Number Of Previous Suicide Attempts Research Articles

Thinking about dying and trying and intending to die: results on suicidal behavior from a large Web-based sample.

Suicide is an important worldwide public health problem. The aim of this study was to characterize risk factors of suicidal behavior using a large Web-based sample. The data were collected by the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP) from November 2010 to July 2011. Suicidal behavior was assessed by an instrument based on the Suicidal Behaviors Questionnaire. The final sample consisted of 48,569 volunteers (25.9% men) with a mean ± SD age of 30.7 ± 10.1 years. More than 60% of the sample reported having had at least a passing thought of killing themselves, and 6.8% of subjects had previously attempted suicide (64% unplanned). The demographic features with the highest risk of attempting suicide were female gender (OR = 1.82, 95% CI = 1.65 to 2.00); elementary school as highest education level completed (OR = 2.84, 95% CI = 2.48 to 3.25); being unable to work (OR = 5.32, 95% CI = 4.15 to 6.81); having no religion (OR = 2.08, 95% CI = 1.90 to 2.29); and, only for female participants, being married (OR = 1.19, 95% CI = 1.08 to 1.32) or divorced (OR = 1.66, 95% CI = 1.41 to 1.96). A family history of a suicide attempt and of a completed suicide showed the same increment in the risk of suicidal behavior. The higher the number of suicide attempts, the higher was the real intention to die (P < .05). Those who really wanted to die reported more emptiness/loneliness (OR = 1.58, 95% CI = 1.35 to 1.85), disconnection (OR = 1.54, 95% CI = 1.30 to 1.81), and hopelessness (OR = 1.74, 95% CI = 1.49 to 2.03), but their methods were not different from the methods of those who did not mean to die. This large Web survey confirmed results from previous studies on suicidal behavior and pointed out the relevance of the number of previous suicide attempts and of a positive family history, even for a noncompleted suicide, as important risk factors.

Abcb1 Haplotype (1236tt-2677tt-3435tt) and Use of Violent Suicide Methods Among Attempters.

Those suicide attempters that choose violent methods dramatically diminish the possibility of survival. Completed suicide using violent means, which appears common among first-time suicide attempters, was recently found to be more likely among T allele carriers in the three most common ABCB1 SNPs, encoding for P-gp. This study examined, for the first time, whether the ABCB1 (C1236T, G2677T/A, C3435T) SNPs were associated with the use of violent means among survivors of a suicide attempt. Suicide attempters (n=578, 87.4% women; of whom 16.6% committed a violent intent) were genotyped for ABCB1 C1236T, G2677T/A, C3435T. The relations of the three genotypes and of the TTT haplotype with the use of a violent suicide method were evaluated separately. The impact of confounds on these variables was controlled. A higher frequency (p=0.02) of suicide attempters using violent methods was found among those carrying the ABCB1 haplotype (1236TT-2677TT-3435TT). Since gender and number of previous suicide attempts were identified as confounds, the relation was tested in the subset of women who were first-time attempters or second- and more-time attempters. The ABCB1 haplotype increased the risk more than three times in those women attempting a violent suicide for the first time (OR=3.6; CI95%:1.08-12.09; p=0.04). The ABCB1 haplotype (1236TT-2677TT-3435TT) was related to the use of a violent suicide attempt method. Genotyping for these three ABCB1 SNPs may be helpful to detect people at risk of first suicide intents using violent methods. FEDER/FSE-GOBEX Consejería Economía, Competitividad e Innovación IB13186 and PD10199.

Psychopathology and Suicide Risk in Patients Suffering From Psoriasis and Other Dermatological Diseases

