Risk Of Completed Suicide Research Articles

Body Mass Index Is an Important Predictor for Suicide: Results from a Systematic Review and Meta-Analysis.

Public health concerns for the independent management of obesity and suicidal behavior are rising. Emerging evidence suggests body weight plays an important role in quantifying the risk of suicide. In light of these findings, we aimed to clarify the association between body mass index (BMI) and suicidal behavior by systematically reviewing and evaluating the literature. Studies were identified by searching MEDLINE, EMBASE, PsycINFO, and CINAHL from inception to January 2015, supplemented by hand and grey literature searches. Study screening, data extraction, and risk of bias assessment were conducted in duplicate. We included 38 observational studies. Meta-analyses supported an inverse association between BMI and completed suicide. Pooled summary estimates demonstrated that underweight was significantly associated with an increased risk of completed suicide (HR=1.21, 95% CI 1.07 to 1.36, p=.002), and obesity (HR=0.71, 95% CI 0.56 to 0.89, p=.003) and overweight (HR=0.78, 95% CI 0.75 to 0.82, p<.0001) were significantly associated with a decreased risk of completed suicide relative to normal weight. A qualitative summary of the literature demonstrated conflicting evidence regarding the association between BMI and attempted suicide and revealed no association between BMI and suicidal ideation. BMI may be used to aid the assessment of suicide risk, especially that of completed suicide. However, unmeasured confounders and systematic biases of individual studies limit the quality of evidence.

Mortality of people with chronic fatigue syndrome: a retrospective cohort study in England and Wales from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Clinical Record Interactive Search (CRIS) Register.

Mortality associated with chronic fatigue syndrome is uncertain. We investigated mortality in individuals diagnosed with chronic fatigue syndrome in secondary and tertiary care using data from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Clinical Record Interactive Search (CRIS) register. We calculated standardised mortality ratios (SMRs) for all-cause, suicide-specific, and cancer-specific mortality for a 7-year observation period using the number of deaths observed in SLaM records compared with age-specific and sex-specific mortality statistics for England and Wales. Study participants were included if they had had contact with the chronic fatigue service (referral, discharge, or case note entry) and received a diagnosis of chronic fatigue syndrome. We identified 2147 cases of chronic fatigue syndrome from CRIS and 17 deaths from Jan 1, 2007, to Dec 31, 2013. 1533 patients were women of whom 11 died, and 614 were men of whom six died. There was no significant difference in age-standardised and sex-standardised mortality ratios (SMRs) for all-cause mortality (SMR 1·14, 95% CI 0·65-1·85; p=0·67) or cancer-specific mortality (1·39, 0·60-2·73; p=0·45) in patients with chronic fatigue syndrome when compared with the general population in England and Wales. This remained the case when deaths from suicide were removed from the analysis. There was a significant increase in suicide-specific mortality (SMR 6·85, 95% CI 2·22-15·98; p=0·002). We did not note increased all-cause mortality in people with chronic fatigue syndrome, but our findings show a substantial increase in mortality from suicide. This highlights the need for clinicians to be aware of the increased risk of completed suicide and to assess suicidality adequately in patients with chronic fatigue syndrome. National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London.

Killing the mother of one's child: psychiatric risk factors among male perpetrators and offspring health consequences.

