Lethality Of Attempts Research Articles

Trajectories in suicide attempt method lethality over a five-year period: Associations with suicide attempt repetition, all-cause, and suicide mortality.

It is not known if there are discernible patterns in method lethality over successive episodes of self–harm and, if so, how these may be differentially associated with risks of self–harm repetition and suicide. Latent trajectory modelling estimated variation in patterns of suicide attempt lethality in 1,719 individuals attended by ambulance services on at least three occasions between 2012 and 2016. Cox regression modelling investigated hazards of suicide attempt repetition, all–cause, and suicide mortality as a function of these patterns. Two distinct trajectories provided optimal fit (BIC: –39,464.92). The first (Low/Moderate to Low/Moderate Lethality group; 92.5%) consisted of those consistently using methods associated with low to moderate potential lethality throughout the observation period. The second (High to Low/Moderate Lethality group; 7.5%) consisted of those who initially used methods with higher potential lethality but who switched to methods characterised by lower lethality. There were no significant differences between groups in the hazards of reattempting suicide (Hazard Ratio [HR] = 1.41, 95% CI 0.76 to 2.59) or all–cause mortality (HR = 1.21, 95% CI 0.63 to 2.32). However, those assigned to the High to Low/Moderate Lethality trajectory group may be at greater risk of suicide (Sub–Hazard Ratio [SHR] = 2.82, 95% CI 1.16 to 6.86). There may be discernible sub–groups of patients with important differences in clinical treatment needs and suicide risk profiles. These differences should be considered when undertaking psychosocial risk/needs assessments with those presenting to clinical services following self-harm.

Characteristics of depressed suicide attempters with remitted substance use disorders

Substance use disorder (SUD) comorbidity in mood disorders increases suicide risk. Suicide attempters with active SUD appear to have distinct characteristics but little is known whether these characteristics persist during remission and if they are related to different aspects of suicidal behavior. In this study, suicide attempters with a DSM mood disorder and remitted SUD (AT+SUD) (N = 135) were compared to those without lifetime SUD (AT-SUD) (N = 219) in terms of demographic, clinical and suicidal behavioral characteristics. Factor analyses were conducted to generate subjective distress and impulsivity/aggression factors – previously identified by our group to predict suicide risk in mood disorders. Associations between these traits and SUD history and suicidal behavior characteristics were then tested. Compared with AT-SUD, AT+SUD were more likely to be male, less educated and to have a Cluster B personality disorder. AT+SUD individuals had greater impulsivity/aggression factor scores, but comparable subjective distress scores. AT+SUD made a greater number of suicide attempts, with higher lethality, despite comparable suicide intent and degree of planning with AT-SUD. Impulsivity/aggression was higher in multiple versus single attempters, but did not correlate with suicide attempt lethality. Among suicide attempters with mood disorders, a history of lifetime SUD was associated with more frequent and more lethal suicide attempts. Among other correlates of lifetime SUD in this sample, impulsive/aggressive traits may explain greater frequency of suicide attempts. The results underscore that persons with mood disorders and lifetime SUD are at particularly high risk of frequent and lethal suicide attempts where more intensive prevention efforts are warranted.

COVID-19 and its effect on emergency presentations to a tertiary hospital with self-harm in Ireland.

This study aimed to assess the impact of COVID-19 on presentations to an acute hospital with self-harm. All presentations to University Hospital Galway with self-harm were assessed during the peak period of the coronavirus crisis in Ireland, over the 3 months from 1 March to 31 May 2020. These data were compared with presentations in the same months in the 3 years preceding (2017-2019). Data were obtained from the anonymised service database. This study found that in 2020, the rate of presentation with self-harm dropped by 35% from March to April and rose by 104% from April to May, peaking from mid-May. When trends over a 4-year period were examined, there was a significantly higher lethality of attempt (p < 0.001), and significant differences in diagnosis (p = 0.031) in 2020 in comparison with the three previous years. The increased lethality of presentations remained significant after age and gender were controlled for (p = 0.036). There were also significant differences in the underlying psychiatric diagnoses (p = 0.018), notably with a significant increase in substance misuse disorders presenting during the 2020 study period. COVID-19 showed a reduction in self-harm presentations initially, followed by a sharp increase in May 2020. If a period of economic instability follows as predicted, it is likely that this will further impact the mental health of the population, along with rates of self-harm and suicidal behaviours. There is a need for research into the longer-term effect of COVID-19 and lockdown restrictions, especially with respect to self-harm.

