Suicide Risk In People Research Articles

Research round-up

Results from a Danish retrospective cohort study highlight the risk of suicide in people with a neurological disorder. Annette Erlangsen and colleagues included data from 7·3 million people in their study, of whom 1·2 million had a neurological disorder. Over a median follow-up of 23·6 years (IQR 10·0–37·0), there were 35 483 deaths by suicide. The suicide rate in people with a neurological disorder was higher than in individuals without a neurological disorder (44·0 per 100 000 person-years vs 20·1 per 100 000 person-years; adjusted incidence rate ratio [IRR] 1·8 [95% CI 1·7–1·8]). The highest risks for suicide were noted in association with Huntington's disease (IRR 4·9 [95% CI 3·1–7·7]), amyotrophic lateral sclerosis (4·9 [3·5–6·9]), Guillain-Barré syndrome (2·2 [1·2–4·1]), and multiple sclerosis (2·2 [1·9–2·6]).

Factors Affecting Suicide Risk in People with Alcohol Use Disorder

Although heightened risk for suicide has long been associated with alcohol use disorder (AUD), questions remain about the potentially confounding

Glutamine and New Pharmacological Targets to Treat Suicidal Ideation.

Glutamate is the major excitatory neurotransmitter in the central nervous system, and it is linked with the amino acid glutamine through a metabolic relationship of enzymatic compound interconversion and transportation, also known as the glutamate-glutamine cycle.A growing body of evidence suggests involvement of the glutamatergic neurotransmitter system in suicidal behaviours. The initial evidence comes from the pathophysiology of neuropsychiatric disorders, as disruptions in glutamate neurotransmission have been found underlying pathology in multiple suicide-related psychiatric conditions such as major depressive disorder, schizophrenia, post-traumatic stress disorder, and bipolar disorder.Existing data from experimental animal models and human in vivo studies also demonstrate that glutamate plays a key role in suicide-related personality traits including aggression and impulsive aggression.Further studies on glutamate system dysfunction underlying suicidal behaviours have focused on the different steps of the glutamate-glutamine cycle: an inflammation-mediated reduction of glutamine synthetase activity has been found in depressed suicide attempters, phosphate-activated glutaminase genes are reduced in suicide completers, and gene expression abnormalities in NMDA receptors have also been discovered in suicide victims.Evidence of a role of the glutamate-glutamine cycle in suicidal behaviours unveils new targets for anti-suicide interventions. Lithium's mechanism to reduce the risk of suicide in people with mood disorders may be related to its ability to increase glutamine synthetase, whereas novel NMDA antagonists such as ketamine [or its S(+) enantiomer esketamine] have already demonstrated positive results in reducing suicidal ideation.

Suicide risk in people living with AIDS/HIV: the effect of childhood trauma is mediated by mental disorders and social vulnerability

ABSTRACTSuicide is an important problem in people living with HIV/AIDS (PLWHA). The importance of mental disorders and social vulnerability on suicidal behaviors is described in the literature; however, the impact of childhood traumatic events in this scenario is not clear. The aim of this study was to verify the mediation effect of mental disorder comorbidities and social vulnerability in association with childhood trauma intensity and suicide risk level. This cross-sectional study of HIV-positive outpatients was conducted in a specialized care service in the city of Pelotas in Southern Brazil. Sociodemographic data and HIV-related information were collected and the Childhood Trauma Questionnaire was applied. A total of 364 patients underwent psychiatric evaluation using MINI Plus including module C of suicide risk severity. Suicide risk was present in 39.3% of the sample. The relation between childhood traumatic events and the level of suicide risk is mediated by mental disorder comorbidities and socioeconomic vulnerability. Specific psychosocial interventions in PLWHA should consider the potential role of abusive traumatic experiences in the current mental health conditions and suicidal behaviors.

Psychiatric morbidity and suicidal behaviour in psoriasis: a primary care cohort study.

