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Vidal-Ribas P, Govender T, Sundaram R, Perlis RH, Gilman SE. Prenatal origins of suicide mortality: A prospective cohort study in the United States. Transl Psychiatry 2022; 12:14. [PMID: 35013255 PMCID: PMC8748551 DOI: 10.1038/s41398-021-01777-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/07/2021] [Accepted: 12/20/2021] [Indexed: 12/01/2022] Open
Abstract
Most suicide research focuses on acute precipitants and is conducted in high-risk populations. Yet, vulnerability to suicide is likely established years prior to its occurrence. In this study, we aimed to investigate the risk of suicide mortality conferred by prenatal sociodemographic and pregnancy-related factors. Offspring of participants (N = 49,853) of the Collaborative Perinatal Project, a U.S. population-based cohort of pregnancies enrolled between 1959 and 1966, were linked to the U.S. National Death Index to determine their vital status by the end 2016. We examined associations between sociodemographic factors during pregnancy, pregnancy complications, labor and delivery complications, and neonatal complications with suicide death coded according to ICD-9/10 criteria. By the end of 2016, 3,555 participants had died. Of these, 288 (214 males, 74 females) died by suicide (incidence rate = 15.6 per 100,000 person-years, 95% Confidence Interval [CI] = 13.9-17.5). In adjusted models, male sex (Hazard Ratio [HR] = 2.98, CI: 2.26-3.93), White race (HR = 2.14, CI = 1.63-2.83), low parental education (HR = 2.23, CI = 1.38-3.62), manual parental occupation (HR = 1.38, CI = 1.05-1.82), being a younger sibling (HR = 1.52, CI = 1.10-2.11), higher rates of pregnancy complications (HR = 2.36, CI = 1.08-5.16), and smoking during pregnancy (HR = 1,28, CI = 0.99-1.66) were independently associated with suicide risk, whereas birth and neonatal complications were not. Consistent with the developmental origins of psychiatric disorders, vulnerability to suicide mortality is established early in development. Both sociodemographic and pregnancy factors play a role in this risk, which underscores the importance of considering life course approaches to suicide prevention, possibly including provision of high-quality prenatal care, and alleviating the socioeconomic burdens of mothers and families.
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Affiliation(s)
- Pablo Vidal-Ribas
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
| | - Theemeshni Govender
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Roy H Perlis
- Center for Quantitative Health, Center for Genomic Medicine and Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Stephen E Gilman
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Das UN. Polyunsaturated fatty acids and their metabolites in the pathobiology of schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2013; 42:122-34. [PMID: 22735394 DOI: 10.1016/j.pnpbp.2012.06.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 05/27/2012] [Accepted: 06/13/2012] [Indexed: 01/01/2023]
Abstract
Schizophrenia can be considered as a low-grade systemic inflammatory disease with its origins in the perinatal period. It is likely that genetic, environmental, and nutritional factors interact to induce excess production of pro-inflammatory cytokines that, in turn, damage fetal neurons leading to the adult onset of schizophrenia. Polyunsaturated fatty acids (PUFAs) and their metabolites such as lipoxins, resolvins, protectins, maresins and nitrolipids not only have potent neuroprotective action but also are capable of inhibiting the production of pro-inflammatory cytokines. Decreased formation of PUFAs as a result of low activity of Δ(6) and Δ(5) desaturases can result in an increase in the production of pro-inflammatory cytokines due to the absence of negative control exerted by PUFAs and their anti-inflammatory metabolites that, in turn, may predispose to neuronal damage and development of schizophrenia in adult life. Furthermore, PUFAs are essential for brain growth and development. If this proposal is correct, this implies that perinatal and adult supplementation of PUFAs not only prevents but also helps in the treatment of schizophrenia. Furthermore, synthetic analogs of lipoxins, resolvins, and protectins may be of significant benefit in schizophrenia.
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Affiliation(s)
- Undurti N Das
- UND Life Sciences, 13800 Fairhill Road, Shaker Heights, OH 44120, USA.
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de Kernier N, Marty F, Devouche E. Restoring psychic containers of identity after a suicide attempt in adolescence. Bull Menninger Clin 2012; 76:365-92. [PMID: 23244527 DOI: 10.1521/bumc.2012.76.4.365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Suicidal acts during adolescence reveal narcissistic vulnerabilities. The author's observation concerns the quality of ego boundaries, as well as their evolution. Longitudinal studies were conducted on the basis of interviews and projective tests performed within 15 days after the suicide attempt and once again the following year. The quantitative analyses of Fisher and Cleveland's Barrier/Penetration scores on the Rorschach show the evolution of identity mechanisms. The results underscore the importance of restoring psychic containers of identity.
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Affiliation(s)
- Nathalie de Kernier
- Laboratory of Psychoanalytical Psychopathology (LASIEA4430), Paris Ouest Nanterre La Défense University, Nanterre, France.
