Independent Risk Factor For Suicide Research Articles

Suicidal Ideation and Attempts Among Youth With Physical-Mental Comorbidity in Canada: Proposal for an Epidemiological Study.

Evidence suggests that having a chronic physical illness (CPI; eg, asthma, diabetes, and epilepsy) is an independent risk factor for suicidality (ie, suicidal ideation or attempts) among youth. Less is known about the mechanisms linking CPI and suicidality. Some evidence suggests that mental illness (eg, depression and anxiety) or neurodevelopmental disorder (eg, attention-deficit/hyperactivity disorder) mediates or moderates the CPI-suicidality association. Missing from the knowledge base is information on the association between having co-occurring CPI and mental illness or neurodevelopmental disorder (MIND) on youth suicidality. This study uses epidemiological data from the 2019 Canadian Health Survey of Children and Youth (CHSCY) to study the intersection of CPI, MIND, and suicidality in youth. We will estimate prevalence, identify predictors, and investigate psychosocial and service use outcomes for youth with CPI-MIND comorbidity versus other morbidity groups (ie, healthy, CPI only, and MIND only). Conducted by Statistics Canada, the CHSCY collected data from 47,850 children (aged 1-17 years) and their primary caregiving parent. Measures of youth CPI, MIND, family environment, and sociodemographics are available using youth and parent informants. Information on psychiatric services use is available via parent report and linkage to national administrative health data found in the National Ambulatory Care Reporting System and the Discharge Abstract Database, which allow the investigation of hospital-based mental health services (eg, emergency department visits, hospitalizations, and length of stay in hospital). Questions about suicidality were restricted to youths aged 15-17 years (n=6950), which form our analytic sample. Weighted regression-based analyses will account for the complex survey design. Our study began in November 2023, funded by the American Foundation for Suicide Prevention (SRG-0-008-22). Access to the linked CHSCY microdata file was granted in May 2024. Initial examination of CHSCY data shows that approximately 20% (1390/6950) of youth have CPI, 7% (490/6950) have MIND, 7% (490/6950) seriously considered suicide in the past year, and 3% (210/6950) had attempted suicide anytime during their life. Findings will provide estimates of suicidality among youth with CPI-MIND comorbidity, which will inform intervention planning to prevent loss of life in this vulnerable population. Modeling correlates of suicidality will advance understanding of the relative and joint effects of factors at multiple levels-information needed to target prevention efforts and services. Understanding patterns of psychiatric service use is vital to understanding access and barriers to services. This will inform whether use matches need, identifying opportunities to advise policy makers about upstream resources to prevent suicidality. Importantly, findings will provide robust baseline of information on the link between CPI-MIND comorbidity and suicidality in youth, which can be used by future studies to address questions related to the impact of the COVID-19 pandemic and associated countermeasures in this vulnerable population of youth. DERR1-10.2196/57103.

P130: Suicide risk after dementia diagnosis - what do we know and what to expect?

Objective:The purpose of this research is to review the association between the dementia diagnosis and suicide risk, to debate what to expect on this topic in the future, and to identify some strategies to control suicide risk after dementia diagnosis.Methods:Non-systematic review of the literature with selection of scientific articles published in the last 10 years, using PUBMED as database and the following keywords: «suicide», «dementia» and «dementia diagnosis». Nine studies were included.Results:Nowadays, suicide account for one million deaths worldwide per year. Suicide rates are up to 8 times higher in the elderly than in general population, in relative numbers. Dementia is an incurable diagnosis and usually result in loss of mental competence. After being diagnosed with dementia, people face emotional challenges and use to feel loss, anger, and uncertainty.Different studies found dementia as an independent risk factor for suicide. Also, some factors that increase the risk for suicide in dementia are described: the existence of psychiatric comorbidity, such as depression, anxiety, psychosis and substance use; The initial stages of dementia, often within three months of diagnosis, because the person perceive a higher threat to his life, with progressive physical and cognitive impairment, increasingly higher levels of dependence and concern on becoming a burden for their family, and, at the same time, preserving intellectual and volitive capacities to plan and carry out suicide; And younger age at dementia diagnosis, with higher difficulties in adjusting to the diagnosis.We are moving towards pre-symptomatic and early dementia diagnosis utilizing biomarkers and genetic tests. This implies that the diagnosis is made in younger people, so concerns have been raised about a potential increase for suicidal behavior.Conclusion:The findings of this research highlight the importance of providing support and paying attention to people with recent dementia diagnosis, particularly in the first year and for patients aged < 75 years. We suggest active management of pre-existing mental disorders, suicide risk evaluation, assessment of patient and caregiver needs and restricting access to lethal means.

