Frequency Of Suicide Attempts Research Articles

Bipolar disorder. IV: Early suicide attempts in a long-term follow-up of patients with bipolar disorder

BackgroundBipolar disorder (BD) is a serious chronic disease with a high frequency of suicide attempts (SA) and suicides. There are few long-term studies concerning characteristics of SA in BD, especially what characterizes early from late SA. MethodsA long-term study of 51 BD patients (DSM-IV) with SA were collected from lithium dispensaries in northern Sweden. Patients were divided into early SA (the first five years) after age of onset (AOO) or late SA. ResultsPatients with early SA were younger (p = 0.036), met BD earlier (p = 0.005), had less repeated depressions before SA (p = 0.002), often performed SA at first episode (p < 0.001) and before initiating of lithium (p = 0.002). Before first SA they had, fewer but more frequent episodes/year (p < 0.001), fewer depressive (p < 0.001) but more frequent depressive episodes/year (p < 0.001), lower frequency of hypomanic (p = 0.016) or manic episodes (p = 0.006). They had a higher frequency of episodes/year off (p = 0.047) and on (p = 0.042) lithium. Twenty percent of all patients performed SA at first episode, 47 % early SA and 65 % first ten years after AOO.Early SA was associated with a family history of first- and/or second-degree relative of affective disorder (AD) (p = 0.005), first-degree relative of AD (p = 0.031) and first-degree relative of BD (p = 0.049). All patients with early SA had a family history of AD. ConclusionsPatients with early SA have a more severe form of BD. Family history of AD among first- and/or second-degree relatives is significantly associated with especially early SA which implies a special psychiatric treatment and care for this BD group.

The effectiveness and safety of dialectical behavior therapy for suicidal ideation and behavior in autistic adults: a pragmatic randomized controlled trial.

Many autistic people in mental health are suicidal. This study evaluated the effectiveness of dialectical behavior therapy (DBT) v. treatment as usual (TAU) in reducing suicidal ideation and suicide attempts. At six Dutch mental health centers, 123 outpatients (18-65 years) with DSM-5 diagnosed autism spectrum disorder (ASD) and suicidal behavior were randomly assigned to the DBT intervention group (n = 63) or TAU control group (n = 60). Assessments were conducted at baseline, post-treatment at 6 months and 12-month follow-up. The primary outcomes were severity of suicidal ideation and frequency of suicide attempts. The severity of depression and social anxiety were secondary outcomes. At end-of-treatment, DBT significantly reduced both suicidal ideation (z = -2.24; p = 0.025; b = -4.41; s.e. = 197.0) and suicide attempts (z = -3.15; p = 0.002; IRR = 0.046; s.e. = 0.045) compared to TAU, but lost statistical significance at the 12-month follow-up. Depression severity significantly decreased with DBT (z = -1.99; p = 0.046: b = -2.74; s.e. = 1.37) remaining so at 12 months (z = -2.46; p = 0.014; b = -3.37; s.e. = 1.37). No effects were observed on social anxiety. Severe adverse events included two suicides in the TAU condition. DBT is an acceptable, safe, and short-term effective intervention to reduce suicidal ideation and suicide attempts in autistic adults with suicidal behavior.

Análisis retrospectivo de las hipoglucemias inducidas por venlafaxina en pacientes con sobredosis

IntroductionRecent publications relate the presence of hypoglycemia in venlafaxine (VLX) poisoning depending on the dose. Our aim was to analyze the clinical characteristics of patients who presented hypoglycemia induced by VLF overdose. Patients and methodsRetrospective study carried out in the Balearic Islands (2020–2023). Inclusion criteria: serum concentrations of VLX + O-desmethyl-venlafaxine (O-VLX)>800 ng/mL. The characteristics of patients with and without hypoglycemia were compared. ResultsTwenty-one patients were included, 8 (38.1%) with hypoglycemia. No differences were found in the doses referred to in both groups. Peak concentrations of VLX + O-VLX (ng/mL) were 9,783 [4,459–17,976] in patients with hypoglycemia and 1,413 [930–1,719] in patients without hypoglycemia (p<0.0001). The presence of hypoglycemia was associated with: lower age and level of consciousness; and higher frequency of suicide attempts, seizures, mydriasis, tachycardia and serotonin syndrome, invasive respiratory support, fluid therapy and ICU admission (p<0.05). ConclusionsThe detection of hypoglycemia in a VLX overdose case is a readily available marker to suspect the severity of the patient. In any case, serum concentrations when available allow us to confirm intoxication.

