Suicidal Persons Research Articles

Perceived Need for Care and Health Care Utilization Among Depressed and Anxious Patients With and Without Suicidal Ideation

Information is scarce concerning the perceived needs and the amount of health-care utilization of persons with suicidal ideation (SI) compared to those without SI. To describe the needs and health care use of persons with and without SI and to investigate whether these differences are associated with the severity of the axis-I symptomatology. Data were obtained from 1,699 respondents with a depressive and/or anxiety disorder who participated in the Netherlands Study of Depression and Anxiety. Persons with and without SI were distinguished. Outcome variables were perceived needs and health-care utilization. We used multivariate regression in two models: (1) adjusted only for sociodemographic variables and (2) adjusted additionally for severity of axis-I symptomatology. Persons with SI had higher odds for both unmet and met needs in almost all domains and made more intensive use of mental-health care. Differences in needs and health-care utilization of persons with and without SI were strongly associated with severity of axis I symptomatology. Our results validate previous findings about perceived needs and health-care use of persons with SI. The results also suggest that suicidal persons are more seriously ill, and that they need more professional care, dedication, and specialized expertise than anxious and depressed persons without SI, especially in the domains of information and referral.

When and why should mentally ill prisoners be transferred to secure hospitals: A proposed algorithm

For reasons well known and researched in detail, worldwide prevalence rates for mental disorders are much higher in prison populations than in general, not only for sentenced prisoners but also for prisoners on remand, asylum seekers on warrant for deportation and others. Moreover, the proportion of imprisoned individuals is rising in most countries. Therefore forensic psychiatry must deal not only with the typically young criminal population, vulnerable to mental illness due to social stress and at an age when rates of schizophrenia, suicide, drug abuse and most personality disorders are highest, but also with an increasingly older population with age-related diseases such as dementia.While treatment standards for these mental disorders are largely published and accepted, and scientific evidence as to screening prisoners for mental illness is growing, where to treat them is dependent on considerations for public safety and local conditions such as national legislation, special regulations and the availability of treatment facilities (e.g., in prisons, in special medical wards within prisons or in secure hospitals). While from a medical point of view a mentally ill prisoner should be treated in a hospital, the ultimate decision must consider these different issues. In this article the authors propose an algorithm comprising screening procedures for mental health and a treatment chain for mentally ill prisoners based on treatment facilities in prison, medical safety, human rights, ethics, and the availability of services at this interface between prison and medicine.

1302 – Characteristics of suicidal attempts in bipolar disorder: differences between subtypes 1 and 2

Suicidal behaviour represents a main cause of morbidity in patients with bipolar disorder. Researchers estimate that between 25% and 60% of individuals with bipolar disorder will attempt suicide at least once in their lives. Although it remains a controversial issue, several studies have found that patients with bipolar-II disorder have a higher risk of suicide attempt than those with bipolar-I. To investigate whether bipolar II disorder has different characteristics from bipolar I disorder among suicide attempters. 311 patients suffering from bipolar disorder, hospitalized after a suicide attempt, were interviewed by semi-structured interview, suicide attempt characteristics and a wide range of personality traits relevant to suicidal vulnerability. There was no significant difference between BP-I and BP-II suicide attempters according to sociodemographic variables. BP-I and BP-II patients did not differ for intent and lethality of suicide attempt for both BP subtypes. There was no significant difference for other characteristics of suicide behavior such as number of previous attempts, age at first suicide attempt, use of violent mean. Personality traits such as impulsivity, aggression, emotional lability, and hopelessness were similar between BP-I and BP-II patients. There was no significant difference between the groups in rates of comorbid substance abuse, anxious disorder or eating disorder. Retrospective study, lack of information about number of previous episodes and severity of acute episode of the bipolar disorder. BP-I and BP-II subtypes have similar features of suicide attempt and personality traits relevant to suicidal risk.