Effects of sleep quality on suicide risk in COVID-19 patients: The chain mediating of anxiety and depressive symptoms

BackgroundAlthough current studies have identified sleep disorders as an independent risk factor for suicide, the relationship between sleep disorders and suicide risk has not been well established. This study explored whether anxiety and depressive symptoms are used as mediators to participate in the impact of sleep quality on suicide risk. MethodsThis is a cross-sectional study. We administered a psychological questionnaire to the participants, using a combination of self-assessment and psychiatrist assessment.Sleep quality, suicide risk, level of anxiety and depressive symptoms were assessed by PSQI, NGASR, SAS and SDS.The study subjects were 391 hospitalized COVID-19 patients from Wuhan hospitals. We used model 6 in the PROCESS (version 3.5) plug-in of SPSS software to conduct mediation test with sleep quality as the independent variable, suicide risk as the dependent variable, level of anxiety and depressive symptoms as intermediate variables. ResultsThe severity of anxiety and depressive symptoms and the risk of suicide in the sleep disorder group (63.15 ± 13.71, 59.85 ± 13.38, 6.52 ± 3.67) were higher than those in the non-sleep disorder group (49.83 ± 13.14, 44.87 ± 10.19, 2.87 ± 3.26) (P < 0.001). The mediation model works well, The total indirect effect was 0.22 (95%CI = [0.17, 0.28]), and the direct effect was 0.16 (95%CI = [0.08, 0.24]). LimitationsThis study used a self-assessment scale. ConclusionsAnxiety and depressive symptoms played a chain mediating role between sleep quality and suicide risk.

Risk of Attempted Suicide Among Patients With IBD: A Nationwide Longitudinal Follow-up Study.

Evidence suggests that IBD is related to an increased risk of depressive disorder and suicide. Whether IBD is an independent risk factor for suicide remains unclear. A matched cohort study design. Taiwan National Health Insurance Research Database. A total of 3625 adults with IBD aged ≥20 years and 36,250 matched controls were selected between 1997 and 2013 and followed-up to the end of 2013. Any suicide attempt was identified during the study period. Stratified Cox regression analysis was conducted on each matched pair to investigate the attempted suicide risk between the IBD and control groups. The hazard ratio for any suicide attempt among the patients with IBD was 4.61 (95% CI, 3.29-6.48) compared with controls matched exactly for depressive disorder. No significant difference in suicide attempts was noted between patients with ulcerative colitis (HR, 4.12; 95% CI, 2.69-6.32) and patients with Crohn's disease (HR, 5.78; 95% CI, 3.27-10.22). The incidence of any suicide attempt may be underestimated. IBD was an independent risk factor for attempted suicide. However, further studies are required to elucidate the definite pathomechanisms between IBD and suicide. ANTECEDENTES: La evidencia sugiere que la enfermedad inflamatoria intestinal (EII) está relacionada con un mayor riesgo de trastornos depresivos y de suicidios.OBJETIVOS: Sin embargo, aún no está claro si la EII es un factor de riesgo independiente para llegar al suicidio.DISEÑO: Estudio de cohortes de tipo pareado.AJUSTES: Investigación en la base de datos del seguro nacional de salud de Taiwán.PACIENTES: Se seleccionaron un total de 3.625 adultos con EII de ≥20 años y 36.250 controes emparejados entre 1997 y 2013, se les dio un seguimiento hasta finales de 2013.PRINCIPALES MEDIDAS DE RESULTADO: Se identificó cualquier intento de suicidio durante el período del estudio. Se realizó un análisis de regresión de Cox estratificado en cada dupla apareada dentro la investigación del riesgo de intento de suicidio comparado entre los grupos de EII y el grupo control.RESULTADOS: El cociente de riesgo instantáneo (HR) para cualquier intento de suicidio entre los pacientes con EII fue de 4,61 (el intervalo de confianza [IC] del 95 %: 3,29-6,48) en comparación con los controles apareados exactamente en casos de trastorno depresivo. No se observaron diferencias significativas en los intentos de suicidio entre los pacientes con colitis ulcerosa (HR: 4,12, IC 95 %: 2,69-6,32) y enfermedad de Crohn (HR: 5,78, IC 95 %: 3,27-10,22).LIMITACIONES: La incidencia de cualquier intento de suicidio puede estar subestimada.CONCLUSIÓN: La EII fué un factor de riesgo independiente para el intento de suicidio. Sin embargo, se requieren más estudios para dilucidar los mecanismos patogénicos definitivos entre la EII y el suicidio. (Traducción-Dr. Xavier Delgadillo ).