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Perinatal conditions and parental age at birth as risk markers for subsequent suicide attempt and suicide: a population based case-control study. Eur J Epidemiol 2012; 27:729-38. [PMID: 22911024 DOI: 10.1007/s10654-012-9724-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 07/27/2012] [Indexed: 10/28/2022]
Abstract
Restricted fetal growth and young maternal age have been associated with increased risk of suicidal behaviour later in life. Research investigating the independent and interacting effects of these risk factors with parental mental health and socio-economic status is scarce. A case-control study was effected through record linkage between Swedish registers. Individuals born 1973-1983 who were hospitalized due to a suicide attempt (n = 17,159) or committed suicide (n = 1,407) were matched to ≤10 controls by sex, month and county of birth. Controlling for parental conditions, significantly increased odds ratios (OR) for suicide attempt were found for low birth weight (OR = 1.12, 95 % CI 1.01-1.25), short birth length (OR = 1.15, 95 % CI 1.08-1.22), short and light for gestational age (OR = 1.23, 95 % CI: 1.10-1.38), short but not light for gestational age (OR = 1.18, 95 % CI: 1.09, 1.29), teenage motherhood (OR = 1.66, 95 % CI 1.53-1.80), young fatherhood (OR = 1.33, 95 % CI 1.27-1.39) and multiparity (OR = 1.40, 95 % CI 1.31-1.50). For completed suicide, increased odds ratios were found for low birth weight (OR = 1.65, 95 % CI 1.16-2.35), teenage motherhood (OR = 1.44, 95 % CI 1.09-1.90) and young fatherhood (OR = 1.20, 95 % CI 1.02-1.41). There was a synergy effect between teenage motherhood and parental psychiatric inpatient care with regard to suicide attempt in offspring [synergy index = 1.53 (95 % CI 1.27-1.84)]. Low birth weight and length, and short and light for gestational age may increase the risk of subsequent suicidal behaviour, and more research is needed to investigate underlying mechanisms. Public health implications from this study include measures to improve pre- and perinatal parental mental health, particularly in teenage pregnancies.
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Gyland EA. Infant Pain Assessment: A Quality Improvement Project in a Level III Neonatal Intensive Care Unit in Northeast Florida. ACTA ACUST UNITED AC 2012. [DOI: 10.1053/j.nainr.2011.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Maternal smoking during pregnancy and risks of suicidal acts in young offspring. Eur J Epidemiol 2011; 26:485-92. [PMID: 21331660 DOI: 10.1007/s10654-011-9556-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
Abstract
Obstetric and neonatal complications have been associated with completed and attempted suicide (suicidal acts) in young offspring. Maternal smoking is one of the most important risk factors for obstetric complications, but the association between prenatal smoking exposure and offspring risk of suicidal acts is unknown. We performed a population-based study of 1,449,333 single births born in Sweden between 1983 and 1996, derived from linked registry data. Maternal smoking and risks of suicidal acts in offspring were estimated using hazard ratios, derived from proportional-hazard models, controlling for potential confounding of parental socio-demographic factors and psychiatric care in first degree relatives. To control for unmeasured familial confounding, a matched case-control analysis of suicidal acts was performed within sibling pairs discordant for prenatal smoking exposure. In the cohort analysis, the adjusted hazard ratio for completed suicide among offspring to women smoking 1-9 cigarettes and at least 10 cigarettes per day were 1.67, 95% confidence interval (CI), 1.29-2.16, and 1.54, 95% CI, 1.12-2.10. For suicidal acts, corresponding hazard ratios were 1.28, 95% CI 1.21-1.35 and 1.48, 95% CI 1.39-1.57, respectively. However, in sibling pairs discordant for suicidal acts and prenatal smoking exposure, we found no evidence that prenatal smoking exposure increased the risk of suicidal acts. We conclude that the association between prenatal smoking exposure and offspring risk of suicidal acts is probably confounded by unmeasured familial factors.
