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Civardi SC, Besana F, Carnevale Miacca G, Mazzoni F, Arienti V, Politi P, Brondino N, Olivola M. Risk factors for suicidal attempts in a sample of outpatients with treatment-resistant depression: an observational study. Front Psychiatry 2024; 15:1371139. [PMID: 38585482 PMCID: PMC10995380 DOI: 10.3389/fpsyt.2024.1371139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/08/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Treatment-resistant depression (TRD) is commonly defined as the failure of at least two trials with antidepressant drugs, given at the right dose and for an appropriate duration. TRD is associated with increased mortality, compared to patients with a simple major depressive episode. This increased rate was mainly attributed to death from external causes, including suicide and accidents. The aim of our study is to identify socio-demographic and psychopathological variables associated with suicidal attempts in a sample of outpatients with TRD. Material and methods We performed a monocentric observational study with a retrospective design including a sample of 63 subjects with TRD referred to an Italian outpatient mental health centre. We collected socio-demographic and psychopathological data from interviews and clinical records. Results 77.8% of the sample (N=49) were females, the mean age was 49.2 (15.9). 33.3% (N=21) of patients had attempted suicide. 54% (N=34) of patients had a psychiatric comorbidity. Among the collected variables, substance use (p=0.031), psychiatric comorbidities (p=0.049) and high scores of HAM-D (p=0.011) were associated with the occurrence of suicide attempts. In the regression model, substance use (OR 6.779), psychiatric comorbidities (OR 3.788) and HAM-D scores (OR 1.057) were predictive of suicide attempts. When controlling for gender, only substance use (OR 6.114) and HAM-D scores (OR 1.057) maintained association with suicide attempts. Conclusion The integrated treatment of comorbidities and substance abuse, which involves different mental health services, is fundamental in achieving the recovery of these patients. Our study supports the importance of performing a careful clinical evaluation of patients with TRD in order to identify factors associated with increased risk of suicide attempts.
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Affiliation(s)
| | - Filippo Besana
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | | | - Filippo Mazzoni
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Vincenzo Arienti
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Department of Mental Health and Addictions, Azienda Socio-Sanitaria Territoriale (ASST), Pavia, Pavia, Italy
| | - Natascia Brondino
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Department of Mental Health and Addictions, Azienda Socio-Sanitaria Territoriale (ASST), Pavia, Pavia, Italy
| | - Miriam Olivola
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Department of Mental Health and Addictions, Azienda Socio-Sanitaria Territoriale (ASST), Pavia, Pavia, Italy
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2
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Barker J, Oakes-Rogers S, Lince K, Roberts A, Keddie R, Bruce H, Selvarajah S, Fish D, Aspen C, Leddy A. Can clinician's risk assessments distinguish those who disclose suicidal ideation from those who attempt suicide? DEATH STUDIES 2024; 48:129-139. [PMID: 36961770 DOI: 10.1080/07481187.2023.2192532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Participants were 85 individuals who made suicide attempts within two years of their Improving Access to Psychological Therapies (IAPT) assessment, identified using record linkage. Two comparison groups, non-suicidal controls (n = 1416) and (ideators, n = 743) were compared on variables extracted from the standardized IAPT risk assessment interview. Disclosure of a historical suicide attempt or non-suicidal self-injury (NSSI) distinguished those making an attempt from those with suicidal ideation only, but suicidal intent did not. A third of the participants concealed a historical suicide attempt. The IAPT Phobia Scale classified 49.30% of attempters with 100% specificity. The IAPT Phobia Scale may have clinical value in assessing risk but requires validation. Past suicide attempt and NSSI have better clinical risk assessment utility than current suicidal ideation intensity. Risk assessment relying on disclosure is likely to be flawed and risks support being withheld from those assumed to be at lower risk.
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Affiliation(s)
- Joseph Barker
- Department of Clinical Psychology, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Sophie Oakes-Rogers
- Department of Clinical Psychology, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Karen Lince
- Wellbeing Norfolk and Suffolk, The Conifers, Norwich, UK
| | - Ashley Roberts
- Wellbeing Norfolk and Suffolk, The Conifers, Norwich, UK
| | - Ronan Keddie
- Wellbeing Norfolk and Suffolk, The Conifers, Norwich, UK
| | - Harley Bruce
- Wellbeing Norfolk and Suffolk, The Conifers, Norwich, UK
| | | | - Daisy Fish
- Wellbeing Norfolk and Suffolk, The Conifers, Norwich, UK
| | - Caitlin Aspen
- Wellbeing Norfolk and Suffolk, The Conifers, Norwich, UK
| | - Adrian Leddy
- Department of Clinical Psychology, University of East Anglia, Norwich Research Park, Norwich, UK
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Wang LJZ, Lan Y, Liu SJ, Yan WS. Impact of the COVID-19 and psychological risk factors on non-suicidal self-injury behavior among high school students: a one-year follow-up study. BMC Psychiatry 2023; 23:512. [PMID: 37452290 PMCID: PMC10349405 DOI: 10.1186/s12888-023-05021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES Non-suicidal self-injury (NSSI) behavior is a severe public health issue in adolescents. This study investigated the possible impact of the coronavirus disease 2019 (COVID-19) and analyzed psychological risk factors on adolescent NSSI. METHODS A one-year follow-up study was conducted in September 2019 (Time 1) and September 2020 (Time 2) among 3588 high school students. The completed follow-up participants (N = 2527) were classified into no NSSI (negative at both time points), emerging NSSI (negative at Time 1 but positive at Time 2), and sustained NSSI (positive at both time points) subgroups according to their NSSI behaviors before and during the COVID-19 pandemic. Perceived family functioning, perceived school climate, negative life events, personality traits (neuroticism, impulsivity, and self-control) were assessed using self-report scales. RESULTS The data indicated an increase (10.3%) in the incidence of NSSI. Compared to no NSSI subjects, the emerging NSSI and sustained NSSI subgroups had lower perceived family functioning, higher neuroticism, higher impulse-system but lower self-control scores, and more negative life events. Logistic regressions revealed that after controlling for demographics, neuroticism and impulse-system levels at Time 1 positively predicted emerging NSSI behavior, and similarly, higher neuroticism and impulsivity and lower self-control at Time 1 predicted sustained NSSI behavior. CONCLUSIONS These findings highlighted the aggravated impact of the COVID-19 on NSSI, and suggested that individual neuroticism, impulsivity, and self-control traits might be crucial for the development of NSSI behavior among adolescent students.
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Affiliation(s)
- Lu-Jiao-Zi Wang
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang, 550004, China
| | - Yan Lan
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang, 550004, China
| | - Su-Jiao Liu
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang, 550004, China
| | - Wan-Sen Yan
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang, 550004, China.
- Guizhou Research Institute for Health Development, Guizhou Medical University, Guiyang, China.
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Castro-Ramirez F, Paz-Pérez MA, McGuire TC, Rankin O, Alfaro MCG, Audirac AM, Campuzano MLG, Coady P, Núñez-Delgado M, Manana J, Hernández-de la Rosa C, Tambedou T, Vergara GA, Barranco LA, Cudris-Torres L, Nock MK, Naslund JA, Benjet C. A Qualitative Examination of the Impact of Suicidal Thoughts and Behavior on Help-Seeking Among University Students in Colombia and Mexico. JOURNAL OF BEHAVIORAL AND COGNITIVE THERAPY 2023; 33:67-80. [PMID: 37680902 PMCID: PMC10482072 DOI: 10.1016/j.jbct.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
This study examined descriptions of suicidal thoughts and behavior (STB) to identify risk and protective factors that may present in clinical settings among university students from Latin America. Our focus was on answering the following key questions: How are suicidal thoughts and behavior described? What are reasons for wanting to die and for living? What impact do STBs have on motivations to seek or avoid psychological treatment? To this end, 55 qualitative interviews were completed with university students from Colombia and Mexico who recently endorsed emotional difficulties in the World Mental Health International College Student (WMH-ICS) surveys. Interviews were coded to identify themes specific to STBs. Findings revealed insight on symptom presentations and consequences of STBs. Participants described uncontrollable somatic symptoms during periods of high suicide risk, which serves as a relevant clinical marker for health providers. An important reason for living was to avoid suffering for family, which was protective against suicide and motivates familial involvement in treatment planning. Participants sought solutions to emotional problems after experiencing STBs, including psychological treatment. Cultural stigma of mental illness induced feelings of shame and burden, which led to avolition, avoidance, and nondisclosure of symptom severity. This study provides insight into the utility of evaluating cultural context in (a) detecting antecedents to STBs frequently reported as somatic symptoms, (b) identifying protective factors against suicide, and (c) recognizing how stigma of mental illness and suicide, shame avoidance, and familism might influence personal motivations to seek or avoid help for emotional distress.
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Affiliation(s)
| | | | | | - Osiris Rankin
- Department of Psychology, Harvard University, United States
| | | | | | | | - Parker Coady
- Department of Psychology, Harvard University, United States
| | | | | | | | - Tida Tambedou
- Department of Psychology, Harvard University, United States
| | | | | | | | - Matthew K Nock
- Department of Psychology, Harvard University, United States
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, United States
| | - Corina Benjet
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, México City, México
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5
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Hatton SL, Pandey MK. Fat and Protein Combat Triggers Immunological Weapons of Innate and Adaptive Immune Systems to Launch Neuroinflammation in Parkinson's Disease. Int J Mol Sci 2022; 23:1089. [PMID: 35163013 PMCID: PMC8835271 DOI: 10.3390/ijms23031089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 01/27/2023] Open
Abstract
Parkinson's disease (PD) is the second-most common neurodegenerative disease in the world, affecting up to 10 million people. This disease mainly happens due to the loss of dopaminergic neurons accountable for memory and motor function. Partial glucocerebrosidase enzyme deficiency and the resultant excess accumulation of glycosphingolipids and alpha-synuclein (α-syn) aggregation have been linked to predominant risk factors that lead to neurodegeneration and memory and motor defects in PD, with known and unknown causes. An increasing body of evidence uncovers the role of several other lipids and their association with α-syn aggregation, which activates the innate and adaptive immune system and sparks brain inflammation in PD. Here, we review the emerging role of a number of lipids, i.e., triglyceride (TG), diglycerides (DG), glycerophosphoethanolamines (GPE), polyunsaturated fatty acids (PUFA), sphingolipids, gangliosides, glycerophospholipids (GPL), and cholesterols, and their connection with α-syn aggregation as well as the induction of innate and adaptive immune reactions that trigger neuroinflammation in PD.
