Non-suicidal Group Research Articles

Dysregulated zinc homeostasis and microadenomas in the anterior pituitary: pathological insights into suicide risk.

Suicide is a significant public health problem influenced by various risk factors, including dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis. Zinc (Zn), essential for pituitary function in hormone synthesis and release, has been linked to suicide, with studies noting reduced serum levels and altered brain transport mechanisms. Despite Zn's crucial role in pituitary function and its involvement in suicidal behavior, information on pituitary Zn in suicide is scarce. Tumor cells modify Zn dynamics in tissues, and a previous report suggests microadenomas in the anterior pituitary as a risk factor for suicide. Histopathological analysis with hematoxylin-eosin stain and histochemical techniques to assess Zn homeostasis were carried out on anterior pituitary postmortem samples from 14 suicide completers and 9 non-suicidal cases. Pituitary microadenomas were identified in 35% of suicide cases and none in the non-suicidal cases. Furthermore, compartmentalized Zn (detected via dithizone reactivity), but not free Zn levels (detected via zinquin reactivity), was lower in the suicide cases compared to the non-suicidal group. This is the first report of a potential association between disrupted Zn homeostasis and microadenomas in the anterior pituitary as a feature in suicide and provides critical insights for future neuroendocrine Zn-related research.

Certain immune parameters may have a significant impact on suicidal behaviour - a naturalistic study among psychiatric in-patients

IntroductionSeveral research already proved the role of certain immunological factors (neutrophil-lymphocyte (NLR), monocyte-lymphocyte (MLR) and platelet-lymphocyte (PLR) ratio, and C-reactive protein (CRP)) in the background of suicidal behaviour.ObjectivesThe aim of this research was to study the association between routinely measurable low-grade inflammation parameters and suicidal behaviour among patients in the acute psychiatric care setting.MethodsThe study population included psychiatric in-patients (N=100) consecutively treated with depressive disorders and/or suicidal behaviour in a University Clinic between December 1, 2020 and December 31, 2021. Three different patient-groups were generated based on their suicidal behaviour: suicide attempters (N=55) including recent attempters(N=36) and past attempters (N=19) and non-suicidal patients (N=45), who never had a suicide attempt. Basic socio-demographic data, the severity of depression and immunological parameters (white blood cell count: lymphocytes, monocytes, neutrophil, eosinophil, basophil granulocytes; thrombocytes; C-reactive protein) were recorded.Descriptive analyses and multivariate regression model were performed with RStudio version 4.2.3.ResultsCRP was significantly higher (2.00 vs. 1.00; p=0.007) in suicidal patients (N=55), however other immunological parameters did not differ significantly between the suicidal and the non-suicidal groups (NLR: 2.02 vs. 2.19; MLR: 0.22 vs. 0.11; PLR: 118 vs. 130). NLR and MLR showed significantly higher values (NLR: 2.83 vs. 1.93, p=0.021; MLR: 0.28 vs. 0.11, p=0.01) for those who currently attempted suicide (N=36) compared to the patients with no or past suicide attempt (N=64). In the regression analysis, the NLR and MLR showed significantly higher values in current suicide attempters even when gender, age, suicidal risk and severity of depression were included in the model. However, no significant differences were found when comparing current and past suicide attempters with the non-suicidal patients.ConclusionsDespite the small number of cases in the samples, our results confirmed the association of certain immunological parameters (NLR, MLR) and acute suicidal behaviour. This relationship was found to be independent of depression and its severity. Our data suggest that, unlike the NLR and MLR parameters, the higher CRP value may not be related to acute suicide attempt, but rather to suicidal vulnerability, as a trait-marker. Markers of chronic systemic inflammation may help in the prediction of suicidal behaviour and in the development of new therapeutic options, however, further prospective studies are needed to identify the specific role of immunological factors in suicidal behaviour more precisely.Disclosure of InterestNone Declared

