Suicidal Act Research Articles

Update: Reports of suicidality in patients taking diabetes/obesity medicines

The below is from a January 11 Drug Safety Communication from the U.S. Food and Drug Administration (FDA) evaluating reports of suicidal thoughts or actions in patients treated with a class of medicines called glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs). The initial evaluation found that there is no evidence of a link between these medicines and suicidality. Below is the FDA's report.

First Case of Medically Assisted Suicide in Italy Set New Legal Perspectives.

The first act of assisted suicide in Italy was recently carried out. This event is an absolute novelty for the country, affected by recent legislative changes aimed only at introducing the right to interrupt health treatments and, therefore, carry out exclusively omissive end-of-life acts. These normative provisions lay their foundations in a cultural context centered on the protection of the right to life and health; however, the cases that have occurred over time, including the famous story of DJ Fabo, have led the Constitutional Court to re-evaluate these dictates, introducing in 2019 the right to resort to assisted suicide procedures within well-defined areas, including incurability of the condition, the serious suffering of the individual and the retained ability to stand trial. The case addressed concerns a quadriplegic subject who was the victim of a road accident. Following consultation with a specialized institution, the subject made the decision to undergo an assisted sui-cide procedure in Italy. Having obtained the authorization from the competent authorities, he started a fundraiser to finance the devices and drugs required and, finally, he died. The opening by Italy towards the assisted suicide procedure represents a great step towards a broad context, as well as a decisive act for the purpose of protecting the right to self-determination of the individual. However, the current legislative framework presents significant criticalities and shortcomings. In first place, the dissonance between the laws in force and the judicial sentences is likely to generate problems of uneven application of the rules in a country dominated by the principle of Civil Law. Furthermore, the need for the applicant to fully self-finance the procedure clearly clashes with the constitutional principle of free access to care. Then emerges the need for a guideline document regarding the completion of the procedure itself, the times, methods and drugs implied, in order to significantly reduce the decision-making process by the ethics committees that still weighs on each individual case. Finally, conside-ring what has been observed on the subject of voluntary termination of pregnancy, it is necessary to ask what will be the general orientation of the doctors called to perform the act and whether they will be given the opportunity to express their refusal. The case analyzed could represent the beginning of a new era for Italian culture, but the large-scale application of assisted suicide procedures requires the introduction of legislative provisions that definitively eliminate the critical issues that have emerged so far.

Eksistensi Kematian sebagai Akhir: Thanatos dan Eros dalam Ziarah Karya Iwan Simatupang (Perspektif Psikoanalisis Freudian)

This article explores personality dynamics in Indonesian literature by taking the theme of death in the novel Ziarah by Iwan Simatupang (1969). The concept of 'Thanatos and Eros' from Freudian psychoanalytic research is understood as the relationship between instincts in human behavior, which are described as conflicting settings, namely the death instinct and the life instinct. This research uses a qualitative description method and a content analysis method in the form of presenting data in the form of words and sentences taken from the novel Ziarah by Iwan Simatupang (1969) on the aspects of Thanatos (death instinct), eros (life instinct) and anxitas (anxiety). The research techniques used are literature review, note-taking, and data processing techniques. Thus, research into personality dynamics in the novel Ziarah by Iwan Simatupang obtained six data on Thanatos (death instinct), five data on eros (life instinct), and one data on anxitas (anxiety). Thanatos (death instinct) data emphasizes the death instinct in the form of aggression and suicidal actions in the Painter character, the Young and Old Operative character, and the Mayor character. The eros data (life instinct) emphasizes the sexual instinct in the painter's characters and the non-sexual instinct (lamentation poetry) in fulfilling physical needs such as feelings of hunger, thirst, work, and others. Anxiety data emphasizes the anxiety of death in the painter's character.

The prevalence of off-label use and supratherapeutic blood levels of outpatient psychotropic medication in suicidal adolescents.

