Higher Rates Of Suicide Attempts Research Articles

1524 – Personality disorders and previous suicide attempts: a psychological autopsy study

Introduction Suicide is a major public health problem. Although suicide statistics have always been difficult to determine, there is no doubt that deaths caused by this psychiatric challenge are similar to the ones caused by homicide or road traffic injuries. The presence of a personality disorder has often been related to suicide. Objectives In the present work we analyze the presence of personality disorders (PD) in suicide victims and controls, in order to determinate such axis II disorders were more common in the suicide group. Methods We compared the results of two samples (271 suicides and 142 sudden-death controls), which were studied using a psychological autopsy. Personality disorders were diagnosed using the SCID-II. Data were analyzed using the SPSS software 19.0 version. Results Although age differences were found between both groups, they were almost not statistically significant (p=0’049). There were no differences in gender results (p=0’289). The prevalence of PD was statistically significant (p=0’00) among the suicide group. When we studied the suicide group, we found that the existence of previous suicide attempts and PD was statistically significant also. Conclusions Although PD were more frequent among suicide victims, we found that PD also had more previous suicide attempts. Therefore, the presence of more PD among suicide victims may be due to the higher rates of suicide attempts

2670 – Comorbid bipolar disorder and borderline personality disorder and history of suicide attempts

Background Both bipolar disorder and borderline personality disorder are associated with elevated rates of completed and attempted suicide. No studies have examined whether there is an additive risk for suicidal behavior in patients diagnosed with both disorders. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project we tested the hypothesis that patients diagnosed with both bipolar disorder and borderline personality disorder would have a higher rate of suicide attempts than patients with either diagnosis alone. Methods Three thousand four hundred and sixty-five psychiatric outpatients were interviewed with semi-structured interviews. Results The suicide attempt rate in both the bipolar disorder and borderline personality disorder groups was significantly higher than the rate in patients without either of these disorders. Compared to the bipolar patients without borderline personality disorder, the patients diagnosed with both bipolar and borderline personality disorder were significantly more likely to have made a prior suicide attempt (58.0% vs. 28.9%, p Conclusions While bipolar disorder and borderline personality disorder are each risk factors for suicidal behavior, the cooccurrence of these disorders confers an additive risk.

Gender and Racial Differences for Suicide Attempters and Ideators in a High-Risk Community Corrections Population

Community corrections populations are a high-risk group who carry multiple suicide risk factors. To identify factors correlated with historical suicide attempts and ideation among African-American men, African-American women, White men, and White women in a community corrections population. Self-report data from 18,753 enrollees in community corrections were analyzed. Multinomial logistic regression analyses were conducted to determine associations between historical suicidal ideation and attempts among the four demographic groups. Participants with historical suicide attempts tended to be younger, White, female, be taking psychotropic medication, have a history of physical or sexual abuse, and meet criteria for dependence on alcohol, amphetamines, cocaine, opioids, or sedatives. Five variables were commonly associated with suicide attempts for all four race/gender groups: younger age, being on disability or retirement, taking psychotropic medication, history of sexual or physical abuse, and cocaine dependence. Other demographic variables had race or gender specificities as risk factors for suicide attempts. Participants had high rates of historical suicide attempts with unique correlates differentiating attempters from ideators among different racial and gender groups. Cocaine dependence was universal predictor of suicide attempts, while other substance dependencies show specific racial and gender profiles associated with suicide attempts.

Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury.