Comparison of the Neurological and Neuropsychological Functions Within Depressed Patients with and Without Suicidal Thoughts

Objectives: This study was designed and conducted to compare the neurological and neuropsychological functions of depressed patients with and without suicidal thoughts. Methods: This research is a case-comparative study. A group of depressed patients visited NAJA Imam Sajjad Hospital between early August and late October 2016. According to the Morgan table, 66 individuals (33 with suicidal thoughts and 33 without) were selected for comparison with controlled variables in this examination. The Beck Depression Inventory (BDI), Neurological Evaluation Scale, and Wechsler Memory Scale (for neuropsychological function) were administered to all the participants. Data were analyzed using one-way analysis of variance (ANOVA), Scheffe follow-up test, and SPSS version 22 software. Results: The findings indicated that the group of depressed patients with suicidal thoughts showed poorer scores in neurological functions compared to the control group (P = 0.01). Furthermore, the control group scored higher than the depressed group with suicidal thoughts on the Wechsler Memory Scale (P = 0.05). Conclusions: The results suggest that depressed patients with suicidal thoughts exhibit worse performance in both neurological and neuropsychological functions compared to the non-suicidal group.

Adolescent patients presenting to the emergency department due to falls from heights: a comparative analysis of suicidal and non-suicidal cases

Aims: This study aims to categorize adolescent patients presenting to the hospital due to falls from heights into two groups: suicidal and non-suicidal. It seeks to compare the clinical characteristics, trauma patterns, and outcomes between these groups. Methods: A total of 69 patients were included in the study. The demographic features, trauma patterns, imaging methods, medical interventions, and clinical outcomes of the patients were retrospectively assessed. Results: 63.8% (n=44) of the patients were categorized in the suicidal group, while 36.2% (n=25) were in the non-suicidal group. There was no statistically significant difference observed between the mean age of the suicidal group (16.27±2.52) and the non-suicidal group (15.96±2.85) (p=0.638). In the suicidal group, the incidence rates of maxillofacial trauma, pelvic trauma, and thoracic trauma were statistically significantly higher compared to the non-suicidal group (respectively; p=0.041, p=0.014, p<0.001). The in-hospital mortality rate in the suicidal group (22.7%, n=10) was statistically significantly higher than in the non-suicidal group (0%, n=0) (p=0.007). Conclusion: Cases of falls from heights due to suicide attempts result in more severe outcomes compared to accidental falls. These patients require a more comprehensive medical assessment and intervention.

Suicidality in the Light of Schema Therapy Constructs, i.e., Early Maladaptive Schema and Schema Modes: A Longitudinal Study.

(1) Background: The search for new strategies to diagnose people at risk of suicide and to help them is highly significant in view of the still high rate of suicidality. Schema therapy and its core constructs, i.e., early maladaptive schemas (EMSs) and schema modes, correspond to both directions. (2) Methods: This study compared the severity of EMSs and schema modes in a clinical group of suicide risk, a clinical non-suicidal group, and a control group. Intragroup comparisons were also conducted between times of crisis and psychological stability. The evaluation was supported by controlling for the psychopathological symptoms presented, following the dimensional concept. (3) Results: The unquestionable relevance of the disconnection/rejection domain in suicidality has been proven. The importance of EMSs from other domains, especially during psychiatric crises, was confirmed. Among the schema modes, child and Punitive Parent modes proved to be the most significant. There were changes in coping modes but of a lesser effect size. The protective importance of the Healthy Adult and Happy Child modes was also proven. (4) Conclusions: The results provide an indication for practitioners about the EMSs and schema modes most associated with suicide risk. They can also serve as a framework for deepening the issue of identifying and preventing suicidality in schema therapy.

Centrality depression-anxiety symptoms linked to suicidal ideation among depressed college students--A network approach.

