Personal History Of Suicide Attempt Research Articles

Prevalence of the generalized anxiety disorder in Tunisia: A study of 707 primary care outpatients.

This study examined the prevalence and correlates of generalized anxiety disorder (GAD) among primary care outpatients. A multicenter, cross-sectional study was conducted that included 707 primary care outpatients being seen at 20 primary healthcare centers in Tunis and Sfax, Tunisia. The Mini International Neuropsychiatric Interview was used to identify a diagnosis of GAD. The Beck Depression Inventory was used to assess depressive symptom severity, and the Sheehan Disability Scale (SDS) was used to measure functional impairment. The prevalence of GAD was 11%. GAD was positively correlated with female gender (P = .005), family history of psychiatric disorder (P < .001), personal history of suicide attempt (P = .019), and depressive symptoms (P < .001). Based on the SDS, severe to very severe functional limitations were reported at work, in social life, and family life (56.4%, 60.2%, and 73.1%, respectively) among GAD patients. This study indicated a relatively high prevalence of GAD among primary care patients in Tunisia. Risk factors were also determined that may help to identify these patients. This information may help primary care physicians recognize this diagnosis and provide timely referrals to mental health professionals to prevent complications and preserve quality of life.

Risk factors for suicidal ideations and suicide attempts among medical students

IntroductionMedical students are a high-risk population for having suicidal thoughts and behaviors. However, few studies have been fulfilled on this subject.ObjectivesThe objective of this study was to provide a systematic overview of risk factors for suicidal ideations (SI) and suicide attempts (SA) among medical students.Methods We set out to summarize the literature on the MEDLINE (via PUBMED) and Science Direct databases, regarding risk factors for SI and SA in medical students, using the key words : « medical student» ; « suicide attempt» ; « suicidal ideation », « risk ».Results Recent studies showed that poor mental health outcomes including depression, anxiety, burnout, comorbid mental illness, and stress presented the strongest risk for SI among medical students. In addition, SI was statistically significantly associated with alcohol use, Tobacco consumption, personal history of suicide attempt, female gender and poor social support.On the other hand, SA were significantly associated with the presence of a long-term illness, anxiety and depression. Conversely, stress, female gender, and alcohol use were not significant risk factors for SA among medical students.ConclusionsMedical students face a number of personal, environmental, and academic challenges that may put them at risk for SI and SA. Additional research on individual risk factors is needed to construct effective suicide prevention programs in medical schools.Disclosure of InterestNone Declared

Factors associated with suicidal ideation among medical residents in Tehran during the COVID-19 pandemic: A multicentric cross-sectional survey.

The mental health of medical residents, challenged by their intensive training, is of utmost concern. In light of reported suicides among Iranian medical residents in 2021, this study investigates the factors behind suicidal ideation among medical residents during the COVID-19 pandemic in Tehran. This study conducted a cross-sectional online survey among medical residents in various specialties in Tehran, Iran, amidst the COVID-19 pandemic. Suicidal ideation was assessed using the Beck Scale for Suicidal Ideation (BSSI), while depression, anxiety, and stress were measured using the DASS-21. It also collected demographic and clinical data from the participants. The data were analyzed using descriptive statistics, the Chi-square test, and multiple linear regression to examine the prevalence and determinants of suicidal ideation among medical residents. The study enrolled 353 medical residents and found that 34.3% of them had suicidal ideation, with 10.2% indicating a high risk. The study also found high levels of depression, anxiety, and stress among the participants. The variables that significantly predicted suicidal ideation were depression, history of alcohol/substance use, personal history of suicide attempts, history of self-mutilation, family history of suicide attempts, number of shifts in a month, death of close persons because of COVID-19, and income. Depression was the strongest predictor of suicidal ideation. These findings underscore the urgent need for effective interventions and support systems to address the mental health needs of medical residents in Iran. The strategies should prioritize destigmatizing mental health, promoting access to mental health services, fostering a supportive training environment, and enhancing income opportunities.

Correlation Between Systemic Immune-Inflammation Index and Suicide Attempts in Children and Adolescents with First-Episode, Drug-Naïve Major Depressive Disorder During the COVID-19 Pandemic.