Co-developmental trajectories of suicidal ideation and non-suicidal self-injury among Chinese adolescents: Transdiagnostic predictors and association with suicide attempts.

Adolescent suicidal ideation (SI) and non-suicidal self-injury (NSSI) are crucial public health issues, yet their co-developmental trajectories during early adolescence and their associations with predictors and outcomes are unclear. This study aimed to (a) identify heterogeneous co-developmental trajectories of SI and NSSI, (b) explore associations between transdiagnostic predictors and trajectories, and (c) assess suicide attempt risk across trajectories. Four hundred fifty-three adolescents (Mage = 12.35 years, 48.3% boys) completed surveys at 6-month intervals across 2 years. At Time 1 (Nov 2020), participants completed surveys encompassing SI, and NSSI, along with family, peer, and individual predictors. Subsequent surveys (Times 2-4) measured SI and NSSI, with suicide attempts queried at Time 4. Parallel process latent class growth models revealed three co-developmental groups (i.e., Stable low NSSI and SI; Moderate-NSSI and high-SI, parallel decreasing; High-NSSI and moderate-SI, parallel increasing). Multivariate logistic regression indicated that group membership was predicted by parental rejection, parental warmth, bullying victimization, depressive and anxiety symptoms, thwarted belongingness, and perceived burdensomeness. Adolescents in the "High-NSSI and moderate-SI, parallel increasing" group reported the highest suicide attempt frequency. These findings underscore subgroup distinctions and transdiagnostic predictors in comprehending SI and NSSI progression, emphasizing the necessity of dynamic monitoring and tailored interventions for distinct subgroup characteristics.

Trend of suicide by self-immolation in a 13-year timeline: was the COVID-19 pandemic a potentially important stressor?

Self-immolation is an uncommon way of attempting and committing a suicide, with a fatality rate of 80%. The risk factors in self-immolation victims vary depending on demographic characteristics, socio-economic and cultural factors as well as religious beliefs. Whether the COVID-19 pandemic was a potentially important stressor for self-immolation is still unknown, with insufficient studies examining this issue. Therefore, in this study, we aimed to examine the trend of self-immolation in a 13-year timeline, and the potential association of COVID-19 pandemic with the increase in the incidence and severity of self-immolation injuries in Serbia in 2021. The study included hospitalized patients due to intentional burns caused by self-immolation in the period from January 1, 2008 to December 31, 2021. Joinpoint regression analysis was used for the analysis of continuous linear trends of self-immolation cases with change points. While a rising trend was observed in the 2008-2013 time segment, followed by a decline in the upcoming 2013-2016 time segment, a significant increase reached its maximum during COVID-19 pandemic (2021), with annual percent change of 37.1% (p = 0.001). A significant increase in the median number of cases per year was observed during 2021 compared to the previous periods (7.5 vs. 2). Frequency of patients with a psychiatric diagnosis vs. those without a psychiatric diagnosis was significantly higher during than before the COVID-19 period (66.7 vs. 36.1%, p = 0.046). In our study, a significant increase in the frequency of suicide attempts by self-immolation during COVID-19 pandemic was noticed. There was also an increased frequency of pre-existing psychiatric illness among patients during the pandemic period. With limited high-quality data available, the study adds to a rising body of evidence for assessment of outcomes of the pandemic on mental health and recognition of stressors for self-immolation.

Cyclical exacerbation of suicidal ideation in female outpatients: Prospective evidence from daily ratings in a transdiagnostic sample.