Taboo obsessions and their association with suicidality in obsessive-compulsive disorder

Individuals with obsessive-compulsive disorder (OCD) more often think about, attempt, and die by suicide than individuals from the general population. Sexual and religious obsessions (i.e., taboo obsessions) have been linked to increased risk of suicidality, but it is unclear if they explain additional risk over and above other risk factors. We refined the recently proposed multidimensional hierarchical model of OCD and explored how each symptom dimension in the model was associated with suicidality in a random half (n = 500) of a well-characterized cohort of patients with OCD. Symptom dimensions and other risk factors significantly associated with suicidality were included in a confirmatory multivariable model conducted with the other half of the sample (n = 501). The predictive confirmatory model accounted for 19% of the variance in suicidality. Taboo obsessions, the general OCD factor (i.e., having many different OCD symptoms at the same time), lifetime major depression, and lifetime substance use disorders significantly predicted suicidality in this model. Lifetime major depression explained most unique variance in suicidality (5.6%) followed by taboo obsessions and the general OCD factor (1.9% each). Taboo obsessions explain a small but significant proportion of variance in suicidality and should be considered an independent risk factor for suicidality in patients with OCD.

Blind box over-engagement and suicide risk among adolescents and young adults: Results of a large-scale survey.

SummaryBackgroundGambling appears to be an independent risk factor for suicide among the young population worldwide. Blind boxes are collectable toys packed randomly in the box, which share certain similarities with gambling and are popular among the young population. This is the first study that examined the association between blind box engagement and suicide risk in the young population, the leading consumption group of blind boxes.MethodsThis study is part of a large-scale, cross-sectional study using convenience sampling conducted Oct 26 to Nov 18, 2021, which covered all the university and college students in the Jilin province, China. A total of 73,206 participants completed the survey with valid data for the current study (male: N = 28,762; female: N = 44,444; Mean age = 19·59). Participants’ blind box engagement, suicide risk, depression, anxiety, alcohol use, smoking habit, and sociodemographic characteristics were assessed. First, we used univariate and multivariable binary logistic regression models to examine the relationship between blind box engagement and suicide risk in all participants. Second, we tested whether depression and anxiety would mediate the association between blind box engagement and suicide risk. Third, we analysed the association between “Frequency (i.e., frequency of blind box engagement),” “Bet (i.e., expenditure on the blind box that exceeds affordability),” “Tolerance (i.e., level of addiction),” “Borrowed (i.e., the amount of money borrowed for blind box engagement),” and suicide risk in the group with blind box engagement history.Findings4,195 participants (5·73%) have engaged in blind boxes, with 3,255 females (77·59%) and 940 males (22·41%). In the univariate models, binary logistic regression showed that blind box engagement was associated with suicide risk in both male and female participants (male: OR = 2·21, 95% CI = 1·86-2·63; female: OR = 1·64, 95% CI = 1·50-1·78). In the multivariable models, after controlling age, subjective socioeconomic status, per capita disposable income, alcohol use, and smoking habit, blind box engagement still was associated with suicide risk across genders (male: OR = 2·25, 95% CI = 1·89-2·68; female: OR = 1·58, 95% CI = 1·45-1·73). Depression (male: indirect effect = 0·31, SE = 0·04, p < 0·001; female: indirect effect = 0·20, SE = 0·02, p < 0·001) and anxiety (male: indirect effect = 0·26, SE = 0·03, p < 0·001; female: indirect effect = 0·13, SE = 0·02, p < 0·001) mediate the association between blind box engagement and suicide risk. Within the blind box engagement group, forward binary logistic regression revealed that “Tolerance” was associated with participants’ suicide risk in both males (p = 0·001) and females (p < 0·001); “Borrowed” (p = 0·019) alone was associated with the male participants’ suicide risk.InterpretationOur findings showed that blind box over-engagement is positively associated with suicide risk in both young males and females, and this association persisted after adjusting for influencing factors. In spite of the limitations in this study (e.g., cross-sectional, convenience sampling), current findings can assist policymakers in developing regulations for such a prosperous youth-dominant consumption industry while protecting youth's mental health worldwide.FundingNone.

