Hospitalized Suicide Attempters Research Articles

The Mental Health of First Nations Children in Manitoba: A Population-Based Retrospective Cohort Study Using Linked Administrative Data: La santé mentale des enfants des Premières Nations au Manitoba : une étude de cohorte rétrospective dans la population, à l'aide de données administratives liées.

First Nations children face a greater risk of experiencing mental disorders than other children from the general population because of family and societal factors, yet there is little research examining their mental health. This study compares diagnosed mental disorders and suicidal behaviours of First Nations children living on-reserve and off-reserve to all other children living in Manitoba. The research team, which included First Nations and non-First Nations researchers, utilized population-based administrative data that linked de-identified individual-level records from the 2016 First Nations Research File to health and social information for children living in Manitoba. Adjusted rates and rate ratios of mental disorders and suicide behaviours were calculated using a generalized linear modelling approach to compare First Nations children (n = 40,574) and all other children (n = 197,109) and comparing First Nations children living on- and off-reserve. Compared with all other children, First Nations children had a higher prevalence of schizophrenia (adjusted rate ratio (aRR): 4.42, 95% confidence interval (CI), 3.36 to 5.82), attention-deficit hyperactivity disorder (ADHD; aRR: 1.21, 95% CI, 1.09 to 1.33), substance use disorders (aRR: 5.19; 95% CI, 4.25 to 6.33), hospitalizations for suicide attempts (aRR: 6.96; 95% CI, 4.36 to 11.13) and suicide deaths (aRR: 10.63; 95% CI, 7.08 to 15.95). The prevalence of ADHD and mood/anxiety disorders was significantly higher for First Nations children living off-reserve compared with on-reserve; in contrast, hospitalization rates for suicide attempts were twice as high on-reserve than off-reserve. When the comparison cohort was restricted to only other children in low-income areas, a higher prevalence of almost all disorders remained for First Nations children. Large disparities were found in mental health indicators between First Nations children and other children in Manitoba, demonstrating that considerable work is required to improve the mental well-being of First Nations children. Equitable access to culturally safe services is urgently needed and these services should be self-determined, planned, and implemented by First Nations people.

Patterns of follow-up mental health care after hospitalization for suicide-related behaviors among older adults in South Korea

ObjectiveThis study aimed to investigate the sociodemographic and clinical factors associated with receiving follow-up mental healthcare within 7 days and 30 days after hospitalization for suicide-related behaviors (SRB) among older adults in South Korea. MethodsData from the Korean National Health Information Database were used, including information on sociodemographic variables and healthcare utilization. The study cohort consisted of individuals born in 1950 or before with a prior hospitalization record for suicide attempts or probable suicide attempts. Logistic regression analysis was conducted to predict the odds of receiving follow-up care within 7 days and 30 days, adjusting for covariates. ResultsAmong the 37,595 older adults discharged from hospitalization for SRB, 29.13 % and 37.86 % received follow-up care within 7 days and 30 days, respectively. Follow-up care was more common among younger individuals, women, those with higher socio-economic status (SES), urban residents, and individuals with comorbidities. ConclusionThe provision of mental health follow-up care for older adults after hospitalization for suicide attempts is inadequate in South Korea. Increasing access to follow-up care among those with lower income, residing in rural areas, and older age is crucial. Public awareness campaigns, stigma reduction training for healthcare providers, and system-level changes, such as telemedicine and integrated care pathways, can help bridge the healthcare gap and reduce suicide mortality among older adults.

Association of hospitalization for suicide attempts in adolescent girls with subsequent hospitalization for eating disorders.

