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Suicide as an outcome for mental disorders. A meta-analysis
Abstract
Mental disorders have a strong association with suicide. This meta-analysis, or statistical overview, of the literature gives an estimate of the suicide risk of the common mental disorders.
We searched the medical literature to find reports on the mortality of mental disorders. English language reports were located on MEDLINE (1966-1993) with the search terms mental disorders', 'brain injury', 'eating disorders', 'epilepsy', 'suicide attempt', 'psychosurgery', with 'mortality' and 'follow-up studies', and from the reference lists of these reports. We abstracted 249 reports with two years or more follow-up and less than 10% loss of subjects, and compared observed numbers of suicides with those expected. A standardised mortality ratio (SMR) was calculated for each disorder.
Of 44 disorders considered, 36 have a significantly raised SMR for suicide, five have a raised SMR which fails to reach significance, one SMR is not raised and for two entries the SMR could not be calculated.
If these results can be generalised then virtually all mental disorders have an increased risk of suicide excepting mental retardation and dementia. The suicide risk is highest for functional and lowest for organic disorders with substance misuse disorders lying between. However, within these broad groupings the suicide risk varies widely.
... An important feature of BDNF is its ability to cross the blood-brain barrier; therefore, serum and cerebrospinal fluid levels are strongly correlated with brain levels (Gururajan et al., 2014;Harris & Barraclough, 1997;St Laurent et al., 2013). It is relevant to consider that an estrogen response element (ERE) is present in the BDNF gene, so estrogens increase the expression of this neurotrophic factor (Singh et al., 1995;Sohrabji et al., 1995), making its expression sex-dependent. ...
... In the adult brain, BDNF fulfils certain functions such as regulating neuronal integrity, promoting brain plasticity, modulating synthesis, metabolism and release of neurotransmitters, and intervening in neuroplasticity processes (Crump et al., 2014). Importantly, BDNF crosses the blood-brain barrier and serum levels correlate strongly with brain levels (Harris & Barraclough, 1997). Serum BDNF levels have been shown to increase after three months on a reduced-calorie diet (Araya et al., 2008) but it is not known what happens in the face of chronic iron deficiency, a situation experienced by a large proportion of the population mainly in developing countries. ...
Iron deficiency is a public health problem that greatly impacts women and children, especially at the neurological level, being BDNF a relevant factor involved in such pathogeny. Objectives: To determine in females suffering from chronic iron deficiency, from the perinatal stage to adulthood, the levels of peripheral BDNF in blood. In addition, the effect of iron supplementation after weaning. Methodology: female Wistar rats with chronic iron deficiency and rats supplemented from weaning to adulthood (70 postnatal days) were euthanized to analyze BDNF levels in blood samples. Contribution: we demonstrate that in the presence of chronic iron deficiency, BDNF levels decrease peripherally and supplementation normalizes them. In addition, hemoglobin-bound iron (Fe-Hb) levels correlate positively with BDNF levels in blood. This could indirectly indicate a possible restoration or contribution to the improvement of the patient's cognitive or behavioral processes.
... Suicidality or suicidal behaviour occurs in a spectrum that ranges from the concept or intentions of suicide (ideation), to conversations linked to suicide, suicide attempts and eventually suicide (CDC, 2012). Suicide ideation is a critical part of the suicide process; it precedes suicide attempts and completed suicides (Harris & Barraclough, 1997). It is essential to identify this early step in the suicide process, so as to stop its progression into suicide plan or attempt (Arria, et. ...
... It is essential to identify this early step in the suicide process, so as to stop its progression into suicide plan or attempt (Arria, et. al., 2011;Harris & Barraclough, 1997). Thus, suicide ideation plays an important role in detecting and preventing suicidal behaviour (Palmer, 2004). ...