Identifying the Medical Lethality of Suicide Attempts Using Network Analysis and Deep Learning: Nationwide Study.

BackgroundSuicide is one of the leading causes of death among young and middle-aged people. However, little is understood about the behaviors leading up to actual suicide attempts and whether these behaviors are specific to the nature of suicide attempts.ObjectiveThe goal of this study was to examine the clusters of behaviors antecedent to suicide attempts to determine if they could be used to assess the potential lethality of the attempt. To accomplish this goal, we developed a deep learning model using the relationships among behaviors antecedent to suicide attempts and the attempts themselves.MethodsThis study used data from the Korea National Suicide Survey. We identified 1112 individuals who attempted suicide and completed a psychiatric evaluation in the emergency room. The 15-item Beck Suicide Intent Scale (SIS) was used for assessing antecedent behaviors, and the medical outcomes of the suicide attempts were measured by assessing lethality with the Columbia Suicide Severity Rating Scale (C-SSRS; lethal suicide attempt >3 and nonlethal attempt ≤3).ResultsUsing scores from the SIS, individuals who had lethal and nonlethal attempts comprised two different network nodes with the edges representing the relationships among nodes. Among the antecedent behaviors, the conception of a method’s lethality predicted suicidal behaviors with severe medical outcomes. The vectorized relationship values among the elements of antecedent behaviors in our deep learning model (E-GONet) increased performances, such as F1 and area under the precision-recall gain curve (AUPRG), for identifying lethal attempts (up to 3% for F1 and 32% for AUPRG), as compared with other models (mean F1: 0.81 for E-GONet, 0.78 for linear regression, and 0.80 for random forest; mean AUPRG: 0.73 for E-GONet, 0.41 for linear regression, and 0.69 for random forest).ConclusionsThe relationships among behaviors antecedent to suicide attempts can be used to understand the suicidal intent of individuals and help identify the lethality of potential suicide attempts. Such a model may be useful in prioritizing cases for preventive intervention.

The neuropsychology of epilepsy and suicide: A review

Abstract Suicide accounts for three-quarters of violent deaths in the U.S. Epilepsy is diagnosed in 1.2% of the U.S. population. Within persons with epilepsy, the risk of suicide is 22% higher than in typical adults. Neuropsychologists are a part of epilepsy center care teams, yet to date there is no literature addressing the neuropsychology or brain-behavior relationship of suicide in persons with epilepsy. In this review, we summarized and integrated the literature on epilepsy and suicide. Findings included persons with epilepsy run a two-fold risk of suicidal behavior; risk increased with comorbidity, type of epilepsy, and neurosurgical intervention; no association was consistently evidenced between suicidality and recency of epilepsy diagnosis or duration of seizure or control, nor was a relationship confirmed between lethality of attempt and neurocognitive sequelae. Findings supported the bidirectionality of risk in epilepsy and suicidality. We reviewed potential neurobiological origins of suicide and epilepsy in the hypothalamic-pituitary-adrenal axis, hippocampus, and serotonergic, noradrenergic, and glutamatergic/GABAergic pathways, and of epilepsy in cellular plasticity, inflammatory response, and excitatory-inhibitory dysfunction. Neuropsychological theories of suicide were also reviewed. Neuropsychological domains of assessment were surveyed, and clinical implications discussed. Directions for further research were proposed.

COGNITION AND LATE-LIFE SUICIDE: COGNITIVE PROFILES AMONG DEPRESSED SUICIDAL SUBGROUPS AS A FUNCTION OF MEDICAL SERIOUSNESS AND ONSET OF SUICIDAL BEHAVIOR