Incidence, trend and risk factors associated with suicide among patients with malignant intracranial tumors: a surveillance, epidemiology, and end results analysis.

Cancer patients are associated with an elevated risk of suicide. This study aims to investigate the suicide rates and identify risk factors for suicide among patients with malignant intracranial tumors (MITs). Patients diagnosed with MITs during the years of 1975-2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) program. Suicide rates and standardized mortality ratios (SMR) were calculated. Cox regression analyses were used to identified risk factors for suicide among MIT patients. Among 115,668 patients with MITs collected from the SEER program, 99 committed suicide. The rate of suicide was 23.02 per 100,000 person-years, and SMR of suicide was 1.90. Diagnosis in recent era (years 2000-2015, SMR = 2.01), male gender (SMR = 1.78), older age (60-79years, SMR = 3.54), white race (SMR = 1.86), married persons (SMR = 2.31), living in rural areas (SMR = 2.50), history of other malignancy (SMR = 3.81), diagnosis of glioblastoma (SMR = 4.05) and supratentorial location (SMR = 2.45) were associated with an increased incidence of suicide. In addition, the risk of suicide increased significantly within the first year after diagnosis (SMR = 13.04). Multivariate Cox regressions showed that older age, male sex, and supratentorial location were independent risk factors for suicide. The suicide mortality among patients with MITs steadily elevated in the past decades. Male sex, older age, and supratentorial location were significantly associated with risk of suicide, especially within the first year following diagnosis. Healthcare providers should early identify and effectively intervene with MIT patients at risk.

Pharmacological Management of Nightmares Associated with Posttraumatic Stress Disorder.

Posttraumatic stress disorder (PTSD) can be a chronic and disabling condition. Post-traumatic nightmares (PTNs) form a core component of PTSD and are highly prevalent in this patient population. Nightmares in PTSD have been associated with significant distress, functional impairment, poor health outcomes, and decreased quality of life. Nightmares in PTSD are also an independent risk factor for suicide. Nightmare cessation can lead to improved quality of life, fewer hospital admissions, lower healthcare costs, and reduced all-cause mortality. Effective treatment of nightmares is critical and often leads to improvement of other PTSD symptomatology. However, approved pharmacological agents for the treatment of PTSD have modest effects on sleep and nightmares, and may cause adverse effects. No pharmacological agent has been approved specifically for the treatment of PTNs, but multiple agents have been studied. This current narrative review aimed to critically appraise proven as well as novel pharmacological agents used in the treatment of PTNs. Evidence of varying quality exists for the use of prazosin, doxazosin, clonidine, tricyclic antidepressants, trazodone, mirtazapine, atypical antipsychotics (especially risperidone, olanzapine and quetiapine), gabapentin, topiramate, and cyproheptadine. Evidence does not support the use of venlafaxine, β-blockers, benzodiazepines, or sedative hypnotics. Novel agents such as ramelteon, cannabinoids, ketamine, psychedelic agents, and trihexyphenidyl have shown promising results. Large randomized controlled trials (RCTs) are needed to evaluate the use of these novel agents. Future research directions are identified to optimize the treatment of nightmares in patients with PTSD.

