Incidence Of Suicide Attempts Research Articles

Incidence and predictors of suicide attempts in bipolar I and II disorders: A 5‐year follow‐up study

Few long-term studies on bipolar disorder (BD) have investigated the incidence and risk factors of suicide attempts (SAs) specifically related to illness phases. We examined the incidence of SAs during different phases of BD in a long-term prospective cohort of bipolar I (BD-I) and bipolar II (BD-II) patients, and risk factors specifically for SAs during major depressive episodes (MDEs). In the Jorvi Bipolar Study (JoBS), 191 BD-I and BD-II patients were followed using life-chart methodology. Prospective information on SAs of 177 patients (92.7%) during different illness phases was available up to 5years. The incidence of SAs and their predictors were investigated using logistic and Poisson regression models. Analyses of risk factors for SAs occurring during MDEs were conducted using two-level random-intercept logistic regression models. During the 5 years of follow-up, 90 SAs per 718 patient-years occurred. The incidence was highest, over 120-fold higher than in euthymia, during mixed states (765/1000 person-years; 95% confidence interval [CI] 461-1269 person-years), and also very high in MDEs, almost 60-fold higher than in euthymia (354/1000 person-years; 95% CI 277-451 person-years). For risk of SAs during MDEs, the duration of MDEs, severity of depression, and cluster C personality disorders were significant predictors. We confirmed in this long-term study that the highest incidences of SAs occur in mixed and major depressive illness phases. The variations in incidence rates between euthymia and illness phases were remarkably large, suggesting that the question "when" rather than "who" may be more relevant for suicide risk in BD. However, risk during MDEs is likely also influenced by personality factors.

Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army Soldiers: A randomized clinical trial

ObjectiveTo evaluate the effectiveness of crisis response planning for the prevention of suicide attempts. MethodRandomized clinical trial of active duty Army Soldiers (N=97) at Fort Carson, Colorado, presenting for an emergency behavioral health appointment. Participants were randomly assigned to receive a contract for safety, a standard crisis response plan, or an enhanced crisis response plan. Incidence of suicide attempts during follow-up was assessed with the Suicide Attempt Self-Injury Interview. Inclusion criteria were the presence of suicidal ideation during the past week and/or a lifetime history of suicide attempt. Exclusion criteria were the presence of a medical condition that precluded informed consent (e.g., active psychosis, mania). Survival curve analyses were used to determine efficacy on time to first suicide attempt. Longitudinal mixed effects models were used to determine efficacy on severity of suicide ideation and follow-up mental health care utilization. ResultsFrom baseline to the 6-month follow-up, 3 participants receiving a crisis response plan (estimated proportion: 5%) and 5 participants receiving a contract for safety (estimated proportion: 19%) attempted suicide (log-rank χ2(1)=4.85, p=0.028; hazard ratio=0.24, 95% CI=0.06–0.96), suggesting a 76% reduction in suicide attempts. Crisis response planning was associated with significantly faster decline in suicide ideation (F(3,195)=18.64, p<0.001) and fewer inpatient hospitalization days (F(1,82)=7.41, p<0.001). There were no differences between the enhanced and standard crisis response plan conditions. ConclusionCrisis response planning was more effective than a contract for safety in preventing suicide attempts, resolving suicide ideation, and reducing inpatient hospitalization among high-risk active duty Soldiers.

Epidemiological Study of Suicide in Khuzestan Province, South West of Iran, during 2011 to 2014.

Aim of the study: Suicide is a worldwide major public health problem. This study was carried out in Khuzestan province for the examination of the epidemiology of suicide. Material and methods: This is a descriptive-cross-sectional study on epidemiology of suicide in 23 township of Khuzestan provinces, during 2011 to 2014. Data were collected from records in Mental Health Units in Khuzestan Province which has located in South West of Iran. Statistical analysis was performed using SPSS-22 software. Results: from 11180 recorded suicides, about 60% were female and about 40% were male. The cumulative incidence of suicide attempts was estimated 339/100,000.The highest suicide rate was from the city of Masjed Soleiman with an annual average incidence of 327/100,000 cases of suicide. Most common method of suicide was drug abuse (279/100,000) and most common method of Completed Suicides was hanging (7/100,000). The most important motivation of the suicide was related to Familial discords by 72/100,000 of suicide attempts and 4/100,000 cases of suicide deaths and the highest incidence occurred among the people in the age range of 24-18 years. The suicide attempts and suicide deaths increased over studied years. Conclusions: According to the results, the most common suicide method was drug abuse and the family discord was the most motivated suicide. Moreover, highest incidence of suicide was among the age group of 18-24 years. Educational programs should be provided in fields of problem solving skills and crisis management in relation to life problems. Also facilitating access to specialized psychological and psychiatric services, and appropriate intervention plans is essential.

