Risk Factors For Suicide Attempts Research Articles

Evaluation of elderly patients in adult suicide cases admitted to the emergency department

The proportion of elderly people in the general population has been increasing in our country. The suicide rate increases by a person's age, and old age appears as one of the life periods with a high suicide incidence. We aimed at investigating the causes and risk factors of suicide attempts and to analyze the sociodemographic and clinical features of the elderly individuals presenting to the emergency department after suicide attempt. Cross-sectional retrospective study was performed.1403 patients were enrolled. The patients were categorized into two age groups of 18–64 years and 65 years or older. The male gender had a greater proportion in both groups. The young group contained more subjects having an educational level of primary school while the illiterate ones in the older group had a greater suicide tendency. The married subjects had a greater suicide tendency in the younger group while widowed/divorced subjects had a greater suicide tendency in the older group. Subjects without any comorbidity or medication use had a greater suicide tendency in the younger group whereas those who had comorbidities or medication use greater suicide tendency. Mood disorders were the most common psychiatric disorder in both groups. Medication intake was the most common method of suicide in both groups; suicide attempts were more common in summer and between 16:00–24:00. Domestic problems as the cause of suicide were more common in the younger group, while communication problems were more common in the older group. Male gender, divorced/widowed, low education and sociocultural level, presence of depression, communication problems have been identified as risk factors for older group.

Incidence and Risk Factors for Suicide Attempts in Patients Diagnosed with Major Depressive Disorder.

ObjectiveThis study seeks to investigate the cumulative incidence and risk factors of suicide attempts in an outpatient sample of adults diagnosed with major depressive disorder (MDD).Materials and MethodsThis is a longitudinal study with 377 patients aged between 18 and 60 years. Those were diagnosed with MDD with no history of suicide attempts when they sought care at the Mental Health Outpatient Clinic of the Catholic University of Pelotas and evaluated again 3 years after. Participants were evaluated with the Mini International Neuropsychiatric Interview (MINI Plus) and answered instruments of clinical investigation and a sociodemographic questionnaire.ResultsThe cumulative incidence of suicide attempts in the sample was 10.1%. Youths aged up to 29 years (OR 2.23; 95% CI 1.13 to 4.64), with low schooling (OR 2.35; 95% CI 1.15 to 4.80), who suffered intense physical abuse during childhood (OR 2.77; 95% CI 1.31 to 5.84) and were at prior suicide risk (OR 3.39; 95% CI 1.56 to 7.37) were more likely to attempt suicide.ConclusionThe findings of this study may help health professionals identify depressed patients at greater risk for a first suicide attempt, supporting clinical decision and therapeutic planning.

Regional Exposure to Air Pollution and Health Behaviors as a Risk Factor for Suicide Attempt: The Seventh Korean National Health and Nutrition Examination Survey (KNHANES), 2016-2017, Korea Centers for Disease Control and Prevention

Background/Objectives: The purpose of this study is to identify the influencing factors of fine particleconcentration levelby region and health behaviors on suicide attempts.Method/Statistical Analysis: This study used the 7th (2016-2017) primitive data disclosed by the NationalHealth Nutrition Examination Survey. Considering the design features of the sample data, it is analyzed witha complex sampling method by reflecting stratas, clusters, and weight. The data were analyzed using logisticregression analysis of the complex sampleusing the SPSS/WIN 18.0 program.Findings: As a result of logistic regression analysis, the provability of suicide attempt was 12.32 times(95% CI 5.33-28.49, p<.001) higher in depression diagnosis group, 5.55 times (95% CI 1.87-16.46, p=.002)higher in 10 or more drinks in single session group, 2.48 times (95% CI 1.07-5.73, p=.003) higher in highperceived stress group, and 0.1 unit increase in Health-related Quality of life (? = -2.35, p=.030) resulted in0.79 times factor on suicide attempt rate.Improvements/Applications: This study can provide basic data to develop an intervention program that canreduce suicide attempt rate by analyzing environmental and health related factors affecting suicide attempts.

