Severe Suicide Attempts Research Articles

Nonsuicidal self-injury and disordered eating: Differences in acquired capability and suicide attempt severity

Nonsuicidal self-injury (NSSI) and eating disorders are both strongly related to suicide behaviors, and both can be conceptualized as painful and provocative events that associate with acquired capability for suicide. Individuals who self-injure report greater acquired capability than those who do not engage in these behaviors, but results are mixed in eating disorder samples. Given that NSSI and disordered eating (DE) commonly co-occur, it is important to examine how acquired capability for suicide and suicide attempt severity may differ between individuals who engage in either, both, or neither of these behaviors. It was expected that individuals with both NSSI and DE would report the greatest acquired capability, assessed by fearlessness about death and fear about suicide, and suicide attempt severity, compared to NSSI only, DE only, and controls. In a sample of 1179 undergraduates, results indicated no differences on fearlessness about death, but the NSSI + DE group reported the lowest scores on fear of suicide and greatest suicide attempt severity compared to the other groups. Differences between fearlessness about death and fear about suicide are discussed, as well as the possible additive effect of engaging in both direct (NSSI) and indirect (DE) self-harm on fear about suicide and suicide risk.

Poisoning Severity Associated with a Range of Medications in Suicide Attempts by Ingestion.

There are limited data on the medical severity of suicide attempts by intentional self-poisoning (ISP) associated with ingestion of differing classes of medications and meager data on specific agents. The purpose of the study was to address these gaps. This was an analysis of a consecutive series of ISP cases ages 13 to 65 treated at a U.S. university medical center (N=671). The outcome, poisoning severity, was dichotomized as "moderate-severe" and "low" (reference) based on a standard measure. Class of medication (e.g., opiate) and specific agents ingested were the predictors of interest. Covariates were age, sex, and the ingestion of multiple classes of medications. Data were analyzed using multivariate logistic regression models. At the class level, ingestion of opiate was uniquely associated with increased risk for moderate-severe ISP at a statistically significant level, adjusted odds ratio (95% CI) = 2.97 (1.69, 5.21), p = .0002. Several specific agents were also associated with moderate-severe ISP. Along with the key role of opiate medications in unintentional overdose morbidity and mortality, opiate medications may also play an important and largely unrecognized role in medically serious suicidal behavior. Results also underscore the variability in toxicity of specific agents within drug classes.

Ketamine Use for Suicidal Ideation in the General Hospital: Case Report and Short Review

Low-dose infusion of ketamine may have rapid antisuicide properties. Such a treatment may therefore be useful in the general hospital to prevent suicide in an environment that cannot be made safe enough. We report on the use of ketamine as an efficient, well-tolerated treatment for persistent suicidal ideation in a patient hospitalized in a general hospital after a severe suicide attempt. Based on data in the literature, we suggest that the benefit-risk ratio for ketamine use in such a context is highly favorable.

A Bridge Across Silent Trauma: Enactment, Art, and Emergence in the Treatment of a Traumatized Adolescence

This paper recounts the 4-year treatment of Hannah, a virtually silent, traumatized adolescent. Over the course of 4 years Hannah was in and out of the hospital with severe self-injury and suicide attempts. While Hannah communicated her distress through bloodied scabs and overdoses, her words were few. Eventually, Hannah and her therapist were able to find their way to communicate about her pain and terror through shared art making, which became a bridge across the silence. Hannah’s art and her therapist’s struggle to find ways to be with her, communicate with her, and help her heal through moments of meeting and shared art making are explored.

A Narrative Web-Based Study of Reasons To Go On Living after a Suicide Attempt: Positive Impacts of the Mental Health System