Emergency department visits for attempted suicide and self harm in the USA: 2006-2013.

To characterise and identify nationwide trends in suicide-related emergency department (ED) visits in the USA from 2006 to 2013. We used data from the Nationwide Emergency Department Sample (NEDS) from 2006 to 2013. E-codes were used to identify ED visits related to suicide attempts and self-inflicted injury. Visits were characterised by factors such as age, sex, US census region, calendar month, as well as injury severity and mechanism. Injury severity and mechanism were compared between age groups and sex by chi-square tests and Wilcoxon rank-sum tests. Population-based rates were computed using US Census data. Between 2006 and 2013, a total of 3 567 084 suicide attempt-related ED visits were reported. The total number of visits was stable between 2006 and 2013, with a population-based rate ranging from 163.1 to 173.8 per 100 000 annually. The frequency of these visits peaks during ages 15-19 and plateaus during ages 35-45, with a mean age at presentation of 33.2 years. More visits were by females (57.4%) than by males (42.6%); however, the age patterns for males and females were similar. Visits peaked in late spring (8.9% of all visits occurred in May), with a smaller peak in the fall. The most common mechanism of injury was poisoning (66.5%), followed by cutting and piercing (22.1%). Males were 1.6 times more likely than females to use violent methods to attempt suicide (OR = 1.64; 95% CI = 1.60-1.68; p < 0.001). The vast majority of patients (82.7%) had a concurrent mental disorder. Mood disorders were the most common (42.1%), followed by substance-related disorders (12.1%), alcohol-related disorders (8.9%) and anxiety disorders (6.4%). The annual incidence of ED visits for attempted suicide and self-inflicted injury in the NEDS is comparable with figures previously reported from other national databases. We highlighted the value of the NEDS in allowing us to look in depth at age, sex, seasonal and mechanism patterns. Furthermore, using this large national database, we confirmed results from previous smaller studies, including a higher incidence of suicide attempts among women and individuals aged 15-19 years, a large seasonal peak in suicide attempts in the spring, a predominance of poisoning as the mechanism of injury for suicide attempts and a greater use of violent mechanisms in men, suggesting possible avenues for further research into strategies for prevention.

Selective RP-HPLC method for determination of quetiapine in presence of coadministered drugs: Application for long-term stability study of quetiapine in whole blood

Incidence of suicidal attempts presents an explanation for the high prevalence of quetiapine (QTI) in forensic cases. Thus, the interpretation of its concentrations in biological specimens is needed, but in forensic toxicology, potential postmortem changes such as instability of the target drugs should be taken in consideration. High-performance liquid chromatography (HPLC) method has been developed for determination of QTI. This method was based on reversed phase (RP)-HPLC separation of QTI on a C-18 column (150 mm × 4.6 mm, 5 μm) with elution system of acetonitrile—methanol—0.025 M phosphate buffer (pH 2.5), containing 1 mL TEA in each 250 mL, in a ratio of 40:30:30%, v/v, at the flow rate of 1.2 mL min−1 using mirtazapine as internal standard (IS). The proposed method was applied to the determination of QTI in plasma in presence of coadministered drugs. The application of the proposed method was extended for long-term stability study of two different concentration levels of QTI in the whole blood.

Suicidality and symptoms of anxiety, irritability, and agitation in patients experiencing manic episodes with depressive symptoms: a naturalistic study.

