Risk Factors For Suicide Death Research Articles

Cardiovascular drugs and suicide death: Determination of carvedilol, amlodipine, doxazosin and diltiazem in two fatal cases

A number of medical conditions are identified as risk factors for suicide death; in particular, cardiovascular illnesses are recognized as a major suicide risk factor. In this case, self-poisoning is the common method of suicide and cardiovascular drugs are among the major medications associated with fatal overdose, with calcium channel blockers being one of the most common agents. The present study describes two different fatal suicide cases involving four cardiovascular drugs: carvedilol, doxazosin and amlodipine (case 1) and diltiazem (case 2). The concentrations of the target cardiovascular drugs in the different biological specimens (central and femoral blood, urine, liver, brain) are presented, giving information about the potentially fatal data and the distribution of the drugs in the body. The study led to the implementation of a fast, sensitive and simple method for the detection and quantification of the four commonly prescribed cardiovascular drugs in post-mortem specimens including fluids and tissues for forensic purposes. The method was fully validated. The toxicological results of the studied cases are discussed, along with the autopsy results, histopathological evidence, and circumstances of death. The toxicological findings presented in the study provide new data regarding cardiovascular drugs in different post-mortem specimens, which will contribute to the currently limited knowledge about the toxicological profile of cardiovascular drugs and their distribution.

Voluntary Firearm Divestment and Suicide Risk: Real-World Importance in the Absence of Causal Identification.

Voluntary Firearm Divestment and Suicide Risk: Real-World Importance in the Absence of Causal Identification.

Suicide attempt, impulsivity, and exposure to trauma in college students

Objectives:Past suicide attempt (SA) is one of the most important risk factors for suicide death. An ideation-to-action framework posits that impulsivity, potentially traumatic events, and mental disorders also play a role in increasing suicide risk. This study aimed to assess the association between trait impulsivity, lifetime exposure to trauma, and post-traumatic stress disorder (PTSD) with SA in a sample of Brazilian college students.Methods:A total of 2,137 participants filled self-reported questionnaires consisting of a sociodemographic and clinical questionnaire, Trauma History Questionnaire, Post-Traumatic Stress Disorder Checklist – Civilian version, and Barratt Impulsiveness Scale.Results:Our findings suggest that trait impulsivity may be interpreted as exerting a distal effect on SA, even in the presence of other variables – such as trauma history, psychological neglect, and PTSD – which also increase the odds of SA. High and medium levels of impulsivity, history of trauma, and PTSD increased the likelihood of SA.Conclusions:Intervention strategies to prevent SA may target trait impulsivity and exposure to traumatic experiences.

44.6 Clinical and Genetic Evaluation of Suicide Death Among Young Individuals Exposed to Trauma

Suicide is the second leading cause of death in the United States for individuals aged 10 to 24 years and remains difficult to predict despite being inherently preventable. Exposure to trauma is known to be a risk factor for suicidal behavior and worse mental health clinical trajectories. This study leverages a unique collection of individuals who have died from suicide as part of the Utah Population Database (UPDB) to evaluate clinical and genetic risk factors for death by suicide in young individuals (aged 12-25 years) who have a history of exposure to trauma. A total of 9052 UPDB deidentified individuals who died from suicide and had linked medical records were evaluated. Individuals aged 0 to 25 years with a diagnosis of PTSD or medically documented trauma were selected (N = 156; “YTS”). YTS were compared with remaining individuals who died by suicide (N = 8,869; “AS”) by common comorbid diagnoses (found in ≥5% of all subjects). Significant findings were used to direct a polygenic risk score (PRS) assessment of a subset of genotyped European individuals (YTS N = 85; AS N = 3766). All statistics utilized logistic regression and were adjusted for critical covariates and multiple tests. Clinical analyses yielded several diagnoses that were overrepresented within the YTS group as compared with the AS group. These included MDD (OR = 4.7; 95% CI, 3.1-7.2), generalized anxiety disorder (OR = 3.4; 95% CI, 2.0-5.6), bipolar disorder (OR = 3.0; 95% CI, 1.8-5.0), tobacco use disorder (OR = 2.9; 95% CI, 1.8-4.4), and unspecified psychosis (OR = 2.6; 95% CI, 1.4-4.7). PRSs were calculated based on large studies of anxiety, PTSD, MDD, bipolar disorder, and smoking, but none survived correction, noting nominal significance of PTSD PRSs. These results identify several comorbid diagnoses that may serve as combined risk factors for suicide death in the setting of young, trauma-exposed individuals, as compared with other suicide deaths. A particular enrichment of major mental health diagnoses and substance use was observed. These findings may be helpful in directing future screening and research efforts targeted toward identifying those at highest risk for suicide.

