High Risk For Suicidal Behavior Research Articles

The Association Between Child Abuse and Attempted Suicide

. Background: Child abuse and suicide among the young population is a serious and prevalent problem. Many studies have demonstrated that people with adverse childhood experiences, such as child abuse, are likely to develop suicidal behavior. This study evaluates the connection between child abuse and suicidal behavior in the Hong Kong community where incidents of child abuse have been on the rise over the past decade. Aims: To determine the association between child abuse and attempted suicide in the child population of Hong Kong using hospital electronic medical records system. Method: From January 1, 1995 to July 31, 2016, patients with admission age < 18 years with the diagnosis of child abuse or influenza infection (comparison group) were included in this study (n = 54,256). In secondary data analysis, an association was found between children who had experienced child abuse and the outcome measure of hospital admission for attempted suicide compared with influenza infection. Results: The adjusted hazard ratio of attempting suicide in children who experienced sexual abuse and physical abuse compared with the influenza-infected group was 6.48 (95% CI [4.56, 9.19]) and 4.83 (95% CI [3.67, 6.34]). The age at onset of adverse incidents was negatively associated with the attempted suicide timing. Female patients had a 1.64 higher risk of repeating attempted suicide. In addition, nearly 5% of children who had experienced child abuse attempted suicide in the 10 years after their admission, and more than 36% of patients had a record of repeated suicide attempt in the 20 years after the initial admission. Limitations: The accuracy of the diagnosis, selection bias, insufficiency of study period, Berkson's bias, incomplete socioeconomic status, as well as the absence of psychiatric diagnosis are the limitations. Conclusion: Our results indicate that there is a significant association between child abuse and suicide attempts in Hong Kong. If confirmed, the study (a) demonstrates that hospital admission records are a critical source for identifying children with a high risk for suicidal behavior; (b) may inform policy makers that additional and long-term intervention programs should be provided to children so as to reduce subsequent suicide attempts.

DETERMINANTS OF SUICIDAL IDEATION IN OLDER ADULTS WITH MAJOR DEPRESSION – ASSOCIATIONS WITH PERCEIVED STRESS

Introduction Depression has been strongly linked to suicide ideation in older adults. However, the role of other factors is less clear. Perceived stress is a factor that is emerging as a potential contributing factor in suicide ideation in older adults. We hypothesized higher levels of perceived stress would be associated with increased self-reported suicidal ideation independent of depressive symptom severity in older adults with LLD. Methods This study used data from community-dwelling older adults aged 65 with current diagnosis of major depression. Eligible participants completed measures of depression symptom severity (Hamilton Depression Rating Scale-17 item), current suicidal ideation (Geriatric Suicide Ideation Scale; GSIS), and perceived stress (Perceived Stress Scale; PSS). Statistical analyses were conducted using SPSS version 20. Descriptive statistics, including demographic and clinical characteristics of the participants were obtained. A linear regression analysis was then conducted, assessing the relationship of perceived stress to suicidal ideation, controlling for the effects of age, education, gender, and depression symptom severity. R2 were then calculated based on standardized beta values in the final model. Results Participants were 225 older adults with a mean age of 71.4 (SD = 5.6), who were 64.9% female. Sixteen percent of the variance in suicidality (GSIS total score) was accounted for by the variables assessed. In particular, lower education (B = −.13, p = .04), male gender (B = −.13, p = .04), greater depression severity (B = .15, p = .02) and higher current perceived stress (B = .32, p Conclusions Our findings suggest that increased perceived stress might be a particularly important factor of those more likely to think about suicide. Perceive stress may thus be a useful factor that could improve early identification and intervention of suicide ideation among late life depression patients at a high risk for suicidal behaviors. Mechanisms and coping strategies to reduce perceived stress could be directly implemented in depressed patients with suicidal ideation. Further research is warranted on perceived stress in relation to suicidal ideation. This research was funded by This work was supported by R01 MH0977669: (PI:Mackin), R01 MH101472 (PI:Mackin); UCSF Epstein Endowment Fund

Self-Reported Suicidal Ideation as a Predictor of Suicidal Behavior Among Outpatients With Diagnoses of Psychotic Disorders.

