Lucas Giner

• MD. PhD
• Professor at University of Seville

Introduction Suicide is a global public health issue necessitating evidence-based prevention strategies. Many individuals who die by suicide have had prior contact with healthcare services. Nearly half visit a primary care provider within a month before their death, and many visit emergency departments (EDs) frequently. Effective risk assessment in...

Introduction There is a discussion whether military and police corps show increased suicide rates, as the line of work is characterised by both protective and risk factors for suicidality. To examine deaths by suicide rates and trends in the Spanish Guardia Civil as compared with the general population. Methods This is a retrospective case–control...

Individuals who use substances such as cocaine, cannabis, heroin, alcohol and nicotine are at increased risk for suicidal behavior. Our objective is to examine the relationship between substance use and suicide. An observational psychological autopsy study design was used to compare substance use in individuals who died by suicide and individuals w...

Purpose of Review This systematic review explores the relationship between personality disorders (PDs) and lethal suicide behavior. Following PRISMA guidelines, the study examines psychological autopsy studies with suicide deaths and identified PDs. Inclusion criteria encompass studies using the psychological autopsy method, reporting PD diagnosis...

Background: This study explored the characteristics of people who die by suicide, comparing those who had depression with those who did not. Methods: Clinical data were collected through a postmortem proxy-based semistructured interview (psychological autopsy). Postmortem toxicological analysis provides data on the presence of substances or drugs i...

Background:: Stressful life events (SLEs), impulsivity, aggression, and hostility are known risk factors for suicide. The existence of an "I-A-H Triad" (composed of impulsiveness, aggressiveness and hostility) is proposed as a mediating factor between SLEs and suicide. Method:: Data on 399 deceased people (274 from suicide, 125 from other causes) w...

Depressive disorders represent the largest proportion of mental illnesses, and by 2030, they are expected to be the first cause of disability-adjusted life years [1]. The COVID-19 pandemic exacerbated prevalence and burden of depression and increased the occurrence of depressive symptoms in general population [2]. The urgency of implementing mental...

Background Many patients with depression refuse treatment. Moreover, suicide attempters often display low perceived need of treatment and impaired decision-making. These observations raise questions about the capacity to treatment consent in depressed suicide attempters (SA). Methods In patients with current depressive episode ( N = 33 SAs and N =...

Background. Managing patient with suicidal thoughts and behaviours presents significant challenges due to the scarcity of robust evidence and clear guidance. This study sought to develop a comprehensive set of practical guidelines for the assessment and management of suicidal crises.Methods. Utilizing the Delphi methodology, 80 suicide clinician an...

Objective: The aim of this study was to examine suicide rates in Spain during the COVID-19 pandemic and the influenza pandemic of 1918-1920. Methods: Data on deaths by cause for the periods 1910-1925 and 2016-2020 were obtained from the National Statistics Institute of Spain. Results: During the Spanish influenza pandemic, a peak of deaths in 1918...

Background: The exact mechanisms through which the impact of the SARS-CoV-2 pandemic could influence the prevalence of suicidal thoughts are not yet known, both in the general population and in health workers. The objectives of the present study are to determine the prevalence of suicidal thoughts in the physician population and to detect sociodem...

Purpose of Review Since the declaration of the COVID-19 pandemic, there have been numerous social changes to try to contain the spread of the disease. These sudden changes in daily life have also changed the way we relate to others, in addition to creating a climate of uncertainty and fear. Therefore, the objective of this review is to compile publ...

We present data on the incidence of admissions for first episode psychosis in a region of southern Spain. All consecutive cases of admissions to the psychiatric hospitalization unit due to psychosis were selected. The incidence rates for first episode psychosis among immigrants and non-immigrants between two years were calculated. Incidence rate ra...

Objective: To analyze the relationship between suicide in men and stratified measures of religiosity. Methods: We studied 192 suicides and 81 controls (nonsuicide, sudden, or accidental death). We employed the psychological autopsy method to compile diagnoses based on DSM-IV criteria. Overall, religiosity and participation in religious associati...

Introduction The first thoracic lobectomies and robotic transsegmental resections date from 2003, since then robotic-assisted thoracic surgeries have been increasing (1). Extensive benefits of robotic-assisted thoracic surgery (RATS) versus video-assisted thoracic surgery (VATS) have been demonstrated, among which we find improvement in surgical fi...

