Suicide Group Research Articles

Suicide pacts in the Milan district (Italy): A retrospective autopsy-based study with literature review

Suicide pacts are unique events, which involve two or more individuals. In such cases, the initiator and the addicted victim decide to end their lives together in the same place and at the same time. In the present research, on the 26,054 autopsy reports assessed at the Milan Institute of Legal Medicine from 1993 to 2020, 4596 suicides were collected. Among them, 6 cases of suicide pacts were registered, which involved two couples of friends, two couples of spouses, one couple of lovers and one couple of identical twins. Gunshots and acute poisonings were the most common suicidal methods that were adopted. Suicidal notes were documented in 4 cases, which reported the reasons and the consent of the victims. Suicidal notes clearly allow the correct identification of suicide pacts. Furthermore, they often explain the reasons which are frequently based on either psychiatric disorders or financial problems. In the other cases, the absence of farewell notes could complicate forensic investigations, especially to establish the differential diagnosis with murder-suicides without the explicit consent of the victims. In this setting, multidisciplinary skills are preferably required, including a full forensic autopsy with ancillary postmortem analyses (e.g., toxicology, histopathology, and forensic genetics). Furthermore, this study aims to discuss the suicide pacts from a medicolegal, criminological, and sociological point of view, providing a review of the literature with a comparison of our forensic cases.

Suicidal behaviour in the social environment: Does exposure moderate the relationship between an individual's own suicidal ideation and behaviour?

Suicidal behaviour still cannot be sufficiently predicted. Exposure to suicidal behaviour in the personal social environment is assumed to moderate the individual's transition from suicidal ideation to suicidal behaviour within the integrated motivational-volitional model of suicidal behaviour (IMV model). This study aimed to investigate this moderating effect in a German high-risk sample. We interviewed 308 psychiatric inpatients (53% female) aged 18 to 81 years (M = 36.9, SD = 14.30) admitted after attempted suicide (53%) or due to an acute suicidal crisis (47%) regarding exposure events in their social environment. Four types of exposure events were analysed using moderation analyses: familial suicides/suicide attempts and non-familial suicides/suicide attempts. Additionally, the numbers of reported exposure events were compared between patients with and without a recent suicide attempt as well as between patients with lifetime suicide attempts and lifetime suicidal ideation. Neither moderating effects of exposure events on the relationship between lifetime suicidal ideation and recent suicidal behaviour nor group differences between suicidal ideators and suicide attempters regarding the exposure events were found. Exposure events might have differential and possibly protective effects on suicidal behaviour-depending on type and quality (intensity, personal relevance and recency) of event-and on the outcome (suicide vs. suicide attempt).

Psychosocial factors that distinguish between men and women who have suicidal thoughts and attempt suicide: findings from a national probability sample of adults.

Previous research has highlighted the importance of understanding which psychosocial factors distinguish between those with suicide thoughts compared to those who attempt suicide. This study aims to investigate these distinguishing factors further within an ideation-to-action framework and to explore sex differences in suicide risk. Participants (n = 7546, aged 16+) were from the cross-sectional Adult Psychiatric Morbidity Survey (APMS; 2014) of England. Face-to-face and self-completion questionnaires assessed lifetime suicidal ideation, lifetime suicide attempts, demographic characteristics, life experiences, social support, health and mental illness. Multinomial logistic regression examined factors differentiating between those with suicidal ideation only and suicide attempt histories (with or without suicidal ideation) in men and women. Overall men were less likely to report suicidal thoughts and attempts, compared to females. More factors differentiated between suicidal thoughts and attempts in women compared to in men; these included hospital admission for mental illness, below degree level qualifications, being single and childhood adversity. In men, factors which significantly differentiated between suicidal thoughts and attempts included self-report of professional diagnosis of mental illness and childhood adversity. Higher levels of social support were associated with being in the suicidal thoughts group v. in the attempts group in men. This study identified some key differences between men and women in factors associated with suicide attempts compared to suicidal thoughts. The findings support the use of the ideation-to-action framework to investigate sex differences in suicidal behaviour. Future research should examine the extent to which these factors are associated with suicide risk over time.