2988 – The european psychiatric association (EPA) guidance on suicide treatment and prevention

Suicide is a major public health problem in the WHO European Region accounting for over 150,000 deaths per year. Suicidal crisis: Acute intervention should start immediately in order to keep the patient alive.An underlying psychiatric disorder is present in up to 90% of people who completed suicide. Comorbidity with depression, anxiety, substance abuse and personality disorders is high. In order to achieve successful prevention of suicidality, adequate diagnostic procedures and appropriate treatment for the underlying disorder are essential.Existing evidence supports the efficacy of pharmacological treatment and cognitive behavioural therapy (CBT) in preventing suicidal behaviour. Some other psychological treatments are promising, but the supporting evidence is currently insufficient. Studies show that antidepressant treatment decreases the risk for suicidality among depressed patients. However, the risk of suicidal behaviour in depressed patients treated with antidepressants exists during the first 10-14 days of treatment, which requires careful monitoring. Short-term supplementary medication with anxiolytics and hypnotics in the case of anxiety and insomnia is recommended. TREATMENT with antidepressants of children and adolescents should only be given under supervision of a specialist. Long-term treatment with lithium has been shown to be effective in preventing both suicide and attempted suicide in patients with unipolar and bipolar depression. TREATMENT with clozapine is effective in reducing suicidal behaviour in patients with schizophrenia. Other atypical antipsychotics are promising but more evidence is required. TREATMENT team: Multidisciplinary treatment teams including psychiatrist and other professionals such as psychologist, social worker, and occupational therapist are always preferable, as integration of pharmacological, psychological and social rehabilitation is recommended especially for patients with chronic suicidality. Family: The suicidal person independently of age should always be motivated to involve family in the treatment. Social support: Psychosocial treatment and support is recommended, as the majority of suicidal patients have problems with relationships, work, school and lack functioning social networks.A secure home, public and hospital environment, without access to suicidal means is a necessary strategy in suicide prevention. Each treatment option, prescription of medication and discharge of the patient from hospital should be carefully evaluated against the involved risks. Training of personnel: Training of general practitioners (GPs) is effective in the prevention of suicide. It improves treatment of depression and anxiety, quality of the provided care and attitudes towards suicide. Continuous training including discussions about ethical and legal issues is necessary for psychiatrists and other mental health professionals.

Suicide: Global Perspectives From the WHO World Mental Health Surveysedited by NockMatthew K., BorgesGuilherme, and OnoYutaka. Cambridge, United Kingdom, Cambridge University Press, 2012, 404 pp., $120.00.

Suicide: Global Perspectives From the WHO World Mental Health Surveysedited by NockMatthew K., BorgesGuilherme, and OnoYutaka. Cambridge, United Kingdom, Cambridge University Press, 2012, 404 pp., $120.00.

3007 – Treating clinical realities through virtual reality: ICTS as a new therapeutical weapon

Self-harm and suicide are major public health problems in adolescents, with rates of self-harm being high in the teenage years and suicide being the second most common cause of death in young people worldwide. Moreover, research indicates that far from all who suffer from depression and suicidal ideation seek treatment and the determination of suicide risk and prevention of suicide attempts is traditionally difficult. In an era of empowered public and patients awareness, internet may be a more powerful determinant of health-seeking behavior than medical opinion. Suicide information is easily accessible over the web, as are special chat rooms for discussions with likeminded people. Internet can be considered as well as efficiently exploited to help people in severe emotional distress, including those contemplating suicide. Some websites advise acutely suicidal persons to seek help. Promotion and announcement of suicide are forbidden. Some websites offer a variety of professional help, including psychological and health-related information on various troubling issues, questions and answers and professional guidance intended to promote self-help in coping with numerous psychological problems. One promising treatment is activation, two kinds of which are behavioural activation, and one solely focused on physical exercise. These two kinds of activation therapy have the potential to be administered via the Internet, which would both lower the threshold for those seeking treatment, while also providing effective treatment to a low cost.