El suicidio constituye un importante problema de salud pública. La mortalidad por suicidio, la calidad de las estadísticas y su validez son un elemento crucial en su monitorización y prevención. En este artículo pretendemos realizar una actualización de las aportaciones de la medicina forense a la conducta suicida, destacando la importancia de las...

Resumen El manejo del trastorno límite de personalidad puede ser un reto para el clínico, especialmente en el servicio de urgencias hospitalarias, donde se hacen necesarias decisiones rápidas que deben ser además las más beneficiosas y en conjunto con el paciente, favoreciendo su autonomía y participación en la resolución de la crisis. En este artí...

Background: Suicide prevention is one of the greatest challenges in mental health policies. Since a previous suicide attempt is the main predictor of future suicidal behaviour, clinical management of suicide attempters is vital for lowering mortality. Psychopharmacological interventions are still nonspecific, and their effectiveness have often bee...

Purpose of review: The purpose of this review is to review the most recent literature regarding diagnostic stability of mood disorders, focusing on epidemiological, clinical-psychopathological, and neurobiological data for unipolar and bipolar affective disorders. Recent findings: Unipolar depression follows a chronic course in at least half of...

Purpose of review: Historically, anxiety disorders have not been considered as important determinants of suicide, but in the last years, many works have challenged this assumption. Here, we will review the available evidence on the relationship between suicide and anxiety disorders (e.g., obsessive-compulsive disorder, post-traumatic stress disord...

Suicide is one of the leading causes of violent death in many countries and its prevention is included in worldwide health objectives. Currently, the DSM-5 considers suicidal behavior as an entity that requires further study. Among the three validators required for considering a psychiatric disorder, there is one based on psychological correlates,...

Between 10 and 20 million people attempt suicide every year worldwide, and suicide attempts represent a major economic burden. Suicide attempters suffer from high rates of comorbidity, and comorbidity is the rule in suicide re-attempters. Comorbidity complicates treatment and prognosis and causes a more protracted course. In the present narrative r...

Suicidal behavior and its prevention constitute a major public health issue. Etiology of suicidal behavior is multifactorial. Whereas current research is mostly focused on clinical and biological risk factors, the sociodemographic risk factors for suicidal behavior, first highlighted by Durkheim, have received less attention. Besides the well-known...

Today we understand suicidal behavior as a spectrum of actions and thought processes. This framework is the result of centuries of thought and study on the subject. This chapter will provide a historical context for attempts to classify and understand the various manifestations of suicidal behavior. This chapter traces the evolution of the study of...

Monitoring patients for suicide risk is a vital aspect of both initial and long-term psychiatric care for patients with suicidal behavior. A prior suicide attempt is the biggest risk factor for completed suicide, and the period immediately following a suicide attempt requires a high level of vigilance on the part of the care providers. Ongoing long...

Introduction It has been suggested that there is a relationship between BMI and suicide. Thus, BMI of subjects who commit suicide would be lower than the BMI of other unnatural deaths (Flaig 2013). Objectives Explore the possible relationship between BMI and suicide. Material and methods A total of 1197 suicides and 473 unnatural deaths (not by s...

Introduction Psychological autopsy studies have constantly indicated a clear relation between mental disorders and suicide. This relation has been found in studies across the world, although the percentage of cases with at least one mental disorder diagnosed may vary between studies and specially, between countries and geographical regions. Method...

Suicidal behaviour (SB) entered the DSM-5, underlying a specific biological vulnerability. Then, recent findings suggested a possible role of the immune system in SB pathogenesis. The objective of this review is to present these main immune factors involved in SB pathogenesis. We conducted a review using Preferred Reporting Items for Systematic rev...

Suicide poses a major mental health challenge. Numerous studies have reported gender differences in suicidal behavior, though the specific influence of gender remains unclear. Time and again the same "gender paradox" has been seen: while women make more suicide attempts (two to three times as often), men have higher rates of completed suicide. In t...

Background and objectives To be able to prevent suicides, The exact magnitude of suicides must be known in order to prevent them. There is evidence that data provided on the number of suicides by the Spanish Statistical Office (Instituto Nacional de Estadística [INE]) differs from that identified by forensic pathologists. This paper aims to determi...