Psoriasis has a significant impact on the mental and emotional functioning. It has been shown that the risk of psychiatric comorbidity as well as suicide risk increases with the severity of the disease. To analyze the association between psoriasis, mental disorders and suicidal ideation in a sample of patients affected by psoriasis. To analyze the differences between patients affected by psoriasis and patients with other dermatologic diseases. we enrolled 157 consecutive patients (90 women and 67 men), mean age 50,15 years (±16,21); 91 affected by psoriasis (58.0 %), 35 by melanoma (22.3 %) and 31 with atopic dermatitis (19.7%). All participants completed a structured sociodemographic interview. We also administered the following rating scale: Hamilton Rating Scale for Depression (HAM- D) and the Hamilton Rating Scale for Anxiety (HAM -A). We assessed current and prior suicidal ideation and the number of previous suicide attempts. Patients with psoriasis, more frequently had a comorbid psychiatric disorder (38.5% vs 16.7 %, p < 0.05), and reported more frequently previous suicidal ideation (37.4% vs 16.7%) and history of one or more suicide attempts (6.6% vs 0.0%, p < 0.05). Moreover, patients with psoriasis, have higher scores on the HAM -D (T155 = 3.09, p < 0.01). The duration of illness of more than 8 years (beta = 1.51, p< 0.001) was the only factor independently associated with psoriasis. The clinical evaluation of patients with psoriasis should include the assessment of psychiatric comorbidities and the routine assessment of suicide risk.

ABCB1 gene polymorphisms and violent suicide attempt among survivors

IntroductionThose suicide attempters that choose violent methods dramatically diminish the possibility of survival. Completed suicide using violent means, which is common among first-time suicide attempters, was recently found to be more likely among T allele carriers in the three most common ABCB1 SNPs, encoding for P-gp. Thus, this study examined, for the first time, whether these ABCB1 SNPs were associated with the use of violent means among survivors of a suicide attempt. Material and methodsSuicide attempters (n = 578, 87.4% women; of whom 16.6% committed a violent intent) were genotyped for exonic SNPs in the ABCB1 (C1236T, G2677T/A, C3435T). The relations of the three genotypes and of the TTT haplotype with the use of a violent suicide method were evaluated separately. The impact of confounds on these variables was controlled. ResultsA higher frequency (p = 0.02) of suicide attempters using violent methods was found among those carrying the ABCB1 haplotype (1236TT-2677TT-3435TT). Since gender and number of previous suicide attempts were identified as confounds, the relation was tested in the subset of women who were first-time attempters or second- and more-time attempters. The ABCB1 haplotype increased the risk more than three times in those women attempting a violent suicide for the first time (OR = 3.6; CI95%: 1.08–12.09; p = 0.04). DiscussionThe ABCB1 haplotype (1236TT-2677TT-3435TT) was related to the use of a violent suicide attempt method. Genotyping for these three ABCB1 SNPs may be helpful to detect people at risk of first suicide intents using violent methods.

Low neuropeptide Y in cerebrospinal fluid in bipolar patients is associated with previous and prospective suicide attempts

The attempted and accomplished suicide rates in patients with bipolar disorder are 40–50% and 15–20%, respectively. No biological markers that help predict suicide been identified. Human and experimental animal data indicate that dysregulation of the neuropeptide Y (NPY) system plays a role in depression, anxiety, and posttraumatic stress disorder (PTSD). The aim of this study was to explore if low cerebrospinal fluid (CSF) NPY is associated with (1) past suicide attempts, (2) future suicide attempts, and (3) trait anxiety. Lumbar puncture was performed on 120 clinically stable patients with bipolar disorder enrolled in the St Göran Bipolar Project, where the number of previous suicide attempts was documented. NPY-like immunoreactivity (NPY-LI) was determined in cerebrospinal fluid (CSF). Patients were reexamined one year after the lumbar puncture and suicide attempts were recorded. NPY-LI was significantly lower in patients with a history of suicide attempt than in patients who had not attempted suicide prior to lumbar puncture. Importantly, NPY-LI was markedly lower in patients who made a suicide attempt during the follow-up period compared to patients who did not. Patients who attempted suicide during the follow-up also had markedly lower NPY-LI than those with previous suicide attempts who did not reattempt. Our results suggest that low CSF NPY-LI predicts future suicide attempts. The data are in line with the hypothesis that NPY signaling is altered in affective disorders and states of emotional dysregulation.