Neurexin 1 variants as risk factors for suicide death

Suicide is a significant public health concern with complex etiology. Although the genetic component of suicide is well established, the scope of gene networks and biological mechanisms underlying suicide has yet to be defined. Previously, we reported genome-wide evidence that neurexin 1 (NRXN1), a key synapse organizing molecule, is associated with familial suicide risk. Here we present new evidence for two non-synonymous variants (rs78540316; P469S and rs199784139; H885Y) associated with increased familial risk of suicide death. We tested the impact of these variants on binding interactions with known partners and assessed functionality in a hemi-synapse formation assay. Although the formation of hemi-synapses was not altered with the P469S variant relative to wild-type, both variants increased binding to the postsynaptic binding partner, leucine-rich repeat transmembrane neuronal 2 (LRRTM2) in vitro. Our findings indicate that variants in NRXN1 and related synaptic genes warrant further study as risk factors for suicide death.

Assessment of suicide attempt and death in bipolar affective disorder: a combined clinical and genetic approach

Bipolar disorder (BP) suicide death rates are 10–30 times greater than the general population, likely arising from environmental and genetic risk factors. Though suicidal behavior in BP has been investigated, studies have not addressed combined clinical and genetic factors specific to suicide death. To address this gap, a large, harmonized BP cohort was assessed to identify clinical risk factors for suicide death and attempt which then directed testing of underlying polygenic risks. 5901 individuals of European ancestry were assessed: 353 individuals with BP and 2498 without BP who died from suicide (BPS and NBPS, respectively) from a population-derived sample along with a volunteer-derived sample of 799 individuals with BP and a history of suicide attempt (BPSA), 824 individuals with BP and no prior attempts (BPNSA), and 1427 individuals without several common psychiatric illnesses per self-report (C). Clinical and subsequent directed genetic analyses utilized multivariable logistic models accounting for critical covariates and multiple testing. There was overrepresentation of diagnosis of PTSD (OR = 4.9, 95%CI: 3.1–7.6) in BPS versus BPSA, driven by female subjects. PRS assessments showed elevations in BPS including PTSD (OR = 1.3, 95%CI:1.1–1.5, versus C), female-derived ADHD (OR = 1.2, 95%CI:1.1–1.4, versus C), and male insomnia (OR = 1.4, 95%CI: 1.1–1.7, versus BPSA). The results provide support from genetic and clinical standpoints for dysregulated traumatic response particularly increasing risk of suicide death among individuals with BP of Northern European ancestry. Such findings may direct more aggressive treatment and prevention of trauma sequelae within at-risk bipolar individuals.

National trends in non-fatal suicidal behaviors among adults in the USA from 2009 to 2017.

The age-adjusted rate of suicide death in the USA has increased significantly since 2000 and little is known about national trends in non-fatal suicidal behaviors (ideation, plan, and attempt) among adults and their associated sociodemographic and clinical characteristics. This study examined trends in non-fatal suicidal behaviors among adults in the USA. Data were obtained from adults 18-65 years of age who participated in the National Survey on Drug Use and Health (NSDUH), including mental health assessment, from 2009 to 2017 (n = 335 359). Examinations of data involved trend analysis methods with the use of logistic regressions and interaction terms. Suicidal ideation showed fluctuation from 2009 to 2017, whereas suicide plan and attempt showed significantly positive linear trends with the odds increasing by an average of 3% and 4%, respectively. Suicide plan increased the most for females and adults ages 18-34, and attempt increased the most for adults with drug dependence. Both plan and attempt increased the most among adults who either had mental illness but were not in treatment or had no mental illness. Given attempted suicide is the strongest known risk factor for suicide death, reducing non-fatal suicidal behaviors including attempt are important public health and clinical goals. The interactional findings of age, sex, mental health status, and drug dependence point toward the importance of tailoring prevention efforts to various sociodemographic and clinical factors.

Incidence of and sociological risk factors for suicide death in patients with leukemia: A population-based study

ObjectivesSuicide is closely related to sociological factors, but sociological analyses of suicide risk in leukemia are lacking. This study is the first to use the Surveillance, Epidemiology, and End Results Program (SEER) database to analyze sociological risk factors for suicide death in leukemia patients.MethodsA retrospective search of the SEER database was conducted. Logistic regression was used to identify independent risk factors for suicide death. Variables significant in the univariate logistic regression models were subsequently analyzed using multivariate regression.ResultsThe death rate was highest in California (1.73%). Suicide mortality was more common during the 1970s and 1980s, after which it trended downward. Young age at diagnosis (18–34 vs. >64 years: odds ratio [OR] = 1.537, 95% confidence interval [CI] = 1.007–2.347; 35–64 vs. >64 years: OR = 1.610, 95% CI = 1.309–1.979), being male (OR = 1.518, 95% CI = 1.230–1.873), and living where a high proportion of people have at least a bachelor’s degree (>50% vs. <20%: OR = 8.115, 95% CI = 5.053–13.034) significantly increased suicide death risk.ConclusionOur findings could increase clinician awareness of and appropriate support for leukemia patients at risk of death by suicide.

