Suicide Attempts In Patients Research Articles

Psychological distress and attitudes of emergency personnel towards suicide attempters

Emergency personnel attitudes towards suicide attempters are important because they have a key role in the management of these patients. We examined the association between staff members’ psychological distress and the attitudes towards suicide attempters. We also compared the attitudes towards suicide attempters among emergency personnel between a general and a psychiatric hospital. The Understanding Suicidal Patients (USP) Questionnaire and the 12-item version of General Health Questionnaire were given to all staff in the emergency rooms of a general hospital and a psychiatric hospital (n=151). There was a general tendency among emergency room staff to view attempted suicide patients positively and sympathetically. However, there were clear differences in staff attitudes between the two hospitals: those working in the general hospital expressed more negative attitudes than those in the psychiatric hospital. No evidence emerged of association between staff members’ psychological distress and negative attitudes towards suicide attempters. There was no association between psychological distress and negative attitudes towards suicide attempters.

Relevance of Family History of Suicide in the Long-Term Outcome of Bipolar Disorders

This study examined the association between family history of completed suicide and suicidal behavior and other clinical variables in subjects with bipolar disorder. 374 outpatients aged from 19 to 88 years (mean +/- SD age = 41.9 +/- 4.1 years) (54.3% female) meeting DSM-IV criteria for bipolar disorder type I or II or schizoaffective disorder, bipolar subtype, were included in the study. Forty-eight subjects with a family history of completed suicide were compared to 326 subjects without a family history of completed suicide regarding several clinical and demographic variables. The study was conducted from 2001 to 2004. There were no statistically significant demographic differences between bipolar disorder subjects with and without a family history of suicide. Bipolar disorder subjects with a family history of suicide showed higher rates of cluster C personality disorders than subjects without a family history of suicide (14.9% vs. 2.5%, OR = 6.72, 95% CI = 2.31 to 19.51, p < .001). Subjects with a family history of suicide also demonstrated a significantly greater lifetime prevalence of suicide attempts (52.2% vs. 25.5%, OR = 3.19, 95% CI = 1.7 to 6.0, p < .001). Results remained significant after controlling for all possible interactions. Family history of completed suicide is a significant risk factor associated with suicidal attempts in patients with bipolar disorder. These findings underscore the importance of identifying patients with a family history of suicide in order to provide prompt treatment and careful follow-up.

Evaluation of attempted-suicide management in a rural district of KwaZulu-Natal

&lt;p&gt;&lt;strong&gt;Objectives.&lt;/strong&gt; Critical aspects in the management of attempted-suicide patients have been identified in the literature. The aim of this study was to determine which of these aspects were included in the management of patients who attempted suicide in a rural district of KwaZulu-Natal.&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design.&lt;/strong&gt; Descriptive study. Setting. The two hospitals in a rural district of KwaZulu-Natal.&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Subjects.&lt;/strong&gt; Attempted-suicide patients admitted to the above two hospitals between 1 June 2001 and 31 March 2002.Outcome measures. Patients were interviewed regarding how they were managed and were followed up until 3 months after the attempted suicide.&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results.&lt;/strong&gt; Medicine was given to 41% of participants on admission and 64% were counselled by a doctor. A no-suicide contract was entered into in 42% of counselled cases. Family therapy, social worker involvement and psychiatric referral were very low and there was no involvement of friends, teachers or priests.&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion.&lt;/strong&gt; Management of patients who attempted suicide in this district is inadequate as there are no proper policy guidelines. It is important that health caregivers be trained in psychiatry.&lt;/p&gt;

Attitudes of general hospital emergency room personnel towards attempted suicide patients

The aim of this study was to compare the attitudes of emergency room staff towards patients who have attempted suicide between two general hospitals, one with psychiatric consultation available and the other without. The Understanding Suicidal Patients (USP) Questionnaire was given to all staff in the emergency rooms of Jorvi Hospital (in the city of Espoo, with routine psychiatric consultation) and Malmi Hospital (in the city of Helsinki, without routine psychiatric consultation) (n=115). There were clear differences in staff attitudes between the hospitals. Female gender, older age and working in Malmi Hospital without routine psychiatric consultation were associated with more positive attitudes towards attempted suicide patients. Surprisingly, only working in Jorvi Hospital was associated with more negative attitudes. Differences in attitudes towards suicide attempters between personnel working in the different hospitals were found. Further investigation is needed to find the ideal psychiatric consultation arrangement for suicide attempters in good cooperation with emergency room staff.