This study aims to investigate the association between the systemic immune-inflammatory index (SII) and suicide attempt (SA) in children and adolescents with first-episode, drug-naïve Major Depressive Disorder (MDD) during the COVID-19 pandemic. A retrospective study was conducted on 263 MDD patients hospitalized at the Third Hospital of Fuyang City between 2020 and 2022. Patients were categorized into two groups based on the presence of previous SA. The study compared the differences in SII and clinical characteristics between the two groups and used the receiver operating characteristic (ROC) curve to determine the optimal critical value of SII and the area under the curve. Binary logistic regression was used to analyze the independent risk factors for SA. Compared with the patients without SA history, the patients with a personal history of SA had a higher mean HDRS scores (Z=-2.369, p=0.018), higher mean neutrophil count (Z=-2.870, p=0.004), higher mean platelet count (Z=-2.155, p=0.031), and higher mean SII (Z=-3.170, p=0.002). The optimal critical SII determined by the ROC curve was 548.15 (sensitivity = 63.2%, specificity = 83.1%), and the area under the curve was 0.661. After adjusting for gender, age, BMI, illness duration and HDRS score, the risk of total SA in patients with high SII was 8.296 times higher than in those with low SII (OR = 8.296, 95% CI: 3.803-18.095, P < 0.001), The risk of recent SA was 13.922 times higher in patients with high SII than in those with low SII (OR = 13.922, 95% CI: 5.587-34.693, p < 0.001). However, high SII was not a risk factor for past SA (OR = 0.547, 95% CI: 0.062-4.842, P=0.587). SII may be an inexpensive, easily accessible strategy that can assist in determining suicide risk in adolescents with MDD.

Clinical factors associated with unipolar mania: A systematic review and meta-analysis

IntroductionThe existence of a clinical entity on the spectrum of mood disorders characterized by the occurrence of manic episodes without major depressive episodes (Unipolar Mania, UM) is largely debated. Although not classified nosologically, the studies exploring this topic have suggested that UM might differ from bipolar disorder with a manic-depressive course (md-BD), in terms of several clinical characteristics. Individuals with UM might represent a subpopulation with specific clinical profiles and unmet care needs, requiring personalized treatments, as compared with those suffering from md-BD.ObjectivesTo identify clinical factors associated with UM, as compared with md-BD.MethodsWe performed a systematic review and meta-analysis of observational studies according to the MOOSE guidelines. We searched for articles indexed up to July 2022 in the main electronic databases. We conducted random-effects meta-analyses of the association between UM and relevant correlates, using odds ratio for categorical variables and standardized mean difference for continuous variables.ResultsBased on data from 21 studies meeting the eligibility criteria, we found that individuals with UM, as compared with md-BD, were more likely to be males (p = 0.007) and to have an earlier age at onset (p = 0.020). Moreover, UM was significantly associated with a higher number of hospitalizations (p &lt; 0.001), the occurrence of psychotic features (p &lt; 0.001), as well as hyperthymic temperament (p = 0.012). Finally, subjects with UM were less likely to report a family history of depression (p = 0.006) and a personal history of suicide attempts (p &lt; 0.001).ConclusionsOur work supports the hypothesis that UM might represent a distinctive diagnostic construct, with peculiar clinical correlates. Additional research is needed to better differentiate UM in the context of affective disorders.Disclosure of InterestNone Declared

