Diagnosis Of Suicide Research Articles

Neighborhood-Level Social Determinants of Health and Adolescent Mental Health

ObjectiveMental health diagnoses among adolescents are increasing in prevalence. Existing literature considers associations between individual-level social determinants of health (SDOH) and adolescent mental health. Neighborhood-level SDOH can have a substantial impact on health. This paper examines associations between neighborhood-level SDOH and mental health diagnoses of anxiety, depression, and suicidal ideation among hospitalized adolescents. MethodsWe used 2018 and 2019 Texas Inpatient Discharge Public Use Data Files linked to the zip-code level Child Opportunity Index 2.0, a composite measure of subdomains which characterize neighborhood-level SDOH, to examine rates of mental health diagnoses and associations with patient characteristics across opportunity level quintiles. ResultsThe sample included 50,011 adolescents ages 10–19 admitted to the hospital with the mental health diagnoses anxiety, depression, and/or suicide. Most had a single diagnosis; anxiety (12.9%), depression (37.5%), or suicide (13.0%). Hospitalized adolescents 10–14 years old were a plurality (44.2%) of the sample. Most adolescents were White (64.2%) and non-Hispanic (67.4%) and lived in rural areas (29.6%). Adolescents from racial minority populations and those in rural communities with mental health diagnoses had lower opportunity-levels. Higher opportunity levels were associated with greater odds of having an anxiety or suicide diagnosis while a depression diagnosis was associated with a lower opportunity-level. ConclusionsThere are significant differences in adolescent mental health diagnoses associated with neighborhood opportunity-level. While all adolescents can benefit from mental health education, screening, and early interventions, additional resources tailored to neighborhood-level opportunity may prove a more meaningful way to improve population-level mental health outcomes.

Emergency department visits and boarding for pediatric patients with suicidality before and during the COVID-19 pandemic.

To quantify the increase in pediatric patients presenting to the emergency department with suicidality before and during the COVID-19 pandemic, and the subsequent impact on emergency department length of stay and boarding. This retrospective cohort study from June 1, 2016, to October 31, 2022, identified patients ages 6 to 21 presenting to the emergency department at a pediatric academic medical center with suicidality using ICD-10 codes. Number of emergency department encounters for suicidality, demographic characteristics of patients with suicidality, and emergency department length of stay were compared before and during the COVID-19 pandemic. Unobserved components models were used to describe monthly counts of emergency department encounters for suicidality. There were 179,736 patient encounters to the emergency department during the study period, 6,215 (3.5%) for suicidality. There were, on average, more encounters for suicidality each month during the COVID-19 pandemic than before the COVID-19 pandemic. A time series unobserved components model demonstrated a temporary drop of 32.7 encounters for suicidality in April and May of 2020 (p<0.001), followed by a sustained increase of 31.2 encounters starting in July 2020 (p = 0.003). The average length of stay for patients that boarded in the emergency department with a diagnosis of suicidality was 37.4 hours longer during the COVID-19 pandemic compared to before the COVID-19 pandemic (p<0.001). The number of encounters for suicidality among pediatric patients and the emergency department length of stay for psychiatry boarders has increased during the COVID-19 pandemic. There is a need for acute care mental health services and solutions to emergency department capacity issues.