The long-term effects of the COVID-19 pandemic have caused severe mental health problems among college students, which can eventually cause suicidal ideation. Therefore, through network analysis, this study aims to explore the new characteristics of the depression-anxiety symptom network that arose during the long-term lockdown of the COVID-19 pandemic and to identify the most influential symptoms linked to suicidal ideation. We used a Patient Health Questionnaire (PHQ-9) score above 10 as the cutoff and screened 622 participants with an inclination toward depressive disorders from 7976 college students, and then divided the sample into suicidal and nonsuicidal groups based on the presence or absence of suicidal ideation. The General Anxiety Disorder scale (GAD-7) was also used. Network analysis was used to identify the network structure of anxiety-depression and which symptoms were directly related to suicidal ideation in the network. The prevalence of depression and anxiety among Chinese college students in the late stage of the COVID-19 pandemic was 7.8% and 17.8%, respectively. The most central symptoms in the nonsuicidal group were "excessive worry," "uncontrollable worry," and "nervousness," and in the suicidal group they were "excessive worry," "motor function," and "irritability." The network of the suicidal group was denser than that of the nonsuicidal group. The most influential symptom directly related to suicidal ideation was "guilt." The most influential central symptom of depression-anxiety comorbidity characteristics of Chinese adolescents showed a tendency to shift from depression-oriented (i.e., sad mood) to anxiety-oriented (i.e., excessive worry) with the continuation of the COVID-19 pandemic. Treatments or interventions focused on these critical symptoms could be useful in preventing college students from suicide risk.

Differences in temperament and character inventory (TCI) profile between suicidal and nonsuicidal psychiatric outpatients.

The purpose of this study was to identify personality traits associated with suicide attempt in a clinical sample. Temperament and character inventory (TCI) profiles of 759 patients who met the inclusion criteria among 1000 randomly selected hospital records collected. Of these 759 patients, 103 had a history of at least 1 actual suicide attempt (suicidal group) whereas 656 had no such history (nonsuicidal group). The suicidal group showed higher scores of novelty seeking (mean ± SD: 36.1 ± 1.2 vs 33.3 ± 0.5; P = .026) and harm avoidance (57.1 ± 1.5 vs 53.0 ± 0.6; P = .01) but lower scores of self-directedness (27.5 ± 1.5 vs 34.4 ± 0.6; P < .001) than the nonsuicidal group. Higher novelty seeking (OR [95% CI]: 1.031 [1.008–1.054]; P = .007) and lower self-directedness: 0.955 [0.927–0.983]; P = .002 were also associated with suicide attempts in the analysis of 7 personality scales. These findings suggest that patients who attempt suicide differ from nonattempters in terms of personality traits, especially in novelty seeking (NS), harm avoidance (HA), and self-directedness (SD). It is noteworthy that this study contains data from actual visits to the emergency room to evaluate suicide attempts.Abbreviations: CO = cooperativeness, Ha = harm avoidance, NS = novelty seeking, PS = persistence, RD = reward dependence, SD = self-directedness, ST = self-transcendence, TCI = temperament and character inventory.

The association between self-esteem and suicidal risk: a meta-analysis

IntroductionBackground: Existing evidence poses low self-esteem as a risk factor for both suicidal ideation (SI) and suicide attempts (SAs) in the general population.ObjectivesThe present study assesses the relationship between self-esteem level and SI/SA, considering across the lifespan. Two separate meta-analyses, one for SI and the other for SA are herein reported since they substantially overlap in terms of eligibility procedures and search strategies.MethodsEligible studies documented at least one suicidal, and a non-suicidal group. Data were analyzed using the Cochrane Collaboration Review Manager Software (RevMan, version 5.4.1) under the random-effects models. Values were standardized owing to the anticipated heterogeneity of self-esteem rating tools. Sensitivity analyses were performed to control for heterogeneity.ResultsOut of 3,310 initial hits, 24 studies were deemed eligible for inclusion. The meta-analyses showed that individuals with lower levels of self-esteem, compared to those with higher levels, were more likely to endorse both SI and SA. SI reached a standardized mean difference of -0.43 (CI: -0.81, -0.05), while SA reduced by -0.89 (CI: -1.02, -0.76), overall. Limitations: The herein presented results rely on standardized mean differences rather than odds of either SI or SA since the original studies failed to systematically fetch rates of the events.ConclusionsLower levels of self-esteem represent a risk factor for both SI and SA across the lifespan. Forthcoming studies should systematically account for multiple moderators to allow meta-analytic synthesis including sub-group and meta-regression analyses assuming high-heterogeneity would still be concerned.DisclosureNo significant relationships.

