Higher Levels Of Suicidality Research Articles

Borderline personality disorder: Gender bias and diagnostic disparities

Borderline Personality Disorder (BPD) is a DSM-5 Cluster B mental health condition. One of the lesser understood mental health conditions, BPD is marked by a multi-symptom profile such as high levels of emotional dysregulation, distorted self-image, volatile and unstable relationships, emotional instability, and higher levels of suicidality. Symptoms are often intense and enduring, causing significant chaos and stress in an individual’s life as well as those closest to them. Because there is a significant overlap of symptomology and diagnosis with other psychiatric disorders, BPD was at one time a contested diagnosis, thus research and treatment options remained limited. Currently, BPD is one of the more widely researched conditions, which has informed evidenced-based treatment, however, individuals carrying the diagnosis report difficulty accessing treatment and difficulty feeling understood by mental healthcare providers. The development of BPD remains unclear, although consistent with other mental health conditions there is a genetic constituent, and with BPD in particular a history of trauma. This research manual will explore current evidence-based practices and assessment methods to inform best practices when working with BPD.

Relevance of the Mental Health Problem of Higher education Students: analysis and Prospects of Solution for Kazakhstan

The analysis revealed that the problem of mental health is relevant at the global level, with a marked trend of increasing psychological stress, depression, and anxiety, especially among young people. In the Republic of Kazakhstan, there is an insufficient study of awareness of mental health among students; the lack of comprehensive preventive measures to improve their mental health, as well as a high level of suicide, exacerbate this problem. Creating an educational space that provides favorable conditions for students' mental health is a priority task for educational institutions at all levels. It is due to the need to form an environment that promotes the free and harmonious development of personality and the satisfaction of social and cognitive needs, as well as increasing the body's adaptive capabilities to improve students' quality of life and overall health.

Mortality from suicide among adolescents and young people in the Altai Republic, Russia, for the period of 1990-2019

IntroductionThe Altai Republic (AR) is the national subject of the Russian Federation where suicidal situation is unfavorable as the death rate from suicide exceeds the national rates by three times. The high level of suicide among adolescents and young people is especially alarming.ObjectivesTo analyze the dynamics of mortality from suicide among adolescents and young people in the AR for the period from 1990 to 2019.MethodsData on mortality of the population were obtained from the Russian databases of demographic indicators and analyzed in terms standardized per 100,000 population.ResultsThe highest mortality rates from suicide are recorded in the 20-24 age group. The suicide rate, compared to 1990, decreased slightly from 82.5 (in 1990) to 79.7 per 100 thousand (in 2019). The dynamics of mortality from suicide among adolescents aged 15-19 is also unstable. When comparing the indicators in 1990 and in 2019, one can verify the negative dynamics in the form of a 4-fold increase in the suicide rate – from 14.4 (in 1990) to 58 (in 2019). An analysis of the ethnicity of young people who committed complete suicide showed that the majority of suicides (90%) were indigenous Altaians.ConclusionsIn adolescents and young people of the AR, the death rate from suicide exceeds the all-Russian indicators from 7.9 to 9.3 times. Effective preventive measures are needed to improve the situation.DisclosureNo significant relationships.

Problem anger in veterans and military personnel: Prevalence, predictors, and associated harms of suicide and violence

BackgroundProblem anger is increasingly identified as an important issue, and may be associated with suicidality and violence. This study investigates the relationship between problem anger, suicidality, and violence amongst veterans and military personnel. MethodsCross-sectional survey data from n = 12,806 military personnel and veterans were subject to analyses. These considered the weighted prevalence of problem anger, while further analyses of veterans (n = 4326) considered risk factors and co-occurrence with other psychiatric conditions. Path analyses examined inter-relationships involving anger, violence and suicidality. ResultsThere were 30.7% of veterans and 16.4% of military personnel that reported past month problem anger, while 14.9% of veterans and 7.4% of military personnel reported physical violence. There were higher levels of suicidality among veterans (30.3%), than military personnel (14.3%). Logistic regression models indicated that PTSD was the strongest risk factor for problem anger (PCL-5, OR = 21.68), while there were small but substantial increases in anger rates associated with depression (OR = 15.62) and alcohol dependence (OR = 6.55). Path models indicated that problem anger had an influence on suicide attempts, occurring primarily through suicidal ideation, and an influence on violence. Influences of problem anger on suicidal ideation and violence remained significant when controlling for co-occurring mental health problems. ConclusionsProblem anger, violence, and suicidality are common and inter-related issues among military personnel and veterans. Problem anger is a unique correlate of suicidality, supporting the need for anger to be included as part of violence and suicide risk assessment, and clinician training.