The Relationship Between Suicide Attempts and Ideation with Depression, Insight, and Internalized Stigmatization in Schizophrenia.

Suicidal behavior is quite common in schizophrenia and various risk factors for suicide have been reported. The aim of this study was to examine the relationship between suicide attempts and ideation with depression, insight, and internalized stigmatization in patients with schizophrenia. Thirty-six patients with a history of suicide attempts and 52 patients without suicide attempts who were diagnosed as schizophrenia according to DSM-5 diagnostic criteria were included in this study. According to the score which they obtained from the eighth item of the Calgary Depression Scale for Schizophrenia, patients were divided into two groups: not suicidal ideations (zero points) and suicidal ideations (one, two, or three points). Sociodemographic information form, Positive and Negative Syndrome Scale, Calgary Schizophrenia Depression Scale, Schedule for Assessing the Three-Component of Insight, The Internalized Stigma of Mental Illness Scale, and The Suicide Ideation Scale were applied to all of the patients who participated in the study. Patients with suicide attempts were more likely to be single and had higher the Internalized Stigma of Mental Illness Scale scores compared to patients without suicide attempts. Patients with suicidal ideation had higher Positive and Negative Syndrome Scale total scores, higher Calgary Schizophrenia Depression Scale scores, and higher the Internalized Stigma of Mental Illness Scale scores than those without suicidal ideation. There was a strong, positive correlation between the Suicide Ideation Scale and Calgary Schizophrenia Depression Scale, as well as there was a moderate, positive correlation between Positive and Negative Syndrome Scale, the Internalized Stigma of Mental Illness Scale, and the Suicide Ideation Scale in the suicidal ideation group. In regression analysis, depression was found to be a predictor of suicidal ideation. Depression and internalized stigma were risk factors for suicide in schizophrenia. Risk factors need to be carefully assessed to prevent suicide in schizophrenia.

Filicide-suicide or a suicide pact? A case report from Sri Lanka with implications for child protection

The Sri Lanka Journal of Psychiatry (SLJP) is a peer-reviewed, open access journal published bi annually by the Sri Lanka College of Psychiatrists.The Journal publishes original papers, brief reports including case reports and commentaries relevant to psychiatry and allied sciences. The Sri Lanka Journal of Psychiatry is committed to maintaining and conforming to the editorial and ethical standards recommended by the International Committee of Medical Journal Editors.Cover“Perseverance”. These tenacious fishermen in Mannar continue their livelihood despite numerous difficulties. L. N. P. Samarasinghe, Acting Consultant Psychiatrist, Base Hospital Nikaweratiya, Sri Lanka.

A Study on the factor that affects juvenile’s suicidal ideation - focus on social bond factors -