Suicide and Impossible Worlds

Suicide has a devastating impact on both survivors and society, and many obstacles to improving prevention efforts stem from our inadequate understanding of suicidality. A potential source of this shortcoming is that the majority of empirical studies focus only on a single specified etiology of suicide. To address this limitation, we present a further promising way to understand the suicidal state. We do so (1) by providing a brief review of something known as worlds theory (Bergner, 2006), and (b) by presenting the results of a study exploring the relationship between a person's taking it that his or her world is impossible/nonviable and his or her suicidal state. In this research, participants were asked to assess the perceived levels of world viability (vs. impossibility/nonviability) of 12 actual persons depicted in clinical vignettes. As predicted, participants judged the worlds of suicidal committers significantly more nonviable than those of suicide attempters, and these in turn significantly more nonviable than those of mentally disordered but nonsuicidal persons. These findings indicate that the worlds of suicidal persons are unlivable--in worlds terms: impossible. We discuss implications of these findings for understanding the suicidal state and for intervening therapeutically.

Love and suicide: the structure of the Affective Intensity Rating Scale (AIRS) and its relation to suicidal behavior.

BackgroundSuicide has been linked to intense negative affect. However, little is known about the range of affects experienced by suicidal persons, or the separate effects of affect valence and intensity. We examine a novel self-report scale, the 17-item Affective Intensity Rating Scale (AIRS), and its relation to suicidality in a high-risk sample.Methodology/Principal FindingsPatients presenting with suicidality were recruited from the Emergency Department in a large urban hospital, and completed a battery of assessments there. Structure of the AIRS was assessed using Maximum Likelihood Factor Analysis with Oblimin rotation. Convergent and divergent validity were assessed by regressing AIRS subscales against Brief Symptom Inventory subscales. Relation to suicidality was assessed by regression of suicide attempt status against scale and subscale scores, and individual items and two-way item interactions, along with significant clinical and demographic factors. 176 subjects were included in analyses. Three reliable subscales were identified within the AIRS measure: positive feelings towards self, negative feelings towards self, and negative feelings towards other. Only individual AIRS items associated significantly with suicide attempt status; strong ‘feelings of love’ associated positively with actual suicide attempt, while ‘feelings of calm’ and ‘positive feelings towards self’ associated negatively. Interaction analyses suggest ‘calm’ moderates the association of ‘love’ with suicide attempt.Conclusions/SignificanceFactor analysis of the AIRS is consistent with a circumplex model of affect. Affective dimensions did not predict suicidal behavior, but intense feelings of love, particularly in the absence of protective feelings of calm or positive self-view associated with current attempt.