Treatment Modalities for Chronic Pain in Elderly Patients With Depression: A Systematic Review.

Objective: To review the best pharmacologic and nonpharmacologic interventions in the management of chronic pain in elderly patients with depression.Data Sources: A systematic review of the literature was performed following the PRISMA guidelines and using PubMed. Articles published from 2010 to 2020 were included in the search. Search terms included (major depressive disorder OR MDD OR unipolar depression) AND (chronic pain) AND (elderly).Study Selection: The PubMed search identified 540 articles. All studies were in English and included reports about pain and depression in elderly individuals aged ≥ 65 years.Data Extraction: Articles were reviewed in 2 phases: abstract review followed by full-text review.Results: Abstracts were reviewed for relevance, and a total of 37 articles were identified for full-text review. In this phase, articles not meeting the elderly age criteria (≥ 65 years) or not discussing any treatment modalities were excluded. Nine papers were included after full-text review. The results showed co-occurrence of chronic pain and depression in 13% of the elderly population. Common pain symptoms were related to cancer, back pain, and arthritis.Conclusions: The findings emphasize the importance of individualized assessment of chronic pain in elderly patients with mood disorders such as depression. Since chronic pain and depression are independent risk factors for suicide, it is crucial to complete a thorough history and physical examination and to apply relevant screening tools for both depression and pain.

Pain and suicide: what should we tell our trainees?

Chronic pain is a debilitating medical condition affecting a significant percentage of the population worldwide. Considerable evidence suggests that pain is an independent risk factor for suicide and inadequately managing pain has been identified as a risk for suicidal behaviour. Additionally, medications used to treat pain may also contribute to suicidal behaviour. Extensive research on pain highlights deficiencies in the clinical management on pain with more gaps in care when patients have pain in combination with mental illness and suicidal behaviour. Providing trainees additional knowledge and equipping them with relevant tools to screen and manage chronic pain efficiently is a potential strategy to mitigate suicide risk. Also, trainees need to be educated on how to screen for suicidality in individuals with pain and apply suicide prevention interventions. This paper will emphasise the necessity to improve education about pain, its close relationship with suicide and effective suicide screening as well as management strategies for medical providers. With additional research, it is the hope that novel treatment modalities will be developed to treat pain to improve the quality of life of individuals suffering from this condition and to decrease suicide risk in this patient population.

Risk of suicide among individuals with a history of childhood cancer

Previous studies have described suicidal ideation among survivors of childhood cancer, but small numbers of events limit the understanding of suicide risk. The objectives of this study were to assess whether childhood cancer survivors are at increased risk of suicide in comparison with the general population and to determine risk factors associated with risk in a population-based cohort. First primary malignancies among individuals aged 0 to 19 years from 1975 to 2016 were identified from Surveillance, Epidemiology, and End Results (SEER) databases. Standardized mortality ratios (SMRs) of suicide were obtained via SEER*Stat software from SEER 9. Fine and Gray proportional hazards models were used to identify suicide-associated factors among childhood cancer patients included in SEER 18. In all, 96,948 childhood cancer cases and 89 suicides were identified. Across all attained ages, the suicide risk for individuals with a childhood cancer history (11.64 per 100,000 person-years) was similar to the risk for those without a cancer history (SMR, 1.14; 95% confidence interval [CI], 0.91-1.43). However, for survivors alive beyond the age of 28 years (the median age of death by suicide), the suicide risk was significantly elevated (suicides per 100,000 person-years, 22.43; SMR, 1.40; 95% CI, 1.02-1.87). Females (hazard ratio, 0.29; 95% CI, 0.18-0.59; P < .01) had lower risks than males. These results suggest that long-term childhood cancer survivors may be at increased suicide risk. Male sex is an independent risk factor for suicide. However, the absolute risk of suicide in older survivors is still low at ~1 per 5000 person-years. Future efforts should identify survivorship strategies to mitigate suicide risk.

Youth suicide risk screening in an outpatient child abuse clinic.

