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González-Ortega I, Diaz-Marsa M, López-Peña P, Fernández-Sevillano J, Andreo-Jover J, Bobes J, Bravo-Ortiz MF, Cebria AI, Crespo-Facorro B, de la Torre-Luque A, Elices M, Fernández-Rodrigues V, Garrido-Torres N, Grande I, Palao-Tarrero Á, Pemau A, Roberto N, Ruiz-Veguilla M, Seijo-Zazo E, Alberich S, González-Pinto A, Pérez V. Clinical predictors and psychosocial risk factors of suicide attempt severity. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023:S2950-2853(23)00034-0. [PMID: 38591830 DOI: 10.1016/j.sjpmh.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/06/2023] [Accepted: 07/09/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND Suicide attempts are an important predictor of completed suicide and may differ in terms of severity of medical consequences or medical lethality. There is little evidence on serious suicide attempt (SSA) and very few studies have compared SSA with non-SSA. OBJECTIVE The aim of this multisite, coordinated, cohort study was to analyze the role of clinical variables and the sociodemographic and psychological risk factors of SSA. METHOD In this multisite, coordinated, cohort study, 684 participants (222 for the mild suicide attempt group, 371 for the moderate suicide attempt group and 91 for the SSA group) were included in the study. Ordinal regression models were performed to analyze the predictor variables of SSA. RESULTS Early physical abuse (OR=1.231) and impulsivity (OR=1.036) were predictors of SSA, while depressive symptoms were associated with a lower risk of SSA. CONCLUSION Environmental and psychological factors as physical abuse and impulsivity are related with severe suicide severity. These findings will help to develop strategies to prevent suicide and may be considered for the treatment and management of suicide.
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Affiliation(s)
- Itxaso González-Ortega
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain; Department of Personality, Assessment and Psychological Treatment, National University of Distance Education (UNED), Vitoria, Spain
| | - Marina Diaz-Marsa
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Hospital Clínico San Carlos, Madrid, Spain; Complutense University of Madrid, Madrid, Spain
| | - Purificación López-Peña
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain; Department of Neurosciences, University of the Basque Country, Leioa, Spain
| | - Jessica Fernández-Sevillano
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain
| | - Jorge Andreo-Jover
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
| | - Julio Bobes
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Department of Psychiatry, University of Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain; Instituto de Neurociencias del Principado de Asturias (INEUROPA), Spain; Mental Health Services of the Principality of Asturias (SESPA), Oviedo, Spain
| | - María Fe Bravo-Ortiz
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain; Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
| | - Ana Isabel Cebria
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Mental Health Service, Hospital Universitari Parc Taulí, Unitat Mixta de Neurociència Traslacional I3PT-INc-UAB, Barcelona, Spain; Department of Clinical and Health Psychology, Faculty of Psychology, Universitat Autònoma of Barcelona, Cerdanyola del Vallès, Spain
| | - Benedicto Crespo-Facorro
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain; Department of Psychiatry, University of Sevilla, Sevilla, Spain
| | - Alejandro de la Torre-Luque
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Complutense University of Madrid, Madrid, Spain
| | - Matilde Elices
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Mar Institute of Medical Research (IMIM), Parc de Salut Mar, Barcelona, Spain
| | | | - Nathalia Garrido-Torres
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain
| | - Iria Grande
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Institute of Neurosciences (UBNeuro) P. de la Vall d'Hebron, Barcelona, Spain; Department de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Ángela Palao-Tarrero
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain; Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
| | | | - Natalia Roberto
- Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Institute of Neurosciences (UBNeuro) P. de la Vall d'Hebron, Barcelona, Spain
| | - Miguel Ruiz-Veguilla
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain; Department of Psychiatry, University of Sevilla, Sevilla, Spain
| | - Elisa Seijo-Zazo
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain; Instituto de Neurociencias del Principado de Asturias (INEUROPA), Spain; Mental Health Services of the Principality of Asturias (SESPA), Oviedo, Spain
| | - Susana Alberich
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain; Department of Personality, Assessment and Psychological Treatment, National University of Distance Education (UNED), Vitoria, Spain
| | - Ana González-Pinto
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain; Department of Neurosciences, University of the Basque Country, Leioa, Spain; Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Psychiatry and Forensic Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain.
