Heightened Suicide Risk Research Articles

The Prospective Huntington At-Risk Observational Study (PHAROS): The Emotional Well-Being, Safety and Feasibility of Long-Term Research Participation.

There is limited understanding of the feasibility of conducting long-term research among undiagnosed (pre-symptomatic) adults at risk to develop Huntington disease (HD), while protecting their emotional well-being and safety. To assess pre-specified events pertaining to emotional well-being, safety, and feasibility among healthy consenting adults at risk for developing HD who have chosen not to undergo genetic testing. PHAROS research participants prospectively reported the occurrence of events pertaining to psychological distress (psychiatric evaluations, depression, suicidality) and feasibility (maintaining confidentiality, study attrition). PHAROS enrolled 1001 participants. Events pertaining to psychological distress were reported by 35% of participants. The most common events included heightened suicide risk (26%), new onset depression (12%), and new mental health evaluation (9%); all occurred significantly more frequently among participants with expanded trinucleotide CAG repeats (≥37). Five deaths occurred, none related to suicide. Forty-one percent of participants reported self-disclosure of their HD at-risk status, and 15% reported that someone else (usually a family member) had done so. Confidentiality of CAG test results was maintained by investigators. The withdrawal rate was largely uniform over the study period and did not differ significantly by gender or CAG status. The potentially vulnerable research participants in PHAROS showed good emotional tolerability and safety. Individual CAG data were not disclosed, and confidentiality about disclosure of at-risk HD status was well maintained by others (family, friends, etc.). Long-term research participation of adults at risk for HD who choose not to undergo pre-symptomatic DNA testing is well tolerated, safe and feasible.

“Some guidance and somewhere safe”: Caregiver and clinician perspectives on service provision for families of young people experiencing serious suicide ideation and attempt

BackgroundPrevious research has recommended the involvement of caregivers in the treatment of young people with depressive illness, but the best form and type of involvement remains largely unknown. This qualitative study aimed to explore clinician and caregiver perspectives on service provision for family members of young people (15–25 years) attending a specialist clinic for moderate–severe mood disorder.MethodsEight caregivers, and eight specialist clinicians were interviewed via a semi‐structured interview. Thematic analysis was used to interpret qualitative findings.ResultsThematic analysis revealed four key themes related to caregivers initial needs, crisis needs, discharge needs and broad challenges. Recurrent subthemes included the need for both information and support, especially at times of heightened suicide risk, or preceding a suicide attempt. Caregivers sought greater information, specific to their young person, and more support and guidance in their role managing the safety of the young person in their care.ConclusionsResults highlight that addressing the unmet support and information needs of caregivers may be of benefit to all (both the caregivers and the young person in their care). The lived experience of caregivers in this study indicates the significant stressors placed on them (especially when the young person they are supporting is at high risk of suicide), and the need to develop efficient and cost‐effective ways to enhance their perceived competence and skills. Implications are discussed for practitioners working with young people experiencing ongoing suicidal ideation.

Identifying suicide risk among college students: A systematic review

Mental health research highlights the need to focus on suicide risk in college students. However, evidence for associated risk and protective factors in this cohort is mixed. This review synthesizes data from 29 independent studies (N = 11,557 participants). Self-reported depression, cumulative stressful life events, sleep difficulties, a disconnection from others, and a sense of hopelessness demonstrated significant associations with heightened suicide risk. Reasons to live and hope provided significant protective effects. The findings highlight key intervention targets, pointing to the importance of cognitive-behavioral interventions to ameliorate suicidal thoughts but also build dispositional hope and goal-directed thinking.

Acute and long-term mental and physical sequelae in the aftermath of traumatic exposure - some remarks on "the body keeps the score".

