Past History Of Suicide Attempts Research Articles

Computerized Adaptive Test vs. decision trees: Development of a support decision system to identify suicidal behavior

BackgroundSeveral Computerized Adaptive Tests (CATs) have been proposed to facilitate assessments in mental health. These tests are built in a standard way, disregarding useful and usually available information not included in the assessment scales that could increase the precision and utility of CATs, such as the history of suicide attempts. MethodsUsing the items of a previously developed scale for suicidal risk, we compared the performance of a standard CAT and a decision tree in a support decision system to identify suicidal behavior. We included the history of past suicide attempts as a class for the separation of patients in the decision tree. ResultsThe decision tree needed an average of four items to achieve a similar accuracy than a standard CAT with nine items. The accuracy of the decision tree, obtained after 25 cross-validations, was 81.4%. A shortened test adapted for the separation of suicidal and non-suicidal patients was developed. ConclusionCATs can be very useful tools for the assessment of suicidal risk. However, standard CATs do not use all the information that is available. A decision tree can improve the precision of the assessment since they are constructed using a priori information.

Optimizing the assessment of suicide attempters with a decision tree

BackgroundOptimizing psychiatric assessments could help to standardize the use of structured instruments in clinical practice. In recent years, several research groups have applied Computerized Adaptive Tests (CATs) to simplify assessments in depression, anxiety and also suicidal behaviors. We aimed to construct a shortened test to classify suicide attempters using a decision tree methodology that allows the integration of relevant clinical information, namely the history of past suicide attempts, in the construction of the test.MethodsThe sample was composed of 902 adult participants in three subsamples: first-time suicide attempters, psychiatric inpatients that never attempted suicide and healthy controls. The performance of a decision tree built using the items of a previously developed scale for suicidal risk was examined. The history of past suicide attempts was used to separate patients in the decision tree. The data was randomly divided in a training set and a test set. The test set, that contained 25% of the data, was used to determine the accuracy of the decision tree. Twenty-five cross-validations of this set up were conducted.ResultsThe first four items of the decision tree classified correctly 81.4% of the patients.ConclusionAs a result of a methodology based on decision trees that, contrary to CATs, can incorporate relevant information in building the test we were able to create a shortened test capable of separating suicidal and non-suicidal patients. Using all the information that is available improves the precision and utility of instruments adapted for psychiatric assessments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Depression and risk of suicide in patients with obsessive-compulsive disorder: A hospital-based study.

Background:Obsessive Compulsive Disorder (OCD) is a chronic, distressing, anxiety disorder associated with significant functional impairment. Patient with OCD often suffer from one or more co-morbid disorders. Major depression has been the most common co-morbid syndrome. Comorbid Axis I disorders along with increased severity of comorbid depressive and anxiety symptoms, increased severity of obsessions, feelings of hopelessness and past history of suicide attempts have been associated with worsening levels of suicidality in OCD (Angelakis I, Gooding P., 2015). As per data Thirty-six percent of the patients of OCD report lifetime suicidal thoughts and 11% have a history of attempted suicide(Torres AR, Ramos-Cerqueira AT, et al, 2011). There is a reasonable probability that the patient of OCD have suicidal thoughts, plans or actually attempt suicide.Aim:To assess depression and suicidality in OCD patients.Method:This study was conducted on 50 patients diagnosed with OCD as per ICD 10 criteria, both outpatient & indoor, from department of psychiatry, Dayanand Medical College & Hospital, Ludhiana, Punjab, India. A socio-demographic proforma (containing demographic details), Hamilton Depression Rating & Scale, Columbia suicide severity rating scale (CSSRS) & Yale Brown Obsessive Compulsive Scale Symptom Checklist (YBOCS) were administered.Results:Mild depression was found out to be 40% whereas 16% were suffering from moderate depression and 10% and 14% had severe and very severe depression respectively. Suicidal ideation was found in 52 % of patients.16% of patients had history of actual attempt. Data showed that 70% of females had suicidal ideations. It was also found that in cases of severe and very severe depression associated with OCD all the patients had suicidal ideations as compared to 35% in mild and 87.5% in moderate depressive patients. It was found that 40% of severe depressive and 28.57% of very severe depressive patients had attempted suicide one or more times during the course of illness. Also suicidality was found to be maximum in those with symptoms of cleanliness and contamination (57%) followed by religious obsessions (45%), sexual obsessions (33%), repeated rituals (31%) and other obsessions like need to touch, ask (26%) respectively.Conclusion:OCD is associated with high risk not only depression but also of suicidal behavior. It is vital that patients of OCD undergo detailed assessment for suicide risk and associated depression. Aggressive treatment of depression may be warranted to modify the risk of suicide. Behavioral and cognitive techniques along with pharmacotherapy should be used to target co-existing depressive symptoms so as to decrease morbidity and mortality.