To study possible psychiatric and criminological risk factors of intimate partner femicide (IPF) as well as the bereaved offspring's psychiatric morbidity and premature death. We conducted a nested case-control study, based on Swedish national registries, including all perpetrators of IPF. We computed risk estimates relative to matched population controls, which were compared to those of non-IPF homicide offenders. Exposed children were matched to population controls and followed longitudinally up to 37 years. Offspring outcomes were psychiatric and substance use disorders (according to ICD) self-harm; violent crime; suicide; and premature, all-cause death. We identified 261 male IPF perpetrators and 494 bereaved children from 1973 through 2009. Multivariable logistic regression suggested that major mental disorder (adjusted odds ratio [OR] = 5.9; 95% CI, 3.3-10.6) and violent crime convictions (adjusted OR = 4.4; 95% CI, 2.7-7.2) were independent risk factors of IPF, but substance use disorders were not (aOR = 0.4; 95% CI, 0.2-1.0). Children exposed to IPF before age 18 years had elevated risks of major mental disorder (adjusted hazard ratio [HR] = 5.7; 95% Cl, 3.0-10.6), substance use disorders (adjusted HR = 5.8; 95% CI, 2.8-11.9) and self-harm (adjusted HR = 5.7; 95% CI, 3.0-11.1). Offspring 18 years or older at the IPF had an increased risk of completed suicide (adjusted HR = 4.3; 95% CI, 1.3-14.5). Previous major mental disorder and violent behavior were strong independent risk factors for IPF. Bereavement caused by IPF had significant associations with the offspring's future life, especially for those below 18 years of age at exposure. Our findings demonstrate the need of direct support to the exposed offspring by health care providers and social services.

Risk of completed suicide in 89,049 young males assessed by a mental health professional

In an individual who seeks help or is referred to a mental health professional it is common sense and clinical practice to assume that suicidal thoughts and previous attempts constitute risk factors for imminent suicide. However, this assumption has not been supported by large, population-based longitudinal studies. The current study investigated whether reports of current suicidal ideation and a history of suicide attempts indeed increase risk for later completed suicide in a historical prospective study design. Sequential records on 89,049 young males assessed by mental health professionals were screened for suicidal ideation and a history of suicide attempts. The data were linked with death records from the Israeli Central Bureau of Statistics. Over a follow-up period ranging from 2 months to 9.8 years, 54 individuals died by suicide, constituting an average suicide rate of 6.48 per 100,000 person-years. Overall, neither reporting current suicidal ideation (without a history of suicide attempts; HR=1.29, 95% CI=0.57–2.90) nor reporting a history of suicide attempts (with or without current suicidal ideation; HR=1.67, 95% CI=0.71–3.97) were significantly associated with increased risk for later completed suicide. However, young males with a previously diagnosed psychiatric disorder who reported current suicidal ideation (HR=4.52, 95% CI=1.08–18.91) or a history of suicide attempts (HR=6.43, 95% CI=1.54–26.90) were at increased risk of death by suicide. These findings indicate that in this particular population reports of current suicidal ideation or of a history of suicide attempts are helpful in predicting future suicide only among those with a previous diagnosis of a psychiatric disorder.

Associations between marital and educational status and risk of completed suicide in Hungary

BackgroundSuicide rates in Hungary are notoriously high. According to the literature, marital and educational status are associated with suicidal behaviour and these associations are somewhat influenced by gender. Since in Hungary these associations have not yet been investigated by means of large-scale multivariate epidemiological studies we aimed to investigate these in the current paper. MethodCensus data on marital and educational status, age and gender from 1980, 1990, 2001 and 2011 were used for the general population. Corresponding data from the same years for suicide victims derived from the Hungarian Demographic Register. Suicide victims younger than 20 years were excluded. Negative binomial regression analyses were used to reveal the effects of the above variables on suicide. All statistical procedures were conducted using Stata 12 software (StataCorp. 2011). ResultsFemale gender, young age, higher educational attainment and marriage were significantly associated with decreased risks of suicide. Intriguingly, effects of educational and marital status on suicide were stronger in males. LimitationsData on the length of the periods between changes in marital status and suicides were unavailable. Our four categories are not suitable to cover the whole gamut of marital statuses in a modern society (e.g. we did not have a specific category for people living in cohabitation). Ecological study design. ConclusionWe found that in Hungary between 1980 and 2011 the effects of some frequently investigated societal factors (e.g. educational and marital status) on suicide risk were very similar to those found in the majority of other countries. The effects of studied determinants of suicide have not changed dramatically over the past three decades in Hungary.