Verbal Response Latency as a Behavioral Indicator of Diminished Wish to Live in a Clinical Sample of Active Duty Army Personnel with Recent Suicidal Ideation

Objective Research on risk factors of suicide attempt has yielded little improvement in imminent risk detection for clinicians, due in part to the inherent limitations of self-report methodologies. Therefore, objective behavioral indicators of suicide risk that can be implemented practically with little cost in clinical settings are needed. Method The current study examined verbal response latency, measured as the length of time to answer a question asking about reasons for living (i.e., What are your reasons for living or not killing yourself?), as a potential indicator of suicide risk among 97 active duty Army personnel presenting to an emergency department or behavioral health clinic for current suicide ideation and/or a recent suicide attempt. Results Verbal response latency was significantly correlated with diminished wish to live at the participant level but was not significantly correlated with wish to die or overall severity of suicidal ideation. Conclusion Verbal response latency may serve as an objective indicator of suicide risk. Highlights Response latency to a life construct may be an objective indicator of suicide risk Delayed response latency is indicative of diminished wish to live Pathological mechanisms may manifest within dyadic interactions via verbal behaviors

Race, Age, and Lack of Insurance Increase Risk of Suicide Attempt in Trauma Patients

Objective The overall rate of suicide between 1999 and 2017 increased by 33% in the United States. We sought to examine suicide attempts in the trauma patient population, hypothesizing that in adult trauma patients race and lack of insurance status would be predictors of suicide attempt. Method The Trauma Quality Improvement Program (2010–2016) was queried for trauma patients ≥18 years old. The primary outcome was suicide attempt. A multivariable logistic regression model was performed including covariates that influence risk of suicide attempt. Results From 1,403,466 adult trauma admissions, 16,263 (1.2%) patients attempted suicide. Death after suicide attempt occurred in 30.2% of patients. Independent predictors of suicide attempt were age < 40 years old (odds ratio [OR] = 1.46, 95% confidence interval [CI] [1.41, 1.51], p < .001) and no insurance (OR = 1.92, 95% CI [1.85, 2.00], p < .001). Black (vs. White) race was associated with decreased risk of suicide attempt (OR = 0.63, 95% CI [0.60, 0.67], p < .001). Hispanic (versus non-Hispanic) patients demonstrated lower associated risk of suicide attempt by gun (OR = 0.50, 95% CI [0.45, 0.54], p < .001), while Asian (vs. White) patients exhibited higher risk of suicide attempt overall (OR = 1.25, 95% CI [1.12, 1.39], p < .001) and more specifically by knife (OR = 2.55, 95% CI [2.16, 3.00], p < .001). Conclusions Age younger than 40 years and lack of insurance were associated with higher risk of suicide attempt in adult trauma patients. Asian race was associated with the highest risk of suicide, with >2.5 times increased risk of attempt by knife. Awareness of these demographic-specific risk factors for suicide attempt, and in particular violent mechanisms of suicide attempt, is critical to implementation of effective suicide prevention efforts. Highlights Age younger than 40 and no insurance were associated with risk of suicide attempt. Black (vs. White) race was associated with decreased risk of suicide attempt. Asian race was associated with an increased risk of suicide attempt with a knife.