EPA-0478 – Hyperthymic temperament as a protective factor against suicidal risk

Introduction Suicide is a leading cause of death and suffering worldwide, mental disorder being a major risk factor for it. Recent data suggest that the underlying temperament may be more important as a risk factor than the exact psychiatric diagnosis. Methods A cross-sectional non-interventional study of 79 patients with DSM-IV major depressive episode (58 females, 21 males; aged 19–66 years), evaluated by M.I.N.I. Their temperament was assessed through the self-rated TEMPS-A. Patients were distributed into four groups: 1) fMDE - first major depressive episode (n=16); 2) RMD - recurrent major depression: at least 5 years duration of illness, no previous (hypo)manic/mixed episodes, and no first-degree relatives with bipolar disorder (n=23); 3) BDI - MDE with at least one previous manic episode (n=19); 4) BDII – two or more MDE with at least one previous hypomanic episode (n=21). Results No significant intergroup differences in the level of suicidal risk measured by the M.I.N.I. No gender difference in the M.I.N.I. risk for suicide, however, female gender was associated with a higher number of previous suicide attempts (p=0.001). The fMDE group had higher mean score for hyperthymic temperament, and the RMD group had higher mean score for anxious temperament. After controlling for the diagnosis and gender, a significant positive correlation was found between level of suicidal risk and mean score for depressive, cyclothymic, and irritable temperament (p Conclusions We suggest that hyperthymic temperament is a protective factor against suicide in patients with affective disorders.

ENHANCING HISPANIC PARTICIPATION IN MENTAL HEALTH CLINICAL RESEARCH: DEVELOPMENT OF A SPANISH-SPEAKING DEPRESSION RESEARCH SITE

Hispanics, particularly those with limited English proficiency, are underrepresented in psychiatric clinical research studies. We developed a bilingual and bicultural research clinic dedicated to the recruitment and treatment of Spanish-speaking subjects in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study, a large clinical trial of treatment-naïve subjects with major depressive disorder (MDD). Demographic and clinical data derived from screening evaluations of the first 1,174 subjects presenting for participation were compared between the Spanish-speaking site (N = 275) and the primary English-speaking site (N = 899). Reasons for ineligibility (N = 888) for the PReDICT study were tallied for each site. Compared to English speakers, Spanish speakers had a lower level of education and were more likely to be female, uninsured, and have uncontrolled medical conditions. Clinically, Spanish speakers demonstrated greater depression severity, with higher mean symptom severity scores, and a greater number of previous suicide attempts. Among the subjects who were not randomized into the PReDICT study, Spanish-speaking subjects were more likely to have an uncontrolled medical condition or refuse participation, whereas English-speaking subjects were more likely to have bipolar disorder or a non-MDD depressive disorder. Recruitment of Hispanic subjects with MDD is feasible and may enhance efforts at signal detection, given the higher severity of depression among Spanish-speaking participants presenting for clinical trials. Specific approaches for the recruitment and retention of Spanish-speaking participants are required.

Nicotine Dependence among Patients Examined in Emergency after a Suicide Attempt

Background: To assess the prevalence of nicotine dependence in a population of patients examined following a suicide attempt and to compare suicide attempts with and without nicotine dependence. Methods: 200 patients were examined in an emergency department after a suicide attempt. They answered the MAST and the Fagerström questionnaire, and the DSM-IV-TR criteria for alcohol and nicotine were checked. We also assessed socio-demographic characteristics, the mode of suicide attempt and level of sensation seeking. Results: The prevalence of nicotine dependence was 57% among suicide attempters. Suicide attempters with nicotine dependence were more often men (42 vs. 12%, p=0.001), single (67 vs. 32%, p=0.008) and had taken alcohol before suicide. They were often multi-attempters (2.7 vs. 1 suicide attempt in their history) and had been more often hospitalized in psychiatry (1.9 vs. 0.6 hospitalization, p<0.001) than others. They drank more alcohol (3.7 vs. 0.7 drinks/ day, p<0.001), presented more alcohol dependence and abuse (36 vs. 8%, p<0.00001) and had a higher level of sensation seeking. Factors associated to nicotine dependence were male gender, ingestion of alcohol before suicide attempt, number of previous suicide attempts and number of alcohol intoxication per week. Conclusion: 57% of the patients examined after a suicide attempt present nicotine dependence. Emergency units may provide an opportunity to systematically identify a dependence disorder and to offer appropriate information and treatment.