Individuals with psychotic disorders are at high risk of suicidal behavior. The study examined whether response to item 9 of the Patient Health Questionnaire (PHQ-9), which asks about thoughts of death or self-harm, predicts suicidal behavior among outpatients with diagnoses of psychotic disorders. Electronic health records (EHRs) from seven large integrated health systems were used to identify all outpatient visits by adults with a diagnosis of schizophrenia spectrum psychosis or unspecified psychosis from January 1, 2009, to June 30, 2015, during which a PHQ-9 was completed (N=32,982 visits by 5,947 patients). Suicide attempts over the 90 days following each visit were ascertained from EHRs and insurance claims. Suicide deaths were ascertained from state death certificate files. Risk of suicide attempt within 90 days of an outpatient visit was .8% among patients reporting no thoughts of death or self-harm and 3.5% among those reporting such thoughts "nearly every day." Over 90 days of follow-up, 47% of suicide attempts occurred among those who reported any recent thoughts of death or self-harm at the sampled visit. Also, 59% of attempts occurred among those reporting thoughts of death or self-harm at the index visit or any visit in the prior year. The number of suicide deaths within 90 days (N=10) was too small to accurately assess the relationship between PHQ-9 item 9 response and subsequent suicide death. Among outpatients with psychotic disorders, response to item 9 of the PHQ-9 accurately identified those at increased short-term risk of a suicide attempt.

Association between nonmedical use of opioids or sedatives and suicidal behavior among Chinese adolescents: An analysis of sex differences.

The rising rate of suicidal behavior among adolescents is a growing concern, and sex differences may induce differential exposure to prescription drug misuse or suicidal behavior. We estimated, among Chinese adolescents, (1) the prevalence of nonmedical use of prescription drugs, suicidal ideation and suicide attempts; (2) whether nonmedical use of prescription drugs was independently associated with suicidal ideation and suicide attempts; and (3) whether there were sex differences in the associations. This was a secondary analysis of the data drawn from the 2015 National School-based Chinese Adolescents Health Survey. A total of 94,911 students completed questionnaires and qualified for our survey (response rate: 93.7%). All analyses were conducted separately for boys and girls. There were significant sex differences in the prevalence of opioid or sedative misuse, and the sources and reasons for nonmedical use of prescription drugs ( p < 0.05). The prevalence of suicidal ideation or suicide attempts was significantly higher in girls than in boys (suicidal ideation: 17.9% among girls vs 14.1% among boys; suicide attempts: 3.5% among girls vs 2.7% among boys). Among girls, frequent use of opioids was associated with an increased risk of suicidal ideation (adjusted odds ratio = 1.84, 95% confidence interval = [1.57, 2.17]) and suicide attempts (adjusted odds ratio = 2.96, 95% confidence interval = [2.34, 3.74]), and frequent use of sedatives was also positively associated with suicidal ideation (adjusted odds ratio = 2.23, 95% confidence interval = [1.91, 2.60]) and suicide attempts (adjusted odds ratio = 4.02, 95% confidence interval = [3.25, 4.99]). These associations were also statistically significant in boys, but the magnitudes of adjusted odds ratios for the associations between frequent use of opioids and sedatives and suicidal behavior were greater in girls than boys. There exist significant sex differences in the prevalence rates of nonmedical use of prescription drugs and suicidal behavior, and the child's sex plays a role in the association between nonmedical use of prescription drugs and suicidal behavior. The significant sex differences found above may provide a basis for early identification of adolescents at high risk of suicidal behavior.

Suicide Risk among Immigrants and Ethnic Minorities: A Literature Overview.

