Predictors Of Suicidal Behavior Research Articles

Cortisol in violent suicidal behaviour: association with personality and monoaminergic activity

Background: According to recent theories, suicidal behaviour is associated with depressive disorders that are commonly induced by social stressors in persons with a trait-dependent vulnerability. Stressor-induced increased cortisol secretion may interfere with this vulnerability that can be defined in terms of (possibly inter-related) biological and psychological or personality-related characteristics. Delineation of such trait-like characteristics may increase the specificity in the prediction of suicidal behaviour and thus lead to new approaches to the treatment and prevention of suicidal behaviour. Methods: Psychiatric symptomatology, personality dimensions (Cloninger’s Temperament and Character), peripheral markers of serotonergic (whole blood serotonin, platelet MAO activity) and noradrenergic (plasma MHPG) activity, and urinary cortisol were measured in a random sample of patients with a history of violent suicidal behaviour and compared to those of patients without such a history. Results: When compared to patients without a history of violent suicidal behaviour ( n=23), patients with such a history ( n=17) were characterised by higher urinary cortisol levels, a significantly lower mean score on Reward Dependence, a borderline significantly increased score on Novelty Seeking and a significantly lower mean plasma MHPG level. Urinary cortisol level correlated significantly with Reward Dependence and Novelty Seeking scores. There were no differences between patient groups regarding severity of anxiety or depressive symptomatology. No differences with regard to the biological parameters were found between patients who recently attempted suicide and those with a history of suicidal behaviour. Limitations: Limitations of this study included a relatively small number of study subjects and the use of peripheral markers to assess central neurotransmission functions. Conclusions: Violent suicidal behaviour is associated with increased cortisol secretion, a personality profile defined by low Reward Dependence (reflecting the degree of sensitivity to social stressors) and a tendency of increased Novelty Seeking (related to impulsivity and the regulation of anger), and reduced noradrenergic functioning (possibly reflecting an inability to adapt to stressors).

Suicide Among Seniors

Abstract. Older adults are considered the highest risk group for suicide. Although numbers are smaller, rates equal those of much‐publicised younger age groups. The ratio of attempted to completed suicide is considerably lower among seniors than young adults: seniors who attempt suicide are generally successful. There appears to be little awareness, however, that seniors who are experiencing difficulties in their lives may consider death as a solution. This paper reviews recent literature on suicide among older adults. Factors which are recognised as being predictors of suicidal behaviour among seniors are presented, as well as cultural effects, gender differences, suicide notes, prevention and intervention strategies, and society's role in the suicide of older adults.

Effects of sexual victimization on suicidal ideation and behavior in U.S. college women.

This study examines the relationship between suicidal ideation and behavior and five types of sexual victimization in a sample of 393 female undergraduate students. Participants completed self-report measures of sexual victimization, hopelessness, suicidal ideation, and suicidal behavior. Adult sexual victimization, but not childhood sexual abuse, predicted current hopelessness and suicidal ideation. Both childhood sexual abuse and adult sexual victimization predicted suicidal behavior. One in four rape victims, in contrast to approximately 1 in 20 nonvictimized women, had engaged in a suicidal act. Vaginal penetration following the threat or use of physical force was a stronger predictor of suicidal behavior than penetration without the use of force and/or force without penetration. The findings point to the importance of inquiring about experiences of sexual victimization when conducting research or treatment with suicidal women as well as the need for suicide risk assessment in programs for victims of sexual violence.

Predictors of Youth Suicide Attempts and Ideation

A number of epidemiological and psychological autopsy studies (interviews of surviving family and peers) have been conducted to identify predictors of suicidal behavior in children and adolescents. This study distinguishes between predictors of suicide attempt and suicide ideation by gender. As part of a large, multisite, epidemiological study, 1,285 youths aged 9 to 17 …

Physical activity, participation in team sports, and risk of suicidal behavior in adolescents.