To determine the association between adolescent hospitalization for suicide attempts and the subsequent risk of eating disorder hospitalization. This was a cohort study of 162,398 adolescent girls in Quebec, Canada, including 7741 with suicide attempts before 20 years of age, matched to 154,657 adolescents with no attempt between 1989 and 2019. The main exposure measure was suicide attempt hospitalization. The main outcome measure was hospitalization for an eating disorder up to 31 years later, including anorexia nervosa, bulimia nervosa, and other eating disorders. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between adolescent suicide attempts and eating disorder hospitalization. Adolescent girls admitted for a suicide attempt had 5.55 times the risk of eating disorder hospitalization over time (95% CI 3.74-8.23), compared with matched controls. Suicide attempt was associated with anorexia nervosa (HR 3.57, 95% CI 1.78-7.17) and bulimia nervosa and other eating disorders (HR 8.55, 95% CI 5.48-13.32). Associations were pronounced in girls with repeated suicide attempts. Girls who attempted suicide through self-poisoning had an elevated risk of anorexia nervosa, whereas girls who used violent methods such as cutting or piercing had a greater risk of bulimia nervosa and other eating disorders. Suicide attempt was strongly associated with eating disorder hospitalization in the year following the attempt, but associations persisted throughout follow-up. Suicide attempt admission is associated with the long-term risk of eating disorder hospitalization in adolescent girls. This study of adolescent girls suggests that suicide attempt admission is associated with the long-term risk of hospitalization for eating disorders. The risk is greatest in the year after the attempt, but persists over time. Adolescents who present with a suicide attempt may benefit from screening for eating disorders and long-term follow-up to help prevent the exacerbation or development of eating disorders.

Risk factors for mortality after hospitalization for suicide attempt: results of 11-year follow-up study in Piedmont Region, Italy

PurposeSuicide attempters are at high risk of premature death, both for suicide and for non-suicidal causes. The aim of this study is to investigate risk factors and temporal span for mortality in a cohort of cases admitted to hospital for suicide attempt.MethodsThe cohort included 1489 patients resident in Piedmont Region, North West of Italy, who had been admitted to hospital or emergency department for suicide attempt between 2010 and 2020. Cox regression models were used to identify risk factors for death. The final multivariate model included gender, age, area deprivation index, family composition, psychiatric disorders, malignant neoplasms, neurological disorders, diabetes mellitus, cardiovascular diseases, chronic obstructive pulmonary disease, and intracranial injury or skull fracture.ResultsDuring the observation period, 7.3% of patients died. The highest mortality was observed within the first 12 months after suicide attempt, and remained elevated for many years afterwards. Male gender, older age, high deprivation index of the census area, single-parent family, mood disorders, malignant neoplasms, diabetes mellitus and intracranial injuries or skull fracture were independent predictors of death. Risk factors for natural and unnatural causes of death were also identified.ConclusionsThe mortality risk of suicide attempters is very high, both in the months immediately following the attempt and afterwards. The identification of high-risk groups can help to plan outpatient care following the hospital discharge. Our findings urge the need to design strategies for the assistance and care of these patients at long term in order to reduce the unfavourable outcomes.

Suicide Attempts in Children Aged 10–14 Years During the First Year of the COVID-19 Pandemic

PurposeTo determine if suicide attempts increased during the first year of the pandemic among young adolescents in Quebec, Canada. MethodsWe analyzed children aged 10–14 years who were hospitalized for a suicide attempt between January 2000 and March 2021. We calculated age-specific and sex-specific suicide attempt rates and the proportion of hospitalizations for suicide attempts before and during the pandemic and compared rates with patients aged 15–19 years. We used interrupted time series regression to measure changes in rates during the first (March 2020 to August 2020) and second (September 2020 to March 2021) waves and difference-in-difference analysis to determine if the pandemic had a greater impact on girls than boys. ResultsSuicide attempt rates decreased for children aged 10–14 years during the first wave. However, rates increased sharply during the second wave for girls, without changing for boys. Girls aged 10–14 years had an excess of 5.1 suicide attempts per 10,000 at the start of wave 2, with rates continuing to increase by 0.6 per 10,000 every month thereafter. Compared with the prepandemic period, the increase in the proportion of girls aged 10–14 years hospitalized for a suicide attempt was 2.2% greater than that of boys during wave 2. The pattern seen in girls aged 10–14 years was not present in girls aged 15–19 years. DiscussionHospitalizations for suicide attempts among girls aged 10–14 years increased considerably during the second wave of the pandemic, compared with boys and older girls. Young adolescent girls may benefit from screening and targeted interventions to address suicidal behavior.