Background and Objective Suicide attempts are 10-20X more common than completed suicide and an important risk factor for death by suicide, yet most people who attempt suicide do not die by suicide. The process of recovering after a suicide attempt has not been well studied. The Reasons to go on Living (RTGOL) Project, a narrative web-based study, focuses on experiences of people who have attempted suicide and made the decision to go on living, a process not well studied. Narrative research is ideally suited to understanding personal experiences critical to recovery following a suicide attempt, including the transition to a state of hopefulness. Voices from people with lived experience can help us plan and conceptualize this work. This paper reports on a secondary research question of the larger study: what stories do participants tell of the positive role/impact of the mental health system. Material and Methods A website created for The RTGOL Project ( www.thereasons.ca ) enabled participants to anonymously submit a story about their suicide attempt and recovery, a process which enabled participation from a large and diverse group of participants. The only direction given was “if you have made a suicide attempt or seriously considered suicide and now want to go on living, we want to hear from you.” The unstructured narrative format allowed participants to describe their experiences in their own words, to include and emphasize what they considered important. Over 5 years, data analysis occurred in several phases over the course of the study, resulting in the identification of data that were inputted into an Excel file. This analysis used stories where participants described positive involvement with the mental health system (50 stories). Results Several participants reflected on experiences many years previous, providing the privilege of learning how their life unfolded, what made a difference. Over a five-year period, 50 of 226 stories identified positive experiences with mental health care with sufficient details to allow analysis, and are the focus of this paper. There were a range of suicidal behaviours in these 50 stories, from suicidal ideation only to medically severe suicide attempts. Most described one or more suicide attempts. Three themes identified included: 1) trust and relationship with a health care professional, 2) the role of friends and family and friends, and 3) a wide range of services. Conclusion Stories open a window into the experiences of the period after a suicide attempt. This study allowed for an understanding of how mental health professionals might help individuals who have attempted suicide write a different story, a life-affirming story. The stories that participants shared offer some understanding of “how” to provide support at a most-needed critical juncture for people as they interact with health care providers, including immediately after a suicide attempt. Results of this study reinforce that just one caring professional can make a tremendous difference to a person who has survived a suicide attempt.

Chapter 11 - Medical treatment of behavioral manifestations of Huntington disease

Almost all patients with Huntington disease (HD) show some form of behavioral changes during the disease progression. These behavioral manifestations may already be present before cognitive or motor symptoms become apparent, and vary from subtle anxiety to severe psychosis and suicide attempts. These behavioral manifestations are related to both psychologic factors, like the burden of having a severe disease, and biologic factors that are related to the disease itself. In this chapter, both nonpharmacologic and pharmacologic interventions are discussed. Common treatment guidelines give guidance to the treatment of symptoms like depression, anxiety, and psychosis, but for more disease-specific symptoms like apathy, irritability, and obsessive-compulsive behaviors, off-label use of psychotropic medication seems to be inevitable since evidence for all interventions in HD is limited. Type and dosage of medication often depend on comorbidity, side-effects, and the use of other drugs, and because of the neurodegenerative nature of the disease, it is necessary to monitor patients clinically at a regular interval and adjust drugs accordingly as the disease progresses.

Rare CNVs in Suicide Attempt include Schizophrenia-Associated Loci and Neurodevelopmental Genes: A Pilot Genome-Wide and Family-Based Study.

Suicidal behavior (SB) has a complex etiology involving genes and environment. One of the genetic components in SB could be copy number variations (CNVs), as CNVs are implicated in neurodevelopmental disorders. However, a recently published genome-wide and case-control study did not observe any significant role of CNVs in SB. Here we complemented these initial observations by instead using a family-based trio-sample that is robust to control biases, having severe suicide attempt (SA) in offspring as main outcome (n = 660 trios). We first tested for CNV associations on the genome-wide Illumina 1M SNP-array by using FBAT-CNV methodology, which allows for evaluating CNVs without reliance on CNV calling algorithms, analogous to a common SNP-based GWAS. We observed association of certain T-cell receptor markers, but this likely reflected inter-individual variation in somatic rearrangements rather than association with SA outcome. Next, we used the PennCNV software to call 385 putative rare (<1%) and large (>100 kb) CNVs, observed in n = 225 SA offspring. Nine SA offspring had rare CNV calls in a set of previously schizophrenia-associated loci, indicating the importance of such CNVs in certain SA subjects. Several additional, very large (>1MB) sized CNV calls in 15 other SA offspring also spanned pathogenic regions or other neural genes of interest. Overall, 45 SA had CNVs enriched for 65 medically relevant genes previously shown to be affected by CNVs, which were characterized by a neurodevelopmental biology. A neurodevelopmental implication was partly congruent with our previous SNP-based GWAS, but follow-up analysis here indicated that carriers of rare CNVs had a decreased burden of common SNP risk-alleles compared to non-carriers. In conclusion, while CNVs did not show genome-wide association by the FBAT-CNV methodology, our preliminary observations indicate rare pathogenic CNVs affecting neurodevelopmental functions in a subset of SA, who were distinct from SA having increased SNP risk-allele burden. These observations may open up new avenues in the genetic etiology of SB.