We performed a 10-year prospective follow-up of a childhood-ascertained (6-12 years), ethnically and socioeconomically diverse sample of girls with attention-deficit/hyperactivity disorder (ADHD; N = 140: combined type [ADHD-C] n = 93; inattentive type [ADHD-I] n = 47) plus a matched comparison group (N = 88). Girls were recruited from schools, mental health centers, pediatric practices, and via advertisements; extensive evaluations confirmed ADHD versus comparison status. Ten-year outcomes (age range 17-24 years; retention rate = 95%) included symptoms (ADHD, externalizing, internalizing), substance use, eating pathology, self-perceptions, functional impairment (global, academic, service utilization), self-harm (suicide attempts, self-injury), and driving behavior. Participants with childhood-diagnosed ADHD continued to display higher rates of ADHD and comorbid symptoms, showed more serious impairment (both global and specific), and had higher rates of suicide attempts and self-injury than the comparison sample, with effect sizes from medium to very large; yet the groups did not differ significantly in terms of eating pathology, substance use, or driving behavior. ADHD-C and ADHD-I types rarely differed significantly, except for suicide attempts and self-injury, which were highly concentrated in ADHD-C. Domains of externalizing behavior, global impairment, service utilization, and self-harm (self-injury and suicide attempts) survived stringent control of crucial childhood covariates (age, demographics, comorbidities, IQ). Girls with childhood ADHD maintain marked impairment by early adulthood, spreading from symptoms to risk for serious self-harm. Our future research addresses the viability of different diagnostic conceptions of adult ADHD and their linkages with core life impairments.

Predictors of Prospectively Examined Suicide Attempts Among Youth With Bipolar Disorder

Individuals with early onset of bipolar disorder are at high risk for suicide. Yet, no study to date has examined factors associated with prospective risk for suicide attempts among youth with bipolar disorder. To examine past, intake, and follow-up predictors of prospectively observed suicide attempts among youth with bipolar disorder. We interviewed subjects, on average, every 9 months over a mean of 5 years using the Longitudinal Interval Follow-up Evaluation. Outpatient and inpatient units at 3 university centers. A total of 413 youths (mean [SD] age, 12.6 [3.3] years) who received a diagnosis of bipolar I disorder (n=244), bipolar II disorder (n=28), or bipolar disorder not otherwise specified (n=141). Suicide attempt over prospective follow-up and past, intake, and follow-up predictors of suicide attempts. Of the 413 youths with bipolar disorder, 76 (18%) made at least 1 suicide attempt within 5 years of study intake; of these, 31 (8% of the entire sample and 41% of attempters) made multiple attempts. Girls had higher rates of attempts than did boys, but rates were similar for bipolar subtypes. The most potent past and intake predictors of prospectively examined suicide attempts included severity of depressive episode at study intake and family history of depression. Follow-up data were aggregated over 8-week intervals; greater number of weeks spent with threshold depression, substance use disorder, and mixed mood symptoms and greater number of weeks spent receiving outpatient psychosocial services in the preceding 8-week period predicted greater likelihood of a suicide attempt. Early-onset bipolar disorder is associated with high rates of suicide attempts. Factors such as intake depressive severity and family history of depression should be considered in the assessment of suicide risk among youth with bipolar disorder. Persistent depression, mixed presentations, and active substance use disorder signal imminent risk for suicidal behavior in this population.

Predisposition for Self-Destruction? Affective Temperaments as a Suicide Risk Factor in Patients With Mood Disorders