Psychological distress among people with psoriasis may lead to elevated risks of suicide and nonfatal self-harm. To investigate psychiatric comorbidity, psychotropic medication prescribing and risk of suicidality in people with psoriasis. A cohort of patients with psoriasis (1998-2014) was delineated using the Clinical Practice Research Datalink, with linkage to Hospital Episode Statistics and Office for National Statistics mortality records. Each patient with psoriasis was matched with up to 20 patients without psoriasis on age, sex and general practice. A stratified Cox regression model was used to estimate the hazard ratios (HRs) for suicide or nonfatal self-harm risks adjusted for socioeconomic status. At baseline, among 56 961 and 876 919 patients with and without psoriasis, higher prevalence for histories of alcohol misuse, bipolar disorder, depression, anxiety disorders, self-harm and psychotropic drug prescription were observed. The deprivation-adjusted HR indicated lower suicide risk in people with psoriasis [HR 0·59, 95% confidence interval (CI) 0·41-0·85]. The risk of suicide varied according to age: it was lower in people with psoriasis diagnosed at ≥ 40 years (HR 0·38, 95% CI 0·21-0·66), whereas there was no difference in risk of suicide in people with psoriasis diagnosed before age 40 years (HR 0·92, 95% CI 0·58-1·46). Conversely, there was a small increased risk for self-harm (HR 1·15, 95% CI 1·04-1·27) associated with psoriasis. The prevalence of mental illness was raised in people with psoriasis, and this may lead to a greater risk of self-harm. Nevertheless, having psoriasis does not appear to be associated with an increased risk of suicide. Healthcare professionals caring for patients with psoriasis should continue to monitor and tackle effectively the psychological needs of these individuals.

Suicide Risk in Persons with HIV/AIDS in South Korea: a Partial Test of the Interpersonal Theory of Suicide.

The high disease burden associated with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is linked to the elevated suicide risk in this population. Informed by the interpersonal theory of suicide, this study examined how and under which conditions depression is related to suicide risk in people living with HIV/AIDS. A total of 202 outpatients with HIV/AIDS participated in a cross-sectional and multi-center survey involving four university hospitals in South Korea. This self-reported survey included the Hospital Anxiety and Depression Scale, Interpersonal Needs Questionnaire, and Mini-International Neuropsychiatric Interview suicidality module. Participants' mean age was 48.6 (SD=13.4) and the majority was male (89.1%). The proportions of those at high, medium, and low suicide risk were 18.5%, 20%, and 15.4%, respectively. Depression was associated with suicide risk directly and indirectly by increasing perceived burdensomeness (PB) and the indirect effect of depression on suicide risk mediated by PB was contingent on the level of thwarted belongingness (TB). PB was associated with suicide risk even after controlling for depression, suggesting its independent effect on suicide risk. PB and TB are potential mechanisms through which depression is associated with suicide risk, supporting the applicability of the interpersonal theory of suicide to understanding a complex interplay of risk factors in people with HIV/AIDS. Moreover, given the independent association of PB with suicide risk, as well as a protective effect of TB in suicide risk, monitoring and management of these factors should be included in the care of people with HIV/AIDS.

What do the genetic association data say about the high risk of suicide in people with depression? A novel network-based approach to find common molecular basis for depression and suicidal behavior and related therapeutic targets

BackgroundAvailable sources indicate that the risk of suicide in people with major depression is higher than other psychiatric disorders. Although it seems that these two conditions may have a shared cause in some cases, no studies have been conducted to identify a common basis for them. MethodsIn this study, following an extensive review of literature, we found almost all the genes that are involved in major depression and suicidal behavior, and we isolated genes shared between the two conditions. Then, we found all physical or functional interactions within three mentioned gene sets and reconstructed three genetic interactive networks. All networks were analyzed topologically and enriched functionally. Finally, using a drug repurposing approach, we found the main available drugs that interacted with the most central genes shared between suicidal behavior and depression. ResultsThe results demonstrated that BDNF, SLC6A4, CREB1, and TNF are the most fundamental shared genes; and generally, disordered dopaminergic, serotonergic, and immunologic pathways in neuronal projections are the main shared deficient pathways. In addition, we found two genes, SLC6A4 and SLC6A2, to be the main therapeutic targets, and Serotonin-Norepinephrine Reuptake Inhibitors (SNRI) and Tricyclic Antidepressants (TCA) to be the most effective drugs for individuals with depression at risk for suicide. ConclusionsOur results, in addition to shedding light on the integrated molecular basis of depression-suicide, offer new therapeutic targets for individuals with depression at high risk for suicide and could pave the way for future preclinical and clinical studies. However, integrative systems biology-based studies highly depend on existing data and related databases, as well as the arrival of new experimental data sources in the future, possibly affecting the current results.