Adolescents with mental disorders show an increased risk of suicidal phenomena. Vice versa, suicidality is a serious adverse event of psychotropic drug therapy in adolescents. There are only a few new psychotropic agents approved for this young age group. We evaluated the (pre-pandemic) prevalence of off-label use as well as detailed blood concentrations of outpatient psychotropic medication and sex differences in a clinical population of suicidal adolescents. The urine presence and serum levels of psychotropic substances of adolescents hospitalized due to their acute suicidality but without a known actual suicide attempt (i.e., no acute intoxication or serious self-injuries) were investigated routinely between 01.03.2017 and 31.01.2018. Urine (N = 205) and blood samples (N = 193) were taken at the beginning of closed inpatient admission, i.e., the results of the laboratory analysis reflect outpatient drug intake. The serum levels of psychopharmacological medication and OTC medication were measured. Our sample consists of 231 cases (boys: N = 54; girls: N = 177, ratio: 1:3.3), aged 12-17 years (average age: 15,4 years). The most prevalent psychiatric diagnoses were depressive episodes (54%) and adjustment disorders (25%), and girls were more often diagnosed with depressive disorders than boys (boy/girl ratio: 1:9.5, p < 0.0001). More than half of adolescents (56%) used at least one prescribed psychotropic drug at admission (24.8% ≥ two psychotropic drugs). Off-label use of second-generation antipsychotics was significantly more frequent than off-label use of antidepressants (85% vs. 31%, p < 0.01). Adolescents suffering from depressive disorders were significantly more often on-label treated than adolescents with neurotic or stress-related disorders (56% vs. 10%). Female cases with prescribed psychotropic drug use showed significantly more frequent supratherapeutic drug levels than male cases (5% vs. 27%, p < 0.05). Female adolescents may have an increased risk of supratherapeutic blood levels, especially when outpatient prescribed psychotropic drugs are off-label used. Measurement of blood levels of outpatient-prescribed psychotropic drugs could be used to enhance the safety and efficacy of the individual psychopharmacological treatment of adolescent suicidal patients. There is an urgent need for more real-world evidence on the effective treatment of adolescents with psychotropic drugs.

Impairment in recognition memory may be associated with near-term risk for suicide attempt in a high-risk sample

IntroductionPrior work has implicated several neurocognitive domains, including memory, in patients with a history of prior suicide attempt. The current study evaluated whether a delayed recognition test could enhance prospective prediction of near-term suicide outcomes in a sample of patients at high-risk for suicide. Methods132 Veterans at high-risk for suicide completed a computer-based recognition memory test including semantically-related and -unrelated words. Outcomes were coded as actual suicide attempt (ASA), other suicide-related event (OtherSE) such as aborted/interrupted attempt or preparatory behavior, or neither (noSE), within 90 days after testing. ResultsReduced performance was a significant predictor of upcoming ASA, but not OtherSE, after controlling for standard clinical variables such as current suicidal ideation and history of prior suicide attempt. However, compared to the noSE reference group, the OtherSE group showed a reduction in the expected benefit of semantic relatedness in recognizing familiar words. A computational model, the drift diffusion model (DDM), to explore latent cognitive processes, revealed the OtherSE group had decreased decisional efficiency for semantically-related compared to semantically-unrelated familiar words. LimitationsThis study was a secondary analysis of an existing dataset, involving participants in a treatment trial, and requires replication; ~10 % of the sample was excluded from analysis due to failure to master the practice tasks and/or apparent noncompliance. ConclusionImpairments in recognition memory may be associated with near-term risk for suicide attempt, and may provide a tool to improve prediction of when at-risk individuals may be transitioning into a period of heightened risk for suicide attempt.

Reappraisal of the DNA phosphorothioate modification machinery: uncovering neglected functional modalities and identification of new counter-invader defense systems.