The impact of COVID-19 stressors on psychological distress and suicidality in a nationwide community survey in Taiwan

COVID-19 stressors and psychological stress response are important correlates of suicide risks under the COVID-19 pandemic. This study aimed to investigate the prevalence of COVID-19 stress, its impact on mental health and associated risk factors among the general population during the outbreak of COVID-19 in July 2020 throughout Taiwan. A nationwide population-based survey was conducted using a computer-assisted telephone interview system with a stratified, proportional randomization method for the survey. The questionnaire comprised demographic variables, psychological distress assessed by the five-item Brief Symptom Rating Scale and independent psychosocial variables including COVID-19 stressors, loneliness, suicidality, and health-related self-efficacy. In total, 2094 respondents completed the survey (female 51%). The COVID-19 stress was experienced among 45.4% of the participants, with the most prevalent stressors related to daily life and job/financial concerns. Higher levels of suicidality, loneliness, and a lower level of self-efficacy had significantly higher odds of having COVID-19 stress. The structural equation model revealed that COVID-19 stress was moderately associated with psychological distress and mediated by other psychosocial risk factors. The findings call for more attention on strategies of stress management and mental health promotion for the public to prevent larger scales of psychological consequences in future waves of the COVID-19 pandemic.

Anxiety disorders in adult ADHD: A frequent comorbidity and a risk factor for externalizing problems

IntroductionADHD is a common neurodevelopmental disorder and is highly prevalent in adults. It is associated with several negative outcomes, impacting well-being and global functioning. ADHD is highly associated with comorbidities, anxiety disorders being probably the most frequent. The goal of our study is to assess the prevalence of anxiety disorders and their impact in adults with ADHD. Method353 individuals diagnosed with ADHD were recruited. Severity of ADHD was assessed as well as lifetime anxiety disorders and other psychiatric comorbidities. We performed logistic and linear regressions to test the impact of lifetime anxiety disorders on demographic and clinical variables. ResultsMore than half of the patients had at least one anxiety disorder. The presence of comorbid anxiety disorders was associated with worse clinical presentation (positive history of suicide attempts, higher disposition toward anger, higher rate of hospitalization and psychotic symptoms) and with a lower level of education. ConclusionAnxiety disorders are highly prevalent in ADHD and are associated with higher levels of suicidality and disposition towards anger, more severe clinical presentation and lower functioning. Comorbid anxiety needs to be evaluated and treated by clinicians to limit distress, aggression towards self and others and to improve quality of life.

Developing resilience and promoting positive mental health strategies in university students

AimsSuicide is one of the leading causes of death in young people living in Australia, accounting for 7.3% of all deaths among individuals aged 15–19 years. Historically, high levels of suicide have been recorded in Australian university students. This project aims to develop and test a massive online course-program (MOOC) for university students, underpinned by literature and strength-based suicide prevention principles, building resilience and awareness of mental health promoting activities.MethodA scoping review of the literature was undertaken to explore the effectiveness of current suicide prevention programs for undergraduate university students, and the effective elements contributing to the success of these programs. Six electronic databases were searched to identify relevant literature. Further, mental health consumers and university students were involved in co-producing the content of the six modules of the ‘Talk-to-me' MOOC.ResultNine articles were included in the review, discussing four types of programs including; gatekeeping, education, promotional messaging and online consultation. It was apparent from this review that there is a significant dearth of interventions and programs currently available to reduce the risk of suicide among undergraduate students, with many of the programs having limited efficacy. Despite this, a number of program elements were identified as beneficial to preventing suicide among post-secondary students including upskilling of students, and improving resilience, and self-management. These findings and further consultation with mental health consumers and undergraduate university students underpinned the development of the content of the ‘Talk-to-me' MOOC which is tailored to meet the needs of university students. The MOOC contains six modules: Mental fitness; strategies to increase mental fitness; self-harm; suicidal behaviour in young adults; interventions for suicidal behaviour; and, gatekeeper interventions. Two case study senarios depicting mental health challenges commonly experienced by yound adults portraying appropriate crisis communication skills were developed and filmed complementing the six ‘Talk-to-me' modules.ConclusionOverall, studies included in the review provide evidence to suggest that preventative programs, incorporating an educational component may be effective to be used in the MOOC to improving help-seeking behaviours among post-secondary education students. Findings from this review have underpinned the development of the ‘Talk-to-Me' MOOC which was launched in March 2020. To date this MOOC has enrolled over 45,000 participants from over 150 countries, with the average age of users being 24 years. Collectively, this line of work highlights that MOOCs are an effective means of mental health promotion to young adults.

