Lethality Of Attempts Research Articles

Risk factors for suicidal behavior in borderline personality disorder.

This study identified potential risk factors for suicidal behavior in patients with borderline personality disorder defined by the Diagnostic Interview for Borderline Patients and by DSM-III-R criteria for patients who did and did not attempt suicide. Histories of suicide attempts and attempt characteristics were obtained by Schedule for Affective Disorders and Schizophrenia interviews from 84 patients with borderline personality disorder and were related to severity of borderline pathology, diagnostic comorbidity, and state and trait symptoms. There were 61 patients with a lifetime history of suicide attempts (72.6%), with an average of 3.39 (SD = 2.87) attempts per patient. Attempters were significantly older than nonattempters, with more impulse actions, antisocial personality disorder comorbidity, and state depression. State depression was significantly less severe in patients who had attempted suicide in the present episode (or past year) than in patients who had attempted suicide only in the past. A comorbid diagnosis of major depression, alcoholism, or drug use disorder did not distinguish attempters from nonattempters. Suicide attempt in the present episode was best predicted by the number of prior lifetime attempts. A highly serious intent to commit suicide was predicted by the number of lifetime attempts and subjective depression, while a low intent was predicted by a mixed subtype of borderline personality disorder plus schizotypal personality disorder and paranoid ideation. A high degree of medical lethality was predicted by number of lifetime attempts, older age, and hysteroid dysphoria, while low lethality attempts were associated with high degrees of anger. Risk factors for suicidal behavior in patients with borderline personality disorder include older age, prior suicide attempts, antisocial personality, impulsive actions, and depressive moods but not comorbid affective disorder, alcoholism, or drug use disorders.

Serotonin and impulsive/ aggressive behavior in parolees with and without a history of violence

males only: p, 0.016) when compared to those with neither. These data raise the possibility that the central 5-HT abnormality reported in suicide attempters may be associated with self-directed aggression, whether manifested as SIB or suicide attempts, and not necessarily with suicidal intent nor the lethality of the attempt. Further study of the spectrum of self-directed aggression using covariant analysis to examine various characteristics of the behavior such as affective state, impulsivity, the degree of violence, and the number of episodes, may clarify the relationship of selfdirected aggression with diminished 5-HT activity.

Suicidal ideation and suicide attempts among youth with insulin-dependent diabetes mellitus.

To investigate the prevalence and correlates of suicidal behaviors among youth with insulin-dependent diabetes mellitus (IDDM) for up to 12 years after disease onset. The occurrence of suicidal ideation and suicide attempts was assessed shortly after disease onset and repeatedly thereafter as part of a longitudinal study of diabetic children. Initial psychiatric status and symptomatology, characteristics of the medical illness, and sociodemographic variables were considered as potential correlates of suicidal behaviors. Young patients evidenced higher than expected rates of suicidal ideation, but relatively few attempted suicide over the follow-up. Among those who did attempt suicide, diabetes-related methods commonly were used. Suicidal ideation shortly after IDDM onset was related only to concurrent severity of depressive symptoms. Suicidal ideation over the follow-up was associated with later noncompliance with the medical regimen. Clinicians should be alert to the possibility of suicidal ideation among youth with IDDM because of the prevalence of those cognitions, the potential lethality of attempts due to insulin misuse, and the relationship of suicidal thoughts to later noncompliance with the medical regimen.

Hopeless Depression and Suicidal Symptoms in Adolescents

A structured interview of 47 hospitalized adolescents revealed significant differences between adolescents attempting suicide and adolescents not attempting suicide. Suicidal adolescents were significantly more likely to show diagnosed chronic depression and any depression combined with schizotypical features. The medical lethality of the suicide attempt was associated with a serious intent to die and a previous attempt. Suicidal behavior was associated with self-reported depressed feelings, distinct quality of depressed mood, hopelessness, worrying, guilt, negative self-evaluation, and somatic anxiety. Hopelessness was strongly associated with general suicidal tendencies, dual attempts, and medical lethality of attempts. Awareness of these clinical indicators may help identify potentially suicidal adolescents.