Neuroscience, mind and meaning: an attempt at synthesis in a Relational Affective Hypothesis

This paper sets out a falsifiable Relational Affective Hypothesis, describing a neurological and relational pathway, through which affect and sensations arising from the interior of the body are translated, in a relational context, into language and a capacity for symbolisation. It describes the role of psychodynamic defences in narcissistic disorder, which can result in collapse in the function of this pathway. The hypothesis arose from clinical psychodynamic work with patients with severe and complex narcissistic disorders. They are characterised as severe, because they are at high risk of completed suicide and so are commonly treated in locked units, and complex because of their anorexic and bulimic eating patterns, tendency towards somatisation and the co-occurrence of autistic difficulties. A more or less profound failure of symbolisation is a feature common to these presentations. This interdisciplinary thinking offers a perspective on brain and psychological development, taking into account the complex interplay between genetic, environmental, relational and dynamic influences. It can be tested empirically and has implications for psychoanalytic thinking, psychiatry and neuroscience.

Assessment and treatment of mood disorders in the context of substance abuse

Recognition and management of mood symptoms in individuals using alcohol and/or other drugs represent a daily challenge for clinicians in both inpatient and outpatient treatment settings. Diagnosis of underlying mood disorders in the context of ongoing substance abuse requires careful collection of psychiatric history, and is often critical for optimal treatment planning and outcomes. Failure to recognize major depression or bipolar disorders in these patients can result in increased relapse rates, recurrence of mood episodes, and elevated risk of completed suicide. Over the past decade, epidemiologic research has clarified the prevalence of comorbid mood disorders in substance-dependent individuals, overturning previous assumptions that depression in these patients is simply an artifact of intoxication and/or withdrawal, therefore requiring no treatment. However, our understanding of the bidirectional relationships between mood and substance use disorders in terms of their course(s) of illness and prognoses remains limited. Like-wise, strikingly little treatment research exists to guide clinical decision making in co-occurring mood and substance use disorders, given their high prevalence and public health burden. Here we overview what is known and the salient gaps of knowledge where data might enhance diagnosis and treatment of these complicated patients.

Religion and Completed Suicide: a Meta-Analysis.

IntroductionSuicide is a major public health concern and a leading cause of death around the world. How religion influences the risk of completed suicide in different settings across the world requires clarification in order to best inform suicide prevention strategies.MethodsA meta-analysis using search results from Pubmed and Web of Science databases was conducted following PRISMA protocol and using the keywords “religion” or “religious” or “religiosity” or “spiritual” or “spirituality” plus “suicide” or “suicidality” or “suicide attempt”. Random and fixed effects models were used to generate pooled ORs and I2 values. Sub-analyses were conducted among the following categories: young age (<45yo), older age (≥45yo), western culture, eastern culture, and religious homogeneity.ResultsNine studies that altogether evaluated 2339 suicide cases and 5252 comparison participants met all selection criteria and were included in the meta-analysis. The meta-analysis suggested an overall protective effect of religiosity from completed suicide with a pooled OR of 0.38 (95% CI: 0.21–0.71) and I2 of 91%. Sub-analyses similarly revealed significant protective effects for studies performed in western cultures (OR = 0.29, 95% CI: 0.18–0.46), areas with religious homogeneity (OR = 0.18, 95% CI: 0.13–0.26), and among older populations (OR = 0.42, 95% CI: 0.21–0.84). High heterogeneity of our meta-analysis was attributed to three studies in which the methods varied from the other six.ConclusionReligion plays a protective role against suicide in a majority of settings where suicide research is conducted. However, this effect varies based on the cultural and religious context. Therefore, public health professionals need to strongly consider the current social and religious atmosphere of a given population when designing suicide prevention strategies.

Is There an Association Between the Body Mass Index and Interpersonal Violent Behavior?