The DndABCDE systems catalysing the unusual phosphorothioate (PT) DNA backbone modification, and the DndFGH systems, which restrict invasive DNA, have enigmatic and paradoxical features. Using comparative genomics and sequence-structure analyses, we show that the DndABCDE module is commonly functionally decoupled from the DndFGH module. However, the modification gene-neighborhoods encode other nucleases, potentially acting as the actual restriction components or suicide effectors limiting propagation of the selfish elements. The modification module's core consists of a coevolving gene-pair encoding the DNA-scanning apparatus - a DndD/CxC-clade ABC ATPase and DndE with two ribbon-helix-helix (MetJ/Arc) DNA-binding domains. Diversification of DndE's DNA-binding interface suggests a multiplicity of target specificities. Additionally, many systems feature DNA cytosine methylase genes instead of PT modification, indicating the DndDE core can recruit other nucleobase modifications. We show that DndFGH is a distinct counter-invader system with several previously uncharacterized domains, including a nucleotide kinase. These likely trigger its restriction endonuclease domain in response to multiple stimuli, like nucleotides, while blocking protective modifications by invader methylases. Remarkably, different DndH variants contain a HerA/FtsK ATPase domain acquired from multiple sources, including cellular genome-segregation systems and mobile elements. Thus, we uncovered novel HerA/FtsK-dependent defense systems that might intercept invasive DNA during replication, conjugation, or packaging.

Prevalencia de enfermedad psiquiátrica entre los suicidios consumados en la provincia de Badajoz en el periodo 2015-2017

A study is carried out in 157 subjects who during the period established between July 01, 2015 and December 31, 2017 committed a consummated suicide in the province of Badajoz to investigate what percentage of consummated suicides had a history of mental pathology. The results indicate that there is a lower-than-expected relationship between the suicidal act and the presence of a personal psychiatric history, as these only appear in two-fifths of the sample. If they do exist, the most frequent diagnosis is depressive disorder and the most frequent treatment is antidepressants. These data contrast with other data collected in the literature that report much higher percentages of psychiatric pathology in subjects who commit suicide.

Extent and Intensity of Suicidal Ideation and Planning in Patients Presenting With Psychiatric Emergencies

Background In emergency psychiatry high levels of suicidality are encountered. However, empirical studies about the extent of suicidal ideation remain scarce, and data are often gathered retrospectively via medical records. The present observational study aims to assess suicidal ideation, planning, and actions experienced by patients presenting with psychiatric emergencies. Methods In a consecutive sample of 136 patients, a standard psychiatric examination including the Chronological Assessment of Suicide Events (CASE Approach) was completed. An evaluative monitoring form for the CASE Approach was designed to record and quantify the garnered information. Results Almost 60% of the patients reported suicidal ideation with some planning. Approximately 25% had experienced over 10 hours of suicidal ideation on their worst days in the past 2 months; 27% had procured their method of choice, and another 27% had practiced a small, moderate, or serious suicide attempt. Conclusion Findings suggest more intense suicidality in emergency psychiatry than has been reported in previous empirical studies.

Promoting the well-being of investigators, prosecutors and judges in Latvia

The international survey, which aimed to assess the well-being and mental health of legal professionals worldwide, found that more than a third of the lawyers surveyed believe that work has a negative impact on their mental state and well-being. In addition, the survey found that 29% of the respondents had experienced suicidal thoughts or actions at some point in their career, and 45% reported experiencing stress-related health problems (International Bar Association, 2021). The aim of this study is to theoretically describe and practically explore aspects of well-being and the factors influencing it, as well as the needs of investigators, prosecutors and judges and the possibilities of supervision in promoting well-being. Two questionnaires ‘Professional well-being’ and ‘Professional needs’ were developed. The survey was carried out among 354 respondents: judges, prosecutors and investigators. It was concluded that the mental health, workload, work–life balance, knowledge, development and socialisation needs of judges, prosecutors and investigators are influenced by the need for a supportive working environment and psychological support, which determine the possibilities for supervision. At the same time, there are statistically significant differences between the job satisfaction, mental health and work–life balance of investigators, prosecutors and judges. There are also statistically significant differences between judges’, prosecutors’ and investigators’ needs for support, knowledge and development. Keywords: investigators; judges; prosecutors; professional needs; well-being; work–life balance.

