Non-lethal Suicidal Behavior Research Articles

Non-lethal suicidal behavior in university students of Spain during COVID-19.

Suicide is the fourth external cause of death in the world, in persons between the ages of l5 and 29. The objectives of this study were to measure the prevalence of suicidal behavior in university students and analyze the relationship of suicide risk with psychological distress, resilience, and family and social support. An observational and transversal study wherein the students at the University of Malaga (Spain) completed an online questionnaire which included items from different scales, sociodemographic and academic questions, and the subjective impact of the COVID-19 pandemic. Descriptive analyses and prevalence rates of suicidal behavior were calculated, and bivariate analyses, multiple linear regression, and a mediation and moderation analyses were conducted. A total of 2,212 students completed the questionnaire. The prevalence of the last 6 months was 30.4% wishing for death, 14.7% suicidal ideation, 5% self-harm injuries, and 0.5% suicide attempts. Psychological distress, family and social support were linked to the risk of suicide. Lastly, resilience and family support measure and moderate the relation between psychological stress and suicide risk. Psychological distress is a risk factor for suicidal behavior, while resilience and family and social support are linked to a lower risk of suicide.

Suicides between 2010 and 2014 in the German Armed Forces-Comparison of Suicide Registry Data and a German Armed Forces Survey.

The last 10years have seen an increase in the number of suicides in the US Armed Forces. Accordingly, the topic of suicides in the German military has received a lot of attention in media and science alike. This study retrospectively examined all suicides (N=107) committed by active, nonretired German military personnel from 2010 to the end of 2014, analyzing archived medical records. In a second step, these data were compared to a representative German Armed Forces survey conducted in 2012 (N=1,549). The following risk groups for suicide were identified: male (OR=9.6), single (OR=7.8), aged over 45years (OR=4.0), short period of service (<2years; OR=2.7), and low level of education (OR=2.2). Surprisingly, military personnel with little experience in deployments abroad (<2 missions) showed double the risk (OR=2.0) compared to those who had been deployed more than once. Multiple robustness checks show that being single, aged over 45years, and having obtained a low level of education exhibit the most robust effects on suicide risk. Efforts should be made to develop and evaluate risk group-focused prevention programs. We conclude, that further studies should be initiated to show differences of risk groups between lethal and nonlethal suicidal behavior.

When Saying "Sorry" Isn't Enough: Is Some Suicidal Behavior a Costly Signal of Apology? : A Cross-Cultural Test.

Lethal and nonlethal suicidal behaviors are major global public health problems. Much suicidal behavior (SB) occurs after the suicide victim committed a murder or other serious transgression. The present study tested a novel evolutionary model termed the Costly Apology Model (CAM) against the ethnographic record. The bargaining model (BRM) sees nonlethal suicidal behavior as an evolved costly signal of need in the wake of adversity. Relying on this same theoretical framework, the CAM posits that nonlethal suicidal behavior can sometimes serve as an honest signal of apology in the wake of committing a severe transgression, thereby repairing valuable social relationships. To test this hypothesis, the CAM was operationalized into a set of variables, and two independent coders coded 473 text records on suicidal behavior from 53 cultures from the probability sample of the Human Relations Area Files. The results indicated that in ethnographic accounts of suicidal behavior, transgressions, punishment, and shame were relatively common, supporting the CAM, but explicit motives to apologize and evidence of forgiveness were rare, contrary to the CAM. The theoretical variables of the CAM nevertheless formed a cluster distinct from the BRM, and a subset of cases of suicidal behavior were largely related to transgressions and other CAM variables rather than BRM or other variables. Support for the CAM varied widely across cultures, but there was evidence for it in every major geographical region. Exploratory analyses suggested that the CAM is potentially more likely to occur in response to severe conflicts concerning transgressions committed against nonkin. Furthermore, in text records that involved transgressions, male suicidal behavior was most frequently associated with murder, whereas female suicidal behavior was most frequently associated with sexual transgressions. In conclusion, the results provided mixed support for the hypothesis that some instances of suicidal behavior function to send a costly signal of apology to those harmed by a transgression.

Does Religiosity Predict Suicidal Behavior?