Assessment of obsessive and compulsive symptoms in patients with schizophrenia

IntroductionObsessive-Compulsive Symptoms (OCS) are common in patients with schizophrenia, with a prevalence of 3.5% to 25%.ObjectivesThe aim of our study was to assess the frequency of OCS in patients with schizophrenia, and to study the clinical and evolutionary characteristics of schizophrenia and OCS comorbidity.MethodsWe conducted a cross-sectional, descriptive, and analytical study. Thirty schizophrenic patients were recruited in the department of psychiatry B of Hedi Chaker university hospital of Sfax. We used the Yale-Brown Obsession-Compulsion Scale (Y-BOCS) to assess obsessive and compulsive symptoms, at the end of hospitalization, after clinical remission of schizophrenic symptoms.ResultsThe mean age of patients was 41.2, that of disease onset was 27.3. Most of patients were male (86.7%) and unemployed (81.3%). A personal history of suicide attempts was found in 16.6% of patients. The average number of hospitalizations was 8.83. OCS were noted in 36% of patients with a Y-BOCS mean score of 5.5. Patients with OCS had significantly more frequent alcohol use (p = 0,008), a higher number (p = 0.03) and longer duration of hospitalizations (P = 0,034) and are more frequently treated with atypical antipsychotics (p = 0.001).ConclusionsOur results show that patients with schizophrenia frequently present OCS. This comorbidity has a negative impact on the evolution and the prognosis of the disease, as well as the functioning of patients. Therefore, it should be investigated in order to ensure better care and promote the socio-professional reintegration of these patients.DisclosureNo significant relationships.

Assessment of depressive symptoms in hospitalized patients with schizophrenia

IntroductionThe prevalence of depressive disorders in patients with schizophrenia is estimated at 25%. Nevertheless, depressive symptoms occurring during the acute decompensation of schizophrenia have rarely been studied.ObjectivesThe aim of our study was to assess depressive symptoms in hospitalized patients suffering from schizophrenia.MethodsWe conducted a cross-sectional, descriptive and analytical study, including 30 schizophrenic patients, hospitalized in the psychiatry B “department of the Hedi Chaker university hospital in Sfax. The assessment of clinical severity of schizophrenia was performed by the Positive and Negative Syndrome Scale (PANSS), that of depressive symptoms by the “Calgary Depression Scale for Schizophrenia” (CDSS).ResultsThe mean age of patients was 41.2. Most of patients were male (86.7%) and unemployed (83.3%). Only 13.3% of them were married. Patients were hospitalized 8.83 times in average. A personal history of suicide attempts was found in 16.70% of cases. The mean score in the CDSS scale was 5.12. According to the CDSS score, a depressive state was diagnosed in 36.7% % of patients. Depression was associated with significantly more frequent history of suicide attempts (p=0.028), as well as significantly higher scores in the positive dimension of the PANSS (p=0.03).ConclusionsOur results show that depressive symptoms are common during the acute decompensation phase of schizophrenia. They are associated with impaired functioning of patients, as well as a higher risk of suicide. Screening for depressive symptoms in patients hospitalized for schizophrenia is therefore essential in order to ensure better management.DisclosureNo significant relationships.

Antisocial personality disorder in women: a cross-sectional study about 20 cases

IntroductionAntisocial personality disorder (ASPD) is characterized by a long term pattern of disregard for, or violation of the rights of others that occurs in childhood or early adolescence and continues into adulthood. This disorder remains unknown in women.ObjectivesThe aim of this study was to describe socio-demographic, clinical, psychometric and therapeutic characteristics of women with ASPD hospitalized in psychiatric ward.MethodsA cross-sectional and descriptive study was conducted in G psychiatry department, in Razi hospital. It included 20 women with ASPD and hospitalized in psychiatric ward. Socio-demographic, clinical and therapeutic characteristics were assessed. A psychometric evaluation was carried out by the application of six scales: BIS 11, HCR 20, VRAG, PCL-R, ENFP and PID5-BF.ResultsThe mean age of the patients was 34 ± 9 years. Patients with a personal history of suicide attempt accounted for 45% of the study population. Patients with a criminal history accounted for 67.5% of the study population. A substance-related disorder was found in 85% of the patients. Adjustment Disorder was retained in 42.5% of the patients and Psychotic Disorder was diagnosed in 32.5% of the population. The average score at VRAG was 6.18 ± 5.8. The mean score at PCL R was 24 ± 4.2. High impulsivity scores were found.ConclusionsASPD represents a major concern for clinicians in psychiatric wards. A better knowledge of the characteristics of this trouble in women could improve their quality of care.DisclosureNo significant relationships.

Prevalence of and Risk Factors for Suicide Attempts Among Patients With Severe Psychiatric Disorders in Eastern Morocco.