Purpose: The purpose of the study was to find out the prevalence of suicide ideation among undergraduate students of the University of Cape Coast and the gender distribution of suicide ideation among them. Methodology: This study was a quantitative one and it used the quasi-experimental research design, specifically, the pre-test, post-test and control group design. A total of 30 undergraduate students from four colleges of the University of Cape Coast in the Central Region of Ghana was non-randomly assigned to two treatment groups, Individual Psychology and Cognitive Behavioural Therapy (IP and CBT) and one control group. Beck Scale for Suicide Ideation was used for the collection of data for the study. Descriptive Statistics such as frequencies and percentages were used to analyse the data. Findings: Results showed that two out of every 15 UCC undergraduate students experience suicide ideation continuously and persistently. Again, the rate at which female students think suicidal, that is, have suicidal ideas, is higher than the male students. In other words, female undergraduate students of University of Cape Coast experience suicide ideation more than their male counterparts. It was concluded that suicide ideation is prevalent, 13.3%, among undergraduate students of UCC. Unique Contribution to Theory, Policy and Practice: Based on the findings, it was recommended that constant screening of suicide ideation be made part of the University’s program and the Counselling Centre should be mandated to organise the screening exercise. This will help educate and create more awareness on suicide ideation and offer more people, per the screening, the opportunity to benefit from the therapies.
... Prison inmates are recognized as a population with a high burden of disease from a wide range of physical and mental health problems e.g., [1]. Studies underlined that mental disorder and substance abuse, but also criminal behavior, are independently associated with an increased risk of premature death [2][3][4], specifically suicide [5]. ...
... These data do not depend on the environment, since it is statistically relevant even if twins are separated at birth [53]. Empirical data on homicide and homicide offenders underlined that criminal behavior, mental disorder and substance abuse are independently related to an increased risk of premature death, in particular by suicide [3,5,54]. The evaluation of suicides' risk in prison related to homicide behavior is a neglected research area, because it is difficult to assess the risk factors of suicide relative to homicide. ...
Homicide-suicide can be defined as homicide followed by the suicide of the perpetrator shortly afterward. In the so-called “homicide-delayed suicide”, homicide and suicide occur but within a wide and not strictly defined timeframe. This study analyzes data concerning the suicide of 667 inmates in Italy between 2002 and 2015, considering homicide perpetrators compared to all offenders. The analyses revealed that inmates who had committed homicide were more likely to commit suicide (71% versus 45%; χ2 = 10.952, p = 0.001) and the odds of suicide increase concerning 1.58 times among homicide perpetrators. The time-to-suicide interval after homicide ranges between 0 to 9.125 days (mean = 1.687,9; SD = 2.303,1). Moreover, the intimate-homicide offenders who committed suicide had a significantly shorter survival time after the offense than did the other non-intimate offenders who died by suicide (t test, t = −3.56, df = 90, p = 0.001). The link between homicide and higher suicide risk in homicide perpetrators should be highlighted because of all the homicide offenders passing through the criminal justice system. Superior knowledge about the path of homicide-delayed suicide will be of particular use to professionals in evaluating and treating homicide inmates.
... In accordance with the extensive literature available (36)(37)(38), effectiveness of antipsychotics and mood stabilizers for relapse prevention in patients with schizophrenic and bipolar disorder was confirmed in our study. Finally, consistently with both the UK (NICE) and Australian guidelines, we confirmed that pharmacotherapy does not seem to be effective in preventing relapses in the course of personality disorders (39,40). ...
... guidelines recommending psychotherapy as primary, or core, treatment for this group of disorders (39,40). ...
OBJECTIVES: To measure the gap between contact and effective coverage of mental healthcare (MHC).
MATERIALS & METHODS: 45,761 newly referred cases of depression, schizophrenia, bipolar disorder, and personality disorder from four Italian regions were included. A variant of the self-controlled case series method was adopted to estimate the incidence rate ratio (IRR) for the relationship between exposure (i.e., use of different types of MHC such as pharmacotherapy, generic contact with the outpatient services, psychosocial intervention, and psychotherapy) and relapse (emergency hospital admissions for mental illness).
