Chronic alcohol problems among suicide attempters - Post-mortem findings of a 14-year follow-up

Department of Psychiatry, University of Helsinki, Helsinki, Uusimaa, Finland
Nordic Journal of Psychiatry (Impact Factor: 1.34). 02/2005; 59(1):45-50. DOI: 10.1080/08039480510018823
Source: PubMed


This study set out to describe the clinical characteristics of a subgroup of suicide attempters with clear post-mortem evidence of long-term alcohol misuse, and to investigate the risk factors predicting chronic alcohol misuse/dependence using survival analysis. Data were collected over 14 years on all unselected deliberate self-poisoning patients (n=1018) treated in the emergency unit of Helsinki University Central Hospital. Of the 222 (22.7%) who had died by the end of the follow-up period, 85 (38.5%) showed clear post-mortem evidence of long-term alcohol misuse. Seventy-four per cent of misusers were men. The risk factors for chronic alcohol misuse/dependence among deceased suicide attempters were: male sex, numerous previous suicide attempts, non-impulsive suicide attempts, certain intention to die and subjective motive of the index attempt other than "wish to die". The findings emphasize that more attention should be focused on evaluating alcohol use and the risk of alcohol dependence in suicide attempters encountered in the emergency room of general hospitals.

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    • "to have a chronic ethanol intake , a higher reported dose ingested , higher latency time and longer hospital stay . In our study , males had a significantly higher rate of chronic alcohol intake . A direct association between chronic alcohol intake and suicidal behaviour tends to be a gender - specific feature among males ( Zaidan et al . , 2002 ; Suokas et al . , 2005 ; Sudhir Kumar et al . , 2006 ) . Interventions targeted at those with alcohol problems may be a useful strategy in males at risk of suicide . Males had higher amounts of acetaminophen ingested in our study , and therefore the extensive amounts ingested expose the male patients to higher risk . Similar conclusions were reported by other"
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    ABSTRACT: The objectives of this study were to determine the risk factors and life stressors that are prevalent among the acetaminophen deliberate self-poisoning (DSP) cases, to identify gender differences in the associated factors, and to determine the prevalence of psychiatric diagnosis and the patterns and types of psychotherapeutic interventions provided by psychiatrists. This is a cross-sectional study, a retrospective descriptive case review of hospital admissions for acetaminophen DSP. There were 177 incidences of DSP during the study period. The mean age of the cases was 23.1 +/- 7.3 years and 84.1% of them were females. The risk factors were more significantly associated with males: chronic ethanol intake (p = 0.04), higher reported dose ingested (p = 0.01), higher latency time (p = 0.04) and longer hospital stay (p = 0.03). The most commonly reported psychotherapeutic interventions used by psychiatrists were psychoeducation of the patient, followed by referral to a psychiatric clinic, family psychoeducation and psychotropic medication. Sertraline (SSRI) was the most frequently prescribed antidepressant. Males have been shown to use more toxic doses and to delay treatment due to high latency time. Most DSP patients have different life stressors and psychiatric diagnoses that may be associated with varying degrees of suicidal intent. All patients presenting following DSP need to be carefully screened for psychiatric illness. Randomized controlled studies need to be conducted on DSP patients with psychiatric illness to determine which treatments are effective.
    Human Psychopharmacology Clinical and Experimental 08/2010; 25(6):500-8. DOI:10.1002/hup.1140 · 2.19 Impact Factor
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    ABSTRACT: BACKGROUND: Suicidal ideation and attempted suicide are important presenting complaints in the Emergency Department (ED). The Joint Commission established a National Patient Safety Goal that requires screening for suicidal ideation to identify patients at risk for suicide. OBJECTIVES: Given the emphasis on screening for suicidal ideation in the general hospital and ED, it is important for Emergency Physicians to be able to understand and perform suicide risk assessment. METHODS: A review of literature was conducted using PubMed to determine important elements of suicide assessment in adults, ages 18 years and over, in the ED. Four typical ED cases are presented and the assessment of suicide risk in each case is discussed. RESULTS: The goal of an ED evaluation is to appropriately determine which patients are at lowest suicide risk, and which patients are at higher or indeterminate risk such that psychiatry consultation is warranted while the patient is in the ED. Emergency clinicians should estimate this risk by taking into account baseline risk factors, such as previous suicide attempts, as well as acute risk factors, such as the presence of a suicide plan. CONCLUSION: Although a brief screening of suicide risk in the ED does not have the sensitivity to accurately determine which patients are at highest risk of suicide after leaving the ED, patients at lowest risk may be identified. In these low-risk patients, psychiatric holds and real-time psychiatric consultation while in the ED may not be needed, facilitating more expeditious dispositions from the ED.
    Journal of Emergency Medicine 10/2012; 43(5). DOI:10.1016/j.jemermed.2012.08.015 · 0.97 Impact Factor
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    ABSTRACT: Introduction Research on suicide attempt impulsivity is plagued by inconsistent definitions of the concept to the extent that its utility has been questioned. A systematic review of literature is briefly presented to show how marginal differences in the assessment of suicide attempt impulsivity limit integration of data and the capacity to evaluate the validity of the current assessment strategies. To inform the framework for the definition and assessment of suicide attempt impulsivity we explored how experienced clinicians and suicide attempters themselves understand suicide attempt impulsivity. Methods Semi-structured interviews with 8 suicide attempters were conducted to recreate timelines of their suicide process. The timelines were reviewed with 7 experienced clinicians. Thematic analysis of the data was conducted. Results The results indicate lack of consensus among the clinicians on the definition of suicide attempt impulsivity. Two groups of criteria emerged that assess proximal versus chronic suicidality symptoms. Illustrations of the criteria are presented based on the cases. Discussion Criteria that emerged in the study are compared with those currently used in research, illustrating lack of systematic assessment of chronic symptoms in current studies on impulsive suicide attempts. Suggestions for modifications of impulsivity assessment are made. The concept of suicide attempt impulsivity had little meaning for suicide attempters themselves, which indicates limitations in using self-identification of attempt impulsivity in further research. Conclusions Suicide attempt impulsivity can be described as lack of both proximal and chronic suicidality symptoms. Current assessment of suicide attempt impulsivity can be improved by simultaneously addressing both.
    15th European Symposium on Suicide and Suicidal Behaviour (ESSSB15), Tallinn, Estonia; 08/2014
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