이 연구에서는 청소년들의 자살충동에 영향을 미치는 다양한 요인 가운데 청소년들의 정상적 성장에 가장 중요한 영향을 미치는 부모, 교사, 친구 등과의 애착, 그리고 참여와 전념, 신념 등 사회유대이론에서 강조하는 요인들을 중심으로 어떠한 요인들이 중요한 영향요인으로 작용하는지를 분석하였다. 분석결과, 청소년들의 자살충동에 영향을 미치는 요인으로는 먼저 통제변수 가운데 성별(여성), 학교폭력 피해경험, 흡연여부, 음주여부 그리고 조절변수인 가출충동이 유의미한 영향을 미치는 가운데 독립변수에 있어서는 사회유대를 구성하는 하위요인 가운데 부모애착, 친구애착 등에서 통계적으로 유의미한 영향을 미치고 있는 것으로 나타났다. 따라서 청소년들의 자살충동을 억제하고 나아가 자살을 예방하기 위해서는 다음과 같은 정책적 방안이 수립되어야 할 것이다. 첫째, 여성 청소년들의 특수성을 고려한 고위험군 여성 청소년에 대한 맞춤형 심리지원과 자살예방 프로그램의 확대가 필요하다. 둘째, 학교폭력 역시 청소년의 자살충동에 유의미한 영향을 미치고 있으므로 학교폭력에 대해서는 기본적으로 가해학생에 대한 적정하고 엄정한 조치를 원칙으로 피해학생에 대해서는 신속한 심리적 개입과 각종 피해자 보호 지원 프로그램의 가동, 그리고 2차 피해 억제를 위한 철저한 보호를 통해 학교폭력 피해자가 더 이상의 심리적 충격에 노출되지 않도록 해야 할 것이다. 셋째, 청소년들이 경험하는 각종 스트레스와 같은 내적 갈등이 음주와 흡연, 가출충동에 영향을 미치고, 이것이 자살충동으로 이어지고 있기 때문에 음주와 흡연, 가출 등 비행행위를 유발하는 청소년들의 내적갈등을 최소화할 수 있는 제도적 지원방안이 필요할 것이다. 넷째, 기존에 제시된 다수의 논의들과 마찬가지로 이 연구에서도 애착 요인이 청소년의 자살에 유의미한 영향을 미치는 주요한 사회유대 요인으로 제시되고 있다. 따라서 부모 애착과 관련해서는 어린 시절 부터 부모와의 긍정적 애착관계를 형성하지 못하였거나 자살 고위험군으로 판별된 청소년의 경우 부모 등 보호자에 대해서도 학교, 기타 관련 상담 관련 기관과 센터에서 실시되는 프로그램에 의무적으로 참여하도록 제도화 하여 가정의 부정적 요인을 제거하도록 해야 할 것이다. 그리고 친구애착의 강화를 위해서는 학교생활 적응과 긍정적 교우관계 형성을 위한 프로그램의 확대가 필요할 것이다.This study analyzes which factors are statistically significant among the various factors that affect juvenile s suicide ideation from attachment between parent, teacher, peer group among the factors that most significantly influence juvenile s growth, to factors emphasized at the Social Bond Theory such as Commitment, Involvement, Belief. As a result, the factors that affect juvenile’ suicidal ideation were Gender(Female), School Violence Experience, Smoking Status, Drinking Status as the control variables, Runaway Impulse as the moderating variable. Additionally, as the independent variables, Parental Attachment and Peer Attachment among the sub-factors of the social bond, have statistically significant effects. Therefore, policy plans should be established for the control and prevention of juvenile’ suicidal ideation. First, the extension of customized psychological support and suicide prevention programs for the high-risk female juvenile groups considering the characteristics of female juveniles. Second, school violence also has significant effects on suicidal ideation. Therefore, for school violence, executing appropriate and strict actions against perpetrators and ensuring that victims of school violence are not exposed to psychological damages anymore through prompt psychological intervention, victim protection programs, and protection to restrain secondary victimization should be taken simultaneously. Third, because juvenile s inner conflict such as stress affects to drink, smoking and runaway which induce suicidal ideation, institutional supports that minimize juvenile s inner conflict inducing deviant behaviors are required. Forth, similar to previously suggested discussions, this study suggested that attachment are the main factor of Social Bond affecting juvenile suicide. Therefore, on the parental attachment side, in the case of a juvenile who has not established positive attachment between parents and is distinguished as a high-risk group for suicide, institutionalization that obliges guardians like parents to participate in counseling programs conducted at schools and other institutions and centers is required for eliminating negative factors from family. Additionally, for enhancing peer attachment, the extension of programs for adjusting the school environment and establishing positive peer relationships are also requested.

Association of BDNF / TrkB and NGF / TrkA Levels in Postmortem Brain with Major Depression and Suicide.

