The suicidal process among young people

Centre for Suicide Research and Prevention, Karolinska Hospital, Stockholm, Sweden.
Acta Psychiatrica Scandinavica (Impact Factor: 5.61). 01/1996; 93(1):35-42. DOI: 10.1111/j.1600-0447.1996.tb10616.x
Source: PubMed


Fifty-eight consecutive suicides among 15- to 29-year-olds (42 men and 16 women) were investigated by modified psychological autopsies and examined from the perspective of the suicidal process. Previous suicide attempts were evident in 66% and more than two suicide attempts found in 17% of men and in 56% of women. The median interval from first suicidal communication to the suicide was shorter in men than in women (12 vs 42 months). The median interval was 47 months in schizophrenia, 30 months in borderline personality disorder, 3 months in major depression and < 1 month in adjustment disorder. There were also differences in the prevalence of next-of kin models for suicidal behavior, previous suicidal communication and in the characteristics of the suicide. We conclude that focusing on the process heightens understanding of serious suicidal behavior in young people.

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    • "The risk factors associated with suicidal behaviour in DE include younger age, major depression, dysthymia, PTSD and alcohol dependence (Bernal et al., 2007). Suicidal behaviours occur earlier in the course of AD than in DE (Runeson et al., 1996), as does suicide (Portzky et al., 2005; Schnyder and Valach, 1997). All aspects of suicidality, including suicidal ideation, behaviour or death by suicide have been under researched in AD, instead focussing on DE and other mood disorders (Bernal et al., 2007). "
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    ABSTRACT: Little is known about suicidal ideation and behaviours in adjustment disorder (AD). In this paper we sought to examine the variables independently associated with suicidal ideation and behaviour in patients diagnosed with AD or depressive (DE) episode among psychiatric outpatients and in liaison psychiatry. 370 patients who were referred to the liaison psychiatry services (including those seen in the Emergency Department) at 3 Dublin hospitals, and were clinically diagnosed with either DE or AD, based on the ICD 10 diagnostic criteria, were recruited to the study. We examined their demographic and clinical characteristics, and the associations between these and suicidal ideation and behaviour on multivariate analysis. Younger age, single marital status, and greater severity of depressive symptoms were significantly associated with suicidality across both diagnoses. On multivariate analysis, greater severity of depressive symptoms was associated with suicidality in those with AD (p=0.012) and DE (p=0.009). Those with AD exhibited suicidality at lower symptom scores than did those with DE but in both groups it still occurred at the highest level of severity. There were differences in the objective circumstances measure of suicide intent. We used clinical diagnosis rather as the main diagnostic classification. The generalisability of this paper may be limited to consultation-liaison psychiatry settings, where suicidal ideation and behaviours are common. Suicidality in AD and DE has broadly similar risk factors but differ in aspects of suicide intent. Different mechanisms may underpin suicidality in those with AD compared to DE. Copyright © 2014. Published by Elsevier B.V.
    Journal of Affective Disorders 12/2014; 174C:441-446. DOI:10.1016/j.jad.2014.12.003 · 3.38 Impact Factor
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    • "One possible clue to this apparent paradox is that too little attention has yet been paid during the present crisis to the different stages of the suicidal process. The suicidal process framework classifies suicidal behaviour starting with suicidal ideas and thoughts, progressing to plans, then growing through suicidal attempts and finally to fatal suicide [9]. "
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    ABSTRACT: Introduction Although suicide rates have increased in some European countries in relation to the current economic crisis and austerity policies, that trend has not been observed in Spain. This study examines the impact of the economic crisis on suicide attempts, the previously neglected endpoint of the suicidal process, and its relation to unemployment, age and sex. Methods The study was carried out in Andalusia, the most populated region of Spain, and which has a high level of unemployment. Information on suicide attempts attended by emergency services was extracted from the Health Emergencies Public Enterprise Information System (SIEPES). Suicide attempts occurring between 2003 and 2012 were included, in order to cover five years prior to the crisis (2003–2007) and five years after its onset (2008–2012). Information was retrieved from 24,380 cases (11,494 men and 12,886 women) on sex, age, address, and type of attention provided. Age-adjusted suicide attempt rates were calculated. Excess numbers of attempts from 2008 to 2012 were estimated for each sex using historical trends of the five previous years, through time regression models using negative binomial regression analysis. To assess the association between unemployment and suicide attempts rates, linear regression models with fixed effects were performed. Results A sharp increase in suicide attempt rates in Andalusia was detected after the onset of the crisis, both in men and in women. Adults aged 35 to 54 years were the most affected in both sexes. Suicide attempt rates were associated with unemployment rates in men, accounting for almost half of the cases during the five initial years of the crisis. Women were also affected during the recession period but this association could not be specifically attributed to unemployment. Conclusions This study enhances our understanding of the potential effects of the economic crisis on the rapidly increasing suicide attempt rates in women and men, and the association of unemployment with growing suicidal behaviour in men. Research on the suicide effects of the economic crisis may need to take into account earlier stages of the suicidal process, and that this effect may differ by age and sex.
    International Journal for Equity in Health 07/2014; 13(1):55. DOI:10.1186/1475-9276-13-55 · 1.71 Impact Factor
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    • "The risk of suicide in adjustment disorder was found to be 4%, mostly along with presence of alcohol abuse. The interval between suicidal communication and act was less than 1 month in adjustment disorder, which was lesser compared with other disorders (depression 3 months, bipolar disorder 30 months, and schizophrenia 47 months).[27] One recent study on psychological autopsy of suicide found that 15% had adjustment disorder.[28] "
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    ABSTRACT: Adjustment disorder is a common diagnosis in psychiatric settings and carries a significant rate of morbidity. However, diagnostic criteria are vague and not much helpful in clinical practice. Also there has been relatively little research done on this disorder. In this article, we review the information that is available on the epidemiology, clinical features, validity, and current diagnostic status of adjustment disorder. In this article, the controversy surrounding the diagnosis is also highlighted. It also discusses the differential and comorbid diagnosis. The various recommendations for DSM-V and ICD-11 conclude the article.
    Indian Journal of Psychological Medicine 03/2013; 35(1):4-9. DOI:10.4103/0253-7176.112193
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