Traumata, by definition, refer to exterior events that expose a person to experiences of overwhelming threat and catastrophe and elicit feelings of death anxiety, panic, horror, helplessness, loss of personal control, and intractability. Most affected persons respond with at least some distressing symptoms of trauma-related memory intrusions, autonomic hyperarousal, dissociation, and depression in the acute aftermath. Fortunately, the majority of traumatized individuals succeed in coping with this major stress quite well during the following weeks and months unless the process of recovery is hampered by additional adverse psychosocial circumstances, psychological disposition or biological vulnerability. In a subgroup of persons a transition to acute and posttraumatic stress disorder or other major psychiatric disorders, e.g. depressive, anxiety, substance-related disorders may be observed. Posttraumatic stress disorders very often run a chronic course of illness enduring for many years or even life-long. The typical course of illness in PTSD is characterized not only by major psychiatric comorbidities contributing to a dramatically reduced health-related quality of life, to many deficits of psychosocial adaptation and a heightened suicide risk. It is also associated with a lot of major somatic health problems both in acute and long-term stages. The main focus here is on this special dimension of physical comorbidities in posttraumatic disorders. Empirical evidence underscores that trauma exposure, and in particular PTSD is significantly associated with major physical health problems in addition to well-known PTSD-related psychological, behavioural, and psychosocial impairments. Both self-report-based and objective assessments emphasized significantly increased rates of somatoform/functional syndromes and physical comorbidities, premature all-cause and specific mortality rates, heightened medical utilization behaviours, major socioeconomic costs, and reduced health-related quality of life in the aftermath of trauma exposure and posttraumatic stress disorders, thus defining a major challenge to any medical care system. Complex psycho-behavioural-somatic and somato-psycho-behavioural models are needed to better understand both acute and long-term effects of a perpetuating stress system on physical health.

Suicide in India: a complex public health tragedy in need of a plan

Suicide in India: a complex public health tragedy in need of a plan

Audiologists’ Role in Managing Patient Suicide Risk

Audiologists’ Role in Managing Patient Suicide Risk

Comorbid sleep disorders and suicide risk among children and adolescents with bipolar disorder

Children and adolescents with bipolar disorder are at increased risk for suicide. Sleep disturbances are common among youth with bipolar disorder and are also independently implicated in suicide risk; thus, comorbid sleep disorders may amplify suicide risk in this clinical population. This study examined the effects of comorbid sleep disorders on suicide risk among youth with bipolar disorder. We conducted secondary analyses of baseline data from the Treatment of Early Age Mania (TEAM) study, a randomized controlled trial of individuals aged 6–15 years (mean ± SD = 10.2 ± 2.7 years) with DSM-IV bipolar I disorder (N = 379). Sleep disorders (i.e., nightmare, sleep terror, and sleepwalking disorders) and suicide risk were assessed via the WASH-U-KSADS and the CDRS-R, respectively. We constructed uncontrolled logistic regression models as well as models controlling for trauma history, a generalized anxiety disorder (GAD) diagnosis, and depression symptoms. Participants with a current comorbid nightmare disorder versus those without were nearly twice as likely to screen positive for suicide risk in an uncontrolled model and models controlling for trauma history, a GAD diagnosis, and depression symptoms. Neither a current comorbid sleep terror disorder nor a sleepwalking disorder was significantly associated with suicide risk. This pattern of findings remained consistent for both current and lifetime sleep disorder diagnoses. Youth with bipolar I disorder and a comorbid nightmare disorder appear to be at heightened suicide risk. Implications for assessment and treatment are discussed.

From neuroleptics to neuroscience and from Pavlov to psychotherapy: more than just the "emperor's new treatments" for mental illnesses?