Sex Differences in Determinants of Suicide Risk Preceding Psychiatric Admission: An Electronic Medical Record Study.

BackgroundIndividuals requiring inpatient psychiatric care represent a group at higher risk of progressing toward suicide attempt. Using electronic medical record (EMR) data collected from psychiatric inpatient admissions, the objective of this study was to identify sex differences in risk factors for suicide plans and/or attempts within the 30 days preceding hospital admission.MethodsResident Assessment Instrument for Mental Health (RAI-MH) intake data were obtained for patients admitted to a Canadian tertiary-care hospital deemed a “threat or danger to self” during a 10-year period (2008–2018). Data was extracted for individuals categorized into three groups: non-suicidal (N = 568), presence of suicide plan (N = 178), and presence of suspected suicide attempt (N = 124) in the 30 days prior to hospital admission. Multivariate logistic regression models were used to examine determinants of suicide risk.ResultsAcross all models, diagnosis of depression was the strongest predictor of suicide plan and/or attempt (OR = 5.54, 95% CI = 3.71–8.27, p < 0.001). Comparing clinical symptoms between suicidal and non-suicidal groups at the time of admission, the largest effect sizes were found for hopelessness (p < 0.001, η2 = 0.11), and guilt or shame (p < 0.001, η2 = 0.09). Female sex was identified as a significant factor for elevated suicidal risk (OR = 1.56, 95% CI = 1.01–2.21, p = 0.01), thus we stratified the regression model by sex to identify specific risk factors for suicide plan and/or attempt for males and females. Among males, having no confidant (OR = 2.13, 95% CI = 1.19–3.80, p = 0.01), presence of recent stressors (OR = 1.95, 95% CI = 1.16–3.29, p = 0.01), and participation in social activities (OR = 1.67, 95% CI = 1.02–2.71, p = 0.04) were important predictors, while among females, younger age (OR = 0.96, 95% CI = 0.94–0.97, p < 0.001) increased odds of suicide plan and/or attempt.ConclusionEMR-derived findings highlight different psychosocial and clinical determinants for males and females associated with suicide plan or attempt prior to psychiatric admission. Identifying precipitating factors that elevate imminent suicide risk may inform suicide prevention efforts for psychiatric inpatients.

A longitudinal study of relationship between family conflict and suicidal behavior in adolescents

Objective: To explore the relationship between family conflict and adolescent future suicidal behavior. Methods: A total of 7 072 adolescents who participated in the baseline survey and the first follow-up survey of Shandong Adolescent Behavior and Health Cohort were included in the analysis. They were sampled from 8 middle schools in 3 counties of Shandong province, China. A self-reported questionnaire was used to measure suicidal behavior, family conflict, depression, and demographic characteristics. Logistic regression model was used to analyze the relationship between family conflict and suicidal behavior. Results: In the baseline survey, the age of 7 072 subjects was (14.58±1.45) years, and boys and girls accounted for 50.0% respectively. 750 people (10.6%) had any suicidal behavior, of which 707 (10.0%), 258 (3.6%) and 190 (2.7%) had suicidal ideation, suicide planning and suicide attempt, respectively. The family conflict scores of the suicidal group were higher than those of the non-suicidal group. After adjusting for covariates, logistic regressions showed that family conflict was associated with increased risk of suicidal behavior (OR=1.05, 95%CI: 1.01-1.10), suicidal ideation (OR=1.05, 95%CI: 1.00-1.09), suicide planning (OR=1.08, 95%CI: 1.01-1.16) and suicide attempt (OR=1.10, 95%CI: 1.02-1.19). Further stratified by gender, results showed no significant association between family conflict and suicidal behavior in girls; the association of family conflict with suicidal behavior was more significant in boys, especially for suicidal ideation and suicide planning, and the OR value of the latter was higher than the former. The results were stable after sensitivity analysis in males. Conclusions: Family conflict might increase the risk of adolescent suicidal behavior, especially in males. Harmonious family environment and good family atmosphere are of great significance to adolescent suicide prevention and control.