An inverse relationship between the body mass index (BMI) and the risk of completed suicide was shown in several studies. Furthermore, it is suggested that obesity might be associated with a lower risk for violent criminality. Therefore, the aim of this study was to analyze whether a higher BMI is associated with a lower risk for being arrested due to violent behavior in a sample of 43,992 male offenders. Multinomial logistic regression analysis was applied to assess the relationship between different BMI categories and categories of committed crime as outcome variable by including various covariates. Our results indicated that compared to a normal BMI a higher BMI was associated with a significantly lower risk for being arrested in different crime categories associated with interpersonal violence, such as crimes against life and limb (for example: odds ratio=0.60, CI 95%: 0.52-0.69 for 30-34.9 kg/m2).

Acute air pollution exposure and risk of suicide completion.

Research into environmental factors associated with suicide has historically focused on meteorological variables. Recently, a heightened risk of suicide related to short-term exposure to airborne particulate matter was reported. Here, we examined the associations between short-term exposure to nitrogen dioxide, particulate matter, and sulfur dioxide and completed suicide in Salt Lake County, Utah (n = 1,546) from 2000 to 2010. We used a time-stratified case-crossover design to estimate adjusted odds ratios for the relationship between suicide and exposure to air pollutants on the day of the suicide and during the days preceding the suicide. We observed maximum heightened odds of suicide associated with interquartile-range increases in nitrogen dioxide during cumulative lag 3 (average of the 3 days preceding suicide; odds ratio (OR) = 1.20, 95% confidence interval (CI): 1.04, 1.39) and fine particulate matter (diameter ≤2.5 μm) on lag day 2 (day 2 before suicide; OR = 1.05, 95% CI: 1.01, 1.10). Following stratification by season, an increased suicide risk was associated with exposure to nitrogen dioxide during the spring/fall transition period (OR = 1.35, 95% CI: 1.09, 1.66) and fine particulate matter in the spring (OR = 1.28, 95% CI: 1.01, 1.61) during cumulative lag 3. Findings of positive associations between air pollution and suicide appear to be consistent across study locations with vastly different meteorological, geographical, and cultural characteristics.

Completed suicide and associated risk factors: a six-year population based survey.

The investigations on suicide conducted within low- and middle-income countries are limited. This study evaluated the trend of suicide and its associated risk factors in the west of Iran. This six-year population-based survey was conducted in Kermanshah Province, in 2012. The data on suicide was extracted from the suicide database of the Provincial Health Center, which was collected for six successive years. Multivariate logistic regression analysis was performed and odds ratio (OR) as well as its 95% confidence intervals (CI) was reported. During the study period, 13,810 attempted suicides occurred of which 1,564 (11.33%) were completed. The incidence rate of suicide has increased in recent years. Based on logistic regression analysis, OR estimate of completed suicide increased 1.46 (95% CI: 1.36, 1.56) fold for every 10-year increase in age. Moreover, OR estimate of completed suicide was 2.53 (95% CI: 1.94, 3.31) in men compared to women. Compared to married people, the OR estimate of completed suicide was 1.41 (95% CI: 1.15, 1.72) in single people, 1.92 (95% CI: 1.15, 3.23) in widowed people, and 1.97 (1.32, 2.95) in divorced people. The lower the educational level, the higher the risk of completed suicide. Compared to school/college students, the risk of completed suicide was higher among housewives, employed people or employees, and retirees. A majority of the suicides (90.05%) occurred at home. Taking medications was the most common way (69.13%) of a suicide attempt. We indicated that associated factors with completed suicide vary in Iran compared to other developed and developing countries and that factors associated with attempted suicide are different from that of completed suicide.

Age-specific suicide mortality following non-fatal self-harm: national cohort study in Sweden.