Child abuse is an important independent risk factor for suicide. The purpose of the project was to evaluate the implementation of a universal suicide risk screening and assessment tool in an outpatient child abuse evaluation clinic. Participants consisted of all patients between the ages of 10 and 18 years who received services at the study site within a 3-month period (n = 162). The study site implemented a tool created for the sole purpose of detecting suicide risk, the Ask Suicide-Screening Questions (ASQ) tool. Data was retrospectively collected using electronic health records; rates of compliance with screening and screen positive rates were calculated. Suicide risk screening with the ASQ was conducted on 90.7% (147) of the patients. Forty-three (29.2%) patients screened positive for suicide risk. This is a significant increase in detection rates compared to baseline preimplementation data. Of the 67 preteens, 10-12 years of age, that were screened, 14.9% (10/67) screened positive for suicide risk, making up 23% of the positive screens. Implementing a universal suicide risk screening tool was a successful strategy for detecting suicide risk. A quarter of the youth who screened positive on the ASQ were preteens, highlighting the importance of screening the 10- to 12-year olds for suicide risk.

Dementia and suicide: What relationship to establish and what risks to consider?

IntroductionGiven the marked population aging in the world, the incidence of dementia has significantly increased, becoming a growing health care problem. Suicide is a considerable health issue throughout the life span, being prevalent in older adults, and in many countries the highest suicide rates are found in the elderly. Thus far, the relationship between dementia and suicide remains poorly understood and inconsistent.ObjectivesThe aim of this study is to do a non-systematic review of the current literature regarding the association between suicide risk and dementia.MethodsWe conducted a research using the Medline database, through the Pubmed search engine, using the following key-words: “dementia”, “suicide” and “risk factors”.ResultsOverall, the risk of suicide in people with dementia appears to be the same as that of age-matched general population. However, studies point to the existence of a number of factors that can increase this risk, such as: early age of dementia diagnosis, recent diagnosis, disease awareness and depression, hopelessness, male gender, failure to respond to anti-dementia medication, history of inpatient psychiatric hospitalizations, concurrent medical comorbidities.ConclusionsStudies have reported mixed results as to whether dementia itself is an independent risk factor for suicide. Despite these findings, understanding the risk factors for suicide among people with dementia is crucial and suicide prevention efforts should be carried out in this population.

CLINICAL AND SOCIO-DEMOGRAPHIC CORELATES IN PATIENTS OF DEPRESSION WITH SUICIDAL BEHAVIOUR.

Background: Suicidal behaviour is frequently seen in context of depression. Few studies have demonstrated sociodemographic distinction between depression with and without suicidal behaviour. This study compares various psycho-socio-demographic factors associated with depression in context of suicidal behaviour. Materials And Methods: 60 depression patients with suicidal behaviour and 60 depression patients without suicidal behaviour were compared using a specially designed intake proforma, ICD-10 diagnostic criteria for research,Hamilton Rating Scale for Depression-17 (HAMD-17). Results: Depression with suicidal behaviour had more females, married, Hindu, literate, low socioeconomic status, urban locality, nuclear family samples, with earlier age of onset of illness. The total HAM-D scores were signicantly higher in the depression with suicidal behaviour group. Conclusions: Sociodemographic parameters are intricated crucially with suicidality.The present study identies female gender, nuclear family, urban background, unemployment and literacy to be an independent risk factor for suicidality. Suicidal behaviour increases with amount of time spent in depressive illness. Hence socio-demographic factors can be helpful as indicators of suicidal behaviour with depression.

Coincident Patterns of Suicide Risk Among Adult Patients with a Primary Solid Tumor: A Large-Scale Population Study.