A risk-scoring scheme for suicide attempts among patients with bipolar disorder in a Thai patient cohort

BackgroundIn Thailand, risk factors associated with suicide attempts in bipolar disorder (BD) are rarely investigated, nor has a specific risk-scoring scheme to assist in the identification of BD patients at risk for attempting suicide been proposed.ObjectiveTo develop a simple risk-scoring scheme to identify patients with BD who may be at risk for attempting suicide.MethodsMedical files of 489 patients diagnosed with BD at Suanprung Psychiatric Hospital between October 2006 and May 2009 were reviewed. Cases included BD patients hospitalized due to attempted suicide (n = 58), and seven controls were selected (per suicide case) among BD in- and out-patients who did not attempt suicide, with patients being visited the same day or within 1 week of case study (n = 431). Broad sociodemographic and clinical factors were gathered and analyzed using multivariate logistic regression, to obtain a set of risk factors. Scores for each indicator were weighted, assigned, and summed to create a total risk score, which was divided into low, moderate, and high-risk suicide attempt groups.ResultsSix statistically significant indicators associated with suicide attempts were included in the risk-scoring scheme: depression, psychotic symptom(s), number of previous suicide attempts, stressful life event(s), medication adherence, and BD treatment years. A total risk score (possible range −1.5 to 11.5) explained an 88.6% probability of suicide attempts based on the receiver operating characteristic (ROC) analysis. Likelihood ratios of suicide attempts with low risk scores (below 2.5), moderate risk scores (2.5–8.0), and high risk scores (above 8.0) were 0.11 (95% CI 0.04–0.32), 1.72 (95% CI 1.41–2.10), and 19.0 (95% CI 6.17–58.16), respectively.ConclusionThe proposed risk-scoring scheme is BD-specific, comprising six key indicators for simple, routine assessment and classification of patients to three risk groups. Further validation is required before adopting this scheme in other clinical settings.

Sleep disturbance in euthymic bipolar patients

Sleep disturbance is a common feature during mood episodes in bipolar disorder. The aim of this study was to investigate the prevalence of such symptoms among euthymic bipolar patients, and their association with risk for mood episode recurrence. A cohort of bipolar I and II subjects participating in the Systematic Treatment Enhancement Program for Bipolar Disorder who were euthymic for at least 8 weeks were included in this analysis. Survival analysis was used to examine the association between sleep disturbance on the Montgomery-Asberg Depression Rating Scale (MADRS) and recurrence risk. A total of 73/483 bipolar I and II subjects reported at least mild sleep disturbance (MADRS sleep item ≥2) for the week prior to study entry. The presence of sleep problems was associated with a history of psychosis, number of previous suicide attempts, and anticonvulsant use. Sleep disturbance at study entry was significantly associated with risk for mood episode recurrence. Sleep disturbance is not uncommon between episodes for individuals with bipolar disorder and may be associated with a more severe course of illness. This suggests that sleep disturbance is an important prodromal symptom of bipolar disorder and should be considered a target for pharmacologic or psychosocial maintenance treatment.

A Comparison of Depressed Patients with and Without Borderline Personality Disorder: Implications for Interpreting Studies of the Validity of the Bipolar Spectrum

The nosological status of borderline personality disorder as it relates to the bipolar disorder spectrum has been controversial. Studies have supported, in part, the validity of the bipolar spectrum by demonstrating that these patients, compared to patients with nonbipolar depression, are characterized by earlier age of onset of depression, recurrent depressive episodes, comorbid anxiety and substance use disorders and increased suicidality. However, all of these factors have likewise been found to distinguish depressed patients with and without borderline personality disorder. A family history of bipolar disorder is one of the few disorder specific validators. In the present study from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared the demographic and clinical characteristics of depressed patients with and without borderline personality disorder. We hypothesized that many of the factors used to validate the bipolar spectrum will also distinguish depressed patients with and without borderline personality disorder except, however, a family history of bipolar disorder. Two thousand nine hundred psychiatric outpatients at Rhode Island Hospital were evaluated with the Structured Clinical Interview for DSM-IV (SCID) and Structured Interview for DSM-IV Personality Disorders (SIDP-IV). Family history information regarding first-degree relatives was obtained from the patient using the Family History Research Diagnostic Criteria. One hundred and one patients with borderline personality disorder plus major depressive disorder were compared to 947 patients with major depressive disorder alone on the prevalence of bipolar disorder validators. Compared to depressed patients without borderline personality disorder, depressed patients with borderline personality disorder had a younger age of onset, more depressive episodes, a greater likelihood of experiencing atypical symptoms and had a higher prevalence of comorbid anxiety disorders, substance use disorders, and number of previous suicide attempts. The depressed patients with borderline personality disorder did not significantly differ from the patients without borderline personality disorder on morbid risk for bipolar disorder in first degree relatives. In addition, patients with a diagnosis of bipolar disorder had a significantly higher morbid risk of bipolar disorder in first degree relatives than the borderline personality disorder group. The findings indicate that many factors used to validate the bipolar spectrum are not disorder specific. These results raise questions about studies of the validity of the broad bipolar spectrum that do not assess borderline personality disorder. Our results do not support inclusion of borderline personality disorder as part of the bipolar spectrum.

