Decreased Suicide Risk Research Articles

Belief system, meaningfulness, and psychopathology associated with suicidality among Chinese college students: a cross-sectional survey

BackgroundResearch suggests that Chinese religious believers are more likely to commit suicide than those identifying as non-religious among rural young adults, contrary to findings in Western countries. However, one cannot conclude that religiosity is associated with elevated suicide risk without examining the effect of political and religious beliefs in a generally atheist country like China where political belief plays a dominant role in the belief system of young adults. The present study investigated the effects of political and religious belief on suicidality with meaningfulness and psychopathology as potential mediators in a large representative sample of Chinese college students.MethodsA cross-sectional survey was conducted among 1390 first-year college students randomly sampled from 10 colleges and universities in mainland China.ResultsA total of 1168 respondents (84.0%) provided complete data on all variables. Lifetime prevalence of suicidal ideation, plan, and attempt were 45.1%, 6.8%, and 1.9% respectively, with one-year suicidal ideation showing at 19.3%. Female gender was associated with elevated risk of suicidality. Political belief but not religious belief was associated with decreased suicide risk. A significant interactive effect of political belief and religious belief was found, indicating that for political believers, being religious was associated with decreased suicide risk; for non-political believers, being religious was associated with increased suicide risk. Multi-group structural equation modeling showed that meaningfulness completely mediated and psychopathology partially mediated the effect of belief system on suicidality. Gender differences were found in pathways of political belief by religious beliefs to suicidality and political belief to psychopathology. The coefficients were significant for males but not for females.ConclusionsIn less religious societies, political belief may serve as a means of integration as does religious affiliation in religious societies. Males were more likely to benefit from the protective effect of a belief system on suicidality than females.

Combined Effects of Neuroticism and Extraversion

Neuroticism and extraversion are potentially important markers of personality vulnerability to suicide. Whereas previous studies have examined these traits independently, we examined their combined effects. Data were collected from family members and/or friends of individuals 18 years or older who died by suicide (n = 64) in rural China and from age-, sex-, and geographically matched controls (n = 64). Personality was assessed with the NEO-Five Factor Inventory. Individuals with a personality style characterized by high neuroticism and low extraversion were at 3.07 (95% confidence interval [CI], 1.44-6.55) times greater risk for suicide than were individuals without this personality style; in contrast, a style characterized by low neuroticism and high extraversion conferred decreased suicide risk (odds ratio, 0.41; 95% CI, 1.44-6.55). We conclude that it may be clinically inadequate to conceptualize neuroticism, by itself, as a risk marker for suicide. However, when the negative affect characteristic of neuroticism is combined with the joylessness, pessimism, and hopelessness characteristic of low extraversion, risk for suicide is elevated.

Prospective predictors of suicidal behavior in borderline personality disorder at 6-year follow-up.

Recurrent suicidal behavior is a defining characteristic of borderline personality disorder. Although most patients achieve remission of suicidal behavior over time, as many as 10% die by suicide, raising the question of whether there is a high-risk suicidal subtype. The authors conducted a longitudinal study of suicidal behavior in borderline personality disorder patients to identify prospective predictors of suicide attempts and to characterize those patients at highest risk for suicide completion. Demographic and diagnostic characteristics and clinical and psychosocial risk factors assessed at baseline were examined for predictive association with medically significant suicide attempts using Cox proportional hazards models. The authors defined prospective predictors for participants who completed 6 or more years in the study and compared the data to those of earlier intervals. Among 90 participants, 25 (27.8%) made at least one suicide attempt in the interval, and most attempts occurred in the first 2 years. The risk of suicide attempt was increased by low socioeconomic status, poor psychosocial adjustment, family history of suicide, previous psychiatric hospitalization, and absence of any outpatient treatment before the attempt. Higher global functioning scores at baseline decreased this risk. Risk factors predictive of suicide attempt change over time. Acute stressors such as major depressive disorder were predictive only in the short term (12 months), while poor psychosocial functioning had persistent and long-term effects on suicide risk. Half of borderline patients have poor psychosocial outcomes despite symptomatic improvement. A social and vocational rehabilitation model of treatment is needed to decrease suicide risk and optimize long-term outcomes.

