Current Suicidal Behavior Research Articles

Inward- and Outward-Directed Violence in the Lives of Urban Minority Adults Followed from Middle School into Their Thirties.

This study explores connections between inward-directed violence and outward-directed violence using data from the Reach for Health sample, which was originally recruited in the 1990s from three middle schools in economically distressed, predominantly African American neighborhoods of New York City. Now in their thirties, participants (N=595) completed surveys assessing current suicidal thoughts and behaviors as well as other violence involvements, including intimate partner violence victimization and perpetration. About 10% of males and females reported any suicidal ideation or attempt in the past 12months. In logistic regression analyses adjusting for sociodemographics, prior reports of feeling blue in middle school (OR: 1.12, CI: 1.02-4.39) and young adult suicidality (OR: 2.54, CI: 1.30-4.95) are significantly related to later suicidality. So are concurrent aggressive behaviors, including reports of physical fighting outside the home (OR: 2.70, CI: 1.29-5.67) and IPV perpetration (OR: 2.09, CI: 1.11-3.94). Neither IPV victimization nor witnessing neighborhood violence is correlated. Findings shed light on the persistence of suicidality in the lives of those who come of age, and often remain, in communities with high levels of poverty, and confirm linkages of suicidality with externally directed aggression. Life-stage interventions are needed to counter the interwoven causes and consequences of multiple forms of violence.

The link between sleep disturbances and suicidal thoughts and behaviors in remitted bipolar I patients.

We aimed to evaluate the links between different sleep parameters and suicidal ideation and behavior in remitted bipolar I patients. One hundred eight remitted bipolar I patients were recruited from the psychiatry department of Razi Hospital. The third item of the "Hamilton Depression Rating Scale" was used to evaluate current suicidal behaviors. Circadian typology, daytime sleepiness and sleep quality were evaluated using the "Horne and Ostberg Morningness-Eveningness Questionnaire," the "Epworth Sleepiness Scale," and the "Pittsburgh Sleep Quality Index," respectively. Current suicidal ideation and behavior were significantly associated with circadian typology, daytime sleepiness, and sleep quality. After controlling for demographic variables (age and gender) and psychosocial factors (depression and substance use), suicidal ideation significantly contributed to sleep quality. Depression was a significant predictor within the second step when entered with other psychosocial variables; however, once suicide variables were included, depression was no longer a significant predictor. An evaluation of sleep's quality should be included in the suicide risk assessment of bipolar I patients.

Suicide risk configuration system in a clustered clinical sample: a generalized linear model obtained through the LASSO technique.

Objective:To identify clinical and sociodemographic factors that increase or decrease suicidal risk in a clinical sample of subjects seeking mental health care.Method:A cross-sectional study was performed at three health centers in Santiago, Chile. The Parental Bonding Instrument (PBI), Depressive Experience Questionnaire (DEQ), Outcome Questionnaire (OQ-45.2), Reasons for Living Inventory (RFL), and State Trait Anger Expression Inventory (STAXI-2), in addition to a sociodemographic survey, were applied to 544 participants (333 with suicidal behavior and 211 without current suicidal behavior). Through hierarchical clustering analysis, participants were grouped by similarity regarding suicidal risk. Then, a regression analysis was performed using the Least Absolute Shrinkage and Selection Operator (LASSO) technique, and factors that decrease or increase suicide risk (SR) were identified for each cluster.Results:The resultant clusters were grouped mainly by the age of participants. The most important protective factor was having confidence in one’s own coping skills in difficult situations. Relevant risk factors were major depressive disorder (MDD), poor anger management, and difficulties in interpersonal relationships.Conclusions:Suicidal risk manifests differently throughout the life cycle, and different types of bonds may protect from or increase risk of suicide.