Risk factors associated with suicide in patients with prostate cancer in the United States.

84 Background: For a patient, receiving a diagnosis of cancer can be quite challenging and is often associated with depression and increased suicidal ideation. Previous studies have indicated that the risk of suicide in cancer patients is twice that of general population. Prostate cancer is the most common cancer in men. It has also been found to be associated with highest rates of suicide in genitourinary malignancies. We sought to evaluate the incidence and identify risk factors associated with suicide among men with prostate cancer. Methods: Patients with prostate cancer between the years 1973 and 2016 were identified in the Surveillance, Epidemiology, and End Results database (SEER). Multivariate logistic regression analysis was performed to identify independent risk factors for suicide death only on variables that were statistically significant in univariate statistical analysis. Results: In 1,307,625 patients with prostate cancer, 3,435 patients had committed suicide. Younger age (≤50 vs &gt; 70: OR = 4.73 , P &lt; 0.0001; 51-70 vs &gt; 70: OR = 1.93, P &lt; 0.04), Caucasian race (OR: 3.61, P &lt; 0.0001) and not undergoing surgery (OR: 1.33, P &lt; 0.0001) were significantly associated with increased risk of suicide. Furthermore, patients with &lt; 1 year since the diagnosis of prostate cancer were also found to be associated with increased risk of suicide death ( &lt; 1 vs &gt; 5 years: OR = 1.46, P &lt; 0.0001). Conclusions: Addressing mental health in patients with prostate cancer is an important issue. We found that several factors such as younger age, Caucasian race were significantly associated with risk of suicide. Patients who did not undergo surgery likely had advanced disease, which could explain their increased risk of suicide. Patients with &lt; 1 year since the diagnosis of prostate cancer are more vulnerable and at increased risk of suicide which emphasizes the necessity of identifying and treating patients at risk of suicide as early as possible. It is vital that health care providers recognize these patients and offer them appropriate support.

Incidence and risk factors for suicide death in male patients with genital-system cancer in the United States

BackgroundA diagnosis of cancer is associated with increased risks of suicidal ideation and suicide attempts. Genital-system cancer comprises nearly a third of all cancers in males. We used the SEER database to identify the incidence of and risk factors for suicide death in male patients with genital-system cancer in the United States. MethodPatients were selected from the SEER database, and X-tile software was used to find the best cutoffs for stratifying age. Logistic regression was used to identify independent risk factors for suicide death. Only variables that were statistically significant in the univariate logistic regression models were analyzed in multivariate logistic regression models. ResultThis study found that age (18–66 vs ≥ 76 years: OR = 3.300, P < 0.001; 67–75 vs ≥ 76 years: OR = 1.832, P < 0.001), being unmarried (OR = 1.332, P = 0.010), being divorced, separated, or widowed (OR = 1.338, P = 0.002), caucasian (OR = 2.074, P = 0.003) and not receiving surgery or having an unknown surgery status (OR = 1.405, P < 0.001) significantly increased the risk of suicide death. A particularly important finding was that a time of <1 year after the diagnosis was related to an increased risk of suicide death (<1 vs ≥ 10 years: OR = 1.761, P = 0.008). ConclusionWe found that a number of factors significantly increased the risk of suicide. Importantly, a time of <1 year after the diagnosis was related to an increased risk of suicide death, which indicates the importance of identifying and treating people at risk of suicide as early as possible. These can help clinicians to understand suicidal patients and provide them with appropriate support.

Incidence rate and risk factors for suicide death in patients with skin malignant melanoma: a Surveillance, Epidemiology, and End Results analysis.

The purpose of this study was to use the Surveillance, Epidemiology, and End Results database to identify the incidence rate and risk factors for suicide death in patients with skin malignant melanoma (MM) in the USA. We screened cases of skin MM in the SEER database. The balance of covariates between the two groups was examined by the χ-test and Fisher's exact test. Logistic regression was used to identify independent risk factors for committing suicide. A propensity 1: 2 matched analysis was applied to minimize the risk of bias. In total, 103 500 patients with skin MM were included in the study, of whom 623 had died of suicide. The rate of suicide death did not differ significantly between different time intervals. In logistic regression before propensity score matching, age, being divorced, separated, or widowed, receiving radiation or chemotherapy, and the elapsed time since diagnosis were independently associated with an increased rate of suicide death. Only age (P < 0.001) and being in the first year after a diagnosis (P < 0.001) significantly increased the risk of suicide death after propensity score matching. In addition, after the propensity score matching, age was a risk factor for localized, regional, and unstaged, and being the first year after a diagnosis was only a risk factor for regional. It is important to identify and treat people at risk of suicide as early as possible. These results can help clinicians to understand suicidal patients and provide them with appropriate support.