A Systematic Review of Social Factors and Suicidal Behavior in Older Adulthood

Suicide in later life is a global public health problem. The aim of this review was to conduct a systematic analysis of studies with comparison groups that examined the associations between social factors and suicidal behavior (including ideation, non-fatal suicidal behavior, or deaths) among individuals aged 65 and older. Our search identified only 16 articles (across 14 independent samples) that met inclusion criteria. The limited number of studies points to the need for further research. Included studies were conducted in Canada (n = 2), Germany (n = 1), Hong Kong (n = 1), Japan (n = 1), Singapore (n = 1), Sweden (n = 2), Taiwan (n = 1), the U.K. (n = 2), and the U.S. (n = 3). The majority of the social factors examined in this review can be conceptualized as indices of positive social connectedness—the degree of positive involvement with family, friends, and social groups. Findings indicated that at least in industrialized countries, limited social connectedness is associated with suicidal ideation, non-fatal suicidal behavior, and suicide in later life. Primary prevention programs designed to enhance social connections as well as a sense of community could potentially decrease suicide risk, especially among men.

Suicide Risk: Navigating the Failure Modes

Suicide Risk: Navigating the Failure Modes

Suicide risk and its correlate in adolescents who experienced typhoon-induced mudslides: a structural equation model

The aims of this study were to examine the direct and indirect effects of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), disaster-exposure experience, gender, and perceived family support on suicide risk (including suicide ideation and attempt) in adolescents 3 months after they had experienced Typhoon Morakot-associated mudslides in Taiwan using a structural equation model (SEM). Two hundred and seventy-one adolescents in the worst affected mountainous regions of southern Taiwan were recruited. Suicide risk and diagnoses of PTSD and MDD were assessed using the Mini-International Neuropsychiatric Interview for Children and Adolescents. The direct and indirect effects of PTSD, MDD, disaster-exposure experience, gender, and perceived family support on suicide risk were examined using SEM. The results of SEM indicated that increased disaster-exposure experience and female gender had direct influences on an increased suicide risk and indirect influences on increased suicide risk that were mediated by PTSD and MDD. Perceived high family support directly decreased suicide risk. Both PTSD and MDD had direct influences on an increased suicide risk, and PTSD had an indirect influence on an increased suicide risk that was mediated by MDD. Gender, disaster-exposure experience, perceived high family support, PTSD, and MDD all had effects on suicide risk in adolescents who had experienced the threat of mudslides caused by Typhoon Morakot. The results provide healthcare professionals with a comprehensive understanding to develop intervention programs to prevent and intervene in suicide risk.

Long-term outcomes for the promoting CARE suicide prevention program.

To provide a long-term look at suicide risk from adolescence to young adulthood for former participants in Promoting CARE, an indicated suicide prevention program. Five hundred ninety-three suicide-vulnerable high school youth were involved in a long-term follow-up study. Latent class growth models identify patterns of change in suicide risk over this period. Three distinct trajectories are determined, all showing a maintenance of decreased suicide risk from postintervention in adolescence into young adulthood for direct suicide-risk behaviors, depression and anger. Intervention conditions as well as key risk/protective factors are identified that predict to the long-term trajectories. Early intervention is successful in promoting and maintaining lower-risk status from adolescence to young adulthood, with the caveat that some high-risk behaviors may indicate a need for additional intervention to establish earlier effects.

Does sport have a protective effect against suicide?