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Wilber AA, Lin GL, Wellman CL. Neonatal corticosterone administration impairs adult eyeblink conditioning and decreases glucocorticoid receptor expression in the cerebellar interpositus nucleus. Neuroscience 2011; 177:56-65. [PMID: 21223994 DOI: 10.1016/j.neuroscience.2011.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Revised: 01/04/2011] [Accepted: 01/05/2011] [Indexed: 11/18/2022]
Abstract
Neonatal maternal separation alters adult learning and memory. Previously, we showed that neonatal separation impaired eyeblink conditioning in adult rats and increased glucocorticoid receptor (GR) expression in the cerebellar interpositus nucleus, a critical site of learning-related plasticity. Daily neonatal separation (1 h/day on postnatal days 2-14) increases neonatal plasma corticosterone levels. Therefore, effects of separation on GR expression in the interpositus and consequently adult eyeblink conditioning may be mediated by neonatal increases in corticosterone. As a first step in exploring a potential role for corticosterone in the neonatal separation effects we observed, we assessed whether systemic daily (postnatal days 2-14) corticosterone injections mimic neonatal separation effects on adult eyeblink conditioning and GR expression in the interpositus. Control uninjected animals were compared to animals receiving either daily corticosterone injections or daily injections of an equal volume of vehicle. Plasma corticosterone values were measured in a separate group of control, neonatally separated, vehicle injected, or corticosterone injected pups. In adulthood, rats underwent surgery for implantation of recording and stimulating electrodes. After recovery from surgery, rats underwent 10 daily sessions of eyeblink conditioning. Then, brains were processed for GR immunohistochemistry and GR expression in the interpositus nucleus was assessed. Vehicle and corticosterone injections both produced much larger increases in neonatal plasma corticosterone than did daily maternal separation, with the largest increases occurring in the corticosterone-injected group. Neonatal corticosterone injections impaired adult eyeblink conditioning and decreased GR expression in the interpositus nucleus, while the effects of vehicle injections were intermediate. Thus, while neonatal injections and maternal separation both produce adult impairments in learning and memory, these manipulations produce opposite changes in GR expression. This suggests an inverted U-shaped relationship may exist between both neonatal corticosterone levels and adult GR expression in the interpositus nucleus, and adult GR expression in the interpositus and eyeblink conditioning.
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MESH Headings
- Aging/drug effects
- Aging/physiology
- Animals
- Animals, Newborn
- Cerebellar Nuclei/drug effects
- Cerebellar Nuclei/metabolism
- Conditioning, Eyelid/drug effects
- Conditioning, Eyelid/physiology
- Corticosterone/administration & dosage
- Corticosterone/blood
- Disease Models, Animal
- Female
- Male
- Maternal Deprivation
- Rats
- Rats, Long-Evans
- Receptors, Glucocorticoid/antagonists & inhibitors
- Receptors, Glucocorticoid/biosynthesis
- Receptors, Glucocorticoid/deficiency
- Stress, Psychological/metabolism
- Stress, Psychological/physiopathology
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Affiliation(s)
- A A Wilber
- Canadian Centre for Behavioural Neuroscience, University of Lethbridge, 4401 University Drive West, Lethbridge, AB, Canada T1K 3M4.
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Rovnaghi CR, Garg S, Hall RW, Bhutta AT, Anand KJ. Ketamine analgesia for inflammatory pain in neonatal rats: a factorial randomized trial examining long-term effects. Behav Brain Funct 2008; 4:35. [PMID: 18687139 PMCID: PMC2527299 DOI: 10.1186/1744-9081-4-35] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 08/07/2008] [Indexed: 11/18/2022] Open
Abstract
Background Neonatal rats exposed to repetitive inflammatory pain have altered behaviors in young adulthood, partly ameliorated by Ketamine analgesia. We examined the relationships between protein expression, neuronal survival and plasticity in the neonatal rat brain, and correlated these changes with adult cognitive behavior. Methods Using Western immunoblot techniques, homogenates of cortical tissue were analyzed from neonatal rats 18–20 hours following repeated exposure to 4% formalin injections (F, N = 9), Ketamine (K, 2.5 mg/kg × 2, N = 9), Ketamine prior to formalin (KF, N = 9), or undisturbed controls (C, N = 9). Brain tissues from another cohort of rat pups (F = 11, K = 12, KF = 10, C = 15) were used for cellular staining with Fos immunohistochemistry or FluoroJade-B (FJB), followed by cell counting in eleven cortical and three hippocampal areas. Long-term cognitive testing using a delayed non-match to sample (DNMS) paradigm in the 8-arm radial maze was performed in adult rats receiving the same treatments (F = 20, K = 24, KF = 21, C = 27) in the neonatal period. Results Greater cell death occurred in F vs. C, K, KF in parietal and retrosplenial areas, vs. K, KF in piriform, temporal, and occipital areas, vs. C, K in frontal and hindlimb areas. In retrosplenial cortex, less Fos expression occurred in F vs. C, KF. Cell death correlated inversely with Fos expression in piriform, retrosplenial, and occipital areas, but only in F. Cortical expression of glial fibrillary acidic protein (GFAP) was elevated in F, K and KF vs. C. No significant differences occurred in Caspase-3, Bax, and Bcl-2 expression between groups, but cellular changes in cortical areas were significantly correlated with protein expression patterns. Cluster analysis of the frequencies and durations of behaviors grouped them as exploratory, learning, preparatory, consumptive, and foraging behaviors. Neonatal inflammatory pain exposure reduced exploratory behaviors in adult males, learning and preparatory behaviors in females, whereas Ketamine ameliorated these long-term effects. Conclusion Neuroprotective effects of Ketamine attenuate the impaired cognitive behaviors resulting from pain-induced cell death in the cortical and hippocampal fields of neonatal rats. This cell death was not dependent on the apoptosis associated proteins, but was correlated with glial activation.