Suicide Attempts are the main complications of Major Depressive Episodes and are difficult to predict. There is still a lack of knowledge about its neurochemical aspects. There is increasing evidence that Brain-derived neurotrophic factor (BDNF) and Nerve growth factor (NGF) play a role in the pathophysiology and treatment of depression by binding and activating cognate receptors Tyrosine Kinase B (TrkB) and Tyrosie Kinase A (TrkA), respectively. This study was conducted to examine whether BDNF and / or TrkB as well as NGF and / or TrkA expression profiles were changed in the hippocampus of postmortem brain of individuals with depression who committed suicide. This study was conducted with the brain tissue of 61 victims who died as a result of suicide due to depression and 25 people who died due to traffic accidents. The psychiatric history of the cases was determined by the psychological autopsy method. Samples were taken from the hippocampus region of the brain at the forensic medicine institution. After storage under appropriate conditions, protein and mRNA levels of BDNF, TrkB, NGF and TrkA were determined in the genetics laboratory. Average age of the suicide group was 30 and the average age of the control group was 24.5. The suicide group consisted of 70.5% male and 29.5% female cases. There was no significant difference between the groups in terms of age (p=0.062) and gender (p=0.718). BDNF, NGF, TrkA and TrkB values were found to be lower in the suicide group compared to the control group and there was a significant difference between the groups (p≤0.001; p=0.001; p=0.001; p=0.011). Given the importance of BDNF and NGF and their cognate receptors in mediating physiological functions, including cell survival and synaptic plasticity, our findings regarding decreased expression of BDNF, TrkB, NGF and TrkA in both protein and mRNA levels of postmortem brains of suicide victims suggests that it may play an important role in the pathophysiological aspects of its behavior. Further studies in this context may be useful both in understanding the molecular basis of suicide and in designing therapeutic models targeting these molecular pathways.

Emotional Modulation of Response Inhibition in Adolescents During Acute Suicidal Crisis: Event-Related Potentials in an Emotional Go/NoGo Task.

Objectives. Suicide is the second leading cause of adolescent deaths and may be linked to difficulties with inhibitory and emotional processing. This study assessed the neural correlates of cognitive inhibition during emotional processing in adolescents hospitalized for a suicidal crisis. Methods. Event-related potentials were recorded during an emotional Go/NoGo task in 12 adolescents who attempted suicide and 12 age- and sex-matched healthy controls. Results. Compared to the control group, the suicidal group showed significantly reduced positivity at the time of the P3d (difference waveform reflecting NoGo minus Go trials) in response to happy and neutral, but not sad stimuli. For happy stimuli, this group difference was restricted to the right hemisphere. Further analyses indicated that the suicidal group had a reversed pattern of P3 amplitude in response to inhibition, with lower amplitudes in the NoGo compared to the Go conditions. Suicidal symptoms severity strongly correlated with lower amplitude of the P3d in response to neutral faces. Conclusions. These findings provide more insight into inhibition difficulties in adolescents with acute suicidal risk. Interactions between emotional and inhibition processing should be considered when treating acutely suicidal youths.

Three confounded high-risk groups for suicide in adolescents and young adults.

Suicide rates among adolescents and young adults have been increasing in the last decade. The current knowledge of the warning signs, risk factors, and the use of screening tools has many gaps. There are many views from within, critics, survivors, and advocacy groups to focus more on the contextual understanding of symptomatology. In clinical practice, many of these high-risk groups fail to raise the red flags due to the complex and ambiguous nature of presentations. Therefore, these groups need greater attention, and given their counter-initiative nature, they challenge the current approaches to address suicidality in adolescents and young adults.