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Affiliation(s)
- Shelby Loraine Hatton
- Cincinnati Children’s Hospital Medical Center, Division of Human Genetics, 3333 Burnet Avenue, Cincinnati, OH 45229, USA;
| | - Manoj Kumar Pandey
- Cincinnati Children’s Hospital Medical Center, Division of Human Genetics, 3333 Burnet Avenue, Cincinnati, OH 45229, USA;
- Department of Pediatrics, Division of Human Genetics, College of Medicine, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
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6
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Shaker NM, Sultan M, Mohamed MY, Helal SA, Abd El Moneam MHED. Lipid Profile and Impulsivity in Suicidal Patients with Major Depressive Disorder. Arch Suicide Res 2021; 25:641-656. [PMID: 32252618 DOI: 10.1080/13811118.2020.1746456] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Previous observational cohort studies showed an association between low serum lipid levels and suicide. This study was undertaken to examine the relationship between lipid parameters and impulsivity in suicidal patients with major depressive disorder (MDD). METHODS The current study included 100 patients with MDD distributed as 50 patients with recent suicidal attempts and 50 patients with no lifetime history of suicide. Participants were subjected to Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I) to confirm the diagnosis. The risk of suicide was assessed through the Suicide Probability Scale (SPS), while the intent and seriousness of suicide were assessed through Beck's Suicidal Intent Scale. assessment of impulsivity was carried out through Barratt Impulsivity Scale. Serum lipid levels were measured in mg/dL after an overnight fast. RESULTS Total cholesterol (TC) was found significantly lower in the suicidal group compared to the non-suicidal depressed group (p = 0.040). Low high-density lipoprotein (HDL) level was significantly correlated with suicidality and high suicide intent was correlated with hopelessness. Logistic regression for lipid profile in both groups revealed significant TC and low-density lipoprotein (LDL) as predictors for suicide. There was no significant correlation between impulsivity and characteristics of depression, suicide probability, suicide intent, and all elements of the lipid profile. CONCLUSIONS Low TC and LDL could predict suicidal behavior in patients with MDD. Impulsivity could not be a mediator or predictor of suicide risk in patients with MDD.
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7
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Bilska K, Pawlak J, Kapelski P, Narożna B, Zakowicz P, Szczepankiewicz A, Skibińska M, Dmitrzak-Węglarz M. Differences in the Clinical Picture in Women with a Depressive Episode in the Course of Unipolar and Bipolar Disorder. J Clin Med 2021; 10:jcm10040676. [PMID: 33578674 PMCID: PMC7916360 DOI: 10.3390/jcm10040676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/23/2021] [Accepted: 02/04/2021] [Indexed: 11/16/2022] Open
Abstract
Due to current depression prevalence, it is crucial to make the correct diagnosis as soon as possible. The study aimed to identify commonly available, easy to apply, and quick to interpret tools allowing for a differential diagnosis between unipolar and bipolar disorder. The study group includes women with long duration of unipolar (UP, N = 34) and bipolar (BP, N = 43) affective disorder. The diagnosis was established according to the DSM criteria using SCID questionnaire. Additional questionnaires were used to differentiate between UP and BP. BP patients had an earlier age of onset, were hospitalized more times, and more often had a family history of psychiatric disorders than UP (p-value < 0.05). Moreover, BP achieved a higher impulsiveness score and more frequently had experienced severe problems with close individuals. To our knowledge, this is the first publication presenting results of numerous questionnaires applied simultaneously in patients on clinical group. Several of them suggest the direction of clinical assessment, such as: the age of onset, family psychiatric burdens, history of stressful life events, learning problems, social and job relations. Further studies are necessary to confirm the utility of this approach.
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Affiliation(s)
- Karolina Bilska
- Department of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (J.P.); (P.K.); (P.Z.); (M.S.); (M.D.-W.)
- Correspondence: ; Tel.: +48-618-547-641
| | - Joanna Pawlak
- Department of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (J.P.); (P.K.); (P.Z.); (M.S.); (M.D.-W.)
| | - Paweł Kapelski
- Department of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (J.P.); (P.K.); (P.Z.); (M.S.); (M.D.-W.)
| | - Beata Narożna
- Laboratory of Molecular and Cell Biology, Department of Pediatric Pulmonology, Allergy and Clinical Immunology, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (B.N.); (A.S.)
| | - Przemysław Zakowicz
- Department of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (J.P.); (P.K.); (P.Z.); (M.S.); (M.D.-W.)
- Center for Child and Adolescent Treatment, 66-003 Zabór, Poland
| | - Aleksandra Szczepankiewicz
- Laboratory of Molecular and Cell Biology, Department of Pediatric Pulmonology, Allergy and Clinical Immunology, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (B.N.); (A.S.)
| | - Maria Skibińska
- Department of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (J.P.); (P.K.); (P.Z.); (M.S.); (M.D.-W.)
| | - Monika Dmitrzak-Węglarz
- Department of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (J.P.); (P.K.); (P.Z.); (M.S.); (M.D.-W.)
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8
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Vargas-Medrano J, Diaz-Pacheco V, Castaneda C, Miranda-Arango M, Longhurst MO, Martin SL, Ghumman U, Mangadu T, Chheda S, Thompson PM, Gadad BS. Psychological and neurobiological aspects of suicide in adolescents: Current outlooks. Brain Behav Immun Health 2020; 7:100124. [PMID: 32835300 PMCID: PMC7405877 DOI: 10.1016/j.bbih.2020.100124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 01/10/2023] Open
Abstract
Suicidality is one of the leading causes of death among young adults in the United States and represents a significant health problem worldwide. The suicide rate among adolescents in the United States has increased dramatically in the latest years and has been accompanied by considerable changes in youth suicide, especially among young girls. Henceforth, we need a good understanding of the risk factors contributing to suicidal behavior in youth. An explanatory model for suicidal behavior that links clinical and psychological risk factors to the underlying neurobiological, neuropsychological abnormalities related to suicidal behavior might predict to help identify treatment options and have empirical value. Our explanatory model proposes that developmental, biological factors (genetics, proteomics, epigenetics, immunological) and psychological or clinical (childhood adversities) may have causal relevance to the changes associated with suicidal behavior. In this way, our model integrates findings from several perspectives in suicidality and attempts to explain the relationship between various neurobiological, genetic, and clinical observations in suicide research, offering a comprehensive hypothesis to facilitate understanding of this complex outcome. Unraveling the knowledge of the complex interplay of psychological, biological, sociobiological, and clinical risk factors is highly essential, concerning the development of effective prevention strategy plans for suicidal ideation and suicide.
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Affiliation(s)
- Javier Vargas-Medrano
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
- Southwest Brain Bank, Texas Tech University Health Science Center, El Paso, TX, 79905, University of Texas, El Paso, USA
| | - Valeria Diaz-Pacheco
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
- Southwest Brain Bank, Texas Tech University Health Science Center, El Paso, TX, 79905, University of Texas, El Paso, USA
| | - Christopher Castaneda
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
| | - Manuel Miranda-Arango
- Department of Biological Sciences, Border Biomedical Research Center, The University of Texas at El Paso, TX, 79968, USA
| | - Melanie O Longhurst
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
| | - Sarah L. Martin
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
| | - Usman Ghumman
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
| | - Thenral Mangadu
- Minority AIDS Research Center, Department of Health Sciences, The University of Texas at El Paso, TX, 79968, USA
| | - Sadhana Chheda
- Department of Pediatrics, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
| | - Peter M. Thompson
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
- Southwest Brain Bank, Texas Tech University Health Science Center, El Paso, TX, 79905, University of Texas, El Paso, USA
| | - Bharathi S. Gadad
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
- Southwest Brain Bank, Texas Tech University Health Science Center, El Paso, TX, 79905, University of Texas, El Paso, USA
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9
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Shen Y, Zhang Y, Chan BSM, Meng F, Yang T, Luo X, Huang C. Association of ADHD symptoms, depression and suicidal behaviors with anxiety in Chinese medical college students. BMC Psychiatry 2020; 20:180. [PMID: 32321462 PMCID: PMC7175542 DOI: 10.1186/s12888-020-02555-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 03/18/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Anxiety is one of the most common psychiatric disorder and imposes a great burden on both the individual and the society. Previous studies indicate a high comorbidity of anxiety disorders and Attention Deficit Hyperactivity Disorder (ADHD). However, few studies have examined the comorbidity of anxiety and ADHD among medical college students in mainland China. This study aimed to examine the prevalence of anxiety and the associated risk factor of anxiety disorder as well as to explore the association between ADHD symptoms, depression, suicidal behaviors and anxiety. METHODS A cross-sectional design was employed among 4882 medical college students who were recruited and enrolled with convenience sampling. Self-reported demographic information and clinical characteristics were collected online on a computer or through a social media app named Wechat. RESULTS The prevalence of anxiety in this study was 19.9%. Students with anxiety were more likely to have a poor relationship with parents, be of Han nationality, have smoking or drinking habits, have an extensive physical disorder history and have engaged in suicidal behaviors. The independent risk factors for anxiety were: smoking, physical disorder history, suicidal ideations, suicide attempts, inattention and hyperactivity. Significant associations were observed between anxiety and depression, inattention, hyperactivity, suicide plans and suicide attempts. CONCLUSIONS Nearly one in five medical students suffered from anxiety. The findings of this study indicate the importance of addressing both anxiety and ADHD symptoms in order to better promote mental health and the well-being of medical students as well as reduce suicidal behaviors.