RESULTS: 11,500 relapses occurred. Relapse risk was reduced during periods covered by (i) psychotherapy for patients with depression (IRR 0.67; 95% CI: 0.49 to 0.91) and bipolar disorder (0.64; 0.29 to 0.99); (ii) psychosocial interventions for those with depression (0.74; 0.56 to 0.98), schizophrenia (0.83; 0.68 to 0.99), and bipolar disorder (0.55; 0.36 to 0.84), (iii) pharmacotherapy for patients with schizophrenia (0.58; 0.49 to 0.69), and bipolar disorder (0.59; 0.44 to 0.78). Coverage with generic care, in absence of psychosocial/psychotherapeutic interventions, did not affect risk of relapse.
CONCLUSION: This study ascertained the gap between contact and effective coverage of MHC and showed that administrative data can usefully contribute to assess the effectiveness of a mental health system.
... Most suicides occur in individuals with mental illness, and almost all psychiatric disorders are associated with increased suicide-mortality (Cho et al., 2016;Harris and Barraclough, 1997;Yeh et al., 2019). Individuals with mental illness who have been discharged from psychiatric hospitals may be at greater risk for suicide than other mentally ill persons (Chung et al., 2017;Haglund et al., 2019;Honkonen et al., 2008;Isometsa et al., 1993;Madsen et al., 2020;Madsen and Nordentoft, 2013;Nordentoft et al., 2016;Prestmo et al., 2020). ...
... Although age, sex, gender, poverty, and in Canada, Indigenous status, have been identified as risk factors for suicide (World Health Organization, 2021; Public Health Agency of Canada, 2021), mental disorders have also been identified as a key factors (Harris and Barraclough, 1997). There are complex connections between demographic, biological, psychological, environmental factors, and suicide. ...
Introduction:
Worldwide, approximately 1900 people die by suicide daily. Daily elevations in air pollution and temperature have previously been linked to a higher risk of death from suicide. To date, there have been relatively few studies of air pollution, particularly at national levels. National analyses can play an important role in shaping health policy to mitigate against adverse health outcomes.
Methods:
We used a time-stratified case-crossover study design to investigate the influence of short-term (i.e., day to day) interquartile range (IQR) increases in air pollutants (nitrogen dioxide [NO2], ozone [O3], and fine particulate matter [PM2.5]) and temperature on suicide deaths in Canada between 2002 and 2015. For air pollution models, odds ratios (ORs) derived from conditional logistic regression models were adjusted for average daily temperature, and holidays. For temperature models, ORs were adjusted for holidays. Stratified analyses were undertaken by suicide type (non-violent and violent), sex, age, and season.
Results:
Analyses are based on 50,800 suicide deaths. Overall, temperature effects were stronger than those for air pollution. A same day IQR increase in temperature (9.6 °C) was associated with a 10.1% increase (95% confidence interval (CI): 9.0%-11.2%) of death from suicide. For 3-day average increase of O3 (IQR = 14.1 ppb), PM2.5 (IQR = 5.6 μg/m3) and NO2 (IQR = 9.7 ppb) the corresponding risks were 4.7 (95% CI: 3.9, 5.6), 3.4% (95% CI: 3.0, 3.8), and 2.0% (95% CI: 1.1, 2.8), respectively. All pollutants showed stronger associations with suicide during the warmer season (April-September). Stratified analyses revealed stronger associations for both temperature and air pollution in women.
Conclusions:
Daily increases in air pollution and temperature were found to increase the risk of death from suicide. Females, particularly during warmer season, were most vulnerable to these exposures. Policy decisions related to air pollution and climate change should consider effects on mental health.
... The use of PASs is one of the most important risk factors for suicide, as it is often related to predisposing and precipitating factors of suicide attempt, such as mental disorders. Reviews of cohort studies [12,13] have shown that substance use is strongly associated with suicide. Indeed, substance use disorders and mood disorders are the most prevalent categories of mental disorders among fatal suicide attempt, as documented by more than 20 major psychological autopsy projects [14,15]. ...
Background: Psychoactive substances (PASs) are an important risk factor for the suicide. This study investigated the sociodemographic characteristics, the methods employed, the circumstances of the events, and the use of PASs in all suicides that occurred between 2005-2014 in the Brazilian Federal District, besides to compare cases with positive and negative detection for PASs in the post-mortem analysis.