Relations Between Nonsuicidal Self-Injury and Suicide Attempt Characteristics in a Sample of Recent Suicide Attempters.

Although nonsuicidal self-injury (NSSI) is known to be associated with increased risk of death by suicide and suicide attempts, minimal research has focused on comparing recent suicide attempters with and without NSSI on suicide attempt characteristics (frequency and severity of suicide attempts). Understanding how NSSI impacts suicide attempt characteristics can help providers to enhance their assessment and treatment strategies so as to prevent future suicidal behaviors. The present study investigated the extent to which a history of NSSI was related to the frequency and severity of suicide attempts in a sample of recent suicide attempters. Participants included 171 adult patients who presented to the hospital within 24 hr of a suicide attempt. Information about their suicide attempts and NSSI was gathered using self-report questionnaires and interviews. Suicide attempters with a history of NSSI reported significantly more suicide attempts and more suicide attempts requiring medical attention, after controlling for important clinical covariates. NSSI was uniquely associated with suicide attempt characteristics, highlighting the importance of NSSI in suicide assessment, prevention, and treatment efforts.

Clinical Characteristics Associated with Suicide Attempts in Clinical Settings: A Comparison of Suicidal and Non-Suicidal Depressed Inpatients.

Both psychiatrists and psychiatric nurses are involved in the psychiatric management of suicidal inpatients. One-to-one observation by qualified nurses and the accommodation of the patient in a room close to the infirmary are usually recommended. Suicidal risk should be reassessed periodically to check response to treatment. To compare the severity of depressive symptoms in depressed inpatients admitted after an attempted suicide and those admitted for any other reason and to assess the severity of suicide attempts and the management of suicidal risk in clinical settings. We divided the sample into two subgroups: patients with a diagnosis of depression admitted because of a recent suicide attempt and depressed patients with no recent history of attempted suicide. Socio-demographic and clinical data were gathered; assessments included the Montgomery-Asberg Depression Rating Scale and the Nurses' Global Assessment of Suicide Risk (NGASR). Forty-six patients were recruited over a 1-year period: 20 were admitted to the hospital following a suicide attempt; the other 26 had not attempted suicide and were admitted for other depression-related reasons. Multivariate analysis revealed a correlation between use of antidepressants and recent attempted suicide. Attempting suicide was not related to the severity of depressive symptoms. In the recent suicide attempt subgroup, NGASR suicide risk levels were lower at discharge than at admission. Patients with a recent history of attempted suicide had a higher number of suicide attempts in their clinical history than patients with no recent history of attempted suicide. There were no correlations between psychiatric diagnosis, severity of depressive symptoms, and recent suicide attempt. Antidepressant therapy protected against suicide attempts. History of suicide attempts was one of the best predictors of recent attempted suicide. A more thorough understanding of the complex phenomenon of suicide and the reasons for suicidal behavior is needed.

Prevention of Suicidal Behavior in Prisons

. Background: Worldwide, prisoners are at high risk of suicide. Research on near-lethal suicide attempts can provide important insights into risk and protective factors, and inform suicide prevention initiatives in prison. Aims: To synthesize findings of research on near-lethal attempts in prisons, and consider their implications for suicide prevention policies and practice, in the context of other research in custody and other settings. Method: We searched two bibliographic indexes for studies in any language on near-lethal and severe self-harm in prisoners, supplemented by targeted searches over the period 2000–2014. We extracted information on risk factors descriptively. Data were not meta-analyzed owing to heterogeneity of samples and methods. Results: We identified eight studies reporting associations between prisoner near-lethal attempts and specific factors. The latter included historical, prison-related, and clinical factors, including psychiatric morbidity and comorbidity, trauma, social isolation, and bullying. These factors were also identified as important in prisoners' own accounts of what may have contributed to their attempts (presented in four studies). Conclusion: Factors associated with prisoners' severe suicide attempts include a range of potentially modifiable clinical, psychosocial, and environmental factors. We make recommendations to address these factors in order to improve detection, management, and prevention of suicide risk in prisoners.