Because suicide is overall a relatively rare event, its prediction in individual cases remains very difficult. Suicidal behavior (both fatal and nonfatal) is, however, quite frequent among psychiatric patients who have contacted different levels of the health-care system some weeks or months before their attempt (Luoma, Martin, & Pearson, 2002). Untreated unipolar or bipolar major depressive episode is the main clinical substrate of suicide, accounting for 56–87% of the cases. What is most important in this respect is that suicidal behavior in mood disorder patients is a phenomenon dependent on the state and severity of the underlying disease, and that suicidality decreases/vanishes after clinical recovery (Rihmer, 2007). But because the majority of depressed patients never complete suicide and about half of them never attempt it, special clinical, psychological, and psychosocial risk factors also play a significant role (Rihmer, 2007). A look at these factors may help us to identify patients who are at an especially high risk for suicide. As to psychological characteristics, it has been well known for many decades that suicidality is also associated with certain personality features, such as aggressive/impulsive traits, hopelessness and pessimism, and that the risk increases if these traits are present in combination (Mann, Waternaux, Haas, & Malone, 1999; Oquendo et al., 2004; MacKinnon et al., 2005). Impulsivity, a characteristic trait in bipolar patients, has been associated with nonlethal suicide attempts in general samples, and in affective patients it is also associated with severe suicide attempts and completed suicide (Swann et al., 2005). Impulsivity distinguishes suicidal and nonsuicidal affective inpatients and controls, and in bipolar patients suicidal intent is correlated with impulsivity even when controlling for aggression. Impulsivity increases suicide risk when combined with depression; even modest manic symptoms during bipolar depressive episodes are associated with a greater level of impulsivity and higher rate of suicide attempts (Swann et al., 2007). In the case of bipolar disorder, suicidal behavior was also associated with aggressive traits (Grunebaum et al., 2006). Bipolar patients with family history of suicidal behavior and exposed to childhood physical and/or sexual abuse are at greater risk for suicide attempts (Carballo et al, 2008), and impulsivity seems to be the link between childhood abuse and suicidal behavior (Braquehais, Oquendo, Baca-Garcia, & Sher, 2010). In a study on bipolar patients, harm avoidance and persistence as measured by Cloninger’s TCI were significantly related to prior suicide attempts (Engstrom, Brandstrom, Sigvardsson, Cloninger, & Nylander, 2004). Hostility was also found to be a risk factor for suicide attempt, with reasons for living being an important protective factor in bipolar disorder (Chaudhury et al., 2007). Only in the last decade, however, has it become clear that affective temperaments – known to be subclinical manifestations and precursors of major mood disorders – also predispose risk for suicidal behavior. Classically, temperament has included the temporally stable biological “core” of an individual’s personality and plays a role in establishing activity level, rhythms, moods, and related cognitions as well as their variability. Personality, on the other hand,

Are suicide attempts by young Latinas a cultural idiom of distress?

The high rates of suicide attempts among adolescent Hispanic females in the United States have been well established by epidemiological and clinical studies. In this paper, we review the research history of Latina suicide attempts and their characteristics. Then we apply multi-faceted conceptual and empirical criteria found in the anthropological and psychiatric literature about cultural idioms of distress to the suicide attempts of young Latinas. We contrast the suicide-attempt phenomenon to the well-known ataque de nervios and propose that the phenomenon may reflect a developmental or cultural variant of the ataque. The attempt-as-idiom proposition is intended to invite discussion that can deepen our understanding of the cultural roots of the suicide attempts and their possible designation as cultural idiom. Establishing the meaning of suicide attempts within a cultural perspective can assist psychological and psychiatric research and clinical interventions.

Suicide Attempts in 107 Adolescents and Adults with Kleptomania

Suicide attempts in kleptomania have received little investigation. This study examined rates, correlates, and predictors of suicide attempts in kleptomania. A total of 107 adolescent and adult subjects (n = 32 [29.9%] males) with DSM-IV kleptomania were assessed with standard measures of symptom severity, psychiatric comorbidity, and functional impairment. Subjects had high rates of suicide attempts (24.3%). The suicide attempt in 92.3% of those who attempted suicide was attributed specifically to kleptomania. Suicide attempts were associated with current and life-time bipolar disorder (p = .047) and lifetime personality disorder (p = .049). Individuals with kleptomania have high rates of suicide attempts. Bipolar disorder is associated with suicide attempts in individuals with kleptomania and underscores the importance of carefully assessing and monitoring suicidality in patients with kleptomania.

Posttraumatic stress disorder and co‐occurring substance use disorders: Advances in assessment and treatment.

Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) are prevalent and frequently co-occur. Comorbid PTSD/SUD is associated with a more complex and costly clinical course when compared with either disorder alone, including increased chronic physical health problems, poorer social functioning, higher rates of suicide attempts, more legal problems, increased risk of violence, worse treatment adherence, and less improvement during treatment. In response, psychosocial treatment options have increased substantially over the past decade and integrated approaches - treatments that address symptoms of both PTSD and SUD concurrently -are fast becoming the preferred model for treatment. This paper reviews the prevalence, etiology and assessment practices as well as advances in the behavioral and pharmacologic treatment of comorbid PTSD and SUDs.

Une entité clinique aux implications thérapeutiques majeures : le trouble bipolaire à début précoce

ObjectivesBipolar affective disorder (BPAD) is a multifactorial disorder with heterogeneous clinical presentation, in particular according to age at onset (AAO). AAO has been discussed as a potential specifier in future nosographical classification and may be included in future algorithms of treatment decisions. MethodsThe present article provides a comprehensive review of existing clinical data on age at onset and on pharmacological strategies in early onset BPAD. ResultsSeven admixtures studies have demonstrated the existence of three subgroups of BPAD individuals according to AAO (early, intermediate and late AAO) with two cut-off points of 21 (21.28years±1.6) and 33years (33.57years±5.8). Differential clinical features and outcomes have characterized the early onset subgroup: higher rate of suicide attempts, rapid cycles, alcohol and drugs abuse, psychotic symptoms and co-morbid anxiety disorders. This might partially explain the delayed diagnosis and mood stabilizer initiation. Implementation of AAO in the algorithms of treatment might be discussed although the level of proof for focused medications strategies remains to be consolidated. Targeted prevention of specific comorbidities also should be strongly recommended. ConclusionGiven the high frequency of early onset BPAD, awareness of clinicians should be stimulated in order to provide an early and accurate detection, preventive strategies and possibly specific cares.

Child/Adolescent Abuse and Suicidal Behavior: Are They Sex Related?

The association between childhood and adolescent abuse and suicidal behavior, and the possible contribution of abuse to sex differences in non lethal suicidal behavior, was investigated. Data were extracted from the Israel-based component of the WHO World Mental Health Survey (Kessler & Utsun, 2008a). Increased risk for ideation, plan, and suicidal attempt were associated with childhood abuse, and increased risk for attempt was associated also with abuse at adolescence. No associations with sex or sex by abuse interactions were observed. The higher frequency of childhood abuse among women could account in part for their higher rates of suicidal attempts as compared to men.

Attempted Suicide in Immigrants from Turkey: A Comparison with Swiss Suicide Attempters

Background/Aims: Turkish migrants have been shown to have an increased rate of suicide attempts as compared to native local populations and also to people in Turkey. In this study we conducted in-depth interviews with patients regarding their reasons for the attempt. Subjects and Methods: Seventy Turkish immigrants admitted to the emergency unit of the Basel University Hospital after a suicide attempt were interviewed. Seventy Swiss suicide attempters, matched for age and sex, served as a comparator (case-control study). Results: Turkish immigrants showed high rates of suicide attempts. The gender ratio (women/men) was 2.2; 38.6% of all Turkish suicide attempters were women aged between 15 and 25 years. Most patients mentioned problems in their partnerships as the main reason for the suicide attempt (63% of Swiss and 54% of Turkish patients); 14% of the Swiss but none of the Turkish suicide attempters named social isolation as a cause; 9% of the Turkish patients reported ‘threat of loss/rejection of status as refugee’ as the main reason. Immigrants used analgesics more often, whilst Swiss patients tended to favour benzodiazepines. Conclusions: Our study suggests that cultural and immigration-specific issues play a role in the suicidal behaviour of immigrants. Turkish women aged between 15 and 25 years seem to be at an especially high risk.