Introduction Depressed older adults are at high-risk for suicidal behavior (Pfeiffer et al., 2013, Vannoy et al., 2007) and for developing dementia (Kaup et al, 2016; Mizra et al., 2016). Executive dysfunction has been described across the life-span in suicide attempters (Keilp et al., 2013, Clark et al., 2011, Richards-Devantoy et al., 2012). However, few studies have explored the links between several domains of cognition and suicide risk in those with late-life depression and the extant evidence is equivocal at best (Conejero et al., 2018, Tu et al., 2018, Erlangsen et al., 2008). Suicidal behavior is heterogeneous, and it is unclear whether the medical seriousness (Beck et al., 1975) of the suicide attempt or whether the onset of first suicidal behavior (initiated earlier in life relative to late-life (60+ years)) relates differently to cognitive deficits. Methods This project uses a case-control design and includes 278 adults aged 50?years and older: 56 non-depressed controls (no life-time history of psychiatric disorder), 67 non-suicidal depressed older adults(no life-time history of suicide ideation or suicide attempt), 63 depressed suicide ideators, and 92 depressed adults with a history of suicide attempt. Analysis 1 examined cognitive profiles of low (n=52) vs. high-lethality (i.e., potentially fatal without medical intervention) (n=40) suicide attempters relative to non-suicidal depressed older adults and non-depressed controls. Analysis 2 examined cognitive profiles of those making their first suicide attempt prior to age 60 (early onset: n=66) and those making their first suicide attempt at or after age 60 (late-onset: n=26) relative to non-suicidal depressed older adults and non-depressed controls. Lethality of attempt was similarly distributed across early- and late-onset attempters. Depression severity was assessed using the Hamilton Depression Rating Scale (HAM-D-17 minus the suicide item). Cognitive functioning was assessed using the Repeatable Battery of Neuropsychological Status (RBANS) and the Trail Making Test from the Delis Kaplan Executive Functioning System (D-KEFS). Linear mixed effects models were used for assessing group differences cognitive domains assessed using multiple subtests or trials (i.e., learning and memory) and linear regression was used for cognitive domains assessed using a single test (i.e., processing speed, executive functioning). Demographic covariates were used for all data analyses (i.e., age, sex, education). Analyses comparing suicidal subgroups with non-suicidal depressed older adults additionally adjusted for depression severity and lifetime history of anxiety and substance use disorders. Results High-lethality attempters performed worse than low-lethality attempters and non-depressed controls on measures of verbal memory (Linear mixed effects model; group x test interaction: F=1.997, p=0.03). On a measure of executive functioning, low- but not high-lethality attempters performed worse than non-suicidal depressed older adults (LL: Beta= -0.18, p=0.01; HL: Beta=-0.12, p=0.08) and non-depressed controls (LL: Beta=0.31, p Conclusions Cognitive profiles of older suicidal attempters varied based on the lethality of most lethal suicide attempt and age of first suicide attempt. Those with low-lethality and early-onset suicide attempts exhibited executive dysfunction relative to non-suicidal depressed older adults, in-line with previous findings indicating executive dysfunction as part of life-long suicide vulnerability factors. In contrast, late-onset attempters exhibited slower processing speed relative to non-suicidal depressed older adults, and high-lethality attempters performed worse on memory measures relative to low-lethality attempters, possibly indicating a dementia prodrome. This research was funded by: NIMH: R01 MH085651; VA VISN 4 MIRECC Advanced Research Fellowship, VA Office of Academic Affiliations

Dexamethasone Suppression Test May Predict More Severe/Violent Suicidal Behavior.

IntroductionSeveral studies demonstrated that the hypothalamic-pituitary-adrenal (HPA) axis is dysregulated in suicide attempters. Prospective studies found that people with an abnormal response at the dexamethasone suppression test (DST) are more likely to commit suicide. However, whether DST may predict suicide attempts remains less clear. A possible strategy to address this question is to consider the suicide attempt lethality.Objectives(1) To compare the pre- and post-DST cortisol levels in serious/violent suicide attempters and in non-serious/non-violent suicide attempters, and (2) to investigate whether cortisol level can predict new suicide attempts or their lethality.MethodsThe study included 70 recent suicide attempters (25 with a serious or violent attempt) who were followed for two years. Three saliva samples for cortisol measurement were obtained at 8a.m., 3p.m., and 9p.m. before the DST (pre-DST). Then, at 11 p.m., 1 mg of dexamethasone was given orally. The following day (post-DST), three saliva samples were collected at the same hours as before. The post-DST–pre-DST salivary cortisol Δ index was calculated for each collection time. The Risk-Rescue Ratio Scale (RRRS) and the Suicidal Intent Scale (SIS) were used to characterize the suicide attempt at inclusion and those occurring during the follow-up.ResultsPost-DST cortisol level at 9 p.m. was higher in patients with an initial violent or serious suicide attempt than in non-violent/non-serious attempters (p < .010). Higher post-DST cortisol at 9p.m. was associated with lower RRRS rescue score and higher clinical impression of suicide severity at inclusion. Among the 66 patients who completed the follow-up, 26 attempted suicide again at least once. Higher pre-DST cortisol at 8a.m. predicted new suicide attempts during the follow-up (OR = 2.15 [1.11, 4.15]), and higher cortisol Δ index at 9p.m. was associated with higher suicide intent during the follow-up.ConclusionsOur results suggest that HPA axis hyper-reactivity monitored with the DST is a marker of violent/serious suicide attempt with lower rescue possibility. Furthermore, higher changes between pre-DST and post-DST cortisol levels may predict higher suicide intent. These findings might help to characterize the biological features of nearest suicide phenotypes.