Experience of using the molecular genetic studies to assess the risk of suicide

In the recent decades, there has been widespread the opinion that genetic markers of the suicidal behavior (suicide, suicidal attempts, suicidal thoughts) can be used to predict the suicidal behavior.The purpose of the study was to determine the possibility of using the method of molecular genetic research to assess the risk of suicide in men of 18‒27 years.The study used the case-control method. The control group included 100 men of 18‒27 years who never had mental disorders. The suicide group included the persons who committed highly traumatic methods of self-harm and were motivated to commit suicide (30 persons). DNA isolation was performed using a NucleoSpin Blood kit (Macherey‒Nagel, Germany) according to the manufacturer’s protocol. Each DNA sample was analyzed for polymorphism by allelic discrimination using the real-time polymerase chain reaction (PCR).The frequencies of occurrence of genotypes and alleles of the following genes were analyzed: HTR1A, rs6295 (G/C); BDNF, rs6265 (G/A); COMT, rs4680 (G/A); SKA2, rs7208505 (C/T); SLC6A4 (5HTT), rs25531 (T/C); 5HTR2A, rs6313 (G/A); TPH2, rs4570625 (G/T); TPH1, rs1800532 (G/T).A statistically significant difference was found for the frequency of occurrence of genotypes and alleles of the rs25531 polymorphism of the SLC6A4 (5HTT) gene. The chance of being in the suicide group with a heterozygous genotype (T/C) carriage was 2.346 times higher.The significance of the rs25531 polymorphism of the SLC6A4 (5HTT) gene for the formation of the suicidal behavior was confirmed.

A longitudinal study of relationship between family conflict and suicidal behavior in adolescents

Objective: To explore the relationship between family conflict and adolescent future suicidal behavior. Methods: A total of 7 072 adolescents who participated in the baseline survey and the first follow-up survey of Shandong Adolescent Behavior and Health Cohort were included in the analysis. They were sampled from 8 middle schools in 3 counties of Shandong province, China. A self-reported questionnaire was used to measure suicidal behavior, family conflict, depression, and demographic characteristics. Logistic regression model was used to analyze the relationship between family conflict and suicidal behavior. Results: In the baseline survey, the age of 7 072 subjects was (14.58±1.45) years, and boys and girls accounted for 50.0% respectively. 750 people (10.6%) had any suicidal behavior, of which 707 (10.0%), 258 (3.6%) and 190 (2.7%) had suicidal ideation, suicide planning and suicide attempt, respectively. The family conflict scores of the suicidal group were higher than those of the non-suicidal group. After adjusting for covariates, logistic regressions showed that family conflict was associated with increased risk of suicidal behavior (OR=1.05, 95%CI: 1.01-1.10), suicidal ideation (OR=1.05, 95%CI: 1.00-1.09), suicide planning (OR=1.08, 95%CI: 1.01-1.16) and suicide attempt (OR=1.10, 95%CI: 1.02-1.19). Further stratified by gender, results showed no significant association between family conflict and suicidal behavior in girls; the association of family conflict with suicidal behavior was more significant in boys, especially for suicidal ideation and suicide planning, and the OR value of the latter was higher than the former. The results were stable after sensitivity analysis in males. Conclusions: Family conflict might increase the risk of adolescent suicidal behavior, especially in males. Harmonious family environment and good family atmosphere are of great significance to adolescent suicide prevention and control.

An outlook on suicide enzyme inhibition and drug design

There have been recent renewed interests in the importance of suicide enzyme inhibition. The principal objective of this review is to investigate all types of suicide inhibitions for natural enzymes, artificial biocatalysts as well as therapeutic potential of enzyme suicide inhibition. It is discussed the suicide inhibition beneficial in drug design and treatments and non-beneficial achievements for some industrial enzymes such as HRP peroxidase enzyme. The design of biomimetic artificial enzymes explained to prevent inhibition by protecting the active site via environmental conditions. Suicide enzyme inhibition development can be the key mechanism against sever diseases such as SARS. In this report, suicide enzyme inactivation classes are classified based on target enzyme groups via their substrates.Graphic abstractSuicide substrate deceives enzyme by its shape similarity to normal substrate and after interaction with enzyme, its suicidal functional group appears (e.g., Trojan horse).

Development of a Suicide Prediction Model for the Elderly Using Health Screening Data.