Possible age-related differences in risk of completed suicide following non-fatal self-harm remain unexplored. We examined associations between self-harm and completed suicide across age groups of self-harming patients, and whether these associations varied by violent index method, presence of mental disorder, and repeated self-harm. The design was a cohort study with linked national registers in Sweden. The study population comprised individuals aged ⩾10 years hospitalized during 1990-1999 due to non-fatal self-harm (n = 53 843; 58% females) who were followed for 9-19 years. We computed hazard ratios (HRs) across age groups (age at index self-harm episode), with time to completed suicide as outcome. The 1-year HR for suicide among younger males (10-19 years) was 14.6 [95% confidence interval (CI) 4.1-51.9] for violent method and 8.4 (95% CI 1.8-40.0) for mental disorder. By contrast, none of the three potential risk factors increased the 1-year risks in the youngest females. Among patients aged ⩾20 years, the 1-year HR for violent method was 4.6 (95% CI 3.8-5.4) for males and 10.4 (95% CI 8.3-13.0) for females. HRs for repeated self-harm during years 2-9 of follow-up were higher in 10- to 19-year-olds (males: HR 4.0, 95% CI 2.0-7.8; females: HR 3.7, 95% CI 2.1-6.5). The ⩾20 years age groups had higher HRs than the youngest, particularly for females and especially within 1 year. Violent method and mental disorder increase the 1-year suicide risk in young male self-harm patients. Further, violent method increases suicide risk within 1 year in all age and gender groups except the youngest females. Repeated self-harm may increase the long-term risk more in young patients. These aspects should be accounted for in clinical suicide risk assessment.

Factors associated with choice of high lethality methods in suicide attempters: a cross-sectional study.

BackgroundMost attempted suicides have a low lethality, but hanging, drowning, and jumping from a great height have a high risk of completed suicide. The aim of this study was to assess the sociodemographic profiles of patients who attempted suicide using high lethality methods relative to all other methods of attempted suicide.MethodsWe retrospectively investigated all attempted suicides treated at a tertiary university hospital in Seoul between January 2008 and February 2012. The following variables were considered: the patients’ attempted suicide methods, age, sex, history of attempted suicides, previous psychiatric history, occupation, and living conditions. The suicide methods were categorized into two groups: high lethality (e.g., hanging, falling, and drowning) and low lethality methods (e.g., self-poisoning and cutting). We investigated risk factors related to the choice of high lethality methods.ResultsA total of 560 patients were enrolled in this study. Deliberate self-poisoning was the most common method of attempted suicide (61.6%), followed by cutting (22.5%), hanging (10.4%), falling (4.1%), and drowning (1.4%). In logistic regression analyses, odds ratios for the choice of high lethality methods were 1.02 (95% CI = 1.01 to 1.03, p < .01), 7.22 (95% CI = 3.06 to 17.04, P < .01), and 0.59 (95% CI = 0.35 to 0.99, p = .04) for age, previous attempted suicide with a high lethality method, and alcohol co-ingestion, respectively.ConclusionsOur findings indicated that age and past attempted suicide using a high lethality method are associated with the use of high lethality methods for attempting suicide.

Suicide, hospital-presenting suicide attempts, and criminality in bipolar disorder: examination of risk for multiple adverse outcomes.

To compare risks for suicidality and criminality in a national cohort of people diagnosed with bipolar disorder, and to assess how risk factor profiles differ between these outcomes. We conducted 2 case-cohort studies using interlinked Swedish national registers. Primarily, using International Classification of Diseases (ICD) coding, we identified 15,337 people diagnosed with bipolar disorder, 1973-2009, matched by age and gender to 20 individuals per case sampled randomly from the general population. We estimated risks of suicide and hospital-presenting attempted suicide, and violent and nonviolent criminal offending. We separately assessed these risks among 14,677 unaffected siblings matched to a second general population sample. 22.2% of bipolar disorder cohort members engaged in suicidal or criminal acts after diagnosis. They were at greatly elevated risk for completed suicide (risk ratio = 18.8; 95% CI, 16.0-22.2), attempted suicide (risk ratio = 14.3; 95% CI, 13.5-15.2), violent crime (risk ratio = 5.0; 95% CI, 4.6-5.4), and nonviolent crime (risk ratio = 2.9; 95% CI, 2.8-3.1) compared with the general population. Elevations in risk were far less marked among the unaffected siblings than in the bipolar disorder cohort. Three factors independently predicted raised risk of all 4 adverse outcomes: if the first 2 patient episodes for bipolar disorder required admission, a history of attempted suicide, and a history of diagnosed alcohol/drug disorder. Criminal offending before bipolar diagnosis was an especially strong independent predictor of criminality after diagnosis. The combined risk of suicidality or criminality is substantially elevated in both relative and absolute terms. Clinical prediction rules focusing on multiple vulnerabilities following onset of bipolar disorder, especially when there is history of attempted suicide, substance misuse disorders, or criminal offending, may improve risk management.