Methods: A population-based, observational, cross-sectional study with an analytical aspect was conducted with suicides cases collected from local police, which toxicological examination was performed (headspace gas chromatographic-mass spectrometry-HS-GC/MS) for detection of ethanol and methanol in blood samples; immunoassay for other substances (cocaine, marijuana, benzodiazepines, etc.).
Results: The results showed that the increase in the suicide rate was 10x greater than the population growth and 44% of the individuals used PASs before suicide. Individuals are more likely to die by suicide at home, to be male, to have tried before and to change their behaviour days before death; they chose hanging as the method and are under the influence of alcohol.
Conclusion: Identifying what sociodemographic characteristics are associated with a fatal suicide attempt among individuals who use PASs and those who do not use, as well as among those who have/not have mental disorders and what methods are employed, could be a path to better interventions. Thus, prevention actions could be planned and directed to individuals with greater risk.
... Approximately 90% of suicide cases are attributed to at least one mental disorder, and depression is listed in most of these cases [69,70]. Similarly, an increase in the cumulative number of ACEs causes a 1.264 increase in the likelihood of developing suicidal ideation. ...
Background:
Adverse childhood experiences (ACEs) among university students have been linked to a variety of factors and have been shown to have a dose-response relationship with adult health and behavior.
Objective:
To investigate the effect of exposure to ACEs on academic performance, depression, and suicidal ideations among university students.
Methods:
A cross-sectional survey among university students at a public university in southwestern Uganda was conducted in 2021, integrating the Adverse Childhood Experiences International Questionnaire for assessing ACEs, the Patient Health Questionnaire for assessing depression symptoms and suicidal ideations, and questions assessing the family structure and academic performance as adopted from similar studies. Regression analysis was performed, and 3 models were generated to answer the study hypotheses.
Results:
A total of 653 undergraduate university students with a mean age of 22.80 (± 3.16) years were recruited. Almost all students (99.8%) experienced one or more ACEs, with physical abuse being the common ACE reported. The average depression symptom severity was statistically higher among individuals who experienced any form of ACEs. No relationship was observed between the ACEs experienced and self-rated academic performance. Similarly, on regression analysis, the cumulative number of ACEs was not associated with self-rated academic performance (β = - 0.007; 95% CI - 0.031 to 0.016; p = 0.558). However, the cumulative number of ACEs was positively associated with depression symptom severity (β = 0.684; 95% CI 0.531-0.837; p < 0.001), as well as increased the likelihood of suicidal ideations (aOR = 1.264; 95% CI 01.090-1.465; p < 0.001).
Conclusions:
The burden of ACEs is exceedingly high among Ugandan university students, highlighting the urgency in strengthening effective child protection strategies to protect Uganda's rapidly growing population from mental ill-health and avoid future psychological disability, a burden to the healthcare system. The study's findings will also be useful to practitioners/policymakers working to prevent/limit child maltreatment globally.
... According to a study by Nascimento et al. (2019), increased suicide risk is associated with a family history of suicide, substance use, mood disorders, or eating disorders, with eating disorders having the strongest association with suicide risk of these factors (Nascimento et al., 2019). A meta-analysis by Harris and Barraclough (1994) suggested that eating disorders may present the highest suicide risk out of all psychiatric disorders. Although mortality rates, including death from suicide, tend to be highest in patients with anorexia nervosa, bulimia nervosa and binge eating are often associated with high suicide rates as well (Franko et al., 2004; Page 6 of 27 Crow et al., 2009). ...
Keywords: Sexual Assault, Binge Eating, Treatment, Gender
Though a relationship between sexual assault and suicidal thinking is established, fewer studies explore complex coping mechanisms for these college student treatment issues. We hypothesized a relationship between sexual assault and suicide ideation mediated by binge eating, and that treatment for recent sexual assault would also result in greater change in eating concerns and suicidal thoughts. An eating concerns subscale and an item assessing suicidal thoughts from the Collegiate Center for Mental Health (CCMH) 2018-2019 data set were completed during treatment (n=53,016). Results supported the hypotheses, revealing eating concerns as a significant partial mediator. Moreover, recent sexual assault survivors, particularly men, experienced greater changes during treatment than clients with other presenting concerns. Findings suggest problematic coping strategies that may increase likelihood of suicidal thinking following sexual assault. Practitioners should monitor students' eating concerns and emphasize emotional regulation strategies to reduce suicidality. Limitations of correlational methodology and small effect sizes are also discussed.