Heavy tobacco dependence in suicide attempters making recurrent and medically serious attempts

AimsTobacco dependence and suicidal behaviors have been repeatedly associated in several studies but their relationship is still unclear. We aim to investigate, specifically, the association between the level of tobacco dependence and the severity of suicidal outcomes among suicide attempters, as well as the relationship of impulsivity with both conditions. MethodsWe examined a cross-sectional sample of 542 adult suicide attempters to compare the characteristics of the attempts depending on the level of tobacco dependence, which was assessed with the Fagerstrom test. ResultsSmokers with heavy dependence (Fagerstrom ≥7) made more attempts and reached higher medical lethality compared to non-smokers. Smokers with moderate dependence were not associated with features of severity in the suicide attempts. The combination of high impulsivity and heavy tobacco dependence showed an additive effect on the number of suicide attempts. ConclusionsA high or very high level of tobacco dependence could indicate a specific vulnerability leading to more severe suicide attempts. Impulsive attempters with heavy tobacco dependence were particularly at risk.

The Effect of Tobacco Dependence On Severity Outcomes Among Suicide Attempters

Background Smoking and suicidal behavior are two major public health problems associated in epidemiological and clinical studies. Smoking has been associated with suicidal ideation, suicide attempts, and suicide, independently of mental disorders. Yet, the mechanism that links smoking and suicidal behavior is unknown. We investigated the relationship between the level of tobacco dependence and the severity of suicidal outcomes among suicide attempters. Methods We examined a sample of 542 adult suicide attempters to compare the characteristics of the attempts depending on the level of tobacco dependence. All participants had made a suicide attempt in the previous two years (criterion for suicidal behavior disorder). Level of tobacco dependence was assessed with the Fagerstrom test. Diagnoses were ascertained with the Mini International Neuropsychiatric Interview and suicidal behaviors were assessed, among others, with the Risk Rescue Rating Scale and the Suicidal Intent Scale. Impulsivity was measured with the Barratt Impulsiveness Scale. Results Independently of potential confounders, heavy smokers (Fagerstrom≥7) made more attempts and reached higher medical lethality than non-smokers (OR=2.42; 95%CI= 1.43-4.11, p=0.001, and OR=1.88; 95%CI=1.09-3.24; p=0.03, respectively). Light smokers (Fagerstrom Discussion A high level of tobacco dependence could indicate a specific vulnerability leading to more severe suicide attempts, which was only partially explained by impulsivity traits.

Cyberbullying and adolescent mental health: systematic review

Cyberbullying is a new form of violence that is expressed through electronic media and has given rise to concern for parents, educators and researchers. In this paper, an association between cyberbullying and adolescent mental health will be assessed through a systematic review of two databases: PubMed and Virtual Health Library (BVS). The prevalence of cyberbullying ranged from 6.5% to 35.4%. Previous or current experiences of traditional bullying were associated with victims and perpetrators of cyberbullying. Daily use of three or more hours of Internet, web camera, text messages, posting personal information and harassing others online were associated with cyberbullying. Cybervictims and cyberbullies had more emotional and psychosomatic problems, social difficulties and did not feel safe and cared for in school. Cyberbullying was associated with moderate to severe depressive symptoms, substance use, ideation and suicide attempts. Health professionals should be aware of the violent nature of interactions occurring in the virtual environment and its harm to the mental health of adolescents.

Prevalence of Suicidal Ideation Among Students

Introduction In Portugal there are no national epidemiologic registers on the prevalence/incidence of suicidal ideation and attempts. Although there is no evidence that suicide is higher in University students than in other people of the same age, it is a cause of premature death. Aims To analyze the prevalence and characteristics of suicidality in university students Methods 549 University students (80.1% females) filled in a booklet of questionnaires that included the Suicidal Behaviour Section of the Diagnostic Interview of Genetic Studies (Azevedo et al, 1993; Nurnberger et al., 1994), which was slight modified. Results 0.4% reported lifetime poor psychological health and 1.3% reported lifetime hospitalizations due to emotional/behavioural problems. Lifetime thoughts of death, lifetime active suicidal ideation, and lifetime suicidal attempts were described by 20.4%, 11.9% and by 2.3% of the students, respectively. Regarding the more severe lifetime suicide attempt (N=15) the method used was predominantly self-poisoning (medication) (9/13), 40% (6/15) were hospitalized after this attempt, 53.3% (8/15) reported death wishes when the act was performed, and 60% (9/15) considered that death could be the consequence of the act. During last month suicidal ideation occurred in 1.9% of the students. During the last two weeks suicidal ideation without planning was found in 2.2% and 0.2% refereed they are going to attempt suicide if they will have an opportunity. Conclusions In university students recent, frequent and severe suicide ideation might occur. Results highlighted the need for suicidality prevention/early intervention and that Health University Care Services should screen systematically suicidal ideation.