Suicidality in schizophrenic psychosis: a current overview

Suicidality in schizophrenic psychosis is an important topic but stands in clinical everyday work behind the perception of suicide especially in affective disorders. Schizophrenic psychosis is recognized as an independent risk factor for suicide attempts and suicides, whereas it poses particular challenges to the clinical professional due to the frequent unpredictability, abruptness and brutality of the methods used. For this reason, the suicide of apsychotic patient often leaves the professional and non-professional environment disturbed. An overview of the existing relevant literature on suicide in psychosis is given. Explanations on the psychodynamics, indications on pharmacotherapy and psychotherapy and considerations on prevention round off this article and provide an up to date overview of this topic for clinicians. Asearch was carried out in PubMed and Google scholar using the terms "suicide", "suicidality", "schizophrenia", "suicide AND schizophrenia", "suicide AND psychosis", "suicidality AND schizophrenia", "suicidality AND psychosis", "suicidality AND psychosis AND prevention", "suicide AND psychosis AND prevention", "suicidality AND schizophrenia AND prevention", "suicide AND schizophrenia AND prevention". Clinicians must have knowledge of the specific risk factors for suicide in psychotic patients, the characteristics of suicide in terms of design and temporal connection with treatment. The exploration and assessment of suicidality is often more difficult in psychotic patients than in affective or personality disorder patients, as there are often impulsive suicide attempts that can be explained by (suddenly occurring) psychotic symptoms and are therefore difficult or even impossible to foresee.

Catalonia Suicide Risk Code Epidemiology (CSRC-Epi) study: protocol for a population-representative nested case–control study of suicide attempts in Catalonia, Spain

IntroductionSuicide attempts represent an important public health burden. Centralised electronic health record (EHR) systems have high potential to provide suicide attempt surveillance, to inform public health action aimed at reducing...

Risk factors for suicide attempt in children, adolescents, and young adults hospitalized for mental health disorders.

Suicide is a leading cause of death among children, adolescents, and young adults (AYA), and mental health disorders are a major contributing factor. Yet, suicidal behaviors among children and AYA with mental health concerns remain understudied and age-specific risk factors are poorly understood. We examined the risk factors for suicide attempt in children and AYA with mental health disorders across three age groups: pre-adolescent children (aged≤12), adolescents (aged 13-17), and young adults (aged 18-25). A cross-sectional study of children and AYA hospitalized for a mental health disorder (n=18,018) at a private hospital system with 141 facilities across the United States (year 2014). Suicide attempts six months prior to hospitalization were reported in 12.1% (n=177) pre-adolescent children, 22% (n=1476) adolescents, and 17.9% (n=1766) young adults. Evidence of psychological trauma was present in 55.4% of pre-adolescent children, 51.2% of adolescents, and 44.5% of young adults. Predictors for suicide attempt observed across all three age groups included the following: female sex, depressive disorder, and being a victim of bullying. Risk factors for suicide attempt specific to pre-adolescent children included being uninsured and having an unsafe home or school environment. Among AYA, suicide attempt was associated with non-Hispanic white, family history of suicide, emotional traumas, and other traumatic experiences. Alcohol use disorder was also a significant predictor of suicide attempt in young adults. Suicide attempts among children and AYA admitted to a hospital with mental health concerns are highly prevalent. Socioeconomic stressors appeared to be an important contributing factor of suicidal behavior in pre-adolescent children but not in older AYA. Effective suicide prevention strategies targeting children and AYA would need to consider age-specific risk factors.

An investigation of clinical decisionmaking: identifying important factors in treatment planning for suicidal patients in the emergency department.

ObjectiveWe sought to evaluate the influence of several well‐documented, readily available risk factors that may influence a psychiatric consultant's decision to admit an emergency department (ED) patient reporting suicidal ideation for psychiatric hospitalization.MethodsWe conducted a retrospective study of adult patients presenting to six affiliated EDs within Pennsylvania from January 2015 to June 2017. We identified 533 patients reporting current active suicidal ideation and receiving a complete psychiatric consultation. Socio‐demographic characteristics, psychiatric presentation and history, and disposition were collected. Decision tree analysis was conducted with disposition as the outcome.ResultsFour of 27 variables emerged as most influential to decisionmaking, including psychiatric consultant determination of current suicide risk, patient age, current depressive disorder diagnosis, and patient history of physical violence. Likelihood of admission versus discharge ranged from 97% to 58%, depending on the variables considered. Post hoc analysis indicated that current suicide plan, access to means, lack of social support, and suicide attempt history were significantly associated with psychiatric consultant determination of moderate‐to‐high suicide risk, with small‐to‐medium effect sizes emerging.ConclusionsOnly a handful of variables drive disposition decisions for ED patients reporting current active suicidal ideation, with both high and low fidelity decisions made. Patient suicide risk, determined by considering empirically supported risk factors for suicide attempt and death, contributes the greatest influence on a psychiatric consultant's decision to admit. In line with American College of Emergency Physicians (ACEP) recommendations, this study accentuates the importance of using clinical judgment and adjunct measures to determine patient disposition within this population.