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Affiliation(s)
- Cynthia R Rovnaghi
- Departments of Pediatrics, Anesthesiology, Pharmacology, Neurobiology & Developmental Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
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Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S. Suicide and suicidal behavior. Epidemiol Rev 2008; 30:133-54. [PMID: 18653727 DOI: 10.1093/epirev/mxn002] [Citation(s) in RCA: 1457] [Impact Index Per Article: 91.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Suicidal behavior is a leading cause of injury and death worldwide. Information about the epidemiology of such behavior is important for policy-making and prevention. The authors reviewed government data on suicide and suicidal behavior and conducted a systematic review of studies on the epidemiology of suicide published from 1997 to 2007. The authors' aims were to examine the prevalence of, trends in, and risk and protective factors for suicidal behavior in the United States and cross-nationally. The data revealed significant cross-national variability in the prevalence of suicidal behavior but consistency in age of onset, transition probabilities, and key risk factors. Suicide is more prevalent among men, whereas nonfatal suicidal behaviors are more prevalent among women and persons who are young, are unmarried, or have a psychiatric disorder. Despite an increase in the treatment of suicidal persons over the past decade, incidence rates of suicidal behavior have remained largely unchanged. Most epidemiologic research on suicidal behavior has focused on patterns and correlates of prevalence. The next generation of studies must examine synergistic effects among modifiable risk and protective factors. New studies must incorporate recent advances in survey methods and clinical assessment. Results should be used in ongoing efforts to decrease the significant loss of life caused by suicidal behavior.
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Affiliation(s)
- Matthew K Nock
- Department of Psychology, Harvard University, 33 Kirkland Street, Room 1280, Cambridge, MA 02138, USA.
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Mittendorfer-Rutz E, Wasserman D. Pregnancies in high psychosocial risk groups: research findings and implications for early intervention. Psychiatr Clin North Am 2008; 31:205-12. [PMID: 18439444 DOI: 10.1016/j.psc.2008.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Besides the well-known risk factors for youth suicidal behavior, recent evidence suggests that risk for youth suicidal behavior can be determined even very early in life, during the prenatal and perinatal period. Low birth weight and short birth length adjusted for gestational age were found to increase the risk for suicidal behavior, particularly by violent means. Several parental factors like low parental socioeconomic status, teenage and single parenthood, multiparity and parental psychopathology, substance abuse and suicidal behavior have been linked to an increase in youth suicidal behavior. Effective collaboration among the sectors within health care and social services is crucial for early detection and adequate intervention.
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Affiliation(s)
- Ellenor Mittendorfer-Rutz
- Department of Public Health Sciences, Karolinska Institutet, Granits väg 4, Solna, Stockholm, Sweden
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Anand KJS, Garg S, Rovnaghi CR, Narsinghani U, Bhutta AT, Hall RW. Ketamine reduces the cell death following inflammatory pain in newborn rat brain. Pediatr Res 2007; 62:283-90. [PMID: 17551412 DOI: 10.1203/pdr.0b013e3180986d2f] [Citation(s) in RCA: 161] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Premature infants experience untreated repetitive pain that may alter their brain development. Effects of ketamine and repetitive pain on cellular death and subsequent behavior were studied in neonatal rats. Rat pups were randomized to undisturbed controls (C), 4% formalin injection (F), ketamine alone (K, 5 mg/kg) or formalin plus ketamine (KF) and were assessed for neuroactivation with Fos protein, cellular death with FluoroJade-B, cognition with the radial arm maze, and pain thresholds with the hot-plate. Greater Fos expression and cell death occurred in F vs. C groups in defined brain areas at 1 and 4 h in F compared with other groups. Cell death was accentuated 3.3-fold in cortical areas and 1.6-fold in subcortical areas in the F compared with the C group following repetitive pain and sacrifice 18-20 h later. These effects were ameliorated by ketamine. Compared with the F group, all other groups demonstrated greater exploratory and rearing behaviors and decreased time for bait consumption at 1-h and 3-h intervals. Significantly greater thermal pain latencies occurred in the KF and F groups. Repetitive neonatal pain accentuates neuronal excitation and cell death in developmentally regulated cortical and subcortical areas, which decreases the acquisition of visual-spatial clues, short-term and long-term memory, and increases pain latencies. Ketamine analgesia mitigates most of these effects.
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Affiliation(s)
- Kanwaljeet J S Anand
- Pain Neurobiology Lab, Arkansas Children's Hospital Research Institute, Little Rock, Arkansas 72202, USA.