Background: Suicide attempts are common in patients with severe psychiatric disorders; however, they are rarely studied in this population. Aims: To investigate the prevalence and risk factors associated with suicide attempts among patients with severe psychiatric disorders. Method: This is a cross-sectional study of patients admitted to the Mohammed VI University Hospital of Psychiatry in Oujda, Morocco. Results: A total of 250 patients with a psychiatric disorder were recruited in this study. Among these, 78 cases (31.2%) had a personal history of suicide attempts. A personal history of suicide attempt was significantly higher among women compared to men (45.5% vs. 27.2%, p = .0099). The most common method of suicide attempts was jumping from heights (31%). Patients with a personal history of suicide attempts had a significantly higher prevalence of alcohol consumption (p = .0063), family history of psychiatric disorders (p = .002), family history of suicide attempt (p = .00004), and family history of suicide (p = .018) compared to those who had never made suicide attempts. Limitations: As suicidal behavior is highly stigmatized in Morocco, the number of patients who have made a suicide attempt may be underestimated. Conclusion: Our findings justify the need to provide specialized support to psychiatric patients with risk factors for suicide attempts.

Suicidal ideation, suicide literacy and stigma, disclosure expectations and attitudes toward help-seeking among university students: The impact of schizotypal personality traits.

Similarly to patients with schizophrenia, non-clinical individuals with schizotypal traits have been reported to show an increased risk for suicide-related outcomes. We aimed to assess suicidal ideation, and to determine factors that may have associations with help-seeking attitudes in high schizotypal individuals as compared to low schizotypal individuals. We carried out a cross-sectional survey. The Schizotypal Personality Questionnaire, the attitudes toward seeking professional psychological help scale-short form, the disclosure expectations scale, the scale of suicide ideation, the stigma of suicide scale-short form, the literacy of suicide scale, and the depression anxiety stress scales were administered to 504 college students. A total of 51 students were classified in the high-schizotypy group, and 50 were classified in the low-schizotypy group. High-schizotypal students experienced significantly more suicidal ideation, had greater literacy of suicide, had more glorification of suicide, had higher anticipated risks of disclosure and more negative help-seeking attitudes than low-schizotypal students. After controlling for sociodemographic (age, gender, income and tobacco use) and psychosocial variables (personal psychiatric history, family history of suicide, personal history of suicide attempt[s]), depression and suicide ideation), disclosure expectations had both a significant negative independent effect through anticipated risks, and a positive independent effect through anticipated benefits, on high-schizotypal students' help-seeking attitudes. The apprehension and reluctance to seek help found in high-schizotypal students highlight an urgent need to further understand barriers to help-seeking among at-risk adolescents, and what may motivate them to reach out for support when they are more at-risk for suicide.

Les maladies chroniques chez les étudiants en médecine au Maroc : quelles interactions avec le stress psychosocial ?

ObjectivesTo evaluate the prevalence and factors associated with Chronic psychiatric and somatic illness among medical students in Morocco. MethodsA multicentric cross-sectional study during a period of four weeks in February 2019 involving 605 students of 1st, 2nd and 3rd cycle of medical studies of the faculties of medicine in Morocco. Results41.5% (251) of students confirmed having a chronic disease, among which 80% were under treatment. Psychiatric conditions represented the most frequent chronic illnesses among medical students (28%), followed by dermatological (16%), allergic and respiratory (12.2%), and gastroenterological (11%) conditions. Chronic illnesses among medical students were significantly associated with female gender (P: 0.0000000037), level of education (P: 0.0000), personal history of suicide attempts (P: 0.0000259), and a consumption of psychoactive substances (P: 0.0000029046). ConclusionChronic illnesses are frequent, underestimated and undertreated among medical students in Morocco. The link with stress has been suggested as the value of establishing a program to train medical students in stress management.