PurposePatients with a bipolar I disorder (BD-I) manic episode meeting the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), criteria for “with mixed features” have a high incidence of suicide attempts and of anxiety, irritability, and agitation (AIA) symptoms. The aim of this analysis was to explore the relationship between suicidality and AIA symptoms in patients with BD-I experiencing mania with depressive symptoms, using data from a previous naturalistic study.Patients and methodsPsychiatrists completed an online questionnaire about their adult patients who had a current BD-I manic episode. Questions covered the DSM-5 “with mixed features” specifier, the severity of AIA symptoms, the frequency and controllability of suicidal ideation, and the number of suicide attempts.ResultsOf 1,035 patients with BD-I mania who were included in the analyses, 348 (33.6%) met the criteria for the DSM-5 “with mixed features” specifier (three or more depressive symptoms). These patients were further stratified according to the severity of their AIA symptoms: “mild AIA” (zero or one AIA symptom above a severity threshold; 105 patients) or “severe AIA” (all three AIA symptoms above a severity threshold; 167 patients). A greater incidence of suicidal ideation was observed in the severe AIA group (71.9%) than in the mild AIA group (47.6%). Twice as many patients had easily controlled suicidal ideation than difficult-to-control suicidal ideation in both subgroups. The mean number of suicide attempts was higher in the severe AIA group than in the mild AIA group, during the current episode (0.84 vs 0.34 attempts, respectively; P<0.05) and over the patient’s lifetime (1.56 vs 1.04 attempts, respectively).ConclusionThe high risk of suicide among BD-I mania patients with depressive symptoms is further increased when they experience severe AIA symptoms. Recognizing AIA symptoms in BD-I mania could provide a means of identifying patients with depressive symptoms, as well as those who may be suicidal, thereby allowing for appropriate, tailored treatment.

Effective Causes of Suicide in Zahedan (in 2015)

&lt;span lang="EN-US"&gt;The present study aims to examine the effective causes of suicide in Zahedan city, Iran 2014-2015. In fact, suicide is a dangerous behavior to end the life, which would impose a social problem and cost a lot of harm to individuals, families and society. The main question is that what are the factors contributing to the suicide? Important assumptions include: marriage and having children reduces the suicide attempts. Education and employment could reduce the incidence of suicide attempts and suicide attempts are higher at a young age. This study makes use of fieldwork and analytical methods. The population of this research included people who committed suicide during nine months, from Azar 2014 to September 2015 and have been referred to Khatamolanbia (PBUH) hospital, Imam Ali (AS) hospital and Zahedan's forensic medicine. The findings suggest that all of 71 samples were Muslims; 36 persons were women (50.7%) and 35 persons were men (49.3%).There isn't any relationship between mental disorders and suicide attempts. The incidence of suicide among people 16 to 30 years old with 83.2% is much more than other age groups. Suicide attempts rates among educated people are less than under diploma with 66.2%. There is no significant relationship between marital status and suicide, but suicide (67.6%) among those without children is more than people with a family. Suicide attempts among people with higher-income levels and favorable socio-economic conditions and poor people with 15.5%, is much less than middle-income and good-income with 84.5%. 29.6% of those surveyed, that is 21 people, who attempted suicide had died. &lt;/span&gt;

Risk Factors, Methods, and Timing of Suicide Attempts Among US Army Soldiers.

