Family History Of Completed Suicide Research Articles

A family history of suicide in bipolar disorders: powerful, powerless

IntroductionWhen completing the medical record of a patient with bipolar disoder (BD), hardly anything is more impacting than a family history of completed suicide (FHS). In fact, FHS is a main risk factor for personal suicide attempts and death in this population. There are few modifiable protective factors against suicide in BD, such as lithium treatment and absence of substance abuse.ObjectivesWe aimed to explore the relationship between a FHS and clinical characteristics in patients with BD. Given the impact that FHS has on the individual and on healthcare professionals, we hypothesized that it would modify behaviors towards a higher prevalence of the modifiable protective factors against suicide, namely more treatment with lithium and less drug addiction.MethodsThis is a cross-sectional study that included all patients with BD that were followed up in a specialised unit between 1998 and 2020. Only subjects with complete information on FHS were retained for the analysis. We assessed sociodemographic and clinical data and described it with measures of frequency, central tendency and dispersion. Differences between subjects with and without FHS were calculated with χ², Fisher’s exact test and Student’s t-test as appropriate. We set the significance level at p≤0.05. All tests were two-tailed.ResultsThe sample consisted of 480 subjects with a mean age of 45.9 years (standard deviation 14.4, range 18-88), of which 54.4% (n=261) were women. 69.2% (n=332) had a diagnosis of BD type I and 30.8% (n=148) of BD type II. 77 subjects (16%) had a FHS. Regarding differences between groups, those with relatives who had committed suicide did not show statistically significant differences in terms of sociodemographic variables (age, gender, civil status, employment) or key clinical features (type of BD, illness duration, psychotic features, predominant polarity, rapid cycling, number of lifetime manic and depressive episodes, comorbid personality disorder), neither did they have a higher use of lithium (55.8% vs 59.3%, p=0.572) nor lower substance use disorder (10.9% vs 15.5%, p=0.34). Predictably, people with FHS had a higher prevalence of family history of mental and affective disorders (96.1% vs 70.9%, p<0.001; 86.3% vs 56.3%, p<0.001) and of stressful life events (71.6% vs 58.9%, p=0.05). Personal lifetime suicide attempts also tended to be higher (36.4% vs 26.7%, p=0.088).ConclusionsContrary to our hypothesis, in our sample of subjects with BD a FHS was not associated with a higher prevalence of the modifiable protective factors against suicide. Therefore, although suicide has a major impact both in families and healthcare professionals, our results suggest it does not modify attitudes towards prevention in a real-life scenario. The main limitation of our study is its cross-sectional design, which does not allow for causal inference. In conclusion, there is room for improvement in the fight against suicide.Disclosure of InterestNone Declared

Suicide attempt among adolescent in Tamil Nadu: A case-control study

Introduction: Suicide is a complex social issue and a serious global health problem. Its incidence among adolescents is increasing. Understanding of risk factors helps early detection and prompt treatment of high-risk youngsters. Materials and Methods: It was a hospital-based case-control study carried out among 60 adolescent suicide attempters and 60 of their normal counterparts for the period of one year. Pretested structured questionnaire was used to collect information. Ethical principles were followed throughout the study. SPSS version 24 was used to do the analysis. Odd's ratio (OR) and its 95% confidence interval (CI) were calculated as a measure of the strength of association between risk factors and suicide attempts. Results: Among the study participants, 70% were in the age group of 16 – 18 years and 45% were males. The identified risk factors for suicide attempt were, presence of psychiatric illness (OR-7.8; 95% CI: 3.3-19), substance abuse among family members (OR-4.3; 95% CI: 2-9.3), family history of attempted suicide (OR-7.2; 95% CI: 1.5-3.3), family history of completed suicide (OR-3.6; 95% CI: 1.2-1.1) and residence at rural areas (OR-2.8; 95% CI: 1.2 – 6.3). Suicide intent score was significantly correlated with various standard scoring tools for stress and depression among cases. Conclusion: The established risk factors should be considered in creating an effective intervention program and strategies with intersectoral collaboration and coordination to prevent suicide among high-risk adolescents. Keywords: Adolescent, Attempted suicide, Case-control study, Risk factors.

Clinical Correlates of Planned and Unplanned Suicide Attempts.