Identifying suicidal symptoms in prostate cancer survivors using brief self-report.

Prostate cancer (PC) survivors are at elevated risk for completed suicide even many years post-treatment. Despite this risk, practical and efficient methods for assessing these symptoms have not been established. We sought to determine if suicidal symptoms could be effectively and efficiently identified in a cohort of PC survivors, and whether these men were receptive to emotional health interventions. Six hundred fifty-six PC survivors, an average of 5 years post-diagnosis, completed eight self-report items about suicidal symptoms and behavior in the past 7 days, and 12 months, as well as medical utilization and interest in emotional health support. Between 3.6 and 17.9% of PC survivors endorsed a single suicidal ideation item, and denied all other ideation. All survivors who endorsed serious suicidal ideation/behavior also endorsed either passive or active ideation. 58.3% of survivors denied any suicidal symptoms within the past week, but endorsed it within the past year. Most survivors had medical provider contact within the past year and were open to receiving information about emotional health interventions. Suicidal ideation in PC survivors cannot be accurately evaluated using only a one-item screen, or by inquiring within a single time frame. In both research and clinical settings, the evaluation for suicidal ideation in PC survivors should utilize multiple questions, across several time periods. It is possible to skip queries about serious ideation/behavior if passive or active ideation is denied. Once identified, medical providers should refer these men to psychosocial providers who can offer emotional support.

Tobacco use disorder and the risk of completed suicide in VHA

are to calculate TIJ and to examine factors associated with TIJ in a sample of drug injectors. Methods: As part of an exploratory study on injection drug initiation, interviewswere conductedwith drug injectors recruited at outreach sites in Los Angeles and San Francisco, CA (n=549) during 2011–12. Interviews covered demographics, family history, drug use and drug injection initiation among others. TIJ was calculated by subtracting age at first drug injection from age of first illicit drug use. We used multivariate linear regression to determine factors independently associated with TIJ. Results: The sample was 33%White, 32% Black, 25% Latino, 27% female, and 60% homeless. Mean age was 46.9 (IQR 41, 56) and mean years of drug injection were 24.8 (IQR 13, 36). Mean age of first illicit drug use was 13.8 (IQR 12, 15) andmean age of injection initiationwas22.1 (IQR16, 26).MeanTIJ for the samplewas8.4 (IQR 2, 12) years. In a multivariate linear regression model, we found that drug types ever usedwere associatedwith TIJ (crack use =+2.9 years, p =0.004; powder cocaine use =+3.3 years, p<0.001; heroin use =−3.2 years,p=0.009; prescription stimulants use =−2.6 years, p=0.001). Any substance abuse treatment prior to injection was associated with longer TIJ (+3.9 years, p<0.001), while being born after 1979 (−2.9, p=003) and having your first injection administered by a familymember (−3.4 years, p=0.006) or self (−2.1 years, p=0.016) were associated with shorter TIJ. Conclusions: TIJ was influenced by drug type, substance abuse treatment, birth cohort, and injection initiator characteristics. These data highlight the need for surveillance of emerging trends in injection drug use and novel prevention strategies targeting transitions to injection among at-risk populations. Financial support: NIDA grant number R01DA027689 and R01DA030427.