Suicidal attempts, insomnia, and major depressive disorder among family members of suicide victims in South Korea

BackgroundSuicide survivors are defined as victims who experienced suicide of siblings or parents, spouses, or lineal relatives within the fourth degree who had lived with them. We compared the effects of major depressive disorder (MDD), symptoms of posttraumatic stress disorder (PTSD), and impulsivity on lifetime suicide attempts among suicide survivors. MethodsParticipants included 272 suicide survivors. We compared them to 5,200 members from the general population who were matched by age, sex, and years of education. We evaluated participants using the Patient Health Questionnaire-9 (PHQ-9), the EuroQuality of Life (EuroQol) scale, the Impact of Events Scale-Revised (IES-R), the Barratt Impulsiveness Scale-11 (BIS-11), and the Composite International Diagnostic Interview (K-CIDI). ResultsAmong the 272 suicide survivors, MDD was nine times higher (47.1% vs. 5.3%), and suicidal attempts were six times higher (20.5% vs. 3.3%) than reported among the general population. The suicide survivors showed more severe depression, greater impulsivity, and poorer quality of life than did the general population. In multivariate logistic regression analyses performed to evaluate each IES-R item, “trouble staying asleep” was the only PTSD symptom item that was significantly associated with suicide attempts among suicide survivors. Suicide survivors who had both MDD with insomnia and high impulsivity were at four times higher risk for suicide attempts than the general population with no MDD (AOR = 4.04, 95% CI: 1.25-13.09). ConclusionsSurviving suicide by family members is an important risk factor for suicide attempts. In particular, MDD with insomnia and impulsivity are associated with suicide attempts among suicide survivors.

Preferences in Information Processing, Marginalized Identity, and Non-Monogamy: Understanding Factors in Suicide-Related Behavior among Members of the Alternative Sexuality Community.

Suicide-related behavior (SRB) is a mental health disparity experienced by the alternative sexuality community. We assessed mental health, relationship orientation, marginalized identities (i.e., sexual orientation minority, gender minority, racial minority, ethnic minority, and lower education), and preferences in information processing (PIP) as factors differentiating lifetime SRB groups. An online cross-sectional survey study was conducted in 2018. Members of the National Coalition for Sexual Freedom (NCSF; n = 334) took part. Bivariate analyses identified the following SRB risk factors: female and transgender/gender non-binary identity, sexual orientation minority identity, lower education, suicide attempt/death exposure, Need for Affect (NFA) Avoidance, depression, and anxiety. Monogamous relationship orientation was a protective factor. Multi-nomial regression revealed the following: (1) monogamous relationship orientation was a protective factor for suicidal ideation and attempt; (2) lower education was a risk factor for suicide attempt; (3) anxiety was a risk factor for suicide attempt; and (4) depression was a risk factor for suicidal ideation. A two-way interaction showed that elevated NFA Approach buffered the negative impacts of depression. Relationship orientation, several marginalized identities (i.e., based on gender, sexual orientation, and educational level), and PIP all contributed uniquely to SRB. Further study is necessary to understand the role of relationship orientation with suicide. Health education and suicide prevention efforts with NCSF should be tailored to account for marginalized identity, mental health, and NFA factors.

Sexual minorities and teen suicide attempts in a southeastern state with prominent exclusionary policies

This study examines differences in suicide-related behaviors between heterosexual and sexual minority youth in a southeastern state with exclusionary policies. Furthermore, it seeks to further knowledge regarding risk factors for suicide attempts among sexual minority high school students. Utilizing the 2017 Youth Risk Behavior Survey data, descriptive analysis tests, and logistic regression tests were conducted. Findings indicate that sexual minorities were three times as likely to experience suicidal thoughts and plans but four times as likely to attempt suicide. Risk factors were noted for sexual minority youth. Policy advocacy is recommended to decrease suicide-related behaviors among this population.