Suicide is a leading cause of death among females of reproductive age. The menstrual cycle is a plausible yet understudied trigger for acute suicide risk. Cross-sectional studies have demonstrated a greater frequency of suicide attempts and deaths in the weeks before and after the onset of menses compared to other cycle phases. Here, using prospective daily ratings, we examine the relationship between the cycle and suicidal ideation (SI) and related symptoms known to show a cyclical change in some patients (depression, hopelessness, guilt, rejection sensitivity, interpersonal conflict, anxiety, mood swings, and anger/irritability). Thirty-eight naturally cycling outpatients recruited for past-month SI reported SI severity and other symptoms across an average of 40 days. Participants were excluded for hormone use, pregnancy, irregular cycles, serious medical illness, and body mass index > 29.9 or < 18. Intraclass correlations ranged from .29 to .46, highlighting that most symptom variance lies within-person. Cyclical worsening of symptoms was evaluated using phase contrasts in multilevel models. Most symptoms, including SI, were significantly worse in the perimenstrual phase than in all other phases. Additionally, anger/irritability was higher in the midluteal than in the midfollicular phase, and several symptoms of depression were higher in the midfollicular than in the periovulatory phase. Otherwise, symptoms did not significantly differ between the midluteal, midfollicular, and periovulatory phases. Cycle phase predictors accounted for 25% of the within-person variance in SI. Females with SI may be at risk for perimenstrual worsening of SI and related symptoms. These findings highlight the importance of assessing the cycle phase for improved prediction of suicide risk. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

DSM-5 Non-Suicidal Self-Injury Disorder in a Clinical Sample of Adolescents with Recurrent Self-Harm Behavior

Introduction Non-suicidal self-injury disorder (NSSID) is a new diagnosis proposed in DSM-5 with a need of further study, especially in adolescent clinical populations where non-suicidal self-injury (NSSI) is particularly prevalent. We aimed to study characteristics of NSSID and estimate an optimal cutoff frequency level of NSSI behavior. Methods Data were collected from 103 outpatient adolescents (ages 12–18) with recurrent self-harm behavior. Results Adolescents with NSSID reported significantly more frequent NSSI behavior and suicide attempts than adolescents without NSSID. Frequency of NSSI, global functioning, depressive symptoms, number of self-harm methods and anxiety symptoms best discriminated between adolescents with and without NSSID. An optimal cutoff level for a diagnosis of NSSID was found to be ≥15 days with NSSI during the last year, which led to a reduction in the rate of adolescents diagnosed with NSSID from 54% to 46%. Conclusion This study shows that NSSID is a highly impairing disorder characterized by high risk of multiple NSSI and suicide attempts, decreased functioning and other associated psychiatric disorders. Clinical awareness of these risks are important to ensure early detection and treatment. Future prospective longitudinal studies are needed to further validate the characteristics of the NSSID diagnosis and its clinical utility.

Suicide attempts among children and adolescents admitted to a Polish Emergency Department: Analysis of epidemiology, circumstances and methods of 154 cases.

Suicide attempts among pediatric patients are currently one of the most critical issues in modern psychiatry and emergency medicine, and constitute a serious public health problem that affects people of almost every age group. It is often emphasized that attempted suicide is a cry for help, and according to international studies, the pandemic year of 2020 massively impacted the frequency of suicide attempts among children. However, such studies have yet to appear in Poland. To characterize the frequency, circumstances and methods of suicide attempts among children and adolescents, and investigate their relationship with coronavirus disease 2019 (COVID-19). The study retrospectively analyzed the medical records of 154 children admitted to the Emergency Department due to suicide attempts between January 2020 and June 2021. No statistical relationship was found between the direct impact of the pandemic and suicide attempts among children and adolescents. However, age and gender influenced the methods used and the frequency of suicide attempts. Females are more likely to attempt suicide than males, and patients as young as 8 tried to take their own lives. Due to the increasing frequency of suicide attempts in children and adolescents, people at particular risk of such behaviors should be identified and provided with effective care. Unfortunately, although the vast majority of pediatric patients who attempted suicide had psychiatric consultations in the past, it did not prevent them from actively trying to end their lives. Furthermore, even children of a very young age are at risk of suicide events.