Emotional Intelligence and Suicide: Need to Expand Vision

Suicide is the process of purposely ending one's own life. Nearly 1 million people worldwide commit suicide each year. It is a complex event which affected equally the every age of people. Approximately 95 % of all persons who commit or attempt suicide have a diagnosed with mental disorder 1 suicide is a major complication of depression.2. Suicidal process is formed through a continuum of thoughts of death to suicidal ideation; suicide attempts and completed suicide. 3 women attempt suicide three to four times more likely than men where as men are three to four times more likely to die by suicide. 90 % of those who complete suicide have at least one psychiatric disorder.4 There are different cognitive, emotive and cognitive behavioural theories that explain suicidal behaviours. First, Aaron Beck's concept of the cognitive triad, negative thoughts about oneself, the future and others/ environment was central to the cognitive theory of suicide. Beck's cognitive perspectives also states that hopelessness is the important clinical variable implicated in suicidal behaviour. According to Daniel Goleman's theory of emotional competenceo, a person with high emotional intelligence has better emotional self awareness and higher empathy and is more competent in managing his/ her own emotions and handling interpersonal relationships. Empirical studies also stated that there was an emotional element in suicidal ideation. Rudd7also suggested a cognitive behavioural theory of suicidality. According to this theory, suicidality was associated with the behavioural system, cognitive system, physiological system and affective system.Apart from gathering material privileges for ourselves, many of us feel a sense of loneliness and face emotional problems while going through life. With emotions running high and each of us trying to find our balance in life, some of us become prone to negative beliefs and thoughts of self harm.Today increasing the cause of suicide is given by the wrong life styles and maladaptive thinking.There is age, gender, ethnic and geographical and psychological risk factors for suicide. Some contributing risk factors are* Unbearable psychological pain is a common trigger for suicide a depth of darkness in which the person feels especially hopeless, helpless and everything out of control.* Narrow thinking, tunnel vision or rigid thoughts is one of the deadliest aspects of suicide. Person sees it as only one solution for their current difficulties. They think everything is hopeless and things will never be better.* The suicidal person is deeply ambivalent. He/she wants both to live and to die.* Among 90 % of suicidal people have psychiatric disorders, such as depression or psychosis. Suicidality is not a mental illness but suicidal peoples are often suffering from a mental illness.* Suicidal person feels fragile and lacks of positive view of themselves and a sense of personal strength.* Person feels alone and cut off from others. They may have experienced low self esteem, conflicts and rejections from others. They may think they have been dishonourable or failed in family, friends and society.* Experience of loss of concern e.g. spouse leaving, fired from a job, ill health, social embarrassment is often a trigger for suicide.Research suggests that those who react with anger and aggression may be more at risk for suicide and escaping tendency is also responsible for it, except these other factors are guilt, frustration, stressful and traumatic childhood experiences, low self confidence, excessive unhealthy competitive feelings, lack of ability to manage emotions, feelings of insecurity, economic inequality, maximization of own rewards, lack of satisfaction with own Ufe, materialization of physical worlds etc.Emotional IntelligenceEmotional intelligence is defined as the ability to perceive and to think about emotions promoting the experience of positive affect8. …

Lifetime Risk of Suicidal Behaviors and Communication to a Health Professional About Suicidal Ideation

There is presently a lack of information on the role of healthcare in suicidal ideation in adults. To assess the frequencies, patterns, and factors associated with the communication of suicidal ideation toward a health professional. Participants stem from a French cross-sectional survey of 22,133 randomly selected adults. Lifetime suicidal behaviors and 12-month mental disorder patterns were assessed using the short form of the Composite International Diagnostic Interview. Participants with suicidal ideation were asked whether they had talked about it and, if they had, to whom. Around 20% of people with suicidal ideation had talked about this distress to a health professional. It was more frequent for people with more severe suicidal behaviors (plan or a prior attempt), among women, those aged 30 or more, those suffering from major depressive episode, panic disorder, or drug use disorder. Above all, it was more frequent among those who had also talked to friends or relatives. Prevention strategies that encourage suicidal persons to seek help for their distress, whoever that is, may be the more important strategies to develop.

Fats and Factors: Lipid Profiles Associate with Personality Factors and Suicidal History in Bipolar Subjects

Polyunsaturated fatty acids (PUFA) have shown efficacy in the treatment of bipolar disorder, however their specific role in treating the illness is unclear. Serum PUFA and dietary intakes of PUFA associate with suicidal behavior in epidemiological studies. The objective of this study was to assess serum n-3 and n-6 PUFA levels in bipolar subjects and determine possible associations with suicidal risk, including suicidal history and relevant personality factors that have been associated with suicidality. We studied 27 bipolar subjects using the NEO-PI to assess the big five personality factors, structured interviews to verify diagnosis and assess suicidal history, and lipomics to quantify n-3 and n-6 PUFA in serum. We found positive associations between personality factors and ratios of n-3 PUFA, suggesting that conversion of short chain to long chain n-3s and the activity of enzymes in this pathway may associate with measures of personality. Thus, ratios of docosahexaenoic acid (DHA) to alpha linolenic acid (ALA) and the activity of fatty acid desaturase 2 (FADS2) involved in the conversion of ALA to DHA were positively associated with openness factor scores. Ratios of eicosapentaenoic acid (EPA) to ALA and ratios of EPA to DHA were positively associated with agreeableness factor scores. Finally, serum concentrations of the n-6, arachidonic acid (AA), were significantly lower in subjects with a history of suicide attempt compared to non-attempters. The data suggest that specific lipid profiles, which are controlled by an interaction between diet and genetics, correlate with suicidal history and personality factors related to suicidal risk. This study provides preliminary data for future studies to determine whether manipulation of PUFA profiles (through diet or supplementation) can affect personality measures and disease outcome in bipolar subjects and supports the need for further investigations into individualized specific modulations of lipid profiles to add adjunctive value to treatment paradigms.