A tool to predict suicidal ideation and behavior in bipolar disorder: The Concise Health Risk Tracking Self-Report

BackgroundFew brief, self-report measures exist that can reliably predict adverse suicidality outcomes in patients with BD. This study utilized the Concise Health Risk Tracking Self-Report (CHRT) to assess suicidality in patients with BD and examined its psychometric performance, clinical correlates, and prospective value in predicting adverse events related to suicidality. MethodsThe CHRT was administered at baseline and follow-up to 482 adult patients in Bipolar CHOICE, a 6-month randomized comparative effectiveness trial. The Columbia Suicide Severity Rating Scale (CSSRS) was used at baseline to assess lifetime history of suicide attempts and related behaviors. Clinician-rated measures of mood (Bipolar Inventory of Symptoms Scale) and bipolar symptoms (Clinical Global Impressions-Bipolar Version) were conducted at baseline and follow-up. ResultsThe CHRT showed excellent internal consistency and construct validity and was highly correlated with clinician ratings of depression, anxiety, and overall functioning at baseline and throughout the study. Baseline CHRT scores significantly predicted risk of subsequent suicidality-related Serious Adverse Events (sSAEs), after controlling for mood and comorbidity. Specifically, the hazard of a sSAE increased by 76% for every 10-point increase in baseline CHRT score. Past history of suicide attempts and related behaviors, as assessed by the CSSRS, did not predict subsequent sSAEs. LimitationsThe CSSRS was used to assess static risk factors in terms of past suicidal behaviors and may have been a more powerful predictor over longer-term follow-up. ConclusionsThe CHRT offers a quick and robust self-report tool for assessing suicidal risk and has important implications for future research and clinical practice.

Increased risk of suicide attempt in bipolar patients with severe tobacco dependence

BackgroundThe aim of our study was to investigate, in bipolar patients, the association between tobacco status (use and dependence) and history of suicide attempt, and to assess the possible role of inflammation as a missing link in the association between smoking status and history of suicide attempt. MethodsA total of 453 adult bipolar out-patients recruited in the French FondaMental Advanced Centres of Expertise for Bipolar Disorder were divided into two subgroups: 274 patients without past history of suicide attempt (non-SA), and 179 patients with a past history of suicide attempt (SA). Tobacco use and dependence, psychiatric and somatic comorbidities, history of childhood abuse, family history of suicide were assessed. Fasting blood tests yielded samples collected for the measurement of high sensitivity (hs-)CRP. ResultsThe risk of suicide attempt increased with smoking dependence. Notably, bipolar patients with a history of suicide attempt were three times more likely to have severe tobacco dependence, independently of confounding factors. However, we failed to find arguments promoting the hypothesis of inflammatory markers (through hs-CRP measure) in the link between tobacco dependence and suicidal behavior. ConclusionsWe found a significant association between severe tobacco dependence and history of suicide attempt, but not with level of CRP, independently of confusing factors. Longitudinal studies taken into account all these potential confusing factors are needed to confirm our results.

Religiosity/spirituality: Relationships with non-suicidal self-harm behaviors and attempted suicide.