Recent studies have demonstrated that immigrants and ethnic minorities may be at higher risk of suicidal behaviour as compared to the general population. We conducted a literature search to identify studies in English from 1980 to 2017 related to suicide risk among immigrants and ethnic minorities. Six hundred and seventy-eight reports were screened, and 43 articles were included in the qualitative synthesis of the review. Some studies reported lower rates of suicide attempts, while other findings suggested higher rates of suicidal behaviour and deaths among immigrants as compared to the native population. Also, a positive correlation was found between suicidal behaviour and specific countries of origin. Non-European immigrant women were at the highest risk for suicide attempts, a group which included young women of South Asian and black African origin. Risk factors among migrants and ethnic minorities were found to be: language barriers, worrying about family back home, and separation from family. The lack of information on health care system, loss of status, loss of social network, and acculturation were identified as possible triggers for suicidal behaviour. Overall, results suggest that specific migrant populations and ethnic minorities present a higher risk of suicidal behaviour than native populations, as well as a higher risk of death by suicide.

Perseveration and Suicide in Huntington's Disease.

Huntington's disease (HD) patients are at significantly higher risk of suicidal behavior, and associated cognitive and behavioral factors play an important role. Impulsivity is commonly thought to be a risk factor, but does not completely account for all suicide attempts. To provide clinical evidence that perseverative behavior may precipitate suicide attempts in HD. Case review of four HD patients who attempted suicide. Each patient demonstrated a clinical history of perseverative behavior, and endorsed perseveration on upsetting thoughts leading up to their suicide attempts. The attempts were planned in response to these ruminations. The patients in this series experienced uncontrollable distressful thoughts prior to their thoughtfully planned suicide attempts. These patients did not appear to act impulsively in their decision to attempt suicide.

Occult Suicidality and Psychiatric Disease Among Emergency Department Patients with Low-acuity Chief Complaints.

IntroductionPatients presenting to emergency departments (ED) are often screened for suicidality, even when their chief complaint does not involve mental health concerns. Patient receptiveness to ED-based mental health screening and intervention is unknown, particularly among patients with low-acuity chief complaints, who often prioritize rapid evaluation and discharge.MethodsThis cross-sectional study included adults with low-acuity chief complaints presenting to an urban, academic ED in the Northeastern United States during daytime and evening hours, from 2015 to 2016. Participants completed validated mental health screening instruments, including the Suicide Behaviors Questionnaire-Revised and the Patient Health Questionnaire-4. Participants were also asked to rate the importance of addressing mental health concerns during their ED visit.ResultsWe approached 1,688 patients, and 816 (48.4%) consented to participate in the study. Of these, 27% screened positive for anxiety and 25% screened positive for depression. Even among patients with no prior depression history, 17% were at high risk of depression. Eleven percent of participants were at high risk for suicidal behavior, including 5% of those with no reported history of depression or bipolar disorder. Thirty-five percent of patients at risk for suicide and 53% of those at high risk of depression thought it was important or very important to address these issues during the ED visit.ConclusionSymptoms of mental health disorders were common among this group of ED patients presenting with low-acuity chief complaints. Patients often desired to address these mental health concerns as part of their ED visit.

Pathways to Late-Life Suicidal Behavior: Cluster Analysis and Predictive Validation of Suicidal Behavior in a Sample of Older Adults With Major Depression.