To be able to prevent suicides, The exact magnitude of suicides must be known in order to prevent them. There is evidence that data provided on the number of suicides by the Spanish Statistical Office (Instituto Nacional de Estadística [INE]) differs from that identified by forensic pathologists. This paper aims to determine whether the INE data ar...

The use of violence in a suicide attempt and its medical consequences can be used to characterize specific subpopulations of suicide attempters that could be at higher risk of ever completing suicide. A population of 1,148 suicide attempters was consecutively recruited from 2001 to 2010. Violent suicide attempts were classified using Asberg's crite...

Introduction Although religion is one the protective factors classically related to suicidal behavior, as far as we know, no studied based on psychological autopsy has been published. Holy Week in Seville (Spain) may be the most important traditional event of the city. Besides socio-cultural and economic aspects, it is the celebration of the Passio...

Introduction Suicide is a major public health problem. Although suicide statistics have always been difficult to determine, there is no doubt that deaths caused by this psychiatric challenge are similar to the ones caused by homicide or road traffic injuries. The presence of a personality disorder has often been related to suicide. Objectives In t...

A recent publication focused on biomarkers of future suicidal behaviors identifies several genes expressed in high-risk states among four samples. We discuss the implications of this study as well as the current state of research regarding biomarkers of suicidal behavior.

Background: The use of physical restraints or a seclusion room for the treatment of adolescents in a psychiatric inpatient setting raises ethical dilemmas. We investigated the attitudes of adolescents towards these two means of confinement. Method: We used a structured questionnaire to collect data on the attitudes of 50 adolescent patients, hos...

Whether suicide attempters and completers represent the same population evaluated at different points along a progression towards suicide death, overlapping populations, or completely different populations is a problem still unresolved. 446 Adult suicide attempters and knowledgeable collateral informants for 190 adult suicide probands were intervie...

Although emptiness is usually considered a critical issue in the suicidal process, there is surprisingly little empirical research on the relationship between emptiness and suicidal behavior. The major aim of this exploratory review is to examine the relationship between emptiness and suicidal behavior. To this end, four databases (PsychInfo 1806–A...

In Spain, suicide has become the leading cause of violent death, ahead of traffic accidents. Prevention programs are based on risk factors of suicidal behavior, which are mainly drawn from studies of suicide attempts and to a lesser extent, from studies of completed suicide. Our main objectives were to determine if difference exists between suicide...

In Spain, suicide is the leading cause of violent death, ahead of motor vehicle accidents, with about 3,500 people dying by this mean in Spain. The risk factors identified are primarily based on studies of suicide attempts.The centralization of autopsies in the Institutes of Legal Medicine allows the homogenization of working methods and the consis...

Every year, suicide is among the top 20 leading causes of death globally for all ages. Unfortunately, suicide is difficult to prevent, in large part because the prevalence of risk factors is high among the general population. In this review, clinical and psychological risk factors are examined and methods for suicide prevention are discussed. Preve...

Suicidal behaviour is a major public health issue. Suicidal behaviour is one of the main causes of years of life lost and it is the third leading cause of death among young adults. This project was initiated by the Spanish Society of Psychiatry and the Spanish Society of Biological Psychiatry with the aim of providing a document containing the main...

Inter-rater agreement is a crucial aspect in the planning and performance of a clinical trial in which the main assessment tool is the clinical interview. The main objectives of this study are to study the inter-rater agreement of a tool for the assessment of suicidal behavior (Brief Suicide Questionnaire) and to examine whether the inter-examiner...

IntroductionSuicidal behaviour is a major public health issue. Suicidal behaviour is one of the main causes of years of life lost and it is the third leading cause of death among young adults. This project was initiated by the Spanish Society of Psychiatry and the Spanish Society of Biological Psychiatry with the aim of providing a document contain...

IntroductionInter-rater agreement is a crucial aspect in the planning and performance of a clinical trial in which the main assessment tool is the clinical interview. The main objectives of this study are to study the inter-rater agreement of a tool for the assessment of suicidal behavior (Brief Suicide Questionnaire) and to examine whether the int...