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Affiliation(s)
- Yanmei Shen
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, 410011, Hunan, China.,The Department of Educational and Counselling Psychology, and Special Education, The University of British Columbia, Vancouver, Canada
| | - Yaru Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, 410011, Hunan, China
| | - Bella Siu Man Chan
- The Department of Educational and Counselling Psychology, and Special Education, The University of British Columbia, Vancouver, Canada
| | - Fanchao Meng
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, 410011, Hunan, China
| | - Tingyu Yang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, 410011, Hunan, China
| | - Xuerong Luo
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China. .,Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, 410011, Hunan, China.
| | - Chunxiang Huang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China. .,Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, 410011, Hunan, China.
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10
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Bonanni L, Gualtieri F, Lester D, Falcone G, Nardella A, Fiorillo A, Pompili M. Can Anhedonia Be Considered a Suicide Risk Factor? A Review of the Literature. MEDICINA-LITHUANIA 2019; 55:medicina55080458. [PMID: 31405085 PMCID: PMC6723513 DOI: 10.3390/medicina55080458] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/25/2019] [Accepted: 08/06/2019] [Indexed: 01/19/2023]
Abstract
Background and Objectives: At present, data collected from the literature about suicide and anhedonia are controversial. Some studies have shown that low levels of anhedonia are associated with serious suicide attempts and death by suicide, while other studies have shown that high levels of anhedonia are associated with suicide. Materials and Methods: For this review, we searched PubMed, Medline, and ScienceDirect for clinical studies published from 1 January 1990 to 31 December 2018 with the following search terms used in the title or in the abstract: “anhedonia AND suicid*.” We obtained a total of 155 articles; 133 items were excluded using specific exclusion criteria, the remaining 22 articles included were divided into six groups based on the psychiatric diagnosis: mood disorders, schizophrenia spectrum disorders, post-traumatic stress disorder (PTSD), other diagnoses, attempted suicides, and others (healthy subjects). Results: The results of this review reveal inconsistencies. Some studies reported that high anhedonia scores were associated with suicidal behavior (regardless of the diagnosis), while other studies found that low anhedonia scores were associated with suicidal behavior, and a few studies reported no association. The most consistent association between anhedonia and suicidal behavior was found for affective disorders (7 of 7 studies reported a significant positive association) and for PTSD (3 of 3 studies reported a positive association). In the two studies of patients with schizophrenia, one found no association, and one found a negative association. For patients who attempted suicide (undiagnosed), one study found a positive association, one a positive association only for depressed attempters, and one a negative association. Conclusions: We found the most consistent positive association for patients with affective disorders and PTSD, indicating that the assessment of anhedonia may be useful in the evaluation of suicidal risk.
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Affiliation(s)
- Luca Bonanni
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Flavia Gualtieri
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - David Lester
- Psychology Program, Stockton University, Galloway, NJ 08205, USA
| | - Giulia Falcone
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Adele Nardella
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy.
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11
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Melhem NM, Porta G, Oquendo MA, Zelazny J, Keilp JG, Iyengar S, Burke A, Birmaher B, Stanley B, Mann JJ, Brent DA. Severity and Variability of Depression Symptoms Predicting Suicide Attempt in High-Risk Individuals. JAMA Psychiatry 2019; 76:603-613. [PMID: 30810713 PMCID: PMC6551844 DOI: 10.1001/jamapsychiatry.2018.4513] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE Predicting suicidal behavior continues to be among the most challenging tasks in psychiatry. OBJECTIVES To examine the trajectories of clinical predictors of suicide attempt (specifically, depression symptoms, hopelessness, impulsivity, aggression, impulsive aggression, and irritability) for their ability to predict suicide attempt and to compute a risk score for suicide attempts. DESIGN, SETTING, AND PARTICIPANTS This is a longitudinal study of the offspring of parents (or probands) with mood disorders who were recruited from inpatient units at Western Psychiatric Institute and Clinic (Pittsburgh) and New York State Psychiatric Institute. Participants were recruited from July 15, 1997, to September 6, 2005, and were followed up through January 21, 2014. Probands and offspring (n = 663) were interviewed at baseline and at yearly follow-ups for 12 years. Lifetime and current psychiatric disorders were assessed, and self-reported questionnaires were administered. Model evaluation used 10-fold cross-validation, which split the entire data set into 10 equal parts, fit the model to 90% of the data (training set), and assessed it on the remaining 10% (test set) and repeated that process 10 times. Preliminary analyses were performed from July 20, 2015, to October 5, 2016. Additional analyses were conducted from July 26, 2017, to July 24, 2018. MAIN OUTCOMES AND MEASURES The broad definition of suicide attempt included actual, interrupted, and aborted attempts as well as suicidal ideation that prompted emergency referrals during the study. The narrow definition referred to actual attempt only. RESULTS The sample of offspring (n = 663) was almost equally distributed by sex (316 female [47.7%]) and had a mean (SD) age of 23.8 (8.5) years at the time of censored observations. Among the 663 offspring, 71 (10.7%) had suicide attempts over the course of the study. The trajectory of depression symptoms with the highest mean scores and variability over time was the only trajectory to predict suicide attempt (odds ratio [OR], 4.72; 95% CI, 1.47-15.21; P = .01). In addition, we identified the following predictors: younger age (OR, 0.82; 95% CI, 0.74-0.90; P < .001), lifetime history of unipolar disorder (OR, 4.71; 95% CI, 1.63-13.58; P = .004), lifetime history of bipolar disorder (OR, 3.4; 95% CI, 0.96-12.04; P = .06), history of childhood abuse (OR, 2.98; 95% CI, 1.40-6.38; P = .01), and proband actual attempt (OR, 2.24; 95% CI, 1.06-4.75; P = .04). Endorsing a score of 3 or higher on the risk score tool resulted in high sensitivity (87.3%) and moderate specificity (63%; area under the curve = 0.80). CONCLUSIONS AND RELEVANCE The specific predictors of suicide attempt identified are those that clinicians already assess during routine psychiatric evaluations; monitoring and treating depression symptoms to reduce their severity and fluctuation may attenuate the risk for suicidal behavior.
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Affiliation(s)
- Nadine M. Melhem
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Giovanna Porta
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Maria A. Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jamie Zelazny
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - John G. Keilp
- Department of Psychiatry, Columbia University, New York, New York
| | - Satish Iyengar
- Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ainsley Burke
- Department of Psychiatry, Columbia University, New York, New York
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Barbara Stanley
- Department of Psychiatry, Columbia University, New York, New York
| | - J. John Mann
- Department of Psychiatry, Columbia University, New York, New York
| | - David A. Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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12
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Bahamón Muñetón MJ, Alarcón-Vásquez Y. Diseño y validación de una escala para evaluar el Riesgo Suicida (ERS) en adolescentes colombianos. UNIVERSITAS PSYCHOLOGICA 2018. [DOI: 10.11144/javeriana.upsy17-4.dvee] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
El objetivo del estudio fue construir y validar una escala para la evaluación del riesgo suicida en adolescentes. Los ítems iniciales se elaboraron con base en la revisión bibliográfica y se sometió a evaluación de expertos con el fin de analizar aspectos teóricos y lingüísticos. La muestra fue de 537 adolescentes entre 13 y 18 años, con una media de 15.2 (DE = 1.1), 268 hombres (49.9 %) y 269 (50.1 %) mujeres. La consistencia interna total del instrumento fue de 0.934; las escalas mostraron alfa de Cronbach entre 0.71 y 0.929; se aplicó el omega de Mcdonald con el uso del software R y los resultados fueron muy similares. Se realizó análisis factorial exploratorio método VARIMAX y análisis factorial confirmatorio con el uso del programa estadístico AMOS. Los análisis de ítems, correlación y efectos de suelo y techo mostraron correlaciones entre 0.411** y 0.784** con el puntaje global. Las correlaciones de los ítems con las dimensiones fluctuaron entre 0.71** y 0.908**. Una vez obtenida la agrupación de los ítems en cuatro factores, se hallaron correlaciones significativamente altas entre las subescalas con el puntaje global (0.749**a 0.868**). En conclusión, el instrumento constituye una medida válida y confiable para la evaluación del riesgo suicida en adolescentes colombianos.
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13
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Efstathiou V, Papadopoulou A, Christodoulou C, Gournellis R, Michopoulos I, Ferentinos P, Papageorgiou C, Douzenis A. The Relationship between Hopelessness and Clinical Characteristics of Hospitalized Patients with Recent Suicide Attempt. Issues Ment Health Nurs 2018; 39:876-882. [PMID: 30252555 DOI: 10.1080/01612840.2018.1491656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study aimed to assess hopelessness in 170 hospitalized individuals with recent suicide attempt and examine its association with patients' characteristics, with a view to improving awareness in health professionals and especially nurses, who are among the first to take care of these patients. Participants completed Beck Hopelessness Scale and Beck Depression Inventory. More than half (51.18%) experienced moderate-to-severe hopelessness. A multiple linear regression analysis showed that age, attempted suicide method, past suicide attempt, and psychiatric diagnosis contributed statistically significantly to hopelessness prediction. Hopelessness assessment could efficiently help health professionals to minimize both inpatient suicide and suicidal acts after discharge.