Clinical heterogeneity is a key challenge to understanding suicidal risk, as different pathways to suicidal behavior are likely to exist. We aimed to identify such pathways by uncovering latent classes of late-life depression cases and relating them to prior and future suicidal behavior. Data were collected from June 2010 to September 2015. In this longitudinal study we examined distinct associations of clinical and cognitive/decision-making factors with suicidal behavior in 194 older (50+ years) nondemented, depressed patients; 57 nonpsychiatric healthy controls provided benchmark data. The DSM-IV was used to establish diagnostic criteria. We identified multivariate patterns of risk factors, defining clusters based on personality traits, perceived social support, cognitive performance, and decision-making in an analysis blinded to participants' history of suicidal behavior. We validated these clusters using past and prospective suicidal ideation and behavior. Of 5 clusters identified, 3 were associated with high risk for suicidal behavior: (1) cognitive deficits, dysfunctional personality, low social support, high willingness to delay future rewards, and overrepresentation of high-lethality attempters; (2) high-personality pathology (ie, low self-esteem), minimal or no cognitive deficits, and overrepresentation of low-lethality attempters and ideators; (3) cognitive deficits, inability to delay future rewards, and similar distribution of high- and low-lethality attempters. There were significant between-cluster differences in number (P < .001) and lethality (P = .002) of past suicide attempts and in the likelihood of future suicide attempts (P = .010, 30 attempts by 22 patients, 2 fatal) and emergency psychiatric hospitalizations to prevent suicide (P = .005, 31 participants). Three pathways to suicidal behavior in older patients were found, marked by (1) very high levels of cognitive and dispositional risk factors suggesting a dementia prodrome, (2) dysfunctional personality traits, and (3) impulsive decision-making and cognitive deficits.

A case for identifying smoking in presentations to the emergency department with suicidality.

The aim of this study was to identify mental health and lifestyle factors predicting smoking among people at high risk of suicidal behaviour. Participants ( n = 363) completed self-report mental health and lifestyle measures at first appointment in a hospital clinic following presentation to the emergency department for deliberate self-harm or suicidal ideation. The rate of daily smoking in this group, 61.4%, is more than four times the rate observed in the general population. Those with a history of previous deliberate self-harm were twice as likely to be smokers. Each one-point increase in poor health behaviours increased the odds of smoking by 22%. Identifying and managing smoking and related lifestyle behaviours are important considerations in routine clinical assessments.

The association between pain and suicidal behavior in an English national sample: The role of psychopathology

Pain has been linked with an increased risk of engaging in suicidal behavior. However, the role of common mental disorders (CMDs) and borderline personality disorder (BPD) traits in this association is largely unknown. This study was based on data from the 2007 Adult Psychiatric Morbidity Survey (N = 7403). Suicidal behavior referred to past 12-month suicidal ideation and suicide attempt. Pain was assessed in terms of the level of its interference with work activity in the past four weeks. BPD traits were assessed with the structured interview for DSM disorders questionnaire, and CMDs with the Clinical Interview Schedule Revised (CIS-R). Multivariate logistic regression and mediation analyses were conducted to analyze the association between pain and suicidal behavior, and the role of CMDs and BPD traits in this association. The prevalence of past 12-month suicidal ideation and suicide attempt increased from 2.7% to 11.5% and 0.2% to 2.4%, respectively, between no pain and extreme pain. Pain was found to be significantly associated with suicidal ideation (ORs = 1.61–2.92) and suicide attempt (ORs = 2.95–6.70). CMDs were significant mediators in the pain-suicidal behavior relationship but did not fully explain the association. BPD had little influence in this association. Assessing suicide risk in individuals with pain may be important for suicide prevention. Treating CMDs may reduce risk for suicide in these individuals but other factors leading to higher risk for suicidal behavior should also be investigated in future studies.

Depression and Epilepsy: Comorbidity, Pathogenetic Similarity, and Principles of Treatment

The literature has in recent years seen confi rmation of the link between depression and epilepsy, with mutual increases in the severity of both diseases. The presence of depression in patients with epilepsy has been shown to increase the risk of developing fi rst unprovoked episodes, to decrease compliance, to lead to decreases in responses to both pharmacological and surgical treatment, to increase the risk of developing side effects of antiepileptic drugs, and to lead to decreases in overall quality of life. In addition, the presence of depression is linked with a high risk of suicidal behavior. Most cases of depression in epilepsy are characterized by an atypical course, which hinders diagnosis and treatment. The situation is exacerbated by patients’ fear of increases in stigmatization associated with mental illness. In this case, depression becomes the cause of the lack of timely pharmacological and psychotherapeutic intervention. Nonetheless, patients with comorbid depression visit doctors 2–4 times more frequently than those without depression, leading to signifi cant increases in the economic burden for the healthcare system.

