History Of Prior Attempts Research Articles

Clinical and Social Correlates of Duration of Untreated Psychosis and Impact on Short-Term Outcome in Patients with First-Episode Psychosis

Abstract Background: The duration of untreated psychosis (DUP) impacts symptomatic and functional outcome in patients with psychosis. Objectives: This study assessed DUP, its association with sociodemographic and clinical factors and its impact on short-term clinical and functional outcome in patients with first episode psychosis. Methodology: Sixty-nine first contact patients with first episode psychosis who had not received adequate treatment for psychosis (adequate treatment - antipsychotic medication of ≥3.5 mg haloperidol equivalents for ≥ 4 weeks) previously were assessed with Symptom Onset in Schizophrenia Inventory to determine DUP. They were followed up for 12 weeks. Positive and Negative Syndrome Scale and World Health Organization Disability Assessment Scale – II were used to assess symptoms and functioning at presentation and after 12 weeks. Results: The mean DUP for the sample (n=69) was 56.7 ± 89.1 weeks (13.2 ± 20.8 months). About three fifths (60.9%) of the subjects had DUP ≤ 3 months (short DUP) and two fifths (39.1%) had DUP > 3 months (long DUP). Univariate analysis found age, employment, mode of onset and diagnosis to be significant. At followup, treatment-related improvement in positive, general and total symptom scores was significantly negatively correlated with DUP and improvement in functioning was significantly greater in patients with DUP < 3 months. A step-wise multiple logistic regression model identified mode of onset, age, and history of prior attempts at treatment as independent predictors of membership to the two DUP categories; insidious onset led to a 20-fold and a history of prior treatment attempts indicated a 400% increase in the odds of belonging to the long DUP category. An average of 9% increase in odds of having long DUP was observed with every one-year increase in age. Conclusion: Early detection (short DUP) of psychosis was found to have a salutary impact on clinical and functional outcome.

Circumstances of Suicide Among Lesbian, Gay, Bisexual and Transgender Individuals

Suicide rates for sexual minorities are higher than the heterosexual population. The purpose of this study is to explore circumstances surrounding suicide completion to inform future intervention strategies for suicide among lesbian, gay, bisexual and transgender (LGBT) individuals. We completed a retrospective analysis of data from the National Violent Death Reporting System (NVDRS) from 2013-2017. Victims identified as transgender were considered separately. We stratified analysis by identified sex of the victim for the LGB population. Of the 16,831 victims whose sexual orientation or transgender status was known: 3886 (23.1%) were identified as female, 12,945 (76.9%) were identified as male. 479 (2.8%) were identified as LGBT; of these, 53 (11%) were transgender. LGBT victims were younger than non-LGBT victims. Male LGB victims were more likely to have a history of prior suicide attempts, past or current mental illness diagnosis, and were less likely to use firearms than male heterosexual victims. Female LGB victims were more likely to have problems in an intimate partner relationship than heterosexual women, while LGB men were more likely to have problems in family or other relationships. Transgender victims were again more likely to have mental health problems and a history of prior attempts, but less likely to have intimate partner problems and more likely to have a history of child abuse. These results highlight the importance of promoting suicide interventions that recognize the complex intersection between stated gender, sex, and sexuality and the different cultural impacts these identities can have.

An Examination of United States Air Force Suicide Decedents Based on Documented Suicide Attempt Histories

In this study, we compared United States military decedents who died by suicide on their first attempt with decedents who had made multiple attempts. Death investigation files for 217 United States Air Force (USAF) personnel who died by suicide between 1996 and 2006 were coded for demographic, psychosocial, and psychiatric characteristics. Among USAF suicide decedents, 77% died by suicide on their first attempt and 23% had a documented history of at least one prior attempt. Decedents with a history of prior attempts were more likely to have an interpersonal stressor within 3 months of death and were twice as likely to have a documented Axis I diagnosis. There were few differences between military suicide decedents based on history of prior attempts. Further research is needed to inform military suicide prevention endeavors.

A 2-year psychological autopsy study of completed suicides in the athens greater area, Greece.