Suicide poses a serious problem globally, especially among the elderly population. To tackle the issue, this study aimed to develop a model for predicting suicide by using machine learning based on the elderly population. To obtain a large sample, the study used the big data health screening cohort provided by the National Health Insurance Sharing Service. By applying a machine learning technique, a predictive model that comprehensively utilized various factors was developed to select the elderly aged > 65 years at risk of suicide. A total of 48,047 subjects were included in the analysis. Individuals who died by suicide were older, and the number of men was significantly greater. The suicide group had a more prominent history of depression, with the use of medicaments significantly higher. Specifically, the prescription of benzodiazepines alone was associated with a high suicide risk. Furthermore, body mass index, waist circumference, total cholesterol, and low-density lipoprotein level were lower in the suicide group. We developed a model for predicting suicide by using machine learning based on the elderly population. This suicide prediction model can satisfy the performance to some extent by employing only the medical service usage behavior without subjective reports.

Brain 5-HT1A Receptor PET Binding, Cortisol Responses to Stress, and the Familial Transmission of Suicidal Behavior.

BackgroundThe serotonin 1A (5-HT1A) receptor has been implicated in depression and suicidal behavior. Lower resting cortisol levels are associated with higher 5-HT1A receptor binding, and both differentiate suicide attempters with depression. However, it is not clear whether 5-HT1A receptor binding and cortisol responses to stress are related to familial risk and resilience for suicidal behavior.Methods[11C]CUMI-101 positron emission tomography imaging to quantify regional brain 5-HT1A receptor binding was conducted in individuals considered to be at high risk for mood disorder or suicidal behavior on the basis of having a first- or second-degree relative(s) with an early onset mood disorder and history of suicidal behavior. These high-risk individuals were subdivided into the following groups: high risk resilient having no mood disorder or suicidal behavior (n = 29); high risk with mood disorder and no suicidal behavior history (n = 31); and high risk with mood disorder and suicidal behavior (n = 25). Groups were compared with healthy volunteers without a family history of mood disorder or suicidal behavior (n = 34). Participants underwent the Trier Social Stress Task (TSST). All participants were free from psychotropic medications at the time of the TSST and PET scanning.ResultsWe observed no group differences in 5-HT1A receptor binding considering all regions simultaneously, nor did we observe heterogeneity of the effect of group across regions. These results were similar across outcome measures (BPND for all participants and BPp in a subset of the sample) and definitions of regions of interest (ROIs; standard or serotonin system-specific ROIs). We also found no group differences on TSST outcomes. Within the high risk with mood disorder and suicidal behavior group, lower BPp binding (β = −0.084, SE = 0.038, P = .048) and higher cortisol reactivity to stress (β = 9.25, 95% CI [3.27,15.23], P = .004) were associated with higher lethality attempts. There were no significant relationships between 5-HT1A binding and cortisol outcomes.Conclusions5-HT1A receptor binding in ROIs was not linked to familial risk or resilience protecting against suicidal behavior or mood disorder although it may be related to lethality of suicide attempt. Future studies are needed to better understand the biological mechanisms implicated in familial risk for suicidal behavior and how hypothalamic-pituitary-adrenal axis function influences such risk.

Suicide after reception into prison: A case-control study examining differences in early and late events

Objective Prisoners constitute a high-risk group for suicide, with suicide rates about 5 to 8 times higher than in the general population. The first weeks of imprisonment are a particularly vulnerable time, but there is limited knowledge about the risk factors for either early or late suicide events. Methods Based on a national total sample of prison suicides in Germany between 2005 and 2017, suicides within the first 2 (4 and 8) weeks after reception into prison were matched by age and penalty length with cases that occurred later. Factors that potentially influence the timing of suicide were investigated. Results The study has shown that 16.7% (31.5%) of all 390 suicides in German prisons occurred within the first two weeks (two months) of imprisonment. Factors that facilitate adaptation to the prison environment (e.g. prior prison experience) were negatively associated with early suicide events. Factors that hindered the adaptation process (e.g. withdrawal from illicit drugs) were observed more frequently in early suicide events than in late ones. These factors are active at different times of imprisonment. Conclusion At reception, particular attention should be paid to the following factors associated with early suicide events: widowed marital status, lack of prison experience, and drug dependency.