“The drugs don't work” was one of the hit singles from The Verve's album Urban Hymns , released in 1997. The song was written by lead singer Richard Ashcroft relating to his drug abuse, but it might well relate to the modern treatments for mental illnesses. More than half a century after neuroleptics, antidepressants, benzodiazepines, antipsychotics, behavior therapy, and cognitive treatment were introduced, it is prudent to ask whether “the drugs don't work”. During the past 50 years, the industrialized world has seen a dichotomy between loudly proclaimed therapeutic breakthroughs and rapidly rising numbers of people on disability payments because of mental illness. We hear that antipsychotic, antidepressant, and anti‐anxiety drugs as well as behavior therapy and newer treatments have radically improved what was described as a dismal fate of people suffering from mental disorders. Simultaneously, the percentage of disabled mentally ill patients in the USA has risen by more than 600% since the 1950s (Whitaker, 2010) and similar rates are seen in European countries. Most epidemiologists agree that this “epidemic” is not caused by increased incidence. Moreover, the once rapid succession of new therapeutic developments seems to have halted, at least in pharmacology, as big companies are withdrawing from research on mental disorders. How can this apparent contradiction be explained? Could it be that therapeutic progress is much less than we think or are being told? Could it be that the course of depression, anxiety, schizophrenia, or ADHD has been altered for the worse? Could it be that we cannot make therapeutic progress because the concept of mental illness and its treatment is deeply flawed? There are strong reasons to assume that all three suspicions are in fact true. So, what do we know about the efficiency of pharmacological and psychological treatments? In regard to short‐term outcomes, pharmacotherapy is clearly …

Treating PTSD Within the Context of Heightened Suicide Risk

Because posttraumatic stress disorder (PTSD) is one of the few psychological conditions that predict suicidal behavior among those who think about suicide, many patients with PTSD present clinically with elevated suicide risk. Expert consensus and practice guidelines recommend against trauma-focused treatments for patients with elevated suicide risk, however. Research aimed at understanding the common mechanisms that underlie the association of PTSD and suicide risk has led to several advances in the effective care of suicidal patients diagnosed with PTSD. Based on these results, various combinations and sequences of suicide-focused treatments, risk management procedures, and trauma-focused treatments are implicated.

Mental Defeat Is Associated With Suicide Intent in Patients With Chronic Pain.

Mental defeat has been implicated in precipitating suicide with effects not explained by depression. It has also been found to be elevated in people who are most distressed and disabled by chronic pain. This study examined the role of mental defeat in predicting suicide intent among chronic pain patients and compared the predictive value of mental defeat with other established pain and psychological constructs. Sixty-two chronic pain patients attended a semistructured interview to assess pain characteristics and suicidality (present and worst-ever) and completed self-report measures of anxiety, depression, hopelessness, self-efficacy, pain catastrophizing, and mental defeat. A total of 22.6% of people reported a history of suicide attempt (1 attempt=12.9%; ≥2 attempts=9.7%). The wish to die was reportedly moderate to strong for 63.3% of those who attempted suicide. No significant correlations were found for hopelessness and self-efficacy with suicide intent in this sample. Hierarchical regression analyses suggested that pain intensity was a significant predictor of worst-ever suicidal intent (R=0.11), and mental defeat significantly improved the prediction even when the effect of pain intensity was accounted for (ΔR=0.12). Anxiety, depression, and pain catastrophizing were significant correlates of suicide intent, but they did not add to the prediction of worst-ever suicide intent after the effect of pain intensity was controlled for. Mental defeat may be a key indicator for heightened suicide risk. Therapeutic interventions targeting mental defeat offer a novel avenue for reducing suicide risk in chronic pain patients.

Differences in characteristics between suicide cases of farm managers compared to those of farm labourers in Queensland, Australia