Research was reviewed on whether self-report measures of religiosity were a protective factor against suicidal behaviors. It was found that scores on Francis’s measure of religiosity was negatively associated with non-lethal suicidal behavior (ideation and attempts), a protective effect. Similarly, it was found that intrinsic religiosity (but not extrinsic religiosity) was negatively associated with non-lethal suicidal behaviors. However, these associations were weak. Research is needed on the issue whether counselors can use their patients’ religiosity to reduce the risk of dying by suicide.

Big Five Personality Scores and Rates of Suicidality in the United States

Voracek (2009) reported that suicide rates in the American states were negatively associated with the mean neuroticism scores of residents in those states. In the present study, state rates of suicidal ideation and attempted suicide were not found to be associated with any state scores for the Big Five personality traits, suggesting that lethal and non-lethal suicidal behavior may have different ecological correlates.

Suicide: Global Perspectives From the WHO World Mental Health Surveysedited by NockMatthew K., BorgesGuilherme, and OnoYutaka. Cambridge, United Kingdom, Cambridge University Press, 2012, 404 pp., $120.00.

Suicide: Global Perspectives From the WHO World Mental Health Surveysedited by NockMatthew K., BorgesGuilherme, and OnoYutaka. Cambridge, United Kingdom, Cambridge University Press, 2012, 404 pp., $120.00.

Religion and Spirituality Along the Suicidal Path

The inner experience of spiritual and religious feelings is an integral part of the everyday lives of many individuals. For over 100 years the role of religion as a deterrent to suicidal behavior has been studied in various disciplines. We attempt to systematize the existing literature investigating the relationship between religion/spirituality and suicide in this paper. After an overview of the attitudes of the dominant religions (e.g., Catholicism, Islam, and Buddhism) toward suicide, the three main theories that have speculated regarding the link between religion and suicide are presented: "integration theory" (Durkheim, 1897/1997), "religious commitment theory" (Stack, 1983a; Stark, 1983), and "network theory" (Pescosolido & Georgianna, 1989). Subsequent to this theoretical introduction, we report on studies on religion/spirituality keeping the suicidal path as a reference: from suicidal ideation to nonlethal suicidal behavior to lethal suicidal behavior. Studies presenting indications of religious beliefs as a possible risk factor for suicidal behavior are also presented. The last section reviews possible intervention strategies for suicidal patients and suicide survivors. Indications for future research, such as more studies on nonreligious forms of spirituality and the use of qualitative methodology to achieve a better and deeper understanding of the spiritual dimension of suicidal behavior and treatment, are offered.

Bipolar pharmacotherapy and suicidal behavior. Part I: Lithium, divalproex and carbamazepine

Introduction The anti-suicidal benefit of lithium on suicidal behavior in bipolar disorder is well-established. Data are mixed on the effects of divalproex and carbamazepine. Methods Retrospective chart review study of 405 veterans with bipolar disorder followed for a mean of 3 years, with month by month review of clinical progress notes, and systematic assessment of current pharmacotherapy and suicide completion, attempt or hospitalization for suicidality. Comparison of suicide event rates (events/100 patient years) between mood stabilizers and during-vs-after discontinuation of mood stabilizers, with linear regression analysis for influence of potential confounding variables, and robust bootstrap confirmation analysis. Results No completed suicides occurred during or after discontinuation of monotherapy. Rates of non-lethal suicidal behavior were similar during lithium (2.49), divalproex (4.67) and carbamazepine (3.80) monotherapies. There was a sixteen fold greater, highly statistically significant non-lethal suicidal event rate after discontinuation compared with during mood stabilizer monotherapy (55.89 vs. 3.48 events/100 patient years; Chi 2 = 13.95; df = 1; p < 0.0002). On compared with off treatment differences were similar for the three different agents. Limitations Treatments were uncontrolled in this naturalistic setting, and data were analyzed retrospectively. Conclusions Lithium and the anticonvulsants may show similar benefits in protecting bipolar patients from non-lethal suicidal behavior when careful analysis of clinical data is done to confirm medication adherence/non-adherence. Findings in this study were similar to those of a previous study that applied the same methodology in a private practice setting.