ObjectiveTo study the characteristics of a sample of suicide victims from the Athens Greater Area using the psychological autopsy method for the first time in Greece.MethodsWe studied all recorded cases of completed suicide for the 2-year time period November 2007-October 2009 collecting data from the victims' forensic records as well as from the completion of a psychological autopsy questionnaire.Results335 persons were recorded as suicide victims. We contacted relatives of 256 victims interviewing those of 248 of them (96.9%). The differences regarding sex, marital and employment status between our sample and the general population were statistically significant (p<0.001). The male/female ratio was 3:1. Comparatively more victims were divorced, separated or single and a greater proportion were pensioners or unemployed. 26.0% of the victims had history of prior attempts (64.4% once, 20.3% twice and 15.3% more times). 42.6% were taking psychiatric medication-significantly more women than men according to blood tests; 14.2% had been hospitalized in a psychiatric clinic the year prior to their death. 84.8% have deceased at the place of suicide and 15.2% died in the hospital; 80.3% died indoors and 19.7% outdoors. Men died primarily by hanging or shooting by a firearm while women preferred jumping from height instead (p<0.001). As many as 48.8% had expressed their intention to die to their relatives; 26.6% left a suicide note.ConclusionOur study has shown that the psychological autopsy method is applicable and widely accepted yielding results comparable to the international literature. Specific parameters associated with suicide have been studied for the first time in Greece.

2732 – Persistence or change? Focusing on the relation between suicide methods of last attempted and of completed suicide

Introduction Research on suicide method substitution between last attempted and completed suicide is scarce (five studies). Objectives The results are conflicting (three studies report persistence and two studies report switch). Aim To investigate this topic studying a sample of suicide victims from Greece. Methods We studied all recorded cases of completed suicide of the period November 2007-October 2009 in Athens Department of Forensic Medicine. We performed phone interviews with relatives of the deceased focusing, among other topics, on the characteristics of prior attempts. Results 335 individuals were recorded as suicide victims: 250 men (74.7%) & 85 women (35.3%). Interviews were conducted with the relatives of 246 victims: 24% had history of prior attempts (59 cases), 39 men (66.1%) & 20 women (33.9%). Most frequent last attempted suicide methods were: self-poisoning (57.6%), jumping from a height (20.3%), wrist-cutting (15.3%) & hanging (6.8%). 74.6% of the attempters became completers using a different method (p=0.016). Individuals with previous attempt by self-poisoning or wrist-cutting died by hanging or jumping while attempters by hanging or jumping became completers primarily by the same methods. Conclusion Most of the suicide completers had never been attempters in the past. Those who had attempted with low lethality methods- committed suicide choosing a different, more lethal method. Restrictions in the availability of lethal means may result in more surviving attempters while some suicides could also be prevented because a particularly lethal method is not in hand.

2735 – Suicide in physicians: an overview

Physicians have an increased risk of dying by suicide in comparison with the general population. This difference has been studied in the literature. To present the characteristics of this phenomenon. Literature review using Medline and hand search of relevant articles. The suicide risk is slightly higher for male and substantially higher for female physicians in comparison with the general population (relative risk 1.1-3.4 and 2.5-5.7 respectively). It also varies from 1.5-3.8 in males and 3.7-4.5 in females as compared with other professionals. Depression, drug & alcohol abuse problems, history of prior attempts, availability of method (drugs), physical illness, burn-out syndrome, interpersonal difficulties and loneliness constitute risk factors. Physicians rarely do “unsuccessful” attempts and most commonly die by drug poisoning. This may be due to the fact that they have easy access to drugs, knowing better their lethal doses. Anesthesiologists, Psychiatrists and General Practitioners have the highest risk. The increased risk in female physicians is concerning given the rising number of women in the medical profession. However, as poor status integration has been proposed as an explanation, their increasing proportion in the medical workforce could hopefully help reverse this trend. Physicians -particularly female- present high risk of suicide. Adequate services of counseling, support and care that provide anonymity and confidentiality should be the cornerstones of preventive efforts. The last are complicated by the fact that restriction in the main suicide method (drugs) seems a hardly applicable preventive measure in this population.