Impulse control disorder comorbidity among patients with bipolar I disorder

Objective Impulsivity is associated with mood instability, behavioral problems, and action without planning in patients with bipolar disorder. Increased impulsivity levels are reported at all types of mood episodes. This association suggests a high comorbidity between impulse control disorders (ICDs) and bipolar disorder. The aim of this study is to compare the prevalence of ICDs and associated clinical and sociodemographic variables in euthymic bipolar I patients. Method A total of 124 consecutive bipolar I patients who were recruited from regular attendees from the outpatient clinic of our Bipolar Disorder Unit were included in the study. All patients were symptomatically in remission. Diagnosis of bipolar disorder was confirmed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Impulse control disorders were investigated using the modified version of the Minnesota Impulsive Disorders Interview. Impulsivity was measured with the Barratt Impulsiveness Scale Version 11. Furthermore, all patients completed the Zuckerman Sensation-Seeking Scale Form V. Results The prevalence rate of all comorbid ICDs in our sample was 27.4% (n = 34). The most common ICD subtype was pathologic skin picking, followed by compulsive buying, intermittent explosive disorder, and trichotillomania. There were no instances of pyromania or compulsive sexual behavior. There was no statistically significant difference between the sociodemographic characteristics of bipolar patients with and without ICDs with regard to age, sex, education level, or marital status. Comorbidity of alcohol/substance abuse and number of suicide attempts were higher in the ICD(+) group than the ICD(−) group. Length of time between mood episodes was higher in the ICD(−) group than the ICD(+) group. There was a statistically significant difference between the total number of mood episodes between the 2 groups, but the number of depressive episodes was higher in the ICD(+) patients as compared with the ICD(−) patients. There was no statistically significant difference between the age of first episode, seasonality, presence of psychotic features, and chronicity of illness. A statistically significant difference was observed between the ICD(+) and ICD(−) groups in terms of total impulsivity, attention, nonplanning, and motor impulsivity scores as determined by the Barratt Impulsiveness Scale Version 11. Conclusion The present study revealed that there is a high comorbidity rate between bipolar disorder and ICDs based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria. Alcohol/substance use disorders, a high number of previous suicide attempts, and depressive episodes should alert the physician to the presence of comorbid ICDs among bipolar patients that could affect the course and treatment of the disorder.

The Treatment of Adolescent Suicide Attempters Study (TASA): Predictors of Suicidal Events in an Open Treatment Trial

ObjectiveTo identify the predictors of suicidal events and attempts in adolescent suicide attempters with depression treated in an open treatment trial. MethodAdolescents who had made a recent suicide attempt and had unipolar depression (n =124) were either randomized (n = 22) or given a choice (n = 102) among three conditions. Two participants withdrew before treatment assignment. The remaining 124 youths received a specialized psychotherapy for suicide attempting adolescents (n = 17), a medication algorithm (n = 14), or the combination (n = 93). The participants were followed up 6 months after intake with respect to rate, timing, and predictors of a suicidal event (attempt or acute suicidal ideation necessitating emergency referral). ResultsThe morbid risks of suicidal events and attempts on 6-month follow-up were 0.19 and 0.12, respectively, with a median time to event of 44 days. Higher self-rated depression, suicidal ideation, family income, greater number of previous suicide attempts, lower maximum lethality of previous attempt, history of sexual abuse, and lower family cohesion predicted the occurrence, and earlier time to event, with similar findings for the outcome of attempts. A slower decline in suicidal ideation was associated with the occurrence of a suicidal event. ConclusionsIn this open trial, the 6-month morbid risks for suicidal events and for reattempts were lower than those in other comparable samples, suggesting that this intervention should be studied further. Important treatment targets include suicidal ideation, family cohesion, and sequelae of previous abuse. Because 40% of events occurred with 4 weeks of intake, an emphasis on safety planning and increased therapeutic contact early in treatment may be warranted. J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(10):987–996.