The relationships between religiosity/spirituality (RS) and self-harm behavior, including non-suicidal self-harm behavior (NS-SHB) and suicide attempts/completions, remain of keen interest. Whereas the majority of studies strongly suggest that RS protects against suicide attempts/completions, relationships between RS and NS-SHB have been rarely studied. In this study, we examined RS in relationship to both NS-SHB (six explicit behaviors) and past history of suicide attempts. In a cross-sectional sample of 306 consecutive primary care outpatients, we administered four self-report assessments for RS (extent participant considered self a religious person, extent participant considered self a spiritual person, extent religion is involved in understanding/dealing with stressful situations, Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12)) as well as examined seven items on the Self-Harm Inventory: six items reflecting NS-SHB and one item reflecting a past suicide attempt. While two RS items yielded no significant findings (extent participant considered self a spiritual person, extent religion is involved in understanding/dealing with stressful situations), the remaining two items were associated with a lowered risk of self-harm behavior, particularly the FACIT-Sp-12. Some but not all aspects of RS are associated with lowered risk for self-harm. In this study, considering oneself a religious person and reporting a general sense of RS well-being offered the most protective effect to participants, particularly the latter.

Usefulness of and Factors Associated with Global Assessment Scale (GAS) Scores in Suicide Attempters

Background: The purpose of this study is to determine, by classifying emergently admitted suicide attempter patients according to their Global Assessment Scale (GAS) scores, the characteristics of and factors associated with each group of patients. Methods: The subjects of this study were 1,317 suicide attempters who were seen at the primary/secondary emergency department of the Iwate Medical University Hospital and at the Iwate Advanced Critical Care and Emergency Center, during the period of 7 years from April 1, 2006. These subjects were classified into three groups, consisting of the low, middle and high score groups, and were analyzed by comparing these groups with each other in terms of background factors and psychiatric assessment of emergency psychiatry case cards. Comparison examination was performed among 3 groups, and multiple logistic regression analysis was performed by using investigation items and the three GAS score groups as explanatory and dependent variables, respectively Results: Factors associated with the low score group included being male, advanced age and unemployed, and high life event values. The odds of completed suicide in this group were more than 5-fold higher than in the other two groups. Past history of suicide attempts was extracted as a factor associated with the middle score group. Factors associated with the high score group included: being female; young age; having no history of regular psychiatric visits; having history of advice seeking prior to the attempted suicide; and complex motives. Conclusions: This paper determined characteristics of emergently admitted suicide attempters according to their GAS score levels, and proposed specific measures to be taken according to individual patients’ GAS scores. It was suggested that in an emergency setting involving a suicide attempter, a global assessment of the patient and treatment given according to the assessment results may lead to the prevention of further suicide attempts.

Military sexual trauma in US veterans: results from the National Health and Resilience in Veterans Study.

To evaluate the prevalence of military sexual trauma (MST) among US veterans, identify sociodemographic and military characteristics of MST, and examine the relationships between MST and psychiatric comorbidities, functioning/quality of life, and mental health treatment utilization. Data were analyzed from the National Health and Resilience in Veterans Study, a contemporary, nationally representative survey of 1,484 US veterans conducted September-October 2013. Poststratification weights were applied to analyses to permit generalizability of results to the US veteran population. Outcomes measured include history of MST, trauma histories, lifetime and current DSM-IV mental disorders, functioning and quality of life, and utilization of mental health treatment. The overall prevalence of MST was 7.6% and was higher among female than male veterans (32.4% vs 4.8%) and younger than older veterans (22.8% among veterans aged 18-29 years vs 4.5% among veterans aged 60+ years). After adjustment for sociodemographic and military characteristics, MST was associated with elevated rates of current major depressive disorder, posttraumatic stress disorder, and generalized anxiety disorder (adjusted odds ratio [aOR] range, 2.19-3.12); past history of suicide attempt (aOR = 2.78) and current suicidal ideation (aOR = 2.19); and decreased mental and cognitive functioning and quality of life (Cohen d, 0.23-0.38). MST was also associated with increased current utilization of psychotropic medication (aOR = 3.70) and psychotherapy or counseling (aOR = 2.41), independent of psychiatric morbidities. 7.6% of US veterans screen positive for MST, with substantially higher rates among female and younger veterans. MST is associated with elevated rates of several psychiatric morbidities and suicidality, reduced functioning and quality of life, and increased mental health treatment utilization, independent of other sociodemographic, military, and mental health factors. These results suggest that MST is prevalent among US veterans and associated with elevated health burden. Findings can help inform efforts to identify at-risk veterans and characterize the concomitant health burden and needs associated with MST in this population.