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Affiliation(s)
- Vasiliki Efstathiou
- a Second Department of Psychiatry , National and Kapodistrian University of Athens, Medical School "Attikon" University General Hospital , Athens , Greece
| | - Athanasia Papadopoulou
- a Second Department of Psychiatry , National and Kapodistrian University of Athens, Medical School "Attikon" University General Hospital , Athens , Greece
| | - Christos Christodoulou
- a Second Department of Psychiatry , National and Kapodistrian University of Athens, Medical School "Attikon" University General Hospital , Athens , Greece
| | - Rossetos Gournellis
- a Second Department of Psychiatry , National and Kapodistrian University of Athens, Medical School "Attikon" University General Hospital , Athens , Greece
| | - Ioannis Michopoulos
- a Second Department of Psychiatry , National and Kapodistrian University of Athens, Medical School "Attikon" University General Hospital , Athens , Greece
| | - Panagiotis Ferentinos
- a Second Department of Psychiatry , National and Kapodistrian University of Athens, Medical School "Attikon" University General Hospital , Athens , Greece
| | - Charalabos Papageorgiou
- b First Department of Psychiatry , National and Kapodistrian University of Athens, Medical School, "Eginition" Hospital , Athens , Greece
| | - Athanassios Douzenis
- a Second Department of Psychiatry , National and Kapodistrian University of Athens, Medical School "Attikon" University General Hospital , Athens , Greece
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14
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Berman AL. Risk Factors Proximate to Suicide and Suicide Risk Assessment in the Context of Denied Suicide Ideation. Suicide Life Threat Behav 2018; 48:340-352. [PMID: 28429385 DOI: 10.1111/sltb.12351] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 02/02/2017] [Indexed: 02/05/2023]
Abstract
Health care providers have significant opportunities to identify individuals at near-term risk for suicide, but lack empirical data on near-term risk factors. This study aimed to identify dynamic, state-related risk factors observed by clinical practitioners within the last 30 days of life of 157 patients who died by suicide and to compare these near-term risk factors among patients who denied versus responded positively to having suicide ideation (SI) when last asked by a clinical practitioner prior to their death. Risk factors charted for the majority of all decedents were a history of prior suicide ideation and/or suicide attempt, current anxiety/agitation and sleep problems, current interpersonal problems or job/financial strain, current comorbid diagnoses, current social isolation/withdrawal, and a family history of mental disorder. Two-thirds of patients denied having SI when last asked and one-half of these patients were dead by suicide within 2 days. Decedents who denied having SI were quite similar in charted diagnoses, symptoms, behaviors, and environmental circumstances to decedents who responded affirmatively to having SI. Reliance on verbalized or reported SI as a gateway to a suicide risk assessment is questioned and the need for better understanding near-term risk for suicide, particularly in the absence of stated SI, is highlighted.
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Affiliation(s)
- Alan L Berman
- Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
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15
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Yu L, Li Y, Liu L, Li S, Na J, An X, Zhou Y, Gu Y, Bi X, Mu H, Zhang R, Dong W, Pan G. Association of recent gay-related stressful events and emotional distress with suicidal behaviors over 12 months in Chinese men who have sex with men. Asia Pac Psychiatry 2018. [PMID: 28636234 DOI: 10.1111/appy.12286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The study was designed to assess the association of gay-related stressful events (GRSEs) and emotional distress with suicidal behaviors over a 12-month period in Chinese men who have sex with men (MSM). METHODS A total of 807 MSM were recruited using a respondent-driven sampling method from 4 cities in northeastern China. The GRSEs were measured using the Gay-related Stressful Life Events Scale, depression using the Self-rating Depression Scale, and anxiety using the Self-rating Anxiety Scale. RESULTS A total of 26.0% of study participants experienced GRSEs during the 3 months, and their average Self-rating Depression Scale and Self-rating Anxiety Scale scores were significantly lower than the national norms. Over a 12-month period, the prevalence of suicidal ideation, plan, and attempt was 9.7%, 4.0%, and 3.0%, respectively, each of which is at least 3 to 4 times greater than that of male adults in the general population of China. Multiple logistic regression analysis showed that GRSEs significantly increased the risk of suicidal ideation (odds ratio [OR] = 2.3, 95% confidence interval [CI], 1.4-3.7) and plan (OR = 2.8, 95% CI, 1.3-6.0). Depressive symptoms significantly increased the risk of suicidal ideation (OR = 3.5, 95% CI, 2.1-5.8), plan (OR = 4.4, 95% CI, 2.0-9.6), and attempt (OR = 5.6, 95% CI, 21.94.8). Anxiety symptoms (OR = 3.4, 95% CI, 1.4-8.4) and cohabitation with a same sex partner (OR = 3.0, 95% CI, 1.2-7.9) significantly increased the risk of suicide attempt. DISCUSSION More efforts to reduce GRSE are worth investigating as a strategy to reduce suicidal thoughts and behaviors in Chinese MSM.
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Affiliation(s)
- Liya Yu
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
| | - Yanxia Li
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
| | - Li Liu
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
| | - Shuang Li
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
| | - Jun Na
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
| | - Xiaoxia An
- Benxi Municipal Center for Disease Control and Prevention, Benxi, China
| | - Yan Zhou
- Dandong Municipal Center for Disease Control and Prevention, Dandong, China
| | - Yuan Gu
- Shenyang Municipal Center for Disease Control and Prevention, Shenyang, China
| | - Xuejuan Bi
- Anshan Municipal Center for Disease Control and Prevention, Anshan, China
| | - Huijuan Mu
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
| | - Rui Zhang
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
| | - Wen Dong
- Dalian Medical University, Dalian, China
| | - Guowei Pan
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
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16
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Perry LM, Goldstein-Piekarski AN, Williams LM. Sex differences modulating serotonergic polymorphisms implicated in the mechanistic pathways of risk for depression and related disorders. J Neurosci Res 2017; 95:737-762. [PMID: 27870440 DOI: 10.1002/jnr.23877] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 12/27/2022]
Abstract
Despite consistent observations of sex differences in depression and related emotional disorders, we do not yet know how these sex differences modulate the effects of genetic polymorphisms implicated in risk for these disorders. This Mini-Review focuses on genetic polymorphisms of the serotonergic system to illustrate how sex differences might modulate the neurobiological pathways involved in the development of depression. We consider the interacting role of environmental factors such as early-life stress. Given limited current knowledge about this topic, we highlight methodological considerations, challenges, and guidelines for future research. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- LeeAnn M Perry
- Neurosciences Program, Stanford University, Stanford, California
| | - Andrea N Goldstein-Piekarski
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.,Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.,Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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17
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Mu H, Li Y, Liu L, Na J, Yu L, Bi X, An X, Gu Y, Zhou Y, Li S, Zhang R, Jiang C, Pan G. Prevalence and risk factors for lifetime suicide ideation, plan and attempt in Chinese men who have sex with men. BMC Psychiatry 2016; 16:117. [PMID: 27129468 PMCID: PMC4850688 DOI: 10.1186/s12888-016-0830-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/25/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To describe the level and risk factors for suicidal behaviors in Chinese men who have sex with men (MSM). METHODS A total of 807 MSM were recruited using a respondent-driven sampling method from Anshan, Benxi, Dandong, and Shenyang cities in northeastern China. RESULTS Chinese MSM had lifetime prevalences of suicide ideation (18.3%), plan (8.7%) and attempt (4.6%) that were about 2.8, 5.8 and 5.8 times greater than that of male adults in the general population of China. The MSM with any psychiatric disorders were 4-7 times more likely to think about, plan or attempt suicide than those MSM with no disorder, and there was a clear relationship between the number of comorbid disorders and suicidal behaviors. Multiple regression analysis showed that major depression, bipolar disorder, dysthymia and alcohol use disorder significantly increased the risk for suicide ideation, but not for suicide attempt. Drug dependence disorder, panic disorder and generalized anxiety disorder significantly increased the risk for suicide attempt, but not for suicide ideation. More advanced education reduced the risk of suicidal behaviors, sexual orientations revealed to or discovered by family members or friends significantly increased risk of these suicidal behaviors. CONCLUSIONS Chinese MSM have significantly increased risk for suicidal behaviors, mental disorders and their comorbidities could be the largest risk factors for the elevated suicidal behaviors in Chinese MSM. Reducing the family and social stigma and rejection of homosexual behavior and early detection and effective treatment of psychiatric disorders and their comorbidities in MSM may help to decrease suicidal behaviors of Chinese MSM.
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Affiliation(s)
- Huijuan Mu
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Sayang Road 242, Heping District, Shenyang, 110005 P.R. China
| | - Yanxia Li
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Sayang Road 242, Heping District, Shenyang, 110005 P.R. China
| | - Li Liu
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Sayang Road 242, Heping District, Shenyang, 110005 P.R. China
| | - Jun Na
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Sayang Road 242, Heping District, Shenyang, 110005 P.R. China
| | - Liya Yu
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Sayang Road 242, Heping District, Shenyang, 110005 P.R. China
| | - Xuejuan Bi
- Anshan Municipal Center for Disease Control and Prevention, Anshan, P.R. China
| | - Xiaoxia An
- Benxi Municipal Center for Disease Control and Prevention, Benxi, P.R. China
| | - Yuan Gu
- Shenyang Municipal Center for Disease Control and Prevention, Shenyang, P.R. China
| | - Yan Zhou
- Dandong Municipal Center for Disease Control and Prevention, Dandong, P.R. China
| | - Shuang Li
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Sayang Road 242, Heping District, Shenyang, 110005 P.R. China
| | - Rui Zhang
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Sayang Road 242, Heping District, Shenyang, 110005 P.R. China
| | - Chao Jiang
- Department of Psychiatry, Dalian Medical University, Dalian, P.R. China
| | - Guowei Pan
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Sayang Road 242, Heping District, Shenyang, 110005, P.R. China.
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18
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Bakst SS, Braun T, Shohat T. The postmortem proxy-based interview--future directions. J Psychiatr Res 2016; 75:46-56. [PMID: 26802810 DOI: 10.1016/j.jpsychires.2016.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/01/2015] [Accepted: 01/07/2016] [Indexed: 12/13/2022]
Abstract
The present study aims to provide an overview of the procedural and methodological challenges that need to be addressed when determining the content and application of postmortem proxy-based interviews and recommendations for meeting these challenges in future death investigations are outlined. Preliminary interview considerations are discussed and a step-by-step procedural algorithm for applying proxy-based interview protocol is supplied. A vulnerability-stress model is used for organizing the conceptualization of risk and protective factors into domains of theoretically similar factors. Techniques to improve data collected about mental disorders and stressful life events-variables addressed in nearly all psychological autopsy studies-are suggested, and the importance of examining certain understudied constructs (e.g., psychological factors, family history, select situational factors, childhood adversity, and protective factors) is emphasized. Given the convergence of findings across postmortem proxy-based interviews, whereby extracting postmortem psychiatric diagnoses is the rule, the next generation of studies must offer a point of departure from univariate models, by studying how and why well known exposures interact to produce suicide. In practical terms, targeting specific sub-populations and high-risk individuals can serve as the basis for constructing and testing different clinical hypothesis, which in turn may yield insights into the underlying etiological heterogeneity of suicide.