Suicide attempters differ in the degree of planning for their suicide attempts. The purpose of this study was to identify differences between individuals who make planned (≥3 hours of planning) and unplanned (<3 hours of planning) suicide attempts. Depressed suicide attempters (n = 110) were compared based on degree of planning of their most recent suicide attempt on demographic and clinical variables. Participants who made planned suicide attempts were more likely to have family history of completed suicide, more severe and frequent suicidal ideation, greater trait impulsivity, and greater suicidal intent and more severe medical consequences for both their most recent and most serious suicide attempts. These results suggest clear clinical differences based on the degree of suicide attempt planning. Severe suicidal ideation, high suicide intent, family history of suicide completion, and high levels of motor impulsivity contribute to a phenotype that is at greater risk of planned, highly lethal suicide attempts.

Differences between female suicidal patients with family history of suicide attempt and family history of completed suicide

BackgroundFamily history of suicidal behavior and suicide are both risk factors for suicide. However, the effects of family history of suicide versus suicide attempts on patient suicidal behavior remain unclear. The aim of the present study was to understand if family history of suicide as compared to family history of suicide attempts or no family history of suicidal behavior evidences different associations with suicidal behavior among psychiatric patients. MethodParticipants included 157 female patients between the ages of 18 and 65years admitted at the Dr. Braulio A. Moyano Neuropsychiatric Women's Hospital. ResultsSeventy-nine patients (50.3%) reported no family history of suicidal behavior (NFHSB), while 78 patients (49.7%) reported a family history of suicidal behavior. Specifically, 41 patients (26.1%) reported a family history of suicide attempt (FHSA) and 37 patients (23.6%) reported a family history of suicide (FHS). These groups showed significant differences between family history of psychopathology and number of previous suicide attempts. Patients with an FHSA were more likely to present with a greater number of previous suicide attempts as compared to patients with NFHSB and FHS. ConclusionThere is an association between the number of suicide attempts and family history of suicide attempts in female patients hospitalized for suicidal behavior.

Affective temperament, history of suicide attempt and family history of suicide in general practice patients

BackgroundUntreated major affective disorders are strongly associated with suicidal behaviour; however, clinical, psychological and psycho-social risk factors also play a contributory role. Personal history and family history of suicide are also important predictors of suicidal behaviours, and are also a powerful marker of current major depressive episode in general practice patients. Affective temperaments, which can be considered the subaffective manifestations of major mood disorders also show a specific pattern of association with suicidal behaviour. In the present study our aim was to investigate the association between affective temperaments, personal history of suicide attempts and family history of completed suicide in primary practice patients. MethodsFive hundred and nine patients from 6 primary care practices completed the TEMPS-A, and were assessed concerning self-reported history of personal or family suicide. ResultsWe found that among those answering questions concerning suicide, 9.1% reported a family history of suicide in first and second degree relatives and 4.8% had at least one prior suicide attempt. Among those giving a positive answer to both questions, those who had a positive family history had significantly more frequent suicide attempts (15.4% vs. 4.0%). Patients with prior suicide attempts had a significantly higher score on the cyclothymic and depressive, and those with positive family history of suicide had on cyclothymic and anxious subscales. LimitationsIn the present study, personal and family history of suicide was assessed retrospectively and in a self-report way. The cross-sectional nature of this study and the facts that no current psychiatric morbidity has been investigated and only the documented history of depressive and anxiety disorders have been detected limit the generalisability of this study. DiscussionWe found a significant relationship between depressive and cyclothymic affective temperament and personal history of suicide attempts, and between cyclothymic and anxious temperament and family history of completed suicide in first and second degree relatives. This is in line with previous findings showing a strong relationship between these affective temperaments and major mood episodes and that these temperaments are overrepresented among suicide attempters. Our findings also suggest that the presence of cyclothymic (and to lesser extent depressive) affective temperament in a patient with family history of completed suicide indicates a very high risk of suicidal behaviour.