Адаптация методик исследования cуицидального поведения на выборке лиц c попытками самоубийства

The adaptation of the Russian-language variants of the «The Psychache Scale» R.R. Holden, K. Mehta et al. (2001), «Reasons for Living Inventory» M.M. Linehan, J.L. Goodstein et al. (1983) and «Reasons for Attempting Suicide Questionnaire» D. Johns, R.R. Holden (1997) on a sample of 290 people hospitalized in Moscow Ambulance Research Institute named after N.V. Sklifosovsky after incomplete attempts to commit suicide. Patients in the department of crisis conditions and psychosomatic disorders aged 16 to 44 participated in the questioning and testing. When assessing the psychometric properties of the techniques adapted on a sample of 290 suicides, satisfactory results were obtained for their reliability and construct validity. Using the method of the main components with rotation varimax, the correspondence of the factor structure of Russian versions to the structure of the original tests was confirmed. The Russian-language versions of the Psych Psychology Scale, Reasons for Living Inventory and Reasons for Attempting Suicide Questionnaire can be used to analyze the reasons for voluntary withdrawal and assess the extent of suicide risk in people of working age with auto aggressive behavior.

Risk of Suicidality in People with Psoriasis: A Systematic Review and Meta-Analysis of Cohort Studies.

Psoriasis has been associated with psychiatric disorders such as depression and anxiety, but its relationship with suicidality (including suicide, suicide attempt, and suicidal ideation) is unclear. Our objective was to assess the risk of suicide, suicide attempt, suicidal ideation, and suicidality in people with psoriasis. We conducted a systematic review and meta-analysis of cohort studies examining the risk of suicide, suicide attempt, suicidal ideation, and suicidality in people with psoriasis. We searched the Cochrane Library, PubMed, and EMBASE from inception to 24 March 2017. Two authors independently selected studies, assessed the quality of included studies, and extracted data. Any disagreement was resolved by discussion with a third author. Five population-based cohort studies were included and considered to be of high quality. We found no increase in the risk of suicide (risk ratio [RR] 1.13; 95% confidence interval [CI] 0.87-1.46), suicide attempt (RR 1.25; 95% CI 0.89-1.75), or suicidality (RR 1.26; 95% CI 0.97-1.64) among people with psoriasis. In the stratified analysis, we also found no increase in suicide, suicide attempt, and suicidality among people with either severe or mild psoriasis. The available limited, very low-quality evidence does not support an association between psoriasis and suicidal thought and behavior. Further studies that provide data for different age and sex groups are needed to clarify whether a subgroup of patients with psoriasis has an elevated risk of suicidality.

Characteristics of suicide attempters with a high lethality means

IntroductionSuicide attempts with higher lethality increase the likelihood of suicide completion. Accumulating knowledge on risk factors contributing to higher suicide lethality may help clinicians to allocate their limited resources to more endangered people.ObjectivesTo explore the factors associated with higher lethality in suicide attempts.MethodsAll suicide attempters, who visited the emergency department of Uijeongbu St. Mary's hospital from January 2014 to December 2015, were reviewed retrospectively. We compared between the high vs. the low lethality group, of which had been recorded based on clinical judgment using t-test or Chi2/Fisher's exact test with two-sided P-value of 0.05.ResultsAmong the 753 suicide attempters, the assessed lethality was recorded in 736 cases. Low and highly lethal attempters were 426 (57.9%) and 310 (42.1%), respectively. For demographic variables, the high lethality attempters were significantly more likely to be older (48.3 vs. 44.78; P = 0.009), unemployed (61.0% vs. 56.5%; P = 0.042, without religion (90.9% vs. 84.9%; P = 0.017). For clinical variables, the high lethality attempters were significantly more likely have hopelessness (67.7% vs. 58.2%; P = 0.013) and a history of schizophrenia (4.5% vs. 1.4%; P = 0.023, while they did display any difference for mood disorders. The low lethality suicide attempts were more frequent in patients with comorbid personality disorders (9.2% vs. 4.9%; P = 0.031).ConclusionsThese results are in line with literatures reporting higher suicide risk in people, who are old, unemployed, not having a religion, psychotic and hopeless. These may have been moderated by committing a higher lethal means of suicide at least in part and warrants additional investigations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Defeat and Entrapment in Bipolar Disorder: Exploring the Relationship with Suicidal Ideation from a Psychological Theoretical Perspective.