TENTATIVA DE SUICÍDIO EM MULHERES PRIVADAS DE LIBERDADE EM UNIDADE PRISIONAL

ABSTRACT Objective: to describe the occurrences and factors associated with attempted suicide among women deprived of their freedom in a prison unit. Method: a cross-sectional study conducted at a detention facility in Paraná - Brazil, with 30 women, with data collected in 2022 using the Columbia-Suicide Severity Rating Scale instrument and another one prepared by the authors and analyzed descriptively and inferentially. Results: during their lifetime, 16 (53.3%) women presented suicidal behavior; 14 (46.7%) made actual suicide attempts; 14 (46.7%) had physical damage; and 10 (33.3%) preparatory acts. An actual suicide attempt was associated with suicidal thoughts before arrest (p&lt;0.01) and with thoughts during arrest (p&lt;0.02). Conclusion: previous history of ideation influenced the suicide attempt. Therefore, it is important to evaluate suicidal behavior in the admission and permanence of women deprived of their freedom. This study contributes to reducing the gap in the Brazilian scientific production on this topic with this population segment.

Comparative analysis of factors influencing suicidal actions performance before and during the COVID-19 pandemic

To study the influence of COVID-19, as well as various factors on the rate of deaths caused by suicide. The statistical analysis of mortality according to the data of «Bureau of FME» in the period from 2019 to 2020 yrs. and the search of scientific publications over the past 10 years in PubMed database have been conducted. Articles describing the factors influencing suicidal deaths in different population groups were selected from the publications. Statistically significant features that determine the influence of quarantine measures in the period COVID-19 on the mental component of citizens and suicidal dynamics were considered and established.

Le passage à l’acte suicidaire dans sa dimension perverse, analyse d’un cas clinique

ObjectiveThe notions of psychosis, neurosis, and perversion structured clinical thought during the golden age of psychoanalysis. But, even if psychosis and neurosis are still an integral part of our medical vocabulary, perversion, on the other hand, has become a forgotten or even obsolete concept. However, some mechanisms of interaction between patients and more precisely some suicide attempts seem to be significantly related to it. In this article, we offer the reader a second look at this clinical perversion. MethodologyThis article aims to study some perverse mechanisms that are present in clinical work with suicidal patients and to establish a current, historical, and non-exhaustive definition that will answer the following question: “can a suicide attempt be thought of as a perverse act in its address to the therapist?” The theoretical input will be supported by a preliminary clinical illustration about the hospital and ambulatory monitoring of a young patient. ResultsWhen suicidal acting out takes on a special meaning addressed to the therapist and allows the patient to seize power in the therapeutic relationship, we can clearly see the characteristics of perversion. DiscussionA cautious approach should be adopted about this proposition: not all suicidal acts are to be associated without nuance with perversion. Similarly, it is up to the therapist to understand the mechanisms developed by the patient in the therapeutic relationship and to make them the object of shared therapeutic work. ConclusionThis article offers the reader a theoretical and clinical approach to the suicidal act in patients whose psychic structure can be considered perverse. It allows us to: differentiate between addressed and un-addressed suicidal acts, acknowledge the resulting clinical difficulties, and explore avenues about the monitoring of patients after a suicide attempt.

Social Representations of Suicide in Patients with Suicide Attempt Hospitalized in a Mental Health Institution

BACKGROUND: The suicide rate in the last 45 years has increased considerably in the world, being the frequency of attempted suicide 20 times higher than that of completed suicide. Pereira is one of the cities with the highest rates in the country. METHODS: This qualitative research uses grounded theory as an analysis method, obtaining the data through semi-structured open-type interviews with selective purposive sampling. The analysis of the interviews was done through the grounded theory method and the results are expressed through the theory of social representations. RESULTS: The findings of this research present the discourse of hospitalized patients with suicide attempt. According to social representations, family and derivatives are vital for individual development and their relationship with the environment. Dysfunctions in the family nucleus increase the risk of developing negative thoughts, which can later turn into suicidal behavior. Associated psychiatric pathologies, low self-esteem, relationship problems, sexual abuse and feelings of rejection are risk factors, while study, life projects, and spirituality are protective factors. No relationship was found regarding the consumption of psychoactive substances. CONCLUSION: The family is fundamental in the configuration of the individual and its role as a protective or risk factor in terms of suicide attempt depends on its functionality. It is suggested that work in the families could serve as a strategy for the prevention of the non-fatal suicidal act.

The influence of peer non-suicidal self-harm on young adults' urges to self-harm: experimental study.