Comparing Suicide Attempters With and Without Mental Disorders: A Study of Young Adults in Rural China.

Over 90% of suicides in the West could be diagnosed with mental disorders, while only 50-70% of Chinese suicides had mental disorders. Using data from a case-control study on suicide attempt, we aimed to compare characteristics and risk factors between suicide attempters with and without mental disorders. Demographic and social psychological characteristics were compared between attempters with and without mental disorders. 19.1% of the suicide attempters were diagnosed with mental disorders. Suicide attempters with mental disorders endured more strain than those without. Strain was an independent risk factor for suicide attempt among people without mental disorders. Psychological strain might be an important reason for both mental disorders and following suicide attempt. More efforts on suicide prevention should be spent on people without mental disorders. The impact of social psychological factors, such as religion, negative life events, and psychological strains should be considered.

Lower intimate relationship satisfaction among partnered female service members/veterans is associated with the presence of suicidal ideation.

Risk for suicide among female service members/veterans (SM/Vs) is increasing, suggesting a need for additional studies of risk factors in this population. This study examined relationship satisfaction as a correlate of suicidal ideation (SI) after accounting for established risk factors for SI. Partnered female SM/Vs (N = 818) completed a demographic inventory and measures of SI, relationship satisfaction, sexual function, posttraumatic stress disorder (PTSD), and depression. After accounting for covariates, lower relationship satisfaction, higher depression and PTSD severity, and minority race were associated with the presence of SI. PTSD and depression severity did not moderate this association, suggesting that regardless of mental health symptoms, relationship satisfaction is associated with increased SI risk. Screening for relationship satisfaction may identify SI risk in partnered female SM/Vs. Future studies should explore relationship satisfaction as a risk factor for suicidal attempts as not all SM/Vs who experience SI will attempt suicide.

Suicide attempt among adolescent in Tamil Nadu: A case-control study

Introduction: Suicide is a complex social issue and a serious global health problem. Its incidence among adolescents is increasing. Understanding of risk factors helps early detection and prompt treatment of high-risk youngsters. Materials and Methods: It was a hospital-based case-control study carried out among 60 adolescent suicide attempters and 60 of their normal counterparts for the period of one year. Pretested structured questionnaire was used to collect information. Ethical principles were followed throughout the study. SPSS version 24 was used to do the analysis. Odd's ratio (OR) and its 95% confidence interval (CI) were calculated as a measure of the strength of association between risk factors and suicide attempts. Results: Among the study participants, 70% were in the age group of 16 – 18 years and 45% were males. The identified risk factors for suicide attempt were, presence of psychiatric illness (OR-7.8; 95% CI: 3.3-19), substance abuse among family members (OR-4.3; 95% CI: 2-9.3), family history of attempted suicide (OR-7.2; 95% CI: 1.5-3.3), family history of completed suicide (OR-3.6; 95% CI: 1.2-1.1) and residence at rural areas (OR-2.8; 95% CI: 1.2 – 6.3). Suicide intent score was significantly correlated with various standard scoring tools for stress and depression among cases. Conclusion: The established risk factors should be considered in creating an effective intervention program and strategies with intersectoral collaboration and coordination to prevent suicide among high-risk adolescents. Keywords: Adolescent, Attempted suicide, Case-control study, Risk factors.