Risk Factors and Clinical Correlates of Pediatric Serotonin Syndrome in Hospitalized Suicide Attempters

To evaluate the risk factors and clinical correlates of pediatric serotonin syndrome (SS) given that research on SS in adults exists, there is a dearth of literature on pediatric SS. We conducted a retrospective chart review of 183 pediatric patients who were medically hospitalized after a suicide attempt. We investigated associations between SS and several of its risk factors and clinical correlates. We also assessed the sensitivity/specificity of Hunter's criteria and criterion symptoms in predicting SS. SS occurred in 21.7% of patients with a serotonergic overdose. Recent marijuana use and overdose on a selective serotonin reuptake inhibitor were significantly associated with SS. Individuals with SS required a greater number of days to be medically stabilized and had a greater likelihood of being placed on a ventilator during treatment. Hunter's criteria had 66.7% sensitivity and 92.3% specificity in diagnosing SS. Our study reveals both novel risk factors associated with SS (eg, recent marijuana use) and clinical correlates for patients with pediatric SS. In children, Hunter's criteria appeared to have good specificity but poor sensitivity in identifying SS. Our results set the stage for future work aimed at enhancing clinicians' ability to more rapidly identify and treat pediatric SS.

Suicide Attempts in a General Hospital: A Case-Control

Suicide Attempts in a General Hospital: A Case-Control

Suicide and quarantine during the COVID-19 pandemic: Do we know everything?

BackgroundThere is widespread concern over the impact of COVID-19 and lockdown measures on suicidal behaviour. We assessed their effects on suicide and hospitalization for attempted suicide during the initial phase of the pandemic in Chile. MethodsWe used panel data at the county and month level from January 1, 2016 to December 31, 2020 on suicides and related hospitalizations and a pandemic quarantine dataset. Poisson regression models and a difference-in-difference (DiD) methodology was used to estimate the impact of quarantine on both measures. FindingsSuicide and hospitalizations for attempted suicide decreased (18% and 5.8%, respectively) during the COVID-19 outbreak in Chile (March–December 2020) compared to the same period in 2016–2019. The DiD analysis showed that there was at least a 13.2% reduction in suicides in quarantined counties relative to counties without such restrictions. This reduction was in male suicides and unaffected by age. There was no significant difference between quarantined and non-quarantined counties in terms of hospitalization for suicide attempts. ConclusionsThis study shows a significant quarantine effect on reducing suicide during the initial phase of the COVID-19 pandemic in Chile. Changes in the number of hospitalizations for suicide attempts do not explain the differences between quarantined and non-quarantined counties.

Impact of Lithium on Suicidality in the Veteran Population

Lithium has known antisuicidal properties making it an important agent to study in veterans with psychiatric conditions, a population at high risk for suicide.A single-site, retrospective chart review was conducted at a US Department of Veterans Affairs (VA) teaching hospital. Patients taking lithium for at least 6 months were identified using the VA Lithium Lab Monitoring Dashboard. The primary and secondary objectives were to evaluate the change in number of suicide attempts and suicidal ideation from 3 months prior to lithium initiation to 3 months after a 6-month duration of lithium.The review included 98 patients; 47 (47.9%) received concomitant psychotherapy, 50 (51.0%) were taking an antipsychotic, and 29 (29.6%) an additional mood stabilizer. During the 6-month intervention period, 75 (76.5%) patients had a lithium level drawn and 28 were in the therapeutic range. Of the 98 patients, hospitalization for suicide attempt decreased from 4.1% before lithium use to 0% after lithium use for 6 months (P = .045). Hospitalization for suicidal ideation also decreased from 13.3% before lithium use to 1.0% after lithium use for 6 months (P = .0004).We observed a statistically significant reduction in hospitalization for suicide attempts and suicidal ideation in veterans prescribed lithium following nonfatal suicide behavior and suicidal ideation.

