Family history of suicide: a clinical marker for major depression in primary care practice?

Alcohol use disorder and risk of specific methods of suicide death in a national cohort

INTRODUCTION

Alcohol use disorder (AUD) is among the strongest correlates of suicide death, but it is unclear whether AUD status is differentially associated with risk of suicide by particular methods.

METHODS

The authors used competing risks models to evaluate the association between AUD status and risk of suicide by poisoning, suffocation, drowning, firearm, instruments, jumping, or other means in a large Swedish cohort born 1932-1995 (total N = 6,581,827; 48.8% female). Data were derived from Swedish national registers, including the Cause of Death Register and a range of medical registers.

RESULTS

After adjusting for sociodemographic factors and familial liability to suicidal behavior, AUD was positively associated with risk of suicide for each method evaluated (cumulative incidence differences: 0.006-1.040 for females, 0.046-0.680 for males), except the association with firearm suicide in females. AUD was most strongly associated with risk of suicide by poisoning. Sex differences in the effects of AUD and family liability were observed for some, but not all, methods. Furthermore, high familial liability for suicidal behavior exacerbated AUD's impact on risk for suicide by poisoning (both sexes) and suffocation and jumping (males only), while the inverse interaction was observed for firearm suicide (males only).

CONCLUSIONS

AUD increases risk of suicide by all methods examined and is particularly potent with respect to risk of suicide by poisoning. Differences in risk related to sex and familial liability to suicidal behavior underscore AUD's nuanced role in suicide risk. Future research should investigate targeted means restriction effectiveness among persons with AUD.

Psychiatric health care need in Hungary identified by the short screening algorithm of depression and suicide risk used in general medical practices

Suicides are often related to depression. General medical practices (GMPs) should play a role in screening depression. We aimed to test the screening algorithm of Rihmer and Torzsa for depression and suicide and determine the prevalence and number of patients in the nationwide representative Hungarostudy 2002 population, and to estimate the corresponding extra health care need in an average GMP and in the Hungarian population in addition to patients who are already cared for by specialized care. The short version of the Beck Hopelessness Scale (BHS) and the Hungarian version of the short form of the Beck Depression Inventory (BDI-9) were used to screen for suicide risk and depression. The prevalence of suicidal thoughts and depression was determined and findings were extrapolated to an average GMP of 1,600 adults and to the population over 25 years of age. This screening would generate a considerable extra psychiatric care to organize and implement in an average GMP and throughout the country. Our findings show that with easily administered screening instruments a significant number of patients likely to have depression can be identified at the primary care level, arguing for the establishment of the extra psychiatric care capacity in Hungary.

Depression in Bangladeshi university students: The role of sociodemographic, personal, and familial psychopathological factors

PURPOSE

Although depression has adverse effects on all aspects of university students' quality of life, fewer studies have been conducted in Bangladesh; which was investigated herein. DESIGN AND METHODS: A cross-sectional study was carried out among 1844 students enrolled at the University of Dhaka, Bangladesh. Hierarchical regression analyses were performed to investigate the explanatory power of the variables predicting depression in this population.

FINDINGS

Depression prevalence was 28.7%; and female gender, first-year student status, substance use, past-year physical and psychological illness, stressful life events, family psychiatric history, and personal suicidal behaviors were the main risk factors. The final model considering all the studied variables explained 23.5% of the variance in depression. PRACTICAL IMPLICATIONS: Effective psychological help services, awareness and intervention programs, and so on, should be implemented to reduce students' psychological burdens.