Epidemiology of Suicide in the Relief Missions in the Pre-Hospital Emergency System of Mazandaran University of Medical Sciences During 2019-2021

Background: Mazandaran Province is one of the provinces with a high suicide rate. Therefore, this study aimed to determine the epidemiology of relief missions following suicide in the pre-hospital emergency system of Mazandaran University of Medical Sciences. Materials and Methods: This descriptive study was conducted from September 2019 to 2021 in the pre-hospital emergency department of Mazandaran University of Medical Sciences. Statistical information related to the missions carried out after suicide was extracted using the data contained in the emergency national mission form recorded in Asayar software. According to the questionnaire, demographic information including age, gender, accident location, time, method of suicide, as well as mission outcome were extracted. To examine the results, frequency percentage, Mean±SD were used, and to examine the qualitative variables, the Chi-square test, and Fisher’s exact test were used. The collected data were analyzed using SPSS software, version 26 (SPSS Inc., Chicago, IL, USA). A significance level of 0.05 was considered. Results: In this study, 712(53.7%) were men and 615(46.3%) were women. The mean age of patients was 32.12±2.03 years. Fisher›s exact test revealed a statistically significant relationship between age groups and suicide methods (P=0.02). The Chi-square test was used to investigate the relationship between the suicide method and gender. According to the results of this test, a statistically significant relationship was observed between gender and suicide methods (P=0.00). The most common methods of suicide among clients were drug poisoning (32.1%), other cases (30.06%), and self-harm (20.6%), respectively. The highest frequency of suicide attempts occurred between evening and night among 497 people (37.5%) in terms of accident time. Conclusion: Young and productive age groups are among the most vulnerable groups among suicides. Men died about five times more than women after committing suicide in a pre-hospital emergency room. According to the results, more planning is required regarding mental health self-care education in families and schools, implementation of psychological counseling, diagnosis, and prompt treatment in vulnerable groups.

Factitious Disorder Presenting as the Intentional Swallowing of Foreign Objects

Background: Factitious disorder (FD) imposed on self is a psychiatric disorder characterized by the intentional feigning of symptoms or the self-inflicted production of symptoms in the absence of an obvious external reward. Case: This report describes a severe case of FD imposed on self in a 31-year-old male who frequently presented to several regional Emergency Departments with intentional ingestion of foreign objects, ultimately requiring 32 esophagogastroduodenoscopy (EGD) and 28 gastroscopy procedures over two years. Significant history of frequent suicide attempts via medication overdose and clinical suspicion of drug-seeking behavior complicated the case. Motivating factors for the patient’s behavior, suicidality in FD, and thepatient’s treatment and outcome to date will be discussed. Conclusion: There is no well-established treatment for FD documented in the literature. High-quality studies and additional reports of FD could help clinicians when managing such a challenging diagnosis.

The suicidal activity and comorbid mental pathology in persons with gender dystrophia

According to foreign publications, 58% of patients with gender disorders had additional psychiatric diagnosis, 39.3% had at least one suicide attempt. The data of suicidal activity and mental comorbidity in Russian population of transgenders are absent.Purpose of the study is to assess suicidal activity and mental comorbidity in persons with gender disorders.The retrospective analysis of records of patients applied with complains on gender disorders from January 2014 to April 2021 was applied. The demographic characteristics, life anamnesis, comorbid mental pathology at time of appliance, frequency of suicidal attempts, suicidal thoughts and auto-aggressive behavior were examined. The data of 926 patients with gender disorders were included: FtM 515 (55.7%), MtF 411 (44.3%). The median age of patients applied for care appliance was 24 years (13-65 years). In group of transgender patients 75.2% had no mental illness, except gender disorders. At that, there was high prevalence of comorbid mental pathology (24.8% on average). Usually, it was background mental illnesses and reversible mental disorders, which were not causes of gender disorders. The suicide rate in transgender group was 12.5%. For 1 patient with suicidal experience, there were 1.3 suicidal attempts (from 1 to 5). The significant dependence of increased suicidal activity, depression, auto-aggressive behavior and rate of comorbid mental pathology on age of debut of gender disorders was established. The transgender patients with debut of gender dysphoria in puberty age are most vulnerable to development of any mental pathology. The suicidal activity of patients with gender disorders depends on both social causes and presence of comorbid mental pathology. A number of modifiable risk factors for suicidal behavior were identified: support of relatives, external correspondence to associated gender, early steps to "change gender", earlier apply for medical care, background compensated mental illnesses.