Soluble Interleukin 2 Receptor Levels, Temperament and Character in Formerly Depressed Suicide Attempters Compared with Normal Controls

An imbalance of the immune system and mixed personality profiles in suicide attempters have been reported. As suicidal behavior is common in patients with psychiatric disorders within the spectrum of depressive features, in this study we measured soluble interleukin-2 receptor concentrations in plasma (sIL-2R) and investigated temperament and character profile and their potential correlation in formerly depressed patients with a history of suicide attempt. We studied sIL-2R levels in plasma and personality characteristics (using Cloninger's Temperament and Character Inventory [TCI]) of formerly depressed patients who had attempted suicide a mean of 3 years previously (n = 25), and age and gender matched normal controls (n = 25). There was no significant difference in sIL-2R levels between formerly depressed suicide attempters and age and gender matched normal controls (0.23 ng/ml +/- 0.25 vs. 0.19 ng/ml +/- 0.16). When compared to normal controls, suicide attempt patients had a significantly higher score on the temperament dimension "harm avoidance" and a lower score on the character dimension "self-directedness." No significant correlation was found between sIL-2R values and TCI dimensions. We propose that the liability to suicidal behavior among suicide attempters susceptible to depressive symptomatology may be related to high harm avoidance and low self-directedness.

群馬大学医学部附属病院に収容された自殺企図患者の実際

【背 景】 近年, 自殺企図患者が増加している. 群馬大学医学部附属病院救急外来における自殺企図症例について分析した. 【対象・方法】 平成16年1月から12月に当院救急部に搬送, 受診された自殺企図患者の診療録を調査した. 【結 果】 当該期間に受診した全救急患者数は4068例であり, そのうち自殺企図症例は47例で, 複数回受診した患者は4名であった. 年齢別では男女共に20代が最も多く, ついで男性は50代, 女性は30代であった. 自殺企図に用いられた手段として薬物・毒物が27例, 刃物を用いての自傷15例, 縊頸が4例, 高所からの投身未遂が1例であった. 外来診察にて帰宅可能であった症例は23例であり, 入院が必要な症例は20例, 救急外来での死亡は4例であった. 【結 語】 自殺企図患者の診察には精神科医との連携が重要である. また, 中高年の自殺企図も多く, 社会的な問題も懸念される.

After the Attempt: Maintaining the Therapeutic Alliance Following a Patient's Suicide Attempt

The risk of a patient's suicide is a prominent occupational hazard for psychotherapists. The precise number of patients who attempt suicide while in treatment and then resume therapy with the same therapist is not known, but this situation is a relatively common occurrence in clinical practice. Such scenarios can pose significant challenges to the reestablishment of the therapeutic trust and a workable treatment alliance. The aim of this paper is to identify the challenges facing a clinician treating a patient who resumes therapy following a serious suicide attempt, and to offer guidelines for maintaining the viability of the therapeutic alliance.

PII: S0022-3999(05)00155-8

The aim of this study was to evaluate whether deep white matter hyperintensities (DWMH) and periventricular white matter hyperintensities (PVH) are associated with suicidal behavior in patients with major affective disorders. Subjects were 99 consecutively admitted inpatients (42 men; 57 women; mean age: 46.5 years [SD = 15.2; Min./Max. = 19/79]) with a diagnosis of major affective disorder (bipolar disorder type I, bipolar disorder type-II and unipolar major depressive disorder). 44.4% of the participants had made at least one previous suicide attempt. T2-weighted brain magnetic resonance images were rated for the presence and extension of WMH using the modified Fazekas scale. Patients were interviewed for clinical data on average 5 days after admission. Bivariate analyses, corrected for multiple-testing, and logistic regression analysis were used to test the association between suicide attempts and clinical variables. Attempters and nonattempters differed only in the presence of PVH—the former were more likely to have PVH. The logistic regression indicated that the presence of PVH was robustly associated with suicidal behaviors after controlling for age (OR: 8.08). In conclusion, neuroimaging measures may be markers of risk for suicidal attempts in patients with major affective disorders.