A risk index for 12-month suicide attempts in the National Comorbidity Survey Replication (NCS-R)

Clinical judgments about the likelihood of suicide attempt would be aided by an index of risk factors that could be quickly assessed in diverse settings. We sought to develop such a risk index for 12-month suicide attempts among suicide ideators. The National Comorbidity Survey Replication (NCS-R), a household survey of adults aged 18+, assessed the 12-month occurrence of suicide ideation, plans and attempts in a subsample of 5692 respondents. Retrospectively assessed correlates include history of prior suicidality, sociodemographics, parental psychopathology and 12-month DSM-IV disorders. Twelve-month prevalence estimates of suicide ideation, plans and attempts are 2.6, 0.7 and 0.4% respectively. Although ideators with a plan are more likely to make an attempt (31.9%) than those without a plan (9.6%), 43% of attempts were described as unplanned. History of prior attempts is the strongest correlate of 12-month attempts. Other significant correlates include shorter duration of ideation, presence of a suicide plan, and several sociodemographic and parental psychopathology variables. Twelve-month disorders are not powerful correlates. A four-category summary index of correlates is strongly related to attempts among ideators [area under the receiver operator characteristic curve (AUC)=0.88]. The distribution (conditional probability of attempt) of the risk index is: 19.0% very low (0.0%), 51.1% low (3.5%), 16.2% intermediate (21.3%), and 13.7% high (78.1%). Two-thirds (67.1%) of attempts were made by ideators in the high-risk category. A short, preliminary risk index based on retrospectively reported responses to fully structured questions is strongly correlated with 12-month suicide attempts among ideators, with a high concentration of attempts among high-risk ideators.

Social environment factors associated with suicide attempt among low-income African Americans: The protective role of family relationships and social support

Suicide and suicide attempts are important public health concerns, and recent decades have witnessed a rising rate of suicide among African Americans. A history of prior attempts is a leading risk factor for completed suicide. Further research is needed into the social environment risk factors for suicide attempt among African Americans. This study focused on two important dimensions of the social environment, family relationships and social support, as well as an important person-level risk factor--depressive symptoms. Data were obtained from a case-control study of 200 African American men and women aged 18-64 years, who sought services at a large, urban, public hospital. Odds ratios adjusted for significant sociodemographic differences between groups (aORs) were calculated for environment risk factors for suicide attempt among the cases and controls. The role of depressive symptoms was also studied. Lower levels of family adaptability and family cohesion increased the relative rate of suicide attempt in the sample. The aOR associated with the lowest quartile of family adaptability was 3.90, and the aORs associated with the first and second quartiles of family cohesion were 8.91 and 5.51, respectively. Lower levels of social embeddedness and social support increased the relative rate of suicide attempt in our sample. The aOR associated with the first and second quartiles of social embeddedness were 5.67 and 4.93, respectively, and the aOR associated with the lowest quartile of social support was 6.29. A mediating role of depression was discovered when depressive symptoms were entered into the logistic regression models. Our findings indicate that social environment factors including deficits in family functioning and social support are associated strongly with suicide attempts among low-income African American men and women seeking treatment in a large, urban hospital. Thus, better family functioning and social supports can be considered protective factors in this population. The presence of depressive symptoms, a well-known risk factor for suicide attempts and suicide, appears to mediate the association between social environment factors and suicide attempt.

Postdischarge therapy of hospitalized adolescent suicide attempters

To assess the effect of discharge planning on posthospitalization therapy, the admitting physicians of all youths hospitalized for a suicide attempt were contacted by questionnaire or phone. Of the 80 attempters admitted the 42-month study period, adequate information was available on 65 (81%). At discharge, 47 patients had discharge plans in the hospital record; of these, 18 (38%) received posthospitalization care. Nineteen patients had no discharge plans, and only one (6%) received therapy. No other differences were found between those patients receiving care and those not receiving care when gender, age, method of attempt, history of prior attempt(s), and length of hospital stay were examined. Effective discharge planning may have a major impact on posthospitalization therapy for adolescent suicide attempters.