The Use of an Electronic Control Device in Wildlife Management: A Case Series

The Alaska Department of Fish and Game’s (ADF&G) Division of Wildlife Conservation personnel routinely respond to situations in which they must safely and effectively modify an animal’s undesirable behavior or restrain an animal to allow for a rapid disentanglement, injury assessment, or other short-term intervention. In hazing or aversive conditioning situations, traditional methods and tools may fail to correct the undesirable behavior and lethal force may be the only option left. Incapacitating drugs are routinely deployed for restraint and have a good safety record, but can be time consuming and carry inherent risks to the animal both from the delivery systems (e.g., puncture of vital structures) or the drugs themselves (e.g., overdose or other adverse drug reaction and, in some cases, a prolonged recovery period possibly leaving the animal more susceptible to environmental hazards and predators). There is also the risk of accidental human exposure to the drug through the handling and delivery process and in bounced and/or unrecovered darts in residential and other high public-use areas. The use of electricity for wildlife mitigation is not a novel concept. Electric fences for animal exclusion and captivity are widely accepted and in common use. Hand-held electric jab-sticks have also been routinely used in both domestic animal and captive wildlife facilities since the 1950s for staff protection. However, the use of portable, targetable, distance-delivered electronic systems designed to incapacitate and cause noxious stimuli for hazing or aversive conditioning is a new concept in wildlife management, and is based on the modern TASER® Electronic Control Devices (ECD). Law enforcement officers have used these devices for over a decade to safely gain control of non-compliant, combative, and suicidal persons. We present 11 cases of the use of an ECD in the management of common wildlife-related calls for service to ADF&G. This case series demonstrates that ECDs may have a role in wildlife management for 1) temporary restraint and control, 2) hazing and/or aversive conditioning, and 3) personnel safety.

W08-03 - Suicide related information on the internet and implications for prevention

The presentation will give an overview of the Estonian language websites that users are likely to find when seeking suicide related information on the web. The material for the study was collected within the EC Public Health Programme project SUPREME (Suicide Prevention by Internet and Media Based Mental Health Promotion). Sixty search hits were examined using the Google search engine on two different keywords referring to suicide (in Estonian language ‘ suitsiid ’ and ‘ enesetapp ’). Research method was qualitative thematic content analysis. The following five content categories were revealed: statistics about suicide; suicide provoking and stigmatisation; suicide prevention and help for persons in suicidal crisis; neutral informative materials; professional advice. The conclusions based on the results were: the websites of organisations aiming to prevent suicides should include clear guidelines where to refer in case of depression and suicidal thoughts; when developing a website, the strategy for making websites easily available in search engines should be carefully elaborated; the websites that avoid stigma and offer help should open first, when a suicidal person uses in search engines the keywords like suicide and depression; web-based forums should not be un-moderated discussion groups, especially those targeted to adolescents and youth.

Attitudes of psychologists and nurses toward suicide and suicide prevention in Ghana: A qualitative study