Predictors of suicide attempts in patients with borderline personality disorder over 16 years of prospective follow-up

It is clinically important to understand the factors that increase the likelihood of the frequent and recurrent suicide attempts seen in those with borderline personality disorder (BPD). Although several studies have examined this subject in a cross-sectional manner, the aim of this study was to determine the most clinically relevant baseline and time-varying predictors of suicide attempts over 16 years of prospective follow-up among patients with BPD. Two-hundred and ninety in-patients meeting Revised Diagnostic Interview for Borderlines (DIB-R) and DSM-III-R criteria for BPD were assessed during their index admission using a series of semistructured interviews and self-report measures. These subjects were then reassessed using the same instruments every 2 years. The generalized estimating equations (GEE) approach was used to model the odds of suicide attempts in longitudinal analyses, controlling for assessment period, yielding an odds ratio (OR) and 95% confidence interval (CI) for each predictor. Nineteen variables were found to be significant bivariate predictors of suicide attempts. Eight of these, seven of which were time-varying, remained significant in multivariate analyses: diagnosis of major depressive disorder (MDD), substance use disorder (SUD), post-traumatic stress disorder (PTSD), presence of self-harm, adult sexual assault, having a caretaker who has completed suicide, affective instability, and more severe dissociation. The results of this study suggest that prediction of suicide attempts among borderline patients is complex, involving co-occurring disorders, co-occurring symptoms of BPD (self-harm, affective reactivity and dissociation), adult adversity, and a family history of completed suicide.

AS07-01 - Completed suicide vs suicide atempt: similarities and differences ?

In Spain, suicide has become the leading cause of violent death, ahead of traffic accidents. Prevention programs are based on risk factors of suicidal behavior, which are mainly drawn from studies of suicide attempts and to a lesser extent, from studies of completed suicide. Our main objectives were to determine if difference exists between suicide completion and suicide attempt populations with regards to sociodemographic and clinical factors, life events, impulsivity and suicide intent. We recruited completed suicides in the province of Seville and the recruitment of suicide attempters in two university hospitals in Madrid. In the first group, data were collected through close relatives, while the latter group were interviewed within 24 hours after the suicide attempt. There were a higher proportion of males among the completed suicide compared to suicide attempter group. Suicide completers were also older, showed a lower impulsive trait and state, and had more suicide intent than attempters. Clinically, suicide completers had a higher prevalence of schizophrenia but a lower proportion of anxiety disorders than attempters. In Axis II, completers had a lower prevalence of Cluster A and Cluster C personality disorders. However, suicide completers were more likely to have a diagnosis of Narcissistic personality disorder compared to attempters. Family history of completed suicide was more frequent among suicide completers than among attempters. There are significant differences with regards to demographic, clinical, and psychological characteristics, and life events between suicide completers and suicide attempters. They seem to be two distinct populations.

Deliberate self-harm in children and adolescents: an 11-year case note study.

To retrospectively examine the case-notes of all children and adolescents admitted with deliberate self-harm (DSH) or suicidal ideation during the study period 1993-2003. The study aimed to identify underlying reasons why children and adolescents engage in DSH, and to identify common psychiatric, psychosocial and familial factors which may predispose or contribute to an individual's engagement in such behaviour. All children presenting to the hospital with DSH or suicidal ideation were identified and data collected from their case notes. A study specific questionnaire was designed to collect demographic details, details on clinical presentation, past attempts, comorbid psychiatry disorders, family history and family circumstances. Information was also recorded on hospital stay and discharge planning. During the 11-year period, 231 children presented with suicidal ideation or behaviour. The mean age was 12.85 with an age range from 6-17 years, with a female:male ratio of 2.5:1. Overdose was the most common method (81.2%) and paracetamol most commonly the drug of choice. More than half of the group (55.7%) expressed a wish to die. More than half (51.8%) had expressed suicidal ideation in the past, 31% had made a previous attempt, and 11.7% had been previously admitted. Of the children 8% presented with suicidal behaviour more than once over the study period. There was a family history of completed suicide in 6.6%. Deliberate self-harm in young people is a significant public health problem in Ireland. During the period of this study, rates have continued to increase. There is an urgent need for national bodies such as the National Suicide Review Group to extend their focus to include those under age 18 and for services to be developed that might reduce DSH behaviours. More research is needed in the area of childhood suicidal behaviour.