The Relationship Between Suicide Attempt and Gonadotropins, Gonadal Hormones, and Cortisol in Females.

The aim of this study was to examine the relationship between suicidal behavior and gonadotropins, gonadal hormones, and cortisol in females. The study included 3 groups of 23 females each, aged 18-45 years; one group comprising those who had attempted suicide, another group of females matched for age, menstrual phase, and body mass index, with depression but no suicidal tendencies, and a control group of 23 healthy females. For all participants, a sociodemographic information form was completed, and the Beck Depression Inventory, the Beck Anxiety Inventory, and the Beck Hopelessness Scale were used. Blood samples were taken at 8 am (in the attempted-suicide group, within 24 hours of the attempt), and follicle-stimulating hormone, luteinizing hormone, estradiol, testosterone, progesterone, and cortisol levels were measured. No statistically significant differences were observed between the groups with respect to gonadotropin and gonadal hormone levels. There were statistically significant differences in the cortisol levels between the attempted suicide and control groups and between the depression and control groups (P < .05). The cortisol levels negatively correlated with all scale scores. Studies on suicidal patients should pay more attention to the potential role of hypocortisolism. More studies with larger samples are needed to investigate the relationship between gonadotropins, gonadal hormones, and suicidal behavior.

Life Events and Coping Strategies Among Young People Who Died by Suicide or Sudden Violent Death.

Objective: Most empirically anchored psychological models of suicide focus either on the perceived situational stress or on vulnerability factors and coping deficits. The interaction between life stressors and vulnerability factors is less explored.Methods: This case-control study examines interactions between life events and coping strategies in three groups of young people: cases of suicide, cases of other sudden violent death (SVD), and control cases.Results: Four coping strategies, two more adaptive and two more maladaptive, were identified. Distinctive of the suicide and the SVD group was significantly less Planful Problem-Solving, and more Escape-Avoidance and Confrontive Coping than among the controls. Furthermore, Confrontive Coping had significantly higher level in the SVD group than in the suicide group. Between-group differences were partly accounted for differences in negative life events, early and late in life. Both target groups experienced significantly more adverse childhood experiences and recent stressful life events than the controls—the suicide group being more exposed to recent stressful life events even in comparison with the SVD group. This might indicate that adverse childhood experiences are a risk factor for both causes of death, whereas proximal stressful life events are a risk factor for death by suicide to a higher degree than for SVD.Conclusions: Improved understanding of the interplay between life events, both in the far past and present, and coping styles, may facilitate the identification of young people at risk of suicide and violent death.

Suicidal behavior in German military service members: An analysis of attempted- and completed suicides between 2010 and 2016.