Negotiating the maze: risk factors for suicidal behavior in chronic pain patients.

Chronic pain disorders can exert major negative effects on virtually every aspect of an individual's life. It is not surprising then that many chronic pain sufferers find themselves at a point of emotional fragility where they experience thoughts of ending their life. Suicidal behavior encompasses a spectrum of experience, from "life weariness" or passive suicidal ideation, to more active suicidal intent and suicide completion. A range of risk factors for suicidal behavior in the general population have been identified, and these apply equally to the chronic pain population: a family history of mental illness, past history of suicide attempts, and the presence of comorbid depression. With regard specifically to chronic pain patients, elevated suicide risk is also associated with severe or recurrent headache, ambiguous diagnoses (psychogenic pain, abdominal pain), and medicolegal issues related to the pain. A number of suggestions for clinicians managing chronic pain patients with regards to managing suicide risk are given.

Poor response to antidepressants predicts new suicidal ideas and behavior in depressed outpatients

BackgroundOnly a few studies have investigated the factors associated with suicidal behavior after antidepressant treatment onset in adults. We examined the specific predictors of de novo suicidal ideas or attempts among depressed patients in the community, including subjects potentially at risk of suicidal behaviors, who initiated a new antidepressant treatment. MethodsA large set of GPs and psychiatrists throughout France followed-up, for 6 weeks, 4357 outpatients for whom an antidepressant drug was prescribed. Dimensions related with antidepressant-induced suicidal events, such as depression, anxiety or hopelessness, were assessed longitudinally using univariate and multivariate approaches among subjects with treatment-emergent suicide ideation or attempts. ResultsNew suicidal ideas were observed in 9% of patients with no suicidal ideation at baseline (n=81), while suicidal attempts were reported for 1.7% of the sample during the 6-week observation period (n=75). The onset of suicidal ideas and attempts was associated with the initial features of the patients (baseline level of anxiety, past history of suicide attempts and alcohol misuse) and the non-improvement of depression. Worsening of depressive symptoms during the follow-up increased the onset of new suicidal ideas (OR=5.67, p<0.001) and attempts (OR=2.60, p=0.002), corresponding to 67.5% and 56.5% of attributable risk respectively. ConclusionsWhen the analyses are restricted to the occurrence of suicidal ideas or attempts, the link between antidepressants and suicide risk might be more adequately explained by a poor response to antidepressant treatment rather than by a direct trigger-effect. This naturalistic study is limited by the use of non-structured diagnoses and self-report outcomes.

Few older people in New Zealand who commit suicide receive specialist psychogeriatric services.

Suicide in older people is a growing public health concern in many parts of the world. The literature on this issue is lacking in New Zealand. The aim of this study is to ascertain whether this group is accessing specialist psychogeriatric services. A retrospective case series study of completed suicides in older people (≥65 years) during a three-year period from January 2010 to December 2012 was performed. An online survey detailing demographic and clinical information was completed by psychiatrists in 15 of the 20 District Health Boards in New Zealand. Only about 15% of older people who committed suicide were accessing specialist psychogeriatric services and the group with the highest suicide rate (men≥85 years) did not feature in specialist services. Depression (61%) was the most common diagnosis and nearly half (35%) had had contact with specialist services within three days prior to the suicide. Over half (52%) had a history of past suicide attempt(s). Older people who complete suicide are infrequently accessing specialist services. In those that do, there are questions to be answered regarding suicide prediction and prevention for this high-risk group of vulnerable individuals. More research is required targeting those not accessing specialist services, in particular the high risk group of older men. The role of general practitioner, community care, the assessment and management of depression and whether there is any access issue to specialist psychogeriatric services require elucidation.