Contemporary Characteristics and Lethality Correlates of Serious Suicide Attempts in Children and Adolescents.

Adolescent suicide rates have increased in the past decade. Few studies have examined contemporary pediatric suicide attempters with medically serious suicide attempts, particularly among younger pediatric suicide attempters. This preliminary chart review study examined 200 adolescents with medically serious suicide attempts and sought to identify general cohort characteristics, differences in cohort characteristics based on age, correlates of lethality, and correlates of rescue (likelihood of prompt medical attention). Our study found that younger adolescents specifically endorsed increased cyberbullying (β=1.1, p=.046) and less hopelessness (β=-0.83, p=.02) compared to older adolescents. Suicide attempt lethality was negatively associated with female gender (β=-0.59, p=.041), rescue (β=-0.19, p=.005), an anxiety diagnosis (β=-0.81, p=.0003), and history of consensual sexual activity (β=-0.79, p=.002). Rescue was positively associated with an ADHD diagnosis (β=0.73, p=.018) and less attempt planning (β=0.96, p=.01), while a history of previous suicide attempt (β=-0.54, p=.04) and more proximal suicide attempt (β=-0.045, p=.008) were associated with a lower rescue score. Our preliminary findings suggest clinicians and future researchers may need to assess certain social and diagnostic factors in children and adolescents at particularly high risk for death by suicide.

Comorbidity Profiles Identified in Older Primary Care Patients Who Attempt Suicide.

To identify comorbidity profiles of older patients last seen in primary care before a suicide attempt and assess attempt and clinical factors (eg, means and lethality of attempt) associated with these profiles. Cohort study and latent class analysis using Department of Veterans Affairs (VA) national data (2012-2014). All VA medical centers in the United States. A total of 2131 patients 65 years and older who were last seen by a primary care provider before a first documented suicide attempt. Fatal suicide attempt and means were identified using the National Suicide Data Repository. Nonfatal attempt was defined using the National Suicide Prevention Applications Network. Medical and psychiatric diagnoses and other variables were determined from electronic medical records. Patients (mean age = 74.4 y; 98.2% male) were clustered into five classes based on medical and psychiatric diagnoses: Minimal Comorbidity (23.2%); Chronic Pain-Osteoarthritis (30.1%); Depression-Chronic Pain (22.9%); Depression-Medical Comorbidity (16.5%); and High Comorbidity (7.3%). The patients in the Minimal Comorbidity and Chronic Pain-Osteoarthritis classes were most likely to attempt fatally compared with classes with a higher burden of comorbidities. Overall, 61% of the sample attempted fatally, and 82.5% of suicide decedents used firearms. This study provides evidence that most comorbidity profiles (>50%) in primary care patients attempting suicide were characterized by minimal depression diagnoses and fatal attempts, mostly with firearms. These findings suggest that more than a depression diagnosis contributes to risk and that conversations about firearm safety by medical providers may play an important role in suicide intervention and prevention. J Am Geriatr Soc 67:2553-2559, 2019.