La douleur sociale au centre des conduites suicidaires

BackgroundIntolerable pain is often reported in suicide notes. Moreover, the frequency of life events preceding a suicidal act is high, especially interpersonal difficulties. Such adversity is the source of psychological or social pain. MethodsWe propose a narrative review to discuss the role of pain in the suicidal process while having a focus on social ties. ResultsUsing Ecological Momentary Assessment in suicide attempters it has been shown that being alone increased suicidal ideation while being with close others significantly reduced this risk. At a neuroanatomical level, suicidal vulnerability is associated with dysfunctional insula activation during social exclusion, a region involved in social and physical pain processing. Social pain elicited by social exclusion or devaluation shares common neurobiological patterns with physical pain. It is also an exemplar of psychological pain. Despite the complexity of its definition, higher psychological pain levels are associated with suicidal ideation and acts. Finally, intense physical pain or chronic pain are strong risk factors of suicidal ideation and act. Interestingly, suicide notes often report the existence of an intolerable pain. Presence of psychological pain and difficulties in communication predict the lethality and seriousness of suicide attempts. Moreover, presence of psychological pain is associated with more impulsive choices in suicidal patients, suggesting that a suicidal act is a means to escape intolerable suffering despite negative long-term consequences (i.e. death). Analgesics are usually used to get relief from pain but are also frequently involved in suicidal overdoses. It has been shown that opioid analgesics are associated with an increased risk of suicide. Higher consumption of opioid analgesics has been shown in suicidal patients in comparison to patients with history of depression but no suicidal act and healthy controls whereas non-suicidal patients were those reporting higher presence of pain in comparison to healthy controls. It may suggest that opioids are being used by suicidal patients to get relief from psychological/social pain rather than from physical pain. Involvement of opioidergic system in suicidal process opens new therapeutic strategies. Recently, the time-limited, short-term use of very low dosages of sublingual buprenorphine (vs. placebo) was associated with decreased suicidal ideation and mental pain in severely suicidal patients without substance abuse. In a randomized controlled trial comparing a 7-week acceptance and commitment therapy (ACT) versus relaxation group, as adjunct to treatment as usual for adult outpatients suffering from a current suicidal behavior disorder, ACT has shown its effectiveness in reducing suicidal ideation and psychological pain. Evidence indicates that maintaining contact either via letter, postcard or telephone with at-risk adults following discharge from care services after a suicide attempt can reduce reattempt risk. Based on these results, a preventive program of recontact for suicide attempters, VIGILANS, has been developed in France in usual care. ConclusionThe approach of the suicidal issue by the angle of pain and social disconnection offers new advances to improve clinical assessment, to identify new biological pathways involved in suicidal risk, and to propose innovative therapeutic and preventive actions.

Attention-deficit/hyperactivity disorder symptoms and suicidal behavior in adult psychiatric outpatients.

We aimed to examine the association between attention-deficit/hyperactivity disorder (ADHD) symptoms and suicidal behavior in psychiatric outpatients and whether this association differs among patients with different psychiatric disorders. Cross-sectional data came from the Japan Prevalence Study of Adult ADHD at Psychiatric Outpatient Care, which included psychiatric outpatients aged 18-65 years recruited from one university hospital and three general psychiatric outpatient clinics in Kitakyushu City, Fukuoka, Japan from April 2014 to January 2015 (N = 864). The Adult ADHD Self-Report Scale (ASRS) Screener was used to collect information on ADHD symptoms. Reports of current and lifetime suicidal behavior were also obtained. A multivariable Poisson regression analysis was used to examine the association between ADHD symptoms and suicidal behavior. After adjusting for covariates there was a strong association between possible ADHD (ASRS ≥14) and suicidal behavior with prevalence ratios ranging from 1.17 (lifetime suicidal ideation) to 1.59 (lifetime suicide attempt) and 2.36 (current suicidal ideation). When ASRS strata were used, there was a dose-response association between increasing ADHD symptoms and suicidal ideation and suicide attempts. Analyses of individual ICD-10 psychiatric disorders showed that associations varied across disorders and that for anxiety disorder, ADHD symptoms were significantly linked to all forms of suicidal behavior. ADHD symptom severity is associated with an increased risk for suicidal behavior in general psychiatric outpatients. As ADHD symptoms are common among adult psychiatric outpatients, detecting and treating ADHD in this population may be important for preventing suicidal behavior.