... A 4.46-and 5.77-times more elevated risk of lifetime suicide plan and attempt, respectively, were found among the participants with chronic medical conditions, whereas the risk appears 11.64 and 17.41 times higher for past-year suicidal ideation and suicide plan, respectively. Moreover, it has been said that about 90% of suicide deaths occur due to mental health-related issues, whereas depression and mood disorders are reported as the main culprit of suicide [30,31]. In this study, all the assessed mental health problems were not the risk factors for suicidal behaviors across three different times. ...
Background
Suicide is considered as one of the major public health concerns, which can be prevented with cost-effective and timely intervention. In Bangladesh, very few studies assessed the suicidal behavior of rural community people. Thus, this Bangladesh Community Mental Health Study ( BD ComMen Study ) attempted to understand the current situation of suicidality in Bangladeshi rural community people considering three-time frames: lifetime, past year, and past month.
Methods
A cross-sectional study was conducted in a rural community in Bangladesh between May 17 and 31, 2022, using a cluster sampling technique. Information on socio-demographics, COVID-19-related factors, depression, anxiety, insomnia, and suicidal behaviors was collected. The Chi-square test or Fisher’s exact test and logistic regression were used to analyze the data.
Results
During their lifetime, 33.1% of the rural community people had suicidal thoughts, whereas 5.5% made a plan for suicide and 1.8% attempted suicide. The prevalence of past-year suicidal ideation was 3.9%, whereas 1.4% had a suicide plan. In addition, 0.6% had past-month suicidal thoughts, although none of them had planned or attempted suicide. The factors associated with suicidal behaviors included males, lower age, lower educational grade, low-earning jobs, living in a government-provided house, family history of mental health and suicide, and suffering from anxiety and insomnia.
Conclusions
Suicidal behaviors among the rural community people are of great concern as most of the rural people in Bangladesh do not have enough mental health literacy for treatment-seeking due to a high level of mental health-related stigma. Thus, this study would likely help to initiate further studies and stimulate suicide prevention programs, because most suicide can be prevented.
... Mazure, 1998), elles susciteraient chez l'individu la détresse et le désespoir qui conduiraient à l'émergence des IS. À ce titre, les troubles psychiatriques, qui figurent parmi les prédicteurs les plus forts des conduites suicidaires (Harris & Barraclough, 1997;Walker et al., 2015) seraient à ranger selon Turecki & Brent parmi les facteurs précipitants. Il en serait de même pour les troubles et traits pathologiques de personnalité ainsi que pour les troubles liés à l'usage des substance qui contribueraient, par la dimension de levée d'inhibition qu'ils impliquent, à déclencher les passages à l'acte suicidaire. ...
