Suicide Prevention In Patients Research Articles

Validation and application of the Chinese version of the Columbia-Suicide Severity Rating Scale: Suicidality and cognitive deficits in patients with major depressive disorder

BackgroundDepression is a significant risk factor for death by suicide. Additionally, patients with depression who have neurocognitive dysfunction are at a higher risk of exhibiting suicidal behaviors. We aimed to validate the Chinese version of the Columbia Suicide Severity Rating Scale (C-SSRS) and then employ it to examine the association between suicidality and cognitive deficits in patients with Major Depressive Disorder (MDD). MethodsData from 456 patients with MDD who underwent baseline assessment and 3-month follow-up were used for psychometric validation of the C-SSRS. 430 patients were divided into a mild cognitive impairment group (N = 390) and a severe cognitive impairment group (N = 40) using cluster analysis and compared with healthy controls. The relationship between C-SSRS scores and the degree of cognitive impairment was analyzed. Results1) The Chinese version of C-SSRS demonstrated good internal consistency (Cronbach's alpha = 0.884/0.842), convergent and divergent validity. 2) The severity of suicidal ideation (SI), the intensity of SI, and the lifetime history of suicide attempts were significant independent predictors of short-term suicide attempts. 3) Higher worst-point lifetime SI severity and intensity scores in patients with MDD were significantly associated with severe cognitive impairment. LimitationsThe analysis of cognition and suicide was based on cross-sectional studies. Hence, changes in SI and cognitive function over time could not be analyzed. ConclusionsThe Chinese C-SSRS is a reliable and valid assessment tool for suicidal ideation and behavior in patients with depression. Suicidal ideation in patients with MDD is associated with cognitive dysfunction. These findings provide a reference for suicide prevention in patients with depression.

Telephone-Delivered Interventions for Suicide Prevention in Schizophrenia and Related Disorders: A Systematic Review

IntroductionSuicide is a health concern among individuals diagnosed with schizophrenia. Telehealth technology has become an emerging intervention that may afford opportunities for reaching this at-risk group. Consideration of the implementation of telehealth systems in the treatment of patients diagnosed with schizophrenia and suicidal behavior calls for a review of the evidence.ObjectivesThe present aim was to explore the literature on the effectiveness of suicide prevention telephone delivered interventions among patients with schizophrenia and related disorders.MethodsThe bibliographic search was performed in the electronic databases PubMed, PsycInfo, Scopus, and Web of Science following PRISMA guidelines. Two reviewers independently conduct screenings, data extraction and methodological quality assessment. A total of 352 articles were retrieved, of which five studies met the eligibility criteria.ResultsBased on the limited data available, the use of modalities involving telephone contacts appears to be feasible in patients with schizophrenia and suicidal behaviors. In addition, preliminary evidence suggests this system appears to reduce suicidal ideation.ConclusionsThe current data presented here reflect an early stage of effectiveness of telephone-delivered interventions targeted at suicide prevention in patients with schizophrenia. Further research is needed to design evidence-based future interventions and to determine whether this approach can improve patient outcomes.Fundings: This work was supported by the Instituto de Salud Carlos III (grant number: PI19/01484 SURVIVE).Acknowledgements: SURVIVE project (PI19/01484).Keywords: schizophrenia, suicide, telehealth, monitoring.Disclosure of InterestNone Declared

Analysis of the efficacy of lithium in the prevention of suicide in patients with mood disorders: an integrative review

Background: Mood disorders refer to those whose main symptom is a change in mood or affect, altering animosity and the way of feeling, thinking and behaving. Since the 1970s, a number of primary studies have pointed to lithium's effectiveness in reducing the risk of suicide. Objectives: To carry out an integrative review of the literature on the efficacy of lithium in preventing suicide risk in patients with mood disorders. Methodology: Integrative review, which used the descriptors “lithium”, “prevention” and “suicide” in the LILACS, SciELO and PUBMED databases. Inclusion criteria were articles published in English, of the randomized clinical trial type, between 2000 and 2022, indexed in the chosen databases and available for full reading. The research was carried out according to the PRISMA flowchart for integrative and systematic reviews. Six articles were selected for review. Results and Discussion: Three studies showed that lithium did not reduce suicide attempts in patients with bipolar affective disorder (BD) or major depression. Differences in lithium doses, sociodemographic conditions, type of control group and type of mood disorder may cause the results to be discrepant when compared with each other. Conclusion: Although lithium is used to prevent suicidal behavior in patients with mood disorders, the studies analyzed showed divergent results regarding its effectiveness in this group.