The rate of suicide in the United States among prepubertal children and young adolescents had increased by 120% from 1980 to 1992. From 1992 to the present the rate has decreased slightly by 33%. We address a brief review of the most relevant findings in literature that are related to the risk of suicide. Although the most reported findings were ch...

It is questionable whether the Maslach Burnout is suitable for studying burnout prevalence in preclinical medical students because many questions are patient-centered and the students have little or no contact with patients. Among factors associated with burnout in medical students, the gender shows conflicting results. The first aim of this study...

To compare the clinical and demographic characteristics of older adolescents and young adults with and without alcohol misuse in a primary care setting. This study is a case-control study. Eighty-one 18-30 year old adolescents and young adults attending a primary care center were assessed with the CAGE questionnaire, the PRIME-MD instrument and the...

This article describes a diathesis-stress model for understanding suicidal behavior, looking at how stressors interact with a low threshold for acting on suicidal ideas. Environmental, biological, and psychiatric stressors that may lead to suicidal behavior are discussed, along with risk factors that influence the threshold for suicidal behavior.

Background and Objectives: Every year, suicide accounts for approxi- mately one million preventable deaths worldwide. Suicidal behavior is complex and multi-determined with risk factors identified in multiple domains including clinical, ge- netic, environmental, behavioral, neurophysiological, and neurocognitive. Modeling causal pathways that integ...

Serotonin (5-HT) receptors may have a role in suicidal behavior. Previous studies have shown an association between the T102C polymorphism of the 5-HT2a receptor gene and suicidal behavior. However, negative findings have also been reported. We examined the association between the T102C and C1354T (His452Tyr) polymorphisms of the 5-HT2a receptor ge...

The Met allele of the Catechol-O-Methyltransferase (COMT) gene functional polymorphism (COMT-V158M) is associated with lower enzymatic activity than the Val allele and is reported to be associated with aggression, depression, and suicidal behavior. Since depression and impulsive-aggressive behavior may mediate risk for suicidal behavior, we assesse...

Worldwide, suicide is among the top five causes of mortality in the 15- to 19- year age group. Pediatricians and primary care providers are in a distinctive position to help prevent suicide in adolescents. According to the Guidelines for Adolescent Preventive Services, all adolescents should have at least an annual preventive services visit, which...

Alcohol abusers seem to be prone to both suicide attempts and completions. The relationship between alcohol abuse and suicide in adolescence is complex. To examine the role of alcohol abuse and dependence in adolescent suicide in psychological autopsy studies. A search in the National Library of Medicine (NLM) PubMed database using "adolescents" an...

Suicidal behavior and alcohol use disorders among adolescents and young adults are serious public health problems. In the study of suicidal behavior among young people with alcoholism, it has been shown that aggression and impulsivity are higher among those who attempted suicide. Impulsivity has been related to suicidal and self-destructive behavio...

To determine the incidence of alcohol related problems (ARP) among adolescents admitted to the Psychiatric Emergency Room (PER) and to describe the demographic and clinical characteristics. The study was a retrospective review of admissions to the PER, where we reviewed the psychiatric records of all of the 14-30 year olds admitted to the PER durin...

To determine the prevalence of alcohol misuse among older adolescents and young adults evaluated in a primary care setting using the CAGE questionnaire. In this crossover descriptive study, a general practitioner, using the CAGE questionnaire, interviewed consecutive primary care patients aged 18-30 years. 29.5% of adolescents and young adults answ...

The controversy regarding Selective Serotonin Reuptake Inhibitors (SSRIs) and suicidality dates back to the early 1990s. The first agent reported to be associated with suicidality was fluoxotine. In 2003, the British Medicines and Healthcare Products Regulatory Agency (MHRA) warned about possible risk of suicidality in children and adolescents trea...

Adolescents with acute mental illness or suicidal behavior are almost always hospitalized for safety and evaluation purposes. The tendency towards long-term or repeated hospitalizations has many adverse effects such as dependency on the mental health care system and increased chronicity of illness. The causes for these phenomena may be prevented in...

Tesis doctoral inédita realizada en la Universidad Autónoma de Madrid. Departamento de Psiquiatría. Fecha de lectura: 25 de Noviembre de 2010.