Acceptance and Commitment Therapy for the Management of Suicidal Patients: A Randomized Controlled Trial

Background: The management of suicidal crisis remains a major issue for clinicians, driving the development of new strategies to improve suicide prevention. Methods: We conducted a randomized controlled trial comparing a 7-week acceptance and commitment therapy (ACT) versus relaxation group, as adjunct to treatment as usual for adult outpatients suffering from a current suicidal behavior disorder. The primary outcome was the rate of change in the Columbia Suicide Severity Rating Scale suicidal ideation subscore (adding severity and intensity subscores). Secondary outcomes were the rates of change for depressive symptomatology, psychological pain, anxiety, hopelessness, anger, quality of life, and therapeutic processes. Assessments were performed in the 2 weeks preceding the beginning of the treatment (pretreatment assessment), and within 1 week (posttherapy assessment) and 3 months (follow-up assessment) after therapy completion. Results: Forty adults were included and randomized. The rate of change in ACT for suicidal ideation at the posttherapy assessment was higher than in the relaxation group (β [SE] = –1.88 [0.34] vs. –0.79 [0.37], respectively; p = 0.03). ACT effectiveness remained stable at the 3-month follow-up. We found a similar pattern of change for depressive symptomatology and anxiety, psychological pain, hopelessness, anger, and quality of life. Therapeutic processes improved more in the ACT group than in the relaxation group. Treatment adherence was high in the ACT group, all participants reported satisfaction with the program. Conclusions: Through its effectiveness in reducing suicidal ideation and improving the clinical dimensions associated with suicidal risk in patients suffering from a suicidal behavior disorder, ACT could be developed as an adjunctive strategy in programs for suicide prevention.

Characteristics Associated with Non-Disclosure of Suicidal Ideation in Adults.

Suicide prevention efforts often depend on the willingness or ability of people to disclose current suicidal behavior. The aim of this study is to identify characteristics that are associated with non-disclosure of suicidal ideation. Data from the Dutch cross-sectional survey Health Monitor 2016 were used, resulting in 14,322 respondents (age 19+). Multiple logistic regression analyses were conducted to assess the strength of the associations between demographics and health-related characteristics as independent variables, and non-disclosure of suicidal ideation as the dependent variable. The mean age of the respondents was 60 years (SD 16.7) and 45% were male. Of these adults, 5% (n = 719) reported suicidal ideation in the past year, nearly half of which (48%) did not disclose suicidal ideation. Non-disclosure was significantly associated with social loneliness (OR = 1.29). Inverse significant associations were found for age (35–49 years, OR = 0.53), poor health status (OR = 0.63), frequent suicidal ideation (OR = 0.48), and severe psychological distress (OR = 0.63). The accuracy of this model was fair (AUC = 0.73). To conclude, non-disclosure is a substantial problem in adults experiencing suicidal ideation. Adults who do not disclose suicidal ideation are more likely to have few social contacts, while they are less likely to experience poor (mental) health and frequent suicidal thoughts.

The Decision‐Making Process for Disclosing Suicidal Ideation and Behavior to Family and Friends

ObjectiveThis study was designed to explore the decision‐making processes for disclosing suicidal ideation and behavior.BackgroundSuicide attempt survivors are an invaluable resource that can provide essential information about suicidal behavior and related communication to family and friends. Because of the stigma associated with suicide and seeking help, many individuals choose to conceal their suicidal ideation or behavior or to disclose only to a few family and friends.MethodSemistructured, audio‐only interviews were conducted with a convenience sample of 40 suicide‐attempt survivors to develop a grounded theory of factors that influence the decision to disclose current and past suicidal behavior to family members and other individuals within one's social network.ResultsSeveral motivations for disclosing (e.g., seeking help, sharing personal information, informing others) were identified, and a majority of the sample conducted an informal cost–benefit analysis before disclosing. The findings also elucidate the process of choosing a person with whom disclosure occurs, and the importance of having that family or friend with whom attempt survivors feel safe disclosing ideation as it occurs as well as subsequently processing the experience and seeking treatment.ConclusionDecision‐making processes for suicide‐related disclosure include identifying motivations to disclose, an informal cost–benefit analysis, and the selection of a recipient to whom one will disclose.ImplicationsThis emergent model identifies five tangible intervention strategies for increasing the likelihood of suicide disclosure. Future research should examine the internal resources that motivate individuals to engage in subsequent disclosure to individuals from whom they have previously experienced stigma.