Repeated suicidal behaviour: Stressful life events and 5-HTTLPR genetic polymorphism

Stressful life events and dysregulated mono-aminergic neurotransmission have been associated with suicidal behaviour. The aim of this investigation was to analyze suicidal behaviour in multiple attempters in relation to the stressful life events, and to the polymorphism of the serotonin transporter (SERT) gene. Multiple suicide attempters, admitted to the University Psychiatric Clinic, were interviewed for the number of previous suicide attempts and for the occurrence of stressful life events, recorded in a Life History Calendar. The patients were further genotyped for 5-HTTLPR polymorphism of SERT. The number of suicide attempts was found to be significantly correlated with the number of negative life events experienced during the 6 months preceding each suicide attempt. The L/L genotype was associated with a reduced number of multiple suicide attempts. These results should prompt future study with a larger number of subjects to further investigate the interaction of genetic and environmental factors in repeated suicidal behaviour.

Factores Asociados al Intento Suicida e Ideación Suicida Persistente en un Centro de Atención Primaria. Bogotá, 2004-2006

Characterising patients attempting suicide who were evaluated by psychiatry at the Primary Care Unit (PCU) "La Estrella" from October/2004 to October/2005 and determining persistent suicidal ideation and associated factors.An initial description of attempted suicide patients (n=156). A subsequent case control study (n=77) determined persistent suicidal ideation cases (n=27). A multivariate model was used for determining the remaining factors associated with persistent suicide ideation.Cases increased from 6 in October/2004 to 10 in October/2005, average 12+/-3.6 cases monthly. 80% were aged 30 or younger, 66.7% were female, 24.4% were students and 20.5% were unemployed. 35.2% suffered family dysfunction and 35.2% had conflicts between couples as precipitant factors. 49% had consumed alcohol prior to the suicide attempt. Persistent suicidal ideation was associated with being 31 years old or older, being unemployed and having a higher number of previous suicide attempts, unresolved conflicts and family dysfunction. Logistical regression revealed unresolved conflicts (OR=106.7; 6.8; 1,668.4 95% CI) and family dysfunction (OR=11.05; 1.7; 71.2 95% CI) as predictor variables for persistent suicidal ideation.Unresolved conflicts and family dysfunction were found to be predictor factors for persistent suicidal ideation in subjects who had attempted suicide. Consuming alcohol and other associated factors should be controlled by mental health prevention and promotion programmes.

Two Generations of Slovenian Suicidal Adolescent Inpatients

The political and socio-economic situation in Slovenia, a former Yugoslav republic, a country in transition and a country with a high suicide rate, which joined the European Union in 2004, has changed steadily since the beginning of the 1970s. Literature shows constancy in suicide statistics in Slovenia during these times. The present study examines whether the suicidal adolescent inpatient population in Slovenia reflects recent social changes and upheavals. Data on two groups of patients admitted to a specialized adolescent psychiatry department after attempting suicide were collected. The first group (n = 74) were patients admitted from 1975 to 1977, the second group (n = 73) from 2002 to 2004. They were compared on general characteristics, family and living circumstances, risk behaviors, suicide attempts and diagnoses. The comparison revealed statistically significant differences between groups on educational level, number of siblings, frequency of smoking and psychoactive medication misuse as well as number of previous suicide attempts. No differences were found in other family and living circumstances, methods used in the index suicide attempt, other risk behaviors or diagnoses. The post-independence suicidal inpatient population in Slovenia shows a tendency towards higher morbidity, but has changed less than expected considering the vast changes in the society. These results suggest a certain constancy in adolescent suicidal behavior.

Dependency and suicidality in addictive disorders

Excessive interpersonal dependency has been described in depression and addictive disorders. Moreover, excessive dependency and suicidality are linked in psychiatric subjects, but their relationships have not been studied in specific addictions. Separate samples of female anorectic patients ( n = 150), female bulimic patients ( n = 95), male ( n = 150) or female ( n = 68) alcoholics, male ( n = 94) or female ( n = 54) drug abusers and non-psychiatric control subjects ( n = 683) were included in the study. On the basis of a structured interview, suicidal ideations, number of previous suicide attempts and diagnoses of dependent personality disorder (DSM-IV) were collected, and the subjects completed the Interpersonal Dependency Inventory and the Beck Depression Inventory. Logistic regression analysis revealed that excessive dependency and notably dependent personality disorder increased the likelihood of suicidal ideation or suicide attempts with a range of 2.65 to 9.42 in bulimic patients, female alcoholics and male drug abusers. Excessive dependency in specific addictive disorders as well as in male non-psychiatric subjects could constitute a risk factor for suicide. This hypothesis must be confirmed using prospective studies.