Les indications actuelles du lithium : la prévention du risque suicidaire

Affective disorders are associated with an increased risk of suicidal behavior. For instance, 18% of bipolar males having a past history of suicide attempt die by suicide. In comparison to untreated patients, those receiving a continuous pharmacological treatment for bipolar disorder have a reduced surmortality, including by suicide (Angst et al., 2002). Evidence shows that lithium has specific antisuicidal properties. Meta-analyses including long-term randomized controlled trials have shown a 80% decrease of suicidal behaviors in patients receiving lithium for 18months or more. In a recent meta-analysis including controlled studies comparing lithium vs. placebo or active drugs in both unipolar and bipolar disorders, Cipriani et al., 2013 have shown significant reduction of suicide mortality in patients on lithium. In addition, lithium is more efficient than anticonvulsants to prevent suicidal behaviors. In a large Danish study (Sondergard et al., 2009), although the rate of suicide was higher during periods when patients purchased anticonvulsants than during periods with lithium, the suicide rate decreased with the number of prescriptions in a rather similar way for patients first treated with lithium and patients first treated with anticonvulsants. But switch to or augmentation with lithium to patients initiated on anticonvulsants was associated with a significantly reduced rate of suicide whereas a switch to or augmentation with anticonvulsants to patients first started on lithium showed no additional effect on the suicide rate. Antisuicidal effect of lithium is now admitted in bipolar disorder as well as in unipolar depression and seems to be independent of the effect on mood. Ahrens et al., 2001, have investigated a group of high-risk patients with recurrent affective disorders who had committed suicide attempts before the start of lithium. According to their recurrence-related response to long-term lithium prophylaxis, nearly 50% of poor responders did not exhibit any further suicidal behavior during lithium treatment. Khan et al., 2011, have conducted an exploratory proof of concept-randomized trial comparing suicidality in depressed patients assigned to citalopram+lithium or to citalopram+placebo for 4weeks. Lithium when used in therapeutic doses (>0.5mEq/L) was associated with prevention of suicidal thoughts and behaviors. It is important to know that lithium has to be discontinuated very slowly (by 10% a month). After the discontinuation of lithium, suicidal acts are more frequent in the first year than at later times or before start of lithium treatment (Tondo et al., 1998). The mechanism of action of lithium remains poorly understood. It may be due to an action of lithium on suicidal physiopathology. Indeed, lithium reduces aggressive and impulsive behaviors in both humans and animals, and possibly modulates suicidal vulnerability traits. Indeed, decision-making alterations are associated with suicidal phenotype and rely on orbitofrontal cortex dysfunction. In euthymic bipolar patients, decision-making performances have been correlated with lithium dose (Adida et al., submitted). In addition, main molecular targets of lithium, Wnt - GSK3 – β-catenin and IP-3 pathways, have been involved in suicidal vulnerability through post-mortem and genetic studies. In addition, SAT-1 pathway could be involved in antisuicidal effect of lithium. To summarize, for a therapeutic dose, lithium has well demonstrated preventive effect on suicide behaviours in mood disorders, independently of its action on mood. It improves clinical dimensions associated with suicidal risk (impulsivity, aggression), raising the question of dimensional prescription. Finally, further studies are needed to elucidate the antisuicidal mechanism of action of lithium. However, it could be suggested that lithium acts on suicidal vulnerability factors at a macroscopic level (decision-making, cerebral volumes) as well as microscopic level (molecular pathways).

Ethics Commentary: Treatment of PTSD Empirically Based and Ethical Clinical Decision Making

A physician has just completed an assessment of a female survivor of a rape that occurred 6 months earlier. She meets full criteria for chronic posttraumatic stress disorder (PTSD) and major depressive disorder of moderate severity. Although she does not meet criteria for alcohol dependence, she has a history of episodic binge drinking that has increased in frequency since the assault. Also since the assault, she has had intermittent bouts of suicidal ideation but denies any intent or specific plan and has no history of past suicide attempts or nonsuicidal self-injury. The patient indicates a clear preference for psychotherapy overmedication as a startingpoint for treatment, but is willing to consider medication if psychotherapy is not a practical option or psychotherapy proves inadequate. The physician does not feel personally qualified to provide psychotherapy for PTSD and the patient asks the physician for a referral, with a plan for a follow-up visit in 3months to reconsider themedication option.What kind of referral should the physician provide and what ethical issues should be considered inmaking the referral?