Towards an anthropological conception of emotions in psychosomatic medicine

Research has shown that suicide risk is often present in patients suffering from type 1 diabetes mellitus (DM-1).The aim of the present paper was to investigate whether there was a relationship between DM-1 and suicidal behavior and to determine whether or not people affected by DM-1 are at an increased risk of completed suicide, attempted suicide, and suicidal ideation.We performed a careful MedLine, ExcerptaMedica, PsycLit, PsycInfo and Index Medicus search to identify all papers on the topic for the period 1970 to 2013 written in English. The following search terms were used: (suicide OR suicide attempt OR ideation) AND (diabetes mellitus). Where a title or abstract seems to describe a study eligible for inclusion, the full article was examined.We included only original articles published in English peer-reviewed journals. We excluded meta-analyses and systematic reviews, studies that were not clear about follow-up times, the method of statistical analysis, diagnostic criteria or the number of patients included, and studies only on patients affected by type 2 diabetes mellitus (DM-2).The research reviewed indicated that patients with DM-1 are at an increased risk for suicide, although no clear consensus exists regarding the level of the increased risk.The studies used different measurement techniques and different outcomes, and they assessed patients at different time points.Our findings support the recommendation that a suicide risk assessment of patients with DM-1 should be part of the routine clinical assessment. The assessment of patients at risk should consist of the evaluation of current and previous suicidal behaviors (both suicidal ideation and attempted suicide).

Suicide mortality in relation to dietary intake of n-3 and n-6 polyunsaturated fatty acids and fish: equivocal findings from 3 large US cohort studies.

Intake of n-3 and n-6 polyunsaturated fatty acids (PUFAs) has been implicated in the pathogenesis of depression. We sought to estimate the association between intake of fish and n-3 and n-6 PUFAs and suicide mortality over the course of long-term follow-up. In this prospective cohort study, biennial questionnaires were administered to 42,290 men enrolled in the Health Professionals Follow-up Study (1988-2008), 72,231 women enrolled in the Nurses' Health Study (1986-2008), and 90,836 women enrolled in Nurses' Health Study II (1993-2007). Dietary fish and n-3 and n-6 PUFA intakes were assessed every 4 years using a validated food-frequency questionnaire. Suicide mortality was ascertained through blind physician review of death certificates and hospital or pathology reports. Adjusted relative risks of suicide mortality were estimated with multivariable Cox proportional hazards models and pooled across cohorts using random-effects meta-analysis. The pooled multivariable relative risks for suicide among persons in the highest quartile of intake of n-3 or n-6 PUFAs, relative to the lowest quartile, ranged from 1.08 to 1.46 for n-3 PUFAs (Ptrend = 0.11-0.52) and from 0.68 to 1.19 for n-6 PUFAs (Ptrend = 0.09-0.54). We did not find evidence that intake of n-3 PUFAs or fish lowered the risk of completed suicide.

Back From the Brink

Back From the Brink

Risk and predictors of attempted and completed suicide in patients with hematological malignancies.

Hematological malignancies can cause high levels of distress, but few studies have assessed risk of suicidal behavior among these patients. We evaluated risk of attempted and completed suicide in a cohort of 46,309 patients diagnosed with malignant lymphoma, myeloma and leukemia in Sweden 1992 to 2009 and 107,736 cancer-free subjects, using Poisson regression. In all, 146 suicide attempts and 63 completed suicides occurred during a median follow up of 3.1 years (maximum 19 years). The risk of completed suicide was 3.5-fold increased among patients with myeloma [incidence rate ratio (IRR) = 3.52, 95% confidence interval (CI) = 2.05-6.03] and 1.9-fold increased among patients with lymphoma (IRR = 1.87, 95% CI = 1.31-2.67) but not significantly increased among patients with leukemia. Risk of attempted suicide was increased among patients with myeloma (IRR = 2.13, CI = 1.39-3.26) and lymphoma (IRR = 1.34, 95% CI = 1.07-1.69). Both male and female patients were at increased risk of attempted as well as completed suicide. A pre-malignant history of mental disorders conferred 15-fold to 30-fold increased risks, but elevated risks were also observed among patients without such history. Suicidal actions in patients with hematological malignancies have high suicidal intent, and that subgroups of patients should be monitored for suicidal ideation.