Weight and histopathological changes in pancreas in alleged suicide cases

Pancreas will respond differently to stress situations, which results in histopathological changes in the gland. Glucagon and insulin are both secreted by pancreas, the former by alpha cells and latter by beta cells. Insulin may decrease during stress. These endocrine secretions enter the portal vein so that liver is exposed to high concentration of these hormones. This along with increase in its antagonistic hormones can contribute to the stressed induced hyperglycaemia. The aim is to find and compare the weight and histopathological changes of Pancreas in suicide and non suicide deaths. The pancreas were dissected during the autopsy from the cases with known history of death due to alleged suicide with clear history of non administration of steroids and was declared brought dead at GMCH, Chandigarh. The removed glands were preserved and fixed with 10% formalin for more than 2 weeks. After the period of fixation, grossing and section of gland was done, and slides of each subject was prepared and studied.In suicide group maximum weight is 78.2 grams and minimum is 67.3 grams. In non suicide maximum weight is 78.2 grams and minimum is 65.5 grams. The mean weight of the pancreas in the suicidal group was 71.27 grams and the standard deviation was 2.18 grams, whereas the mean weight of the pancreas in the non- suicidal group was 70.87 grams and the standard deviation was 2.63 grams. The P value comes out to be 0.41. Of the total 100 cases, only three (3%) revealed significant pathological findings and the rest 97 (97%) were histologically normal. In the study group there was one case each of pancreatic abscess, and necrotising pancreatitis. Pancreatitis abscess was diagnosed when the histology revealed focus of necrosis of the pancreatic parenchyma with dense neutrophilic infiltration. Necrotising pancreatitis showed extensive necrotising inflammation of the pancreatic parenchyma. In the control group there was only 1 case (2%), of chronic pancreatitis. Chronic pancreatitis was labelled when fibrosis of the pancreatic parenchyma with mild lymphomononuclear cell infiltration. There was no significant difference between the weight of the pancreas in the suicidal and the non-suicidal group. Pathological findings were twice as common in the suicidal group as compared to the non-suicidal group.

Adverse Childhood Experiences, Depression, Exposure to Suicide, Self-injury, Defeat, and Entrapment among Suicide Attempters and Non-suicidal People

Background: Suicide is an important concern with regard to mental health and needs more attention in Iran. Objectives: This study aimed to compare depression, exposure to suicide, self-injury, defeat, and entrapment, and adverse childhood experiences in suicide attempters and normal people. Materials and Methods: The current research method was descriptive in the form of ex post facto research. The research community included two groups of (1) suicide attempters, and (2) normal students. Research measures included the Patient Health Questionnaire-2, exposure to suicidal behavior, non-suicidal self-injury, short defeat and entrapment scale, adverse childhood experiences questionnaire, and future self-injury. The data were analyzed using t-test. Results: The results showed a significant difference between groups on the mean values of depression (2.27 for the non-suicidal group vs. 3.87 for the suicidal group), adverse childhood experiences (5.82 vs. 0.95), exposure to the attempted suicide (0.28 vs. 0.50), self-injury behavior (0.36 vs. 2.13), and future self-injury likelihood (0.56 vs. 2.13). The most significant differences belonged to the defeat and entrapment variable and adverse childhood experiences (P &lt; 0.01). Conclusions: Thus, defeat and depression play an important role in predicting suicide, so we should intervene in these two states of mind.