Psychosocial Factors Contributing to Suicidal Ideation in Hospitalized Schizophrenia Patients in Korea

ObjectiveThis study aimed to comprehensively evaluate psychosocial risk factors associated with suicidality in patients with schizophrenia in Korea.MethodsThe study sample consisted of 84 hospitalized patients with schizophrenia. Suicidal thoughts and a clear desire to be dead within 2 weeks were defined as a current suicidal ideation. Socio-demographic and clinical variables, including family history of completed suicides and psychiatric illnesses, were collected, and the Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), Beck Depression Inventory (BDI), Simpson-Angus Scale (SAS), Scale to assess Unawareness of Mental Disorder (SUMD), and Alcohol Use Disorders Identification Test (AUDIT) were administered to identify factors associated with a current suicidal ideation.ResultsForty-three subjects (51.2%) reported clear suicidal ideation. Multivariate analysis revealed that later age of illness onset, previous suicide attempt, family history of completed suicide, depression, or substance abuse, fewer than one family visitation to the hospital per month, and score on the CDSS were independently related to current suicidal ideation in these subjects. Age, education level, and scores on the SUMD were not significantly associated with current suicidal ideation in the multivariate analysis, but were associated with suicidal ideation in a univariate analysis on the level of p<0.1.ConclusionThe above clinical factors should be evaluated to predict and prevent suicidal risk in patients with schizophrenia. In particular, modifiable factors such as depression should be managed to reduce suicidality of hospitalized patients with schizophrenia.

Atypical depression is associated with suicide attempt in bipolar disorder

There is a dearth of research focusing on factors associated with suicide attempts. High rates of atypical depression have been reported in studies including unipolar and bipolar II patients. In this study, the association between suicide attempt and atypical depression, in addition to other major risk factors, was evaluated in 390 bipolar I and II out-patients. Variables were defined according to DSM-IV criteria, and assessed with a Structured Interview for DSM-IV (axis I and II). History of suicide attempt was obtained through interviews with patients and relatives. Attempters and non-attempters were compared using univariate and multivariate analysis. Attempters showed significantly higher rates of atypical depression, family history of completed suicide, depression at index episode and cluster B personality disorder. Our results highlight the relevance of atypical depression in bipolar disorder. A more accurate identification of potential attempters may contribute to the development of effective preventive treatment strategies.

Suicide and mental illness in parents and risk of suicide in offspring

A family history of completed suicide and psychiatric illness has been identified as risk factors for suicide. To examine the risk of offspring suicide in relation to parental history of suicide and other parental risk factors. The study population consisted of 7,177 adult offspring born 1959-1961 and their parents from the Copenhagen Perinatal Cohort. Cohort members and their parents who had committed suicide were identified in the Danish Causes of Death Registry (follow-up until December 31, 2005), while information on psychiatric hospitalisation history was obtained from the Danish Psychiatric Central Research Register. Forty-eight cohort members, 77 mothers and 133 fathers had committed suicide during the follow-up. Independent of parental psychiatric illness and social status, parental suicide significantly increased suicide risk in offspring (hazard ratio 4.40 with 95% CI 1.81-10.69). A stronger effect of parental suicide was observed in offspring without a history of psychiatric hospitalisation. Parental history of suicide is a risk factor for suicide in offspring, but primarily in offspring without psychiatric hospitalisation.

P02-40 Searching for variables associated with familial suicide attempts using data mining techniques

Introduction:Adoption, twin and family studies suggest that suicide behavior is familial and heritable. Both completed and attempted suicide appear to be transmitted in a familial form. Genetics and environment influences had been detected in various studies. But suicidal behavior suggests to be inherited independently from the mental disorders usually associated with it. While traditional statistics emphasizes inference and estimations, data mining emphasizes the fulfillment of a task such as classification, estimation, or knowledge discovery.Objectives:The goal of this study was to determine in a large sample of suicide attempts which variables are associated with family history of attempted suicide.Methods:In an emergency room, 539 adult suicide attempters were recruited. The two dichotomous dependent variables were family history of suicide attempt (10%) and of completed suicide (4%). Independent variables were 101 clinical variables explored with two data mining techniques: Random Forest and Forward Selection.Results:A model for family history of completed suicide could not be developed. A classificatory model for family history of attempted suicide included the use of alcohol in the intent and family history of completed suicide, provide a sensitivity of 78.4%, a specificity of 98.7% and accuracy of 96.6%.Conclusions:A classificatory model for family history of completed suicide could not be developed using data mining techniques. But it suggested that the use of alcohol in the intent and family history of completed suicide may be associated with familial attempted suicide.