Increased Cyp2d6-cyp2c19 Metabolic Capacity: Relation to Suicide Attempt Severity as Measured by the Beck Sis-objective Circumstances.

Introduction CYP2D6 and CYP2C19 are involved in the metabolism of widely used antidepressants and other drugs with psychotropic activity. They also participate in the metabolism of endogenous substrates, and are expressed in the brain. Objectives and Aims This study examined, for the first time, whether a high CYP2D6-CYP2C19 metabolic capacity combination increases the likelihood of suicidal intent severity in a large study cohort. Methods Survivors of a suicide attempt (n=587; 86.8% women) were genotyped for CYP2C19 (*2, *17) and CYP2D6 (*3, *4, *4xN, *5, *6, *10, wtxN) genetic variation and evaluated with the Beck Suicide Intent Scale (SIS). Results Patients with a high CYP2D6-CYP2C19 metabolic capacity showed an increased risk for a severe suicide attempt (P Conclusions Further research is warranted to evaluate whether the observed relationship is mediated by the role of CYP2D6 and CYP2C19 involvement in the endogenous physiology or drug metabolism or both. Acknoledgments This work was supported in part by Union Europea Fondo Social Europea (FEDER/FSE), Instituto de Salud Carlos III-FIS (PI10/02758) and Gobierno de Extremadura Consejeria de Economia, Competitividad e Innovacion (IB13186 and PD10199). CHU Montpellier (PHRC UF 7653), Agence Nationale de la Recherche (ANR NEURO 2007 'GENESIS').

Does the Transmissible Liability Index (TLI) assessed in late childhood predict suicidal symptoms at young adulthood?

Objective: Our previous work demonstrated that the Transmissible Liability Index (TLI), an instrument designed as an index of liability for substance use disorder (SUD), is associated with risk of substance use disorder. This longitudinal study assessed whether TLI measured in 10–12-year-olds (late childhood) predicts suicidal behavior from age 12–14 (preadolescence) to age 25 (young adulthood). We hypothesized that TLI would predict number and severity of suicide attempts. Methods: Subjects were sons of men who had lifetime history of SUD (n = 250), called the High Average Risk (HAR) group, and sons of men with no lifetime history of a SUD (n = 250), called the Low Average Risk (LAR) group. The TLI was delineated at baseline (age 10–12), and age-specific versions were administered at 12–14, 16, 19, 22, and 25 years of age. Results: TLI was significantly associated with number and severity of lifetime suicide attempts. Conclusions: These findings confirm the hypothesis that TLI assessed at late childhood is a predictor of frequency and severity of suicidal behavior from preadolescence to young adulthood.

Maternal Grand Multiparity and the Risk of Severe Mental Disorders in Adult Offspring.

BackgroundPrevious studies have shown that maternal grand multiparity may predict an increased risk of mental disorders in young adult offspring, but whether such effects persist throughout adulthood remains unknown. The current study examined if maternal grand multiparity predicts the risks of severe mental disorders, suicides, suicide attempts and dementias throughout adult life.MethodsOur study sample comprised 13243 Helsinki Birth Cohort Study 1934–1944 participants (6905 men and 6338 women). According to hospital birth records, 341 offspring were born to grand multiparous mothers. From Finnish national hospital discharge and causes of death registers, we identified 1682 participants diagnosed with mental disorders during 1969–2010.ResultsMaternal grand multiparity predicted significantly increased risks of mood disorders (Hazard Ratio = 1.64, p = 0.03), non-psychotic mood disorders (Hazard Ratio = 2.02, p = 0.002), and suicide attempts (Hazard Ratio = 3.94, p = 0.01) in adult offspring. Furthermore, women born to grand multiparous mothers had significantly increased risks of any severe mental disorder (Hazard Ratio = 1.79, p = 0.01), non-psychotic substance use disorders (Hazard Ratio = 2.77, p = 0.02) schizophrenia, schizotypal and delusional disorders (Hazard Ratio = 2.40, p = 0.02), mood disorders (Hazard Ratio = 2.40, p = 0.002), non-psychotic mood disorders (Hazard Ratio = 2.91, p<0.001), and suicide attempts (Hazard Ratio = 5.05, p = 0.01) in adulthood. The effects of maternal grand multiparity on offspring psychopathology risk were independent of maternal age and body mass index at childbirth, and of year of birth, sex, childhood socioeconomic position, and birth weight of the offspring. In contrast, no significant effects were found among men.ConclusionsWomen born to grand multiparous mothers are at an increased risk of severe mental disorders and suicide attempts across adulthood. Our findings may inform the development of preventive interventions for mental disorders.