111: EFFECT OF COVID-19 LOCKDOWN ON LENGTH OF HOSPITALIZATION FOLLOWING SUICIDE ATTEMPTS IN ADOLESCENTS

Introduction: Mental health related concerns have increased as a consequence of the Covid-19 pandemic. Emerging evidence has suggested that adolescents are at a greater risk compared to other age groups. Frequently, it is hypothesized that suicide attempts have increased following the global pandemic; however, inconsistent data currently exists illustrating the pattern of suicide attempts surrounding the pandemic. Therefore, our purpose was to examine the length of stay (LOS) following pediatric suicide attempts across three phases of the pandemic and the potential associated financial burden. Methods: 1,467 patient encounters from the pediatric ED and PICU with a diagnosis of suicide were retrospectively reviewed. A total of 262 patient records (age: 15±2 yo, 82% female) were included and grouped based on Covid-19 lockdown (defined as March 2020). Three time periods were demarcated: 1-yr pre-lockdown, 1-yr immediately following lockdown, and 2nd-yr following lockdown. A Pearson correlation was conducted between LOS and total cost of care. A 1-way between group ANOVA was used to examine mean differences in LOS. A p-value < 0.05 was defined as significant. Results: A positive relationship was found between LOS and total cost of care (n=142; r=.743; CI95%=.658-.808). The number of attempts per time period was 80, 93, and 89, respectively. The between group ANOVA indicated there was a significant (F=3.77, p=0.024) increase in LOS following the lockdown. Specifically, pairwise comparisons showed that LOS was greater during the 2nd-yr of lockdown compared to pre-lockdown (mean±SEM: 1.11 ± .14 vs. 1.63 ± .13 days; mean difference =.52, CI95% = .15 - .89). Conclusions: There was a relationship between LOS and total cost of care such that the more time spent hospitalized resulted in higher cost. While it still remains to be determined to what degree the incidence rate of attempt was affected by Covid-19 lockdown, here we suggest that LOS (and perhaps cost) increased following the lockdown date. Interestingly, there was only a difference between pre-lockdown and the 2nd-yr of lockdown. Therefore, future studies should examine factors contributing to greater LOS, such as access to mental health professionals and bed availabilities at inpatient psychiatric facilities.

The role of psychological autopsy in investigating a case of atypical suicide in schizophrenia: a case report with a brief review of literature

BackgroundSelf-harm typically is without lethal intent. Death can occur rarely, with suicide taking on an atypical form that raises the suspicion of hetero-aggression. Our study aimed to identify the link between self-harm and suicide intent and also to outline the positive diagnosis of an atypical suicide case which has raised the suspicion of hetero-aggression. For this purpose, the psychological autopsy method should be used regularly in suicide investigation because it not only allows a positive diagnosis of suicide but can also provide a detailed picture of mental degradation and associated suicide risk factors.Case presentationThe case of a 26-year-old man from a rural area, found dead in the basement, at home, naked, barricaded inside, is described.MethodsThe on-site investigation and a complete forensic autopsy were performed. In addition, we apply the psychological autopsy method which gathered enough information to outline the positive diagnosis of suicide. We also made a brief literature review on the suicide risk factors and the behavioral changes that occurred during the COVID-19 pandemic in schizophrenic patients.ResultsThe forensic autopsy revealed that he presented a complex craniofacial trauma as the cause of death (with scalp lacerations, frontal fracture, subarachnoid hemorrhage, and frontal cerebral contusions) associated with torso trauma (with self-inflicted stabbed wounds) with bruises and abrasions on the limbs. The injuries that caused death were self-inflicted and ensued repeatedly hitting his head against blunt objects. Using the psychological autopsy method, we found out that he presented multiple psychiatric hospitalizations for schizophrenia for almost 10 years, recently with reduced compliance to treatment. We also documented two previous suicide attempts and a gradual deterioration of his mental health.ConclusionsWe highlighted the role of the psychological autopsy (in addition to the judicial investigation and the forensic autopsy) for the diagnosis of committed suicide, for making a rigorous differential diagnosis between accident, hetero-aggression, and suicide, and also in pin-pointing the suicide risk factors.

Predicting the Risk of Future Multiple Suicide Attempt among First-Time Suicide Attempters: Implications for Suicide Prevention Policy.

