Lethality Of Attempts Research Articles

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.

Multimodal Neuroimaging of Frontolimbic Structure and Function Associated With Suicide Attempts in Adolescents and Young Adults With Bipolar Disorder.

Bipolar disorder is associated with high risk for suicidal behavior that often develops in adolescence and young adulthood. Elucidation of involved neural systems is critical for prevention. This study of adolescents and young adults with bipolar disorder with and without a history of suicide attempts combines structural, diffusion tensor, and functional MR imaging methods to investigate implicated abnormalities in the morphology and structural and functional connectivity within frontolimbic systems. The study had 26 participants with bipolar disorder who had a prior suicide attempt (the attempter group) and 42 participants with bipolar disorder without a suicide attempt (the nonattempter group). Regional gray matter volume, white matter integrity, and functional connectivity during processing of emotional stimuli were compared between groups, and differences were explored for relationships between imaging modalities and associations with suicide-related symptoms and behaviors. Compared with the nonattempter group, the attempter group showed significant reductions in gray matter volume in the orbitofrontal cortex, hippocampus, and cerebellum; white matter integrity in the uncinate fasciculus, ventral frontal, and right cerebellum regions; and amygdala functional connectivity to the left ventral and right rostral prefrontal cortex. In exploratory analyses, among attempters, there was a significant negative correlation between right rostral prefrontal connectivity and suicidal ideation and between left ventral prefrontal connectivity and attempt lethality. Adolescent and young adult suicide attempters with bipolar disorder demonstrate less gray matter volume and decreased structural and functional connectivity in a ventral frontolimbic neural system subserving emotion regulation. Among attempters, reductions in amygdala-prefrontal functional connectivity may be associated with severity of suicidal ideation and attempt lethality.

A gender-specific analysis of suicide methods in deliberate self-harm

Background: Deliberate self-harm (DSH) is a major public health concern. Gender differences in suicide methods are a controversial realm with various regional and cultural variations. This study compared and assessed the methods used in DSH attempters as undertaken by men and women, and investigated the possible role of gender and other clinical variables in the selection of suicide method. Materials and Methods: Two hundred subjects fulfilling the inclusion and exclusion criteria were recruited in the study. The sociodemographic details were recorded in the semi-structured pro forma. Detailed assessment of psychiatric morbidity and DSH was done by clinical interview and validated by Mini International Neuropsychiatric Interview-Plus 5.0 and Beck Suicide Intent Scale. Data were analyzed using SAS version 9.2 and SPSS version 17.0. The sample was disaggregated by gender to compare the known correlates of suicide risk on the two most common methods of suicide – poison consumption and drug overdose using multivariate analyses. Results: The analysis revealed that majority of the attempters were in the age group of 11–40 years (91%). Females (63%) outnumbered males (37%); poisoning was the most common type of method (50.5%), followed by drug overdose (35%). There were no statistical differences between the two genders with respect to other sociodemographic variables. Males from urban/semi-urban background (odds ratio [OR] = 4.059) and females living alone (OR = 5.723) had high odds ratio of attempting suicide by poison consumption. Females from urban/semi-urban background (P = 0.0514) and male subjects from nuclear families had an increased odds ratio (OR = 4.482) to attempt suicide by drug overdose. There were no statistical differences when the two genders were compared for other variables such as intentionality, lethality, impulsivity, and number of attempts. Conclusions: It appears that gender differences among DSH attempters appear less pronounced in the Indian setting compared to the worldwide literature on the subject. Nevertheless, the unique, gender-specific characteristics pertaining to DSH attempters in our population emphasize the need for gender-specific interventions in future clinical treatment.

Recent advances in differentiating suicide attempters from suicide ideators.