Suicidal ideation and attempts in patients with major depression: Sociodemographic and clinical variables

Background:There is a high risk of suicidal attempt in patients with depression. This risk varies according to the sociodemographic status and clinical presentation.Aim:To assess the prevalence of suicidal ideation and attempt in patients with major depressive disorder, and to find the correlation between the two.Methods:Sixty patients with major depressive disorder having suicidal ideation were recruited in the study. Of these, 10 had a history of suicidal attempt made in the past or current episode. Sociodemographic details were evaluated and the Hamilton Rating Scale for Depression (HAM-D) was administered.Results:Analysis of the data showed that the incidence of suicidal attempt was 16.6% in patients with suicidal ideation. Statistically, a higher risk of suicidal attempt was found in individuals <30 years of age. Single men, married women and students were more likely to attempt suicide; higher education was also a vulnerability factor. Attempters scored significantly higher in severity of suicidal ideation, agitation and paranoid symptoms whereas among non-attempters, hypochondriasis and general somatic symptoms were more often present.Conclusion:All patients expressing suicidal ideation do not attempt suicide. Young patients with depression, especially unmarried men, married women and students, having severe suicidal ideation with agitation or paranoid symptoms are more likely to attempt suicide.

Variables associated with hospitalization decisions by emergency psychiatrists after a patient's suicide attempt.

This study explored the factors psychiatrists considered in deciding on hospitalization for a large sample of suicide attempters in the emergency department of a general hospital in Madrid, Spain, between 1996 and 1998. Psychiatrists assessed 509 patients who had attempted suicide; 196 of these (39 percent) were hospitalized in the psychiatric unit, and 313 (61 percent) were discharged from the emergency department. The assessment included Beck's Suicidal Intent Scale (SIS) and a checklist of 47 clinical variables. Of the 32 clinical variables significantly associated with hospitalization that were introduced in a logistic regression model, 11 remained significant. Six variables were associated with an increased odds of hospitalization: intention to repeat the attempt, plan to use a lethal method, low psychosocial functioning before the suicide attempt, previous psychiatric hospitalization, a suicide attempt in the past year, and planning that nobody would try to save their life after they had attempted suicide. Five variables decreased the odds: a realistic perspective on the future after the attempt, relief that the attempt was not effective, availability of a method to kill oneself (that was not used), belief that the attempt would influence others, and family support. Models based on the SIS total score and individual SIS items had lower specificity and sensitivity. Psychiatrists appear to rely on patients' self-report in deciding on hospitalization rather than focus on demographic, diagnostic, or psychosocial issues. If the findings of this study were replicated in other hospital settings, the implication would be that the guidelines for assessing suicide attempts need to encourage thorough and detailed assessment of the attempt and the future plans.

In This Issue

In This Issue

Clinical evaluation of prior suicide attempts and suicide risk in psychiatric inpatients.

In practice psychiatrists rely on their own experience and intuition to evaluate the suicide potential of individual patients, but the algorithms for the decision-making process remain unclear. (1) to establish models for the decision making process for evaluating suicide risk; (2) to simulate the impact of information concerning the number of previous suicide attempts on the clinician's ability to detect patients who performed medically serious suicide attempts (MSSAs). Four decision models (linear, dichotomized, hyperbolic, and undifferentiated) depicting the influence of the number of previous suicide attempts on the clinician's recognition of MSSAs in 250 psychiatric inpatients were elicited and tested by a series of discriminant analyses. The dichotomized model ("all or none") was found to be the most efficient in detecting medically serious suicide attempts. The "all or none" paradigm seems to be the most appropriate way to evaluate the weight of previous suicide attempts in the decision-making process identifying medically serious suicide attempt patients.

Low serum cholesterol is correlated to suicidality in a Korean sample.

The aim of this study was to examine further the association between low total serum cholesterol and suicidal behaviour. We measured the serum cholesterol levels in 231 patients admitted to an emergency room following a suicide attempt, in 231 age-,sex- and diagnosis-matched non-suicidal psychiatric controls, and in 231 age- and sex-matched normal controls. The suicide attempt patients were divided into five grades according to the degree of injury. The mean total cholesterol level of the suicide attempt patients was significantly lower than that of the psychiatric and normal controls. When the suicide attempt patients and non-suicidal psychiatric controls were divided by diagnosis, this significant relationship held true for major depressive disorders and personality disorders, but not for schizophrenia and bipolar disorders. Cholesterol level and the severity of suicide attempt were inversely correlated. The results suggest that cholesterol level may serve as a marker for suicide risk. Possible explanations are discussed.