Suicide is listed in the top ten causes of death in Taiwan. Previous studies have pointed out that psychiatric patients having suicide attempts in their history are more likely to attempt suicide again than non-psychiatric patients. Therefore, how to predict the future multiple suicide attempts of psychiatric patients is an important issue of public health. Different from previous studies, we collect the psychiatric patients who have a suicide diagnosis in the National Health Insurance Research Database (NHIRD) as the study cohort. Study variables include psychiatric patients’ characteristics, medical behavior characteristics, physician characteristics, and hospital characteristics. Three machine learning techniques, including decision tree (DT), support vector machine (SVM), and artificial neural network (ANN), are used to develop models for predicting the risk of future multiple suicide attempts. The Adaboost technique is further used to improve prediction performance in model development. The experimental results show that Adaboost+DT performs the best in predicting the behavior of multiple suicide attempts among psychiatric patients. The findings of this study can help clinical staffs to early identify high-risk patients and improve the effectiveness of suicide prevention.

Increased paediatric emergency mental health and suicidality presentations during COVID-19 stay at home restrictions.

ObjectiveAnecdotal reports indicate an increase in mental health presentations and acuity to EDs during the COVID‐19 pandemic and associated stay at home restrictions. Paediatric and adolescent data to confirm this are unavailable in the Australian setting.MethodsRetrospective electronic medical record review of all ED patients with mental health discharge codes at a large tertiary children's hospital in Australia during the period of stay at home restrictions from 1 April to 30 September 2020 compared with the same dates in 2019.ResultsWe found a 40% decrease in ED presentations (18 935–11 235) with a concurrent 47% increase in mental health presentations (809–1190) to ED during the study periods between 2019 and 2020. This resulted in an increase of 100 mental health admissions from ED. Diagnoses with greatest percentage increases were eating disorders, social issues and suicidality. We found suicidality presentation numbers were highest in June to September 2020 compared with 2019. Patients with a diagnosis of suicidality had a higher rate of re‐presentation in 2020 (1.83 presentations per patient) compared to 2019 (1.38 presentations per patient).ConclusionsDespite an overall decrease in ED presentations, the absolute increase in mental health presentations for children and adolescents during the stay at home restriction period was pronounced. It is unclear how sustained this change and the impact on mental health resource use will be post‐pandemic.

Trends in Suicidality 1 Year Before and After Birth Among Commercially Insured Childbearing Individuals in the United States, 2006-2017

Suicide deaths are a leading cause of maternal mortality in the US, yet the prevalence and trends in suicidality (suicidal ideation and/or intentional self-harm) among childbearing individuals remain poorly described. To characterize trends in suicidality among childbearing individuals. This serial cross-sectional study analyzed data from a medical claims database for a large commercially insured population in the US from January 2006 to December 2017. There were 2714 diagnoses of suicidality 1 year before or after 698 239 deliveries among 595 237 individuals aged 15 to 44 years who were continuously enrolled in a single commercial health insurance plan. Data were analyzed from October 2019 to September 2020. The primary outcome was diagnosis of suicidality in childbearing individuals 1 year before or after birth based on the identification of relevant International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis codes during at least 1 inpatient or 2 outpatient visits. Of 595 237 included childbearing individuals, the mean (SD) age at delivery was 31.9 (6.4) years. A total of 40 568 individuals (6.8%) were Asian, 52 613 (8.6%) were Black, 73 172 (12.1%) were Hispanic, 369 501 (63.1%) were White, and 59 383 (9.5%) had unknown or missing race/ethnicity data. A total of 2683 individuals were diagnosed with suicidality 1 year before or after giving birth for a total of 2714 diagnoses. The prevalence of suicidal ideation increased from 0.1% per 100 individuals in 2006 to 0.5% per 100 individuals in 2017 (difference, 0.4%; SE, 0.03; P < .001). Intentional self-harm prevalence increased from 0.1% per 100 individuals in 2006 to 0.2% per 100 individuals in 2017 (difference, 0.1%; SE, 0.02; P < .001). Suicidality prevalence increased from 0.2% per 100 individuals in 2006 to 0.6% per 100 individuals in 2017 (difference, 0.4%; SE, 0.04; P < .001). Diagnoses of suicidality with comorbid depression or anxiety increased from 1.2% per 100 individuals in 2006 to 2.6% per 100 individuals in 2017 (difference, 1.4%; SE, 0.2; P < .001). Diagnoses of suicidality with comorbid bipolar or psychotic disorders increased from 6.9% per 100 individuals in 2006 to 16.9% per 100 individuals in 2017 (difference, 10.1%; SE, 0.2; P < .001). Non-Hispanic Black individuals, individuals with lower income, and younger individuals experienced larger increases in suicidality over the study period. In this cross-sectional study of US childbearing individuals, the prevalence of suicidal ideation and intentional self-harm occurring in the year preceding or following birth increased substantially over a 12-year period. Policy makers, health plans, and clinicians should ensure access to universal suicidality screening and appropriate treatment for pregnant and postpartum individuals and seek health system and policy avenues to mitigate this growing public health crisis, particularly for high-risk groups.