| | - Víctor Pérez
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain; Mar Institute of Medical Research (IMIM), Parc de Salut Mar, Barcelona, Spain; Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain; Universitat Pompeu Fabra, UPF, Barcelona, Spain
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Tsuchida T, Takahashi M, Mizugaki A, Narita H, Wada T. Differences in acute outcomes of suicide patients by psychiatric disorder: Retrospective observational study. Medicine (Baltimore) 2023; 102:e35065. [PMID: 37746963 PMCID: PMC10519571 DOI: 10.1097/md.0000000000035065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Suicide is a social problem with significant economic losses, the victims of which are mainly from the productive population. There are numerous reports on the assessment of suicide risk, but most focus on long-term management. Therefore, factors influencing the severity of physical impairments in the acute phase and the prognosis of suicidal patients have not been sufficiently investigated. This is a single-center retrospective observational study. We collected data on suicidal patients admitted to our emergency department. The effect of age, gender, psychiatric history, method of suicide, alcohol consumption, and hospital admission on the outcome of suicide was assessed. Outcomes were assessed using the hospital mortality scale and the cerebral performance category scale for in-hospital mortality within 28 days. Methods of suicide with a high mortality rate (hanging, jumping, carbon monoxide poisoning, and burns) were defined as lethal methods. A detailed risk assessment of outcomes was performed for patients with schizophrenia, mood disorders, and somatoform disorders. We identified 340 suicide patients from computerized medical records and analyzed 322 records without missing data. The non-survivor group predominantly comprised older adults, men, and patients without a history of psychiatric treatment. Contrastingly, more patients drank alcohol before suicide in the survivor group. In the subgroup analysis, patients with schizophrenia had unfavorable neurological outcomes. Patients with mood disorders had worse in-hospital mortality than other psychiatric patients, as did patients who chose the lethal method. By disease, patients with stress-related and somatoform disorders tended to have higher survival rates, although their psychiatric hospitalization rates were lower. Conversely, patients with mood disorders had a higher rate of hospital visits but a lower survival rate. The results suggest that usual outpatient treatment alone may not be sufficient to reduce suicide mortality in patients with mood disorders who are considered to be at high risk of suicide.
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Affiliation(s)
- Takumi Tsuchida
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Masaki Takahashi
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Asumi Mizugaki
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Hisashi Narita
- Department of Psychiatry, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Takeshi Wada
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
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Sasaki T, Shinozaki M, Nemoto A, Nagao Y, Yasuda M, Shimoda K, Suda S, Yasui‐Furukori N. Effects of age on suicide attempts by medication in patients transferred to the emergency rooms of two advanced medical centers: A retrospective chart review of the DJ project. Neuropsychopharmacol Rep 2023; 43:453-456. [PMID: 37433639 PMCID: PMC10496036 DOI: 10.1002/npr2.12367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 07/13/2023] Open
Abstract
AIMS The means of suicide vary, but in cases of impaired consciousness, it is often difficult to determine the initial treatment because it is not known whether a patient has overdosed or used pesticides or poisons. Therefore, we investigated the clinical characteristics of suicide by medication in patients with suicide attempts who were brought to the emergency department, especially the influence of age. METHODS Patients with suicide attempts were transported to the two hospitals. There were 96 males (38.4%) and 154 females (61.6%). The mean age was 43.5 ± 20 years, and both males and females were most often in their 20s. Data on sex, age, motive for suicide, means of suicide attempt, psychiatric diagnosis, length of hospital stay, and place of discharge were retrospectively analyzed. RESULTS The average age of the patients by means of suicide attempt was 40.5 years for "prescription drugs," 30.2 years for "over-the-counter drugs," and 63.5 years for "pesticide/poison." For each means of suicide attempt, there was a significant difference in age among patients with suicide attempts using "prescription drugs," "over-the-counter drugs" and "pesticides/poisons." There was a statistical bias in the means and reasons for each suicide attempt. CONCLUSION The results showed that the age of patients who used over-the-counter medicines and pesticides and poisons varied significantly. It was thought that pesticide use should be considered first, especially when patients aged 50 years and over are brought to the hospital with impaired consciousness due to suicide attempts.