Suicide attempts in the US Army have risen in the past decade. Understanding the association between suicide attempts and deployment, as well as method and timing of suicide attempts, can assist in developing interventions. To examine suicide attempt risk factors, methods, and timing among soldiers currently deployed, previously deployed, and never deployed at the time this study was conducted. This longitudinal, retrospective cohort study of Regular Army-enlisted soldiers on active duty from 2004 through 2009 used individual-level person-month records to examine risk factors (sociodemographic, service related, and mental health), method, and time of suicide attempt by deployment status (never, currently, and previously deployed). Administrative data for the month before each of 9650 incident suicide attempts and an equal-probability sample of 153 528 control person-months for other soldiers were analyzed using a discrete-time survival framework. Suicide attempts and career, mental health, and demographic predictors were obtained from administrative and medical records. Of the 9650 enlisted soldiers who attempted suicide, 86.3% were male, 68.4% were younger than 30 years, 59.8% were non-Hispanic white, 76.5% were high school educated, and 54.7% were currently married. The 40.4% of enlisted soldiers who had never been deployed (n = 12 421 294 person-months) accounted for 61.1% of enlisted soldiers who attempted suicide (n = 5894 cases). Risk among those never deployed was highest in the second month of service (103 per 100 000 person-months). Risk among soldiers on their first deployment was highest in the sixth month of deployment (25 per 100 000 person-months). For those previously deployed, risk was highest at 5 months after return (40 per 100 000 person-months). Currently and previously deployed soldiers were more likely to attempt suicide with a firearm than those never deployed (currently deployed: OR, 4.0; 95% CI, 2.9-5.6; previously deployed: OR, 2.7; 95% CI, 1.8-3.9). Across deployment status, suicide attempts were more likely among soldiers who were women (currently deployed: OR, 3.4; 95% CI, 3.0-4.0; previously deployed: OR, 1.5; 95% CI, 1.4-1.7; and never deployed: OR, 2.4; 95% CI, 2.3-2.6), in their first 2 years of service (currently deployed: OR, 1.9; 95% CI, 1.5-2.3; previously deployed: OR, 2.2; 95% CI, 1.9-2.7; and never deployed: OR, 3.1; 95% CI, 2.7-3.6), and had a recently received a mental health diagnosis in the previous month (currently deployed: OR, 29.8; 95% CI, 25.0-35.5; previously deployed: OR, 22.2; 95% CI, 20.1-24.4; and never deployed: OR, 15.0; 95% CI, 14.2-16.0). Among soldiers with 1 previous deployment, odds of a suicide attempt were higher for those who screened positive for depression or posttraumatic stress disorder after return from deployment and particularly at follow-up screening, about 4 to 6 months after deployment (depression: OR, 1.4; 95% CI, 1.1-1.9; posttraumatic stress disorder: OR, 2.4; 95% CI, 2.1-2.8). Identifying the timing and risk factors for suicide attempt in soldiers requires consideration of environmental context, individual characteristics, and mental health. These factors can inform prevention efforts.

Sleep Disturbances and Suicide Risk in an 8-Year Longitudinal Study of Schizophrenia-Spectrum Disorders.

Disrupted sleep is one of the prominent but often overlooked presenting symptoms in the clinical course of psychotic disorders. The aims of this study were to examine the prevalence of sleep disturbances, particularly insomnia and nightmares, and their prospective associations with the risk of suicide attempts in patients with schizophrenia-spectrum disorders. A naturalistic longitudinal study was conducted in outpatients diagnosed with schizophrenia-spectrum disorders recruited from the psychiatric outpatient clinic of a regional university-affiliated public hospital in Hong Kong. A detailed sleep questionnaire was completed by 388 patients at baseline in May-June 2006. Relevant clinical information was extracted from clinical case notes from June 2007-October 2014. Prevalence of frequent insomnia and frequent nightmares was 19% and 9%, respectively. Baseline frequent insomnia was significantly associated with an increased incidence of suicide attempts during the follow-up period (adjusted hazard ratio = 4.63, 95% confidence interval 1.40-15.36, P < 0.05). Nightmare complaint alone did not predict the occurrence of suicide attempts, but the comorbidity of nightmares and insomnia was associated with the risk of suicide attempt over follow-up (adjusted HR = 11.10, 95% confidence interval: 1.68-73.43, P < 0.05). Sleep disturbances are common in patients with schizophrenia-spectrum disorders. The association between sleep disturbances and suicidal risk underscores the need for enhanced clinical attention and intervention on sleep disturbances in patients with schizophrenia.

The ebb and flow of the wish to live and the wish to die among suicidal military personnel