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Affiliation(s)
- Shelly S Bakst
- Israel Center for Disease Control (ICDC), Israel Ministry of Health, Ramat Gan, Israel.
| | - Tali Braun
- Israel Center for Disease Control (ICDC), Israel Ministry of Health, Ramat Gan, Israel
| | - Tamy Shohat
- Israel Center for Disease Control (ICDC), Israel Ministry of Health, Ramat Gan, Israel; Department of Epidemiology and Preventive Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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19
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Bentley KH, Franklin JC, Ribeiro JD, Kleiman EM, Fox KR, Nock MK. Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: A meta-analytic review. Clin Psychol Rev 2015; 43:30-46. [PMID: 26688478 DOI: 10.1016/j.cpr.2015.11.008] [Citation(s) in RCA: 198] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/18/2015] [Accepted: 11/24/2015] [Indexed: 02/08/2023]
Abstract
Suicidal thoughts and behaviors are highly prevalent public health problems with devastating consequences. There is an urgent need to improve our understanding of risk factors for suicide to identify effective intervention targets. The aim of this meta-analysis was to examine the magnitude and clinical utility of anxiety and its disorders as risk factors for suicide ideation, attempts, and deaths. We conducted a literature search through December 2014; of the 65 articles meeting our inclusion criteria, we extracted 180 cases in which an anxiety-specific variable was used to longitudinally predict a suicide-related outcome. Results indicated that anxiety is a statistically significant, yet weak, predictor of suicide ideation (OR=1.49, 95% CI: 1.18, 1.88) and attempts (OR=1.64, 95% CI: 1.47, 1.83), but not deaths (OR=1.01, 95% CI: 0.87, 1.18). The strongest associations were observed for PTSD. Estimates were reduced after accounting for publication bias, and diagnostic accuracy analyses indicated acceptable specificity but poor sensitivity. Overall, the extant literature suggests that anxiety and its disorders, at least when these constructs are measured in isolation and as trait-like constructs, are relatively weak predictors of suicidal thoughts and behaviors over long follow-up periods. Implications for future research priorities are discussed.
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Affiliation(s)
- Kate H Bentley
- Center for Anxiety and Related Disorders, Boston University, USA.
| | | | - Jessica D Ribeiro
- Department of Psychology, Harvard University, USA; Military Suicide Research Consortium, USA
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Lin CJ, Lai CK, Kao MC, Wu LT, Lo UG, Lin LC, Chen YA, Lin H, Hsieh JT, Lai CH, Lin CD. Impact of cholesterol on disease progression. Biomedicine (Taipei) 2015; 5:7. [PMID: 26048694 PMCID: PMC4502043 DOI: 10.7603/s40681-015-0007-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 04/30/2015] [Indexed: 12/11/2022] Open
Abstract
Cholesterol-rich microdomains (also called lipid rafts), where platforms for signaling are provided and thought to be associated with microbe-induced pathogenesis and lead to cancer progression. After treatment of cells with cholesterol disrupting or usurping agents, raft-associated proteins and lipids can be dissociated, and this renders the cell structure nonfunctional and therefore mitigates disease severity. This review focuses on the role of cholesterol in disease progression including cancer development and infectious diseases. Understanding the molecular mechanisms of cholesterol in these diseases may provide insight into the development of novel strategies for controlling these diseases in clinical scenarios.
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Affiliation(s)
- Chun-Jung Lin
- Department of Urology, University of Texas Southwestern Medical Center, Texas, Dallas, 75235, USA
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Associations between anxiety disorders, suicide ideation, and age in nationally representative samples of Canadian and American adults. J Anxiety Disord 2014; 28:823-9. [PMID: 25306089 DOI: 10.1016/j.janxdis.2014.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 08/08/2014] [Accepted: 09/02/2014] [Indexed: 11/20/2022]
Abstract
Suicidal behaviors are of significant concern for the individuals displaying such behavior and for service providers who encounter them. Using nationally representative samples of Canadian and American adults, we aimed to examine: whether age moderates the relationship between having any anxiety disorder and suicide ideation (SI), the prevalence of SI among younger and older adults, and whether age and individual anxiety disorders were differentially associated with SI. Age moderated the relationship between any anxiety disorder and SI among Americans only. Past-year SI was less prevalent among older, compared to younger, adults; though, nearly every anxiety disorder was associated with increased odds of SI among younger and older Canadian and American adults after controlling for covariates. Effect sizes were particularly large for older American adults, but were coupled with large confidence intervals. Findings contribute to a growing literature suggesting that SI in the context of anxiety is a highly prevalent and complex mental health problem across the adult lifespan.
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Abstract
The causes of suicidal behaviour are not fully understood; however, this behaviour clearly results from the complex interaction of many factors. Although many risk factors have been identified, they mostly do not account for why people try to end their lives. In this Review, we describe key recent developments in theoretical, clinical, and empirical psychological science about the emergence of suicidal thoughts and behaviours, and emphasise the central importance of psychological factors. Personality and individual differences, cognitive factors, social aspects, and negative life events are key contributors to suicidal behaviour. Most people struggling with suicidal thoughts and behaviours do not receive treatment. Some evidence suggests that different forms of cognitive and behavioural therapies can reduce the risk of suicide reattempt, but hardly any evidence about factors that protect against suicide is available. The development of innovative psychological and psychosocial treatments needs urgent attention.
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Price RB, Iosifescu DV, Murrough JW, Chang LC, Al Jurdi RK, Iqbal SZ, Soleimani L, Charney DS, Foulkes AL, Mathew SJ. Effects of ketamine on explicit and implicit suicidal cognition: a randomized controlled trial in treatment-resistant depression. Depress Anxiety 2014; 31:335-43. [PMID: 24668760 PMCID: PMC4112410 DOI: 10.1002/da.22253] [Citation(s) in RCA: 221] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/14/2014] [Accepted: 01/18/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Preliminary evidence suggests intravenous ketamine has rapid effects on suicidal cognition, making it an attractive candidate for depressed patients at imminent risk of suicide. In the first randomized controlled trial of ketamine using an anesthetic control condition, we tested ketamine's acute effects on explicit suicidal cognition and a performance-based index of implicit suicidal cognition (Implicit Association Test; IAT) previously linked to suicidal behavior. METHOD Symptomatic patients with treatment-resistant unipolar major depression (inadequate response to ≥3 antidepressants) were assessed using a composite index of explicit suicidal ideation (Beck Scale for Suicidal Ideation, Montgomery-Asberg Rating Scale suicide item, Quick Inventory of Depressive Symptoms suicide item) and the IAT to assess suicidality implicitly. Measures were taken at baseline and 24 hr following a single subanesthetic dose of ketamine (n = 36) or midazolam (n = 21), a psychoactive placebo agent selected for its similar, rapid anesthetic effects. Twenty four hours postinfusion, explicit suicidal cognition was significantly reduced in the ketamine but not the midazolam group. RESULTS Fifty three percent of ketamine-treated patients scored zero on all three explicit suicide measures at 24 hr, compared with 24% of the midazolam group (χ(2) = 4.6; P = .03). Implicit associations between self- and escape-related words were reduced following ketamine (P = .01; d = .58) but not midazolam (P = .68; d = .09). Ketamine-specific decreases in explicit suicidal cognition were largest in patients with elevated suicidal cognition at baseline, and were mediated by decreases in nonsuicide-related depressive symptoms. CONCLUSIONS Intravenous ketamine produces rapid reductions in suicidal cognition over and above active placebo. Further study is warranted to test ketamine's antisuicidal effects in higher-risk samples.
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Affiliation(s)
- Rebecca B. Price
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Dan V. Iosifescu
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James W. Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lee C. Chang
- Department of Anesthesiology, Baylor College of Medicine, Houston, Texas
| | - Rayan K. Al Jurdi
- Mental Health Care Line, Michael E. Debakey VA Medical Center, Houston, Texas,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Syed Z. Iqbal
- Mental Health Care Line, Michael E. Debakey VA Medical Center, Houston, Texas,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Laili Soleimani
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dennis S. Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York,Pharmacology & Systems Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexandra L. Foulkes
- Department of Anesthesiology, Baylor College of Medicine, Houston, Texas,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Sanjay J. Mathew
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas,Correspondence to: Sanjay J. Mathew, M.D., Michael E. Debakey VA Medical Center & Baylor College of Medicine, Houston, Texas 77030.
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Neuropsychiatric adverse events associated with statins: epidemiology, pathophysiology, prevention and management. CNS Drugs 2014; 28:249-72. [PMID: 24435290 DOI: 10.1007/s40263-013-0135-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Statins, or 3-hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitors, such as lovastatin, atorvastatin, simvastatin, pravastatin, fluvastatin, rosuvastatin and pitavastatin, are cholesterol-lowering drugs used in clinical practice to prevent coronary heart disease. These drugs are generally well tolerated and have been rarely associated with severe adverse effects (e.g. rhabdomyolysis). Over the years, case series and data from national registries of spontaneous adverse drug reaction reports have demonstrated the occurrence of neuropsychiatric reactions associated with statin treatment. They include behavioural alterations (severe irritability, homicidal impulses, threats to others, road rage, depression and violence, paranoia, alienation, antisocial behaviour); cognitive and memory impairments; sleep disturbance (frequent awakenings, shorter sleep duration, early morning awakenings, nightmares, sleepwalking, night terrors); and sexual dysfunction (impotence and decreased libido). Studies designed to investigate specific neuropsychiatric endpoints have yielded conflicting results. Several mechanisms, mainly related to inhibition of cholesterol biosynthesis, have been proposed to explain the detrimental effects of statins on the central nervous system. Approaches to prevent and manage such adverse effects may include drug discontinuation and introduction of dietary restrictions; maintenance of statin treatment for some weeks with close patient monitoring; switching to a different statin; dose reduction; use of ω-3 fatty acids or coenzyme Q10 supplements; and treatment with psychotropic drugs. The available information suggests that neuropsychiatric effects associated with statins are rare events that likely occur in sensitive patients. Additional data are required, and further clinical studies are needed.