The role of emotional clarity and distress tolerance in deliberate self-harm in a sample of trauma-exposed inpatient adolescents at risk for suicide.

The purpose of this study was to examine distress tolerance as a moderator of the relationship between emotional clarity and deliberate self-harm (DSH) in a diverse sample of trauma-exposed adolescents in acute psychiatric care at high risk of suicidal behavior. It was hypothesized that distress tolerance would emerge as a significant moderator, such that the association between emotional clarity and DSH would be significant among youth with high, but not low, distress tolerance. Participants (N=50; 52.0% female; M=15.1years, SD=0.51; 44% White) completed measures of emotion dysregulation, DSH, history of suicide attempts, as well as a behavioral measure of distress tolerance. Controlling for history of suicide attempts, results revealed a significant interaction between distress tolerance and emotional clarity in relation to DSH. Specifically, emotional clarity difficulties were related to DSH at high, but not low, levels of distress tolerance. Findings suggest that DSH among trauma-exposed youth with high rates of past suicide attempts is most likely when low emotion clarity is coupled with a high tolerance for emotional distress. Given that DSH significantly increases risk for suicide among youth with psychiatric needs, assessment of emotional clarity and distress tolerance deficits is apt to be warranted to facilitate identification of these youth for targeted intervention.

Mixed state and suicide: Is the effect of mixed state on suicidal behavior more than the sum of its parts?

To assess whether suicidal behavior during mixed states exceeds that expected from the manic or depressive components alone. This study included 429 participants with bipolar disorder from the National Institute of Mental Health Collaborative Depression Study (CDS). Mood and suicidal behavior were captured using the Longitudinal Interval Follow-up Evaluation and the Schedule of Affective Disorders and Schizophrenia. Suicidal behavior during each mood state, relative to euthymia, was analyzed using Cox regression to allow for repeated events, with a frailty term to account for intra-participant correlation. Mixed states were modeled as a depression-by-mania interaction. Individuals with a history of mixed states were at higher risk of suicidal behavior and spent more time depressed, compared to subjects with no such history. In bipolar I disorder, risk increased during episodes of mania (hazard ratio [HR]: 1.96, 95% confidence interval [CI]: 1.28-2.99, P=.0019) and depression (HR: 5.49, 95% CI: 4.01-7.51, P<.0001) and there was a less than additive effect of mixed states. In bipolar II disorder, risk was increased during episodes of depression (HR: 3.66, 95% CI: 2.51-5.35, P<.0001) and there was no excess risk during mixed states beyond that attributable to the depressed component. Most of the excess risk (71%) among those with a history of mixed states was attributable to a depression predominant course of illness. Individuals with mixed states are at high risk of suicidal behavior, largely due to more time spent depressed. Clinicians should aggressively treat depression to mitigate suicide risk for patients with or without mixed states.

Using Hospitalization and Mortality Data to Identify Areas at Risk for Adolescent Suicide

PurposeThe purpose of this study is to use statewide data on inpatient hospitalizations for suicide attempts and suicide mortality to identify communities and school districts at risk for adolescent suicide. MethodsFive years of data (2010–2014) from the Office of the Connecticut Medical Examiner and the Connecticut Hospital Inpatient Discharge Database were analyzed. A mixed-effects Poisson regression model was used to assess whether suicide attempt/mortality rates in the state's 119 school districts were significantly better or worse than expected after adjusting for 10 community-level characteristics. ResultsTen districts were at significantly higher risk for suicidal behavior, with suicide mortality/hospitalization rates ranging from 154% to 241% of their expected rates, after accounting for their community characteristics. Four districts were identified as having significantly lower risk for suicide attempts than expected after accounting for community-level advantages and disadvantages. ConclusionsData capturing hospitalization for suicide attempts and suicide deaths can inform prevention activities by identifying high-risk areas to which resources should be allocated, as well as low-risk areas that may provide insight into the best practices in suicide prevention.