Iowa Gambling Task performance in currently depressed suicide attempters

Deficits in decision-making using the Iowa Gambling Task (IGT) have been found in past suicide attempters, but primarily euthymic and/or medicated patients. This study compared IGT performance among medication-free, currently depressed patients (unipolar and bipolar) with (n=26) and without (n=46) a past history of suicide attempt, and healthy volunteers (n=42). Attempter status, in a sample whose attempts were predominantly non-violent, was not associated with impaired IGT performance even when accounting for sex, mood disorder type, and comorbid Borderline Personality Disorder. A non-significant trend towards poorer performance was found in a small subgroup of past attempters who had used a violent method, consistent with prior studies. Suicide intent and ideation were unrelated to IGT scores. There were no consistent associations between IGT performance and ratings of impulsiveness (Barratt Impulsiveness Scale (BIS)), hostility (Buss–Durkee Hostility Inventory (BDHI)) or aggression (Brown–Goodwin Aggression Inventory (BGAI)). Results suggest that decision-making impairment is related to specific subtypes of suicidal behavior, but may not be universally sensitive to suicide risk in all types of attempters, especially those using non-violent means. Psychometric and conceptual issues surrounding the IGT also appear to affect its utility as a general marker of suicidal behavior risk.

DECREASED BRAINSTEM AND PUTAMEN SERT BINDING POTENTIAL IN DEPRESSED SUICIDE ATTEMPTERS USING [11C]-ZIENT PET IMAGING

Deficits in serotonergic neurotransmission have been implicated in the pathogenesis of depression and suicidality. The present study utilized a novel positron-emission tomography (PET) ligand to quantitate and compare brain regional serotonin transporter (SERT) binding potential in depressed patients with a past history of suicide attempts to that of healthy comparison subjects. We used [(11) C]-ZIENT PET to label SERT in the serotonergic cell body rich brainstem, and forebrain projection fields. Quantitative PET emission data from 21 adults (10 healthy controls and 11 drug-free patients with major depression) was used for group comparison. SERT binding potential (BPND ) in eight MRI-based brain regions of interest (ROI) were compared in high-resolution PET images. SERT binding potential was significantly decreased in the midbrain/pons (P = .029) and putamen (P = .04) of depressed patients with a past suicide attempt relative to comparison subjects. Forebrain SERT binding was also reduced in the patient sample, though these region effects did not survive a multiple comparison correction. These results suggest that decreased availability of the brainstem and basal ganglia SERT represents a biomarker of depression and thus confirm and extend the role of dysregulation of brain serotonergic neurotransmission in the pathophysiology of depression and suicide.

Clinical and neurocognitive markers of suicidality in young adults

BackgroundSuicide represents a leading cause of death in young people, yet relatively little is known regarding the neurobiological sequelae of preceding suicidal thoughts and behaviours. Although some studies have reported cognitive deficits associated with suicidality, very few studies have been undertaken in young people, especially from non-clinical contexts. AimsTo quantify cognitive deficits associated with suicidality using a representative sample of young people, recruited from the general community using media advertisements. Method304 adults (18–29 years) undertook the Mini-International Neuropsychiatric Inventory (MINI) suicidality module, along with Cambridge Gamble and Stop-Signal tasks. Suicidality was defined as non-zero MINI scores (broad definition) and a past history of suicide attempt(s) (narrow definition). Clinical features and cognitive performance were compared between those with and those without suicidality, using analysis of variance/chi-square; findings were further explored using linear regression. ResultsSuicidality was relatively common (broad definition: 14.8%; narrow definition: 5.3%) in young people and was associated with impaired decision-making on the Cambridge Gamble task (p < 0.05, Bonferroni corrected at the analysis level of each suicidality definition). Linear regression demonstrated that decision-making performance was associated with a significant incremental benefit with respect to predicting suicidality, over and above the utility of demographic and clinical variables considered (p < 0.05 uncorrected). ConclusionsImpaired decision-making exists in young people with suicidality, and may thereby predispose towards a range of suicidal thoughts and behaviours. Further work is needed to clarify the chain of progression from such thoughts/behaviours, which are relatively common, through to actual suicide, which is not.