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Abstract
Suicidal behavior is highly complex and multifaceted. Consequent to the pioneering work of Durkheim and Freud, theoreticians have attempted to explain the biological, social, and psychological nature of suicide. The present work presents an overview and critical discussion of the most influential theoretical models of the psychological mechanisms underlying the development of suicidal behavior. All have been tested to varying degrees and have important implications for the development of therapeutic and preventive interventions. Broader and more in-depth approaches are still needed to further our understanding of suicidal phenomena.
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Affiliation(s)
- Shira Barzilay
- a Feinberg Child Study Center, Schneider Children's Medical Center of Israel , Petach Tikva , Israel
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Preti A, Sheehan DV, Coric V, Distinto M, Pitanti M, Vacca I, Siddi A, Masala C, Petretto DR. Sheehan Suicidality Tracking Scale (S-STS): reliability, convergent and discriminative validity in young Italian adults. Compr Psychiatry 2013; 54:842-9. [PMID: 23618606 DOI: 10.1016/j.comppsych.2013.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 02/12/2013] [Accepted: 03/04/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE The Sheehan Suicidality Tracking Scale (S-STS) is a patient self-report or clinician-administered rating scale that tracks spontaneous and treatment-emergent suicidal ideation and behaviors. This study set out to evaluate the reliability, convergent and divergent validity of the S-STS in a sample of college students, a population with a high risk of completed and attempted suicide. METHODS Cross-sectional, survey design. Participants (303 undergraduate students; males: 42%) completed several measures assessing psychological distress (General Health Questionnaire; GHQ); self-esteem (Rosenberg Self Esteem Scale; RSES); social support (Modified Social Support Survey; MOSSS); and suicidal behavior, including ideation and attempts (S-STS). RESULTS Both internal consistency and test-retest stability were excellent for the S-STS-global score. The S-STS subscale on suicide ideation also showed good reliability, while the subscale on suicidal behavior showed some inconsistency at retest. Convergent and divergent validity of S-STS was confirmed. All S-STS items loaded on a single factor, which had an excellent fit for the unidimensional model, thus justifying the use of the S-STS as a screening tool. In a mediation model, self-esteem and social support explained 45% of the effects of psychological distress on suicide ideation and behavior as measured by the S-STS-global score. CONCLUSIONS This study provided promising evidence on the convergent, divergent, internal consistency and test-retest stability of the Sheehan Suicidality Tracking Scale. The cross-sectional design and lack of measures of hopelessness and helplessness prevent any conclusion about the links of suicidal behavior with self-esteem and social support.
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Affiliation(s)
- Antonio Preti
- Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy; Genneruxi Medical Center, Cagliari, Italy.
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Nock MK, Deming CA, Fullerton CS, Gilman SE, Goldenberg M, Kessler RC, McCarroll JE, McLaughlin KA, Peterson C, Schoenbaum M, Stanley B, Ursano RJ. Suicide Among Soldiers: A Review of Psychosocial Risk and Protective Factors. Psychiatry 2013; 76:97-125. [PMID: 23631542 PMCID: PMC4060831 DOI: 10.1521/psyc.2013.76.2.97] [Citation(s) in RCA: 228] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Suicide is difficult to predict and prevent and remains a leading cause of death worldwide. Although soldiers historically have had a suicide rate well below that of the general population, the suicide rate among members of the U.S. Army has increased markedly over the past several years and now exceeds that of the general population. This paper reviews psychosocial factors known to be associated with the increased risk of suicidal behavior in general and describes how some of these factors may be especially important in understanding suicide among soldiers. Moving forward, the prevention of suicide requires additional research aimed at: (a) better describing when, where, and among whom suicidal behavior occurs, (b) using exploratory studies to discover new risk and protective factors, (c) developing new methods of predicting suicidal behavior that synthesize information about modifiable risk and protective factors from multiple domains, and (d) understanding the mechanisms and pathways through which suicidal behavior develops. Although the scope and severity of this problem is daunting, the increasing attention and dedication to this issue by the Armed Forces, scientists, and society provide hope for our ability to better predict and prevent these tragic outcomes in the future.
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Affiliation(s)
- Matthew K Nock
- Department of Psychology, Harvard University, in Cambridge, Massachusetts 02138, USA.
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Woo JM, Gibbons RD, Rogers CA, Qin P, Kim JB, Roberts DW, Noh ES, Mann JJ, Postolache TT. Pollen counts and suicide rates. Association not replicated. Acta Psychiatr Scand 2012; 125:168-75. [PMID: 22176539 PMCID: PMC6452436 DOI: 10.1111/j.1600-0447.2011.01813.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To replicate a previously reported association between pollen counts and county suicide rates in the continental United States, across space and time. METHOD The authors evaluated the relationship between airborne pollen counts and suicide rates in 42 counties of the continental United States, containing a pollen-counting station participating in the Aeroallergen Monitoring Network in the United States (N = 120,076 suicides), considering years' quarter, age group, sex, race, rural/urban location, number of local psychiatrists, and median household income, from 1999 to 2002. The county-level effects were broken into between-county and within-county. RESULTS No within-county effects were found. Between-county effects for grass and ragweed pollen on suicide rates lost statistical significance after adjustment for median income, number of psychiatrists, and urban vs. rural location. CONCLUSION Future research is necessary to reappraise the previously reported relationship between pollen levels and suicide rates that may have been driven by socioeconomic confounders.
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Affiliation(s)
- J. M. Woo
- Mood and Anxiety Program (MAP), Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA,Department of Psychiatry, Seoul Paik Hospital, Inje University School of Medicine,Stress Research Institute, Inje University, Seoul, Korea
| | - R. D. Gibbons
- Center for Health Statistics, University of Chicago, Chicago, IL
| | - C. A. Rogers
- Environmental Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - P. Qin
- National Centre for Register-Based Research, University of Aarhus, Aarhus C, Denmark
| | - J. B. Kim
- Center for Health Statistics, University of Chicago, Chicago, IL
| | | | - E. S. Noh
- Stress Research Institute, Inje University, Seoul, Korea
| | - J. J. Mann
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - T. T. Postolache
- Mood and Anxiety Program (MAP), Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA,National Center for the Treatment of Phobias, Anxiety and Depression, Washington, DC, USA
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Val1483Ile polymorphism in the fatty acid synthase gene was associated with depressive symptoms under the influence of psychological stress. J Affect Disord 2011; 134:448-52. [PMID: 21641044 DOI: 10.1016/j.jad.2011.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 04/05/2011] [Accepted: 05/08/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND To study the association between lipid-metabolism and depressive symptoms, genetic polymorphisms in serotonin transporter linked promoter region (5-HTTLPR) and fatty acid synthase gene (FASN) were investigated. METHOD A cross-sectional study was conducted on 177 women (n = 166) and men (n = 15) recruited from workers in a hospital and nursing homes in Japan. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression (CES-D) scale and perceived psychological stress was measured using visual analogue scale (VAS). The genotypes of 5-HTTLPR (insertion/deletion; L/S), and FASN (Val1483Ile) were determined by the PCR methods. Linear regression analysis was performed, in which CES-D scores served as a dependent variable, and VAS scores, gene polymorphism, and confounders as independent variables. RESULTS Under the influence of perceived stress, S/S carriers of the 5-HTTLPR gene showed significantly higher CES-D scores in comparison with L/L+L/S carriers (F = 8.2, standardised β = 0.15, p < 0.05). Regression analysis also confirmed that CES-D scores in participants with Ile/Ile+Val/Ile genotypes of the FASN gene were significantly higher than those with Val/Val genotype (F = 8.4, standardised β = 0.16, p<0.05). In relation to physical features, BMI among participants with S/S genotype of 5-HTTLPR was significantly lower compared with those with L/L+L/S genotypes. CONCLUSIONS The Val1483Ile polymorphism in the FASN was associated with depressive symptoms under the influence of psychological stress. The S variant of 5-HTTLPR was related with less obese.
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Impulsividad, búsqueda de sensaciones y agresividad en pacientes bipolares tipo I y II. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2011; 4:195-204. [DOI: 10.1016/j.rpsm.2011.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 07/15/2011] [Accepted: 07/25/2011] [Indexed: 11/20/2022]
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Prins J, Olivier B, Korte SM. Triple reuptake inhibitors for treating subtypes of major depressive disorder: the monoamine hypothesis revisited. Expert Opin Investig Drugs 2011; 20:1107-30. [DOI: 10.1517/13543784.2011.594039] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Animal model and neurobiology of suicide. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:818-30. [PMID: 21354241 DOI: 10.1016/j.pnpbp.2010.10.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 10/06/2010] [Accepted: 10/08/2010] [Indexed: 11/20/2022]
Abstract
Animal models are formidable tools to investigate the etiology, the course and the potential treatment of an illness. No convincing animal model of suicide has been produced to date, and despite the intensive study of thousands of animal species naturalists have not identified suicide in nonhuman species in field situations. When modeling suicidal behavior in the animal, the greatest challenge is reproducing the role of will and intention in suicide mechanics. To overcome this limitation, current investigations on animals focus on every single step leading to suicide in humans. The most promising endophenotypes worth investigating in animals are the cortisol social-stress response and the aggression/impulsivity trait, involving the serotonergic system. Astroglia, neurotrophic factors and neurotrophins are implied in suicide, too. The prevention of suicide rests on the identification and treatment of every element increasing the risk.