Depression and Quality of Life Mediating the Association Between Attention Deficit/Hyperactivity Disorder and Suicidality in Military Recruits.

Military suicide remains a significant concern in many countries. Most psychological autopsy studies in this field focused on certain psychological comorbidities with suicide, namely depression, quality of life, sporadically in different populations. However, much less attention has been paid to Attention Deficit/Hyperactivity Disorder (ADHD), which is among the most common neuropsychiatric conditions in youth. This study aimed to test the associations between childhood ADHD symptoms and several suicidal behaviors, namely suicidal ideation, self-harm behaviors, and suicidal attempts. We, then, tested whether these associations would be mediated by the level of current depression and quality of life in military recruits. A total of 1,047 military recruits (all male, aged 20-34 years) participated in this questionnaire survey. The participants completed the Swanson, Nolan, and Pelham, Version IV Scale-Chinese version for ADHD symptoms before 12 years old; the Beck Depression Inventory, 2nd edition, for depressive symptoms and quality of life for the past 6 months; the Adult ADHD Quality-of-Life Scale; and the questions about current self-harm/suicidal behaviors on the Adult Self-Report Scale Inventory-4-Chinese version. Mediation analyses with bootstrapping of total indirect effects were used for statistical analyses. Our Results revealed significant associations between recalled childhood ADHD symptoms/diagnosis (age 6-12 years) and all the three current suicidal behaviors (suicidal ideation, self-harm behaviors, and suicidal attempts; all p values <0.001). Mediation analyses revealed that all these relationships were significantly and partially mediated by depression (all p values <0.05) and quality of life (p value <0.05, but not for suicidal attempts). The major findings of this study include that the ADHD-suicidality association is partially explained by the mediating effects of depression and quality of life, and that recalled ADHD symptoms had a stronger association with suicide attempt than with suicidal ideation in military recruits. Moreover, our finding of the highest direct effect of ADHD and lowest indirect effects of depression and quality of life on self-harm behavior indicates different associated patterns between deliberate self-harm and suicidal ideation and attempts. Our findings concord Nock's suggestion that different prevention strategies for suicidal ideation, self-harm behaviors, and suicidal attempts are warranted because of distinct courses and underlying psychopathology. This study is limited by a lack of psychiatric interview to make the diagnosis of ADHD and other psychiatric disorders, and only recruiting young men without female participants leading the generalization of our results to young women is questionable. Moreover, the lack of temporal data in this study prohibits us extend our findings to establish causality. The findings imply that assessment and intervention of depression and poor quality of life may help offset suicidal behaviors among military recruits with ADHD symptoms and/or diagnosis. Further investigations about interactions among those factors are warranted.

Correction of: Using New and Emerging Technologies to Identify and Respond to Suicidality Among Help-Seeking Young People: A Cross-Sectional Study.

[This corrects the article DOI: 10.2196/jmir.7897.].

Mental Health Professionals' Suicide Risk Assessment and Management Practices.

Approximately 20% of suicide decedents have had contact with a mental health professional within 1 month prior to their death, and the majority of mental health professionals have treated suicidal individuals. Despite limited evidence-based training, mental health professionals make important clinical decisions related to suicide risk assessment and management. The current study aimed to determine the frequency of suicide risk assessment and management practices and the association between fear of suicide-related outcomes or comfort working with suicidal individuals and adequacy of suicide risk management decisions among mental health professionals. Mental health professionals completed self-report assessments of fear, comfort, and suicide risk assessment and management practices. Approximately one third of mental health professionals did not ask every patient about current or previous suicidal thoughts or behaviors. Further, comfort, but not fear, was positively associated with greater odds of conducting evidence-based suicide risk assessments at first appointments and adequacy of suicide risk management practices with patients reporting suicide ideation and a recent suicide attempt. The study utilized a cross-sectional design and self-report questionnaires. Although the majority of mental health professionals report using evidenced-based practices, there appears to be variability in utilization of evidence-based practices.