Prefrontal 5-HT 2a receptor binding index, hopelessness and personality characteristics in attempted suicide

Background: Depression, hopelessness, impaired problem solving capacities and deficient serotonergic functions have been identified as major causes of suicidal behaviour. In general, the relation between biological markers of attempted suicide and psychological functions has been investigated using indirect peripheral markers of, e.g. the serotonergic system. Recently, functional neuroimaging techniques with radioligands allow direct in vivo assessment of the neurobiological status of the central nervous system. Methods: We studied the binding index of serotonin- 2a (5-HT 2a) receptors in the frontal cortex of attempted suicide patients ( n=9) and normal controls ( n=13) using [ 123I]5-I-R91150, a highly selective 5-HT 2a receptor ligand. Moreover, we measured personality characteristics (using Cloninger’s Temperament and Character Inventory) and levels of hopelessness (using Beck’s Hopelessness Scale), and studied the association between 5-HT 2a receptor binding index, hopelessness and these personality dimensions. Results: When compared to normal controls, attempted suicide patients had a significantly lower binding potential of frontal 5-HT 2a receptors, a higher level of hopelessness, a higher score on the temperament dimension harm avoidance and lower scores on the character dimensions self-directedness and cooperativeness. A significant correlation was found between harm avoidance, hopelessness and binding index in the population of patients that attempted suicide. Limitations: The limited number of patients and potential ingestion of psychotropic drugs may influence the results of the study. Conclusions: Lower central serotonergic function, hopelessness and harm avoidance are interrelated phenomena, which may increase the probability of the occurrence of attempted suicide.

Training program in suicide prevention for psychiatric nursing personnel enhance attitudes to attempted suicide patients

Attitudes of psychiatric nursing personnel towards patients who had attempted suicide were examined before and after a training program in psychiatric suicide prevention. The attitudinal changes were measured by a newly constructed scale, the understanding of suicide attempt patients scale (USP-scale), and responses to three brief clinical vignettes. General understanding and willingness to nurse, as measured by the USP-scale, increased significantly, and the suicide risk of patients described in case vignettes was estimated more accurately after the program. The results suggest that it may be possible to enhance attitudes to attempted suicide patients among psychiatric nursing personnel.

Emergency physicians and physician-assisted suicide, part II: Emergency care for patients who have attempted physician-assisted suicide

Part I of this article reviewed key terms, events, and arguments in the heated national debate regarding physician-assisted suicide (PAS). Part II of the article examines the role of emergency physicians in caring for patients who present to the emergency department after an incomplete or unsuccessful attempt at PAS. The article considers the analogous cases of emergency care for other patients who have attempted suicide and care for terminally ill patients who refuse life-sustaining treatment. Morally relevant features of these situations are identified, including the decisionmaking capacity and the choices of the patient, the opinions of the patient's family or other surrogate decisionmakers, the presenting condition and medical history of the patient, the nature of the patient's suicide attempt, and the physician's own moral convictions. The article evaluates the 3 management options: aggressive intervention to preserve life, palliative care only, and assistance in completing the suicide. It concludes with several general recommendations for addressing these situations. [Moskop JC, Iserson KV. Emergency physicians and physician-assisted suicide, part II: emergency care for patients who have attempted physician-assisted suicide. Ann Emerg Med. November 2001;38:576-582.]

Suicide attempts in a Nigerian military setting.