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Affiliation(s)
- Taro Sasaki
- Department of PsychiatryDokkyo Medical University School of MedicineMibuJapan
| | - Masataka Shinozaki
- Department of PsychiatryDokkyo Medical University School of MedicineMibuJapan
| | - Aki Nemoto
- Department of PsychiatryDokkyo Medical University School of MedicineMibuJapan
| | - Yukiko Nagao
- Department of PsychiatryJichi Medical UniversityShimotukeJapan
| | - Manabu Yasuda
- Department of PsychiatryJichi Medical UniversityShimotukeJapan
| | - Kazutaka Shimoda
- Department of PsychiatryDokkyo Medical University School of MedicineMibuJapan
| | - Shiro Suda
- Department of PsychiatryJichi Medical UniversityShimotukeJapan
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Moritz S, Nguyen C, Jelinek L, Borsutzky S, Scheunemann J, Hegerl U, Püschel K, Gallinat J. Behavioral and location-related antecedents of train suicides. Suicide Life Threat Behav 2023; 53:303-311. [PMID: 36714989 DOI: 10.1111/sltb.12941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/18/2022] [Accepted: 01/03/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND In the European Union, over 2000 suicides on railway premises were reported in 2020. Identifying individuals' behavioral and location patterns just before they die or attempt to die by train suicide (ITS) is critical for effective prevention of suicides by train. We conducted a naturalistic study using a newly developed instrument for the assessment of fatalities in rail traffic that used information from on-site video cameras. METHODS A total of 56 case files and surveillance recordings of ITS prior to their suicide or suicide attempt were compared to 46 surveillance recordings of matched regular train passengers (RTP) before they boarded their trains. Groups were compared on individuals' behavior as well as location and contextual parameters. RESULTS ITS performed unusual movement patterns more frequently, carried luggage less often, stayed on the platform longer, and let more trains pass relative to RTP. CONCLUSIONS If this study is replicated with a larger sample, artificial intelligence could be used to detect suspicious/unusual (movement) patterns in order to prevent train suicide. Social awareness campaigns that foster the identification of people in distress at train stations in combination with lower thresholds for the use of emergency devices on platforms may help to detect potential train suicides and reduce their incidence.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Celine Nguyen
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Swantje Borsutzky
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Scheunemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Hegerl
- Johann Christian Senckenberg Distinguished Professorship, Department for Psychiatry, Psychosomatics and Psychotherapy, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Medical Center of Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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5
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Jeon ME, Gomez MM, Stewart RA, Joiner TE. Acute suicidal affective disturbance and borderline personality disorder symptoms: Distinct yet correlated constructs. J Affect Disord 2023; 325:62-72. [PMID: 36586595 DOI: 10.1016/j.jad.2022.12.131] [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: 01/28/2022] [Revised: 09/08/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Acute Suicidal Affective Disturbance (ASAD) has been proposed to address the need for a suicide-specific diagnostic entity that better accounts for the psychological symptoms that may emerge during an acute suicidal crisis and that may precede imminent suicidal behaviors. However, additional research is needed to establish ASAD's delimitation from preexisting psychological disorders, especially disorders that include suicidal thoughts and behaviors in their diagnostic criteria such as borderline personality disorder (BPD). METHODS We estimated two Gaussian graphical models (GGMs), exploratory factor analysis (EFA) models, and confirmatory factor analysis models in a sample of psychiatric outpatients (N = 460) to examine the structure of ASAD and BPD symptoms. RESULTS Our estimated models showed while most ASAD and BPD symptoms largely shared associations with other symptoms belonging to their respective disorder construct, strong associations connected some ASAD symptoms with BPD symptoms, which, in a network model, emerged in the form of nonzero edges among those symptoms, and in EFA models, as factors that featured both ASAD and BPD symptoms as indicators. CONCLUSIONS Our findings suggest the network structure of the proposed criteria of ASAD features symptoms that are largely distinct to ASAD but do include symptoms that share meaningful correlations with BPD symptoms that suggest ASAD and BPD are correlated constructs.