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Orbach I. From abandonment to symbiosis: A developmental reversal in suicidal adolescents. PSYCHOANALYTIC PSYCHOLOGY 2007. [DOI: 10.1037/0736-9735.24.1.150] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mittendorfer-Rutz E, Rasmussen F, Wasserman D. Restricted fetal growth and adverse maternal psychosocial and socioeconomic conditions as risk factors for suicidal behaviour of offspring: a cohort study. Lancet 2004; 364:1135-40. [PMID: 15451220 DOI: 10.1016/s0140-6736(04)17099-2] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Until now, sparse and contradictory results about an association between adverse neonatal, obstetric, and maternal conditions and heightened suicide risk in adolescents have been reported. The aims of this study were to investigate the relations between fetal growth, obstetric complications, and the mother's psychosocial and socioeconomic situation and the risk in early adulthood of suicide and attempted suicide in the offspring. METHODS Obstetric, neonatal, and maternal risk factors for suicide and attempted suicide in 713370 young adults, born in Sweden between 1973 and 1980, who were followed-up until Dec 31, 1999, were examined by data linkage between Swedish registers. Univariate and multivariate hazard ratios, derived from proportional-hazard models, were estimated. FINDINGS Significantly raised risk of attempted suicide was reported for individuals of short birth length, adjusted for gestational age (hazard ratio 1.29, 95% CI 1.18-1.41, p<0.0001); born fourth or more in birth order (1.79, 1.62-1.97, p<0.0001); born to mothers with a low educational level (1.36, 1.27-1.46, p<0.0001) (attributable proportion 10.3%); and those who, at time of delivery, had mothers aged 19 years or younger (2.09, 1.89-2.32, p<0.0001). Significant predictors of suicide were low birthweight, adjusted for gestational age (2.23, 1.43-3.46, p<0.0001), and teenage motherhood (2.30, 1.64-3.22, p<0.0001). INTERPRETATION Multiparity and low maternal education predicted suicide attempt, whereas restricted fetal growth and teenage motherhood were associated with both suicide completion and attempt in offspring.
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Affiliation(s)
- E Mittendorfer-Rutz
- Swedish National and Stockholm County Council Centre for Suicide Research and Prevention of Mental Ill-Health (NASP) at the National Institute of Psychosocial Medicine, Stockholm, Sweden
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Rosztóczy A, Fioramonti J, Jármay K, Barreau F, Wittmann T, Buéno L. Influence of sex and experimental protocol on the effect of maternal deprivation on rectal sensitivity to distension in the adult rat. Neurogastroenterol Motil 2003; 15:679-86. [PMID: 14651604 DOI: 10.1046/j.1350-1925.2003.00451.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Neonatal maternal separation induces visceral hyperalgesia before and after stress in male rats. This study compares the effects on sensitivity to rectal distension in adult male and female rats, using two protocols of deprivation. Between postnatal days 1 and 14, maternal deprivation was performed for 2 h per day according to a protocol of type M (removal of all pups from home cage) or type P (separation of half of littermates). Visceral sensitivity was assessed at 12 weeks of age by the number of abdominal contractions induced by rectal distension before and after restraint stress. Calcitonin gene-related peptide (CGRP) was identified in the rectal wall by immunohistochemistry. In basal conditions, both separation protocols induced hyperalgesia, that was greater after type M than type P, and in females than in males for type P separation. Acute restraint stress induced hyperalgesia in control females only, and this effect was similarly enhanced by both type P and M separation. No difference was found between controls and deprived rats in rectal CGRP immunoreactivity which was greater in females and increased after rectal distension. These results indicate that long-term visceral hyperalgesia depends upon the type of maternal deprivation and that females are more sensitive than males.
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Affiliation(s)
- A Rosztóczy
- Neurogastroenterology and Nutrition Unit, INRA, Toulouse, France
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Abstract
This paper focuses on the bodily experiences and attitudes toward the body in suicidal individuals. It is argued that bodily experiences and attitudes toward the body, such as rejection of the body, detachment, numbness, physical anhedonia, and lack of protection can facilitate acts of self-destruction. This argument is supported by theories of developmental psychology, theories on suicide, and empirical data. It is demonstrated that suicidal individuals experience their body differently from other populations and that these are related to suicidal behavior.
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Affiliation(s)
- Israel Orbach
- Department of Psychology at Bar-Ilan University in Ramat-Gan, Israel.
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Combalbert N, Bret-Dibat JL, Favard AM. Intérêts et limites de l’approche biologique pour l’étude des comportements agressifs. ANNALES MEDICO-PSYCHOLOGIQUES 2002. [DOI: 10.1016/s0003-4487(02)00228-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Chotai J, Salander Renberg E. Season of birth variations in suicide methods in relation to any history of psychiatric contacts support an independent suicidality trait. J Affect Disord 2002; 69:69-81. [PMID: 12103454 DOI: 10.1016/s0165-0327(00)00379-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Due to reports on season of birth variations in suicidal behaviour as well as in cerebrospinal fluid levels of monoamine metabolites, we investigated season of birth variations in suicide methods for completed suicides in relation to any history of psychiatric contacts. Relationships with the psychiatric diagnoses for those with psychiatric contacts were also studied. METHODS Sociodemographic variables and suicide methods were examined for all the 693 suicide victims during 1961-1980 in Västerbotten, Sweden. Information on any history of psychiatric contacts was obtained from psychiatric in-patient and out-patient records. RESULTS Gender differences in the choice of suicide method were found in the group without any history of psychiatric contacts, but not in those with such a history. Only those without a history of psychiatric contacts showed season of birth variations for suicide methods -- those born during February to April were significantly more likely, and those born during October to January significantly less likely, to have preferred hanging rather than poisoning or petrol gases. These associations were stronger for the determined suicides, for males, and for urban residence. Suicide victims with a history of psychiatric contacts were significantly younger than those without. LIMITATIONS No psychological autopsies for those without psychiatric contacts. No information on eventual contacts with general practitioners. No measures of monoamine neurotransmitters were available. CONCLUSIONS Season of birth association for suicide methods is likely to be mediated by a suicidality trait independently of specific major psychiatric disorders. Monoamine neurotransmitters, particularly serotonin, are likely to underlie such a trait.