Family history of completed suicide and characteristics of major depressive disorder: A STAR ⁎D (sequenced treatment alternatives to relieve depression) study

Background Clinicians routinely ask patients with non-psychotic major depressive disorder (MDD) about their family history of suicide. It is unknown, however, whether patients with a family member who committed suicide differ from those without such a history. Methods Patients were recruited for the STAR ⁎D multicenter trial. At baseline, patients were asked to report first-degree relatives who had died from suicide. Differences in demographic and clinical features for patients with and without a family history of suicide were assessed. Results Patients with a family history of suicide ( n = 142/4001; 3.5%) were more likely to have a family history of MDD, bipolar disorder, or any mood disorder, and familial substance abuse disorder, but not suicidal thoughts as compared to those without such a history. The group with familial suicide had a more pessimistic view of the future and an earlier age of onset of MDD. No other meaningful differences were found in depressive symptoms, severity, recurrence, depressive subtype, or daily function. Conclusions A history of completed suicide in a family member was associated with minimal clinical differences in the cross-sectional presentation of outpatients with MDD. Limitations of the study include lack of information about family members who had attempted suicide and the age of the probands when their family member died. STAR⁎D assessments were limited to those needed to ascertain diagnosis and treatment response and did not include a broader range of psychological measures.

Relevance of Family History of Suicide in the Long-Term Outcome of Bipolar Disorders

This study examined the association between family history of completed suicide and suicidal behavior and other clinical variables in subjects with bipolar disorder. 374 outpatients aged from 19 to 88 years (mean +/- SD age = 41.9 +/- 4.1 years) (54.3% female) meeting DSM-IV criteria for bipolar disorder type I or II or schizoaffective disorder, bipolar subtype, were included in the study. Forty-eight subjects with a family history of completed suicide were compared to 326 subjects without a family history of completed suicide regarding several clinical and demographic variables. The study was conducted from 2001 to 2004. There were no statistically significant demographic differences between bipolar disorder subjects with and without a family history of suicide. Bipolar disorder subjects with a family history of suicide showed higher rates of cluster C personality disorders than subjects without a family history of suicide (14.9% vs. 2.5%, OR = 6.72, 95% CI = 2.31 to 19.51, p < .001). Subjects with a family history of suicide also demonstrated a significantly greater lifetime prevalence of suicide attempts (52.2% vs. 25.5%, OR = 3.19, 95% CI = 1.7 to 6.0, p < .001). Results remained significant after controlling for all possible interactions. Family history of completed suicide is a significant risk factor associated with suicidal attempts in patients with bipolar disorder. These findings underscore the importance of identifying patients with a family history of suicide in order to provide prompt treatment and careful follow-up.

Variables associated with familial suicide attempts in a sample of suicide attempters

Attempted suicide appears to be a familial behavior. This study aims to determine the variables associated with family history of attempted suicide in a large sample of suicide attempters. The sample included 539 suicide attempters 18 years or older recruited in an emergency room. The two dichotomous dependent variables were family history of suicide attempt (10%, 51/539) and of completed suicide (4%, 23/539). Independent variables were 101 clinical variables studied with two data mining techniques: Random Forest and Forward Selection. A model for family history of completed suicide could not be developed. A classificatory model for family history of attempted suicide included the use of alcohol in the intent and family history of completed suicide (sensitivity, specificity, 98.7%; and accuracy, 96.6%). This is the first study that uses a powerful new statistical methodology, data mining, in the field of familial suicidal behaviors and suggests that it may be important to study familial variables associated with alcohol use to better understand the familiality of suicide attempts.