Association between Childhood Trauma and Suicidal Behavior in the General Population.

This study aimed to investigate the associations between various types of childhood trauma and suicidal behavior in the general population in South Korea. This mental health survey included a total of 1,490 general citizens living in a metropolitan South Korean city who completed a questionnaire that assessed respondents' histories of childhood trauma before the age of 12 years, including bullying victimization, emotional abuse, sexual abuse, and physical abuse, as well as suicidal behavior, including current suicidal ideation and histories of suicide planning and attempts. The following psychiatric scales were administered: Hospital Anxiety and Depression Scale (HADS), Rosenberg Self-Esteem Scale (R-SES), Connor-Davidson Resilience Scale (CD-RISC), Perceived Stress Scale (PSS), and visual analogue scale of EuroQol 5D (EQ-5D). Participants who experienced any childhood trauma had significantly higher HADS and PSS scores, and significantly lower EQ-5D scores. Additionally, participants with any type of childhood trauma were significantly more likely to have current suicidal ideation and histories of planned and attempted suicide. Multivariate analyses adjusted for confounding variables indicated that bullying victimization and sexual abuse were associated significantly with all types of suicidal behavior. Physical abuse was associated significantly with histories of suicide planning and attempts. The present findings showed that any type of childhood trauma was associated with higher levels of suicidality, anxiety, depression, and perceived stress, as well as lower health-related quality of life, in the general population. In particular, associations between childhood trauma and suicidality were identified after adjustment for confounding variables.

Rates and Predictors of Deterioration in a Trial of Internet-Delivered Cognitive Behavioral Therapy for Reducing Suicidal Thoughts

Objective It is necessary for suicide prevention interventions to demonstrate safety. One important aspect of safety is evidence that deterioration rates are low. No studies have examined deterioration of suicidal ideation in the context of an internet-based cognitive behavioral therapy (CBT) intervention to reduce suicidal ideation. A secondary analysis of the outcomes of an online trial was conducted to determine rates of deterioration in a CBT intervention called Living with Deadly Thoughts, relative to an attention control condition, and to identify factors associated with deterioration. Method The randomized controlled trial included 418 adults with suicidal ideation at baseline (77% females, mean age 40.6 years). Deterioration was defined in two ways: a reliable increase in Suicidal Ideation Attributes Scale (SIDAS score) of ≥6.0 units; or triggering the safety protocol during the trial as determined by high levels of suicidality. Analyses were repeated with multiply imputed data. Predictors of deterioration were identified using logistic regression analysis. Results 30 (14%) participants in the control group and 15 (7%) in the intervention group met criteria for reliable deterioration (Fisher’s exact p = 0.027). In a fully adjusted logistic regression model, greater initial severity of suicidal thinking was associated with lower odds of deterioration, while intervention condition, demographics, psychological factors and mental health factors had no significant association with deterioration. Conclusions Participation in an online suicide prevention intervention was associated with lower prevalence of reliable deterioration than participation in an attention-control intervention, providing further evidence that internet-based CBT interventions do not cause harm. Highlights First study to assess deterioration in an internet suicide prevention intervention Rates of reliable deterioration were higher in control (14%) than intervention (7%) No psychological or demographic factors were robustly associated with deterioration Findings provide further evidence that internet based CBT programs are not harmful

Prevalence of symptoms, ever having received a diagnosis and treatment of depression and anxiety, and associations with health service use amongst the general population in two Russian cities

BackgroundLittle is known about the burden of common mental disorders in Russia despite high levels of suicide and alcohol-related mortality. Here we investigated levels of symptoms, self-reports of ever having received a diagnosis and treatment of anxiety and depression in two Russian cities.MethodsThe study population was men and women aged 35–69 years old participating in cross-sectional population-based studies in the cities of Arkhangelsk and Novosibirsk (2015–18). Participants completed an interview which included the PHQ-9 and GAD-7 scales, questions on whether participants had ever received a diagnosis of depression or anxiety, and health service use in the past year. Participants also reported current medication use and medications were coded in line with the WHO anatomical therapeutic classification (ATC). Depression was defined as PHQ-9 ≥ 10 and Anxiety as GAD-7 ≥ 10.ResultsAge-standardised prevalence of PHQ-9 ≥ 10 was 10.7% in women and 5.4% in men (GAD-7 ≥ 10 6.2% in women; 3.0% in men). Among those with PHQ-9 ≥ 10 17% reported ever having been diagnosed with depression (equivalent finding for anxiety 29%). Only 1.5% of those with PHQ-9 ≥ 10 reported using anti-depressants and 0.6% of those with GAD-7 ≥ 10 reported using anxiolytics. No men with PHQ-9 ≥ 10 and/or GAD-7 ≥ 10 reported use of anti-depressants or anxiolytics. Use of health services increased with increasing severity of both depression and anxiety.ConclusionThere was a large gap between symptoms and reporting of past diagnosis and treatment of common mental disorders in two Russian cities. Interventions aimed at improving mental health literacy and reducing stigma could be of benefit in closing this substantial treatment gap.