Insomnia symptom severity is associated with increased suicidality and death by suicide in a sample of patients with psychiatric disorders.

Insomnia is a risk factor for suicidal behavior including attempts and death by suicide. We investigated whether insomnia symptom severity was associated with suicidality and death by suicide in patients with psychiatric disorders. The sample included 180 deceased patients with psychiatric disorders seen at Weber Human Services between 2008 and 2018 who completed the Outpatient Questionnaire-45.2 (OQ) prior to death. Insomnia symptom severity was assessed using item 41 from the OQ. Manner of death was determined by death records and autopsy reports. History of suicidality was determined through electronic medical records. Cases were grouped into four lifetime categories: non-suicidal (n = 30), suicidal ideation (n = 36), suicide attempt (n = 95), and death by suicide (n = 19). Demographic, medical, and psychiatric features of each group were compared using linear regression. Logistic regression was used to determine whether insomnia symptom severity was associated with lifetime suicidality severity grouping, adjusting for psychiatric disorders commonly linked to suicidality. Lifetime suicidality was associated with sleep problems, fatigue, headaches, and psychiatric disorders (i.e. depressive, personality, and trauma-related disorders). Referenced to the non-suicidal group, greater insomnia symptom severity was significantly associated with suicide attempts and death by suicide, with odds ratios (OR) of OR = 2.67, p = 0.011, and OR = 5.53, p = 0.002, respectively, even after adjusting important psychiatric diagnoses. Results suggest that insomnia symptom severity endorsed during a clinical visit is associated with heightened suicidality, especially suicidal behavior. The presence of insomnia symptoms in patients with psychiatric disorders may indicate risk for suicide and is a target for suicide prevention.

Brain Gene Expression-DNA Methylation Correlation in Suicide Completers: Preliminary Results.

Gene expression alterations have been implicated in suicide pathology. However, the study of the regulatory effect of DNA methylation on gene expression in the suicidal brain has been restricted to candidate genes. The objective of the study was to identify genes whose expression levels are correlated with DNA methylation in the prefrontal cortex of suicides. Postmortem prefrontal cortex samples from 21 suicides and six non-suicides were collected. Transcriptomic and DNA methylation profiles were evaluated with microarrays; cis correlations between gene expression and CpG methylation were screened. We then analyzed the presence of transcription factor (TF) binding sites (TFBS) at CpG sites correlated with gene expression. Gene expression of TFs involved in neurodevelopmental binding to predicted TFBS was determined in the BrainSpan database. We identified 22 CpG sites whose methylation levels correlated with gene expression in the prefrontal cortex of suicides. Genes annotated to identified CpG sites were involved in neurodevelopment (BBS4, NKX6-2, AXL, CTNND1, and MBP) and polyamine metabolism (polyamine oxidase [PAOX]). Such correlations were not detected in the nonsuicide group. Nine TFs (USF1, TBP, SF1, NRF1, RFX1, SP3, PKNOX1, MAZ, and POU3F2) showed differential expression in pre- and post-natal developmental periods, according to BrainSpan database. The integration of different omic technologies provided novel candidates for the investigation of genes whose expression is altered in the suicidal brain and their potential regulatory mechanisms.

Characteristics of First Visit Pediatric Patients with Suicidal Ideation and Behavior: An 8-Year Retrospective Chart Review.