BackgroundSuicide rate is much higher in cancer patients than in general population. This study examined the suicide risk in survivors of primary solid tumor across 19 cancer sites considering risk coincident patterns based on area-based SES indicators.MethodsA retrospective search of the SEER database was conducted. Independent risk factors for suicide were identified using the Cox proportional-hazards model. Exploratory factor analysis and cluster analysis were used to create coincident patterns of SES factors.ResultsSuicide risk was higher for patients with a primary solid tumor who were older, male, white, unmarried, had no insurance, poorly differentiated, distant metastasis and did not undergo active treatment (especially surgery). The suicide risk was higher for patients living in areas with economic and education disadvantage, high levels of immigration and crowding, and high levels of residential instability. Concomitant presence of high economic and education disadvantage, high immigration and crowding levels and low residential instability, showed the highest risk of suicide.ConclusionIn order to mitigate suicidal risk, clinicians should pay more attention to patients who are older, male, white, not married, high levels of cancer severity, not received active treatment (especially surgery), and having no insurance. Identifying coincident patterns of suicide help further screen high suicidal risk patients based on area-based socioeconomic status.

Abstract P237: Stroke Survivors and Suicide: A Systematic Review and Meta-Analysis

Background: People with neurological conditions are at a higher risk of suicide compared to the general population. Despite the known association of stroke with depression and suicidal ideation, it is unclear if stroke is associated with a higher risk of suicide. Methods: We systematically searched MEDLINE, Embase, PsycINFO, and Google Scholar from their inception to July 26, 2020 using keywords and database-specific subject. We independently adjudicated and selected observational studies that compared the risk of suicide in stroke survivors to a comparison group, consisting either of people without history of stroke or the general population. We evaluated study quality using the Newcastle Ottawa scale. Using random effects meta-analysis, we calculated the pooled adjusted risk ratio (RR) of suicide in stroke survivors, and separately calculated the pooled adjusted RR of death by suicide and suicide attempt. Using prespecified analyses, we explored study-level factors to explain heterogeneity. Results: We screened 4023 articles and included 23 studies, of fair quality, totaling over 2 million stroke survivors, of whom 5563 committed suicide. Compared to the non-stroke group, the pooled adjusted RR of suicide in stroke survivors was 1.73 (95% confidence interval, 1.54-1.95, I 2 = 93%), with a significantly (P=0.03) higher adjusted risk of suicide attempt (RR 2.09, 1.69-2.58) than of death by suicide (RR 1.61, 1.44-1.80). Observed heterogeneity could not be explained by pre-specified meta-regression and subgroup analyses. Conclusions: Stroke should be recognized as an independent risk factor for suicide. Comprehensive strategies to screen and treat depression and suicidal ideation in stroke survivors should be developed to reduce the burden of suicide in stroke survivors.

Suicide and suicidality in children and adolescents with chronic illness: A systematic review

Suicide is currently the second leading cause of death for children and adolescents. Evidence suggests that the presence of a chronic medical illness is an independent risk factor for suicidality and completed suicide in both youth and adults. In addition, the period of childhood and adolescence is already a time of marked vulnerability for psychiatric disorders and suicidality, and youth with medical conditions or chronic illnesses are at an even greater risk for suicide. Previous research has identified elevated risk of suicidality in youth with chronic illness; however, the specific risk factors, psychiatric comorbidities, and etiology for suicide and related behaviors are unique, differ by illness, and are far less understood. The current systematic review provides an evaluation and synthesis of empirical literature from the past 30 years that investigated the relationship between specific chronic illnesses, suicide, and suicidality in a pediatric (under 18) population. Results of this synthesis demonstrate that the effects of chronic illness on youth suicidality are not homogenous as the pathways and risk factors can vary greatly for each specific disease. Given the considerable etiological heterogeneity for suicidality, this review provides clinicians and medical professionals with a clearer pathway to identification and delineation of risks for suicidality in specific illnesses allowing for better informed and more accurate interventions for children and adolescents with chronic illnesses who are at risk for suicide.

Suicidality in Major Depressive Disorder in a Nigerian Psychiatric Hospital—Is There Any Relationship?