Farmers constitute an occupation group at a heightened suicide risk compared to the general population. To date, research has tried to explain this peculiarity by identifying suicide risk factors that are common to the whole of the farming population. There are, however, indications that risk factors may be different for different sub-populations of farmers, such as younger/older farmers or farm managers/farm labourers. This study compared the characteristics of suicides by farm managers and farm labourers, while controlling for the effect of age. A review of two datasets, the Queensland Suicide Register and the National Coroners Information System, was conducted in which a total of 78 cases of farm managers and 69 cases of farm labourers were identified as a suicide during 2000-2009, Queensland, Australia. The main outcome measures included various demographic characteristics, circumstances related to death, health and mental health variables, and history of stressful life events. The two groups differed in marital status, living arrangements, ethnicity, physical and mental illness, alcohol and drug abuse, contact with a health professional prior to death, and specific life events such as relationship breakdown and recent/pending unemployment. The majority of these differences were not statistically significant once age was accounted for. However, differences in psychiatric variables and experience of a recent/pending unemployment remained significant. This study contributes towards better understanding of suicide among farmers in different job positions, and highlights the need for tailored suicide prevention initiatives that consider a combination of age- and job-specific suicide risk and protective factors among farmers.

The Impact of Grit on the Relationship Between Hopelessness and Suicidality

Researchers have recently emphasized the need to develop a greater understanding of factors and contexts that facilitate the progression from suicidal thoughts to suicidal behavior. Hopelessness has been implicated in numerous studies as one of the primary cognitive vulnerabilities associated with heightened suicide risk. This study aimed to address the extent to which grit moderates the association between hopelessness and both suicidal ideation and resolved plans and preparations for suicide within an understudied and high-risk population of United States military personnel. Results were consistent with the authors' hypotheses. Specifically, the relationship between hopelessness and current suicidal ideation decreased in magnitude at higher levels of grit. Similarly, whereas the relationship between hopelessness and resolved plans and preparations for suicide was significant and positive at low levels of grit, it was nonsignificant at mean levels of grit and significant and negative at high levels of gr...

CSF Biomarkers of Suicidal Behavior

This presentation will give an overview of CSF biomarkers related to suicidal behavior. First part will focus on studies on 5-hydroxyindoleacetic acid (5-HIAA) as a biomarker of heightened suicide risk. The second part is about HPA-related CSF neuropeptides including also oxytocin in suicidal behaviour. Finally, the talk includes a short overview on CSF neuroinflammatory biomarkers and growth factors in suicide attempters. Confounders concerning CSF studies will be briefly mentioned.

The Treatment of Pediatric Suicidal Behavior

Psychotherapies have stronger empirical support of efficacy and do not have safety concerns associated with many medications; thus, at present, psychotherapy is an appropriate first-line treatment for suicidal ideation and behavior in youth. Integrated Cognitive-Behavioral Therapy (I-CBT) and Multisystemic Therapy (MST) have the strongest preliminary evidence for psychotherapeutic treatment of suicidal behavior in preadolescents and adolescents with a history of suicidal behavior. Mentalization-Based Treatment for Adolescents (MBT-A), Developmental Group Psychotherapy (DGP), and Dialectical Behavior Therapy for Adolescents (DBT-A) have received some support for youth engaging in non-suicidal and/or suicidal self-injurious behaviors. Resourceful Adolescent Parent Program (RAP-P) may be effective in reducing suicidal thoughts and/or self-injurious behaviors (Table 1). In children with a history of recurrent suicidal behavior and for whom psychotherapy alone is ineffective, psychopharmacological treatment may be necessary. Responsible pharmacological treatment of pediatric suicidal behavior requires understanding of the current dearth of efficacy evidence and the limitations of safety evidence within pediatric populations, the range of possible serious side effects, and the potential use of medications, including less toxic SSRIs (Barbey and Roose J Clin Psychiatry 59:42–8, 1998) [IV], as a suicide method. Time to effect of antidepressants may coincide with heightened suicide risk (Simon et al. Am J Psychiatr 163(1):41–7, 2006) [I], and, thus, patients should be monitored particularly closely during this time period. Psychotropic medications for pediatric patients should be part of a comprehensive and integrated treatment and monitoring strategy, including therapeutic drug monitoring and coordinated communication among providers, caregivers, and patients. Although suicide attempts in children younger than five are extremely rare, they do occur (Rosenthal and Rosenthal Am J Psychiatr 141(4):520–25, 1984) [IV]; treatment will focus on family factors and will typically employ dyadic models of psychotherapy to develop or reestablish co-regulation between the child and the caregiver.