Suicide is the second-leading cause of death in adolescents. ] Suicide rates in 1990 for youth aged 15 to 19 were 18.1 per 100,000 for boys and 3.7 per 100,000 for girls; although girls attempt suicide more often than boys, boys more frequently succeed in their suicide attempts. 2 Nearly one-third of all students in grades 9 through 12 in 1991 had seriously thought about committing suicide, 16% had made a specific plan to commit suicide, and 8% had actually attempted suicide) Because suicidal thoughts and suicide attempts are so prevalent in adolescents, it is important to understand the correlates and predictors of suicidal behavior as well as the factors that may protect adolescents against suicidal behavior. If these risk and protective factors can be identified, it may be possible to identify those adolescents at high risk of attempting suicide or to design school-based suicide prevention programs targeted toward all students. Physical activity is positively associated with self-esteem, well-being, and self-efficacy 4 and negatively associated with depression, 5 anxiety, 6 loneliness, shyness, and hopelesshess. 7 Psychological treatment programs for adolescents 5,s,9

The escape theory of suicide and perfectionism in college students.

A preliminary model of the escape theory of suicide was tested in 168 college students (52 males, 116 females), who completed self-report measures of self-oriented, other-oriented, and socially prescribed perfectionism, negative life stress, depression, hopelessness, anxiety, reasons for living, and suicidal behaviors. A path analysis provided only partial validation for the model and accounted for 26% of the variance in suicidal behaviors. None of the three dimensions of perfectionism significantly accounted for any additional variance in suicidal behaviors above and beyond the other variables used in the study. Socially prescribed perfectionism was the only dimension of perfectionism that showed a statistically significant bivariate correlation with suicidal behaviors. The path analysis indicated that this correlation was an indirect effect through reasons for living. Depression was a better predictor of suicidal behaviors than hopelessness. Perhaps one reason for these equivocal results was the limited amount of variability in suicidal behaviors in this nonclinical sample.

Toward an interactional model of suicidal behaviors: Cognitive rigidity, attributional style, stress, hopelessness, and depression

This paper explores major theoretical models and research findings regarding the interaction of selected cognitive factors, such as cognitive rigidity and attributional style, stress, hopelessness, and depression. Toward the prediction of suicidal behaviors, two models are synthesized: a cognitive rigidity/stress-diathesis-hopelessness model, and a pluralistic, interactional model. In addition, relevant nursing prevention and intervention strategies from a cognitive therapy framework are discussed, as well as implications for nursing research.

Assessment of hopelessness in suicidal patients

Beck (1963) proposed that hopelessness is a common feature of depression and an important element in its etiology. The development of the Hopelessness Scale (Beck, Weissman, Lester, & Trexler, 1974) sparked substantial research into the phenomenon of hopelessness, as well as some controversy. Current interest in the construct and its measurement centers around its potential value in assessing risk for suicidal behavior, since several studies have demonstrated that many suicidal individuals have cognitive and emotional attributes of hopelessness. This paper explores developments in the assessment of hopelessness, and reviews the relevant research supporting its utility in the assessment of suicide risk. Empirical findings and controversies are summarized. Recommendations are made for instrument development, along with further study of state/trait characteristics of hopelessness and the utility of hopelessness as a predictor of suicidal behavior.

5-hydroxyindoleacetic acid in cerebrospinal fluid and prediction of suicidal behaviour in schizophrenia

Low concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in cerebrospinal fluid (CSF) are associated with suicidal behaviour in patients with depressive illness, but studies of the relation between CSF 5-HIAA and suicide in schizophrenia have been inconclusive and have not included long-term follow-up. In a prospective study, we measured 5-HIAA in CSF taken from 30 schizophrenic patients in a drug-free state, and followed these patients for 11 years. 10 patients made suicide attempts during follow-up. Suicide attempters had significantly lower concentrations of CSF 5-HIAA at initial evaluation than non-attempters (mean [SE] 6·7 [2·2] vs 23·6 [5·6] ng/ml, p<0·05). Our findings provide further evidence of the relation between serotoninergic dysfunction and suicide, and suggest a role for drugs with serotoninergic effects in schizophrenia.