2332 – Relevance of the concept of demoralization in schizophrenic patients

Depression is difficult to diagnose in schizophrenic patients although it represents a frequent motive for suicide. In clinical practice nonspecific sadness is more often observed than major depressive episodes. Our analysis of these states led us to the concept of demoralization. The objective of our study was to demonstrate the existence of demoralization in psychotic patients as a real entity and to see how it could be correlated with other dimensions. A total of 55 ambulatory patients diagnosed with a schizophrenic disorder were included and distributed in 2 groups according to the level of demoralization. The correlation with residual psychotics symptoms (PANSS), depression (CDSS), despair (BHS), and quality of life (SQoL) as well as the sociodemographic characteristics and past history of suicide attempts was assessed. More than 94% of our patients were found demoralized, 16,36% of them severely. The degree of demoralization was correlated with the intensity of positive symptoms (p = 0.016), depression (p < 0.001), despair (p = 0.015), suicidality (p < 0.01) as well as poor quality of life (p = 0.007) and low self-esteem (p < 0.000). Demoralization appears to be a relevant concept during schizophrenia, bound in schizophrenic and depressive process, and impacting the suicidal risk. It could represent an important stake in the care of schizophrenic patients especially for the prevention of relapse and suicidal risk.

Prospective study of risk factors for suicidal behavior in individuals with anxiety disorders

Anxiety disorders are very common and increase risk for suicide attempts. Little is known about predictors of increased risk specifically among individuals with anxiety disorders. The purpose of this study was to investigate whether specific anxiety disorders and other co-morbid psychiatric disorders, physical health, or work or social functioning increased the future likelihood of a suicide attempts among individuals with anxiety disorders. Method In this prospective study, 676 individuals with an anxiety disorder were followed for an average of 12 years. As hypothesized, we found that post-traumatic stress disorder, major depressive disorder (MDD), intermittent depressive disorder (IDD), epilepsy, pain, and poor work and social functioning all predicted a shorter time to a suicide attempt in univariate analyses. In multivariate analyses, baseline MDD and IDD were independent predictors of time to suicide attempt, even when controlling for a past history of suicide attempt. No specific anxiety disorder was an independent predictor of time to attempt in this anxiety-disordered sample. Adding baseline physical health variables and social functioning did not improve the ability of the model to predict time to suicide attempt. Mood disorders and past history of suicide attempts are the most powerful predictors of a future suicide attempt in this sample of individuals, all of whom have an anxiety disorder.

The relationship of religious involvement indicators and social support to current and past suicidality among depressed older adults

Elderly people, particularly those with major depression, are at the highest risk for suicide than any other age group. Religious involvement is associated with a range of health outcomes including lower odds of death by suicide. However, not much is known about the effects of religious involvement on suicidal ideation in the elderly or which aspects of religiosity are beneficial. This study examined the relative influence of various conceptualizations of religious involvement, above and beyond the protective effects of social support, on current and past suicidality among depressed older adults. Participants were 248 depressed patients, 59 years and older, enrolled in the Neurocognitive Outcomes of Depression in the Elderly study. A psychiatrist assessed current suicidal ideation using the suicidal thoughts item from the Montgomery–Asberg Depression Rating Scale. Past history of suicide attempts, four religious involvement indicators, social support indicators, and control variables were assessed via self-report. Church attendance, above and beyond importance of religion, private religious practices, and social support, was associated with less suicidal ideation; perceived social support partially mediated this relationship. Current religious practices were not predictive of retrospective reports of past suicide attempts. Church attendance, rather than other religious involvement indicators, has the strongest relationship to current suicidal ideation. Clinicians should consider public religious activity patterns and perceived social support when assessing for other known risk and protective factors for suicide and in developing treatment plans.

P.3.010 Genetic variability at IMPA-2, INPP-1 and glycogen synthase kinase (GSK)-3β increases the risk of suicidal behaviour in bipolar patients