Bipolar pharmacotherapy and suicidal behavior: Part 2. The impact of antidepressants

Antidepressant-induced mania and cycle acceleration is a potential risk in bipolar patients. Another serious risk of antidepressants, that of increasing suicidal behavior, has been identified in some affectively ill populations. However, there is a dearth of knowledge about the effects of antidepressants on suicidal behavior specifically in bipolar patients. Methods Retrospective chart review of 405 veterans with bipolar disorder followed for a mean of three years, with month by month systematic assessment of current pharmacotherapy and suicide completion, attempt or hospitalization for suicidality. Chi-squared comparison of (log) rates of suicidal events during mood stabilizer monotherapy, antidepressant monotherapy, and combination of mood stabilizer and antidepressant. Results Suicidal behavior event rates (per 100 patient years) were greatest during treatment with antidepressant monotherapy (25.92), least during mood stabilizer monotherapy (3.48), and intermediate during mood stabilizer + antidepressant combination treatment (9.75). These differences were statistically significant. Limitations In a clinical setting, antidepressants may have been prescribed because patients were deemed at greater risk of suicidality. Conclusions During treatment with antidepressants (even when coupled with mood stabilizers), patients with bipolar disorder have significantly higher rates of non-lethal suicidal behavior compared to those on mood stabilizers without antidepressants, and thus require careful monitoring.

Bipolar pharmacotherapy and suicidal behavior: Part 3: Impact of antipsychotics

Introduction Antipsychotics, particularly second generation agents, are widely used in bipolar disorder, but their effect on suicidal behavior in this population has not been systematically studied. Methods Retrospective chart review of 405 veterans with bipolar disorder followed for a mean of three years, with month-by-month systematic assessment of current pharmacotherapy and suicide completion, attempt or hospitalization for suicidality. Comparison of rates of suicidal events during mood stabilizer monotherapy, antipsychotic monotherapy, and combination of mood stabilizer and antipsychotic. Results Non-lethal suicide event rates were 9.4 times greater ( χ 2 = 28.29, p < .0001) during antipsychotic monotherapy and 3.5 times greater during mood stabilizer + antipsychotic ( χ 2 = 15.13, p = 0.0001) than during mood stabilizer monotherapy. Limitations Antipsychotics may have been prescribed because patients were at greater risk of suicidal behavior. First and second generation antipsychotics were not distinguished. Conclusions Treatment of bipolar patients with antipsychotics is associated with an increase in non-lethal suicidal behavior. Thus, use of antipsychotics for bipolar patients requires careful monitoring for suicidal behavior. Further studies are urgently needed to better characterize this relationship.

Lithium, anticonvulsants and suicidal behavior in bipolar disorder

Background: Lithium has been found to be effective in reducing suicide rates during long term treatment of patients with bipolar disorders. Data on the efficacy of anticonvulsant mood stabilizers in reducing suicide risk are sparse. Method: Charts of 140 bipolar patients treated continuously for a minimum of 6 months during a 23-year period of private practice by the senior author were extracted from nearly 4000 patient records. Data extracted from the charts were incidence of completed suicide, number of suicide attempts, and number of hospitalizations for suicidal ideation or behavior per 100 patient-years of either ‘on’ or ‘off’ lithium or anticonvulsant mood stabilizer monotherapy. Results: Only one completed suicide (during a period off of lithium) occurred in the patients studied. Incidence of non-lethal suicidal behavior was not different during treatment with lithium, compared with anticonvulsants. Being on a mood stabilizer significantly protected against suicidal behavior. The relative protective effect was more modest than in reports from other treatment settings. Limitations: This was a retrospective chart review study of naturalistically treated patients. Conclusions: Treatment of patients with bipolar disorder with either lithium or anticonvulsant mood stabilizers was associated with reduced risk of suicidal behavior. This study did not find evidence for a difference in the protective effect of the two types of mood stabilizing medications against non-lethal suicidal behavior in the naturalistic setting of private practice.

Youth suicide prevention.

Abstract Youth suicide, the third leading cause of death among teenagers and young adults, accounts for more deaths in the United States than all natural causes combined among 15- to 24-year-olds according to the National Center for Health Statistics (2000a). The public health significance of the problem of youth suicide becomes even more apparent when the high rates of nonlethal suicidal behavior are taken into account. This paper reviews the extensive research literature on youth suicide that has emerged during the past two decades. While great advances in knowledge have led to increased understanding of the risk factors for child and adolescent suicides, the application of this knowledge for designing prevention strategies remains inchoate.