This article summarizes findings from recent studies (published since 2015) examining differences between suicide attempters and suicide ideators. Converging evidence suggests that the capability to attempt suicide (e.g., acquired capability, painful and provocative experiences, high tolerance for pain and distress) is higher in suicide attempters than suicide ideators. Other psychosocial and biological differences have also been identified but require replication. Recent literature reviews find that traditional risk factors for suicide - such as depression, hopelessness, most psychiatric disorders, and even impulsivity - robustly predict suicide ideation but poorly predict suicide attempts among ideators. To address this knowledge gap, studies are increasingly employing an ideation-to-action framework. This framework views the development of suicide ideation and the progression from ideation to potentially lethal attempts as distinct processes with distinct explanations and predictors. Converging evidence suggests that factors associated with diminished fear of pain, injury, and death can increase one's capability to attempt suicide and facilitate the progression from suicidal thoughts to suicidal acts. Recent studies have also identified other variables that may differentiate attempters from ideators, but these require replication. Theories of suicide positioned within the ideation-to-action framework provide testable and promising hypotheses about the progression from ideation to attempts. These include the Interpersonal Theory, Integrated Motivational-Volitional Model, and Three-Step Theory.

Narcissistic Personality Disorder and suicidal behavior in mood disorders

The relationship of Narcissistic Personality Disorder (NPD) to suicidal behavior is understudied. The modest body of existing research suggests that NPD is protective against low-lethality suicide attempts, but is associated with high lethality attempts. Mood-disordered patients (N = 657) received structured interviews including Axis I and II diagnosis and standardized clinical measures. Following chi-square and t-tests, a logistical regression model was constructed to identify predictors of suicide attempt. While there was no bivariate relationship of NPD on suicide attempt, in the logistic regression patients with NPD were 2.4 times less likely to make a suicide attempt (OR = 0.41; 95% CI = 0.19 - 0.88; p < 0.05), compared with non-NPD patients and controlling for possible confounding variables. NPD was not associated with attempt lethality. NPD patients were more likely to be male, to have a substance use disorder, and to have high aggression and hostility scores. Limitations include that the sample consists of only mood-disordered patients, a modest sample size of NPD, and the data are cross-sectional. The multivariate protective effect of NPD on suicide attempt is consistent with most previous research. The lower impulsivity of NPD patients and less severe personality pathology relative to other personality disorders may contribute to this effect. No relationship of NPD to attempt lethality was found, contradicting other research, but perhaps reflecting differences between study samples. Future studies should oversample NPD patients and include suicide death as an outcome. Clinical implications include discussion of individualized suicide risk assessment with NPD patients.

Can imaging predict future suicidal behavior?

Brain concentrations of serotonin 1A receptor in the raphe nuclei determined by in vivo imaging may predict lethality of suicidal attempts.

Pre- versus Postenlistment Timing of First Suicide Attempt as a Predictor of Suicide Risk Factors in an Active Duty Military Population With Suicidal Thoughts

ABSTRACTObjective: This study examines the association of pre- versus post-enlistment timing of first suicide attempt with suicidal ideation, depressive symptoms, single vs. multiple attempts, and highest suicide attempt lethality in an active duty military sample with suicidal thoughts. Method: Data were pooled from baseline assessments of 784 help-seeking Service Members. Results: Adjusting for demographic and military covariates, suicidal ideation was higher for those with a history of suicide attempt. A pre-enlistment suicide attempt was associated with over four times the risk of multiple lifetime attempts. Conclusions: Pre-enlistment suicide attempts are important to assess as they increased risk of multiple attempts.

Detection and Classification of Suicidal Behavior and Nonsuicidal Self-Injury Behavior in Emergency Departments

The degree of concordance between clinical and standardized assessments in the detection and classification of suicidal behavior and nonsuicidal self-injury behavior in psychiatric emergency department settings was examined. Two hundred fifty-four patients at 3 psychiatric emergency departments between 2007 and 2011 were evaluated by research staff using standardized assessments of suicidal behavior and nonsuicidal self-injury behavior. Of 254 patients, 128 (50%) made a recent suicide attempt, 30 (12%) engaged in recent nonsuicidal self-injury behavior, 20 (8%) made a recent suicide attempt interrupted by self or others, and 76 (30%) had other psychiatric symptoms in the absence of recent suicidal or nonsuicidal self-injury behavior. The classifications derived from the standardized assessments using the Centers for Disease Control and Prevention (CDC) nomenclature were compared to clinical assessments independently extracted from emergency department medical records. Agreement between clinical and standardized assessments was substantial for both suicide attempts (κ = 0.76, P < .001) and nonsuicidal self-injury behavior (κ = 0.72, P < .001). Importantly, 18% of patients determined to have made a suicide attempt in the past week by standardized assessment were not identified as such by clinical assessment. In addition, as measured by the Columbia Suicide Severity Rating Scale, the potential lethality of attempts for patients classified as making a recent suicide attempt by both clinician and standardized assessments was significantly greater (t120 = 2.1, P = .04) than that for patients who were classified as having made an attempt by the standardized but not clinical assessment. The use of standardized assessment measures may improve sensitivity and accuracy of identifying suicidal behavior and nonsuicidal self-injury behavior in psychiatric emergency departments.