48. Hospitalization for Suicide Attempt and Self-Harm Among Youth Diagnosed With Gender Dysphoria

Transgender and gender non-conforming (TGNC) youth experience severe discrimination which has been linked to adverse mental health outcomes, including an increased prevalence of suicidality and self-harm. Few epidemiological studies have examined this relationship; thus, we studied the relationship between hospitalization for suicidality, self-harm and gender dysphoria in a large, nationally representative database. We used the 2016 Kids’ Inpatient Database to identify a subset of TGNC youth < 21 years of age captured by the database (using ICD-10 gender dysphoria-related codes). We identified suicidal ideation or suicide attempt using either explicit “suicidality” codes, or one of 355 distinct self-harm codes. Using descriptive statistics, prevalence of suicidality and self-harm was compared between youth with and without gender dysphoria. A multivariable logistic regression model adjusting for individual, admission and hospital-level variables was constructed looking for association between gender dysphoria and suicidality. The cohort included 3,115,589 subjects, of whom 1,980 (64 per 100,000 admissions) had gender dysphoria. Analysis of demographic variables revealed the gender dysphoria diagnosis group was comprised of a disproportionately lower proportion of non-white, publicly insured, and low median income young adults compared to the entire cohort. Prevalence of suicidal ideation and suicide attempt in the entire cohort was 2%, compared to 35.3% in young people with gender dysphoria. Using the expanded definition of self-harm and attempted suicide, prevalence increased to 44.1%. After adjusting for individual, admission and hospital-level variables, subjects with gender dysphoria had 7.89 increased odds of attempted suicide or suicidal ideation (95%CI: 7.09-8.79). Using a large and representative database, we found significantly higher prevalence of suicide attempt and self-harm in hospitalized youth with a gender dysphoria-related diagnosis. For youth hospitalized after suicide attempt or self-harm, gender-affirming care and inclusive language is essential to reduce psychological stress secondary to physician-mediated interpersonal discrimination. Importantly, this study only captured TGNC youth with a formal gender dysphoria diagnosis, and not all youth who identify as TGNC have a diagnosis or disclose their identity; thus, the results should not be generalized to the entire population of TGNC youth. Furthermore, there were fewer non-white, publicly insured, and low median income youth with a gender dysphoria diagnosis compared to the entire cohort, which suggests inequities in accessing gender-affirming care among racial minority and economically disadvantaged youth. The results of this study highlight the need for structural interventions and policies to reduce discrimination and improve access to gender-affirming care in order to prevent these adverse outcomes.

Suicidal Ideation and Suicide-Attempt-Related Hospitalizations among People with Alzheimer's Disease (AD) and AD-Related Dementias in the United States during 2016-2018.

People living with Alzheimer’s disease (AD) and AD-related dementias (ADRDs) are at a higher risk of suicidal behaviors given intersecting risk factors. Previous studies generally only focused on AD, small clinical samples, or grouped all dementia subtypes together, limiting insights for other ADRD subtypes. The objective of this study was to generate evidence related to the relative burden of suicidal behaviors (suicidal ideation and suicide attempt) among people with AD and ADRDs. This retrospective cross-sectional study identified hospitalizations related to suicidal behaviors (suicidal ideation and suicide attempt) for patients with Alzheimer’s disease (AD) and AD-related dementias using ICD-10-CM codes from the Nationwide Readmissions Database (NRD). A logistic regression model was estimated to assess associations between AD/ADRD subtype and patient characteristics, and the risk for a suicidal-behavior-related hospitalization and modes of harm were reported. During 2016–2018, there were 12,538 hospitalizations related to suicidal behaviors for people with AD/ADRDs. The overall prevalence of suicidal-behavior-related hospitalizations was lowest for AD (0.8%) and highest for frontotemporal dementia (2.6%). Among hospitalizations for suicide attempts, the most common mode of harm was medications or drugs (89.2% of all attempts), followed by weapons (17.7%). We found that there was a difference in the frequency of suicidal-behavior-related hospitalizations among AD/ADRD hospitalized patients across dementia subtypes.

Gender differences in death during hospitalization following a survived suicide attempt in Taiwan from 1998 to 2015: a cross-sectional study