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Affiliation(s)
- Min Eun Jeon
- Department of Psychology, Florida State University, Tallahassee, FL, USA.
| | - Marielle M Gomez
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Rochelle A Stewart
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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A comprehensive study of medically serious suicide attempts in France: incidence and associated factors. Epidemiol Psychiatr Sci 2023; 32:e2. [PMID: 36624696 PMCID: PMC9879866 DOI: 10.1017/s2045796022000774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AIMS People who make medically serious suicide attempts (MSSAs) share a number of features with those who die by suicide, and are at a high risk of suicide themselves. Studies to date have mostly focused on clinical samples of MSSAs. An epidemiological examination at a national level can help to identify risk profiles and pathways of care in this population. METHODS We explored the French nationwide hospital discharge database (Programme de Médicalisation des Systèmes d'Information, PMSI) to identify any MSSA taking place between 2012 and 2019. Relevant demographic and medical information was collected about the first MSSA of each attempter. Data from 2010 and 2011 were used to verify the absence of prior attempts. RESULTS First occurrences of MSSAs amounted to 81 959 cases over 8 years, with a mean age of 45.8 years, and 53.6% women. Incidence was higher in women (18.1 v. 17.3 per 1 00 000). The most common suicide method was deliberate self-poisoning (64.9% of cases). In comparison, violent methods associated higher mortality and comorbidity and were more frequent in men. The most common mental disorders were mood disorders (55.6%) and substance use disorders (46.2%). A minority of MSSA survivors were hospitalised in psychiatry (32.5%), mostly women. CONCLUSIONS MSSAs are frequent and easy to identify. There is a need to reinforce the continuity of psychiatric care for this population given the high risk of subsequent suicide, and the low rates of psychiatric hospitalisation after an MSSA even if violent methods are used. Specific care targeting this population could reduce treatment gaps.
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7
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Impulsivity and aggression in suicide ideators and suicide attempters of high and low lethality. BMC Psychiatry 2022; 22:753. [PMID: 36457001 PMCID: PMC9714086 DOI: 10.1186/s12888-022-04398-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Impulsivity and aggression have been associated with all forms of suicidal behaviour and linked to theories of suicide capability. There is a need to clarify the role of impulsivity and aggression in the progression from suicidal thoughts to suicide attempts and suicide. METHOD In this naturalistic cross-sectional study, suicide ideators (35), low lethal suicide attempters (37), and high lethal suicide attempters (26) were compared with the Columbia-suicide severity rating scale (C-SSRS), Barratt impulsiveness scale (BIS-11), and the Buss & Perry aggression questionnaire (AQ). RESULTS Physical aggression score (p = 0.032) contributed to the difference between predicted low lethal suicide attempt and predicted high lethal suicide attempt. This model predicting physical aggression showed a fairly weak positive relationship (OR = 1.1) to high lethal attempt and explained 13% of the variance so there is a need for further replications to verify these results. Impulsive behaviour scores in females were significantly higher in the low lethal suicide attempt group compared to suicide ideators (F(2.51) = 3.47, p = 0.039, η²= 0.12). Hostility aggression in females was significantly higher in the high lethal suicide attempters compared to suicide ideators (F(2.52) = 3.53, p = 0.037, η² = 0.12). Physical aggression scores in females were significantly higher in the high lethal attempters compared to suicide ideators (F(2.52) = 6.79, p = 0.002, η²= 0.21). When these analyses were conducted without the participants who died in suicide, men in the high lethal attempt group scored significantly higher than men in the low lethal attempt group (F(2.37) = 3.8, p = 0.031, η² = 0.17), but men did not differ in aggression and impulsivity scores in other comparisons. CONCLUSION Suicide prevention should address physical aggression, as high levels can be associated with high lethal attempts. Assessment of suicidal patients should address impulsive behaviour with the insight that it can be more prominent in female low lethal suicide attempters. It could be that assessment and treatment of suicidal patients should be tailored differently for men and women. Aggression as a feature of suicide capability could be the link that makes suicide possible.