Lethal suicidal attempt with a mixed-drug intoxication involving metoprolol and propafenone – a first paediatric case report

Lethal suicidal attempt with a mixed-drug intoxication involving metoprolol and propafenone – a first paediatric case report

Seriousness and lethality of attempted suicide: A systematic review

The concepts of seriousness and lethality of suicide attempts are essential to the assessment of suicide risk and, therefore, to prevent suicidal behavior. A review of the literature was conducted in order to identify the most important factors that increase the seriousness and potential lethality of attempted suicide. The factors identified were incorporated into four main categories: progression along the suicide continuum; age and gender; mental disorders and method of suicide. Although each category contains independent risk factors for the severity of the suicide attempt, their combination both within and, above all, between them, has emerged as the most important predictor of suicidal behavior.

Suicide lethality scale: Concerns regarding validity and scoring.

Sir, Kar et al.[1] described the development of an instrument to measure the lethality of a suicide attempt. We have some concerns about the scoring of the instrument that they proposed, as well as about its face and content validity: The minimum score on this scale is 5, not 0. There are known disadvantages of instruments that do not have 0 as the lowest rating; that is, the instruments that are not ratio scales[2] The wording of many items requires improvement. For example, Item B could have been anchored as very high, high, moderate, low, and very low chances of rescue without requiring the grammatically awkward phrasing in the scale as it stands The above notwithstanding, Item B does not measure lethality of the suicide attempt; it measures suicide intent Item D is superfluous because there would be a 1 to 1 correspondence between the scoring of this item and the scoring of Item C. Item E is likewise superfluous because there is a 1 to 1 correspondence with Item A Items C and D would be inapplicable, or scored at lower levels, if rescue occurred early. Because chance also plays a role in the rescue, the scoring of these items is contaminated by variables unrelated to lethality, and the lethality of an attempt could be underestimated. Given these limitations, the instrument may require some revision before recommendation for use in research and practice. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Impulsive traits and unplanned suicide attempts predict exaggerated prefrontal response to angry faces in the elderly.

Abnormal responses to social stimuli are seen in people vulnerable to suicidal behavior, indicating possible disruptions in the neural circuitry mediating the interpretation of socioemotional cues. These disruptions have not been empirically related to psychological and cognitive pathways to suicide. In the present study of older suicide attempters, we examined neural responses to emotional faces and their relationship to impulsivity, one of the components of the suicidal diathesis. Using functional magnetic resonance imaging, we recorded neurohemodynamic responses to angry faces in a carefully characterized sample of 18 depressed elderly with history of suicide attempts, 13 depressed nonsuicidal patients, and 18 healthy individuals, all aged 60+. Impulsivity was assessed with the Social Problem Solving Inventory Impulsivity/Carelessness Style subscale and Barratt Impulsiveness Scale. The Suicide Intent Scale planning subscale was used to describe the degree of planning associated with the most lethal attempt. Depression and history of attempted suicide were not associated with neural responses to angry faces, failing to replicate earlier studies. Higher impulsivity, however, predicted exaggerated responses to angry faces in fronto-opercular and dorsomedial prefrontal cortex (pcorr<0.05). Poorly planned suicide attempts also predicted increased fronto-opercular responses. Results were robust to effects of medication exposure, comorbid anxiety and addiction, severity of depression, burden of physical illness, and possible brain injury from suicide attempts. Impulsive traits and history of unplanned suicide attempts partly explain the heterogeneity in neural responses to angry faces in depressed elderly. Displays of social emotion command excessive cortical processing in impulsive suicide attempters.

Associations between reasons for living and diminished suicide intent among African-American female suicide attempters.