Characteristics of unipolar depression in psychiatric inpatients

IntroductionUnipolar depression is daily encountered in psychiatry.ObjectivesTo describe the socio-demographic and clinical characteristics of patients with unipolar depression.MethodsThis is a cross-sectional, descriptive study carried out at the psychiatric department of the University Hospital of Mahdia. We have included patients with unipolar depression. The data were collected from patients’ medical files using a pre-established 37-item questionnaire.ResultsWe have collected 53 patients. The mean age was 44 years. The majority of patients were female (56.6%) and unemployed (70%). 47.2% of patients were married. 72% of patients had a low socio-economic level. They were smokers in 45.3% of cases. Alcohol consumption was found in 24.5% of cases. A family history of mood disorder and suicide or attempted suicide were present in 7% and 13.2% of the cases respectively. 7% of the patients had a history of a postpartum thymic episode. The mean number of depressive episodes was 2.5. Personal history of suicide attempts was found in 40% of cases. The mean age of the first thymic episode was 35 years. At the psychiatric examination, psychomotor retardation was present in 64% of cases, anxiety distress in 58.5% of cases, psychotic, melancholic and atypical characteristics in 30%, 13.2% and 5.7% of cases respectively. 81% of patients were treated with anxiolytic drugs in combination with an antidepressant. Antipsychotic treatment was combined in 45% of cases and electro-convulsive therapy in 9.4% of cases.ConclusionsOur patients presented predictive criteria of bipolarity. Therefore, vigilance is necessary in their medical management.

Specificities of bipolar depression in psychiatric inpatients

IntroductionBipolar depression is not strictly clinically identical to unipolar depression.ObjectivesTo describe the clinical characteristics of patients with bipolar depression and to identify factors linked to bipolar depression.MethodsThis is a cross-sectional, descriptive and comparative study carried out at the psychiatric department of the University Hospital of Mahdia. We have included 26 patients with bipolar depression and have compared them to 26 patients with unipolar depression. The data were collected from patients’ medical files. The analytical study has been made using Chi2 tests. The threshold of p&lt;0.05 was considered as significant.Results The mean age was 45 years. The majority of patients were male (61.5%) and unemployed (69.2%). Half of the patients were married. Alcohol consumption was found in 30.8% of cases. Family history of bipolar disorder and attempted suicide were present in 27% and 11.5% of cases respectively. A hospitalization number greater than or equal to 4 was found in 54% of cases. Personal history of suicide attempts was found in 46.2% of cases. At the psychiatric examination, psychomotor retardation, anxiety and psychotic and atypical characteristics were present in 73%, 31%, 42.3% and 7.7% of cases respectively. 46.2% of patients were treated with antidepressants in combination with a mood stabilizer. Antipsychotic treatment was combined in 80.8% of cases. A significant difference was noted for the number of hospitalizations, anxiety and antipsychotic treatment.ConclusionsAn early distinction between bipolar and unipolar disorders is crucial for the treatment of both diseases.

Association of traumatic events in childhood, impulsivity and decision-making with previous suicide attempt and/or current suicidal ideation in adult patients with major depressive disorder

IntroductionSuicidal behavior has a great impact on world public health. The literature describes the possible existence of an association between neurobiological, clinical and cognitive factors in suicidal behavior.ObjectivesTo determine the possible relationship between clinical variables (history of abuse/maltreatment in childhood), psychopathology (impulsivity traits) and cognitive (decision-making) with a history of suicide attempt and/or current suicidal idea in patients with major depressive disorder.MethodsCross-sectional study in a sample of adult patients with major depressive disorder in which two types of comparisons are made. In the first case, two groups were compared based on the presence or absence of history of suicide attempt. In the second case, two groups were compared based on the presence or absence of suicidal ideation in the same sample of patients. Finally, sociodemographic, clinical and cognitive variables were evaluated in that population sample.ResultsWhen the joint influence of sociodemographic, clinical and cognitive characteristics are present, it can be said that being single/divorced/separated, a history of sexual abuse in childhood and an alteration in decision-making, specifically a lower number of choices of deck D in the IGT test, are associated with a higher probability of a personal history of suicide attempt. While a higher score on the Barrat impulsivity scale is associated with a greater probability of presenting current suicidal ideation once the influence of sociodemographic, clinical and cognitive variables has been taken into account.ConclusionsDifferent sociodemographic, clinical and cognitive factors are associated with the presence of a history of suicide attempt and/or current suicidal ideation.DisclosureNo significant relationships.