The development of a screening tool for the early identification of risk for suicidal behavior among students in a developing country.

Adolescent suicidal behavior is a public health concern in South Africa. The purpose of this article is to report on the development of a screening tool for teachers to identify South African students who are most at risk for suicidal behavior. This need is addressed within the context of the limited number of mental health professionals available to provide screening and care services in South Africa. Grade 8 students participated by completing sociodemographic questionnaires and self-report psychometric instruments. A screening tool for suicidal behavior was developed using a 4-phase approach. Twelve factors for high-risk suicidal behavior were identified and included in the screening tool. While further research is needed to validate the screening tool, the findings provide a useful preliminary starting point for teachers to refer students at high risk for suicidal behavior to mental health services for treatment. This screening tool is based on factors that were identified as being associated with suicidal behavior from local research on South African adolescents. The tool contributes to research on adolescent mental health, particularly suicidal behavior, in developing low and middle income countries like South Africa, with the aim of creating African prevention and intervention programs. (PsycINFO Database Record

Effect of Housing First on Suicidal Behaviour: A Randomised Controlled Trial of Homeless Adults with Mental Disorders.

This study attempted to determine if Housing First (HF) decreased suicidal ideation and attempts compared to treatment as usual (TAU) amongst homeless persons with mental disorders, a population with a demonstrably high risk of suicidal behaviour. The At Home/Chez Soi project is an unblinded, randomised control trial conducted across 5 Canadian cities (Vancouver, Winnipeg, Toronto, Montreal, Moncton) from 2009 to 2013. Homeless adults with a diagnosed major mental health disorder were recruited through community agencies and randomised to HF ( n = 1265) and TAU ( n = 990). HF participants were provided with private housing units and received case management support services. TAU participants retained access to existing community supports. Past-month suicidal ideation was measured at baseline and 6, 12, 18, and 21/24 months. A history of suicide attempts was measured at baseline and the 21/24-month follow-up. Compared to baseline, there was an overall trend of decreased past-month suicidal ideation (estimate = -.57, SE = .05, P < 0.001), with no effect of treatment group (i.e., HF vs. TAU; estimate = -.04, SE = .06, P = 0.51). Furthermore, there was no effect of treatment status (estimate = -.10, SE = .16, P = 0.52) on prevalence of suicide attempts (HF = 11.9%, TAU = 10.5%) during the 2-year follow-up period. This study failed to find evidence that HF is superior to TAU in reducing suicidal ideation and attempts. We suggest that HF interventions consider supplemental psychological treatments that have proven efficacy in reducing suicidal behaviour. It remains to be determined what kind of suicide prevention interventions (if any) are specifically effective in further reducing suicidal risk in a housing-first intervention.

Multimodal Neuroimaging of Frontolimbic Structure and Function Associated With Suicide Attempts in Adolescents and Young Adults With Bipolar Disorder.

Bipolar disorder is associated with high risk for suicidal behavior that often develops in adolescence and young adulthood. Elucidation of involved neural systems is critical for prevention. This study of adolescents and young adults with bipolar disorder with and without a history of suicide attempts combines structural, diffusion tensor, and functional MR imaging methods to investigate implicated abnormalities in the morphology and structural and functional connectivity within frontolimbic systems. The study had 26 participants with bipolar disorder who had a prior suicide attempt (the attempter group) and 42 participants with bipolar disorder without a suicide attempt (the nonattempter group). Regional gray matter volume, white matter integrity, and functional connectivity during processing of emotional stimuli were compared between groups, and differences were explored for relationships between imaging modalities and associations with suicide-related symptoms and behaviors. Compared with the nonattempter group, the attempter group showed significant reductions in gray matter volume in the orbitofrontal cortex, hippocampus, and cerebellum; white matter integrity in the uncinate fasciculus, ventral frontal, and right cerebellum regions; and amygdala functional connectivity to the left ventral and right rostral prefrontal cortex. In exploratory analyses, among attempters, there was a significant negative correlation between right rostral prefrontal connectivity and suicidal ideation and between left ventral prefrontal connectivity and attempt lethality. Adolescent and young adult suicide attempters with bipolar disorder demonstrate less gray matter volume and decreased structural and functional connectivity in a ventral frontolimbic neural system subserving emotion regulation. Among attempters, reductions in amygdala-prefrontal functional connectivity may be associated with severity of suicidal ideation and attempt lethality.