To test the hypothesis that exposure to peer self-harm induces adolescents' urges to self-harm and that this is influenced by individual suggestibility. We recruited 97 UK-based adults aged 18-25 years with a recent history of self-harm, measuring baseline suggestibility (Resistance to Peer Influence; RPI) and perceived ability to control urges to self-harm (using an adapted item from the Self-Efficacy to Resist Suicidal Action scale; SEASA) before and after two self-harm vignettes featuring named peers from the participant's social network (to simulate exposure to peer non-suicidal self-harm) and after a wash-out exposure. We used paired t-tests to compare mean SEASA scores pre- and post-exposure, and linear regression to test for an association between RPI and change in SEASA scores pre- and post-exposure. Perceived ability to control urges to self-harm was significantly reduced following exposure to peer self-harm (t(96) = 4.02, p < 0.001, mean difference = 0.61; 95% CI = 0.31, 0.91), but was not significantly different from baseline after exposure to a wash-out. We found no association between suggestibility and change in urges to self-harm after exposure to peer self-harm. Our findings support social influences on self-harm in a sample of young adults, regardless of their individual degree of suggestibility.

Cognitive and behavioral factors in the chronification of suicidal behavior

Relevance. Suicide is one of the leading causes of death worldwide. Suicidal behavior is a complex phenomenon that includes suicidal thoughts, intentions and actions; and those actions do not always lead to death, but often turn into chronic suicidal behavior. The study of the factors in chronification of suicidal behavior is necessary for the development of evidence-based programs for the prevention of repeated suicide attempts.Aim of study. is to compare cognitive and behavioral strategies for coping with stress in patients with single suicide attempts and chronic suicidal behavior.The hypothesis of the study is that in patients with repeated suicide attempts, destructive cognitive and behavioral strategies for coping with stress are more pronounced.Materials and methods. The study included 119 patients treated at the somatopsychiatric and toxicology departments, 60 patients after the primary suicide attempt, 59 – after repeated ones. Patients were asked to complete the following procedures: Beck Depression Inventory (Beck, 1961; N.V. Tarabrina, 2001), Beck Anxiety Inventory (Beck, 1961; Tarabrina, 2001), Rumination Scale (Treynor W. et al., 2003; adaptation by O.D. Pugovkina et al., 2021), Alexithymia Scale (Toronto Alexithymia Scale G.J. Taylor et al., 1985; adaptation by Starostina E.G. et al. 2009), COPE Inventory (Ch.S. Carver et al., 1989; adaptation by P.A. Ivanov and N.G. Garanyan, 2013).Results. Patients after repeated suicide attempts, compared with patients who made the first attempt, are more likely to be diagnosed with borderline personality disorder, have more pronounced symptoms of depression and suicidal readiness, higher rates of ruminative thinking and alexithymia — reflecting a deceptive cognitive style, — as well as indicators of the use of destructive behavioral strategies for coping with stress in the form of various types of avoidance behavior.

Uncovering the role of substance use in suicide attempts using a mixed-methods approach.

Substance use is an established risk factor for suicide attempt. Clarifying the role of substance use in suicide attempts may identify modifiable treatment targets. This study used mixed methods to associate substance use with suicide attempt history and identify pathways through which substance use contributes to attempts. Study 1 included 213 adult inpatients (n = 127 with substance use disorder [SUD]), who completed assessments of suicide attempt history as well as demographic and clinical suicide risk factors. Study 2 was a narrative analysis of suicide attempt stories described by 20 inpatients diagnosed with SUD. In Study 1, patients with co-occurring alcohol and drug use disorders reported more actual lifetime suicide attempts than did those without SUD. In addition, alcohol and drug use disorders were independently associated with lifetime suicide attempts after controlling for demographic and clinical confounders. In Study 2, substance use played a role in all suicide attempts through at least one pathway before, during, or after a triggering stressor, or as suicide attempt method. Substances play a role in suicide attempt baseline risk, acute risk and as means. It is important to target chronic and acute substance use in suicide prevention treatment plans.