ObjectivesOur study aimed to analyze the demographic and clinical characteristics of children and adolescents during their first visit to psychiatric outpatient departments for the management of suicidal ideation and behavior, and to compare the changes before and in 2012 or later.MethodsThis multicenter study was conducted at five university hospitals in a metropolitan area in South Korea. Medical records of patients aged 6–18 years were retrospectively reviewed from January 2009 to December 2016. Patients were analyzed by classifying them into suicidal and non-suicidal groups based on their visit to the hospital for management of suicidal ideation or suicide attempt and other mental problems, respectively.ResultsThere were differences in the year of visit, diagnosis, education level, and referral sources between patients in the suicidal and non-suicidal groups. Multiple regression analysis was conducted based on the sex, education level, referral by school, and diagnosis of depression in patients in the suicidal group, which revealed significant association.ConclusionSuicide-related problems were significantly associated with the sex, education level, referral by school, and a diagnosis of depression in the patients. A well-connected referral system would be necessary for professional mental health management of high-risk children and adolescents.

Painful insight vs. usable insight in schizophrenia. Do they have different influences on suicidal behavior?

BackgroundSuicidal behavior is highly prevalent in schizophrenia. Among the risk factors, insight has been little studied and has yielded contradictory results. In addition, it has been studied neglecting relevant psychological aspects, such as beliefs about illness and coping styles. MethodWe assessed 133 outpatients diagnosed with schizophrenia according to ICD-10 criteria. Evaluation included sociodemographic, general clinical, psychopathological, psychological and suicidal behavior variables. ResultsNeither insight nor insight coupled with negative beliefs and/or coping styles were associated with suicidal behavior. Nevertheless, insight coupled with negative beliefs and/or coping styles was associated with greater hopelessness and depression, internalized stigma, worse control over illness and greater global severity as compared to insight coupled with positive beliefs and coping styles. Suicide attempt and suicidal ideation groups showed greater depression and hopelessness, worse global beliefs and worse control over illness, higher socio-economic level, and greater number of previous psychiatric admissions compared to the non-suicidal group. ConclusionsInsight coupled with negative beliefs and/or coping style was not associated with suicidal behavior. Nevertheless, it was associated with greater depression and hopelessness, both of which are firmly established risk factors for suicide in schizophrenia. Prospective studies with long-term follow-up and large samples are needed to clarify this issue. Clinicians should assess these psychological features associated with insight, both in patients with insight and in those with poor insight when promoting it.

Temporal association between zolpidem medication and the risk of suicide: A 12-year population-based, retrospective cohort study

There have been concerns about abuse and unnecessary chronic administration of zolpidem, and zolpidem’s relation to suicide risk. To investigate the temporal association of zolpidem with the risk of suicide, we conducted a 12-year, population-based, retrospective cohort study on the National Health Insurance Service–National Sample Cohort (NHIS-NSC), South Korea. Data were collected from 2002 to 2013 from the NHIS-NSC, and data cleaning was performed for 1,125,691 subjects. Cox proportional hazards regression analysis was used to investigate the correlation over time between zolpidem medication and suicide. Over intervals commencing after 80 months of observation, the adjusted hazard ratio of suicides associated with the use of the zolpidem was 2.01 (95% CI: 1.58–2.56; p < 0.001). The mean cumulative number of days of zolpidem prescription was significantly longer in the suicide group than in the non-suicide group after log-transformation (p = 0.005). Cases of chronic use of zolpidem (over six months or one year) were significantly more common in the suicide group compared to the non-suicide group (p = 0.002 and 0.005, respectively). Subjects who received zolpidem medication had a significantly higher risk of suicide after at least 80 months of observation, suggesting a long-term increased suicide risk associated with insomnia exposed to zolpidem medication.

The mediating effects of psychache and dissociation in the relationship between childhood trauma and suicide attempts

Objective: Childhood maltreatment, including physical, sexual, and emotional abuse and neglect, is a common experience worldwide. The association between childhood maltreatment and suicide has also been well established. This study aimed to investigate the mediator roles of psychache and dissociation in the effect of childhood maltreatment on suicide. Methods: This cross-sectional study included 198 major depressive disorder patients admitted to Cukurova University School of Medicine Balcali Hospital and diagnosed with major depressive disorder according to DSM-5 criteria. The patients were grouped as those who attempted (97 patients) or did not attempt suicide (101 patients). Sociodemographic data form, Beck Depression Inventory (BDI), Childhood Trauma Questionnaire (CTQ), Dissociative Experiences Scale (DES), and Psychache Scale (PS) was used for data collection. Results: The mean BDI, median DES, median CTQ total, and mean PS scores in the suicide group were higher than those in the non-suicide group (p