Avoiding Misdiagnosis When Auditory Verbal Hallucinations Are Present in Borderline Personality Disorder.

Misdiagnosis is common for patients with a primary diagnosis of borderline personality disorder (BPD) who experience auditory verbal hallucinations (AVHs). AVHs in BPD are associated with severe BPD and high levels of suicidality. Wrongly treating these patients as though they are suffering from schizophrenia or other primary psychotic disorder and not treating BPD can cause significant iatrogenic damage. We outline a specific pattern of symptoms and phenomenology that will assist diagnostic accuracy in these cases. A focused review identified the following characteristic pattern: AVHs in BPD cannot be distinguished phenomenologically from AVH in schizophrenia, often meet the criteria for First-Rank Symptoms (FRSs), are highly stress related, and are strongly associated with dissociative experiences and childhood trauma. Formal thought disorder is uncommon, negative symptoms are usually absent, bizarre delusions are absent, affect remains reactive, and sociability is usually retained. Diagnostic accuracy can be improved by examining the overall clinical presentation and is essential to improving the prognosis for these patients.

Suicide among persons who entered same-sex and opposite-sex marriage in Denmark and Sweden, 1989–2016: a binational, register-based cohort study

BackgroundPeople belonging to sexual minority groups have higher levels of suicidality than heterosexuals. However, findings regarding suicide death are sparse. Using unique national data from two countries, we investigated whether...

Of acculturative stress and integration distress: the resettlement challenges of Bhutanese refugees in Metro Atlanta

ABSTRACT Bhutanese refugees represent one of the most recent waves of immigration to the United States. Resettled since 2008, the community finds itself marred by what Berry et al. (1987) termed ‘acculturative stress’, which has resulted in a high level of suicide and fractured communities. This paper contributes to the literature on resettlement through an analysis of the experiences of 32 Bhutanese refugees in Metro Atlanta. The data for this project come from two sets of interviews in 2015 and 2018. The Bhutanese participants exhibited a willingness to engage in the integration process, but this has come with a cost: systematic gaps in the help refugees has created a wave of ‘integration distress’ that has affected the entire Bhutanese community in Atlanta.

The transformation of Buryat families as a factor determining population health

The article considers alterations of institute of traditional Buryat family in historical perspective. The social hygienic and medical demographic analysis of families in actual social economic conditions was implemented including assessment of their fostering function. It is demonstrated that Buryat family represents a transferring form of transition from traditional family typical for cultures of collectivist type to new social institute more specific for cultures of individualist type. It is established that in many families, because of changing of life-style, exists certain deficiency of emotional contacts, breach of children parental relationships. The deficiency of emotional support and parental attention provides no satisfaction of basic need of youth generation in social belonging, safety and protection that is manifested in decreasing of population health of the youth and high level of suicide.

Survivor Guilt in a Posttraumatic Stress Disorder Clinic Sample

Survivor guilt is a commonly used term, but little research has addressed its prevalence in clinical samples. A UK traumatic stress clinic sample was systematically assessed for survivor guilt over an 18-month period. Over a third (38.5%) of participants had survived an event in which others died and 90% of survivors reported feelings of survivor guilt. Surviving a fatal traumatic event was associated with higher levels of suicidality, but not PTSD or depression. Guilt about surviving was associated with more severe PTSD. This study suggests that survivor guilt is a common and distressing problem among traumatized clients and requires further investigation.