Le tribut que l’adolescence paye aux conduites suicidaires est considérable : un jeune sur dix dit avoir pensé à mourir au cours de l’année, et un autre rapporte avoir déjà attenté à sa vie. Pour comprendre le rôle central que joue l’adversité dans l’émergence de ces conduites, l’approche épidémiologique traditionnelle semble atteindre ses limites. À travers la notion de trajectoire de vie, les modèles développementaux ont ouvert la voie à une compréhension plus dynamique et intégrée du processus suicidaire. Les formalisations les plus récentes conçoivent les individus comme des systèmes autorégulés, s’adaptant à l’adversité environnementale par des mécanismes allostatiques de retour à l’homéostasie. Ces modèles prédisent qu’un pic de plasticité allostatique constituerait le substrat de la transition maturative adolescente mais impliquerait un surcroît de vulnérabilité au stress.La présente thèse vise à comprendre les implications de cette dualité développementale dans les trajectoires vers le suicide ou la tentative de suicide (TS). Pour ce faire, nous nous sommes attelés à étayer un modèle systémique développemental des conduites suicidaires. Nous avons procédé par recueil narratif exhaustif puis analyse intégrée des expérience de vie adverses (EVA) traversées par des individus suicidants ou suicidés. Les différentes fenêtres temporelles explorées et stratégies analytiques employées ont permis de tester les trois niveaux hiérarchiques du modèle proposé.Au niveau infra-ordonné, nous appréhendons la dynamique d’épuisement à court terme des systèmes allostatiques (SA) dont la TS serait l’issue. Pour ce faire, nous reconstituons les trajectoires de fardeau d’adversité (FA - supposé représenter l’interaction médiée par le stress entre l’individu et son environnement) dans l’année précédant la TS d’adolescents suicidants.Au niveau inter-ordonné, nous avons testé l’hypothèse selon laquelle les trajectoires d’adversité représentent, à l’échelle des années, une interaction bilatérale entre la survenue d’EVA et les modalités de réaction aux stress des individus. Cette interaction a été modélisée par un processus de Hawkes reliant le niveau d’activation allostatique et la probabilité de survenue des EVA. Compte-tenu de performances inférentielle satisfaisantes, les qualités d’ajustement du modèle encouragent à progresser dans le sens d’un affinement computationnel. Par ailleurs, l’identification de trajectoires-types sur la vie entière de personnes suicidées a permis d’étudier l’épuisement des SA sous l’angle d’une altération progressive des paramètres de régulation du stress. Deux patterns évolutifs de FA ont ainsi été identifiés : l’un, correspondant à des sujets se suicidant jeunes, était constamment croissant de la naissance à la mort ; l’autre, correspondant à des sujets se suicidant aux alentours de 40 ans, augmentait dans l’enfance, se stabilisait à l’adolescence, avant d’augmenter à nouveau au jeune âge adulte.Au niveau supra-ordonné, enfin, l’introduction d’un point de cassure à la puberté dans les trajectoires-type de FA modélisées chez les individus suicidés a permis de tester et de caractériser les conséquences de la puberté dans les trajectoires de vie vers le suicide. Améliorant le pouvoir explicatif des modèles statistiques, ce point de cassure confirmait que la puberté opérait une bifurcation entre les deux patterns évolutifs d’adversité identifiés.Nos résultats confortent la validité du modèle systémique développemental des trajectoires suicidaires tout en ouvrant de nouvelles voies empiriques et computationnelles de validation. Ils suggèrent le rôle crucial de la dualité hyperplasticité/hypervulnérabilité pubertaire dans le processus suicidaire. À ce titre, ils plaident pour un renforcement de l’attention portée aux adolescents dans la prévention des conduites suicidaires, ainsi que pour la promotion d’interventions intensives précoces visant à préserver le pronostic des jeunes en souffrance.
... Gambling-related harms such as interpersonal losses and conflicts, including relationship breakdowns, increase the likelihood of a suicide attempt [5]. Research highlights that clients with a history of suicide attempts are at the highest risk of future suicidal behaviour, including death by suicide [6,7]. A study conducted in Melbourne found that approximately 17.6% of people presenting to local crisis or emergency mental health services were also experiencing problem gambling behaviours [8]. ...
The evidence base for internet therapies is building but little is known yet about the acceptability and effectiveness of providing telehealth online in a group format for the treatment of gambling disorders. Therefore, this uncontrolled, real-world study aimed to evaluate the feasibility and effectiveness of providing evidence-based treatment in a group format using an online platform. This innovative approach to treatment of people experiencing gambling harm was developed during the COVID pandemic so that gamblers could access evidence-based treatment from their homes. A closed group treatment program was developed using telehealth, enabling gamblers to come together weekly to engage in a treatment program based on behavioral therapy using cue exposure. Four online gamblers who met the criteria for Gambling Disorder were recruited from a gambling help service. A case report evaluation methodology was used to gain an in-depth understanding of the effectiveness of this approach to treatment. Treatment was conducted weekly over 12 months. All participants engaged with the program and after completing treatment participants no longer met the criteria for a Gambling Disorder, were abstinent for 12 months post treatment and achieved improved life functioning. This program provides preliminary evidence that providing treatment online in a group setting can be an acceptable and effective model in the delivery of treatment for clients unable to attend face-to-face clinics or preferring telemedicine as an option for treatment delivery. These findings warrant further exploration through a larger randomized controlled study.