The association between sporting activities, or lack there of, and suicidal behaviour has not yet been clarified. The objective of this study was to determine, if sports participation has an impact on risk for completed suicide. Axis I and Axis II disorders, sociodemographic factors, and current and former sports activities, including various sports disciplines, were assessed by a semi-structured interview by psychological autopsy method in 163 suicides and by personal interview in 396 living population-based control persons. Current sports activities (OR = 0.24, 95%CI, 0.15 to 0.39; OR = 0.27, 95%CI, 0.16 to 0.45) and sports activities at some point in life (OR = 0.33, 95%CI, 0.18 to 0.62; OR = 0.40, 95%CI, 0.23 to 0.68, after adjustment for axis I and II disorders or educational level, each) were associated with decreased suicide risk. Current sports activities and sports activities at some point in life may reduce suicide risk.

Chronic medical problems and distressful thoughts of suicide in primary care patients: mitigating role of happiness

Chronic medical problems might amplify suicide risk in later life. Feelings of happiness may reduce this risk. We tested the hypothesis that happiness attenuates the association between number of self-reported chronic diseases and suicidal distress. A sample of 1,801 depressed, primary care patients, 60 years of age or older, entering a clinical trial, were assessed for the presence of positive emotion, suicidal distress and self-reported chronic medical problems. Chronic medical problems are associated with suicide ideation and, as hypothesized, happiness attenuates the relationship between self-reported diseases and suicidal distress. Decreased risk for distressing thoughts of suicide in the context of medical illness is predicted by the presence of positive emotions. Our results suggest that treatments designed to help older primary care patients identify sources of joy and enhance happiness might decrease suicide risk.

Does Acute Treatment with Sedatives/Hypnotics for Anxiety in Depressed Patients Affect Suicide Risk? A Literature Review

Anxiety (among several other symptoms) has been identified in one prospective study as associated with suicide risk in depressed patients early in treatment. It has been suggested that treatment of anxiety in depression with sedative/hypnotic agents, especially benzodiazepines, in the first several weeks may decrease suicide risk. Sedative/hypnotic agents also have depressant and disinhibitory properties which might increase suicide risk, however. This review addresses the potential benefits and risks with regard to suicide of using sedative/hypnotics as an early adjunct to antidepressant treatment in anxious depressed patients. Pertinent medical literature was reviewed using Medline/PubMed search as well as bibliographies from related publications. Reports in English from 1958 to 2006 were included. The review did not reveal any evidence that using sedative/hypnotics as an early adjunct to antidepressant treatment of anxious depressed patients decreases their suicide risk. There is considerable evidence that sedative/hypnotics produce depressant and/or disinhibitory effects in a small proportion (perhaps 5%) of people who take them. However, there is no clear evidence that their brief use early in depression increases suicide risk. Toxicological data of suicides indicate that a majority of people who commit suicide are under the influence of sedative/hypnotic chemicals (including alcohol) at the time. The authors conclude that the question of whether sedative/hypnotics may prevent or provoke suicide in anxious depressed patients cannot be answered definitively with the available information. They believe the potential risks of prescribing sedative/hypnotics for depressed patients who may be suicidal are serious. They suggest that alternatives to sedative/hypnotics should be used if early adjunctive treatment for anxiety in depressed patients is thought to be indicated.

Assessment and immediate management of people at risk of harming themselves

Abstract This article reviews the clinical assessment and management of people at risk of suicide and self-harm. Such people are found in many clinical settings. In any given clinical situation, there are identifiable factors which increase or decrease the risk of suicide. The risk that a person has of suicide in the next few hours, days and weeks depends on the degree to which the person has these factors increasing or decreasing suicide risk. These factors are relevant only to suicide and do not necessarily indicate the risk of self-harm not leading to death. A strategy for the assessment of suicide with or without recent self-harm is provided. These require good general interview skills, clarification of current problems, specific questioning about suicide intent, information on past suicide attempts and coping mechanisms, and information on current and past symptoms of mental disorder. From the assessment, people can be categorized as low, medium, medium–high or very high risk. Each risk category is linked to a set of management options that would be typically carried out. These would include ensuring immediate safety, support in the first 24–72 hour period, follow-up, defining the emotional crisis, restricting access to the means of suicide and further assessment of mental health problems, psychosocial problems and crisis prevention strategies.