Le traitement au long cours des troubles de l’humeur conduit à une diminution marquée de la mortalité, notamment par suicide, de ces patients dont le risque suicidaire est majeur. Les données s’accumulent depuis 40 ans pour proposer que le lithium bénéficie d’un effet suicide, lui conférant une place à part dans l’arsenal thérapeutique. En effet, le lithium présente un effet préventif des conduites suicidaires dans le trouble bipolaire comme dans le trouble unipolaire. Cet effet semble indépendant de son efficacité thymorégulatrice et supérieur à ce qui est observé avec les anticonvulsivants. Les mécanismes d’action du lithium continuent d’être étudiés tant ils sont complexes. Les pistes se multiplient pour envisager que le lithium agisse sur différents traits de vulnérabilité suicidaire ou qu’il puisse corriger des anomalies cérébrales associées au suicide. Les travaux scientifiques, de la molécule à l’épidémiologie, concourent à proposer le lithium en première ligne pour lutter contre le risque suicidaire des patients souffrant de troubles thymiques. Il est alors envisageable de recourir au lithium dans une perspective dimensionnelle, pour traiter le risque suicidaire, l’impulsivité et l’agressivité, et ce, indépendamment du traitement thymorégulateur choisi pour le patient.Affective disorders are associated with an increased risk of suicidal behavior. For instance, 18% of bipolar males having a past history of suicide attempt die by suicide. In comparison to untreated patients, those receiving a continuous pharmacological treatment for bipolar disorder have a reduced surmortality, including by suicide (Angst et al., 2002). Evidence shows that lithium has specific antisuicidal properties. Meta-analyses including long-term randomized controlled trials have shown a 80% decrease of suicidal behaviors in patients receiving lithium for 18 months or more. In a recent meta-analysis including controlled studies comparing lithium vs. placebo or active drugs in both unipolar and bipolar disorders, Cipriani et al., 2013 have shown significant reduction of suicide mortality in patients on lithium. In addition, lithium is more efficient than anticonvulsants to prevent suicidal behaviors. In a large Danish study (Sondergard et al., 2009), although the rate of suicide was higher during periods when patients purchased anticonvulsants than during periods with lithium, the suicide rate decreased with the number of prescriptions in a rather similar way for patients first treated with lithium and patients first treated with anticonvulsants. But switch to or augmentation with lithium to patients initiated on anticonvulsants was associated with a significantly reduced rate of suicide whereas a switch to or augmentation with anticonvulsants to patients first started on lithium showed no additional effect on the suicide rate. Antisuicidal effect of lithium is now admitted in bipolar disorder as well as in unipolar depression and seems to be independent of the effect on mood. Ahrens et al., 2001, have investigated a group of high-risk patients with recurrent affective disorders who had committed suicide attempts before the start of lithium. According to their recurrence-related response to long-term lithium prophylaxis, nearly 50% of poor responders did not exhibit any further suicidal behavior during lithium treatment. Khan et al., 2011, have conducted an exploratory proof of concept-randomized trial comparing suicidality in depressed patients assigned to citalopram + lithium or to citalopram + placebo for 4 weeks. Lithium when used in therapeutic doses (> 0.5 mEq/L) was associated with prevention of suicidal thoughts and behaviors. It is important to know that lithium has to be discontinuated very slowly (by 10% a month). After the discontinuation of lithium, suicidal acts are more frequent in the first year than at later times or before start of lithium treatment (Tondo et al., 1998). The mechanism of action of lithium remains poorly understood. It may be due to an action of lithium on suicidal physiopathology. Indeed, lithium reduces aggressive and impulsive behaviors in both humans and animals, and possibly modulates suicidal vulnerability traits. Indeed, decision-making alterations are associated with suicidal phenotype and rely on orbitofrontal cortex dysfunction. In euthymic bipolar patients, decision-making performances have been correlated with lithium dose (Adida et al., submitted). In addition, main molecular targets of lithium, Wnt - GSK3 – β-catenin and IP-3 pathways, have been involved in suicidal vulnerability through post-mortem and genetic studies. In addition, SAT-1 pathway could be involved in antisuicidal effect of lithium. To summarize, for a therapeutic dose, lithium has well demonstrated preventive effect on suicide behaviours in mood disorders, independently of its action on mood. It improves clinical dimensions associated with suicidal risk (impulsivity, aggression), raising the question of dimensional prescription. Finally, further studies are needed to elucidate the antisuicidal mechanism of action of lithium. However, it could be suggested that lithium acts on suicidal vulnerability factors at a macroscopic level (decision-making, cerebral volumes) as well as microscopic level (molecular pathways).