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Robitschek C, Cukrowicz K, Brown SL, Ciavaglia A. Personal growth initiative as a buffer against suicide ideation severity in psychotherapy outpatients with depressive symptoms. J Clin Psychol 2022; 78:1752-1763. [PMID: 35218207 DOI: 10.1002/jclp.23333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 01/12/2022] [Accepted: 02/11/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Many people who die by suicide experience major depressive disorder (MDD), but most people with MDD do not die by suicide and many do not report thoughts of death or suicide. This cross-sectional study examined the potential of personal growth initiative (PGI) skills to protect against suicide ideation among adult psychotherapy outpatients. METHOD Adult outpatients (N = 178) completed measures of suicide ideation severity (SI), depressive symptom severity (DEP), and PGI skills (PGI) at intake. RESULTS Although higher DEP significantly correlated with higher suicide ideation, a significant DEP × PGI interaction, indicated significant positive relations between DEP and SI only when PGI was at or below the mean for this sample. CONCLUSIONS PGI skills may function as a protective factor against the development of suicide ideation even in the presence of severe depressive symptoms. This suggests that training PGI skills might prevent or reduce suicide ideation among depressed patients.
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Affiliation(s)
- Christine Robitschek
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Kelly Cukrowicz
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA.,School of Veterinary Medicine, Texas Tech University, Amarillo, Texas, USA
| | - Sarah L Brown
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Addison Ciavaglia
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA.,University Medical Center, University of Alabama Family Medicine Residency, Tuscaloosa, Alabama, USA
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9
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Lee DY, Park J, Noh JS, Roh HW, Ha JH, Lee EY, Son SJ, Park RW. Characteristics of Dimensional Psychopathology in Suicidal Patients With Major Psychiatric Disorders and Its Association With the Length of Hospital Stay: Algorithm Validation Study. JMIR Ment Health 2021; 8:e30827. [PMID: 34477555 PMCID: PMC8449292 DOI: 10.2196/30827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/28/2021] [Accepted: 08/02/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Suicide has emerged as a serious concern for public health; however, only few studies have revealed the differences between major psychiatric disorders and suicide. Recent studies have attempted to quantify research domain criteria (RDoC) into numeric scores to systematically use them in computerized methods. The RDoC scores were used to reveal the characteristics of suicide and its association with major psychiatric disorders. OBJECTIVE We intended to investigate the differences in the dimensional psychopathology among hospitalized suicidal patients and the association between the dimensional psychopathology of psychiatric disorders and length of hospital stay. METHODS This retrospective study enrolled hospitalized suicidal patients diagnosed with major psychiatric disorders (depression, schizophrenia, and bipolar disorder) between January 2010 and December 2020 at a tertiary hospital in South Korea. The RDoC scores were calculated using the patients' admission notes. To measure the differences between psychiatric disorder cohorts, analysis of variance and the Cochran Q test were conducted and post hoc analysis for RDoC domains was performed with the independent two-sample t test. A linear regression model was used to analyze the association between the RDoC scores and sociodemographic features and comorbidity index. To estimate the association between the RDoC scores and length of hospital stay, multiple logistic regression models were applied to each psychiatric disorder group. RESULTS We retrieved 732 admissions for 571 patients (465 with depression, 73 with schizophrenia, and 33 with bipolar disorder). We found significant differences in the dimensional psychopathology according to the psychiatric disorders. The patient group with depression showed the highest negative RDoC domain scores. In the cognitive and social RDoC domains, the groups with schizophrenia and bipolar disorder scored higher than the group with depression. In the arousal RDoC domain, the depression and bipolar disorder groups scored higher than the group with schizophrenia. We identified significant associations between the RDoC scores and length of stay for the depression and bipolar disorder groups. The odds ratios (ORs) of the length of stay were increased because of the higher negative RDoC domain scores in the group with depression (OR 1.058, 95% CI 1.006-1.114) and decreased by higher arousal RDoC domain scores in the group with bipolar disorder (OR 0.537, 95% CI 0.285-0.815). CONCLUSIONS This study showed the association between the dimensional psychopathology of major psychiatric disorders related to suicide and the length of hospital stay and identified differences in the dimensional psychopathology of major psychiatric disorders. This may provide new perspectives for understanding suicidal patients.