Contemporary psychological theoretical models of suicide hypothesize that defeat and entrapment underlie the development of suicidal ideation. This hypothesis has never been tested in people who experience bipolar disorder. Regression analysis revealed that defeat and entrapment significantly predicted suicidal ideation at 4-month follow-up. The relationship between defeat and suicidal ideation was mediated by total entrapment and internal entrapment, but not external entrapment. Results suggest that perceived defeat and entrapment underlie the development of prospective suicidal ideation in bipolar disorder. Findings could potentially improve the assessment of suicide risk in people who experience bipolar disorder.

Validation de la traduction française d’un questionnaire court de dépression de Beck (BDI-FS-Fr)

IntroductionDepression is a public health problem and constitutes the most frequently psychic manifestation observed among students. Its prevalence is much higher (30%) than in the other populations. Depression among students can have negative impacts on their social, relational situation and significantly impact their quality of life. Depression is misdiagnosed, misdetected and thus mistreated. In clinical practice at the University, the clinician finds difficulty in correctly diagnosing depression comorbidity including depression with a physical illness and/or somatic problems. It underestimates or overestimates depression (false negative diagnosis or false positive diagnosis). The difficulties of diagnosing depression and overlap with the physical symptoms of the disease are the challenges for the clinician to differentiate if certain symptoms are related to depression or physical illness. Thus, the difficulty in detecting and/or diagnosing depression can lead to false diagnoses of depression. So to avoid the false diagnosis of depression in the university context or in the disease, we must take into account the cognitions of depression. The BDI-FS, self-assessment scale to detect depression, considers these cognitions and therefore avoids the false diagnosis of depression in the presence of problems (such as a physical illness or somatic problems) and properly detects the depression. ObjectiveThis article presents the French validation of the Beck Depression Inventory-Fast Screen (BDI-FS Inventory) on a sample of students. MethodA cross-sectional study was conducted on 473 students of the University of Caen Normandy. ResultsThe Beck Depression Inventory-Fast Screen-France (BDI-FS-Fr) gets a good sensitivity, specificity and good positive and negative predictive value, a coefficient of Yule very strong and area under the curve satisfactory. He has a very good internal validity of structure: an exploratory factor analysis identified a factor that explains 40.21% of the total variance of the BDI-FS-Fr, and he has a satisfactory internal consistency (0.74). The BDI-FS-Fr has a very good external validity of structure (construct validity: convergent and divergent validity; P<0.001) and discriminate validity (P<0.001), and concurrent validity (P<0.001). The split-half reliability (odd-even) was 0.73 (P<0.001). The test-retest reliability was 0.82 (P<0.001). Regarding clinical practice in the University, clinicians can use a simple questionnaire include 7 items (Beck Depression Inventory-Fast Screen-French: BDI-FS-Fr) to assess depression avoiding false diagnosis of depression in the University. The BDI-FS-Fr only evaluates the non-somatic symptoms (cognitive) rather than physical symptoms (somatic), which may overlap with problems due to the university or physical illness and depression may overlap. The BDI-FS-Fr only includes items the BDI-II that are related to the direct psychological experience of depression. Thus, the key strength of the BDI-FS-Fr is that it prevents symptoms of physical illness (e.g., weight loss, difficulty concentrating) from confounding the psychodiagnostic picture. The BDI-FS-Fr also allows us to evaluate the two diagnoses DSM-IV-TR (the main symptoms of depression: sadness and anhedonia). It also allows us to observe and assess the risk of suicide in people (ex. students and patients) by observing the items 2 (pessimism) and 7 (thoughts or desires of suicide) that are considered suicidal risk indicators. The BDI-FS is a diagnostic tool that minimizes the risk of giving falsely high estimates of depression in subjects focusing on the cognitive symptoms of depression. For pre-cited reasons, the clinicians can use the BDI-FS-Fr among students to diagnose their depression and assess their risk for suicide without false negative or false positive diagnosis. ConclusionThe French version of the BDI-FS has very favourable psychometric properties. It is valid for self-assess depression, its intensity and its evolution, and it is a good complement to BDI for students. The BDI-FS-Fr thus has very good psychometric properties and is a useful tool for researchers and practitioners.

