87, CI [0.1-1.6], p=0.02) and SI [(β=0.75, CI [0.03-1.5], p=0.04) were significantly more likely than HCs to have used opioids in the past year at baseline. Opioid use was associated with increased anxiety symptoms (β=0.75, CI [0.001-1.5], p=0.05), PTSD symptoms (β=3.90, CI [1.1-6.7], p=0.01), and aggression (β=0.02, CI [0.01-0.04], p=0.02). Opioid use in the month prior to hospitalization predicted SA at 6months (OR=1.87, CI [1.06-3.31], p=0.032). Opioid use is a proximal predictor for SA. These findings may help clinicians better identify patients at risk for suicidal behavior, allowing for more personalized treatment approaches.

The Narrative-Crisis Model of suicide and its prediction of near-term suicide risk.

Despite decades of research, much remains unknown about the transition from chronic to imminent suicidal risk. In the context of COVID-19, this question is even more urgent. The present study tests a novel, stepwise model of this transition, termed the Narrative-Crisis Model. This model proposes that, in people with chronic risk factors, stressful life events can trigger a specific progression of cognitive-affective responses (the suicidal narrative and the suicide crisis syndrome), resulting in increased near-term risk of suicidal thoughts and behavior (STB). Identification of each step in this progression provides opportunities for more precise interventions. Concurrent validity was tested with 732psychiatric patients and predictive validity with 524 participants, assessed one to two months later. Chronic risk factors were measured with the Childhood Trauma Questionnaire, Relationship Styles Questionnaire, and UPPS-P Impulsive Behavior Scale; acute risk factors with the Stressful Life Events Questionnaire, Suicide Narrative Inventory, and Suicide Crisis Inventory. The Columbia Suicide Severity Rating Scale was administered at the initial research assessment and follow-up. Indirect effects were significant for the full model and most pathways, in both concurrent and prospective analyses. In sum, this study provides empirical support for a novel, stepwise model of the progression from chronic to near-term suicidal risk.

The Correlation of Reduced Fractional Anisotropy in the Cingulum With Suicide Risk in Bipolar Disorder.

Objective: This study aims to investigate the significant alterations in brain white matter integrity in individuals with bipolar disorder (BD) who had attempted suicide by applying a tract-based spatial statistics (TBSS) approach with tensor-based spatial normalization.Methods: A TBSS approach with novel tensor-based registration was used to compare the white matter fractional anisotropy (FA) between 51 individuals with BD, of whom 19 had attempted suicide, and 43 healthy controls (HC). The suicide attempt was assessed with the Columbia-Suicide Severity Rating Scale (C-SSRS). In addition, we also investigated the correlations of FA values with clinical measures in BD, including illness duration, and the severity of depression and anxiety measured by the Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA), respectively.Results: A significant reduction of FA value in the hippocampal cingulum was observed in BD individuals who had attempted suicide compared with those who had not. For the genu/body of the corpus callosum, inferior fronto-occipital fasciculus, uncinate fasciculus, and anterior thalamic radiation, the reductions in FA values were significantly greater in both BD subgroups who attempted suicide and who did not, compared to HC. The correlation analysis showed that the illness duration of attempters was correlated to the FA value of the genu of the corpus callosum, while the HAMD and HAMA scores of non-attempters were relevant to the FA of the superior longitudinal fasciculus.Conclusion: The observation that white matter integrity was altered in the hippocampal cingulum in BD individuals who attempted suicide suggested that this brain area may be the neurobiological basis of suicide attempts. Our findings also support the involvement of white matter (WM) microstructure of frontal–subcortical circuits in the neurobiological mechanism of BD. In addition, the illness duration of patients with attempted suicide may have an effect on the altered integrity of the corpus callosum.

Suicidal ideation among the elderly living in the community: Correlation with living arrangement, subjective memory complaints, and depression

BackgroundThis study aimed to investigate the correlations of living arrangement, subjective memory complaints, and depression on suicidal ideation in elderly men and women. MethodsThere were 1,412 participants (women, 63.5%) from a rural community in South Korea, aged ≥60 years (mean±SD, 73.2 ± 8.0 years). We measured suicidal ideation, subjective memory complaints, and depression using the Columbia-Suicide Severity Rating Scale, Subjective Memory Complaints Questionnaire, and the short form of the Geriatric Depression Scale, respectively. We then estimated correlations of living arrangement, subjective memory complaints, and depression with recent suicidal ideation using multivariate logistic regression analysis. ResultsWith all participants as a group, living alone, subjective memory complaints (SMC+) and high risk of depression (HRD) were found to be significant independent predictors (p = 0.021 for living alone; p = 0.006 for SMC+; p < 0.001 for HRD, respectively) of suicidal ideation (SI+). When men and women were analyzed separately, HRD remained significant both in men and women (OR = 6.01, p < 0.005 for men; OR = 7.23, p < 0.001 for women), while living alone and SMC+ were significant only in men (OR = 3.36, p = 0.013 for living alone; OR = 3.30, p = 0.016 for SMC+). LimitationsThe results may not be generalizable to the urban setting as this study included only elderly persons living in the rural community. ConclusionsLiving alone and subjective memory complaints were significant predictors of recent suicidal ideation only in men while depression was a significant predictor both in men and women.