Gender distribution of suicide attempts among immigrant groups in European countries--an international perspective

Studies report high rates of suicide attempts for female immigrants. This study assesses variations in the distribution of suicide attempts across gender in immigrant and non-immigrant groups in Europe. Data on 64 native and immigrant groups, including 17,662 local and 3755 immigrant person-cases collected, between 1989 and 2003, in 24 million person-years were derived from the WHO/EURO Multicentre Study on Suicidal Behaviour. Female-to-male ratios of suicide attempt rates (SARs) were calculated for all groups. The cases were combined into four major categories: hosts; European and other Western immigrants; non-European immigrants; and Russian immigrants. The non-European immigrants included higher female SARs than the Europeans, both hosts and immigrants. Unlike the other groups, the majority of suicide attempters among the Russian immigrants in Estonia and Estonian hosts were male. This was also true for immigrants from Curaçao, Iran, Libya and Sri Lanka. When the single groups with a male majority were excluded, the correlation between female and male SARs was relatively high among the European immigrants (r = 0.74, P < 0.0005) and lower among the non-European immigrants (r = 0.55, P < 0.03). Generalized estimating equation analysis yielded a highly significant difference (P < 0.0005) in gender ratios of suicide attempts between hosts (ratio 1.52) and both non-European immigrants (ratio 2.32) and Russian immigrants (0.68), but not the European immigrants. The higher suicide attempt rates in non-European immigrant females compared with males may be indicative of difficulties in the acculturation processes in Europe. Further understanding of factors underlying suicidal behaviour in immigrant and minority groups is necessary for planning effective prevention strategies.

Differences Among Major Depressive Disorder With and Without Co-occurring Substance Use Disorders and Substance-Induced Depressive Disorder

Article AbstractObjective: To investigate the association between substance use disorders (SUDs) and the clinical presentation, risk factors, and correlates of major depressive disorder (MDD) by examining differences among 3 groups: (1) individuals with lifetime MDD and no comorbid SUD (MDD-NSUD); (2) individuals with comorbid MDD and SUD (MDD-SUD); and (3) individuals with substance-induced depressive disorder (SIDD).Method: Data were derived from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). Diagnoses were made using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version.Results: The lifetime prevalence of MDD-NSUD was 7.41%, whereas those of MDD-SUD and SIDD were 5.82% and 0.26%, respectively. Overall, risk factors for MDD were more common among individuals with MDD-SUD and SIDD than among those with MDD-NSUD. Individuals with MDD-SUD and SIDD had similar rates of comorbidity with any psychiatric disorder, but both groups had higher rates than individuals with MDD-NSUD (odds ratio = 2.3; 95% CI, 1.9-2.7 and OR = 2.5; 95% CI, 1.4-4.4, respectively). Individuals with SIDD were significantly less likely to receive medication than those with MDD-SUD or MDD-NSUD (OR = 0.5; 95% CI, 0.3-0.9 for both groups).Conclusions: MDD-SUD is associated with high overall vulnerability to additional psychopathology, a higher number of and more severe depressive episodes, and higher rates of suicide attempts in comparison to individuals with MDD-NSUD. SIDD has low prevalence in the general population but is associated with increased clinical severity and low rates of medication treatment. Similar patterns of comorbidity and risk factors in individuals with SIDD and those with MDD-SUD suggest that the 2 conditions may share underlying etiologic factors.J Clinical Psychiatry 2012; 73(6): 865-873© 2012 Physicians Postgraduate Press, Inc.†‹†‹

P-1433 - Suicidal behaviour in schizophrenia - the effect of emotional reactivity and negative symptons