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Affiliation(s)
- Dong Yun Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jimyung Park
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | - Jai Sung Noh
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyun Woong Roh
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jae Ho Ha
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Eun Young Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea.,Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea.,Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
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Höller I, Forkmann T. Brief Self-Report Measure of Agitation: A Psychometric Investigation in a German Sample. J Pers Assess 2021; 104:110-121. [PMID: 33970724 DOI: 10.1080/00223891.2021.1912057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
To perform repeated measurements in clinical practice without putting unnecessary strain on patients, short instruments are needed. The Brief Self-Report Measure of Agitation (BAM) is a short measure assessing agitation, which has been associated with suicidal ideation and behavior. However, its reliability and validity have not been examined in an independent sample. A non-clinical sample of N = 429 participants aged between 18-81 (M = 27.36, SD = 9.67; 82.3% female) was surveyed online. A confirmatory factor analysis was conducted and reliability was investigated. The validity of the BAM was examined by calculating correlations and an ANOVA for differences in BAM scores between subgroups. BAM items significantly loaded onto one factor (factor loadings: ≥ .62) and the measure was found to have good reliability (Cronbach's α = .83) and convergent/discriminant validity. Participants with recent suicidal ideation and those with recent suicidal ideation and lifetime suicide attempts had significantly higher BAM scores than participants without suicidal ideation/suicide attempt. Results indicate good validity and reliability for the measurement of agitation with the German version of the BAM in the present sample. Thereby, we introduce a brief instrument in German for repeated assessment of agitation in research and clinical practice.
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Affiliation(s)
- Inken Höller
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Northrine-Westphalia, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Northrine-Westphalia, Germany
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Kim HJ, Lee DH. Predictive factors for the medical hospitalisation of patients who visited the emergency department with suicide attempt. BMC Psychiatry 2021; 21:79. [PMID: 33549077 PMCID: PMC7866662 DOI: 10.1186/s12888-021-03089-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 02/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is a significant public health problem. Individuals are estimated to make up to 20 suicide attempts before suicide. The emergency department (ED) is the first location where individuals are brought after a suicide attempt. This study investigated the factors related to delays in the medical hospitalisation of patients who attempted suicide and aimed to provide criteria for hospitalisation decisions by physicians. METHODS This study included patients who had deliberately self-harmed (age ≥ 19 years) and presented at the EDs of two tertiary teaching hospitals between March 2017 and April 2020. Those for whom relevant demographic and clinical information were unavailable and those admitted to the psychiatric wards were excluded. RESULTS This study included 414 patients in the hospitalisation group and 1346 in the discharged group. The mean patient age was 50.3 ± 20.0 years and 40.7 ± 17.0 years in the hospitalised and discharged groups (p < 0.001), respectively. The mean ED length of stay (LOS) was 4.2 ± 12.3 and 11.4 ± 18.8 h in the hospitalised and discharged groups, respectively. In the hospitalised group, the odds ratio and confidence interval for aged 35 ~ 64 (2.222, 1.343-3.678), aged over 65 (2.788, 1.416-5.492), sex -male (2.041, 1.302-3.119), and consciousness (1.840, 1.253-2.466). The Risk-Rescue Ratio Scale (RRRS) was (1.298, 1.255-1.343). A receiver operating characteristics analysis of RRRS for the decision to hospitalise patients who attempted suicide showed a cut-off value of 42, with sensitivity, specificity, and area under the curve being 85.7, 85.5%, and 0.924, respectively. CONCLUSION The level of consciousness and the RRRS of patients who attempted suicide can be the factors to decide medical hospitalisation and reduce ED LOS and crowding.