Análise do panorama de mortalidade por suícidio na população idosa da região Sudeste no período de 2011 a 2015

The proportion of elderly people has been increasing in recent years, and with it the related public health problems. Intentional self-inflicted injuries are an important public health problem, even among this section of the population. The aim of this study was to describe the panorama of self-inflicted injuries in the elderly population of the southeast region between 2011 and 2015. It was concluded that self-inflicted injuries in the elderly ranked 6th among external causes of morbidity and mortality between 2011 and 2015 in the southeast region, demonstrating the relevance of the issue in this part of the population. Suicide among the over-60s occurs more frequently in men. It is necessary to identify these patients and what leads them to idealize the suicidal act so that we can address factors that improve their mental health in order to prevent this event.

The association of internet searches and actual suicide in Spain

High suicide rates are a major issue in Spain, to the extent that they are the main non-natural cause of death in this country. The present study analyses the relationship between Internet searches and actual suicide rates in Spain. For this purpose, we employ data from actual suicide rates and Google® searches for Spain, differencing by the means used to commit suicide. Our results show that suicide (“suicidio”) search term seems to be positively associated with higher total suicide rates, in addition to suicides using poison, suffocation and jumping. The suicide (“suicidio”) topic presents similar results to the suicide search term, and suicide by car crash also seems to be associated with Internet searches of this topic.

Suicidal behaviors and adverse childhood experiences: A cross-diagnostic study in persistent depressive disorder and borderline personality disorder

Adverse childhood experiences (ACE) constitute a known risk factor for suicidality. There is a research gap regarding differential patterns of associations between variants of suicidal ideations and behaviors (SIB) and characteristics of ACE in severe mental disorders. This cross-diagnostic study investigates whether SIB are related to ACE subtypes in two high-risk conditions, i.e., persistent depressive disorder (PDD) and borderline personality disorder (BPD). Inpatients with PDD (n = 117; age 40.2 years ± 12.3) and BPD (n = 74; age 26.2 ± 7.9) were assessed with the Columbia-Suicide Severity Rating Scale for suicidal ideations (SI), suicidal behaviors (SB) and actual suicide attempts (SA); ACE were recorded with the Childhood Trauma Questionnaire. In PDD, SI and SA were associated with childhood physical abuse (ORs 7.2 and 2.3, respectively). In BPD, SA were associated with severe experiences of physical abuse (OR 6.5). Weaker yet significant associations were found for childhood emotional abuse in PDD with SB (including SA), and in BPD with SA. Recall of childhood physical abuse may be clinically relevant information for identifying particular risks of SIB. Future studies should investigate these differential patterns in more depth and in terms of causality.

The rise of depression and the risk of suicide: Understanding dysphoria in modern society

Abstract Problem Depression is on the rise and can result in the intense despair that underlies suicide risk. Description of the Problem Modern society has changed in ways that disrupt personal life, reduce lasting values, and create a disconnect from close interpersonal relations. It is important to understand the prevalence of despair and the high rates of death by suicide. Results A comprehensive scoping review identified five relevant factors that play a role in the rise of distress and despair across society. First, many people rely on alcohol or drugs to temporarily suppress emotional reactions. Drug abuse has become commonplace. Further, the over-use of antidepressant medications may result in the social and emotional causes of depression remaining untreated. Second, prescription pills and guns are the most common methods used in a suicidal act and both are commonplace throughout the U.S. Third, many adults struggle with occupational stress and chronic financial worries. In addition, many adults feel their job is repetitive and mundane, providing a source of income but little benefit to person or society. Fourth, many people experience pervasive feelings of loneliness and social isolation, often feeling disconnected from family and friends. Some aspects of social isolation may be related to an excessive use of technology that has changed social interactions in ways that are not helpful. Fifth, many people have been losing hope or lack meaning in life. As society becomes filled with interpersonal conflict, political strife, and suppressed hatred, feelings of hopelessness can grow. Some people have reached a level of fatigue over the assorted crises facing the world today. Lessons The rising suicide rates are not a time-limited epidemic, but despair has become endemic to modern society, quietly undermining the emotional lives of many people. Societal changes can promote positive mental health by addressing each of these five factors. Key messages • Mental Health professionals can promote non-pharmacological means of managing stress and depression. • All fields can encourage supportive and compassionate bonds when confronted with people in distress.