SUicidal risk factors and completed suicide: Meta-analyses based on psychological autopsy studies

Department of Hygiene, School of Medicine, Wakayama Medical University, 8-1-1 Kimiidera, Wakayama, 641-0012, Japan.
Environmental Health and Preventive Medicine 10/2008; 13(5):243-56. DOI: 10.1007/s12199-008-0037-x
Source: PubMed


The purpose of the present review is to evaluate the effects of common risk factors for suicide by meta-analyses using data extracted from studies based on the psychological autopsy method. We focused on five common risk factors of suicide: substance-related disorders, mood disorders, adverse marital status, adverse employment status, and self-harm behaviors. A total of 24 articles were identified from MEDLINE in which the crude odds ratio (OR) could be calculated for the above five risk factors through 30 April 2007, using such search keywords as "suicide," "psychological autopsy," and "case-control study." Overall, both substance-related disorders [OR = 5.24; 95% confidence interval (CI) = 3.30-8.31] and mood disorders [OR = 13.42; 95% CI = 8.05-22.37] were strongly associated with suicidal risk. Suicidal attempt and deliberate self-harm, which can directly lead to completed suicide, have been shown to be very strongly associated with suicidal risk [OR = 16.33; 95% CI = 7.51-35.52]. Effects of social factors such as adverse marital and employment status were relatively small. As substance-related disorders and mood disorders were strongly associated with an increased risk of completed suicide, the comorbidity of these two disorders should be paid a maximum attention. The effective prevention of suicide depends on whether we can successfully incorporate these personal factors as well as social factors into an adequate multi-factorial model.

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    • "Understanding the risk factors leading to suicide is crucial for effectively preventing suicide and managing individuals at risk of suicide. Depression has been strongly associated with suicide in retrospective psychological autopsy studies (Hawton & van Heeringen, 2009; Yoshimasu, Kiyohara & Miyashita, 2008), although an over-underestimation of the association, and biases such as interviewer bias, surrogate interview bias, and recall bias may not be ruled out (Hjelmeland et al., 2012). Prospective studies have been conducted mainly among patients with psychiatric disorders, who may not represent the people with psychiatric disorders in the community (Agerbo, 2007). "
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    ABSTRACT: Background. Few studies have prospectively examined whether depressive symptoms and other risk factors are associated with a higher risk of suicide death in individuals other than high-risk populations such as psychiatric patients and individuals with self-harm histories. The purpose of the study is to prospectively examine whether depressive symptoms assessed by the Beck Depression Inventory (BDI) are associated with greater risk of suicide death and whether depressive symptoms and other risk factors are independent predictors of suicide in general-risk populations. Another aim is to evaluate the sensitivity of the BDI for predicting suicide death. Methods. 10,238 Korean Vietnam War veterans (mean age: 56.3 years) who participated in two surveys in 2001 were followed up for suicide mortality over 7.5 years. Results. 41 men died by suicide. Severely depressed participants had a higher adjusted hazard ratio (aHR = 3.4; 95% CI [1.5-7.7]) of suicide than non-to-moderately depressed ones. Higher suicide risk was associated with more severe depressive symptoms (p for trend = 0.009). After adjustment for depressive symptoms and other factors, very poor health, low education, and past drinking were associated with higher suicide risk, while good health, body mass index, and marital status were not associated with suicide. The sensitivity at the cut-off score of 31 for detecting suicide was higher during the earlier 3.5 years of the follow-up (75%; 95% CI [50-90]) than during the latter 4 years (60%; 95% CI [41-76]). Conclusions. Depressive symptoms are a strong independent predictor and very poor health, low education, and drinking status may be independent predictors of future suicide. The BDI may have acceptable diagnostic properties as a risk assessment tool for identifying people with depression and suicidal potential among middle-aged men.
    PeerJ 07/2015; 3(Suppl 11):e1071. DOI:10.7717/peerj.1071 · 2.11 Impact Factor
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    • "Recent studies show that there is a link between drug use and suicidal behaviour, about 90% of people who commit suicide experience a mental or substance abuse disorder, or both (Lesage et al., 1994; Mosciciki, 2001; SAMHSA, 2008; Wunderlich, Bronsich & Wittchen, 1998). In addition, research has suggested that two major factors that increase the risk for suicide are considered to be mental disorders, in particular depression and substance abuse disorder (Moscicki, 2001; Yoshimasu, Kiyohara & Miyashita, 2008). "
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    ABSTRACT: The aim of this study is to evaluate the prevalence of suicidal behavior among male drug users in Kosovo. The study included 209 participants aged 15 to 52 years old from Kosovo. The total sample consisted of two subsamples; one composed of drug users and one for the general population. Results indicate that the prevalence of suicidal behavior is higher among drug users compared to the general population. However, there was no difference in behavior with regard to the type of drug used or abuse of more than one substance. The findings in this study suggest that exposure to drugs may increase the vulnerability to suicidal behavior, regardless of the type of drug abused.
    Procedia - Social and Behavioral Sciences 12/2014; 159:375-380. DOI:10.1016/j.sbspro.2014.12.391
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    • "The aforementioned studies were limited by retrospective recall, reliance on single items to assess suicide attempt planning and intent, and uncertainty about the proximity between prior depressive episodes and suicide attempts. Most data on the proximal relationship between depressive episodes and suicidal behavior come from psychological autopsy studies (Cavanagh et al., 2003; Yoshimasu et al., 2008). However, the unavailability of people for direct interview in these studies makes the studies poorly suited to answer fi ner grained questions such as those regarding the role of SID and IND (Conner et al., 2011). "
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    ABSTRACT: Objective: Major depressive episodes may be substance induced or occur independent of substance use. Studies of the roles of substance-induced depression (SID) and independent depression (IND) in suicidal behavior are limited to retrospective reports. The purpose of this study was to examine proximal (i.e., acute) risk for suicide attempts associated with SID and IND. Method: Individuals who had attempted suicide (n = 100) and nonsuicidal controls (n = 100) matched for site were recruited from residential substance use treatment programs. Participants were ages 18 and older and screened positive for potential alcohol use disorder. Validated semistructured interviews were used to assess SID, IND, and suicide attempts. Analyses of individual-level risk for attempts were based on multivariate logistic regression that adjusted for risk factors. Population-level attributable risk (PAR) fractions for suicide attempts were also calculated to provide estimates of the percentage of attempts in the study population attributable to SID and IND, respectively. Results: SID was identified in 60% of attempters and 35% of controls and IND in 13% of attempters and 3% of controls. Both variables conferred risk for suicide attempt (SID: odds ratio [OR] = 3.73, 95% CI [1.84, 7.58]; IND: OR = 10.38, 95% CI [2.48, 43.49]. PAR for suicide attempts associated with SID and IND was 0.44 and 0.12, respectively. Conclusions: Both SID and IND confer proximal risk for suicide attempts after adjusting for other risk factors. SID also contributes substantial risk in this population overall. Future research should test the hypothesis that IND confers greater risk than SID at the individual level.
    Journal of studies on alcohol and drugs 07/2014; 75(4):567-72. DOI:10.15288/jsad.2014.75.567 · 2.76 Impact Factor
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