Suicide Prevention in Patients with Severe Mental Disorders

Until 2016, only few interventions were supposed to work in suicide prevention: restriction of access to lethal means, school-based universal prevention, treatment of depression and ensuring chain of care. Then, despite the multiplication of the therapeutic strategies for psychiatric disorders during the last decades, the incidence of suicide has not substantially decreased. Among several hypotheses, we proposed that suicidal depression is a specific form of depression, less responsive to antidepressants, carrying a high suicide risk, which deserves specific interventions. During the last decade, few controlled studies have been performed in at risk patients with short term reduction of the risk of suicide as a main objective, and the interest for old drugs such as lithium and clozapine remains. Recent data allow to propose that a new era is coming with evidence-based strategies of suicide prevention that should lead to change the way we deal with suicidal patients. Importantly, most efforts to develop interventions have moved to a perspective that suicide- specific treatments are necessary in addition to interventions for primary psychiatric disorders. By formulating the hypothesis that suicidal patients present a dysregulated response to social adversity based on specific brain areas associated with psychological pain, relying to opioidergic, immune and glutamatergic systems. Last, due to the difficult management of suicidal patients, innovative psychosocial interventions should be implemented for patients in suicidal crises and including safety planning, coordination of care, brief contact using phone calls. We have probably more solutions than ever to prevent suicide.DisclosureNo significant relationships.

Suicide Risk Screening and Suicide Prevention in Patients With Cancer.

BackgroundSuicide rates are up to 4 times greater in cancer compared with the general population, yet best practices for institutional suicide prevention are unknown. The objective of this study was to examine the association between suicide risk screening (SRS), clinician response, and suicide mortality at a comprehensive cancer treatment center.MethodsWe conducted a naturalistic, retrospective cohort study of patients attending the Princess Margaret Cancer Centre, where routine screening for suicidal intent within the Distress Assessment and Response Tool (DART-SRS) was implemented in 2010. Inverse probability of treatment weighting was used to evaluate the impact of DART-SRS completion on suicide mortality from 2005 to 2014. Chart audits were conducted for clinician response to suicidality, and crude suicide rates over the study period were analyzed. All statistical tests were 2-sided.ResultsAmong 78 650 cancer patients, 89 (0.1%) died by suicide, of whom only 4 (4.5%) had completed DART-SRS. Among DART-SRS completers (n = 14 517), 69 (0.5%) reported suicidal intent, none of whom died by suicide. DART-SRS completion was associated with increased clinician response to suicidality (17.4% vs 6.7%, P = .04), more psychosocial service usage (30.5% vs 18.3%, P < .001), and lower suicide mortality (hazard ratio = 0.29, 95% confidence interval = 0.28 to 0.31). Crude suicide rates at the Princess Margaret Cancer Centre were lower in patients whose first contact year was after DART-SRS implementation.ConclusionDART-SRS completion is associated with lower suicide mortality and increased access to psychosocial care, but patients who did not complete DART-SRS were at highest suicide risk. Further research is needed to identify mechanisms to ensure psychosocial and suicidality assessment in cancer patients who do not complete SRS.

Prevalence and risk factors of suicidal ideation in adult inpatients with five different types of mental disorders

BackgroundSuicide is a major but preventable public health problem in the world. Mental disorders are related to suicide, and can predict suicidal ideation (SI). This study aims to compare the differences in the prevalence and risk factors of SI among patients with five types of mental disorders. MethodsThis study involved adult inpatients with five types of mental disorders in Beijing Anding Hospital. Text mining was used to extract information from the electronic medical records. We performed the Pearson's Chi-square analysis and multivariable unconditional logistic regression to filter factors to assess odds of SI for each type of mental disorders. ResultsOf the 21,287 participants included, 2,619 had experienced SI. For both sexes, the highest risk of SI was found for patients with recurrent depressive disorder (OR = 7.096; P <.001), followed by patients with depressive episode and bipolar affective disorder when comparing with those with substance use disorder. Gender, age, occupation, drinking, single child, personal relationship, family history of mental disorder, family history of suicide and psychological trauma were associated with SI after adjusting for confounding factors, but the risk factors and their effects in each type were different. LimitationsThe clear causal associations between mental disorders and SI cannot be elucidated. In addition, the ability to study the predictors of SI is constrained by the fact that the sample excluded people who completed suicide. ConclusionsSI is common and distinct strategies should be taken in suicide prevention for patients with different types of mental disorders.