Obsessive–compulsive symptoms in schizophrenia: prevalence and associated factors in a Nigerian population

Objectives: The objectives of this study were to determine the prevalence of obsessive–compulsive symptoms (OCS) among subjects with schizophrenia and also to determine their associated factors.Methods: A cross-sectional study involving 232 patients with schizophrenia were recruited from a teaching hospital in Nigeria. Socio-demographic questionnaire, Obsessive–Compulsive Inventory, Positive and Negative Syndrome Scale and Suicidality module of the MINI International Neuropsychiatric Inventory were administered.Results: The prevalence of OCS was 54.3% among patients with schizophrenia, and washing symptom was the most common (51.7%). Patients with schizophrenia that had OCS had more severe psychopathologies and higher levels of suicidality. OCS among patients with schizophrenia were also associated with the use of second-generation antipsychotic medications.Conclusions: OCS are common in schizophrenia. Hence, there is a need for routine screening of patients with schizophrenia for OCS and then, manage them appropriately.

Help-negation in suicidal youth living in Switzerland

ObjectivesTo examine whether help-negation (i.e. not accepting or accessing available helping resources) among suicidal youth could also be found in a Swiss sample. MethodsData from 7335 16–20-year olds, who participated in the 2002 Swiss Multicentre Adolescent Survey on Health, were analyzed. Logistic regression analyses were conducted to predict if a person would generally talk with no one when having a mental health problem (e.g. feeling depressed or anxious). Not talking about such problems was interpreted as indicator for help-negation. The main predictor was suicide severity. Additionally, an indicator of depression and socio-demographic variables were included in the statistical models. ResultsPeople with higher levels of suicidality and depression were more likely to report that they would not talk about mental health problems. More non-Swiss (vs. Swiss) participants and apprentices (vs. students) reported high suicidality. Furthermore, these specific sub-groups seemed to be particularly likely to negate help. ConclusionHelp-negation can also be found in a Swiss sample of young people and seems to be particularly pronounced in some socio-demographic subgroups. By reducing this reluctance to seek help, premature death due to suicide might be reduced.

Prevalence and Characteristics of Body Dysmorphic Disorder Among Patients in a Partial Hospital Program.

Body dysmorphic disorder (BDD) is a common disorder that is usually associated with impaired functioning and high levels of suicidality. The current study is the first to assess prevalence of BDD among patients in a partial hospital program and compare patients with and without BDD on demographic and clinical variables. Participants were 207 patients with a variety of Axis I diagnoses. Prevalence of current BDD was 7.2%, and a diagnosis of BDD did not predict worse treatment outcome in the program. Patients with current BDD were more likely to be female and younger and have more comorbid diagnoses than patients without current BDD. No other significant differences were found at baseline between patients with and without current BDD. Results indicate that BDD is relatively common among patients in partial hospital programs and that such programs may be as beneficial to patients with BDD as to other patients.

Suicide attempts by elderly women - from a gender perspective.

This article analyzes the presence of gender inequality and violence in the lives of elderly women who have attempted suicide. This survey is part of a qualitative research study developed in twelve municipal regions in Brazil with high levels of suicide, and is coordinated by Claves-Fiocruz. Information was obtained by means of semi-structured interviews with thirty-two women from a sampling of fifty-nine elderly women with a history of attempted suicide. It was decided not to identify the interviewees, and to construct a narrative based on events that have occurred in the lives of all these women. The study was based on the women's life cycle (infancy, youth, adult life and old age) to see if gender inequality had been an issue in each of these phases. The inequalities began in infancy with differentiated gender upbringing; these continued during their youth and with their sexual initiation, marriage and maturity these continued during their adult life through acts of violence committed by their partners and/ or other family members which culminates in old age, when they are deprived of their independence and have lost ties, possessions and points of reference. These lives permeated with violence result in a feeling of emptiness and unworthiness, and lead many elderly women to view death as their only solution.

Comorbidity-independent risk for suicidality increases with bulimia nervosa but not with anorexia nervosa

BackgroundEating disorders are serious psychiatric illnesses with high levels of suicidality and high comorbidity. However, no study has established the extent to which suicidality is uniquely associated with eating disorders rather than attributable to comorbid mood, anxiety, or substance use disorders. The current study examined whether unique associations between eating disorders and suicidality exist and whether potential associations differ by eating disorder diagnosis. MethodsParticipants were women (n = 364) from the second stage of a large epidemiological study examining eating and health related attitudes and behaviors. The Structured Clinical Interview for Axis I diagnoses (SCID-I) was used to determine lifetime psychiatric diagnoses and lifetime suicidality. ResultsA multiple regression model including eating and comorbid disorders indicated that bulimia nervosa (BN) was significantly associated with suicidality above and beyond risk predicted by comorbid disorders. No unique association was found for anorexia nervosa (AN) or eating disorder not otherwise specified while controlling for comorbidity. ConclusionsBN is independently associated with suicidality, and findings emphasize the need to incorporate suicide risk assessment in standardized assessments of eating disorders.