Suicidality and Problem Gambling Among Emerging Adults: Results from a Cross-Sectional Online Survey

Background: In many nations, suicidality in young people has increased with a range of factors suggested to explain this, including increased attention on problem gambling as a risk factor for suicidality. Few studies have examined this specifically for young adults or since gambling has become more widely available, online, and normalised. Methods: A cross-sectional online survey collected data from 3549 16-24-year-olds living in Britain. Associations between problem gambling and past year suicidal thoughts and suicide attempts were examined in a series of regression models, with and without adjustment for sociodemographic factors, alcohol use, social media and gaming behaviour, anxiety, loneliness and impulsivity. Results: 37·0% (95%CI: 25.7-48.3) of young men who had attempted suicide in the past year were problem gamblers, compared with 3.6% (2.5-4.5) of young men who had not. Equivalent estimates for young women were 14·4% (6.4-22.4) and 2.0% (1.3-2.7). The unadjusted odds of attempted suicide were 15·1 (8.2-27.9) times higher among male problem gamblers and 8·0 (4.0-16.0) times higher among female problems gamblers. For both men and women, the relationship attenuated but remained significant taking other factors into account. Interpretation: Problem gambling appears to be a risk factor for suicide attempts in young people. This relationship persists once anxiety, impulsivity and life satisfaction are taken into account suggesting other mechanisms, like the harms experienced by those who gamble problematically, or gamble to cope with life stressors, underpin this relationship. Young people with gambling problems should be viewed as high-risk for suicidality. Funding: Funded by Wellcome Trust (no: 200306/Z/15/Z). Declaration of Interests: HW is the Deputy Chair of the Advisory Board for Safer Gambling, which provides advice to the Gambling Commission on policy and regulatory issues. In the last three years, she has worked on one project funded by GambleAware along with SM. HW runs a research consultancy, providing research services to public and third sector bodies. She does not and has not provided consultancy services for the gambling industry. SM declares no further competing interests. Ethics Approval Statement: Ethical approval for the study was granted by London School of Hygiene and Tropical Medicine’s Ethics Review Panel (ref: 15960).

Healthcare utilization, psychiatric medication and risk of rehospitalization in suicide-attempting patients with common mental disorders.

Common mental disorders are strong risk factors for suicide attempt. We compared common mental disorder patients with and without suicide attempt regarding health care utilization and psychiatric medication, assessed gender differences and identified how psychotropic medication of attempters is associated with subsequent rehospitalization. We used administrative claims data of 22,276 common mental disorder patients with inpatient care in Lower Austria between 1 January 2006 and 31 December 2011. Suicide attempters (cases, n = 615) and non-attempters (controls, n = 21,661) were compared regarding specific healthcare utilization by calculating mean differences of time-dependent contact probabilities and psychiatric medication (i.e. prescribed defined daily doses) ± 0.5 years around their suicide attempt (cases)/common mental disorder diagnosis (controls). Cluster analysis was used to group suicide attempters according to their psychiatric medication. The risk of rehospitalization 0.5-3 years after the attempt was calculated with regression analysis controlling for sex, age and morbidity-related factors. Contacts with general practitioners were lower for attempters than non-attempters (mean difference of contact probabilities over observation period, males = -0.05, 95% confidence interval = [-0.07, -0.03]; females: mean difference = -0.04, 95% confidence interval = [-0.05, -0.03]). Regarding psychiatrists, female attempters had markedly higher contact probabilities after the attempt compared to female non-attempters (mean difference = 0.02, 95% confidence interval = [0.007, 0.04]); male attempters had lower contact probabilities before the attempt compared to male non-attempters (mean difference = -0.01, 95% confidence interval = [-0.004, -0.02]). Attempters had higher dosages of psychiatric medication across the entire period. Antidepressant and antipsychotic medication peaked at the time of common mental disorder diagnosis/attempt. Benzodiazepine prescriptions were considerably higher for male attempters than their female counterparts and were constantly elevated for male attempters across the observation period. A cluster of attempters with long-term benzodiazepine prescriptions had an increased risk of rehospitalization (adjusted odds ratio = 2.4, 95% confidence interval = [1.1, 5.5]). Despite lower contact probabilities, common mental disorder patients with suicide attempt are prescribed more psychiatric medication, particularly benzodiazepines, with an elevated risk of rehospitalization. Strong sex differences were found.