Adding Suicide Prevention to the Triple Advantages of Injectable Long-Acting Second-Generation Antipsychotics

With the advent of new treatment perspectives for schizophrenic patients, long-acting injectable antipsychotics promise to provide relapse prevention, neuroprotection, and lower mortality rates (1). In preliminary studies, scholars have also indicated that such treatments could play a central role in suicide prevention in patients (2, 3) for whom suicide is the most likely cause of premature death, in addition to repercussions for caregivers and clinicians. Both Kraepelin (4) and Bleuler (5) highlighted the issue of suicide risk among patients suffering from schizophrenia. Modern studies provided an intricate list of risk factors for suicide, pointing to numerous issues in the management and treatment of schizophrenic patients. Individuals at higher risk are generally unmarried young white males who achieved proper functioning before the onset of the disorder (6). Such patients may easily be overwhelmed by hopelessness and depression, as well as becoming demoralized and being aware that their previous lifestyle cannot be maintained. Such patients feel socially isolated, fear further mental deterioration, have higher rates of substance abuse, and may lose faith in the treatments. Suicide attempts and hospitalizations are frequent, and each time they may realize that both medical and family support is limited; moreover, ad hoc interventions are not available or are difficult to implement. There are also further risk factors for suicide in schizophrenia, such as post-psychotic depression, agitation or motor restlessness, poor adherence to treatment, and command hallucinations (although not well ascertained in terms of statistical significance). However, risk factors often yield too many false positives, pointing to the need for suicide assessments based on factors such as an understanding of mental pain and demoralization, as well as therapeutic relationships, foreseeable life events that may impact the patient, social support, and the available resources. Furthermore, suicide risk is indirectly related to relapse, illness progression, the number of hospitalizations, and plans for rehabilitation after discharge (7). Each admission to a psychiatric ward may represent a further loss of hope and faith in the treatments. The risk of suicide seems to peak not only shortly after discharge, as reported routinely in the literature, but also shortly after admission (7). This fact points to the implementation of human–environmental factors for providing ward safety and close supervision in both inpatient and community settings, especially in the cases of reduced adherence to treatment. Among the various risk factors, preventative actions should be directed over those factors that are modifiable and can be targeted by proper treatment actions (8). Furthermore, suicide risk seems to be higher when patients develop demoralization syndrome, in which repeated exacerbations of psychotic symptoms, functional deterioration compared with premorbid abilities, and a non-delusional awareness of the effects of an illness can lead to feelings of hopelessness, depression, and, ultimately, suicide. Suicidal behavior is also a major issue among patients with first-episode psychosis (9, 10). It is noteworthy that integrated compared with typical treatment proved to be effective in reducing both suicide and other causes of death; the Opus Study (9) demonstrated the effectiveness of this strategy. Such an intervention involved a) assertive community treatment (ACT); b) antipsychotic medication; c) psychoeducational family treatment; and d) social skills training. It resulted in lower mortality for any cause and lower suicide rates. Mortality in Schizophrenia and Pharmacological Treatment A recent study by Bitter et al. (11) highlighted the reduction in life expectancy among patients with schizophrenia. Of note is the fact that, compared with the controls, 20-year-old males with schizophrenia had their life expectancy reduced by 11.5 years and females by 13.7 years; the analogous numbers for 45-year-old schizophrenics were 8.1 and 9.6 years, respectively. Taipale et al. (12) explored mortality in a large sample of approximately 30,000 patients and found that second-generation long-acting antipsychotic therapies [SG LATs; ranking: paliperidone palmitate > oral aripiprazole > long-acting injection (LAI) risperidone > LAI haloperidol > LAI perphenazine > oral perphenazine > LAI olanzapine > LAI zuclopenthixol] were associated with the lowest cumulative mortality rate. In 7.5 years, a follow-up SG LAT observation revealed the lowest cumulative mortality rate as compared with first-generation (FG) and SG oral and with no antipsychotic use. The use of LATs reduces the risk of death by 33% when compared to the corresponding oral equivalent. Such results are in line with further investigations by the same group of researchers (13), who reported their observations over 8 years. They observed that the risk of treatment failure or relapse after discontinuing antipsychotics does not decrease over time and that patients maintaining long-term antipsychotic treatment had increased survival rates.