An Unexpected Death

Back to table of contents Previous article Next article From the PresidentFull AccessAn Unexpected DeathBruce Schwartz, M.D.Bruce SchwartzSearch for more papers by this author, M.D.Published Online:8 Aug 2019https://doi.org/10.1176/appi.pn.2019.8a9The news was shocking. The son of a colleague in our department died by suicide by jumping off an overpass in Los Angeles. There was no warning to his family or history that would suggest why a young man in the prime of his life would take his own life. Los Angeles Police Department officers tried to talk him down, but unsuccessfully. Such unexpected acts are hard for those of us in psychiatry to understand or put into a clinical formulation when information is unavailable. There are also no words to adequately convey the depth of our condolences and sadness to the family despite our experience with these types of acts. We are also at a loss to offer any understanding to our colleagues or the family that might provide them some solace.Suicide is unlike cancer or other terminal illnesses where family and clinicians have some context to understand why and time to prepare for the possible death of the patient. We have all treated patients with suicidality and know how effective we can be with the overwhelming majority of them. We also recognize the limits to our therapeutic efforts and how the autonomy of our fellow humans sometimes leads them to commit irreversible acts in the throes of mental illness and anguish. I could not help but think that if only he had confided in someone, there might have been a chance to stop him. We know that suicide can be highly impulsive, and when lethal attempts are stopped, many of these individuals will not engage in such behavior in the future.The United States is one of the only countries in the world with an increasing rate of suicide. Eastern European countries and Asia have higher rates than this country as economic and cultural factors are often more in play in those countries, but their rates of suicides are declining. We are now approaching a prevalence of about 14 deaths per 100,000 population. For the general population, suicide is the 10th leading cause of death. More disturbing, for young adults, it is the second leading cause of death.So why is this phenomenon occurring in our country? We cannot be certain of the causes for the increase in suicides, but I believe that access to mental health services has become more and more problematic over the past several decades and may well be a contributor. Psychiatrists on the front line of care are required to make very tough decisions about who should be admitted to scarce inpatient beds. Too often suicidal patients have to be discharged before the acute phase of their treatment is completed. Inpatient units in the past strove for “homelike” environments but have been forced to become highly institutional. The push by the Centers for Medicare and Medicaid Services (CMS) and The Joint Commission to be ligature-free has led to the loss of privacy and prisonlike environments. Our therapeutic environments are less than welcoming for someone who wants to seek voluntary treatment for depression. Outpatient care as well is often not accessible in a timely manner, and insurance companies have inadequate numbers of psychiatrists in their networks available to treat suicidal patients.How can we reverse these trends? APA is actively lobbying the Department of Health and Human Services, CMS, and The Joint Commission to bring balance to the inspection process. We also need to bring about improved reimbursement for hospitals and psychiatrists who care for more seriously ill patients. Passage of parity enforcement legislation in Congress and the states is our highest priority. The National Institutes of Health’s funding for suicide research in 2018 was $72 million out of a total research budget of almost $24 billion. Is this evidence of institutionalized discrimination and stigma regarding mental illness?APA has almost 39,000 members. Let’s raise our voices and contact our representatives in Congress to redress this imbalance. Maybe we can reverse the plague of suicide. ■APA has made it easy for you to contact your members of Congress. Go to APA’s Advocacy Action Center. ISSUES NewArchived

Interactive Effects of Acute Suicidal Affective Disturbance and Pain Persistence on Suicide Attempt Frequency and Lethality.

Background: Acute suicidal affective disturbance (ASAD) has been proposed as a suicide-specific entity that confers risk for imminent suicidal behavior. Preliminary evidence suggests that ASAD is associated with suicidal behavior beyond a number of factors; however, no study to date has examined potential moderating variables.Aims: The present study tested the hypotheses that physical pain persistence would moderate the relationship between ASAD and (1) lifetime suicide attempts and (2) attempt lethality. Method: Students (N = 167) with a history of suicidality completed self-report measures assessing the lifetime worst-point ASAD episode and the presence of a lifetime suicide attempt, a clinical interview about attempt lethality, and a physical pain tolerance task. Results: Physical pain persistence was a significant moderator of the association between ASAD and lifetime suicide attempts (B = 0.00001, SE = 0.000004, p = .032), such that the relationship between ASAD and suicide attempts strengthened at increasing levels of pain persistence. The interaction between ASAD and pain persistence in relation to attempt lethality was nonsignificant (B = 0.000004, SE = 0.00001, p = .765). Limitations: This study included a cross-sectional/retrospective analysis of worst-point ASAD symptoms, current physical pain perception, and lifetime suicide attempts. Conclusion: ASAD may confer risk for suicidal behavior most strongly at higher levels of pain persistence, whereas ASAD and pain perception do not influence attempt lethality.