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Affiliation(s)
- Jayanti Chotai
- Division of Psychiatry, Department of Clinical Sciences, University of Umeå, Umeå, Sweden.
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18
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Harrison H. Making Lemonade: A Parent’s View of “Quality of Life” Studies. THE JOURNAL OF CLINICAL ETHICS 2001. [DOI: 10.1086/jce200112307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
This paper presents an integrative approach to understanding of the inner experience of suicidal persons in terms of hemispheric asymmetry. The right hemisphere is involved in formation of polysemantic context. Polysemantic context is determined by multiple interconnections among its elements, while each concrete element bears the stamp of the whole context. Left hemisphere functioning leads to formation of monosemantic context. It is suggested that due to functional insufficiency of the right hemisphere the suicidal person demonstrates a compensatory shift to left hemisphere functioning. This shift manifests itself in reversed asymmetry of neurotransmitters, tendency to dissociation, alienated and negative perception of the body, lower sensitivity to pain, disintegration of self-representation, cognitive constriction, overly general nature of personal memories, difficulties in affect regulation as well as such personality traits as low openness to experience and personal constriction. This hypothesis raises a number of suggestions for future research.
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Affiliation(s)
- I Weinberg
- P.O. Box 331, 54103, Giv'at-Shemuel, Israel.
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Flisher AJ, Kramer RA, Hoven CW, King RA, Bird HR, Davies M, Gould MS, Greenwald S, Lahey BB, Regier DA, Schwab-Stone M, Shaffer D. Risk behavior in a community sample of children and adolescents. J Am Acad Child Adolesc Psychiatry 2000; 39:881-7. [PMID: 10892230 DOI: 10.1097/00004583-200007000-00017] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES First, to investigate whether there is covariation between risk behaviors, including suicidality, in a community probability sample of children and adolescents; and second, to investigate whether risk behavior is associated with selected potential correlates. METHOD A sample of 9- to 17-year-old youths (N = 1,285) and their caretakers were interviewed in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. The risk behaviors were marijuana smoking, alcohol use, intercourse, fighting, cigarette smoking, and suicidal ideation/attempts. Relationships between the risk behaviors were described using odds ratios. Linear regression analyses of an index of risk behavior on the selected potential correlates of risk behavior were conducted. RESULTS There were significant relationships between all pairs of risk behaviors. The score on the index of risk behavior was associated with stressors, lack of resources, family psychiatric disorder, psychopathology, and functional impairment. CONCLUSIONS Clinicians should be alerted to the possibility of risk behaviors, especially in children and adolescents engaging in other risk behaviors and those with inadequate resources, stressors, functional impairment, or psychopathology.
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Appleby L. Violent suicide and obstetric complications. The link is mental illness. BMJ (CLINICAL RESEARCH ED.) 1998; 317:1333-4. [PMID: 9812926 PMCID: PMC1114244 DOI: 10.1136/bmj.317.7169.1333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jacobson B, Bygdeman M. Obstetric care and proneness of offspring to suicide as adults: case-control study. BMJ (CLINICAL RESEARCH ED.) 1998; 317:1346-9. [PMID: 9812930 PMCID: PMC28715 DOI: 10.1136/bmj.317.7169.1346] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate any long term effects of traumatic birth and obstetric procedures in relation to suicide by violent means in offspring as adults. DESIGN Prospective case-control study. SETTING Stockholm, Sweden. SUBJECTS 242 adults who committed suicide by violent means from 1978 to 1995, and who were born in one of seven hospitals in Stockholm during 1945-80, matched with 403 biological siblings born during the same period and at the same group of hospitals. MAIN OUTCOME MEASURES Adverse and beneficial perinatal factors expressed as relative risks (odds ratios) and 95% confidence intervals, derived from logistic regression of cases matched with their siblings. RESULTS For multiple birth trauma the estimated relative risks of offspring subsequently committing suicide by violent means were 4.9 (95% confidence interval 1.8 to 13) for men and 1.04 (0.2 to 4.6) for women. In mothers who received multiple opiate treatment during delivery, the estimated relative risk of offspring subsequently committing suicide was equal for both sexes (0.26, 0.09 to 0.69). CONCLUSION Minimising pain and discomfort to the infant during birth seems to be of importance in reducing the risk of committing suicide by violent means as an adult.