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Pompili M, Serafini G, Innamorati M, Möller-Leimkühler AM, Giupponi G, Girardi P, Tatarelli R, Lester D. The hypothalamic-pituitary-adrenal axis and serotonin abnormalities: a selective overview for the implications of suicide prevention. Eur Arch Psychiatry Clin Neurosci 2010; 260:583-600. [PMID: 20174927 DOI: 10.1007/s00406-010-0108-z] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 02/05/2010] [Indexed: 12/11/2022]
Abstract
Suicidal behavior and mood disorders are one of the world's largest public health problems. The biological vulnerability for these problems includes genetic factors involved in the regulation of the serotonergic system and stress system. The hypothalamic-pituitary-adrenal (HPA) axis is a neuroendocrine system that regulates the body's response to stress and has complex interactions with brain serotonergic, noradrenergic and dopaminergic systems. Corticotropin-releasing hormone and vasopressin act synergistically to stimulate the secretion of ACTH that stimulates the biosynthesis of corticosteroids such as cortisol from cholesterol. Cortisol is a major stress hormone and has effects on many tissues, including on mineralocorticoid receptors and glucocorticoid receptors in the brain. Glucocorticoids produce behavioral changes, and one important target of glucocorticoids is the hypothalamus, which is a major controlling center of the HPA axis. Stress plays a major role in the various pathophysiological processes associated with mood disorders and suicidal behavior. Serotonergic dysfunction is a well-established substrate for mood disorders and suicidal behavior. Corticosteroids may play an important role in the relationship between stress, mood changes and perhaps suicidal behavior by interacting with 5-HT1A receptors. Abnormalities in the HPA axis in response to increased levels of stress are found to be associated with a dysregulation in the serotonergic system, both in subjects with mood disorders and those who engage in suicidal behavior. HPA over-activity may be a good predictor of mood disorders and perhaps suicidal behavior via abnormalities in the serotonergic system.
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Affiliation(s)
- Maurizio Pompili
- Department of Psychiatry, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy.
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Nepon J, Belik SL, Bolton J, Sareen J. The relationship between anxiety disorders and suicide attempts: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Depress Anxiety 2010; 27:791-8. [PMID: 20217852 PMCID: PMC2940247 DOI: 10.1002/da.20674] [Citation(s) in RCA: 196] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Previous work has suggested that anxiety disorders are associated with suicide attempts. However, many studies have been limited by lack of accounting for factors that could influence this relationship, notably personality disorders. This study aims to examine the relationship between anxiety disorders and suicide attempts, accounting for important comorbidities, in a large nationally representative sample. METHODS Data came from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2. Face-to-face interviews were conducted with 34,653 adults between 2004 and 2005 in the United States. The relationship between suicide attempts and anxiety disorders (panic disorder, agoraphobia, social phobia, specific phobia, generalized anxiety disorder, posttraumatic stress disorder (PTSD)) was explored using multivariate regression models controlling for sociodemographics, Axis I and Axis II disorders. RESULTS Among individuals reporting a lifetime history of suicide attempt, over 70% had an anxiety disorder. Even after adjusting for sociodemographic factors, Axis I and Axis II disorders, the presence of an anxiety disorder was significantly associated with having made a suicide attempt (AOR=1.70, 95% confidence interval (CI): 1.40-2.08). Panic disorder (AOR=1.31, 95% CI: 1.06-1.61) and PTSD (AOR=1.81, 95% CI: 1.45-2.26) were independently associated with suicide attempts in multivariate models. Comorbidity of personality disorders with panic disorder (AOR=5.76, 95% CI: 4.58-7.25) and with PTSD (AOR=6.90, 95% CI: 5.41-8.79) demonstrated much stronger associations with suicide attempts over either disorder alone. CONCLUSION Anxiety disorders, especially panic disorder and PTSD, are independently associated with suicide attempts. Clinicians need to assess suicidal behavior among patients presenting with anxiety problems.
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Affiliation(s)
- Josh Nepon
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shay-Lee Belik
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
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Abstract
Mental disorders are among the strongest predictors of suicide attempts. However, little is known regarding which disorders that are uniquely associated with suicidal behavior because of high levels of psychiatric comorbidity. We examined the unique associations between individual disorders and subsequent suicidal behavior (suicide ideation, plans and attempts) using data from the National Comorbidity Survey Replication, a nationally representative household survey of 9282 US adults. Results revealed that approximately 80% of suicide attempters in the United States have a temporally prior mental disorder. Anxiety, mood, impulse-control and substance use disorders all significantly predict subsequent suicide attempts in bivariate analyses (odds ratios (OR)=2.7-6.7); however, these associations decrease substantially in multivariate analyses controlling for comorbidity (OR=1.5-2.3) but remain statistically significant in most cases. Disaggregation of the observed effects reveals that depression predicts suicide ideation, but not suicide plans or attempts among those with ideation. Instead, disorders characterized by severe anxiety/agitation (for example, post-traumatic stress disorder) and poor impulse control (for example, conduct disorder, substance use disorders) predict which suicide ideators who go on to make a plan or attempt. These results advance understanding of the unique associations between mental disorders and different forms of suicidal behavior. Future research must further delineate the mechanisms through which people come to think about suicide and progress from suicidal thoughts to attempts.
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Nock MK, Hwang I, Sampson N, Kessler RC, Angermeyer M, Beautrais A, Borges G, Bromet E, Bruffaerts R, de Girolamo G, de Graaf R, Florescu S, Gureje O, Haro JM, Hu C, Huang Y, Karam EG, Kawakami N, Kovess V, Levinson D, Posada-Villa J, Sagar R, Tomov T, Viana MC, Williams DR. Cross-national analysis of the associations among mental disorders and suicidal behavior: findings from the WHO World Mental Health Surveys. PLoS Med 2009; 6:e1000123. [PMID: 19668361 PMCID: PMC2717212 DOI: 10.1371/journal.pmed.1000123] [Citation(s) in RCA: 503] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 06/25/2009] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Suicide is a leading cause of death worldwide. Mental disorders are among the strongest predictors of suicide; however, little is known about which disorders are uniquely predictive of suicidal behavior, the extent to which disorders predict suicide attempts beyond their association with suicidal thoughts, and whether these associations are similar across developed and developing countries. This study was designed to test each of these questions with a focus on nonfatal suicide attempts. METHODS AND FINDINGS Data on the lifetime presence and age-of-onset of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) mental disorders and nonfatal suicidal behaviors were collected via structured face-to-face interviews with 108,664 respondents from 21 countries participating in the WHO World Mental Health Surveys. The results show that each lifetime disorder examined significantly predicts the subsequent first onset of suicide attempt (odds ratios [ORs] = 2.9-8.9). After controlling for comorbidity, these associations decreased substantially (ORs = 1.5-5.6) but remained significant in most cases. Overall, mental disorders were equally predictive in developed and developing countries, with a key difference being that the strongest predictors of suicide attempts in developed countries were mood disorders, whereas in developing countries impulse-control, substance use, and post-traumatic stress disorders were most predictive. Disaggregation of the associations between mental disorders and nonfatal suicide attempts showed that these associations are largely due to disorders predicting the onset of suicidal thoughts rather than predicting progression from thoughts to attempts. In the few instances where mental disorders predicted the transition from suicidal thoughts to attempts, the significant disorders are characterized by anxiety and poor impulse-control. The limitations of this study include the use of retrospective self-reports of lifetime occurrence and age-of-onset of mental disorders and suicidal behaviors, as well as the narrow focus on mental disorders as predictors of nonfatal suicidal behaviors, each of which must be addressed in future studies. CONCLUSIONS This study found that a wide range of mental disorders increased the odds of experiencing suicide ideation. However, after controlling for psychiatric comorbidity, only disorders characterized by anxiety and poor impulse-control predict which people with suicide ideation act on such thoughts. These findings provide a more fine-grained understanding of the associations between mental disorders and subsequent suicidal behavior than previously available and indicate that mental disorders predict suicidal behaviors similarly in both developed and developing countries. Future research is needed to delineate the mechanisms through which people come to think about suicide and subsequently progress from ideation to attempts.
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Affiliation(s)
- Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA.
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Jokinen J, Nordström AL, Nordström P. CSF 5-HIAA and DST non-suppression--orthogonal biologic risk factors for suicide in male mood disorder inpatients. Psychiatry Res 2009; 165:96-102. [PMID: 19062105 DOI: 10.1016/j.psychres.2007.10.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 09/20/2007] [Accepted: 10/19/2007] [Indexed: 12/23/2022]
Abstract
Two biomarkers of suicide risk; non-suppression in the dexamethasone suppression test (DST) and low 5-hydroxyindoleacetic acid (5-HIAA) in the cerebrospinal fluid (CSF) have been reported to be predictors of suicide in mood disorders. The interrelation of the two systems seems to be different in suicide attempters compared with depressed inpatients who have not made a suicide attempt, indicating that the two biomarkers may be seen as independent. This investigation examined the interrelation of low CSF 5-HIAA and DST non-suppression in suicide victims with mood disorder. Fifty-eight mood disorder inpatients not receiving any treatment with antidepressants underwent lumbar puncture and the DST. Plasma cortisol levels at 8:00 a.m., 4:00 p.m. and 11:00 p.m. were analysed in relation to CSF 5-HIAA. All patients were followed up for causes of death and suicides were verified with death certificates. During follow-up (mean 21 years), 11 (19%) patients had committed suicide. In male suicide victims (n=6), the serum cortisol level at 4:00 p.m. showed a significant positive correlation with CSF 5-HIAA. Low CSF 5-HIAA predicted all early suicides (within 1 year), whereas all males who committed suicide after 1 year were DST non-suppressors. In female suicide victims (n=5), the post-DST serum cortisol did not correlate with CSF 5-HIAA. Low CSF 5-HIAA and DST non-suppression are orthogonal biologic risk factors for suicide in male mood disorder inpatients. CSF 5-HIAA is associated with short-term suicide risk; dysregulation of the hypothalamic-pituitary-adrenal axis seems to be a long-term suicide predictor.
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Affiliation(s)
- Jussi Jokinen
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Karolinska University Hospital, Solna, SE-171 76 Stockholm, Sweden.