Introduction Schizophrenia is a serious and common disease, one of the most disabling mental disorders in developed countries (Azevedo et al., 2010) and it is associated with high suicide attempt rates. A significant percentage of premature deaths is due to suicide and up to 50% of the patients attempt suicide during their lifetime, specially during the earlier course of the disease (Meltzer, 2003). Objectives In this study, the authors aimed to identify clinical factors (focusing on emotional reactivity and negative symptoms) and social-demographic variables associated to suicidal behaviour in Schizophrenia, in a large sample of Portuguese patients. Methods 508 patients with a diagnosis of Schizophrenia were selected according ICD-10 diagnostic criteria definitions, using the OPCRIT polydiagnostic system (McGuffin et al., 1991). Clinical and social-demographic variables were extracted from DIGS (Azevedo et al., 1993; Nurnberger et al., 1994). Suicidal Behaviour was assessed with the “Suicidal Behaviour Section” from DIGS. Results Suicidal behaviour occurred in 21.8% of the patients, with voluntary drug overdosing being the most used method. Although men showed to use more violent methods, the behaviour was more frequent in female patients. There was no association with the severity of delusions or hallucinations. The absence of formal thought changes, emotional withdrawal and affective blunting (meaning greater emotional reactivity) showed to be risk factors for the occurrence of suicidal behaviour. Conclusion This work may have relevant clinical implications due to its potential to guide the clinician in identifying a suicidal profile among his/her patients with Schizophrenia and delineating early intervention strategies.

The Ruined Good Boy

The Ruined Good Boy

Commentary: Preventing adolescent suicide: is proactive screening for mental disorders the answer? – reflections on Christiansen and Larsen (2011)

Commentary: Preventing adolescent suicide: is proactive screening for mental disorders the answer? – reflections on Christiansen and Larsen (2011)

Improving Treatment Adherence in Patients With Schizophrenia

Nonadherence to antipsychotic medications is an enormous challenge for clinicians and patients in the treatment of schizophrenia. Nonadherence and partial adherence are associated with high rates of relapse, rehospitalization, and suicide attempts. Assessing adherence can be difficult because patients are likely to overestimate their medication adherence and may not report skipping doses or discontinuing medication. Strategies for assessing and improving adherence rates among patients with schizophrenia, including the use of long-acting depot antipsychotic medications, are discussed.

499 Fear from Freedom, Tendency to Suicide

Suicide is considered as an important, widespread phenomenon in the world, causing numerous deaths annually. This study is going to investigate how suicidal attempts are affected by several demographic and other underlying factors.The present study was designed to investigate suicide attempts and its related factors in patients referred to Gachsaran Hospital, Iran.This cross-sectional study was conducted on 348 people who had attempted suicide (Please note that 348 was the number of suicidal attempts not the number of suicidal deaths). The data were collected by consent of Shiraz University of Medical Sciences and necessary coordination with the Emergency Management Statistics Center of Shahid Rajaee Hospital in Gachsaran city. The data analysis was performed through the logistic regression test using SPSS software version 19. The significance level was considered 0.05.A total of 348 individuals with a mean age of 23.9 ± 8.1 had attempted suicide in Gachsaran. Of these, 185 were female (53.2%) and 163 were male (46.8%). The results of multivariate regression showed that, after controlling the effect of probable confounding variables, the following variables had a significant relationship with suicide attempts in the individuals who had attempted to suicide: male gender, unemployment, and love problems.Considering the high rate of suicide attempts among unemployed male individuals during one year, counseling centers in Gachsaran city should pay special attention to this group of people. Measures such as creating jobs for young people can help prevent this social dilemma.

Aberrant emotional processing in posterior cortical midline structures in bipolar II depression

Bipolar II depression is a serious and disabling illness associated with significant impairment and high rates of suicide attempts. However, mechanisms underlying emotional dysregulation in this condition are poorly characterized. The goal of this work was to investigate one component of emotional processing in this disorder, brain activation associated with exposure to emotional faces. Functional MRI was used to study 16 unmedicated male subjects with bipolar II depression and 19 healthy male controls. The activation paradigm exposed subjects to happy, fearful and neutral faces. The two key findings of this study were as follows. First, bipolar subjects demonstrated significantly decreased activation in response to happy facial expression in the left posterior cortical midline structures (CMS) and frontal cortex. Second, depression severity was positively correlated with activation of the posterior CMS and other regions. Our results suggest that mechanisms involving CMS dysfunction may play a role in the neurobiology of bipolar II depression as has been demonstrated for unipolar illness. Further investigations of CMS function in bipolar spectrum disorders are warranted.