Background: This study examines gender differences in death during hospitalization following a survived suicide attempt. The outcome of death during hospitalization following a survived suicide attempt and yearly rate of suicide attempts ending in hospitalization is examined. Methods: Data on 53,670 hospitalized patients injured by suicide attempt between January 1, 1998, and December 31, 2015, were collected from the National Health Insurance Database. From 1998 to 2015, 24,052 male patients and 29,618 female patients were screened and matched by age, gender, and filing date. Multinomial logistic regression was used to analyze the risk of death in terms of gender differences and suicide and hospitalization. p &lt; 0.05 was considered statistically significant. Results: The risk of death during hospitalization after a survived suicide attempt of hospitalized male suicide patients was 1.694 times that of females (adjusted odds ratio (AOR) = 1.694, 95% confidence interval (CI) = 1.569–1.829). The risk of suicide and hospital death for male patients older than 65 years was 3.608 times that of male patients aged 10–24 years (AOR = 3.608, 95% CI = 2.914–4.468) and 6.648 times that of females (AOR = 6.648, 95% CI = 5.105–8.658). Every 1-point increase in the Charlson Comorbidity Index score of male suicide patients increased the risk of suicide hospital death by 5.6%, which indicates that the number or severity of the complications experienced by hospitalized male suicide patients was higher than that of women. Conclusions: Although men comprised a smaller proportion of hospitalized individuals following a survived suicide attempt, they also arrived in more critical condition and were more likely to die during their hospitalization. The increasing trend of female suicide attempt hospitalization rates is greater than that of males and yearly rate of suicide attempts ending in hospitalization is examined.

The Need for Collective Awareness of Attempted Suicide Rates in a Warming Climate.

Background: Climate factors may offer a stronger explanation of the variations in suicide rates compared with economic variables, even in the case of patients admitted involuntarily. Aims: We assessed the role of temperature as a determinant of the increased prevalence of suicide attempts (SA). Method: The sample comprised all cases of hospitalization for SA at the Psychiatric Clinic of the IRCCS Ospedale Policlinico San Martino between August 2013 and July 2018. For ambient temperature, data were provided by the Meteorological Observatory of the University of Genoa. Results: We noted a peak in suicides that was typically found in late spring and early summer due to global warming. Limitations: Other environmental/psychological factors contributing to the onset of an acute clinical event were not considered. The cross-sectional design of the study is another limitation. Conclusion: Further studies are needed to clarify the impact of climatic factors on suicide behavior and implement early intervention and preventive strategies for mental health.

An implementation evaluation of "Zero Suicide" using normalization process theory to support high-quality care for patients at risk of suicide.

Background:Suicide rates continue to rise across the United States, galvanizing the need for increased suicide prevention and intervention efforts. The Zero Suicide (ZS) model was developed in response to this need and highlights four key clinical functions of high-quality health care for patients at risk of suicide. The goal of this quality improvement study was to understand how six large health care systems operationalized practices to support these functions—identification, engagement, treatment and care transitions.Methods:Using a key informant interview guide and data collection template, researchers who were embedded in each health care system cataloged and summarized current and future practices supporting ZS, including, (1) the function addressed; (2) a description of practice intent and mechanism of intervention; (3) the target patient population and service setting; (4) when/how the practice was (or will be) implemented; and (5) whether/how the practice was documented and/or measured. Normalization process theory (NPT), an implementation evaluation framework, was applied to help understand how ZS had been operationalized in routine clinical practices and, specifically, what ZS practices were described by key informants (coherence), the current state of norms/conventions supporting these practices (cognitive participation), how health care teams performed these practices (collective action), and whether/how practices were measured when they occurred (reflexive monitoring).Results:The most well-defined and consistently measured ZS practices (current and future) focused on the identification of patients at high risk of suicide. Stakeholders also described numerous engagement and treatment practices, and some practices intended to support care transitions. However, few engagement and transition practices were systematically measured, and few treatment practices were designed specifically for patients at risk of suicide.Conclusions:The findings from this study will support large-scale evaluation of the effectiveness of ZS implementation and inform recommendations for implementation of high-quality suicide-related care in health care systems nationwide.

Suicide and Quarantine During the COVID-19 Pandemic: Do We Know Everything?