BackgroundThe relative balance between the wish to live and the wish to die (i.e., suicidal ambivalence) is a robust predictor of suicidal behavior and may be a mechanism underlying the effectiveness of treatments that reduce suicidal behaviors. To date, however, few studies have explored possible mechanisms of action in these treatments. MethodActive duty Soldiers (N=152) with a recent suicide attempt and/or active suicide ideation were randomized to receive brief cognitive behavioral therapy (BCBT) or treatment as usual (TAU). The Suicide Attempt Self-Injury Inventory (Linehan et al., 2006a) was used to assess the incidence of suicide attempts during the 2-year follow-up. The wish to live and the wish to die were assessed with items 1 and 2, respectively, of the Beck Scale for Suicide Ideation (Beck and Steer, 1991). ResultsAcross both treatments, the wish to live was significantly weaker among patients who attempted suicide but the wish to die was stronger only among patients who attempted suicide in TAU. Among nonattempters, the wish to die stabilized the wish to live, but among attempters the wish to live and the wish to die were not associated with each other. In BCBT the wish to live destabilized the wish to die among nonattempters. LimitationsSelf-report methodology, predominantly male sample. ConclusionsThe emergence of suicidal behavior is driven primarily by the absence of the wish to live. BCBT is associated with a unique coupling of an ambivalent wish to live and wish to die, which may suggest an underlying mechanism of action.

Suicides and Suicide Attempts during Long-Term Treatment with Antidepressants: A Meta-Analysis of 29 Placebo-Controlled Studies Including 6,934 Patients with Major Depressive Disorder

Background: It is unclear whether antidepressants can prevent suicides or suicide attempts, particularly during long-term use. Methods: We carried out a comprehensive review of long-term studies of antidepressants (relapse prevention). Sources were obtained from 5 review articles and by searches of MEDLINE, PubMed Central and a hand search of bibliographies. We meta-analyzed placebo-controlled antidepressant RCTs of at least 3 months' duration and calculated suicide and suicide attempt incidence rates, incidence rate ratios and Peto odds ratios (ORs). Results: Out of 807 studies screened 29 were included, covering 6,934 patients (5,529 patient-years). In total, 1.45 suicides and 2.76 suicide attempts per 1,000 patient-years were reported. Seven out of 8 suicides and 13 out of 14 suicide attempts occurred in antidepressant arms, resulting in incidence rate ratios of 5.03 (0.78-114.1; p = 0.102) for suicides and of 9.02 (1.58-193.6; p = 0.007) for suicide attempts. Peto ORs were 2.6 (0.6-11.2; nonsignificant) and 3.4 (1.1-11.0; p = 0.04), respectively. Dropouts due to unknown reasons were similar in the antidepressant and placebo arms (9.6 vs. 9.9%). The majority of suicides and suicide attempts originated from 1 study, accounting for a fifth of all patient-years in this meta-analysis. Leaving out this study resulted in a nonsignificant incidence rate ratio for suicide attempts of 3.83 (0.53-91.01). Conclusions: Therapists should be aware of the lack of proof from RCTs that antidepressants prevent suicides and suicide attempts. We cannot conclude with certainty whether antidepressants increase the risk for suicide or suicide attempts. Researchers must report all suicides and suicide attempts in RCTs.

Impact of dialectical behavior therapy on incidence of suicidal attempts and non-suicidal self injury among a sample of Egyptian borderline personality disorder patients

IntroductionDialectical behavior therapy (DBT) is a comprehensive psycho-social treatment developed by Marsha Linehan and originally designed for persons meeting criteria for borderline personality disorder (BPD). DBT is considered as a standard evidence based treatment for suicidal BPD patients in most international guidelines. Although its effectiveness has been proved in multiple studies across different patient populations but almost all the research was conducted in North American or European countries. The current study was the first trial to apply DBT in Egypt with a different language and culture than where the treatment was originally developed.ObjectivesAssessment of incidence of suicidal attempts and non-suicidal self-injury (NSSI) among a sample of Egyptian BPD patients enrolled in an outpatient DBT program.AimThe aim of the current study was to estimate impact of comprehensive DBT on suicidal attempts and NSSI when applied to Egyptian BPD patients.MethodsTwenty-five BPD patients, 4 males and 21 females, were included in a comprehensive outpatient DBT program for one year and incidence of suicidal attempts and NSSI were calculated.ResultsFive patients only attempted suicide again with an incidence of 20% and a mean of one attempt/patient. Seven patients attempted NSSI with an incidence of 28%, an overall 22 incidents and a mean of 3 incidents/patient.ConclusionAlthough this was the first time to apply DBT in an Egyptian population, DBT proved to be an effective psycho-therapeutic intervention for suicidal BPD patients across regardless of different language or culture.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Suicide attempts associated with sexual violence: Women – Ecuador