Associations of suicide risk with emotional reactivity, dysregulation, and eating disorder treatment outcomes.

Emotional processes play a role in both suicide risk and eating disorders (EDs), which are often comorbid. However, limited research has explored how emotional processes relate to suicide risk in EDs and the prognostic value of suicide risk for ED treatment. Thus, the current study examined associations between emotion dysregulation and reactivity with suicide risk in patients with EDs, and determined if suicide risk predicts ED treatment outcomes. Participants (n = 201) were adults in an ED partial hospitalization program who completed measures at admission, 1-month post-admission, and discharge. When controlling for depressive symptoms, limited access to adaptive emotion regulation strategies, difficulties engaging in goal-oriented behaviors, and engaging in impulsive behavior when experiencing negative emotions (i.e., emotion dysregulation) were associated with suicide attempt frequency. Depressive symptoms were associated with suicide risk severity, while emotion dysregulation and reactivity were not. Importantly, patients with elevated suicide risk at admission improved comparably to other risk categories across treatment, despite presenting with greater ED symptoms at admission. Emotion dysregulation and depression are salient factors when examining suicide risk in patients with EDs. Suicide risk and attempt history may not negatively impact ED treatment outcomes when using emotion-focused treatment.

Examining the relationship between dysmorphia symptoms and suicidality through the lens of the Interpersonal Theory of Suicide.

Using the Interpersonal Theory of Suicide (IPTS) as a framework, this two-study investigation tested whether burdensomeness and low belongingness explained the association between body and muscle dysmorphia symptoms and suicidal ideation (tested in Study 1 and Study 2), and if fearlessness about death and pain tolerance explained the association between dysmorphia symptoms and previous suicide attempt frequency (tested in Study 2). Study 1 used a community sample (n = 273) and Study 2 used an at-risk population sample (n = 261). Participants completed cross-sectional questionnaires online. In Study 1, both types of dysmorphic symptoms related to suicidal ideation through burdensomeness, but only body dysmorphic symptoms related to suicidal ideation through low belongingness. In Study 2, results were replicated as both types of dysmorphic symptoms related to suicidal ideation through burdensomeness. While both types of symptoms related to low belonging, low belonging did not relate to suicidal ideation. Neither dysmorphic symptoms nor capability for suicide related to frequency of suicide attempts. Results suggest that improving interpersonal needs, such as feeling more effective, may be important treatment targets for individuals with dysmorphic symptoms who also experience suicidal ideation. Future work should continue to identify mediators for suicide attempts among individuals with dysmorphia symptoms.

Examining associations between suicidal desire, implicit fearlessness about death, and lifetime frequency of suicide attempts.

Suicide models propose that the capability for suicide, such as fearlessness about death (FAD), is necessary for the transition from suicidal desire to a suicide attempt. Most studies have relied on self-report methods to assess FAD. However, this research has produced equivocal results. As individuals may have limited awareness of learned or pre-existing associations between fearlessness and death, implicit measures of FAD hold promise. This study used a novel implicit association test (IAT), the IAT-FAD, to examine associations between suicidal desire, implicit FAD, and lifetime suicide attempt frequency. Patients in residential substance use treatment (N=75), a population with increased suicide risk and exposure to painful and provocative events, completed the IAT-FAD and assessments of suicidal desire and past suicide attempts. Implicit FAD moderated the association between suicidal desire and lifetime frequency of suicide attempts associated with an intent to die and requiring medical attention (although not ambivalent suicide attempts). Suicidal desire related to medically attended suicide attempts only at high implicit FAD levels, and to suicide attempts with a clear intent to die only at high or mean implicit FAD levels. Results provide initial support for the relevance of implicit measures of FAD for understanding suicide risk.