“PROJECT LIFE FORCE-GERIATRIC”: A NOVEL SUICIDE SAFETY PLANNING GROUP TREATMENT

Introduction Older Veterans are the largest and fastest growing segment of the Veteran population. Additionally, the rates of suicide completion are highest in older Veterans; 68% of all deaths by suicide are in Veterans that are 50 and older. [1] Lethality of attempts is also greatest in the geriatric population. Youth typically have 25 attempts per one completed suicide, whereas older adults have only four attempts per one completed suicide. [2] Despite their elevated risk, there is limited research and fewer interventions targeting suicide risk in older Veterans. Therefore, there is an urgent need for effective interventions in reducing the risk of suicide in the geriatric population. Our research team hopes Project Life Force-Geriatric (PLF-G) can fill this gap in treatment. Methods Creating a Suicide Safety Plan (SSP) is an effective treatment for Veterans with suicidal ideation and behaviors [3,4]. PLF is an open-label, 6-month study conducted at the James J. Peters VA Medical Center, that piloted a skills group consisting of ten sessions implementing the SSP in Veterans deemed high risk for suicide. However, this PLF pilot sample only included individuals aged 25-66 years old (average: 46.43 years). To target the high-risk geriatric population, our research team is developing PLF-G. In adapting PLF-G for older adults, accommodations have been made for potential hearing and vision impairments as well as limitations in attention spans among older adults who may have mild deficits in working memory and short-term memory. These modifications include: frequent breaks during sessions, writing key points and agenda items on the white board in large print, using select assessments targeted specifically to geriatric population (e.g. the Geriatric Depression Scale), sessions will be 60-minutes (vs. 90-minutes in PLF pilot), paper handouts in addition to mobile applications, and written summaries for each session using large fonts. See Table 1. Results PLF-G specific data will be included in final presentation, but is not yet available. Below are results from the initial PLF study. In the initial PLF study, Veteran participants were assessed at baseline and post intervention (month 3). Demographic information was collected on 37 participants. The average age was: 46.43 years old (range: 25-66 years). Males accounted for 78%. This was a diverse sample with 52.6% identifying as Hispanic. The PLF study resulted in a statistically significant decrease in suicidal ideation, suicidal behavior, hopelessness, and depression as measured by the Beck Depression Inventory-II (BDI-II), the Beck Hopelessness Scale (BHS), and the Beck Scale for Suicide Ideation (BSS). See Figure 1. There were no suicide attempts or completions throughout the course of treatment. A paired samples t-test was performed to compare pre- and post-intervention scores and there were significant decreases in: 1. Suicidal ideation on the BSS; t(20) = 4.41, p = 0.000 2. Depressive symptoms on the BDI-II; t(20) = 3.989, p = 0.001 3. Hopelessness on the BHS; t(20) = 2.330, p = 0.030 Conclusions The initial PLF decreased suicidality in a non-geriatric Veteran population. During this preliminary treatment, the 80-page manual was finalized, the program yielded encouraging results, it was well tolerated, feasible, and effective in reducing suicidal ideations and behaviors. One significant limitation to the pilot study was the lack of representation of high-risk geriatric patients; therefore, a new pilot study titled PLF-G will be conducted within the geriatric population beginning in January 2019. The results of which will be included in final presentation. This research was funded by This research was supported by VA Merit Award (RX-001911-01A1) and the VISN 2 South MIRECC.

Alcohol dependence syndrome in suicide attempters: A cross-sectional study in a rural tertiary hospital

Background: Suicidal attempt is a phenomenon with a tremendous impact on the medical and social well-being of the individual, and alcohol abuse/dependence has consistently been implicated in the triggering of suicidal attempt. This complex interaction of alcohol and suicide needs further exploration. Aim: This study aimed to examine the frequency of alcohol dependence in suicidal survivors and assess the association of sociodemographic and clinical variables with the severity of dependence in suicide attempters. Materials and Methods: It is a hospital-based, cross-sectional, observational study set in a tertiary care institute where a total of 175 admitted cases of suicidal attempt were included. Patients referred to the department of psychiatry of a teaching hospital in Andhra Pradesh within the study period were enrolled after informed consent. With usual detailed workup, alcohol dependence was ascertained. Relevant information was recorded in a pro forma. Alcohol use/dependence was grouped into various categories in relation to suicidal attempt. Results: Alcohol was consumed by 43.43% of suicide attempters. Alcohol dependence constituted of 30.29%. Severe dependence was present in 9.14% of participants. There was a positive correlation between suicidal intent, lethality of attempt, history of smoking, and psychiatric comorbidity with the groups segregated based on the severity of dependence. Conclusion: High suicidal intent and lethality of attempt are risk factors of attempt in moderate-to-severe dependence. Effective treatment of alcohol dependence can mitigate suicidal attempts.