Suicide in Relation to the Experience of Stressful Life Events: A Population-Based Study

Stressful life events have been associated with high risk of suicidal behavior. The aim of this study was to examine whether persons who died by suicide in Denmark had more frequently been exposed to stressful life events, specifically divorce, death of a close relative, exposure to violence, and imprisonment, when compared to gender and age-matched controls. Data from Danish national registers were obtained for the period of 2000–2010 and a nested case-control design was applied. The association between exposure to stressful life events and suicide was examined using logistic regression analysis. In all, 7,115 suicides were identified during the 11 years of follow-up. For each of these, 20 age- and gender-matched controls were randomly selected (n = 142,300). Cases who died by suicide had an odds ratio of 9.3 (CI-95%: 7.8–11.0) of having been exposed to imprisonment five or more times when compared to controls. People who died by suicide had 1.5-fold (CI-95%: 1.3–1.6) higher risk of having experienced a divorce. Stressful life events, such as divorce and imprisonment, were more frequent in temporal proximity to the date of death among the suicide cases than for end of exposure for controls (p < .001 and p < .001, respectively). Our findings confirm that, using nationwide data, stressful life events are positively associated to subsequent suicide. Causal pathways linking the two may, however, be indirect.

Prevention Starts With Awareness: Adoptive Adolescents at High Risk for Suicidal Behavior.

Adolescents are at higher risk for suicide attempts than other age groups. Suicide is now the second leading cause of death in the United States for ages 12 to 18; moreover, the risk of suicide is significantly higher for adoptive teens. In fact, adoptive teenagers have a four times higher rate of suicide attempts than biological children, perhaps due to the underlying nature of adoption, which can involve a pervasive sense of grief and loss for the adoptee. Unresolved anger and sadness from feelings of abandonment-especially when transitioning to adolescence-can cause a seemingly functional child to dissociate through self-harm and eventually demonstrate suicidal behavior. Little evidence-based research exists on the risk factors for adoptive teens who resort to suicidal behavior. Thus, it is vitally important for school nurses to understand the emotional stressors that adolescent adoptees face throughout life to help identify teens at risk for suicide. School districts and registered nurses are well positioned to address this critical health issue through education, assessment, and intervention.

Clinical features and psychiatric comorbidities of borderline personality disorder patients with versus without a history of suicide attempt.

Patients with borderline personality disorder (BPD) are at high risk for suicidal behavior. However, many BPD patients do not engage in suicidal behavior. In this study, we compared clinical features of BPD patients with or without a history of suicide attempts and healthy volunteers. Compared with healthy volunteers, both BPD groups had higher Affective Lability Scale (ALS), ALS - Depression-Anxiety Subscale, Barratt Impulsivity Scale (BIS), and Lifetime History of Aggression (LHA) scores and were more likely to have a history of temper tantrums. BPD suicide attempters had higher ALS, ALS - Depression-Anxiety Subscale and LHA scores and were more likely to have a history of non-suicidal self-injury or temper tantrums compared to BPD non-attempters. Also, BPD suicide attempters were more likely to have a history of comorbid major depressive disorder and less likely to have comorbid narcissistic personality disorder (NPD) in comparison to BPD non-attempters. About 50% of study participants in each BPD group had a history of comorbid substance use disorder (SUD). Our study indicates that BPD patients with a history of suicide attempt are more aggressive, affectively dysregulated and less narcissistic than BPD suicide non-attempters.