Predicting suicide following self-harm: systematic review of risk factors and risk scales.

People with a history of self-harm are at a far greater risk of suicide than the general population. However, the relationship between self-harm and suicide is complex. To undertake the first systematic review and meta-analysis of prospective studies of risk factors and risk assessment scales to predict suicide following self-harm. We conducted a search for prospective cohort studies of populations who had self-harmed. For the review of risk scales we also included studies examining the risk of suicide in people under specialist mental healthcare, in order to broaden the scope of the review and increase the number of studies considered. Differences in predictive accuracy between populations were examined where applicable. Twelve studies on risk factors and 7 studies on risk scales were included. Four risk factors emerged from the meta-analysis, with robust effect sizes that showed little change when adjusted for important potential confounders. These included: previous episodes of self-harm (hazard ratio (HR) = 1.68, 95% CI 1.38-2.05, K = 4), suicidal intent (HR = 2.7, 95% CI 1.91-3.81, K = 3), physical health problems (HR = 1.99, 95% CI 1.16-3.43, K = 3) and male gender (HR = 2.05, 95% CI 1.70-2.46, K = 5). The included studies evaluated only three risk scales (Beck Hopelessness Scale (BHS), Suicide Intent Scale (SIS) and Scale for Suicide Ideation). Where meta-analyses were possible (BHS, SIS), the analysis was based on sparse data and a high heterogeneity was observed. The positive predictive values ranged from 1.3 to 16.7%. The four risk factors that emerged, although of interest, are unlikely to be of much practical use because they are comparatively common in clinical populations. No scales have sufficient evidence to support their use. The use of these scales, or an over-reliance on the identification of risk factors in clinical practice, may provide false reassurance and is, therefore, potentially dangerous. Comprehensive psychosocial assessments of the risks and needs that are specific to the individual should be central to the management of people who have self-harmed.

Impact of disability status on suicide risks in South Korea: Analysis of National Health Insurance cohort data from 2003 to 2013

BackgroundThe elevated risk of suicide in people with disability has been suggested in the previous studies; however, the majority of study results have been limited to specific disability types, and there is a lack of research comparing the risk of suicide in people with disability in general. ObjectivesTo examine the hazard ratio of suicide according to the presence and the types of disability and identify patterns in the results. MethodsIn this study, we used National Health Insurance Service-National Sample Cohort data on 990,598 people, and performed analysis on the cause of death from 2003 through 2013. A Cox proportional hazard model was used to estimate the hazard ratio of suicide associated with disability and its types. ResultsThe hazard ratio of suicide among people with disability was 1.9-folds higher compared to people without disability. The risk of suicide among different disability types was higher in mental disorder, renal failure, brain injury and physical disability. The hazard ratio of suicide in people with disability was not varied by income. The time to death by suicide for people with disability from the onset of their disability was 39.8 months on average. ConclusionsOur findings suggest that when the government plans suicide prevention policies, early and additional interventions specific to people with disability are needed. Disability due to mental disorder, renal failure should be given priority.