Background: There is widespread concern over the impact of COVID-19 and lockdown measures on suicidal behaviour. We assessed their effects on suicide and hospitalization for attempted suicide in Chile.Methods: We used panel data at the county and month level from January 1, 2016 to December 31, 2020 on suicides and related hospitalizations and a pandemic quarantine dataset. Poisson regression models and a difference-in-difference (DiD) methodology was used to estimate the impact of quarantine on both measures.Findings: Suicide and hospitalizations for attempted suicide decreased (18% and 5·8%, respectively) during the COVID-19 outbreak in Chile (March-December 2020) compared to the same period in 2016-2019. The DiD analysis showed that there was at least a 13·2% reduction in suicides in quarantined counties relative to counties without such restrictions. This reduction was in male suicides and unaffected by age. There was no significant difference between quarantined and non-quarantined counties in terms of hospitalization for suicide attempts.Interpretation: This study shows a significant quarantine effect on reducing suicide during the COVID-19 pandemic. Changes in the number of hospitalizations for suicide attempts do not explain the differences between quarantined and non-quarantined counties.Funding Information: ANID/Millennium Science Initiative, grant NCS17_015, NCS17_035, Instituto MIDAP ICS13_005, Fondecyt Postdoctorado nº 3200944.Declaration of Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.Ethics Approval Statement: Ethical approval was obtained from the Ethics Committee of the Faculty of Psychology of Diego Portales University.

Hopelessness and shame in relation to suicide attempts by Cuban adolescents.

Youth suicide rates in Cuba are very high compared with most other countries, despite considerable improvement in recent years. The purpose of our study was to determine whether hopelessness and shame distinguish adolescent suicide attempters from non-attempters, over and above the effects of depression and suicidal ideation. Participants were 844 Cuban adolescents from the province of Holguin in Eastern Cuba. The attempter groups included 38 participants being treated for suicide attempts in a day hospital and 82 participants in the community who self-reported a previous suicide attempt. The other participants were non-attempter controls. All participants were asked to complete measures of depression, hopelessness, shame and suicidal ideation. As expected, attempters scored higher than non-attempters on the control variables of depression and suicidal ideation. In addition, attempters self-reported greater shame, especially behavioral and characterological shame, than non-attempters. Contrary to our hypothesis, there was no significant difference in hopelessness between attempters and non-attempters. The results are inconsistent with the considerable narrative lore about hopelessness as a reason for suicide in Cuba and other socialist countries. However, some collective socialization practices may lead to shame.

Suicide attempts and death among heroin-involved women seeking methadone treatment in Taiwan

BackgroundThe present study aims to profile the hazard fluctuation of suicide attempts and deaths among heroin-involved women seeking methadone maintenance treatment (MMT) and to investigate sociodemographic and clinical factors predicting the time to have suicidal behaviors. MethodsWe identified a retrospective cohort comprising 2780 women receiving methadone treatment in the period of 2012–2016. Healthcare records were obtained from Taiwan’s National Health Insurance Research Database, and suicide deaths were ascertained from the national death register. Competing risk survival analyses were used to estimate the risk of suicide attempts and deaths within one year and three years of MMT enrollment. ResultsA total of 1.2 % of MMT-treated women ever visited hospital for suicide attempt, and 0.5 % died by confirmed suicide. The risk of treated suicide attempt reached its peak at the end of the 8th month after methadone initiation, whereas the risk of confirmed suicide death was relatively stable during the first one and a half years. A history of treated depressive disorders appears to be the strongest risk predictor for treated suicide attempts (Adjusted Hazard Ratio [aHR] = 3.45; 95 % CI = 1.66–7.19) and confirmed suicide death (aHR = 3.47; 95 % CI = 1.20–10.0). Retaining in methadone treatment may significantly lower the hazard of probable suicide death by 52 %. ConclusionsWomen with heroin use disorders should receive careful attention for suicide risk at intake assessment and over the course of treatment and recovery. Preventive strategies should target unmet clinical and social needs and evaluate gender-specific barriers for treatment engagement.

Mental disorders and subsequent suicide events in a representative community population