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Affiliation(s)
- B Jacobson
- Department of Medical Engineering, F60 Novum, Huddinge University Hospital, SE-141 86 Huddinge, Sweden.
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Neugebauer R, Reuss ML. Association of maternal, antenatal and perinatal complications with suicide in adolescence and young adulthood. Acta Psychiatr Scand 1998; 97:412-8. [PMID: 9669512 DOI: 10.1111/j.1600-0447.1998.tb10024.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of the present study was to investigate whether maternal, antenatal and perinatal complications are associated with adolescent or young adulthood suicide in offspring. Cases consisted of individuals, aged 15-22 years, born in New York City and committing suicide in New York City between 1985 and 1991 (n = 189). Two controls were selected for each case, constituting the hospital birth immediately preceding and following that of the case, matched with the case with regard to sex and ethnicity. Cases were compared with controls using an index that summed a range of maternal, antenatal and perinatal complications and also with regard to the frequency of individual complications. In the total sample, cases and controls did not differ either in the mean number of all complications combined or in the proportions with specific complications. This lack of association between complications and outcome also obtained in separate analyses by sex, ethnicity, socio-economic status and age at suicide. These results fail to replicate the findings of two previous reports implicating maternal, antenatal and perinatal complications in risk of youth suicide. At present, epidemiological evidence that adverse reproductive events increase the risk for suicide in offspring remains inconclusive.
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Affiliation(s)
- R Neugebauer
- Epidemiology of Developmental Brain Disorders Department, NYS Psychiatric Institute, New York, NY, USA
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Brown AS, Susser ES, Lin SP, Gorman JM. Affective disorders in Holland after prenatal exposure to the 1957 A2 influenza epidemic. Biol Psychiatry 1995; 38:270-3. [PMID: 8547451 DOI: 10.1016/0006-3223(95)00241-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- A S Brown
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, NY 10032, USA
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Brown AS, Susser ES, Lin SP, Neugebauer R, Gorman JM. Increased risk of affective disorders in males after second trimester prenatal exposure to the Dutch hunger winter of 1944-45. Br J Psychiatry 1995; 166:601-6. [PMID: 7620744 DOI: 10.1192/bjp.166.5.601] [Citation(s) in RCA: 141] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Prenatal and perinatal factors have been linked to affective disorders. We therefore undertook an exploratory study to determine whether prenatal exposure to severe famine was associated with an increased risk of affective disorders. METHOD Monthly birth cohorts that were exposed and unexposed to the Dutch Hunger Winter of 1944-45 were identified. The cumulative incidences of affective psychoses and neurotic depression (ICD-9 criteria) were compared between exposed and unexposed cohorts during each trimester of gestation. RESULTS The relative risk (RR) of affective psychosis (broad and restricted definitions) among persons exposed to famine during the second trimester was significantly increased (broad: RR (95% confidence interval) = 1.62 (1.19, 2.20); restricted: 1.59 (1.14, 2.21)). Separate analysis by gender showed a significant association among males (broad: 2.26 (1.43, 3.57); restricted: 2.40 (1.49, 3.89), but not females (broad: 1.28 (0.84, 1.94); restricted: 1.17 (0.73, 1.76)). The risk of neurotic depression was not increased after prenatal famine exposure. CONCLUSIONS These results suggest a possible relationship between prenatal famine during the second trimester and affective psychosis, lending plausibility to reports that have associated affective psychoses with prenatal exposures. Further studies of this relationship are warranted.
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Affiliation(s)
- A S Brown
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, NY 10032, USA
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Riedlinger TJ, Riedlinger JE. Psychedelic and entactogenic drugs in the treatment of depression. J Psychoactive Drugs 1994; 26:41-55. [PMID: 7913128 DOI: 10.1080/02791072.1994.10472600] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
CNS deficiency of 5-hydroxytryptamine (serotonin) has been implicated as a biochemical basis in some forms of depression. Existing drug modalities for treating depression include some with serotonergic effects. Studies suggest that psychedelic drugs are also serotonergic. This may indicate a role for psychedelics in the treatment of depression. Such treatment has already been attempted using psychedelic drugs in both the indoleamine and phenylalkylamine categories. Encouraging results seem to recommend further research, with special emphasis on drugs in the phenylisopropylamine subgroup of phenylalkylamines that are only peripherally psychedelic. Certain of these, called entactogens or empathogens, cause substantially less distortion of normative consciousness than classic psychedelics, such as LSD or mescaline. They could therefore be more easily assimilated into existing psychotherapy approaches, where their function would be to enhance the normal psychotherapeutic process rather than serving a maintenance role as chemotherapeutic agents. Their usefulness in such an application would be mainly at the start of psychotherapy in order to (1) reduce the client's "fear response" that often inhibits ability to deal with repressed traumatic material; (2) facilitate the client's interpersonal communications with the therapist, spouse or significant others; and (3) accelerate formation of a therapeutic alliance between client and therapist.