Severity features of suicide attempters with epilepsy

BackgroundAfter the Food and Drug Administration alert about antiepileptic medication and suicide, incident epilepsy has been associated with first or recurrent suicide attempts independently of psychiatric comorbidities and antiepileptic treatment. Following this thread, the aim of this study was to analyze if epilepsy was associated with a higher severity of lifetime suicide attempts (SAs). MethodsAnalyses were carried out on 1677 adults hospitalized between 1999 and 2012 after a SA in a specialized ward for affective episodes. Five severity features were studied: frequent SAs (>2), early onset of first SA (≤26 years), history of violent SA, high suicide intent and high lethality of the SA. Adjusted logistic regression models were used to estimate the association between the lifetime diagnosis of epilepsy and the severity features. ResultsAmong suicide attempters, ninety-three patients reported a lifetime diagnosis of epilepsy (5.5%). Epileptic patients diagnosed after the first SA were more likely to be frequent suicide attempters than non-epileptic ones. They showed also higher SA planification scores. LimitationsDiagnosis accuracy is limited by the use of self-reports for epilepsy. The lack of precise information about the disease course and treatment have not allowed for further statistical analysis. With regard to psychiatric comorbidities, personality disorders could not be taken into account. ConclusionsSuicide attempters with epilepsy present an increased severity in some aspects of their suicidal behavior regardless of demographic and clinical variables. Our results give support to the existence of a bidirectional association between epilepsy and suicidal behavior.

Suicide and Repeated Suicide Attempt in Intoxicated Patients: An Epidemiological Survey in a Tertiary Center

Background: Suicide is one of the most important psychological emergencies and it is necessary to deal with it. The goal of this study was to evaluate the frequency of suicide attempts, suicide re-attempt, and guesstimated risk factors in suicidal patients in the poisoning ward of Loghman Hakim Hospital. Methods: This study was performed on suicidal patients in Loghman Hakim hospital in 2021 (January to August). The suicide attempt and the type of mental disorder were confirmed by a psychiatrist and the data sheets were completed. The sample size was 500 cases based on previous similar studies. Results: Three hundred fifteen cases attempted suicide for the first time and 185 had a history of suicide. In both groups, the numbers of women were significantly more than men. In addition, 196 cases of the first group and 121 cases of the second group were under 30 years old and 65.1% of cases with first-time suicides and 62.2% of cases with suicide re-attempts were unemployed. In both groups, the most common drug for suicide was benzodiazepines (30.5% and 21.6%). Unfortunately, two patients died. Also, 67.6% in the first-time suicide attempt group and 57.3% in the suicide re-attempt group had adjustment disorder. No significant differences were observed between both groups in terms of gender, age, marital status, education, chronic disease, drug and habit history, employment status, diagnosed mental disorder, and type of drug used for the current suicide. Conclusion: Young age, unemployment, mental disorders (especially adjustment disorder), and female gender are the most important risk factors for a suicide attempt and re-attempt.

Suicide behaviours in incarcerated males: Links to psychopathic traits, forms of aggression to others, personal characteristics, and current penitentiary variables

Self-injurious behaviours and suicide attempts among incarcerated people are higher when compared with the general population. The current research is designed to examine the prevalence of self-injurious behaviours and suicide attempts among incarcerated males in Spain, and the factors associated with these behaviours. 201 men imprisoned in Spain completed anonymous self-report measures of demographic variables (e.g., age, marital status), the Triarchic Psychopathy Model (boldness, meanness, and disinhibition) and impulsive/premeditated aggression and aggressive behaviour (including physical, verbal, hostility, and anger). Official records were also consulted for information related to criminality (i.e., prior imprisonment and type of offence). Overall, 37.5% of residents reported having injured themselves at a time of anger or despair and 24.9% reported attempting suicide at any point in their lives. Lower scores in meanness, higher scores on impulsive aggression, serious illnesses and previous imprisonment were associated with an increased risk of self-injurious and/or suicide attempting behaviours. Being married acted as a protective factor of attempting suicide. Trait variables related to psychopathy (lower meanness) and aggression (higher impulsive aggression) were associated with increased frequency of suicide attempts in prisoners even after controlling for personal and criminal variables. The prevention of high rates of suicide in prisons needs the treatment of those cognitive variables in addition to more contextual personal and criminal variables.

Emergency Department Adolescent Suicidality: A Pilot Study to Determine How Common Actual Attempts Are.