ObjectiveDetermine the incidence of suicide attempts in women exposed to sexual violence in Ecuador.MaterialsWe applied a transversal descriptive study accomplished by the National Institute of Statistics and Census (INEC). The INEC recruited Ecuadorian women from 15-years-old and ahead, the surveys were focused on this population. Eighteen thousand and eight hundred (18,800) rural and urban housings were selected all over the country, 24 provinces. Date of the survey: November 16–December 15 of 2011. The sample included 737 women of several marital status (single, married and separated woman) who reported had been victims of sexual violence.ResultsThe average age of the sample was 28-years-old. The standard deviation was 21 years, ages: 15–25 years old: 14.265 (21.6%), 25–35-years-old: 9.324 (14.1%), 35–45-years-old: 8.132 (12.3%), 45–55-years-old: 6.283 (9.5%), 55–65-years-old: 4.302 (6.5%) and &gt; 65 years old: 23.745 (35.9%). The incidence of women who had attempted suicide due to sexual violence was 73.95% (545 of 737 women surveyed). According to the marital status, the incidence was 79.3% on single, 65.5% on married and 79.0% on separated women.ConclusionThe rate of suicide attempts in Ecuadorian women undergoing situations of sexual violence is very elevated. The traumatic incident in descending order according to the classification by marital status is: single, separated and married. It was identified the population of unmarried women in our society to be the most vulnerable to develop suicidal behaviors (8 out of 10 women). However, we must keep in mind that these statistics could be even higher due to the fear and rejection to expose personal traumatic experiences in conservative societies such as the Ecuadorian. These results represent a powerful call to the Mental Health Systems. They must increase protection and follow-up programs on sexually abused women in Ecuador and other Latin-American countries.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Sociodemografic and Clinical Characteristics of Suicidal Cases who Attempted to Emergency Services in Ankara

Objective: The aim of the study is to determine the sociodemografic and clinical characteristics of suicide attempted cases who were admitted to the emergency departments of the hospitals in the first six months of 2010 in Ankara. Methods: Data were obtained by examining the suicide attempted registration forms that were filled out in the emergency services of hospitals working for the Ministry of Health retrospectively. Results: The incidence of suicide attempts in women (76.5%) is higher than men (23.5%). Suicide attempts are high in 15-24 group of age (59.3 %). The rate of suicide attempts is high in patients who were single (57.9 %) and students who were in education level of secondary (44.6 %) and high school (40.2 %). The most common hospitals that were applied are Ankara Training and Researsch Hospital (29.8%) and Kecioren Training and Research Hospital (12.4%). Also Mamak (19.7%) and Kecioren (17.2%) are towns that cases were seen mostly. The most applied method of suicide attempted is the usage of drugs and toxic substances with the 96.2%. The increment ratio of the suicide attempts is seen paticularly from January to June. Family (16.0%) and psychiatric disorder (15.2%) are mainly stressors leading to suicide attempted. Discussion: All attempted suicide patients who applied to Emergency Department should be directed to Crisis Intervention Unit immediately and following-up the cases with psychiatric consultation must become obligatory as well as medical treatments. The findings have been discussed with the literature.

EVALUATING POTENTIAL IATROGENIC SUICIDE RISK IN TRAUMA-FOCUSED GROUP COGNITIVE BEHAVIORAL THERAPY FOR THE TREATMENT OF PTSD IN ACTIVE DUTY MILITARY PERSONNEL.