P.1.k.013 Transversal study on severe suicide attempts and related factors in patients admitted to a general hospital

Impulsivity is often cited as a core dysfunction in those who are high in psychopathic traits. However, both impulsivity and psychopathy are both multi-faceted constructs. We examined a 3-factor model of self-reported impulsivity (Barrett Impulsivity: BIS-11) against the 2-factor and 4-facet model of psychopathy as defined by the Psychopathy Checklist-Revised (PCL-R). Those high on ‘secondary psychopathy’ (Factor 2 and Facets 3 and 4 of the PCL-R) showed increased impulsivity as it related to acting with thinking (Motor Scale of BIS) and lack of future planning (Non-Planning scale of BIS), but not did not show any elevated features of poor concentration or distraction (Attention Scale of BIS). On the other hand, there was some evidence that ‘primary psychopathy’ (Factor 1 of PCL-R) was associated with reduced impulsivity as it relates to future planning (Non-Planning scale of BIS). Thus, our results show that only some psychopaths show increased impulsivity and that not all forms of impulsivity are raised.

Posttraumatic Stress Disorder following childhood abuse increases the severity of suicide attempts

ObjectivePosttraumatic Stress Disorder (PTSD) and childhood abuse are both consistently associated with a higher risk for suicide attempts. We hypothesize that among patients reporting childhood abuse, PTSD diagnoses are correlated with an increased severity of suicidal features. MethodWe investigated 726 adult patients who had attempted suicide. These participants were assessed on lifetime clinical diagnoses and childhood abuse. The association of PTSD and childhood abuse dimensions with age at first suicide attempt, number of suicide attempts, violent attempts, serious attempts and suicide intent was studied. An adjusted multinomial logistic regression was performed to ascertain if childhood abuse and PTSD increased the severity of the suicidal behavior when combined. ResultsSeveral types of childhood abuse (emotional, physical and sexual abuse) when combined with a lifetime diagnosis of PTSD showed an increased risk for more suicide attempts, serious attempts, and a higher level of suicidal intent compared with the absence of any or both risk factors. ConclusionThe combination of PTSD and childhood abuse should be investigated in clinical settings due to an augmented risk for more severe suicidal behavior.

A combined high CYP2D6-CYP2C19 metabolic capacity is associated with the severity of suicide attempt as measured by objective circumstances.

This study examined, for the first time, whether a high CYP2D6-CYP2C19 metabolic capacity combination increases the likelihood of suicidal intent severity in a large study cohort. Survivors of a suicide attempt (n=587; 86.8% women) were genotyped for CYP2C19 (*2, *17) and CYP2D6 (*3, *4, *4xN, *5, *6, *10, wtxN) genetic variation and evaluated with the Beck Suicide Intent Scale (SIS). Patients with a high CYP2D6-CYP2C19 metabolic capacity showed an increased risk for a severe suicide attempt (P<0.01) as measured by the SIS-objective circumstance subscale (odds ratio (OR)=1.37; 95% confidence interval (CI)=1.05-1.78; P=0.02) after adjusting for confounders (gender, age, level of studies, marital status, mental disorders, tobacco use, family history of suicide, personal history of attempts and violence of the attempt). Importantly, the risk was greater in those without a family history of suicide (OR=1.82; CI=1.19-2.77; P=0.002). Further research is warranted to evaluate whether the observed relationship is mediated by the role of CYP2D6 and CYP2C19 involvement in the endogenous physiology or drug metabolism or both.