An Observational Study of Suicide Death in Homeless and Precariously Housed People in Toronto.

Homelessness has been identified as an important risk factor for suicide death, but there is limited research characterising homeless people who die by suicide. The goal of this study is to identify personal, clinical, and suicide method-related factors that distinguish homeless and precariously housed people who die from suicide from those who are not homeless at the time of suicide. Coroner records were reviewed for all suicide deaths in Toronto from 1998 to 2012. Data abstracted included housing status as well as other demographics, clinical variables such as the presence of mental illness, and suicide method. Of 3319 suicide deaths, 60 (1.8%) were homeless and 230 (6.9%) were precariously housed. Homeless and precariously housed people were each younger than nonhomeless people ( P < 0.0001). Compared with nonhomeless, homeless people were more likely to be male and less likely to be married, to have interpersonal conflict, or to leave a suicide note. Homeless people and precariously housed were more likely to have died by fall/jump than nonhomeless people (62%, 57%, and 29%, respectively). Homeless and precariously housed people are overrepresented among suicide deaths in a large urban center and differ demographically, clinically, and in their suicide method from nonhomeless people who die by suicide. Targeted suicide prevention strategies should aim to address factors specific to homeless people.

Psychological autopsy study comparing suicide decedents, suicide ideators, and propensity score matched controls: results from the study to assess risk and resilience in service members (Army STARRS).

The suicide rate has increased significantly among US Army soldiers over the past decade. Here we report the first results from a large psychological autopsy study using two control groups designed to reveal risk factors for suicide death among soldiers beyond known sociodemographic factors and the presence of suicide ideation. Informants were next-of-kin and Army supervisors for: 135 suicide cases, 137 control soldiers propensity-score-matched on known sociodemographic risk factors for suicide and Army history variables, and 118 control soldiers who reported suicide ideation in the past year. Results revealed that most (79.3%) soldiers who died by suicide have a prior mental disorder; mental disorders in the prior 30-days were especially strong risk factors for suicide death. Approximately half of suicide decedents tell someone that they are considering suicide. Virtually all of the risk factors identified in this study differed between suicide cases and propensity-score-matched controls, but did not significantly differ between suicide cases and suicide ideators. The most striking difference between suicides and ideators was the presence in the former of an internalizing disorder (especially depression) and multi-morbidity (i.e. 3+ disorders) in the past 30 days. Most soldiers who die by suicide have identifiable mental disorders shortly before their death and tell others about their suicidal thinking, suggesting that there are opportunities for prevention and intervention. However, few risk factors distinguish between suicide ideators and decedents, pointing to an important direction for future research.

Nightmares and Dysfunctional Beliefs about Sleep Mediate the Effect of Insomnia Symptoms on Suicidal Ideation

Many studies have reported a positive association between sleep problems and suicidal ideation. Some prospective studies in the elderly have shown that insomnia is a risk factor for suicide death after controlling for other depressive symptoms. However, hypotheses to explain how this risk is mediated have not previously been assessed. We tested the hypothesis that insomnia symptoms are related to suicidal ideation through mediation by dysfunctional beliefs and attitudes about sleep and/or nightmares. We measured symptoms of depression, hopelessness, insomnia severity, dysfunctional beliefs and attitudes about sleep, nightmares, and suicidal ideation intensity on a convenience sample of 50 patients with depressive disorders, including 23 outpatients, 16 inpatients, and 11 suicidal ED patients. Mediation analysis was used to assess the indirect effects of insomnia symptoms on suicidal ideation through dysfunctional beliefs about sleep and through nightmares. Our findings again confirmed a positive association between insomnia symptoms and the intensity of suicidal ideas in depressed patients (b = 0.64, 95% CI = [0.14, 1.15]). However, we extended and clarified our earlier findings by now showing that dysfunctional beliefs and attitudes about sleep as well as nightmares may mediate the association between insomnia symptoms and suicidal ideation. The indirect effects of insomnia symptoms through dysfunctional beliefs about sleep and through nightmares were 0.38 (-0.03, 0.97) and 0.35 (0.05, 0.75), respectively. Nightmares as well as dysfunctional beliefs and attitudes about sleep each are positively and independently related to the intensity of suicidal ideation, and the effect of insomnia symptoms appears to be mediated through these two variables.

School grades, parental education and suicide—a national register-based cohort study

BackgroundTo investigate whether school performance is a risk factor for suicide death later in life and, if so, to what extent this is explained by intergenerational effects of parental education.MethodsThis...