Association between T-182C, G1287A polymorphism in NET gene and suicidality in major depressive disorder in Chinese patients

Objective: Previous studies have implicated norepinephrine transporter gene (NET) polymorphisms in the etiology of major depressive disorder (MDD). A functional NET T-182C polymorphism (rs2242446) in the promoter region and a synonymous polymorphisms G1287A in the exon 9 (rs5569) were associated with MDD in different populations. However, few studies have focused on the relationship between these polymorphisms and MDD patients with suicidality. The objective of the present study was to examine whether the two polymorphisms are associated with MDD patients with suicidality in the Han Chinese population. Methods: Two hundred and sixty-three suicidal depressed patients and 241 non-suicidal depressed patients who met DSM-IV criteria for MDD were recruited from our hospital. Three hundred and three unrelated, age- and sex-matched healthy control subjects participated in this case-control study. Suicidality was assessed using Mini International Neuropsychiatric Interview (MINI) and the Hamilton rating scale for depression (HAMD). Genotypes of T-182C polymorphism (rs2242446) and G1287A (rs5569) were screened by polymerase chain reaction. Results: No statistical significant differences between patients and controls were found for any of the analysed polymorphisms, either in the genotype or allele distribution. Conclusions: Our results suggest that the investigated polymorphisms are not major susceptibility factors in the etiology of MDD with suicidality. However, the results must be verified in larger samples and different ethnicities.

Comparison of familial and non-familial suicidal behaviors among people with major depressive disorder: Testing the discriminative predicting role of high-yield clinical variables

BACKGROUND

Suicidal behavior in first-degree relatives of people diagnosed with major depressive disorder (MDD) increases the risk of suicidal behavior. Such an effect may be the result of genetic risk factors or environmental ones, including imitation, or both. Surprisingly few studies have examined this question and thus, there still is little known about the effect of first-degree family history of suicidal behavior on the type of suicidal behavior and profile of risk factors related to the diathesis for suicidal behavior. Even less is known about intra-familial risk transmission.

METHODS

Patients with MDD (n = 252) experiencing a current major depressive episode and who had a previous suicide attempt were studied. Those with and without a family history of first-degree relatives who had made a suicide attempt or died by suicide were compared across clinical and suicide-related characteristics.

RESULTS

Suicide attempters with (FDR⁺, n = 59) and without a first-degree relative with suicide attempt or suicide (FDR^-, n = 193) were similar in terms of type or frequency of suicide attempts, level of lifetime aggression and impulsivity, age of onset of depression and age at first suicide attempt.

LIMITATIONS

Cross-Sectional study. Lack of additional external validators.

CONCLUSIONS

Contrary to our hypothesis and the concept of "genetic anticipation", a first-degree family history of suicide attempt or suicide in currently depressed attempters with MDD was not associated with a range of clinical and suicide-related characteristics. Longitudinal studies incorporating external validators and potential biological markers may advance this area of research.

Affective temperament, history of suicide attempt and family history of suicide in general practice patients

BACKGROUND

Untreated major affective disorders are strongly associated with suicidal behaviour; however, clinical, psychological and psycho-social risk factors also play a contributory role. Personal history and family history of suicide are also important predictors of suicidal behaviours, and are also a powerful marker of current major depressive episode in general practice patients. Affective temperaments, which can be considered the subaffective manifestations of major mood disorders also show a specific pattern of association with suicidal behaviour. In the present study our aim was to investigate the association between affective temperaments, personal history of suicide attempts and family history of completed suicide in primary practice patients.

METHODS

Five hundred and nine patients from 6 primary care practices completed the TEMPS-A, and were assessed concerning self-reported history of personal or family suicide.

RESULTS

We found that among those answering questions concerning suicide, 9.1% reported a family history of suicide in first and second degree relatives and 4.8% had at least one prior suicide attempt. Among those giving a positive answer to both questions, those who had a positive family history had significantly more frequent suicide attempts (15.4% vs. 4.0%). Patients with prior suicide attempts had a significantly higher score on the cyclothymic and depressive, and those with positive family history of suicide had on cyclothymic and anxious subscales.

LIMITATIONS

In the present study, personal and family history of suicide was assessed retrospectively and in a self-report way. The cross-sectional nature of this study and the facts that no current psychiatric morbidity has been investigated and only the documented history of depressive and anxiety disorders have been detected limit the generalisability of this study.