To determine whether group cognitive processing therapy-cognitive only version (CPT-C) is associated with iatrogenic suicide risk in a sample of active duty US Army personnel diagnosed with posttraumatic stress disorder (PTSD). Possible iatrogenic effects considered include the incidence and severity of suicide ideation, worsening of preexisting suicide ideation, incidence of new-onset suicide ideation, and incidence of suicide attempts among soldiers receiving group CPT-C. Comparison with group present-centered therapy (PCT) was made to contextualize findings. One hundredeight soldiers (100 men, eight women) diagnosed with PTSD were randomized to receive either group CPT-C or group PCT. PTSD diagnosis was confirmed via structured clinician interview. Suicide ideation, depression severity, and PTSD severity were assessed at pretreatment, weekly during treatment, and 2 weeks, 6 months, and 12 months posttreatment. Rates of suicide ideation significantly decreased across both treatments. Among soldiers with pretreatment suicide ideation, severity of suicide ideation significantly decreased across both treatments and was maintained for up to 12 months posttreatment. Exacerbation of preexisting suicide ideation was uncommon in both treatments. New-onset suicide ideation was rare and similar across both treatments (<16%). There were no suicide attempts during treatment or follow-up in either group. Change in depression symptoms predicted change in suicide risk. Suicide-related outcomes were similar across both treatments and primarily associated with comorbid depression. Suicide-related outcomes in group CPT-C were rare and comparable to patterns observed in an active, nontrauma-focused therapy, even among soldiers who entered treatment with suicide ideation. NCT01286415, https://clinicaltrials.gov/ct2/show/NCT01286415.

Czynniki ryzyka podejmowania prób samobójczych u osób leczonych stacjonarnie z powodu uzależnienia od alkoholu w Polsce

IntroductionAlcohol dependence is an important risk factor for suicidal behaviours. Current data show that between 14 and 43% of alcohol-dependent patients attempt suicide. The aim of the present study was to analyse the risk factors for suicide attempts among patients treated for alcohol dependence. MethodsMedical data of 994 patients hospitalised in Alcohol Detoxification and Rehabilitation Units of Nowowiejski Hospital in Warsaw were analysed. The relationships between variables that are thought to be related to the prevalence of suicide attempts in this population were evaluated. The relevant psycho-social and demographic data as well as information on alcohol use and treatment history were included. Results292 (29%) patients confirmed suicide attempts in the past. Among the variables included in the logistic regression model, previous episodes of delirium tremens, earlier onset of alcohol dependence, comorbidity of somatic disorders, and unemployment proved to be significant risk factors for previous suicide attempts. DiscussionThe higher prevalence of suicide attempts among patients with previous episodes of delirium tremens and earlier onset of alcohol dependence confirms the relationship between the severity of alcohol dependence and suicide attempts. The effect of unemployment and comorbidity of somatic disorders on incidence of suicide attempts might presumably be mediated by co-occurring pain, depression, and poorer social functioning. ConclusionsEarlier onset of alcohol dependence and previous episodes of delirium tremens are the risk factors of suicide attempts attributable to the severity of alcohol dependence. The other risk factors (unemployment and somatic disorders) are nonspecific to alcohol dependence, and were previously found to increase the risk in various psychiatric populations.

Symptoms Moderating the Association Between Recent Suicide Attempts and Trauma Levels: Fan-Shaped Effects

The present study focuses on variables moderating the incidence of recent suicide attempt in a large community sample (n = 39,617) of French citizens with various levels of trauma. Five trauma levels were established based on posttraumatic stress disorder items of the Mini International Neuropsychiatric Interview. Twenty-three symptoms were examined as potential moderating variables with a fan-shaped pattern. Seven symptoms regarding desire for death, self-harm intention, suicidal ideation, lifetime suicide attempt, depressed mood, loss of interest, and panic attack exhibited the fan-shaped pattern. The absence of these moderating symptoms decreases the incidence of suicide attempt and their presence leads to a gradual increase.

Evaluating depressive symptoms in mania: a naturalistic study of patients with bipolar disorder.

ObjectiveThis study aimed to evaluate patients with bipolar I disorder (BD-I) who have mania with depressive symptoms and who meet the new “with mixed features” specifier of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).MethodThis prospective, multinational, naturalistic study surveyed psychiatrists and their patients with BD-I from October 2013 to March 2014. Eligible patients had BD-I, had a (current) manic episode, and had experienced onset of a manic episode within the previous 3 months. Psychiatrists provided patient information on depressive symptoms (DSM-5 criteria); symptoms of anxiety, irritability, and agitation; suicide attempts; and physician satisfaction with treatment response. Data were stratified according to whether patients met the criteria for the BD-I “with mixed features” specifier of DSM-5 (≥3 depressive symptoms) or not, and characteristics were compared between the two subgroups. Patients also self-reported on depressive symptoms using the Mini-International Neuropsychiatric Interview module questionnaire.ResultsOverall, 34% of 1,035 patients met the criteria for BD-I “with mixed features,” exhibiting ≥3 depressive symptoms during their current manic episode. This correlated with the matched patient self-reports of depressive symptoms. During their current manic episode, BD-I patients “with mixed features” had more severe symptoms of anxiety, irritability, and agitation (average composite severity score of 4.1 vs 3.4), a higher incidence of suicide attempts (38% vs 9%), and more physician dissatisfaction with treatment response (22% vs 14%), compared to patients with 0–2 depressive symptoms (all P<0.05).ConclusionThis study found that patients with BD-I “with mixed features” (ie, ≥3 depressive symptoms during a manic episode), suffered, on average, from a greater burden of disease than patients with pure mania. Improved identification of these patients may help to optimize treatment outcomes.