The influence of cognition on suicidal ideation of major depressive patients

Objective To analyze the influence of cognition on suicidal ideation in patients with major depressive disorder. Methods A total of 108 inpatients with major depressive disorder from January 2017 to September 2018 in Beijing Huilongguan Hospital were enrolled.They were divided into suicidal ideation group (n=42) and non-suicidal ideation group (n=66) by the self-rating idea of suicide scale (SIOSS). Cognition was assessed by Repeatable Battery for the Assessment of Neuropsychological Status(RBANS). The general situation was assessed by self-made general situation questionnaire.The related factors were analyzed by Logistic regression. Results (1) The rate of suicidal ideation was 44.4% in patients with major depressive disorder.(2) The total score of RBANS and five-factor scores of RBANS in suicidal ideation group were lower than those in non-suicidal ideation group(total RBANS score(63.0±7.9) vs (73.8±7.7); immediate memory: (62.7±8.8) vs (70.8±7.6); visual span: (67.2±10.0) vs (72.7±9.8); speech function: (83.3±13.8) vs (91.5±4.5); attention: (85.3±11.9) vs (99.9±8.5); delayed memory: (53.5±7.7) vs (62.3±9.7), F=6.335-46.660, P<0.05). (3)Logistic regression showed, years of education were risk factors for suicidal ideation(β=0.289, P=0.013, OR=1.335, 95%CI=1.063-1.676), RBANS attention factor(β=-0.161, P=0.000, OR=0.851, 95%CI=0.778-0.931)and RBANS delayed memory factor score(β=-0.151, P=0.006, OR=0.860, 95%CI=0.772-0.957)were protective factors for suicidal ideation. Conclusion Cognitive function has an impact on suicide ideation of depressive patients, mainly attention and delayed memory are protective factors for suicide ideation. Key words: Depression; Suicidal ideation; Cognition; Attention; Memory

P60. The characteristics of patients with thoracolumbar fractures between suicidal attempters and accidental fallers

BACKGROUND CONTEXT A fall from a height is the one of common causes of thoracolumbar fractures. In most cases, falls from a height are accidental. However, some are the intentional fall for suicidal attempt. Although there may be the different clinical features between suicidal attempters and accidental fallers, there have been few literature reviews comparing them. PURPOSE We analyzed the demographic and the radiological characteristics between suicidal attempters and accidental faller. STUDY DESIGN/SETTING This is a retrospective comparative clinical study in an academic institutional setting. PATIENT SAMPLE Between March 2011 and June 2018, we evaluated 78 consecutive patients (under 40 years old) who suffered unstable traumatic thoracolumbar fractures and were treated surgically in one trauma center. Patients were classified into suicidal group (suicidal attempters, n=30) and non-suicidal group (accidental fallers, n=48) by interviewing patients or inspector of accident. Psychiatrist helped to distinguish these patients. OUTCOME MEASURES Demographic data including gender, age, past history of psychiatric disease, the height of fall, neurological status, associated injuries and treatment were obtained from the medical records. We also reviewed the location and the numbers of fractured vertebrae. METHODS We compared theses parameters between suicidal group and non-suicidal group. RESULTS There were significant differences in gender, age, past history of psychiatric disease and associated injuries (all p CONCLUSIONS There were distinct characteristics of patients with thoracolumbar fractures between suicidal and non-suicidal groups regarding gender, age, past history of psychiatric diseases and associated injury. Patients as suicidal attempters were younger and female-dominant. Psychiatric diseases, especially schizophrenia and major depression disorder, were more common in suicidal attempters. Severe associated injury in pelvis is more common in suicidal attempters. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.