Optimism and Suicide Ideation Among Young Adult College Students

Given that college students may be at increased risk for suicide, it is important to conduct research that could guide suicide prevention efforts on college campuses. Although much research has been conducted on the role of hopelessness and depression in suicide ideation, the role of dispositional optimism is unclear. Subjects were 284 college students (185 female, 65%), ages 18 and over. Optimism was assessed with the Life Orientation Test–Revised. The outcome measure was the Beck Scale for Suicide Ideation. A hierarchical, multivariate regression was used to test the hypothesis that optimism is inversely associated with suicide ideation, even after controlling for age, gender, depressive symptoms, and hopelessness. The hypothesis was supported. Optimism holds promise as a cognitive characteristic associated with decreased thoughts of suicide in college students; a better understanding of its putative protective role in this group, and cross-culturally, is needed. Prevention programs designed to enhance optimism in the college setting might decrease suicide risk.

Reductions in Postdischarge Suicide After Deinstitutionalization and Decentralization: A Nationwide Register Study in Finland

Reductions in Postdischarge Suicide After Deinstitutionalization and Decentralization: A Nationwide Register Study in Finland

Future Orientation and Suicide Ideation and Attempts in Depressed Adults Ages 50 and Over

The objective of this study was to test the hypothesis that future orientation is associated with lower levels of suicide ideation and lower likelihood of suicide attempt in a sample of patients in treatment for major depression. Two hundred two participants (116 female, 57%) ages 50-88 years were recruited from inpatient and outpatient settings. All were diagnosed with major depression using a structured diagnostic interview. Suicide ideation was assessed with the Scale for Suicide Ideation (both current and worst point ratings), and a measure of future orientation was created to assess future expectancies. The authors predicted that greater future orientation would be associated with less current and worst point suicide ideation, and would distinguish current and lifetime suicide attempters from nonattempters. Hypotheses were tested using multivariate logistic regression and linear regression analyses that accounted for age, gender, hopelessness, and depression. As hypothesized, higher future orientation scores were associated with lower current suicidal ideation, less intense suicidal ideation at its worst point, and lower probability of a history of attempted suicide after accounting for covariates. Future orientation was not associated with current attempt status. Future orientation holds promise as a cognitive variable associated with decreased suicide risk; a better understanding of its putative protective role is needed. Treatments designed to enhance future orientation might decrease suicide risk.

Future orientation moderates the relationship between functional status and suicide ideation in depressed adults

Functional impairment might amplify suicide risk in later life. A positive view of the future may reduce this risk. We tested the hypothesis that hopelessness and positive future orientation moderate the association between functional status and suicide ideation in a sample of 136 patients, 55 years of age or older, in treatment for depression. Future orientation moderated the association between functional status and suicide ideation; hopelessness did not. Although prospective research is needed to test more rigorously the hypothesized protective role of positive future orientation, our data suggest that treatments designed to enhance future orientation might decrease suicide risk.

An examination of DSM-IV depressive symptoms and risk for suicide completion in major depressive disorder: A psychological autopsy study