Divalproex and its effect on suicide risk in bipolar disorder: A systematic review and meta-analysis of multinational observational studies

BackgroundDivalproex has become the most prevalent mood stabilizer for bipolar disorder. However, little is known its effects in the prevention of suicide in patients with bipolar disorder, and recent FDA announcement indicated an increased risk of suicidality when using anti-epileptic agents such as divalproex. The aim of this study is to investigate the effect of divalproex on suicide risk in patients with bipolar disorder. MethodsA search strategy was used for the PubMed, Embase, ProQuest, ScienceDirect, Cochrane Library, ClinicalKey, Web of Science, and ClinicalTrials.gov until June 13th, 2018. Peer-reviewed observationally clinical studies in humans, investigating the association of divalproex and suicidality in patients with bipolar disorder were included. A random-effects meta-analysis was implemented to calculate the relative risk (RR) and 95% confidence intervals (CIs) for suicidality among patients receiving divalproex and those without. ResultsTotal 6 studies were included in the final meta-analysis. There was no significant difference in the incidence rates (reported as [RR]; 95% CI) of suicide attempts (0.921; 0.383–2.215) or completed suicides (0.607; 0.180–2.043) between participants receiving divalproex vs. no medication. There was no significant difference in the incidence rates of suicide attempts (0.815; 0.453–1.466) or completed suicides (1.009; 0.410–2.484) between participants receiving divalproex and carbamazepine. LimitationsThe significantly heterogeneous sample sources and study design amount the included trials. ConclusionsTreatment with divalproex did not reduce or increase the incidence of suicide-related events in patients with bipolar disorder.

Suicide Prevention as a Prerequisite for Recovery from Severe Mental Illness

For a significant number of people suffering from severe mental illness (SMI) prevention of suicide is a prerequisite for their recovery. This review summarises and interprets risk/protective factors for suicide in the context of schizophrenia and bipolar disorder, thereby enabling evidence-based suicide risk assessment and management. A history of self-harm greatly increases suicide risk among people with schizophrenia or bipolar disorder. Suicide prevention for patients with SMI necessitates constant vigilance by (mental) health and social care professionals in contact with them, particularly those with a history of self-harm, males, young people, those near illness onset, people with a family history of suicidal behaviour (especially suicide), victims of childhood abuse, those challenged by recent adverse life events (notably interpersonal conflict), people with aggressive/impulsive personality features, and those who have expressed hopelessness. Research suggests that suicide risk associated with SMI should be reduced by early intervention, restricting access to lethal means, improvement of treatment adherence, treating more patients with clozapine and lithium, assertive outreach, treating psychiatric comorbidity (depression, alcohol/drug misuse, etc.), 24-hour crisis care, timely (compulsory) hospitalization (sufficient bed provision imperative), improving psychiatric inpatient ward safety, lowering the risk of absconding from wards, appropriate use of electroconvulsive therapy, intensive follow-up postdischarge, and improving access to psychological/psychosocial interventions, notably cognitive behavioural therapy. The clinical interview is the optimum method of suicide risk assessment and locally developed risk assessment tools should not be used. Evidence-based suicide risk assessment/management within primary care and secondary mental health services warrants recurrent, mandatory training.

Pulmonary Thromboembolism Associated With Clozapine

Pulmonary Thromboembolism Associated With Clozapine

S.4.05 Suicide prevention in patients with mood disorder

Suicide contributes to 1–4 % of deaths worldwide every year. We conducted a systematic review aimed at summarizing evidence on the use of lithium for the prevention of suicide risk both in mood disorders and in the general population.We followed the PRISMA methodology (keywords: “lithium”, “suicide” AND “suicidal” on Pubmed, Cochrane CENTRAL, Clinicaltrial.gov, other databases). Inclusion criteria: lithium therapy in mood disorder or found in drinking water or scalp in the general population. Exclusion criteria: no lithium administration.From 918 screened references, 18 prospective (number of participants: 153786), 10 retrospective (number of participants: 61088) and 16 ecological studies (total sample: 2062) were included. Most of the observational studies reported a reduction in suicide in patients with mood disorders. All studies about lithium treatment’s duration reported that long-term lithium give more benefits than short-term lithium in suicide riskThe evidence seems to attribute an intrinsic anti-suicidal property of lithium, independent of its proven efficacy as a mood stabilizer.

Managing suicide risk in patients with schizophrenia.