Serotonin and Suicidal Behaviora

Studies of the brain of suicide victims indicate there is a decrease in brain stem levels of 5-HT and/or 5-HIAA. There also appears to be a region-specific increase in 5-HT2 receptors, which are post synaptic and may therefore be increased in number secondary to decreased serotonin levels. Lack of information about how 5-HT2 and other serotonin receptor populations are regulated hamper our ability to explain the mechanisms underlying these findings. If the initial reports of a decrease in the number of imipramine binding sites prove to be correct then this finding would be further evidence for an effect involving the serotonin neurons, seen in this case at the level of the terminals. The relationship between suicide attempters and completers remains to be worked out. However, studies of suicide attempters, particularly those making more lethal attempts, appear to confirm the findings made in the brain of suicide completers. Neuroendocrine and CSF studies indicate the presence of serotonin subresponsivity and lower levels of CSF 5-HIAA. Thus, the overall direction of change is towards a weaker serotonin signal which rather than being due to a primary receptor defect (a possibility that cannot be ruled out but for which there is no current evidence), appears to be due to reduced levels of serotonin release. The causes of this effect represent a research challenge. It is clear that reduced levels of serotonin alone cannot explain the timing and type of suicidal behavior. Future studies must address the role of other neurotransmitters which may explain why some aggression is directed outward (towards other people) and in other cases the aggression is directed toward the self (suicidal behavior). Defining the role of serotonin and other involved transmitter systems is a necessary step before a comprehensive pharmacological treatment plan can be designed and tested.

Substance Abuse and Adolescent Suicidal Behavior

Evidence suggests a significant association between use of psychoactive substances among adolescents and suicidal behavior among adolescents during the past two decades. Accumulating evidence, although not unanimous, supports the hypothesis of psychoactive substance abuse among adolescents as a risk factor for a range of suicidal behavior--ideation, attempted suicide, and completed suicide. With increasing rates of psychoactive substance abuse for the adolescent population during the past 20 years, this appears to be an increasingly important factor. It is not known if the association is causal. Psychoactive substance abuse appears to be associated with a greater frequency and repetitiveness of suicide attempts, more medically lethal attempts, a measured seriousness of intention, and greater suicidal ideation. Additional data support a specific association between alcohol intoxication and suicide by firearms among adolescents. Adolescents who abuse psychoactive substances, particularly those with any type of depressive disorder, appear to be at higher risk for suicidal behavior and may need appropriate psychiatric treatment.

Substance abuse and adolescent suicidal behavior

Evidence suggests a significant association between use of psychoactive substances among adolescents and suicidal behavior among adolescents during the past two decades. Accumulating evidence, although not unanimous, supports the hypothesis of psychoactive substance abuse among adolescents as a risk factor for a range of suicidal behavior—ideation, attempted suicide, and completed suicide. With increasing rates of psychoactive substance abuse for the adolescent population during the past 20 years, this appears to be an increasingly important factor. It is not known if the association is causal. Psychoactive substance abuse appears to be associated with a greater frequency and repetitiveness of suicide attempts, more medically lethal attempts, a measured seriousness of intention, and greater suicidal ideation. Additional data support a specific association between alcohol intoxication and suicide by firearms among adolescents. Adolescents who abuse psychoactive substances, particularly those with any type of depressive disorder, appear to be at higher risk for suicidal behavior and may need appropriate psychiatric treatment. (<i>JAMA</i>. 1990;263:3051-3056)

Correlates of the Medical Lethality of Suicide Attempts in Children and Adolescents

The relationship between the medical lethality of suicidal behavior and demographic, psychiatric, social, and familial/environmental variables was examined in chart review of a consecutive series of youthful suicide attempters presenting in a Children's Hospital over a 5-year period. Correlates of the lethality of suicidal behavior included male sex, diagnoses of affective disorder and substance abuse, high suicidal intent, and the ingestion of a psychotropic agent. Patients who made medically lethal attempts appeared to have characteristics which converge with those who have completed suicide. The availability of a lethal agent may be the most significant determinant of the lethality of impulsive attempts, whereas suicidal intent and severity of psychopathology may make the most important contributions to the lethality of attempts by hopeless, dysphoric individuals. The implications of these findings for the prediction and prevention of suicide in children and adolescents are discussed.