Adolescent mental health is a rapidly escalating presentation to emergency departments in the United States with depression and suicidal thoughts being the most prevalent condition. Much of the research and focus has been on preventing future attempts. However, one outcome that may be very important in addition to focus on is the impact of presentations for thoughts without self-injury. The aim was to evaluate outcomes of interest for a larger prospective observational adolescent suicidal trial including frequency of suicide attempts versus thoughts and factors associated with each outcome. This is a prospective pilot study of adolescents at a single pediatric emergency department between December 2016 and September 2017 with acute suicidality. We used descriptive statistics to compare chief complaint, medical history, Patient Health Questionnaire-9 (PHQ-9), and outcomes including final disposition and total emergency department length of stay (LOS). We used t tests for continuous outcomes, χ2 test for categorical data, and Fisher exact tests for categorical and sparse data (20% of cell sizes of <5). Forty-one patients were enrolled, with 43.9% having an attempt; 72.2% of attempts were the result of an ingestion, and approximately 54% were over-the-counter medications. The average (SD) LOS was 30.8 (31.2) hours, and 63% were discharged home to outpatient services. There were no significant differences in age, chief complaint (except overdose), medical history, final disposition, total LOS in the ED, and the PHQ-9. Scores of the PHQ-9 were, on average (SD), 18.51 (4.7) across the entire cohort, 18.06 (5.75) in patients with an attempt, and 18.87 (3.77) in patients without an attempt (P = 0.59). Adolescent mental health is a growing issue for pediatric emergency departments nationally. Prospective research to identify factors associated with worsening outcomes is important to identify and potentially modify if possible. This study did not find any specific factors associated with a suicide attempt, but found that less than half of patients presenting with suicidality actual made an attempt. Future research should focus on not only limiting suicide attempts but also using decreased emergency department visits for worsening thoughts as an outcome of interest.

Analysis of Factors Associated with the Risk of Suicide in a Brazilian Capital: Cross-Sectional Study.

Suicide and suicide attempts are considered global health problems. With regard to the main causes of unnatural deaths, Brazil ranks as the eighth country with the highest absolute number of suicides. The aim of this study was to analyze the factors associated with the risk of suicide in a metropolitan city in Brazil. This was a cross-sectional study carried out in Recife, in the northeast region of Brazil. Epidemiological surveillance was conducted on the information systems regarding attempted suicide, suicide, and undetermined deaths in the period from 2007 to 2017. A record linkage between the information systems was performed. Descriptive statistics, bivariate analysis, and logistic regression were performed with an adopted a significance level of 5%. In the city of Recife, there were 4495 suicide attempts in the period, and the most frequent suicide attempts were by single females, aged between 20 and 39 years old, and who used either medication or poison to die by suicide. A total of 141 individuals died by suicide, and exogenous intoxication was the most common method. Knowing the common characteristics and associated factors of those who attempt and die by suicide is key for the development of prevention policies and intervention strategies for suicide.

Characteristics and Risk Factors for Suicide in People with Schizophrenia in Comparison to Those without Schizophrenia

BackgroundLittle research has been conducted that compares suicide cases with and without schizophrenia. The aim of the present study was to identify demographic, personal, social, relational, and psychological characteristics among suicides identified posthumously with schizophrenia compared to those without. MethodsThe DSM-IV was used to independently assess the presence of schizophrenia among suicide cases by two psychiatrists. Data on risk factors was collected through a psychological autopsy method, which included structured interviews of two informants for each suicide case (a family member and a close friend). Interview questions included demographic characteristics, suicide risk factors, the Beck Hopelessness Scale, Dickman's Impulsivity Inventory, the Spielberger State-Trait Anxiety Inventory, the Hamilton Depression Scale and the Duke Social Support Inventory. ResultsThe prevalence of schizophrenia was 9.69% among suicide cases in this sample. The schizophrenia suicide group was more likely to be female, older, in poorer physical health, suffer from chronic disease, suffer other psychological disorders, and have a family history of psychological disorders compared to those not diagnosed schizophrenia. Other important risk factors included more frequent past suicide attempts, increased levels of depression and anxiety, lower levels of impulsivity, lower help seeking from friends, and lower social interaction social support. ConclusionsThere is a notable link between schizophrenia and suicide in China. Identification of social, personal, relational, and psychological risk factors could beneficially guide attempts to improve future preventive measures against suicide among those with schizophrenia in China.