BackgroundOne way of preventing suicide has been increasing awareness among health care professionals of their own attitudes and taboos toward suicide and its prevention. ObjectiveThe purpose of this study was to understand the attitudes of health professionals toward suicidal behavior and its prevention in Ghana. MethodsA total of 17 informants (9 clinical psychologists and 8 emergency ward nurses) in an urban center were interviewed using a semi-structured interview guide. Interpretative Phenomenological Analysis (IPA) was used to analyze the data. ResultsWe found that the attitudes of these health workers toward suicide and suicide prevention seemed to be transiting between morality and mental health. The psychologists generally saw suicide as a mental health issue, emphasized a caring and empathic view of suicidal persons and approached suicide prevention from a health-service point of view. Mental health education and improvements in primary health care were reported as practical approaches toward suicide prevention. The nurses on the other hand, held a moralistic attitude toward suicide as a crime, viewed suicide persons as blameworthy and approached suicide prevention from a proscriptive perspective. Informal approaches such as talking to people, strengthening the legal code against suicide and threatening suicidal persons with the religious consequences of the act were also indicated as practical approaches to suicide prevention. Educational level, clinical experience with suicidal persons, and religious values, are discussed as influencing the differences in attitudes toward suicide and suicide prevention between psychologists and nurses. ConclusionHealth workers in Ghana need training in suicidology to improve both knowledge and skills relevant for suicide prevention.

The European Psychiatric Association (EPA) guidance on suicide treatment and prevention

Suicide is a major public health problem in the WHO European Region accounting for over 150,000 deaths per year. Suicidal crisisAcute intervention should start immediately in order to keep the patient alive. DiagnosisAn underlying psychiatric disorder is present in up to 90% of people who completed suicide. Comorbidity with depression, anxiety, substance abuse and personality disorders is high. In order to achieve successful prevention of suicidality, adequate diagnostic procedures and appropriate treatment for the underlying disorder are essential. TreatmentExisting evidence supports the efficacy of pharmacological treatment and cognitive behavioural therapy (CBT) in preventing suicidal behaviour. Some other psychological treatments are promising, but the supporting evidence is currently insufficient. Studies show that antidepressant treatment decreases the risk for suicidality among depressed patients. However, the risk of suicidal behaviour in depressed patients treated with antidepressants exists during the first 10–14 days of treatment, which requires careful monitoring. Short-term supplementary medication with anxiolytics and hypnotics in the case of anxiety and insomnia is recommended. Treatment with antidepressants of children and adolescents should only be given under supervision of a specialist. Long-term treatment with lithium has been shown to be effective in preventing both suicide and attempted suicide in patients with unipolar and bipolar depression. Treatment with clozapine is effective in reducing suicidal behaviour in patients with schizophrenia. Other atypical antipsychotics are promising but more evidence is required. Treatment teamMultidisciplinary treatment teams including psychiatrist and other professionals such as psychologist, social worker, and occupational therapist are always preferable, as integration of pharmacological, psychological and social rehabilitation is recommended especially for patients with chronic suicidality. FamilyThe suicidal person independently of age should always be motivated to involve family in the treatment. Social supportPsychosocial treatment and support is recommended, as the majority of suicidal patients have problems with relationships, work, school and lack functioning social networks. SafetyA secure home, public and hospital environment, without access to suicidal means is a necessary strategy in suicide prevention. Each treatment option, prescription of medication and discharge of the patient from hospital should be carefully evaluated against the involved risks. Training of personnelTraining of general practitioners (GPs) is effective in the prevention of suicide. It improves treatment of depression and anxiety, quality of the provided care and attitudes towards suicide. Continuous training including discussions about ethical and legal issues is necessary for psychiatrists and other mental health professionals.

Editorial: Preventing Suicide by Using Consumer Peer Specialists

Psychiatric nurses have always been in the forefront of scholarly work and clinical expertise regarding suicide. We know that our patients with mental illness have a greater likelihood of attempting, and actually committing, suicide than individuals in the general population. We enact suicide precautions on our inpatient units and warn family members about signs of impending suicide attempts by their loved ones who are outpatients. We conduct educational programs in the schools to help teachers and students identify individuals who are suicidal. What we have not done is enlist the help of other patients (hereafter referred to as consumers). Can consumers help us to prevent suicides? Salvatore (2010) asserts that they can. In fact, he recommends the utilization of consumers who themselves have made suicide attempts in the past—but regained their will to live. Because of their own experiences with the discouragement and desperation of the suicidal state, such individuals can deeply empathize with the feelings of others. They can (a) astutely recognize warning signs of suicide in their peers; (b) validate the misery of being suicidal; (c) become part of the suicidal person’s support system; and (d) track what happens after the acute suicidal crisis is resolved, making sure the person is receiving appropriate psychiatric care (Salvatore, 2010). Obviously, peer specialists must understand the boundaries of their roles and know the indications for rapidly mobilizing assistance from psychiatric professionals, police, or a community crisis center.