DISCUSSION

We found a significant relationship between depressive and cyclothymic affective temperament and personal history of suicide attempts, and between cyclothymic and anxious temperament and family history of completed suicide in first and second degree relatives. This is in line with previous findings showing a strong relationship between these affective temperaments and major mood episodes and that these temperaments are overrepresented among suicide attempters. Our findings also suggest that the presence of cyclothymic (and to lesser extent depressive) affective temperament in a patient with family history of completed suicide indicates a very high risk of suicidal behaviour.

Suicide in Hungary-epidemiological and clinical perspectives

Annual suicide rates of Hungary were unexpectedly high in the previous century. In our narrative review, we try to depict, with presentation of the raw data, the main descriptive epidemiological features of the Hungarian suicide scene of the past decades. Accordingly, we present the annual suicide rates of the period mentioned and also data on how they varied by gender, age, urban vs. rural living, seasons, marital status, etc. Furthermore, the overview of trends of other factors that may have influenced suicidal behavior (e.g., alcohol and tobacco consumption, antidepressant prescription, unemployment rate) in the past decades is appended as well. Based on raw data and also on results of the relevant papers of Hungarian suicidology we tried to explain the observable trends of the Hungarian suicide rate. Eventually, we discuss the results, the possibilities, and the future tasks of suicide prevention in Hungary.

Suicidal phenotypes associated with family history of suicidal behavior and early traumatic experiences

BACKGROUND

Family history of suicidal behavior and personal history of childhood trauma are risk factors for suicidal behaviors. We hypothesize that subjects with any of these risk factors will show differential features and that subjects with both of them will display more severe phenotypes.

METHODS

This study compares three groups of suicide attempters (n=878): subjects with a family history of suicidal behavior and a personal history of early traumatic experiences, subjects with a family history of suicidal behavior or a personal history of early traumatic experiences, and subjects with neither of these two risk factors, with regards to psychopathology, personality traits and suicidal behavior.

RESULTS

Subjects with a family history of suicidal behavior and childhood trauma were younger at their first suicide attempt and made more frequent, severe and violent attempts when compared with the other groups. Differences in number and precocity of attempts remained after adjustments in a multinomial regression model. Finally, personality profiles were also substantially different in the group with higher impulsiveness, novelty seeking, affective lability and hopelessness.

LIMITATIONS

The information provided by subjects regarding childhood abuse and family history of suicidal behavior was not confirmed by other sources.

CONCLUSIONS

Suicide attempters with a family history of suicidal behavior and childhood trauma show specific characteristics that might be used to prevent future suicidal behaviors in this population. Both risk factors should be routinely investigated when assessing the suicidal risk of a patient.

Explained factors of suicide attempts in major depression

OBJECTIVE

The aim of this study is to identify risk factors for suicide attempts including bipolarity.

METHOD

The paper presents the most recent data on suicide attempts and depression with or without hypomanic features from three French "Bipolact", studies including 2249 patients with recurrent or resistant depression. Hypomania and BP-II disorder were defined by a score of 10 or more on the Hypomania Checklist-20. Attempters and non-attempters were compared, and multivariate logistic regression analyses were performed on all the significant variables obtained in univariate tests.

RESULTS

Rates of suicide attempts and of a family history of suicide were higher in BP-II disorder. Suicide attempts were best explained by a family history of suicide and mood disorders, recurrence of depression, the "irritable-risk-taking" dimension of hypomania, substance abuse, and need of psychiatric treatment.

LIMITATIONS

The study does not deal with DSM-IV BP-II disorder.

CONCLUSION

Clinicians need to be familiarized with these risk factors.

Primary care research in Hungary. Results and experiences in comparison with Europe

A közlemény a magyar alapellátási rendszerben korábban körzeti, ma háziorvosok által végzett tudományos kutatások történetét, eredményeit és a jelenlegi helyzetet tekinti át, előremutató javaslatokkal a jövőre nézve. Beavatja az olvasót ennek a területnek sajátosságaiba, vizsgálómódszereibe, céljaiba. Áttekinti és összehasonlítja az Európában és Magyarországon vizsgált kutatási témákat, eredményeket, infrastrukturális különbségeket és perspektívákat, információt ad a téma iránt érdeklődő olvasónak a további tájékozódás forrásaihoz.