Background It is unclear whether certain DSM-IV depressive symptoms are more prevalent among individuals who die in the context of a major depressive episode and those who do not, whether this is associated with proximal or distal suicide risk, and whether depressive symptoms cluster to indicate suicide risk. Method A psychological autopsy method with best informants was used to investigate DSM-IV depressive symptoms among 156 suicides who died in the context of a major depressive episode and 81 major depressive controls. Results Suicides' depressive symptoms were more likely to include weight or appetite loss, insomnia, feelings of worthlessness or inappropriate guilt as well as recurrent thoughts of death or suicidal ideation. Fatigue and difficulties concentrating or indecisiveness were less prevalent among depressed suicides. These associations were independent of concomitant axis I and II psychopathology. The concomitant presence of (a) fatigue as well as impaired concentration or indecisiveness and (b) weight or appetite gain and hypersomnia was associated with decreased suicide risk. Inter-episode symptom concordance suggests that insomnia is an immediate indicator of suicide risk, while weight or appetite loss and feelings of worthlessness or guilt are not. Limitations This study employed proxy-based interviews. Conclusions We found that discrete DSM-IV depressive symptoms and clusters of depressive symptoms help differentiate depressed individuals who die by suicide and those who do not. Moreover, some DSM-IV depressive symptoms are associated with an immediate risk for suicide, while others may result from an etiology of depression common to suicide without directly increasing suicide risk.

Asian/Pacific Islander adolescent sexual orientation and suicide risk in Guam.

We examined the effects of same-sex orientation on suicide risks for Guam's Asian/Pacific Islander adolescents. We used a probability sample and logistic regression analysis to identify suicide risk factors. Same-sex orientation was associated with a greater risk of suicide attempt, especially for boys. Adolescents who reported suffering physical abuse in the context of a romantic relationship, engaging in binge drinking, and experiencing feelings of hopelessness were at greater risk for suicidal ideation and attempts. Race/ethnicity was associated with suicide risk for both boys and girls, and patterns suggest that membership in the same racial/ethnic group decreased suicide risk for girls and increased risk of suicide for boys. Gay, lesbian, and bisexual Asian/Pacific Islander adolescents in Guam deserve intervention and counseling programs to reduce suicide risk.

Identification of suicidal ideation and prevention of suicidal behaviour in the elderly.

In almost all industrialised countries, men aged 75 years and older have the highest suicide rate among all age groups. Although in younger age groups suicide attempts are often impulsive and communicative acts, suicide attempts in older people (defined as aged 65 years and older) are often long planned and involve high-lethality methods. These characteristics, in addition to the fact that elderly are more fragile and frequently live alone, more often lead to fatal outcome. In later life, in both sexes, the most common diagnosis in those who attempt or complete suicide is major depression. In contrast to other age groups, comorbidity with substance abuse and personality disorders is less frequent. Physical illness plays an important role in the suicidal behaviour of the elderly: most frequently, depression and illness co-occur; less often, the physical illness or the treating medications are causally related to the depressive symptoms. However, only 2 to 4% of terminally ill elderly commit suicide. In addition to physical illness, complicated or traumatic grief, anxiety, unremitting hopelessness after recovery from a depressive episode and history of previous suicide attempts are risk factors for suicide attempts and completed suicide. During a depressive episode, elderly patients with suicidal ideation have higher levels of anxiety and, during treatment, anxiety decreases the probability of remission and recovery. As well as overt suicide attempts, indirect self-destructive behaviours, which often lead to premature death, are common, especially in residents of nursing homes, where more immediate means to commit suicide are restricted. Although we do not have randomised trials of treatment, studies suggest that antidepressant treatment may decrease suicide risk. Prevention and treatment trials are underway to detect the effectiveness of improved treatment of depression by primary care physicians as a means of reducing the prevalence of depressive symptoms, hopelessness and suicidal ideation.

The ability of lithium and other mood stabilizers to decrease suicide risk and prevent relapse

Bipolar disorder is marked by frequent recurrences, a course from childhood or early adulthood until death, marked increased rates of suicide, and substantial functional morbidity. Maintenance treatment is generally recommended to reduce the ravages of the illness. This article reviews the evidence that lithium, divalproex, and carbamazepine may reduce suicidal risk. It reviews the evidence for relapse prevention for lithium, valproate, and other drugs often employed in the maintenance phase treatment of bipolar disorder. Both lithium and divalproex appear beneficial in prevention of relapse, although recent studies indicate more modest effects for lithium than did early studies from the 1970s.