Aleksitimik olan ve olmayan major depresif bozukluk hastalarında intihar girişimi, intihar düşüncesi ve umutsuzluk düzeyleri

Suicide attempt, suicidal ideation and hopelessness levels in major depressive patients with and without alexithymia Objective: It is known that hopelessness and alexithymia levels are increased in patients with depressive disorder. In the literature, reports are suggesting that high levels of hopelessness in patients with depressive disorder increase suicide attempts and ideations. Here we aimed to investigate whether there are any differences in terms of suicidal ideation, suicide attempt and hopelessness levels in major depressive disorder patients with and without alexithymia. Method: In this study, 99 patients diagnosed with major depressive disorder according to structured interview for DSM-IV (SCID-I/CV) and 50 healthy subjects were included. Sociodemographic questionnaire, Toronto Alexithymia Scale (TAS-20), Beck Hopelessness Scale (BHS), Scale for Suicidal Ideation (SSI) and Hamilton Rating Scale for Depression (HRSD) were administered to patients and controls. Additionally, Suicide Intent Scale (SIS) was administered to patients with suicide attempt. Results: There was no significant difference in terms of sociodemographic data (except for the marital status) between major depressive patients with or without alexithymia and healthy controls. According to a cut off point of 61 for TAS-20, 34.3% (n=34) of the patient group was alexithymic and 65.7% (n=65) was non-alexithymic. Rate of suicide attempt was higher in the alexithymic major depressive patients (67.6%) than the non-alexithymic major depressive patients (29.2%). Mean scores of SSI and BHS were higher in alexithymic patients than non-alexithymic patients. There was a positive correlation between TAS-1 (difficulty identifying feelings), TAS-2 (difficulty expressing feelings) and BHS, SSI scores. Conclusion: In our study, suicidal ideation, suicide attempt and hopelessness levels were higher in major depression patients with alexithymia. Higher incidence of suicide attempts in major depressive patients with higher alexithymia levels and higher suicidal ideation and hopelessness levels in this group of patients suggest the possibility of alexithymia being a predictive factor for suicide attempt.

Comorbidity of Schizophrenia and Social Phobia

Introduction The most common comorbid disorder in schizophrenic patients is a social phobia. It is usually an unrecognized problem that may be associated with a high distortion in managing claims of life. Objectives The aim of our study was to determine the extent to which comorbid social phobia affects the severity and course of schizophrenia. Methods The publications were identified in the database medline and web of science using the keywords “schizophrenia comorbidity” in combination with the terms “social phobia” or “social anxiety disorder”. Other relevant sources of information were obtained from the cited works by important articles. Results The current state of research shows that the incidence of comorbid social phobia in psychotic disease states in the range from 11% to 36%. Social phobia in psychotic patients remains largely unrecognized. An untreated social phobia is associated with more severe psychotic symptoms, worse quality of life and lower self-esteem. It also increases the tendency to social isolation and overall worsens social adaptation. Patients with comorbid social phobia and schizophrenia have a higher amount of lifetime suicide attempts and often abuse alcohol or addictive substance. Conclusions Patients who have both schizophrenia and social phobia have a lower quality of life, impaired functioning in life, a higher incidence of suicide attempts and increased risk of relapse of psychosis. It is, therefore, necessary that physicians treating the patients with schizophrenia had in mind the possibility of the presence of comorbid social phobia, and in the case of its occurrence, they also treat it.