A case-control study of hopelessness and suicidal behavior in the city of Athens, Greece. The role of the financial crisis

This study aimed to examine the psychometric properties of Beck Hopelessness Scale (BHS) in Greek patients with a recent suicide attempt, the predictive ability of BHS especially in terms of age and the possible effect of the financial crisis on hopelessness as it has been identified as a significant suicide risk factor. The study included a total of 510 individuals, citizens of Athens, Greece. Three hundred and forty individuals (170 attempted suicide patients, and 170 -age and gender- matched healthy individuals used as controls) completed BHS before the financial crisis onset (from 2009 to 2010). A sample of 170 healthy individuals also completed the BHS after the financial crisis onset (from 2013 to 2014), when the impact of the austerity measures was being felt by the Greek society. The Greek BHS version demonstrated good psychometric properties and a sufficient degree of internal consistency. Attempted suicide patients (M = 9) presented higher hopelessness than the controls (M = 3). The patients’ age positively correlated with hopelessness (rs = .35, p < .001), and the ROC curve revealed that the BHS ability to discriminate the individuals with pathological rates of hopelessness from those without, strengthened as age increased. No significant differences were found between the individuals evaluated before (M = 3) and after (M = 3, p > .05) the crisis onset. Nevertheless, regarding the latter group, the women, the younger individuals, the less educated, the unemployed and the participants with low or mediocre self-reported financial status presented increased hopelessness. Our findings suggest that BHS could be a useful instrument especially when screening for suicide risk in people of older age, and that the financial crisis in Greece had a greater impact on subgroups of the population regarding hopelessness.

Suicide risk in people with chronic fatigue syndrome.

Suicide risk in people with chronic fatigue syndrome.

Community pharmacists and the assessment and management of suicide risk.

Community pharmacists and the assessment and management of suicide risk.

Suicidal behavior and assisted suicide in dementia

Concerns about suicide risk in people with dementia have been increasing in recent years along with a discourse about rational suicide and assisted suicide. A systematic narrative literature review of suicidal behavior and assisted suicide in persons with dementia. Most studies that have examined the spectrum of suicidal ideation, attempted suicide and suicide in dementia have methodological limitations but the overall suicide risk does not appear to be increased. When suicidal behavior does occur, common themes include the presence of psychiatric comorbidity, mainly depression; occurrence early in the dementia course with preserved insight and capacity; and an increased risk in younger people. The emerging discourse on rational and assisted suicide has been spurred by early and pre-symptomatic diagnosis and poses a number of ethical challenges for clinicians including the role of proxy decision-makers. Although dementia might not confer a significant overall risk for suicidal behavior, clinicians still need to consider the potential for suicide in vulnerable individuals particularly early in the dementia course.

Mental disorders and new opportunities to identify suicide risk in children and adolescents with disabiliting diseases

To study mental health of children and adolescents with disabiliting diseases and comorbid mental disorders and to develop an instrument for assessment suicide risk. The structure of mental disorders in 800 students of correctional schools with disabilities, who have disabiliting diseases (somatoneurological, musculoskeletal, sensory impairment, intellectual disorders), was studied. The prevalence of mental disorders was 83.5%. The highest prevalence was observed for developmental disorders, mental retardation and disorders due to damage or brain dysfunction. High levels of anxiety were found in 33%. There were difficulties in the diagnosis of emotional disorders and signs of suicidal behavior in adolescents with disabiliting diseases and comorbid disorders of psychological development. To detect the signs of suicidal behavior, authors have developed a clinical questionnaire for assessment of suicide risk in people of this category. The results of the screening are presented.

High prevalence of suicide risk in people living with HIV: who is at higher risk?

A cross-sectional study was developed to evaluate suicide risk and associated factors in HIV/AIDS patients at a regional reference center for the treatment of HIV/AIDS in southern Brazil. We assessed 211 patients in regard to suicide risk, clinical and sociodemographic characteristics, drug use, depression, and anxiety. Suicide risk was assessed with Mini International Neuropsychiatric Interview, Module C. Multivariate analysis was performed using Poisson regression. Of the total sample, 34.1% were at risk of suicide. In the multivariate analysis, the following variables were independently associated with suicide risk: female gender; age up to 47 years; unemployment; indicative of anxiety; indicative of depression; and abuse or addiction on psychoactive substances. Suicide risk is high in this population. Psychosocial factors should be included in the physical and clinical evaluation, given their strong association with suicide risk.