Studies identified service members of the United States (US) Armed Forces as a high-risk group for suicide. A significant increase in the suicide rate in the US Armed Forces was found in recent years. To date, there is no military suicide statistic available for the German Armed Forces. This study examined attempted and completed suicides in active service members of the German Armed Forces between 2010 and 2016 retrospectively, on the basis of archived personal and medical records in the central archives of the Medical Service of German Armed Forces. The primary goal was to establish a suicide-statistic for the German Armed Forces and to calculate and compare the suicides rates with the German population. Secondary every case’s data was analysed the groups of attempted and completed suicides were compared. 262 attempted suicides and 148 completed suicides were included in this study (N = 410). The suicide rates of the German Armed Forces peaked over the years 2014–2015 with a suicide rate of 15–16/100.000 active military service members and exceeded the civilian suicide rate in Germany of around 12/100.000 people during those years, although no general trend could be determined. These service members were mostly young men (attempted suicide 81.7%, completed suicide 99.3%), at the age of 17 - <35 years old (87% attempted suicide, 68,3% completed suicide), and were employed less than 6 years in the German Armed Forces (attempted suicide 72.9%, completed suicide 46.3%). Service members with attempted suicides belonged mostly to the military North Atlantic Treaty Organization (NATO)-rank-group for other ranks (lowermost military professionals) OR-1 –OR-4 (48.1%) or to the rank-group OR-6 –OR-9 in the group of completed suicides (34.5%). Only in about one third of cases a psychiatric diagnosis could be found in the records. Most frequent diagnoses were neurotic, stress-related and somatoform disorders (International Classification of Diseases Tenth Revision^ICD-10: F4) in 46.8%, and affective disorders (ICD-10: F3) in 43.3% of all cases. In the majority of cases there were signs for potential stressors in the private sector (attempted suicide 90.6%, completed suicide 82.6%). No typical risk factors which would enable a specific prevention could be identified in this analysis. Therefore, should preventive strategies be aiming at a multi-level intervention program.

Resilience and vulnerability factors influence the cortisol awakening response in individuals vulnerable to suicide

Suicide is a global health issue. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, has been identified as one potential risk factor. Evidence is emerging to suggest that different psychological factors may be associated with increased resilience and vulnerability in this context. The current study investigated whether trait resilience, social support, socially prescribed perfectionism, trait worry and trait impulsivity influenced the cortisol awakening response (CAR) over a 7-day study in individuals vulnerable to suicide. 142 participants with a history of suicidal attempt or ideation (suicide vulnerability group; n = 95) and with no suicide risk history (control group; n = 47) were recruited. Participants completed baseline questionnaires before commencing a 7-day study where they provided cortisol samples immediately upon waking, at 15 min, 30 min and 45 min on 7 consecutive days. Higher worry, socially prescribed perfectionism and impulsivity, lower resilience and social support were found in the suicide vulnerability group compared to the control group. Lower levels of resilience, higher levels of socially prescribed perfectionism, worry and impulsivity were associated with significantly lower total CAR. Suicide group membership was also found to have an indirect effect on total CAR via trait worry. The current findings show for the first time, that these well-known psychological risk factors for suicide are associated with smaller total cortisol awakening responses. Researchers ought to elucidate the precise causal mechanisms linking these traits, CAR and suicide risk in order to develop interventions to help build resilience in vulnerable populations.

Characteristics and Risk Factors for Suicide in People with Schizophrenia in Comparison to Those without Schizophrenia

BackgroundLittle research has been conducted that compares suicide cases with and without schizophrenia. The aim of the present study was to identify demographic, personal, social, relational, and psychological characteristics among suicides identified posthumously with schizophrenia compared to those without. MethodsThe DSM-IV was used to independently assess the presence of schizophrenia among suicide cases by two psychiatrists. Data on risk factors was collected through a psychological autopsy method, which included structured interviews of two informants for each suicide case (a family member and a close friend). Interview questions included demographic characteristics, suicide risk factors, the Beck Hopelessness Scale, Dickman's Impulsivity Inventory, the Spielberger State-Trait Anxiety Inventory, the Hamilton Depression Scale and the Duke Social Support Inventory. ResultsThe prevalence of schizophrenia was 9.69% among suicide cases in this sample. The schizophrenia suicide group was more likely to be female, older, in poorer physical health, suffer from chronic disease, suffer other psychological disorders, and have a family history of psychological disorders compared to those not diagnosed schizophrenia. Other important risk factors included more frequent past suicide attempts, increased levels of depression and anxiety, lower levels of impulsivity, lower help seeking from friends, and lower social interaction social support. ConclusionsThere is a notable link between schizophrenia and suicide in China. Identification of social, personal, relational, and psychological risk factors could beneficially guide attempts to improve future preventive measures against suicide among those with schizophrenia in China.