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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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Palomo T, Kostrzewa RM, Beninger RJ, Archer T. Treatment consideration and manifest complexity in comorbid neuropsychiatric disorders. Neurotox Res 2007; 12:43-60. [PMID: 17513199 DOI: 10.1007/bf03033900] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Psychiatric disorders may co-occur in the same individual. These include, for example, substance abuse or obsessive-compulsive disorder with schizophrenia, and movement disorders or epilepsy with affective dysfunctional states. Medications may produce iatrogenic effects, for example cognitive impairments that co-occur with the residual symptoms of the primary disorder being treated. The observation of comorbid disorders in some cases may reflect diagnostic overlap. Impulsivity, impulsiveness or impulsive behaviour is implicated in a range of diagnostic conditions including substance abuse, affective disorder and obsessive-compulsive disorder. These observations suggest a need to re-evaluate established diagnostic criteria and disorder definitions, focusing instead on symptoms and symptom-profiles.
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Affiliation(s)
- Tomas Palomo
- Psychiatry Service, 12 de Octubre, University Hospital, Madrid 28041, Spain
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Peluso MAM, Hatch JP, Glahn DC, Monkul ES, Sanches M, Najt P, Bowden CL, Barratt ES, Soares JC. Trait impulsivity in patients with mood disorders. J Affect Disord 2007; 100:227-31. [PMID: 17097740 DOI: 10.1016/j.jad.2006.09.037] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Revised: 09/15/2006] [Accepted: 09/27/2006] [Indexed: 01/13/2023]
Abstract
BACKGROUND Impulsivity is a key component of the manic behavior of bipolar disorder and is reported to occur in bipolar patients as a stable characteristic, i.e. a trait. Nevertheless, impulsivity has not been widely studied in depressed bipolar patients. We assessed impulsivity in depressed and euthymic bipolar and unipolar patients and healthy controls. We hypothesized that bipolar subjects would have higher levels of trait impulsivity than the comparison groups. METHODS Twenty-four depressed bipolar, 24 depressed unipolar, 12 euthymic bipolar, and 10 euthymic unipolar patients, as well as 51 healthy subjects were evaluated with the Barratt Impulsiveness Scale (BIS). Analysis of covariance with age and sex as covariates was used to compare mean group differences. RESULTS Depressed bipolar, euthymic bipolar, and depressed unipolar patients did not differ, and showed greater impulsivity than healthy controls on all of the BIS scales. Euthymic unipolar patients scored higher than healthy controls only on motor impulsivity. LIMITATIONS Higher number of past substance abusers in the bipolar groups, and no control for anxiety and personality disorders, as well as small sample sizes, limit the reach of this study. CONCLUSIONS This study replicates prior findings of stable trait impulsivity in bipolar disorder patients, and extends them, confirming that this trait can be demonstrated in depressed patients, as well as manic and euthymic ones. Trait impulsivity may be the result of repeated mood episodes or be present prior to their onset, either way it would influence the clinical presentation of bipolar disorder.
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Affiliation(s)
- M A M Peluso
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, USA.
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Coryell W, Schlesser M. Combined biological tests for suicide prediction. Psychiatry Res 2007; 150:187-91. [PMID: 17289156 PMCID: PMC1880882 DOI: 10.1016/j.psychres.2006.01.021] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Revised: 11/22/2005] [Accepted: 01/02/2006] [Indexed: 10/23/2022]
Abstract
Disturbances in serotonin neuroregulation and in hypothalamic-pituitary-adrenal axis activity are both likely, and possibly independent, factors in the genesis of suicidal behavior. This analysis considers whether clinically accessible measures of these two disturbances have additive value in the estimation of risk for suicide. Seventy-four inpatients with RDC major or schizoaffective depressive disorders entered a prospective follow-up study from 1978-1981, underwent a dexamethasone suppression test (DST) and had fasting serum cholesterol levels available in the medical record. As reported earlier, patients who had had an abnormal DST result were significantly more likely to commit suicide during follow-up. Serum cholesterol concentrations did not differ by DST result and low cholesterol values were associated with subsequent suicide when age was included as a covariate. These results indicate that, with the use of age-appropriate thresholds, serum cholesterol concentrations may be combined with DST results to provide a clinically useful estimate of suicide risk.
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Affiliation(s)
- William Coryell
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, 2-205 MEB, Iowa City, IA 52242-1000, USA.
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Mann JJ, Currier D. A review of prospective studies of biologic predictors of suicidal behavior in mood disorders. Arch Suicide Res 2007; 11:3-16. [PMID: 17178639 DOI: 10.1080/13811110600993124] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Predicting suicide is difficult due to the low base rate, even in high-risk groups, and the multi-causal nature of suicidal behavior. Clinical predictors have shown low specificity. Retrospective and cross-sectional studies have identified a number of biologic anomalies associated with suicide and suicide attempt. Prospective studies provide estimates of the predictive utility of biologic measures. Here we review prospective studies of suicidal behavior and serotonergic, noradrenergic, dopaminergic and hypothalamic-pituitary-adrenocortical axis function in mood disorders. The most promising biologic predictors are low CSF 5-HIAA and HPA axis dysfunction as demonstrated by dexamethasone non-suppression that are each associated with about 4.5 fold greater risk of suicide.
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Affiliation(s)
- J John Mann
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA.
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Balestrieri M, Rucci P, Sbrana A, Ravani L, Benvenuti A, Gonnelli C, Dell'osso L, Cassano GB. Lifetime rhythmicity and mania as correlates of suicidal ideation and attempts in mood disorders. Compr Psychiatry 2006; 47:334-41. [PMID: 16905394 DOI: 10.1016/j.comppsych.2006.01.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Revised: 10/20/2005] [Accepted: 01/17/2006] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The aim of this study is to establish to what degree variation in lifetime experience of rhythmicity and manic-hypomanic features correlates with suicidality in individuals with mood disorders and other major psychiatric diagnoses and in a comparison group of controls. METHOD Suicidal ideation and attempts were investigated in a clinical sample, including 77 patients with schizophrenia, 60 with borderline personality disorder, 61 with bipolar disorder, 88 with unipolar depression, and 57 with panic disorder, and in a comparison group of 102 controls. Using information derived from the diagnostic interview and a self-report assessment of mood spectrum symptoms, subjects were assigned to 3 categories according to the maximum level of suicidality achieved in the lifetime (none, ideation/plans, and suicide attempts). The association of categorical and continuous variables with suicidality levels was investigated using multinomial logistic regression models. RESULTS Suicidal ideation and plans were more common in unipolar depression (50%) and bipolar disorder (42.4%) than in borderline personality disorder (30%), whereas the reverse was true for suicidal attempts. In each of the study groups, the number and the type of mood spectrum items endorsed, including depressive and manic-hypomanic items and rhythmicity and vegetative symptoms, were associated with increased levels of suicidality. CONCLUSIONS Our results suggest that the assessment of lifetime rhythmicity and manic-hypomanic features may be clinically useful to identify potential suicide attempters in high-risk groups.
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Affiliation(s)
- Matteo Balestrieri
- InterUniversity Center for Behavioural Neurosciences, DPMSC, University of Udine, Udine, Italy.
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Abstract
Efforts to identify clinical risk factors for complete suicide through the follow-up of depressed patients have yielded relatively few robust predictors. Those identified by at least three studies are (in order of decreasing frequency) suicidal plans/attempts, male sex, being single or living alone, inpatient status, and hopelessness. Because the best established of these predictors has only modest sensitivity and specificity, the need for other robust tools is clear. A rich body of research has identified two biological risk factors for suicide in depressive disorder: hypothalamic-pituitary-adrenal axis hyperactivity and deficits in serotonin function. Moreover, there is now considerable evidence that the dexamethasone suppression test and measures of serum cholesterol concentrations, respectively, may provide a clinically useful reflection of these two mechanisms. Observations that these measures appear to be additive, both with each other and with other clinical risk factors, indicate that a substantial improvement in the clinician's ability to assess suicide risk is possible.
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Affiliation(s)
- William H Coryell
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.
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Huang T, Chen J. Cholesterol And Lipids In Depression: Stress, Hypothalamo‐Pituitary‐Adrenocortical Axis, And Inflammation/Immunity. Adv Clin Chem 2005. [DOI: 10.1016/s0065-2423(04)39003-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Huan M, Hamazaki K, Sun Y, Itomura M, Liu H, Kang W, Watanabe S, Terasawa K, Hamazaki T. Suicide attempt and n-3 fatty acid levels in red blood cells: a case control study in China. Biol Psychiatry 2004; 56:490-6. [PMID: 15450784 DOI: 10.1016/j.biopsych.2004.06.028] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2004] [Revised: 06/03/2004] [Accepted: 06/25/2004] [Indexed: 11/26/2022]
Abstract
BACKGROUND Epidemiologic studies show that low fish intake is a risk factor of suicidality; however, there are no case-control studies investigating suicide attempt risk and tissue n-3 fatty acid levels. METHODS We recruited 100 suicide-attempt cases and another 100 control patients injured by accidents who were admitted to three hospitals affiliated with Dalian Medical University in Dalian, China. Case and control subjects were matched for age, gender, and smoking status. Those who were inebriated at the time of hospitalization were excluded. Blood was sampled immediately after admission to a hospital. Washed red blood cells (RBCs) were obtained, and the fatty acid composition of the total RBC phospholipid fraction was analyzed by gas chromatography. RESULTS Eicosapentaenoic acid (EPA) levels in RBC in the case subjects were significantly lower than those of the control subjects (.74 +/-.52% vs. 1.06 +/-.62%, p <.0001). When the highest and lowest quartiles of EPA in RBC were compared, the odds ratios of suicide attempt was.12 in the highest quartile (95% confidence interval:.04-.36, p for trend =.0001) after adjustment for possible confounding factors CONCLUSIONS Our findings suggest that low n-3 fatty acid levels in tissues were a risk factor of suicide attempt. Further studies including intervention with fish oil are warranted.
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Affiliation(s)
- Mingming Huan
- Division of Clinical Application , Department of Clinical Sciences, Institute of Natural Medicine, Toyama Medical and Pharmaceutical University, Sugitani, Toyama-City, Japan
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Affiliation(s)
- J John Mann
- Department of Neuroscience, New York State Psychiatric Institute, 1051 Riverside Drive, Box 42, New York, New York 10032, USA.
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