African-American women are at high risk for suicide ideation and suicide attempts and use emergency psychiatric services at disproportionately high rates relative to men and other ethnic groups. However, suicide death rates are low for this population. Cultural variables in the African-American community may promote resilience and prevent fatal suicidal behavior among African-American women. The present study evaluated self-reported reasons for living as a protective factor against suicidal intent and suicide attempt lethality in a sample of African-American female suicide attempters (n = 150). Regression analyses revealed that reasons for living were negatively associated with suicidal intent, even after controlling for spiritual well-being and symptoms of depression. These results indicate that the ability to generate and contemplate reasons for valuing life may serve as a protective characteristic against life-threatening suicidal behavior among African-American women. Implications for research and clinical practice are further discussed.

Depressed parents' attachment: effects on offspring suicidal behavior in a longitudinal family study.

To investigate relationships of depressed parents' attachment style to offspring suicidal behavior. 244 parents diagnosed with a DSM-IV depressive episode completed the Adult Attachment Questionnaire at study entry. Baseline and yearly follow-up interviews of their 488 offspring tracked suicidal behavior and psychopathology. Survival analysis and marginal regression models with correlated errors for siblings investigated the relationship between parent insecure attachment traits and offspring characteristics. Data analyzed were collected 1992-2008 during a longitudinal family study completed January 31, 2014. Parental avoidant attachment predicted offspring suicide attempts at a trend level (P = .083). Parental anxious attachment did not predict offspring attempts (P = .961). In secondary analyses, anxious attachment in parents was associated with offspring impulsivity (P = .034) and, in offspring suicide attempters, was associated with greater intent (P = .045) and lethality of attempts (P = .003). Avoidant attachment in parents was associated with offspring impulsivity (P = .025) and major depressive disorder (P = .012). Parental avoidant attachment predicted a greater number of suicide attempts (P = .048) and greater intent in offspring attempters (P = .003). Results were comparable after adjusting for parent diagnosis of borderline personality disorder. Insecure avoidant, but not anxious, attachment in depressed parents may predict offspring suicide attempt. Insecure parental attachment traits were associated with impulsivity and major depressive disorder in all offspring and with more severe suicidal behavior in offspring attempters. Insecure parental attachment merits further study as a potential target to reduce risk of offspring psychopathology and more severe suicidal behavior.

A study into the psycho-socio-demographic profile and suicidal intent in the persons making suicide attempt : Search for a distinctive group

Introduction : Epidemiological studies simultaneously investigating the combined effects of psychiatric and psychosocial risk factors for suicide are sparse. Presently no distinctive grouping has been done combining the suicide intent and lethality of attempt though there are significant variations in psycho-socio-demographic character within the persons making suicide attempt.Aims : To study the psycho-socio-demographic profile, suicide intent and lethality of attempt in survivors of suicide attempt and finally to categorize them in distinct groups by two dimensions – suicide intent and lethality of suicide attempt.Design : Cross-sectional study.Methods and Material : Two hundred patients who attempted suicide were evaluated by a psychiatrist. The data was recorded for socio demographic variables , psychiatric disorder, suicide intent and for lethality of attempt. Groupings were done first by single dimension, suicide intent, then by two dimensions, suicide intent and lethality of attempt. Two procedures were then compared statistically.Results : The mean age of the study population was 26.36 years, mostly female (50.5%), housewives (35.5%) and students (10%), from nuclear family (55.5%), with no psychiatric disorder (29%). Organophophorus poisoning (79.5%) was the principal mode of suicide attempt, out of problem with primary support group (89.5%). Grouping was more significant when based on combining two dimensions, suicide intent and lethality of attempt, rather than only single dimension, suicide intent.Conclusions : Both suicide intent and lethality of suicide attempt are important dimensions to categorize suicide attempters. There exists four groups and they are different in psycho-socio- demographic profile.Declaration of interest – None.Key-words : Suicide, Suicide intent, Lethality, Deliberate self harm

Scale for assessment of lethality of suicide attempt.