Value-Based Choice, Contingency Learning, and Suicidal Behavior in Mid- and Late-Life Depression

BackgroundSuicidal behavior is associated with impaired decision making in contexts of uncertainty. Existing studies, however, do not definitively address whether suidice attempers have 1) impairment in learning from experience or 2) impairment in choice based on comparison of estimated option values. Our reinforcement learning model–based behavioral study tested these hypotheses directly in middle-aged and older suicide attempters representative of those who die by suicide. MethodsTwo samples (sample 1, n = 135; sample 2, n = 125) of suicide attempters with depression (nattempters = 54 and 39, respectively), suicide ideators, nonsuicidal patients with depression, and healthy control participants completed a probabilistic three-choice decision-making task. A second experiment in sample 2 experimentally dissociated long-term learned value from reward magnitude. Analyses combined computational reinforcement learning and mixed-effects models of decision times and choices. ResultsWith regard to learning, suicide attempters (vs. all comparison groups) were less sensitive to one-back reinforcement, as indicated by a reduced effect on both choices and decision times. Learning deficits scaled with attempt lethality and were partially explained by poor cognitive control. With regard to value-based choice, suicide attempters (vs. all comparison groups) displayed abnormally long decision times when choosing between similarly valued options and were less able to distinguish between the best and second-best options. Group differences in value-based choice were robust to controlling for cognitive performance, comorbidities, impulsivity, psychotropic exposure, and possible brain damage from attempts. ConclusionsSerious suicidal behavior is associated with impaired reward learning, likely undermining the search for alternative solutions. Attempted suicide is associated with impaired value comparison during the choice process, potentially interfering with the consideration of deterrents and alternatives in a crisis.

Impulsivity, Painful and Provocative Events, and Suicide Intent: Testing the Interpersonal Theory of Suicide.

The Interpersonal Theory of Suicide (IPTS; Joiner, 2005. Why People Die by Suicide. Cambridge, MA: Harvard University Press) hypothesizes that repeated exposure to painful and provocative events (PPE) increases capability for suicide (CS), therefore facilitating the development of suicidal intent, and that impulsive individuals are more likely to experience these painful and provocative events, creating an indirect relationship between impulsivity and CS. Research to date largely supports this hypothesis but has not translated this theory to actual suicidal intent. The present study used data from the MacArthur Violence Risk Assessment Study to examine the relationship between PPE and intent, and the indirect relationship between impulsivity and intent among a sample of 245 recent suicide attempters, using the clinician-rated Suicide Intent Scale as an objective measure of intent. Results supported the hypothesized direct relationship between PPE and intent, and the indirect relationship between impulsivity and intent through PPE. There was no direct relationship between impulsivity and intent, suggesting that the relationship between impulsivity and intent occurs entirely through exposure to PPE. These findings suggest that assessing exposure to painful and provocative events is critical in evaluating risk of suicide, and that impulsivity itself does not confer an increased risk of lethal or nearly lethal attempts.

Moral Objections and Fear of Hell: An Important Barrier to Suicidality.

This review explores the literature to test the hypothesis that 'moral objections to suicide (MOS), especially the conviction of going to hell after committing suicide, exert a restraining effect on suicide and suicidality.' Medline and PsycInfo were searched using all relevant search terms; all relevant articles were selected, rated and reviewed. Fifteen cross-sectional studies were available on this topic, and raise sufficient evidence to confirm a restraining effect of MOS, and sparse data on fear of hell. MOS seem to counteract especially the development of suicidal intent and attempts, and possibly the lethality of suicidal attempts. A differential pattern of influence of MOS on the suicidal continuum is suggested.

Prediction of Lethality in Suicide Attempts: Gender Matters

This study explores gender differences in lethality of suicide attempts. Three years of medical records related to suicide attempters (N = 666) were subjected to analysis. Of the sample, 69.2% were female, 30.8% male; 63.8% Chinese, 15.8% Indian, and 15.0 % Malay. Ages ranged from 10 to 85 years old (M = 29.7, SD = 16.1). More males than females made attempts with high perceived lethality (χ2 = 12.10, p < .0001) and high medical lethality (χ2 = 10.59, p < .0001). Available variables were subjected to regression analyses. The regression models predicted more than 60% of high medical lethality suicide attempts and more than 80% of high perceived lethality attempts. Suicide intent and opportunity for rescue were significant predictors for both measures of lethality. Gender differences were examined. Findings were discussed in regard to implications in suicide assessments and interventions.