Sense of coherence, self-esteem, depression and hopelessness as correlates of reattempting suicide.

Sense of coherence (SOC) has been proposed as a psychological factor that predicts good health and positive adjustment. The three components of SOC: manageability, comprehensibility and meaning were assessed together with depression, hopelessness and self-esteem as factors predicting future suicidal ideation and behaviour in parasuicides. One hundred and fifty hospitalized parasuicides were evaluated on these measures and followed up after six months to determine their current level of suicidal ideation and whether they had been readmitted for a further attempt or killed themselves in the intervening period. Suicidal ideation on admission was best predicted by a low score on the SOC meaning subscale and also significantly related to the other predictor variables. Suicidal ideation at the six-month follow-up was best predicted by the SOC subscales manageability and comprehensibility. These two SOC subscales also emerged as discriminators of suicidal behaviour over the six months following admission. Overall prediction of suicidal behaviour was enhanced by also including the background variables of age, a history of previous attempts, unemployment and whether the attempter was living alone. The study ends with a discussion of the importance of widening the focus when assessing and predicting suicidal risk to include not only predictions based on pathology but also psychological factors that promote adjustment.

Prediction of Suicidal Behavior from Biologic Tests

Biochemical studies related with suicidal behavior have mainly dealt with monoaminergic and corticosteroidal measures. We used some of these measures in a study of 61 suicide attempters who, except for occasional doses of benzodiazepines, had been medication free for a mean of 16 days. The monoamine metabolites 5-hydroxyindoleacetic acid, homovanillic acid, and 3-methoxy-4-hydroxyphenylglycol were measured in lumbar cerebrospinal fluid (CSF). We found that violent suicide attempters (N = 18) had 5-hydroxyindoleacetic acid concentrations below the median of all patients, whereas the concentrations of 3-methoxy-4-hydroxyphenylglycol were mainly above the median. We found no significant differences between violent and nonviolent (N = 43) attempters concerning CSF homovanillic acid, 24-hour urinary norepinephrine-epinephrine and cortisol, activity of monoamine oxidase in platelets, or post-dexamethasone plasma cortisol. Four patients completed suicide, and 3 of them had CSF 5-hydroxyindoleacetic acid concentrations at or below the median. All completed suicides had CSF 3-methoxy-4-hydroxyphenylglycol concentrations above the median. Urinary measures and platelet monoamine oxidase activity of completed suicides were in the higher concentration ranges. Patients who repeated suicidal behavior after the index investigation had low 24-hour urinary cortisol levels more often than those who did not repeat. Because our subgroups of patients are small, we cannot draw any firm conclusions about the value of our CSF and urinary biochemical findings predicting suicidal behavior. However, our CSF findings in violent suicide attempters are similar to those observed in other studies.

Elevated CSF CRF in suicide victims

Introduction It has been suggested that several indices of enhanced hypothalamic-pituitary-adrenal axis activity, including dexamethasone nonsuppression, may be indicators of suicidal tendencies. However, recent studies have failed to prove that the Dexamethasone Suppression Test (DST) could be a predictor of suicidal behavior (Dam et al. 1985; Ennis et al. 1985; Kocsis et al. 1986; Secunda et al. 1986; Arato et al. 1986a; Modestin and Ruef 1987). Encouraged by a recent study of Stanley et al. (1985), we resorted to postmortem cerebrospinal fluid postmortem (CSF) analyses as a new research tool in the investigation of completed suicides (Arato et al. 1986b). We found no differences in CSF cortisol and adrenocorticotrophic hormone (ACTH) in suicides and controls. We now report on an extension of that investigation, involving measurement of the concentration of immunoreactive corticotropinreleasing factor (CRF) in CSF. It is quite plausible that excessive, long-lasting and/or uncontrollable stress could lead to a breakdown of the psychological defensive mechanisms and to the suicidal act. In that case,

Psychological predictors of future suicidal behaviour in hospitalized suicide attempters.