Recognising and responding to suicidal crisis within family and social networks: qualitative study

Objective To shed light on the difficulties faced by relatives, friends, and colleagues in interpreting signs of suicidality and deciding whether and how to intervene.Design Qualitative study of completed suicides,...

Psychiatric Knowledge and Skills Required of Occupational Physicians: Priorities in the Japanese Setting

To prioritize the educational content in psychiatry teaching materials for occupational physicians. A preparatory investigation was performed that included interviews with 13 psychiatrists who were well acquainted with occupational health and practices. Brainstorming among the psychiatrists and 12 occupational physicians was used to develop a list of educational content related to psychiatric issues that should be required for occupational physicians. Using a questionnaire survey constructed based on the preparatory investigations, 135 specialists with extensive experience in occupational medicine were asked to prioritize the selected items. A total of 67 specialists responded to the questionnaire. The following were recommended as high educational priorities for occupational physicians to master: awareness and diagnosis of mood disorders, being able to appropriately deal with depressed workers, screening for depression, understanding cases that should be referred for special treatment, appropriate action for a suicidal person, understanding symptoms that require cooperation in an emergency with a specialist, acquisition of the attitude and skills used in active listening and awareness of diseases such as alcohol dependence, adjustment disorders and schizophrenia. What has been presented here is a consensus view of specialists in this field. The items included were those obtained from sitting in on the discussions of psychiatrists and occupational physicians. They represent indicators for the development of teaching materials.

History of suicide attempt in male substance-dependent inpatients and relationship to borderline personality features, anger, hostility and aggression

The aim of this study was to investigate the relationship between severity of borderline personality features and history of suicide attempt (HSA) in male substance-dependent inpatients and the effect of anger, hostility and aggression on this relationship. Further, the effect of some variables that may be related to suicide and/or borderline personality, such as age at inception of regular substance use, substance of dependence (alcohol/drug), depression, and both state and trait anxiety, were controlled. Participants were 200 consecutively admitted male substance-dependent inpatients. Patients were investigated with the Borderline Personality Inventory (BPI), the Buss–Perry Aggression Questionnaire (AQ), the Beck Depression Inventory (BDI) and the State–Trait Anxiety Inventory (STAI). Among substance-dependent inpatients, 33.0% (n=66) were identified as the group with HSA. Mean scores employment status, marital status and duration of education did not differ between groups, whereas current age and age at onset of regular substance use were lower in group with HSA. Mean scores of BPI, AQ and its subscales (anger, hostility and physical/verbal aggression), BDI and STAI were higher in the HSA group. In addition, the rates of drug dependency and borderline personality disorder were higher in this group. The severity of borderline personality symptoms was highly correlated with subscales of the AQ, depression and anxiety, whereas it was negatively correlated with age at onset of regular substance use. The severity of anger and borderline personality features predicted HSA in the logistic regression model. Results suggest that, to reduce the risk of suicide attempt among substance-dependent patients, the feeling of anger must be the target of evaluation and treatment among those with borderline personality features.

An Attachment Model for Assessing Suicidal Risk

A model for addressing suicidal risk utilizing attachment theory is addressed. Risk factors for suicide have generally been conceptualized at the level of individual characteristics rather than relational dynamics. Combining Shneidman’s common characteristics of a suicidal person with Bowlby’s attachment theory provides for a more relational view of suicide-related behaviors and communications. Considering high rates of suicide, especially among some population groups, it is important to have a more comprehensive framework for suicidal risk from which to treat suicidal clients.