Association of Adolescent Dimensional Borderline Personality Pathology with Past and Current Nonsuicidal Self-Injury and Lifetime Suicidal Behavior: A Clinical Multicenter Study

Descriptive diagnoses of nonsuicidal self-injury (NSSI) and suicide attempts (SAs) may detract from underlying dimensional borderline personality pathology (D-BPP). This study aimed to investigate D-BPP in adolescent inpatients with NSSI and SAs. A consecutive sample of 359 adolescent inpatients was assessed for current and past NSSI and life-time SAs. D-BPP and current mental health problems were measured using the Dimensional Assessment of Personality Pathology and the Strengths and Difficulties Questionnaire, respectively. D-BPP was significantly associated with both current (p < 0.001) and past NSSI (p = 0.025) and life-time SAs (p < 0.001) compared to their non-self-harming peers. Patients with current and past NSSI did not differ in terms of D-BPP or current mental health problems. A multivariate model did not show any additional influence of current mental health problems over and above D-BPP in predicting NSSI and SAs. It can be hypothesized that D-BPP underlies adolescent self-harm and may persist even after its termination, promoting a higher burden of mental health problems.

Vivencia-expresión de la rabia y razones para vivir en un grupo de pacientes chilenos con riesgo suicida

This study aimed to deepen in risk and protective factors of suicidal behavior by comparing mental health consultants, mostly with depressive symptoms, with and without suicidal risk. Six hundred and seventy-six consultants were studied in 3 health centers in the Metropolitan region in Chile. The sample was divided into 2 groups: I) without suicidal behavior (n=354), and II) with current suicidal behavior (n=321). At the same time, the group with suicidal behavior was divided into 3 subgroups: a) suicidal ideation, without current suicide attempts (n=165); b) low severity suicide attempt (n=71), and c) high severity suicide attempt (n=85). The studied variables were experience and expression of anger (STAXI-2) and dissuasive reasons to commit suicide (RFL). Descriptive and correlation analyzes were performed. The consultants without suicidal behavior showed a more functional experience and expression of anger, and they emphasized the importance of more reasons for living than the group with suicidal behavior. The suicidal ideation subgroup showed a greater dysfunction in relation to over-control rage. They stand as reasons for not wanting to commit suicide, not want to harm the children or cause suffering to the family. It also highlights as protective factor believe in their own coping abilities in difficult situations. The results contribute to the prevention and treatment of suicidal risk consultants.

EPIGENETIC VARIATION AT SKA2 PREDICTS SUICIDE PHENOTYPES AND INTERNALIZING PSYCHOPATHOLOGY.

DNA methylation of the SKA2 gene has recently been implicated as a biomarker of suicide risk and posttraumatic stress disorder (PTSD). To examine the specificity and reliability of these findings, we examined associations between SKA2 DNA methylation, broad dimensions of psychiatric symptoms, and suicide phenotypes in adults with high levels of trauma exposure. A total of 466 White, non-Hispanic veterans and their intimate partners (65% male) underwent clinical assessment and had blood drawn for genotyping and methylation analysis. DNA methylation of the CpG locus cg13989295 and genotype at the methylation-associated single-nucleotide polymorphism (SNP) rs7208505 were examined in relation to current and lifetime PTSD, internalizing and externalizing psychopathology, and suicide phenotypes (ideation, plans, and attempts). DNA methylation at the previously implicated SKA2 CpG locus (cg13989295) was associated with current and lifetime symptoms of internalizing (but not externalizing) disorders. SKA2 methylation levels also predicted higher rates of current suicidal thoughts and behaviors, even after including well-established psychiatric risk factors for suicide in the model. Associations between PTSD and SKA2 were not significant, and genetic variation at the methylation-associated SNP (rs7208505) was not related to any of the phenotypes examined. SKA2 methylation may index a general propensity to experience stress-related psychopathology, including internalizing disorders and suicidal thoughts and behaviors. This study demonstrates that SKA2 methylation levels explain unique variance in suicide risk not captured by clinical symptom interviews, providing further evidence of its potential utility as a biomarker of suicide risk and stress-related psychopathology.