Naturalistic evaluation of suicidal ideation: Variability and relation to attempt status

Suicidal ideation has been thought to have a relatively stable course across weeks and months. However, daily changes in levels of ideation have not been adequately examined despite the importance of potential variability clinically and conceptually. For example, it has been suggested that variability in suicidal ideation may become less closely tied to variability in other mood symptoms (e.g., depression, hopelessness) among individuals with multiple suicide attempts. The present report had two related goals: (1) to prospectively evaluate suicidal ideation and related mood symptoms, and (2) to determine whether suicide attempt status predicted a decreased association between ideation and other mood symptoms. Non-clinical participants ( N = 108 ) with varying levels of suicidal ideation and number of previous suicide attempts completed the beck hopelessness scale (BHS), beck depression inventory (BDI), and suicide probability scale (SPS) every day for 4 weeks. Findings suggested considerable variability in suicidal ideation, especially for multiple attempters. Multiple attempt status predicted a decreased association between suicidal ideation and depression, although the results were only marginally significant. These findings have implications for conceptual models of suicide risk as well as assessment and treatment of suicidal individuals.

Validation of the Computerized Suicide Risk Scale – a backpropagation neural network instrument (CSRS-BP)

Background. Medically serious suicide attempts have been recognized as the most important predictor of suicide. The Computerized Suicide Risk Scale based on backpropagation neural networks (CSRS-BP) has been recently found efficient in the detection of records of patients who performed medically serious suicide attempts (MSSA). Objectives. To validate the CSRS-BP by: 1) using the CSRS-BP with patients instead of records; 2) comparing the ability of expert psychiatrists to detect MSSA, using the CSRS checklist; and 3) comparing the results of the Risk Estimator for Suicide (RES) and the self-rating Suicide Risk Scale (SRS) with the CSRS-BP. Methods. Two hundred fifty psychiatric inpatients (35 MSSA and 215 non-MSSA) were diagnosed by clinicians using the SCID DSM-IV. Three expert psychiatrists completed the CSRS checklist, and the RES for each patient, and the patients completed the self-report SRS assessment scale. The CSRS-BP was run for each patient. Five other expert psychiatrists assessed the CSRS checklists and estimated the probability of MSSA for each patient. Comparisons of sensitivity and specificity rates between CSRS-BP, assessment scales and experts were done. Results. Initially, the CSRS-BP, RES, SRS, and experts performed poorly. Although sensitivity and specificity rates significantly improved (two to four times) after the inclusion of information regarding the number of previous suicide attempts in the input data set, results still remained insignificant. Conclusions. The CSRS-BP, which was very successful in the detection of MSSA patient records, failed to detect MSSA patients in face-to-face interviews. Information regarding previous suicide attempts is an important MSSA predictor, but remains insufficient for the detection of MSSA in individual patients. The detection rate of the SRS and RES scales was also poor and could therefore not identify MSSA patients or be used to validate the CSRS-BP.

Clinical evaluation of prior suicide attempts and suicide risk in psychiatric inpatients.

In practice psychiatrists rely on their own experience and intuition to evaluate the suicide potential of individual patients, but the algorithms for the decision-making process remain unclear. (1) to establish models for the decision making process for evaluating suicide risk; (2) to simulate the impact of information concerning the number of previous suicide attempts on the clinician's ability to detect patients who performed medically serious suicide attempts (MSSAs). Four decision models (linear, dichotomized, hyperbolic, and undifferentiated) depicting the influence of the number of previous suicide attempts on the clinician's recognition of MSSAs in 250 psychiatric inpatients were elicited and tested by a series of discriminant analyses. The dichotomized model ("all or none") was found to be the most efficient in detecting medically serious suicide attempts. The "all or none" paradigm seems to be the most appropriate way to evaluate the weight of previous suicide attempts in the decision-making process identifying medically serious suicide attempt patients.