Association between suicidal ideation and acoustic parameters of university students’ voice and speech: a pilot study

Purpose At a worldwide level, suicide is a public health problem that, despite displaying downward trends in several areas of the world, in many countries these rates have increased. One of the elements that contributes to its prevention is an early and dynamic evaluation. Due to this, the objective is to determine the association between acoustic parameters of voice and speech (F0, F1, F2, F3, dB, and Jitter) and suicidal ideation arousal amongst some university students from the city of Temuco, Chile. Methods Attending to this issue, a cross-sectional design study was conducted through a non-probabilistic sampling of sixty 18- and 19-year-old adolescents from the city of Temuco, that went through an acoustic evaluation of their voice and speech after taking a test to determine suicidal ideation. Afterwards, data were analyzed through IBM SPSS version 23.0 software (IBM SPSS Statistics, Armonk, NY), by means of exploratory, descriptive, and inferential statistics taking the variable’s levels of measurements and the types of distributions into account. Results The results point out that 30% of the adolescents, from both genders, displayed suicidal ideation. Taking into account the acoustic results of their voice, it is possible to recognize that the fundamental frequency (F0), the formants (F1, F2), and Jitter, are the ones that majorly link to the presence of suicidal ideation, both in women and men (p < .05). The characteristics that describe F3 were only linked to the presence of suicidal ideation in men (p < .05). Conclusions It is concluded that the acoustic parameters of voice and speech differ in adolescents with suicidal behavior, opening the possibility of representing a useful tool in the diagnosis of suicide.

Historical analysis of suicide

Suicide is a dangerous clinical event causing 2% of human mortality. Due to its inherent danger to life and complexity, suicide studies are in high demand. Many resources have been allocated to the development of predicting suicides, its prevention and useful medical interventions so that biomedical and scientific study of the subject is indispensable. Historically, knowledge on suicide was largely based on mental illness studies. The diagnosis of suicide,mood disorders and the treatments have been reported since over 2000 years ago (Hippocrates in 460-377, BC). Despite a long history of association between suicide and mood disorder, the related terminology have evolved greatly. Yet, mortality reduction has been minimal despite many diagnostic and therapeutic studies and no effective therapeutic means have been developed. To improve on this scenario, we review the history and literature on suicide.

Rethinking Suicidal Behavior Disorder.

Background: It is a peculiar fact that the deadliest psychiatric disturbance - suicidality - cannot be formally diagnosed. Suicidal behavior disorder (SBD), a condition for further study in the DSM-5, is the field's first attempt to capture suicidality in a diagnosis. Aims: To provoke discussion about the standing of suicidality as a diagnosable psychiatric condition. Method: I present pragmatic and conceptual rationales for why a diagnosis of suicidality is clinically useful but conclude that SBD does little to aid clinicians in assessing suicidality's symptoms, planning treatment, or monitoring progress. Results: To improve the clinical utility of SBD, I re-conceptualize it from the vantage point of descriptive psychiatry. I hypothesize that this revised SBD is an independent, episodic, and frequently co-occurring condition and propose new cognitive, affective, and behavioral criteria that more completely capture the phenomenology of suicidality. Conclusion: The revised SBD is a starting place for dialogue about whether a clinically significant presentation of suicidality is a mental illness and, if it is, what its defining features should be.