Suicide and the dexamethasone suppression test in adolescence

The identification and treatment of adolescents at risk for suicide is one of the most critical issues in adolescent psychiatry. Suicide is the third leading cause of death in the age group and its prevalence appears to be rising (Holinger, 1978). Clinicians see many adolescents with suicidal thoughts or behavior, however, who are not all equally at risk for future lethal attempts. While demographic, diagnostic, and other clinical factors are helpful in identifying adolescents at risk for suicide (Carlson and Cantwell 1982; Garfinkle et al. 1982; Robbins and Alessi 1983) such factors remain limited in their ability to identify individuals at greatest risk (Pokorny 1983). A biological marker of current or future risk for suicide could be an important adjunct to the clinician confronting this dilemma. Furthermore, study of biological markers may help us towards an understanding of the neurophysiological substrates of severe dysphoric mood states. Carroll (1982) has reported an association of nonsuppression in the dexamethasone suppression test (DST) with severe or lethal suicide attempts in adults. Three other groups also observed DST nonsuppression in patients hospitalized for suicide attempts or who subsequently

Attempted suicide in manic-depressive disorder.

Structured interviews were used to study rates of past suicide attempts among 123 outpatients treated for affective disorders. Subjects met the Feighner criteria for major affective illness, and bipolar and unipolar groups were identified in accordance with the Fieve-Dunner criteria. Although a small group (N = 6), the women with a history of hospitalization for depression and outpatient treatment for hypomania (BP II) had the highest rate of past suicide attempts. (66 percent). This confirms previous findings. Women showed higher rates overall (39 percent vs. 28 percent for men). Suicide attempters were found to be significantly younger than nonattempters, which is in line with previous reports that suicide risk is high early in the course of bipolar illness. A trend for attempters to have received their first treatment at a younger age suggests that early onset may be a risk factor. No differences in marital status were found between attempters and nonattempters. Males and females did not differ in number, seriousness, or lethality of attempts.

Age Differences in Patterns of Attempted Suicide

The suicidal attempts of persons of different ages were examined and a number of differences found. Older suicidal persons were less likely to be black, less likely to have made previous suicidal attempts and threats, and more intent on dying (though they did not make more lethal attempts). The older suicidal persons abused alcohol more while the younger suicidal persons abused other drugs more. In common with nonsuicidal older persons, the suicidal older persons were in poorer physical health and more often lived alone. Psychological variables such as depression and hopelessness and the severity of psychiatic disturbance did not change significantly with the age of the suicidal persons.

Lethality of Suicidal Methods and Suicide Risk: Two Distinct Concepts

Two objective measures of the lethality of 11 suicidal methods were defined: Mean Seriousness of suicidal incidents involving the method, and Probability of Death resulting from use of the method. The measures were found to be essentially interchangeable. Fourteen judges were asked to rank the same 11 methods according to the “probability of death resulting from use of the method in a suicide attempt.” The judges' subjective estimates of lethality corresponded well with objective measures. The relationship between lethality and risk, or the probability of suicide at some future date, was examined. The two variables were clearly distinct. Rank correlation between lethality of, and risk associated with, the 11 suicidal methods was not significant Moreover, when all incidents within a given lethality category were collapsed, and then risk associated with each lethality category evaluated, the most lethal attempts had a significantly lower risk of future suicide than the least lethal attempts.