Suicidal Behavior, Violent Behavior, and Neurocognitive Function in Child and Adolescent Mood Disorder Patients

Objectives: The aim of this study was to examine the association between current suicidal or violent behavior and deficits of specific neurocognitive variables in child and adolescent inpatient samples diagnosed with mood disorder. Methods: A retrospective review of the charts of mood disorder patients hospitalized at Samsung Medical Center between April 2004 and April 2015 was conducted. Child and adolescent patients aged between 10 and 18 years old and those who finished neurocognitive function testing during their hospitalization were included. Among them patients whose full scale IQ was between 85 and 115 were selected (N=111). Participants were first divided into two age-groups–group Y (10≤age≤15, N=54) and group O (16≤age≤18, N=57)–because neurocognitive function test tools were different according to age [Wechsler Intelligence Scale for Children (WISC) for 10 to 15-year-old patients, Wechsler Adult Intelligence Scale (WAIS) for 16 to 18-year-old patients]. They were then divided according to their suicidal or violent behavior–non suicidal/violent group (NG), suicidal group (SG), violent group (VG), and both suicidal/violent group (BG). The Child Behavior Checklist (CBCL) was checked for measurement of participants’ behavior and the Gordon Diagnostic System was checked for measurement of their attention efficiency. Kruskal-Wallis Test and Tukey test was used to determine the differences in neurocognitive function between groups. Results: O-SG patients showed lower scores on the comprehension subscale of WAIS-III than O-NG patients (χ2=8.454, p=.015). O-VG patients showed lower scores on the block design subscales of WAIS than O-SG patients (χ2=7.496, p=.024). Y-VG patients showed higher scores in aggressive behavior, externalizing problems, and total problems scores of CBCL. Conclusion: This study showed relationship between specific neurocognitive deficits and suicidal or violent behavior. These relationships were significant in relatively older adolescents.

Towards an anthropological conception of emotions in psychosomatic medicine

Research has shown that suicide risk is often present in patients suffering from type 1 diabetes mellitus (DM-1).The aim of the present paper was to investigate whether there was a relationship between DM-1 and suicidal behavior and to determine whether or not people affected by DM-1 are at an increased risk of completed suicide, attempted suicide, and suicidal ideation.We performed a careful MedLine, ExcerptaMedica, PsycLit, PsycInfo and Index Medicus search to identify all papers on the topic for the period 1970 to 2013 written in English. The following search terms were used: (suicide OR suicide attempt OR ideation) AND (diabetes mellitus). Where a title or abstract seems to describe a study eligible for inclusion, the full article was examined.We included only original articles published in English peer-reviewed journals. We excluded meta-analyses and systematic reviews, studies that were not clear about follow-up times, the method of statistical analysis, diagnostic criteria or the number of patients included, and studies only on patients affected by type 2 diabetes mellitus (DM-2).The research reviewed indicated that patients with DM-1 are at an increased risk for suicide, although no clear consensus exists regarding the level of the increased risk.The studies used different measurement techniques and different outcomes, and they assessed patients at different time points.Our findings support the recommendation that a suicide risk assessment of patients with DM-1 should be part of the routine clinical assessment. The assessment of patients at risk should consist of the evaluation of current and previous suicidal behaviors (both suicidal ideation and attempted suicide).

Posttraumatic Stress Disorder and Suicide Risk Among Veterans

Posttraumatic stress disorder (PTSD) is frequently associated with suicidal ideation and suicide attempts. Suicide is an important cause of death in veterans, and the risk for intentional death continues to be high many years after service. The aim of the present study was to investigate whether there is a relationship between PTSD and suicidal behavior among veterans. We also discussed the risk factors of suicide among war veterans with PTSD. A systematic review was conducted focusing on war-related PTSD and suicidal behavior. A total of 80 articles from peer-reviewed journals were identified, 34 were assessed for eligibility, and 16 were included. Having a history of PTSD is associated with higher rates of morbidity and mortality and increased the risk for suicidal behavior. The association between PTSD and suicidal behavior was confirmed by the presence of other risk factors and high rates of comorbidity. Current suicidal behavior should be adequately assessed in war veterans.

