Completed Suicide and Psychiatric Diagnoses in Young People: A Critical Examination of the Evidence.

Department of Mental Health and Substance Dependence, World Health Organization, Geneva, Switzerland.
American Journal of Orthopsychiatry (Impact Factor: 1.36). 11/2005; 75(4):676-83. DOI: 10.1037/0002-9432.75.4.676
Source: PubMed


Suicide rates of young people are increasing in many geographic areas. There is a need to recognize more precisely the role of specific mental disorders and their comparative importance for understanding suicide and its prevention. The authors reviewed the published English-language research, where psychiatric diagnoses that met diagnostic criteria were reported, to reexamine the presence and distribution of mental disorders in cases of completed suicide among young people worldwide. The number and geographical distribution of cases were limited (N = 894 cases). The majority of cases (88.6%) had a diagnosis of at least 1 mental disorder. Mood disorders were most frequent (42.1%), followed by substance-related disorders (40.8%) and disruptive behavior disorders (20.8%). Those strategies focusing exclusively on the prevention and treatment of depression in young people need to be reconsidered. A comprehensive suicide prevention strategy among young people should target mental disorders as a whole, not depression alone, and consider contextual factors.

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    • "As we expected, we found a very close relationship between suicidal behavior and mental illness since 93.6% of suicide attempters and 85.9% of suicide completers presented psychiatric diagnoses (axis I and/or axis II). In general, studies report that at least 90% of suicide completers present some kind of mental illness (Arsenault-Lapierre et al., 2004; Fleischmann et al., 2005; Isometsa, 2001; Tidemalm et al., 2008). In agreement with the literature (Angst et al., 1999; Bertolote et al., 2003), we found Major Depressive Disorder to be a risk factor for suicide completion . "
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    ABSTRACT: BACKGROUND: Suicide attempters and suicide completers are two overlapping but distinct suicide populations. This study aims to present a more accurate characterization by comparing populations of suicide attempters and completers from the same geographical area. METHODS: Samples and procedure: All cases of attempted suicide treated at the emergency room of the Corporacio Sanitària i Universitària Tauli Parc de Sabadell in 2008 (n=312) were compared with all completed suicides recorded in the same geographical area from 2008 to 2011 (n=86). Hospital and primary care records were reviewed for sociodemographic and clinical variables. Statistical analysis: Chi-square, ANOVA, and Mann-Whitney U tests were used to identify characteristics related to suicide completion. RESULTS: Compared to suicide attempters, suicide completers were more likely to be male (73.3% vs. 37.8%; p<0.001), pensioners (73.7% vs. 23.4%; p<0.001), and people living alone (31.8% vs. 11.4%; p=0.006). Suicide completers more frequently presented somatic problems (71.7 vs. 15.7; p<0.001), Major Depressive Disorder (54.7% vs. 27.9%; p<0.001), and made use of more lethal methods (74.1 vs. 1.9; p<0.001). Suicide completers were more likely to have been followed by a primary care provider (50.0% vs. 16.0%; p<0.001). 92.3% of the suicides committed were completed during the first or second attempt. LIMITATIONS: Suicide completers were not evaluated using the psychological autopsy method. CONCLUSIONS: Despite presenting a profile of greater social and clinical severity, suicide completers are less likely to be followed by Mental Health Services than suicide attempters. Current prevention programs should be tailored to the specific profile of suicide completers.
    Journal of Affective Disorders 04/2013; 150(3). DOI:10.1016/j.jad.2013.03.013 · 3.38 Impact Factor
    • "It would be beneficial if more treatment strategies were developed to specifically address SSH in young people with a particular mental disorder, such as the CBT trial in early psychosis (Power et al., 2003) or the DBT trial in borderline personality disorder (Turner, 2000). Of note is the paucity of SSH intervention studies in young people with substance use disorders, given their prevalence in youth with SSH (Fleischmann et al., 2005). As such, more clinical research is needed in this particular population. "
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    ABSTRACT: Background: Suicide and self-harm (SSH) in young people is a major cause of disability-adjusted life years. Effective interventions are of critical importance to reducing the mortality and morbidity associated with SSH. Aims: To investigate the extent and nature of research on interventions to prevent and treat SSH in young people using evidence mapping. Method: A systematic search for SSH intervention studies was conducted (participant mean age between 6-25 years). The studies were restricted to high-quality evidence in the form of systematic reviews, meta-analyses, and controlled trials. Results: Thirty-eight controlled studies and six systematic reviews met the study inclusion criteria. The majority (n = 32) involved psychological interventions. Few studies (n = 9) involved treating young people with recognized mental disorders or substance abuse (n = 1) which also addressed SSH. Conclusion: The map was restricted to RCTs, CCTs, systematic reviews, and meta-analyses, and thus might have neglected important information from other study designs. The effectiveness of interventions within the trials was not evaluated. The evidence base for SSH interventions in young people is not well established, which hampers best-practice efforts in this area. Promising interventions that need further research include school-based prevention programs with a skills training component, individual CBT interventions, interpersonal psychotherapy, and attachment-based family therapy. Gaps in the research exist in evaluations of interventions for SSH in young people with identifiable psychopathology, particularly substance use disorder, and research that classifies participants on the basis of their suicidal intent.
    Crisis The Journal of Crisis Intervention and Suicide Prevention 03/2013; 34(4):1-10. DOI:10.1027/0227-5910/a000190 · 1.09 Impact Factor
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    • "Prevention can occur on both the individual and societal level, with the most effective strategies being a combination of efforts [1,3]. An obstacle in the effort to combat suicide is the difficulty in identifying exactly which at-risk individuals will commit suicide [4-6]. Consequently, by informing the public and encouraging a general awareness of mental health problems including suicide, an increased alertness and responsiveness to suicidal individuals will follow [7]. "
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    ABSTRACT: Background The Awareness program was designed as a part of the EU-funded Saving and Empowering Young Lives in Europe (SEYLE) intervention study to promote mental health of adolescents in 11 European countries by helping them to develop problem-solving skills and encouraging them to self-recognize the need for help as well as how to help peers in need. Methods For this descriptive study all coordinators of the SEYLE Awareness program answered an open-ended evaluation questionnaire at the end of the project implementation. Their answers were synthesized and analyzed and are presented here. Results The results show that the program cultivated peer understanding and support. Adolescents not only learned about mental health by participating in the Awareness program, but the majority of them also greatly enjoyed the experience. Conclusions Recommendations for enhancing the successes of mental health awareness programs are presented. Help and cooperation from schools, teachers, local politicians and other stakeholders will lead to more efficacious future programs.
    BMC Public Health 09/2012; 12(1):776. DOI:10.1186/1471-2458-12-776 · 2.26 Impact Factor
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