Background: There is increasing resurgence of suicide globally, especially in developing countries, probably owing to socio-economic instability. Majority of suicidal phenomenon is attributed to depressive disorders, which significantly contribute to the global burden of diseases. Aim: This study assessed the prevalence and correlates of suicidality (suicidal ideation and attempts) among adult outpatients with major depression at Federal Neuro-Psychiatric Hospital (FNPH), Benin City, Nigeria. Method: A cross-sectional study conducted between March and June 2018 utilizing systematic random sampling of eligible participants, aged between 18 and 64 years. One hundred and thirty-two patients with major depression, with their diagnosis confirmed with the Depression module of the Mini International Neuropsychiatric Interview (MINI) were recruited. A Socio-Demographic Questionnaire, the Brief Psychiatric Rating Scale (BPRS), the Pittsburgh Sleep Quality Index (PSQI) and Suicidality Module of MINI were administered to consented participants. Results: The past month prevalence of suicidality and suicidal ideation were 47.7% (n = 63) and 36.4% (n = 48) respectively. While, the lifetime prevalence of suicidal attempts was 18.2% (n = 24), the current suicidal ‘moderate-high risk’ was 12.1% (n = 16). Participants were 35% more likely to report suicidality for every unit increase in symptom severity (BPRS score) (aOR 1.35; 95% CI 1.20 - 1.52, P = 0.001). Conclusion: Suicidality is common among outpatients with major depression at the Federal Neuro-Psychiatric Hospital, Benin City. Severity of psychopathology was an independent risk factor for suicidality in depressive disorder.

Risk Factors for Suicide and Suicide Attempts Among Patients With Treatment-Resistant Depression: Nested Case-Control Study

The risk of suicide is elevated among patients with treatment-resistant depression (TRD). Risk factors for suicide and suicide attempts among cases and controls with TRD were investigated using data from nationwide Swedish registers. Among 119,407 antidepressant initiators with a diagnosis of depression, 15,631 patients who started a third sequential treatment trial during the same depressive episode were classified with TRD. A nested case-control study compared cases with suicide and suicide attempts with up to three closely matched controls. Sociodemographic and clinical risk factors were assessed using conditional logistic regression analyses. In all, 178 patients died by suicide and 1,242 experienced a suicide attempt during follow-up. History of suicide attempts, especially if <1 year after the attempt, was a significant independent risk factor for suicide (adjusted odds ratio [aOR], 8.9; 95% confidence interval [CI], 5.1–15.7) as were 10 to 12 years of education compared to lower education (aOR, 1.69; 95% CI, 1.02–2.81). For attempted suicide, the strongest independent risk factors were history of suicide attempts (<1 year aOR, 5.1; 95% CI, 4.0–6.5), substance abuse (aOR, 2.6; 95% CI, 2.2–3.1), personality disorders (aOR, 1.9; 95% CI, 1.5–2.3), and somatic comorbidity (aOR, 2.0; 95% CI, 1.04–3.9). Suicide attempts, especially if recent, are strong risk factors for completed suicide among patients with TRD. Established risk factors for suicide attempts were confirmed for patients with TRD.

Does physical ill-health increase the risk of suicide? A Census-based follow-up study of over 1 million people

Background/Main Aim Prior poor mental ill-health is a recognised risk factor for suicide but the relationship between multiple physical health conditions and suicide risk is less clear.&#x0D; Methods Data of 1,196,364 adults (18-90years+) enumerated in Northern Ireland’s 2011 Census records were linked to death registrations until the end of 2015. Logistic regression models were generated to determine association between physical health status and both all-cause mortality and death from suicide, with adjustment for census-based attributes including the presence of mental health status. Physical health conditions severity was assessed using limiting long-term illness (LLTI: none, a little, a lot) and number of physical health conditions.&#x0D; Results About 14% of the cohort (n=164,473) had physical multimorbidity (two or more conditions) and 51,672 individuals died during follow-up; 877 due to suicide. A dose-response relationship was evident between number of physical conditions and all-cause death reaching an adjusted odds ratio (AOR) of 3.79 (95%CI: 3.65–3.94) in those with 4-or-more conditions (compared to those with no physical condition), but the association between number of physical conditions and suicide risk disappeared with adjustment for mental health. LLTI however, was an independent risk factor for suicide even after adjustment for mental health (AOR 1.52, 95%CI: 1.25–1.87 for those with daily activities limited a lot). The relationship between LLTI and suicide risk was only evident at younger ages (people aged less than 60).&#x0D; Conclusion This study demonstrates that the number of physical conditions is not an independent risk for suicide but that activity limitation is, though only at younger ages.