Nurture versus nature: evidence of intrauterine effects on suicidal behaviour

In today's Lancet, Ellenor Mittendorfer-Rutz and colleagues report on a cohort of 713 370 individuals born in Sweden between 1973 and 1980. Their goal was to assess the effects of early fetal environment and parental factors on suicidal behaviour in adolescents and young adults: intrauterine and perinatal conditions, and two maternal variables (psychosocial factors as captured by age and parity, and socioeconomic status as reflected in education level). Multivariate analyses revealed that low birthweight (below 2500 g) or being born to a mother still in adolescence increased the risk of later suicide. For suicide attempts, low birthweight and having an adolescent mother increased risk, as did low level of maternal education and being fourth or later in birth order. The effect of these factors on suicide risk was mild and less than the risk conferred by family history of suicidal behaviour. 1 Qin P Agerbo E Mortensen PB Suicide risk in relation to family history of completed suicide and psychiatric disorders: a nested case-control study based on longitudinal registers. Lancet. 2002; 360: 1126-1130 Summary Full Text Full Text PDF PubMed Scopus (256) Google Scholar Restricted fetal growth and adverse maternal psychosocial and socioeconomic conditions as risk factors for suicidal behaviour of offspring: a cohort studyMultiparity and low maternal education predicted suicide attempt, whereas restricted fetal growth and teenage motherhood were associated with both suicide completion and attempt in offspring. Full-Text PDF

Is there an association between serotonin transporter gene polymorphism and family history of depression?

Background: To date, research examining the relationship between the serotonin transporter gene and depression has yielded both positive and negative results. This study will attempt to add further evidence to that body of literature by examining the relationship between the serotonin transporter gene and a family history of depression while controlling for a family history of completed suicide. Methods: Forty-seven volunteers responded to questionnaires regarding family history of depression and suicide, and provided buccal swabs to allow for analysis of the 5-HTTLPR polymorphism. Results: Individuals with the s/s genotype were significantly more likely to have two or more first-degree relatives with a history of depression even when controlling for a family history of completed suicides. Limitations: The small sample size, particularly in the group of individuals with the s/s genotype, is a limitation of this study. Assessment of family history was conducted in abbreviated fashion. Information regarding participants’ personal history of depression and suicide was not collected, so no conclusions regarding participants’ own mental health can be drawn. Conclusions: A significant relationship between family history of depression and the s/s genotype was found, despite the small sample size and while controlling for family history of suicide. Whatever risk short alleles may confer for depression may be distinct from the risk they confer for suicidality.

Suicide risk in relation to family history of completed suicide and psychiatric disorders: a nested case-control study based on longitudinal registers

Familial clustering of suicidal behaviour has been well documented. We aimed to assess whether family history of completed suicide and mental illness that results in admission to hospital are risk factors for suicide, and whether these factors interact. We did a nested case-control study using data from Danish longitudinal registers. We included 4262 people who had committed suicide aged 9-45 years during 1981-97 (cases), and 80238 population-based controls matched for age, sex, and date of suicide. Suicide and psychiatric history of parents and siblings and socioeconomic, demographic, and psychiatric data for every case were retrieved and merged. Data were analysed with conditional logistic regression. A family history of completed suicide and psychiatric illness significantly and independently increased suicide risk (odds ratio 2.58 [95% CI 1.84-3.61] and 1.31 [1.19-1.45], respectively). These effects were not accounted for by the socioeconomic status and psychiatric history of cases. A history of family psychiatric illness significantly raised suicide risk only in people without a history of psychiatric illness (1.55 [1.38-1.75]), whereas a family history of suicide increased suicide risk irrespective of psychiatric illness (2.37 [1.11-5.09] and 2.66 [1.82-3.88]) for people with and without a psychiatric history, respectively. Completed suicide and psychiatric illness in relatives are risk factors for suicide, and the effect of family suicide history is independent of the familial cluster of mental disorders. Family history of suicide should be established in the assessment of suicide risk.

Association of personal and familial suicide risk with low serum cholesterol concentration in male lithium patients.

We sought to establish whether low cholesterol concentration may be associated with a personal history of attempted suicide or a family history of completed suicide in psychiatric out-patients on maintenance lithium treatment, who represent a population at risk for suicide. We retrospectively reviewed charts regarding 783 out-patients consecutively admitted to a lithium clinic from 1976 to 1999. Individual age- and gender-specific quartile of serum cholesterol concentration were correlated against personal lifetime suicide attempts and completed suicide in first-degree relatives. The proportion of men with a personal lifetime history of attempted suicide, especially if violent, and that of men with history of completed suicide in a first-degree relative were significantly higher among the group with cholesterol concentration in the lowest quartile compared to the group with cholesterol levels above the 25th percentile. Low cholesterol concentration should be studied further as a potential biological/genetic marker of suicide risk.