To describe the characteristics of patients who attempted suicide in a military setting and to examine the differences between the suicide attempters and a group of non-suicide, affective disorder patients. Fifty one consecutive cases of suicide attempts were studied using a questionnaire which inquired about demographic characteristics and suicide related issues such as method of attempt used and giving a notice. The suicide attempt group was then compared with a control group who had no history of attempted suicide. Department of Psychiatry, Military Hospital, Yaba, Lagos, Nigeria, which is a 500-bed military general hospital. Fifty one attempted suicide patients. Intervention reports on intervention methods applied were not within the scope of this report. These were also not within the scope of the present study. Suicide attempt patients constituted 0.37% of all admissions during a five-year period, and 60.8% of them were under the age of 30 years. The numbers of male and female patients were approximately the same. Depression and acute stress reaction were the commonest diagnoses. While military dependents most commonly ingested substances in their suicide attempts, military personnel most often used more violent methods including hanging and self-stabbing, but none used firearms. Compared with non suicide patients, suicide attempt ones were more likely to be unmarried and to have a family history of mental disorder but less likely to have lost a parent through death before the age of 18 years. The need for a more controlled access to substances capable of being used for self-destruction was highlighted. The need for emergency room doctors to become more skilfull in the identification and assessment of suicide attempt patients was also emphasized.

Decreased frontal serotonin 5-HT2a receptor binding index in deliberate self-harm patients

Studies of serotonin metabolites in body fluids in attempted suicide patients and of post-mortem brain tissue of suicide victims have demonstrated the involvement of the serotonergic neurotransmission system in the pathogenesis of suicidal behaviour. Recently developed neuroimaging techniques offer the unique possibility of investigating in vivo the functional characteristics of this system. In this study the 5-HT2a receptor population of patients who had recently attempted suicide was studied by means of the highly specific radio-iodinated 5-HT2a receptor antagonist 4-amino-N-[1-[3-(4-fluorophenoxy) propyl]-4-methyl-4-piperidinyl]-5-iodo-2-methoxybenzamide or 123I-5-I-R91150. Nine patients who had recently (1-7 days) attempted suicide and 12 age-matched healthy controls received an intravenous injection of 185 MBq 123I-5-I-R91150 and were scanned with high-resolution brain single-photon emission tomography (SPET). Stereotactic realigned images were analysed semi-quantitatively using predefined volumes of interest. Serotonin binding capacity was expressed as the ratio of specific to non-specific activity. The cerebellum was used as a measure of non-specific activity. An age-dependent 5-HT2a binding index was found, in agreement with previous literature. Deliberate self-harm patients had a significantly reduced mean frontal binding index after correction for age (P=0.002) when compared with controls. The reduction was more pronounced among deliberate self-injury patients (DSI) (P<0.001) than among deliberate self-poisoning patients (DSP). Frontal binding index was significantly lower in DSI patients than in DSP suicide attempters (P<0.001). It is concluded that brain SPET of the 5-HT2a serotonin receptor system in attempted suicide patients who are free of drugs influencing the serotonergic system shows in vivo evidence of a decreased frontal binding index of the 5-HT2a receptor, indicating a decrease in the number and/or in the binding affinity of 5-HT2a receptors.

One-year follow-up of significant others of suicide attempters.

In a previous study we interviewed significant others (SOs) directly following a patient's suicide attempt as a part of the psychiatric assessment. SOs added important information to the assessment and they needed professional counselling themselves. In the present study the opinions of SOs were investigated 1 year after a suicide attempt. Semi-structured interviews of 84 SOs (93% of a consecutive series) were performed by telephone, focusing on the patient's situation, their own involvement in care and treatment as well as their own well-being and need for support. Forty-four percent of the SOs were parents, 27% partners and 29% persons with other relationships. An independent researcher interviewed the patients. According to SOs, 63% of the patients had mental health problems and 80% had other kinds of problems (e.g. relationship problems, financial problems, unemployment and substance abuse) at follow-up. A majority of SOs were worried that the patient was going to hurt their self again. There were differences in the information given by patients and SOs concerning suicide attempts during the follow-up period. Many SOs had questions about the suicidal behaviour, and nearly half of the SOs reported that they had not talked to the patient about the index suicide attempt. Nearly half of the SOs would like to have had professional counselling, preferably shortly after the suicide attempt. Two-thirds of the inpatient SOs and 90% of the outpatient SOs had not been involved in the patient care and treatment, although a majority of them desired such involvement. The well-being of the SOs was generally good, except for a small subgroup. The findings of this study provide further evidence that SOs contribute valuable information about the patient after a suicide attempt. They also point strongly to the fact that SOs themselves need support. Insufficient communication between patient and SOs indicates the need for joint counselling directly after a suicide attempt in order to reduce some of the burden and stress experienced by SOs.

Gunshot wounds of the face in attempted suicide patients

Gunshot wounds of the face in attempted suicide patients