PSYCHOSOCIAL FACTORS AS RISK FACTOR IN SUICIDAL POISONING: A CROSS-SECTIONAL STUDY

Objective: Suicide is known to be a phenomenon in low-, middle-, and high-income countries and occurs in all sociodemographic groups. It ranges from acute to fatal lethal attempts which occur in the context of a social crisis. Deliberate self-poisoning for suicide is a growing public health concern with frequent emergency department admissions. An epidemiological surveillance is essential for every region to understand the pattern, underlying psychological factors, and the scope of preventive measures.Methods: The 2-year retrospective study describes the epidemiology and influencing factors of suicides by self-poisoning in patients admitted to a Government Hospital and a Teaching Hospital in Pune, Maharashtra, from January 1, 2014 to December 31, 2015.Result: Out of 1010 poisoning cases reported, 539 were suicidal self-poisoning. Significantly males more than females were brought to the hospitals due to deliberate self-poisoning (1:0.86, χ2=38.05; p&lt;0.001). The age group most recorded was 20-35 years (67.7%). Psychosocial factors were associated with increased risk of suicidal self-poisoning attempts (risk ratio 4.76, 95% confidence interval 4.07-5.57; p&lt;0.001). Psychosocial factors were interpersonal conflict (52.4%), stress (30.4), dissatisfaction in life (6%), and alcoholism or mental disorders (11.1%). Household and agricultural products (71.8%) were the popular choices of the toxic agent in self-poisoning with phenols (20%) being the most common. 19 cases (3.5%) were severe, out of which 15 cases lead to death (2.8% mortality).Conclusion: There is an urgent need to develop and implement preventative and treatment strategies for high-risk groups attempting suicide by self-poisoning.

Risk-taking behaviors and subgrouping of suicide in Iran: A latent class analysis of national registries data

Suicide is one the most important public health problem which is rapidly growing concerns. The aim of this study was to subgroup suicide using LCA method. This cross-sectional study was conducted in Iran based on 66990 records registered in Ministry of Health in 2014. A case report questionnaire in the form of software was used for case registries. Latent class analysis was used to achieve the research objectives. Four latent classes were identified; (a) Non-lethal attempters without a history of psychiatric disorders, (b) Non-lethal attempters with a history of psychiatric disorders, (c) Lethal attempters without a history of psychiatric disorders, (d) Lethal attempters with a history of psychiatric disorders. The probability of completed/an achieved suicide is high in lethal attempter classes. Being male increases the risk of inclusion in lethal attempters’ classes (OR = 4.93). Also, being single (OR = 1.16), having an age lower than 25 years (OR = 1.14) and being a rural citizen (OR = 2.36) associate with lethal attempters classes. The males tend to use more violent methods and have more completed suicide. Majority of the individuals are non-lethal attempters who need to be addressed by implementing preventive interventions and mental support provision.

Characteristics of suicide attempters with a high lethality means

IntroductionSuicide attempts with higher lethality increase the likelihood of suicide completion. Accumulating knowledge on risk factors contributing to higher suicide lethality may help clinicians to allocate their limited resources to more endangered people.ObjectivesTo explore the factors associated with higher lethality in suicide attempts.MethodsAll suicide attempters, who visited the emergency department of Uijeongbu St. Mary's hospital from January 2014 to December 2015, were reviewed retrospectively. We compared between the high vs. the low lethality group, of which had been recorded based on clinical judgment using t-test or Chi2/Fisher's exact test with two-sided P-value of 0.05.ResultsAmong the 753 suicide attempters, the assessed lethality was recorded in 736 cases. Low and highly lethal attempters were 426 (57.9%) and 310 (42.1%), respectively. For demographic variables, the high lethality attempters were significantly more likely to be older (48.3 vs. 44.78; P = 0.009), unemployed (61.0% vs. 56.5%; P = 0.042, without religion (90.9% vs. 84.9%; P = 0.017). For clinical variables, the high lethality attempters were significantly more likely have hopelessness (67.7% vs. 58.2%; P = 0.013) and a history of schizophrenia (4.5% vs. 1.4%; P = 0.023, while they did display any difference for mood disorders. The low lethality suicide attempts were more frequent in patients with comorbid personality disorders (9.2% vs. 4.9%; P = 0.031).ConclusionsThese results are in line with literatures reporting higher suicide risk in people, who are old, unemployed, not having a religion, psychotic and hopeless. These may have been moderated by committing a higher lethal means of suicide at least in part and warrants additional investigations.Disclosure of interestThe authors have not supplied their declaration of competing interest.