Background:Lethality of suicidal attempt provides useful information regarding the behavior. There is a perceived need for a clinically useful scale that can be easily adapted to various methods and circumstances of attempt.Aims:The study intended to develop and test utility of a scale for measuring lethality that can reflect overall clinical observation taking into account various indicators of lethality and which can be used across clinical scenarios involving different methods.Settings and Design:Cross-sectional study in a hospital.Materials and Methods:The scale for assessment of lethality of suicide attempt (SALSA) has two components: The first component has four items indicating seriousness of the attempt and its likely consequences and the second component is the global impression of lethality. All the items are scored from 1 to 5, higher scores suggestive of increased lethality. SALSA was used to evaluate lethality of 82 consecutive suicide attempters; and it was compared with lethality of suicide attempt rating scale (LSARS) and risk-rescue rating scale.Statistical Analysis:Chi-square, t-test, analysis of variance, Cronbach's alpha, binary logistic regression.Result:There was significant correlation of SALSA score with that of LSARS (r: 0.89) and risk score of risk-rescue rating (r: 0.93, P < 0.001); and negative correlation with rescue score (r: −0.569; P < 0.001). Internal consistency reliability of SALSA was high (Cronbach's alpha: 0.94). Lethality scores of SALSA differentiated known groups with different lethality, e.g. deceased and survived; attempters with different levels of medical intervention: In-patient only, intensive care, ventilator support. SALSA score significantly predicted the lethal outcome (odds ratio: 3.2, confidence interval: 1.12-8.98).Conclusion:SALSA is a useful instrument for assessment of lethality of suicidal behaviors during clinical evaluations considering the ease of administration, its ability to differentiate clinical groups with known variations of lethality and clinical outcomes.

EPA-0540 - To assess the impact of seasonality in suicide attempts of higher lethality, as measured by both the risk-rescue rating and the beck lethality scales

Suicide, in Spain, is currently the first cause of unnatural death ahead of road traffic accidents. In 2011, 3429 people committed suicide in this country. Seasonality in suicidal behavior has been better established for consummated suicides than for suicide attempts. One possible explanation is the reported lower prevalence of violent methods used in attempted suicides, as suicides using more lethal methods have been described to have higher seasonal variations. However, the most widely used classification to determine the lethality of an event – non-violent (poisoning) vs. violent (all the other methods) – is somewhat simplistic, and may lack sensitivity when applied to attempted suicides. The Risk-Rescue Rating, and the Beck Lethality scales are both reliable tools to measure the severity of a suicide attempt. Our goal in this study is to assess the impact of seasonality (month of the year) in suicide attempts of higher lethality, as measured by both the Risk-Rescue Rating and the Beck Lethality scales, when compared to less lethal attempts. Our hypothesis is that the high-scoring suicide attempts on the lethality scales will be associated with seasonal variation to a greater extent than the low-scoring attempts.

EPA-1558 - The impact of seasonality in suicide attempts: a review

Seasonality in consummated suicides has been well established in the literature. Consistently, suicides using violent methods have been described to have higher seasonal variations than non-violent suicides. The literature is scarcer regarding seasonality in suicide attempts, although, to a lesser extent, seasonal patterns have also been described. It has been argued that, due to the lower prevalence of violent methods in attempted suicides, it is not surprising to find a weaker seasonal effect. However, the most widely used classification to determine the lethality of an event – non-violent (poisoning) vs. violent (all the other methods) – is somewhat simplistic, and may lack sensitivity when applied to attempted suicides. Lethality scales, such as the Risk-Rescue Rating, and the Beck Lethality scales are more reliable tools to measure the severity of a suicide attempt. Also, violent suicide methods have been associated with a higher level of lifetime aggression and higher levels of impulsivity. Here, we aim to review the available literature on seasonality in suicide attempts, with particular attention to high lethality attempts, and the role of impulsivity. We hypothesize that both high lethality attempts and high baseline impulsivity are related to a stronger seasonal variation in suicide attempts.

Understanding the suicidal moment in adolescence

Suicide attempts are more common in adolescence than in any other time in life, despite the low prevalence of actual suicide deaths among adolescents. Studies of adolescent suicide risk tend to focus on factors such as psychiatric diagnosis--particularly depression--and history of previous suicide attempts in predicting risk of future suicidal behavior. However, given that a large number of adolescent suicides are first-time attempts, understanding the circumstances that precede suicide attempts--including the nature of suicidal ideation and of the cognitive and emotional responses that precede ideation--is a critical part of preventing a potentially lethal attempt. We review the psychological precipitants that may inform how suicidal thoughts are transferred into action and examine the risk conferred by having a history of previous suicide attempts and ideation.