The management of suicide risk in patients with schizophrenia poses many challenges for clinicians. Compared with the general population, these patients have an 8.5-fold greater risk of suicide. This article reviews the literature dealing with the treatment of at-risk patients with schizophrenia. An integrated psychosocial and pharmacological approach to managing this population of patients is recommended. Although there is at least modest evidence suggesting that antipsychotic medications protect against suicidal risk, the evidence appears to be most favourable for second-generation antipsychotics, particularly clozapine, which is the only medication approved by the US FDA for preventing suicide in patients with schizophrenia. In addition, treating depressive symptoms in patients with schizophrenia is an important component of suicide risk reduction. While selective serotonin receptor inhibitors (SSRIs) ameliorate depressive symptoms in patients with schizophrenia, they also appear to attenuate suicidal thoughts. Further research is needed to more effectively personalize the treatment of suicidal thoughts and behaviours and the prevention of suicide in patients with schizophrenia.

Risk factors of suicide in inpatients and recently discharged patients with affective disorders. A case-control study

Objective Patients with affective disorders are at high risk of suicide, especially during inpatient treatment and during the first year after discharge. Methods A blinded case-control design was used. The study included a total national sample of patients with affective disorder admitted during the period from January 1, 1994 to December 31, 1995, who died because of suicide, either during admission or shortly after discharge. Results A history of suicide attempt was a significant risk factor (IRR 4.9; 95% CI 2.1–11.6). Loss of job during the year prior to the index admission was associated with an increase in suicide risk (IRR: 2.9; 95% CI 1.2–7.5). Clinical improvement during the index admission (IRR: 0.3; 95% CI 0.1–0.7), and treatment with antidepressant drugs at the censoring date (IRR: 0.3; 95% CI 0.1–0.7) were associated with a decrease in suicide risk. Conclusion Improved treatment may be a key factor in suicide prevention in patients during, and shortly after hospitalisation with affective disorders. Also, there is a need to be especially aware of suicide risk in patients with little or no improvement at discharge.

Prediction and prevention of suicide in patients with unipolar depression and anxiety

Prediction and prevention of suicide in patients with unipolar depression and anxiety

Prediction and prevention of suicide in patients with unipolar depression and anxiety

Epidemiological data suggest that between 59 and 87% of suicide victims suffered from major depression while up to 15% of these patients will eventually commit suicide. Male gender, previous suicide attempt(s), comorbid mental disorders, adverse life-situations, acute psycho-social stressors etc. also constitute robust risk factors. Anxiety and minor depression present with a low to moderate increase in suicide risk but anxiety-depression comorbidity increases this risk dramatically Contrary to the traditional psychoanalytic approach which considers suicide as a retrospective murder or an aggression turned in-wards, more recent studies suggest that the motivations to commit suicide may vary and are often too obscure. Neurobiological data suggest that low brain serotonin activity might play a key role along with the tryptophan hydroxylase gene. Social factors include social support networks, religion etc. It is proven that most suicide victims had asked for professional help just before committing suicide, however they were either not diagnosed (particularly males) or the treatment they received was inappropriate or inadequate. The conclusion is that promoting suicide prevention requires the improving of training and skills of both psychiatrists and many non-psychiatrists and especially GPs in recognizing and treating depression and anxiety. A shift of focus of attention is required in primary care to detect potentially suicidal patients presenting with psychological problems. The proper use of antidepressants, after a careful diagnostic evaluation, is important and recent studies suggest that successful acute and long-term antidepressant pharmacotherapy reduces suicide morbidity and mortality.

Clozapine in prevention of suicide in patients with schizophrenia: profile report

Clozapine in prevention of suicide in patients with schizophrenia: profile report

The Prevention of Suicide in Patients with Recurrent Mood Disorder

Recurrent mood disorder carries a risk of suicide of ∼ 15%. Patients who do commit suicide have often received inadequate antidepressant or prophylactic lithium treatment. Long-term treatment with lithium normalizes the excess mortality associated with recurrent mood disorders, including that from suicide. A reduced availability of the most lethal methods of suicide may contribute epidemiologically to a reduced rate of suicide, and therefore the differences in overdose toxicity between antidepressants may be pertinent. Education of mental health workers regarding the effective treatment of mood disorders can help to reduce the rate of suicide. Patient education and psychological support can lead to improved compliance with prophylactic medication and early detection of relapse, but more formal psychotherapy does not appear to be helpful. Specialized mood disorder clinics lead to better patient care than is possible in a routine psychiatric out-patient clinic.