Objective: This study examined the patterns of association between mental disorders and subsequent suicide in a community sample representative of the Canadian household population. Methods: This retrospective cohort study used data from the Canadian Community Health Survey 2002 linked to the Death Database 2000-2011 and the Hospitalization Database 1999/2000-2012/2013) (n=27,000). Mental disorders (past year major depressive episodes (MDE), bipolar disorders (BPD), anxiety disorders (AD), and substance dependence (SD)) and subsequent suicide events (deaths or hospitalizations for suicide attempts) were identified. Competing risk regression models were used to analyze the time-to-event data, adjusting for age, sex, marital status, and educational attainment. Results: Past year mental disorders were diagnosed in 11.38% of the cohort and 0.41% had suicide events. An increased hazard of suicide events associated with MDE, SD and AD weakened over-time, but this was not observed for BPD. For example, the HR of suicide events for MDE was 6.02 (95% confidence interval (CI)=2.65, 13.68) in the first 4 years, whereas, it was 2.03 (95% CI=0.91, 4.53) after 4 years. Whereas, the HRs of suicide events for BPD were 16.95 (95% CI=6.88, 41.75) and 15.81 (95% CI=5.89, 42.45) before and after 4 years. Limitations: Diagnostic data are likely to underestimate the prevalence of suicide events. Conclusions: The risk of suicide events declined over time for MDE, SA and AD, but remained high for BPD. This may reflect improvement over time in MDE, SA and AD, but indicates that people living with BPD have a persistent elevated hazard of suicide events.

Association between hospital admission for ketoacidosis and subsequent suicide attempt in young adults with type 1 diabetes.

The aim of this study was to examine the associations between hospitalisation for diabetic ketoacidosis and subsequent hospitalisation for suicide attempt in young adults with type 1 diabetes. This nationwide historical cohort study included hospital data on all young people hospitalised in France for type 1 diabetes in 2008. Epidemiological follow-up focused on hospitalisations (medical and psychiatric hospital data) from the index hospitalisation to 2017. Survival analyses were done using a Cox proportional hazards regression model to explore the association between hospitalisation for ketoacidosis and subsequent hospitalisation for a suicide attempt. In 2008, 16,431 people aged 18-35years had a hospitalisation mentioning type 1 diabetes. Among them, 1539 (9.4%) had at least one hospitalisation for ketoacidosis between 2008 and 2010. At 9years, 7.2% of the group hospitalised for ketoacidosis had been hospitalised for a suicide attempt vs only 2.5% in the group not hospitalised for ketoacidosis. The association between hospitalisation for ketoacidosis and suicide attempt decreased over time and was no longer significant after 5years. We found that young adults admitted to hospital for diabetic ketoacidosis have an increased risk of being admitted to hospital for a subsequent suicide attempt. The risk of a suicide attempt was the highest in the 12months following the ketoacidosis episode. Our findings support the recommendation that screening for depression and suicide risk should be part of the routine clinical assessment of individuals with type 1 diabetes and ketoacidosis.

Caracterização Sociodemográfica dos Doentes Internados por Tentativas de Suicídio e Comportamentos Autolesivos em Psiquiatria

Introdução: Os comportamentos suicidas acarretam de forma inequívoca consequências tanto a nível da sociedade como no seio familiar. Estes comportamentos podem dividir‑se em atos suicidas (tentativas de suicídio e suicídio consumado) e comportamentos autolesivos, sendo estes importantes preditores de risco para o suicídio. O objetivo deste trabalho baseia‑se na caracterização sociodemográfica do doente internado por tentativas de suicídio e comportamentos autolesivos num período de seis anos (2008‑2013), na comparação destes comportamentos em função do sexo e na avaliação da evolução desses internamentos ao longo desses seis anos.&#x0D; Métodos: Utilizou‑se como fonte de dados os registos dos processos clínicos.&#x0D; Resultados: No período em estudo as tentativas de suicídio foram responsáveis por 13,1% de todos os internamentos enquanto os comportamentos autolesivos estiveram na origem de 0,9%. A maioria permanece internada por um período relativamente curto. Ambos predominam no sexo feminino, na faixa etária dos 31‑40 anos e no concelho de Viana do Castelo. Constata‑se que a maioria dos internamentos por tentativa de suicídio ocorre no mês de fevereiro e na Primavera, fruto de uma perturbação de adaptação. Os comportamentos autolesivos verificam‑se sobretudo em abril e outubro, no Verão, apresentando a maioria psicose afetiva. Em ambos os casos, a intoxicação é o método predominante, sendo os agentes psicotrópicos os mais usados. Em 2013 regista‑se o maior número de internamentos por tentativa de suicídio, não se registando nenhum internamento por comportamentos autolesivos.&#x0D; Conclusão: O presente estudo permite confirmar a importância das tentativas de suicídio e comportamentos autolesivos na saúde pública.