Correlates of Suicide Among Army National Guard Soldiers

Associations among sociodemographic characteristics, mood, trauma-related experiences, and suicidal behaviors were examined with archival data from Army National Guard (ARNG) soldiers that included suicide cases combined with annual random samples of nonsuicide cases for calendar years 2007–2011 (N = 5,390); postdeployed ARNG soldiers (N = 4,567); and home-stationed ARNG soldiers (N = 15,597). Suicidal behavior was associated with demographic characteristics (e.g., young age, male, and White) and loss of a significant other; childhood abuse experiences moderated the relationship between current stressors and suicidal behavior; suicidal behavior appeared to be consistent across the deployment cycle.

Brain-derived neurotrophic factor Val66Met polymorphism and alcohol-related phenotypes

Alcoholism is a chronic psychiatric disorder affecting neural pathways that regulate motivation, stress, reward and arousal. Brain-derived neurotrophic factor (BDNF) regulates mood, response to stress and interacts with neurotransmitters and stress systems involved in reward pathways and addiction. Aim of the study was to evaluate the association between a single nucleotide polymorphism (BDNF Val66Met or rs6265) and alcohol related phenotypes in Caucasian patients. In ethnically homogenous Caucasian subjects of the Croatian origin, the BDNF Val66Met genotype distribution was determined in 549 male and 126 female patients with alcohol dependence and in 655 male and 259 female healthy non-alcoholic control subjects. Based on the structured clinical interview, additional detailed clinical interview, the Brown-Goodwin Scale, the Hamilton Rating Scale for Depression and the Clinical Global Impression scores, alcoholic patients were subdivided into those with or without comorbid depression, aggression, delirium tremens, withdrawal syndrome, early/late onset of alcohol abuse, prior suicidal attempt during lifetime, current suicidal behavior, and severity of alcohol dependence. The results showed no significant association between BDNF Val66Met variants and alcohol dependence and/or any of the alcohol related phenotypes in either Caucasian women, or men, with alcohol dependence. There are few limitations of the study. The overall study sample size was large (N=1589) but not well-powered to detect differences in BDNF Val66Met genotype distribution between studied groups. Healthy control women were older than female alcoholic patients. Only one BDNF polymorphism (rs6265) was studied. In conclusion, these data do not support the view that BDNF Val66Met polymorphism correlates with the specific alcohol related phenotypes in ethnically homogenous medication-free Caucasian subjects with alcohol dependence.

Pre-adult onset and patterns of suicidality in patients with a history of recurrent depression

BackgroundThis report assesses the association between age of onset of major depression and later suicidality in a sample of 276 recurrently depressed patients recruited for the Oxford/Bangor Staying Well after Depression (SWAD) Trial, and interviewed when in remission.MethodsThe study enrolled adult patients with a history of at least three episodes of non-psychotic major depressive disorder from primary care and psychiatric care practices and through community advertisements. At study entry, all participants estimated the age of their first onset of a major depressive episode and completed both self-report and interview-based assessments of past and current suicidal ideation and behavior. Participants were divided into pre-adult and adult onset groups using a cut-off age of 18.ResultsForty-eight percent of the sample reported a pre-adult age of onset. Pre-adult age of onset was significantly associated with suicidality, both from self-report and from interviewer assessment even when adjusting for differences in age, gender, employment status, length of the disorder and early adversity.LimitationsRelevant variables were all assessed through retrospective reports.ConclusionsPre-adult age of onset is closely associated with risk for and severity of later suicidality, replicating, in a sample of patients assessed when in remission, findings from studies that assessed patients when currently depressed. The association of pre-adult age of onset with suicidality is not due to differences in sociodemographic variables, length of the disorder and early adversity.