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Affiliation(s)
- T J Riedlinger
- Botanical Museum of Harvard University, Cambridge, Massachusetts
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Affiliation(s)
- F Earls
- Harvard Medical School, Boston, MA
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Chapter 2 NonRight-Handedness and the Continuum of Reproductive Casualty. ACTA ACUST UNITED AC 1990. [DOI: 10.1016/s0166-4115(08)61243-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Shaffer D, Garland A, Gould M, Fisher P, Trautman P. Preventing teenage suicide: a critical review. J Am Acad Child Adolesc Psychiatry 1988; 27:675-87. [PMID: 3058676 DOI: 10.1097/00004583-198811000-00001] [Citation(s) in RCA: 265] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Moens GF, Haenen W, Van de Voorde H. Epidemiological aspects of suicide among the young in selected European countries. J Epidemiol Community Health 1988; 42:279-85. [PMID: 3251009 PMCID: PMC1052739 DOI: 10.1136/jech.42.3.279] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Trends in reported suicide rates were analysed for the ages 5-24 years in 21 selected European countries in 1970-74 and 1980-84. In children the precision of the rates was found to be low though there appeared to be a trend to increased suicide in boys. In adolescent and young adult males, however, there was a definite increase in suicide over the period studied, and this was much more marked than in females, in whom the rates had declined in eight countries. The Belgian situation was investigated in detail. Increases were most pronounced in 20-24 year-old males. Around 1981, about half of youth suicides were committed by firearms and medicaments, and these methods showed the largest increases in risk. The estimated under-reporting error diminished with increasing age and over the past ten years. It was larger in females, but did not bias the trends substantially. On the aggregated level, youth suicide was found most strongly associated with indicators of anomie and social isolation. The relevance of these findings in the search for determinants and for preventive strategies is discussed.
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Affiliation(s)
- G F Moens
- Division of Community Medicine, School of Public Health, Catholic University Leuven, Belgium
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Blumenthal SJ. Suicide: a guide to risk factors, assessment, and treatment of suicidal patients. Med Clin North Am 1988; 72:937-71. [PMID: 3287045 DOI: 10.1016/s0025-7125(16)30754-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This article summarizes what is known about risk factors for suicide in both adolescent and adult populations. It also translates this knowledge base into practical considerations for the physician on the assessment and treatment of suicidal patients. Since most patients who commit suicide have seen a physician in the weeks to month prior to their deaths, and many kill themselves with medications prescribed by their doctors, the physician's early detection and treatment of suicidal behaviors and associated psychiatric disorders in his or her patients becomes a major suicide prevention strategy.
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Affiliation(s)
- S J Blumenthal
- Behavioral Medicine Program, National Institute of Mental Health, Rockville, Maryland
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Blumenthal SJ, Kupfer DJ. Overview of early detection and treatment strategies for suicidal behavior in young people. J Youth Adolesc 1988; 17:1-23. [PMID: 24277551 DOI: 10.1007/bf01538721] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/1987] [Accepted: 08/07/1987] [Indexed: 11/26/2022]
Affiliation(s)
- S J Blumenthal
- Behavioral Medicine Program, Health and Behavior Research Branch, National Institute of Mental Health, 20857, Rockville, Maryland
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Jacobson B, Eklund G, Hamberger L, Linnarsson D, Sedvall G, Valverius M. Perinatal origin of adult self-destructive behavior. Acta Psychiatr Scand 1987; 76:364-71. [PMID: 3425362 DOI: 10.1111/j.1600-0447.1987.tb05620.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The study was undertaken to test whether obstetric procedures are of importance for eventual adult behavior of the newborn, as ecological data from the United States seem to indicate. Birth record data were gathered for 412 forensic victims comprising suicides, alcoholics and drug addicts born in Stockholm after 1940, and who died there in 1978-1984. The births of the victims were unevenly distributed among six hospitals. Comparison with 2,901 controls, and mutual comparison of categories, showed that suicides involving asphyxiation were closely associated with asphyxia at birth, suicides by violent mechanical means were associated with mechanical birth trauma and drug addiction was associated with opiate and/or barbiturate administration to mothers during labor. Irrespective of the mechanism transferring the birth trauma to adulthood--which might be analogous to imprinting--the results show that obstetric procedures should be carefully evaluated and possibly modified to prevent eventual self-destructive behavior.
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Affiliation(s)
- B Jacobson
- Department of Medical Engineering, State Institute of Forensic Medicine in Stockholm, Solna, Sweden
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Abstract
It is concluded from a review of the literature and a pilot survey that schizophrenic patients more frequently have a history of obstetric complications (OCs) than do other psychiatric patients and normal subjects. OCs are associated with increased cerebral ventricular size in both infancy and adulthood, and are more common among non-familial schizophrenic patients. Neonatal cerebrovascular events consequent upon OCs provide a mechanism to explain the increased risk of neurodevelopmental deviance and later schizophrenia.
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Affiliation(s)
- S W Lewis
- Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, U.K
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