Suicide by Extraordinarily Numerous Blade Wounds

A 42-year-old man with a history of suicidal ideation, was found dead in his garage, with over 54 stab wounds and with multiple cuts. The house was locked and the bay door of the attached garage was closed when his live-in girlfriend arrived home and found him. The scene was bloody and a knife was beside the body. Multiple stab wounds involved the neck and the left pectoral region of the chest, and a single stab wound involved the epigastrium. Incised wounds involved the neck and upper extremities. The head, back, genitalia, and lower extremities had no wounds. The blood smears and spatters in the garage, including a bloody footprint, all were attributable to the decedent. The combined consideration of the history, circumstances, and autopsy findings clearly pointed to self-infliction as the manner of death. Most reported cases of suicide by blade involve fewer than 15 stab wounds. This case report, with a brief review of the literature, underscores the concept that multiplicity of stab wounds does not preclude the diagnosis of suicide.

Graphology for the diagnosis of suicide attempts: a blind proof of principle controlled study

To evaluate the ability of two graphologists and two practising internists not trained in graphology to differentiate letters written by subjects who have attempted to commit suicide by self-poisoning and healthy volunteers, we performed a maximal blind controlled study vs. healthy volunteers. Forty fully recovered patients who had attempted to commit suicide and 40 healthy volunteers wrote and signed a short letter or story not related to the parasuicide or their mental health status. The evaluators classified the 80 letters as 'suicide' or 'no suicide' in an intention-to-treat analysis. Letters expressing sadness were subsequently excluded for a per-protocol analysis. Correct diagnosis of suicide and of healthy controls was made in, respectively, 32 of 40 and 33 of 40 letters by the graphologists and in 27 of 40 and 34 of 40 letters by the internists. After the exclusion of 12 letters expressing sadness, the sensitivity, specificity, positive predictive value and negative predictive value were, respectively, 73, 88, 81 and 82% for the graphologists and 53, 89, 80 and 71% for the internists. Both classified the letters with significantly more effectiveness than chance (p < 0.001) with no statistically significant difference between the two groups of evaluators. We concluded that graphological analysis is able to differentiate letters written by patients who attempt suicide from those written by healthy controls. This technique shows an acceptable degree of accuracy and could therefore become an additional discharge or decision-making tool in Psychiatry or Internal Medicine.

Suicide in psychiatric patients. A prospective study of 67 cases without initial signs of severe depression or alcoholism.

All cases from the county, who were subjected to post-mortem examination at the Department of Forensic Medicine, University of Lund with a diagnosis of suicide during 1949-1984, were compared with the inpatient register at the Department of Psychiatry, University Hospital, Lund during 1949-1969. During these years all patients were rated at discharge with a multidimensional schedule. All patients with initial ratings of severe depression/melancholia and alcoholism were analyzed separately and excluded from the present sample. The ratings of the suicide cases were compared with those of 8,046 other inpatients. There were 67 suicide cases, 36 men and 31 women. The suicide cases had higher frequencies of the item easily led/dependent/immature personality (34% versus 18%) and of attempted suicides (19% versus 8%). There were no differences in ratings of symptoms as slight depression and anxiety or of situational factors. Attempted suicide was related to suicides early in the course, while easily led/dependent/immature was not so related. At the time of the suicide there was a higher frequency of never married and a lower frequency of married subjects in the present series compared with suicides in severe depression/melancholia and alcoholism.

Difficulties in establishing a diagnosis of suicide

Difficulties in establishing a diagnosis of suicide