Le suicide de patients hospitalisés en psychiatrie : analyse qualitative de huit cas à l’hôpital Sainte-Anne à Paris et recommandations

Inpatient suicide rates are high at the psychiatric hospital. Improvement in detecting suicidal patients and preventing suicidal acts during hospitalization is essential. As part of a working group on the evaluation of professional practices on suicide risk at Sainte-Anne Hospital in Paris, we retrospectively studied eight cases of inpatient suicides that occurred between 2009 and 2018. We conducted a qualitative analysis of multidisciplinary morbidity and mortality reviews and medical records data. In our case series, all patients had a personal history of suicide attempts (notably using a violent means), and half of them previously attempted suicide during hospitalization. In most cases, suicide occurred during weekends or public holidays and inside care units. Suicide by hanging was the most prevalent method. Regarding our results and the literature, a past personal suicide attempt is the most frequent risk factor for inpatient suicide. However, prediction of suicide remains weak and all psychiatric inpatients should be considered at significant risk of suicide during hospitalization and just after discharge. Inpatient suicide prevention is primarily based on a safer hospital environment (inventory at entry, anti-suicidal furniture, no height access and windows opening, etc.). In addition, specific and repeated suicide training for care teams, continuity of care, enhanced management with assessment and monitoring protocols, good teamwork communication and better traceability of suicide risk in records appear to be organizational requirements for inpatient suicide prevention. At the individual level, quality of contacts with the patient, interactions with relatives and significant others, and active treatment of psychiatric disorders and comorbidities are fundamental. After a suicide or suicide attempt at the hospital, experience sharing should be systematically put into place to improve care practices. The implementation of postvention measures with the aim to support other patients and caregivers in the affected medical unit, as well as the victim's relatives, should complete the actions to lead.

The Role of Personal Factors and Learning Environment in Suicidal Ideation Among Tunisian Medical Students.

Objective: Little is known about specific professional factors influencing medical students' suicidal ideation and behavior. We aimed to evaluate the prevalence and correlates of suicidal ideation in Tunisian medical students. Method: This was a cross-sectional study; 390 second-cycle medical students were enrolled at the Faculty of Medicine of Tunis. Participants responded to an anonymous questionnaire containing sociodemographic data, educational factors, the Suicidal Ideation Questionnaire (SIQ), and the Depression, Anxiety and Stress scales (DASS-21). Results: Eleven students (2.8%) had made one or more suicide attempts in their lifetime. For a threshold value of 41 based on the SIQ scale, 7.9% of students were considered to have a potential risk of suicide. The multiple hierarchical linear regression analysis identified as main factors independently associated with suicidal ideation: tobacco consumption, perceived sleep quality, depression symptoms, the personal historyofsuicide attempt, the satisfaction with student-supervisor relationship, and choosingto study medicine. Conclusion: Suicide prevention efforts should target high-risk students with prior personal or family history of suicidal behavior. Moreover, medical school authorities should put in place effective strategies to optimize the learning environment at their institutions.

Évaluation des états mentaux à risque de transition psychotique dans un échantillon de jeunes détenus de sexe masculin en Tunisie

BackgroundPrevalence of psychotic disorders in a prison population is higher than in the general population. Recent research has shown that early intervention is feasible in prison settings, and that approximately 5% of screened prisoners have met ultra-high-risk (UHR) for psychosis criteria. We aimed to identify the prevalence of the UHR states for developing psychosis in a group of newly incarcerated men in the Jendouba Civil Prison and to analyze the association between UHR states and socio-demographic data and substance use. MethodWe carried-out a cross-sectional study among 120 prisoners. Every prisoner was interviewed using the Comprehensive Assessment of At-Risk Mental States (CAARMS). The Social and Occupational Functioning Assessment Scale (SOFAS) was used to assess the participant's level of functioning. ResultsWe found a prevalence of subjects meeting the UHR criteria of 21.3%. UHR subjects had significantly more psychiatric family history (P=0.035), personal history of suicide attempt(s) (0.035) and self-injury (P=0.013) compared to non-UHR subjects. Clinical self-evaluation found significantly more depression and anxiety in the UHR group (P=0.020 and P=0.035, respectively). In addition, social and occupational functioning was significantly more impaired in the UHR group (P=0.007). UHR subjects used significantly more cannabis in lifetime (P=0.015) as well as in the past year (P=0.022) and had a significantly higher frequency of cannabis use (P=0.01) compared to non-UHRs. ConclusionPrison mental health teams face the challenge of identifying prisoners who need mental health services and providing early care to this vulnerable group; this challenge may offer a unique opportunity for intervention among a population that might not otherwise have had access to it.