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Affiliation(s)
- Hye Jin Kim
- grid.411612.10000 0004 0470 5112Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Duk Hee Lee
- Department of Emergency Medicine, Ewha Womans University, Anyangchoenro 1071 Yangcheon-gu, Seoul, Republic of Korea.
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Levi-Belz Y, Gvion Y, Apter A. The Serious Suicide Attempts Approach for Understanding Suicide: Review of the Psychological Evidence. OMEGA-JOURNAL OF DEATH AND DYING 2020; 86:591-608. [PMID: 33327864 DOI: 10.1177/0030222820981235] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The study of survivors of a serious suicide attempt (SSA)--an attempt that would have been fatal had it not been for the provision of rapid and effective emergency treatment--can help researchers understand the suicidal mind. Serious suicide attempters are epidemiologically very similar to those who died by suicide, and thus can serve as valid proxies for studying suicides. In this paper, our objective was to briefly review the main risk factors that may facilitate more dangerous suicide behavior with high levels of intent. Our review highlights several dimensions of risk factors for SSAs, including psychopathology, mental pain, communication difficulties, decision-making impulsivity, and aggression. Several studies have indicated that the interaction between some of these dimensions, especially between mental pain and interpersonal difficulties, may serve as major catalysts for SSAs. Suicidal risk assessment should incorporate a designated evaluation of these risk factors as part of suicide prevention models.
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Affiliation(s)
- Yossi Levi-Belz
- Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel.,The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Yari Gvion
- Department of Child Clinical Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Alan Apter
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel.,Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
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Kim DW, Cho SE, Kang JM, Woo SK, Kang SG, Yeon BK, Cho SJ. Risk Factors for Serious Suicide Attempts: Difference Between Older and Younger Attempters in the Emergency Department. Front Psychiatry 2020; 11:607811. [PMID: 33488429 PMCID: PMC7820120 DOI: 10.3389/fpsyt.2020.607811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/07/2020] [Indexed: 01/11/2023] Open
Abstract
Objective: Suicide attempts of the older adults are known to be more serious than that of the younger adults. Despite its major social impact in South Korea, the behavioral mechanism of serious suicide attempt (SSA) in old people remains to be elucidated. Thus, we investigated the risk factors for SSA in older and younger suicide attempters in the emergency department. Methods: Demographic data, clinical information, and the level of seriousness of suicide with Risk Rescue Rating Scale were compared between older (age ≥65) and younger (age <65) adults who visited the emergency department for a suicide attempt. Regression analyses were performed to identify the risk factors for SSA in these two groups. Results: Among 370 patients, 37 were older adults (10%; aged 74.41 ± 6.78), more likely to have another medical disease (p < 0.001), and a higher suicide completion rate (16.2 vs. 5.4%, p = 0.023). In the younger group, old age (B = 0.090, p < 0.001), male sex (B = -0.038, p = 0.019), and impression of schizophrenia (B = 0.074, p = 0.027) were associated with a higher risk-rescue ratio and interpersonal stress condition was associated with a lower risk-rescue ratio (B = -0.045, p = 0.006). In the older group, however, no variables were included significant in the regression model for the Risk Rescue Rating Scale. Conclusions: Demographic and clinical factors such as old age, male sex, interpersonal stress, and impression of schizophrenia were associated with lethality in the younger suicide attempters. However, no factors were associated with SSA in the older adult group. Different mechanisms may underly the lethality in old age suicide.
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Affiliation(s)
- Dong Wook Kim
- College of Medicine, Gachon University, Incheon, South Korea
| | - Seo Eun Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Jae Myeong Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Soo Kyun Woo
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Seung-Gul Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Byeong Kil Yeon
- Department of Psychiatry, Gyeonggi Provincial Medical Center Suwon Hospital, Suwon, South Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
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