Risk factors for suicide attempts among rural youth with a history of suicidal ideation

Youths in rural areas have approximately double the risk for suicide than do urban youth. This study analyzed data from 580 youth aged 10 to 17-years-old who endorsed lifetime suicidal ideation on intake at three large rural behavioral health centers. Results indicated that a five-factor model including older age, number of inpatient hospitalizations, gender (female), impaired legal functioning, and higher impulsivity accounted for the most variance in differentiation between ideators and attempters. These results advance our assessment of rural youth who may be at increased risk for a suicide attempt.

Risk Factors for Suicide and Suicide Attempts Among Patients With Treatment-Resistant Depression: Nested Case-Control Study

The risk of suicide is elevated among patients with treatment-resistant depression (TRD). Risk factors for suicide and suicide attempts among cases and controls with TRD were investigated using data from nationwide Swedish registers. Among 119,407 antidepressant initiators with a diagnosis of depression, 15,631 patients who started a third sequential treatment trial during the same depressive episode were classified with TRD. A nested case-control study compared cases with suicide and suicide attempts with up to three closely matched controls. Sociodemographic and clinical risk factors were assessed using conditional logistic regression analyses. In all, 178 patients died by suicide and 1,242 experienced a suicide attempt during follow-up. History of suicide attempts, especially if <1 year after the attempt, was a significant independent risk factor for suicide (adjusted odds ratio [aOR], 8.9; 95% confidence interval [CI], 5.1–15.7) as were 10 to 12 years of education compared to lower education (aOR, 1.69; 95% CI, 1.02–2.81). For attempted suicide, the strongest independent risk factors were history of suicide attempts (<1 year aOR, 5.1; 95% CI, 4.0–6.5), substance abuse (aOR, 2.6; 95% CI, 2.2–3.1), personality disorders (aOR, 1.9; 95% CI, 1.5–2.3), and somatic comorbidity (aOR, 2.0; 95% CI, 1.04–3.9). Suicide attempts, especially if recent, are strong risk factors for completed suicide among patients with TRD. Established risk factors for suicide attempts were confirmed for patients with TRD.

Isotretinoin and risk factors for suicide attempt: apopulation-based comprehensive case series and nested case-control study using 2010-2014 French Health Insurance Data.

Although the causal role of isotretinoin in suicidal behaviour is controversial, suicide attempts (SA) do occur among patients taking isotretinoin. To describe patient profiles and the management of isotretinoin among patients who committed or attempted suicide under treatment. To assess the risk factors for SA under isotretinoin. We performed a comprehensive case series of suicides and SAs under isotretinoin, and a case-control study, using Nationwide French Health Insurance database. The main analysis compared cases (subjects with a SA during a course of isotretinoin) to controls, individually matched for age, gender and rank of the current course; controls were to be exposed to isotretinoin at the index date (date of SA for the corresponding cases). The patients' psychiatric history at isotretinoin initiation was studied. In a secondary analysis, patients who continued their isotretinoin treatment after their SA were compared to patients who discontinued it. In all, 328018 subjects started a course of isotretinoin between 1 January 2010 and 31 December 2014 and 184 patients were hospitalized for a SA; half of them had a psychiatric history at initiation. In the multivariate analysis, psychiatric history and history of anxiety alone were risk factors for SA [Odds ratio (OR), 18.21; 95% confidence interval (CI), 9.96-33.30 and 4.78; 95% CI, 2.44-9.33, respectively]. Among 176 cases of SA with sufficient follow-up, 103 (58.5%) carried on with their treatment after their SA. Treatment initiation by a dermatologist was inversely associated with the continuation of the treatment after a SA (OR, 0.38; 95% CI, 0.18-0.80). Suicide attempts under isotretinoin are rare events, and our results suggest that most of the patients concerned have a risk-prone profile detectable at the time of treatment initiation. The risk-benefit ratio of continuing isotretinoin after a SA warrants further careful evaluation.