Bipolar Disorder and Suicide: a Review.

Bipolar disorder has the highest rate of suicide of all psychiatric conditions and is approximately 20-30 times that of the general population. The purpose of this review is to discuss findings relevant to bipolar disorder and suicide. Risk factors include male gender, living alone, divorced, no children, Caucasian, younger age (< 35years), elderly age (> 75years), unemployment, and a personal history of suicide attempt and family history of suicide attempt or suicide completion, as well as predominant depressive polarity. Suicide is associated with the depressed or mixed subtypes, not mania. Although there are emerging treatments for bipolar depression, such as ketamine and TMS, lithium remains the only medication associated with lowered suicide rates in bipolar disorder. Understanding clinical and demographic risk factors for suicide in bipolar disorder remains the best way to prevent suicidal behavior. Early intervention and treatment with anti-suicidal medications, such as lithium, along with close observation and follow-up is the best way to mitigate suicide in patients with bipolar disorder.

Neutrophil-to-lymphocyte ratio: A potential new peripheral biomarker of suicidal behavior.

Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) have emerged as important peripheral inflammatory biomarkers. Recent data suggest a possible role of the immune system in the pathophysiology of suicidal behavior (SB). The aim of this study is to evaluate the association among NLR, MLR, and PLR and SB in patients with major depressive disorder (MDD), and to test its validity as a biomarker for suicidality. We evaluated 538 patients with MDD (mean age [standard deviation]=43.87 [14.36] years; females: 68.8%). A logistic regression model was estimated to determine the independent factors associated with suicide risk in patients with and without a history of suicide attempt (SA). Three hundred ninety-three patients (74.7%) had a personal history of SA. Patients with a previous SA were more frequently female (71.9% vs. 59.6%; p=0.007), significantly younger (41.20 vs. 51.77years; p<0.001), had lower depression severity at enrolment (15.58 vs. 18.42; p<0.000), and significantly higher mean NLR and PLR ratios (2.27 vs. 1.68, p=0.001; 127.90 vs. 109.97, p=0.007, respectively). In the final logistic regression model, after controlling for age, sex, and depression severity, NLR was significantly associated with SB (β=0.489, p=0.000; odds ratio [95% confidence intervals]=1.631 [1.266-2.102]). We propose a cut-off value of NLR=1.30 (sensitivity=75% and specificity=35%). Our data suggest that NLR may be a valuable, reproducible, easily accessible, and cost-effective strategy to determine suicide risk in MDD.

Childhood trauma predicts multiple, high lethality suicide attempts in patients with schizophrenia

Childhood trauma has been shown to increase the risk of suicide attempts in individuals with schizophrenia. However, previous literature has been limited by considerable heterogeneity within the category of suicide attempters. Here we tested the predictive effect of childhood maltreatment on lifetime suicide attempt in a homogeneous sample of 650 patients with schizophrenia spectrum disorders. Childhood trauma was assessed using the Childhood Trauma Questionnaire-Short Form and suicide history was measured using subjective and objective validated scales as well as medical chart reviews. We refined our sample into two homogenous groups: 1) suicide attempters: patients who had attempted suicide multiple times, with highly lethal results (medical hospitalization required) (n = 24); and 2) non-ideators: patients who had no personal history of suicide attempt or ideation, or family history of attempt (n = 25). Binary logistic regression models revealed that total childhood trauma (β = 0.002; OR: 1.07; 95% CI: 1.00–1.14) and emotional abuse (β = 0.04; OR: 1.38; 95% CI: 1.08–1.77), but not other trauma subtypes, significantly predicted lifetime multiple, high lethality suicide attempts after adjusting for demographic and clinical covariates. Thus, childhood trauma is a weak, independent risk factor for extreme suicide attempts in patients with schizophrenia spectrum disorders.