Asian American mental health: A call to action.

The U.S. Surgeon General's report Mental Health: Culture, Race, and Ethnicity--A Supplement to Mental Health: A Report of the Surgeon General (U.S. Department of Health and Human Services, 2001) was arguably the best single scholarly contribution on the mental health of ethnic minority groups in the United States. Over 10 years have now elapsed since its publication in 2001. This article highlights advances and illuminates gaps in the knowledge gained about the mental health and psychotherapeutic treatment of Asian Americans in the past decade. Though larger epidemiological surveys point to lower prevalence rates of mental illness in Asian Americans, further advances are needed in culturally valid assessment and quantification of cultural biases in symptom reporting in order to draw definitive conclusions about the state of Asian American mental health. A focus on prevalence in Asian Americans as a whole also shrouds important subgroup elevations such as heightened suicide risk in Asian elderly women or greater posttraumatic stress disorder in Southeast Asian refugees. Despite important developments in our knowledge about mental health prevalence, help-seeking behaviors, and culturally competent treatments for Asian Americans, it appears that troublingly low rates of service utilization still remain even when one accounts for the seemingly low prevalence rates among Asian Americans. Some progress has been made in the cultural adaptations of psychotherapy treatments for Asian Americans. In order to reduce mental health care disparities, greater efforts are needed to provide outreach at the community level and to bridge the gap between mental health and other medical or alternative health facilities. We call for innovation and provide recommendations to address these issues in the next decade.

Data Sound Alarm on Gay Teens' Heightened Suicide Risk

Data Sound Alarm on Gay Teens' Heightened Suicide Risk

P02-50 - When to call it quits - a case report

IntroductionWe present a case report highlighting the central role of psychiatrist in care coordination in spite of current trends when care is fragmented and provided by specialist teams. The importance of organic causation in bio-psycho-social case formulation and its treatment is emphasized.ObjectivesTo demonstrate the range of skills employed by practicing psychiatrist in optimising the care of the patients.AimsThe role of Psychiatrists in managing risk in the suicidal patient with depressive illness is paramount and central.MethodThe highlights in a patient’s journey are revisited via a review of medical notes.ResultsThe opinions of allied professionals and the split in the team in addressing heightened suicide risk is highlighted. The emphasis is placed on reflecting on when to end active management and consider a maintenance postion for the patient.ConclusionsThe concept of continuity of care and specialist knowledge of person in enhancing quality of care and optimising the patient outcome is firmly established.

Risk of suicidal behavior with antiepileptic drugs

Antiepileptic drugs (AeDs) are receiving increasing attention for a possible association with suicidal thoughts and behaviors. Several recent studies examining this association, however, have yielded inconsistent findings, particularly in terms of the risk of suicidal behavior conferred by specific AeDs. In patients with epilepsy, heightened suicide risk is also attributable to comorbid psychiatric conditions.

Are Patients With Depression at Heightened Risk of Suicide as They Begin to Recover?

Are Patients With Depression at Heightened Risk of Suicide as They Begin to Recover?

Are Patients With Depression at Heightened Risk of Suicide as They Begin to Recover?

It has long been taught and believed that patients with depression and suicidal tendencies are at heightened risk of suicide as they begin to recover and their energy and motivation return. What are the data behind this enduring belief? More than a century ago, eminent clinicians noted that some patients with depression committed suicide just as their depression seemed to be improving. The clinicians went on to warn that early recovery carries a high risk of suicide. Although no studies have tracked suicide along with symptomatic change in depression, recent large-scale studies of suicide and phase of treatment do not indicate that suicide is more likely to occur early in recovery than at other times. Our forebears helpfully pointed out that patients with depression may commit suicide as they are beginning to recover. But the idea that these patients are at particular risk of suicide at this time, intuitively plausible as it is, remains to be substantiated.