Rates of attempted suicide have increased in most Western countries over the past 20 years. This level of deliberate self-harm is made more significant by the fact that a large proportion of attempted suicides will reattempt in the six months following their attempt and as a group they have a high risk of eventually killing themselves. While much of the research on prediction of suicidal behaviour has concentrated on demographic factors, little is known about the psychological variables that precede the suicidal act. This study examined 67 New Zealand suicide attempters on a range of psychological variables including self-esteem, hopelessness, depression, cognitive rigidity and social skills. Subjects were followed up after six months to determine their level of suicidal behaviour and ideation. Results suggest hopelessness and self-esteem are important indicators of future suicidal behaviour, with differential effects over short- and long-term periods. The implications for psychological assessment and suicidal risk assignment are discussed.

Suicidal behavior in alcoholic males

Alcoholics have high mortality rates, especially from suicide. To investigate factors correlated with suicidal behavior, a semistructured interview was administered to 262 patients admitted to a veterans hospital alcohol rehabilitation center. Suicide attempters were distinguished from non-attempters by their substance use histories, depressive symptomatology, and antisocial behavior. Logistic regression showed the best predictors of suicidal behavior were (a) the most alcohol consumed in 24 hours; (b) previous alcohol treatment; (c) previous use of other drugs; and (d) a high Hamilton score for depression on admission. Implications for clinical care are discussed.

Will the real social desirability please stand up? Hopelessness, depression, social desirability, and the prediction of suicidal behavior.

Will the real social desirability please stand up? Hopelessness, depression, social desirability, and the prediction of suicidal behavior.

Will the real social desirability please stand up? Hopelessness, depression, social desirability, and the prediction of suicidal behavior.

Will the real social desirability please stand up? Hopelessness, depression, social desirability, and the prediction of suicidal behavior.

Predicting adolescent suicidal behavior and the order of Rorschach measurement.

A total of 48 psychiatrically hospitalized adolescents were divided into four groups according to the sequence of suicidal behavior and measurement: (a) Previous Attempt Only, (b) Unit Attempt Only, (c) Dual Attempt, and (d) Nonsuicidal Control. A composite Rorschach Multiple Sign score was tabulated for each subject. An analysis of variance applied to the composite Rorschach scores was significant beyond the .001 level, with all suicide groups differing from the Control. It was determined that the sequence of assessment was not a significant factor. A cutoff score of four signs was identified as a predictor of suicidal behavior. None of the individual signs proved to differ significantly among the four groups.

Responses to Life Events as Predictors of Suicidal Behavior

This study, built on Jacobs' conceptual work, considered the interaction of a complex of predictor variables (hopelessness; locus of control; preference for inclusion, control, and affection; and stress from life events) in relation to the degree of suicide intent. Although the multiple regression equation computed for the combination of variables was significantly related to the criterion variable, suicide intent, hopelessness and preference for affection were the only major variables that contributed a significant amount of variance. Hopelessness, however, was the only variable that significantly related to suicide intent when considered outside the context of the multiple regression equation. In addition, the correlations between locus of control and hopelessness, as well as preference for affection and hopelessness, were significant and appeared to account for different variance than accounted for by the correlation of hopelessness and suicide intent.

Suicidal and depressive feelings among college students.

A questionnaire concerning their suicidal and depressive thoughts was administered to a sample of university students Over 40% had thought of killing themselves and less than 10% denied at least having felt deeply discouraged and unhappy. Religion was related to the presence of suicidal thoughts, and sex to reported frequency of such thoughts. Students were most likely to tell a friend of such thoughts, and, at a significant level, the friend was of the same sex as the respondent. Scores on locus of control, social desirability, and test anxiety measures were unrelated to suicidal and depressive thoughts. Results are compared with findings from other studies. The utility of reported depressive and suicidal thoughts as predictors of suicidal behavior is questioned.

Model for the Prediction of Suicidal Behavior

A three-factorial model for the prediction of suicidal behaviors has been proposed. This model allows both the integration of past research findings and the generation of new propositions regarding suicidal behaviors by analyzing the interaction of variables on different dimensions.