... It associates not just with depression but with psychiatric disorders almost across the board (Schechter & Goldblatt, 2020). Although the risk of suicide is elevated with depression, higher risk is reported with bipolar disorder, schizophrenia, and anorexia nervosa (Harris & Barraclough, 1997;Nordentoft, Mortensen, & Pedersen, 2011), and suicidal behavior is a supportive criterion for other diagnoses, such as posttraumatic stress disorder and personality disorders (American Psychiatric Association, 2013). Depression predicts suicidal outcomes only weakly-no more accurately than do hundreds of other risk factors (Franklin et al., 2017)-and most people who take their own lives were not observably depressed (Bertolote, Fleischmann, De Leo, & Wasserman, 2004). ...
We offer a commentary on Gaffney, Adams, Syme, and Hagen (2022; Depression and suicidality as evolved credible signals of need in social conflicts. Evolution and Human Behavior, 43, 242–256). Gaffney et al. argue that suicidality and other depressive behaviors evolved as mechanisms by which otherwise powerless individuals obtain concessions from others, and these authors present experimental data to support their argument. While applauding their goals and their study’s strengths, we present reservations and counter-arguments: that the target behaviors to be explained are inadequately defined; that there is insufficient evidence of ancestral fitness benefits arising from them; and that both depression and suicidality lack the evidence of special design required to support an adaptationist explanation. In the light of anomalies noted in Gaffney et al.’s “signaling” stance, we
propose a new theoretical project—toward a comprehensive theory of human mental health and wellbeing.
... solidão causada pelo isolamento social se torna um fator de risco de suicídio(Brådvik, et al., 2008;Costa et al., 2015; DSM-5, 2013;Harris & Barraclough, 1997; Ministério da Saúde, 2021;SHER, 2020).Nesse sentido, devido a importância na prevenção do comportamento suicida e do lítio ser a primeira escolha para esses pacientes, este trabalho tem como objetivo principal realizar uma revisão integrativa da literatura sobre a eficácia do lítio na prevenção do risco de suicídio em pacientes com transtornos do humor. Secundariamente, propõe-se comparar o lítio com outras medicações, como o valproato e a carbamazepina.2. ...
Background: Mood disorders refer to those whose main symptom is a change in mood or affect, altering animosity and the way of feeling, thinking and behaving. Since the 1970s, a number of primary studies have pointed to lithium's effectiveness in reducing the risk of suicide. Objectives: To carry out an integrative review of the literature on the efficacy of lithium in preventing suicide risk in patients with mood disorders. Methodology: Integrative review, which used the descriptors “lithium”, “prevention” and “suicide” in the LILACS, SciELO and PUBMED databases. Inclusion criteria were articles published in English, of the randomized clinical trial type, between 2000 and 2022, indexed in the chosen databases and available for full reading. The research was carried out according to the PRISMA flowchart for integrative and systematic reviews. Six articles were selected for review. Results and Discussion: Three studies showed that lithium did not reduce suicide attempts in patients with bipolar affective disorder (BD) or major depression. Differences in lithium doses, sociodemographic conditions, type of control group and type of mood disorder may cause the results to be discrepant when compared with each other. Conclusion: Although lithium is used to prevent suicidal behavior in patients with mood disorders, the studies analyzed showed divergent results regarding its effectiveness in this group.
... As stated above it's much more common to attempt suicide than realizing it. According to a meta-analysis study, people who has previous suicide attempts are up to 40 times more likely to commit suicide than those who don't (Harris & Barraclough, 1997). This makes people with previous suicide attempts a risk group compared to the general population. ...
This study aims to investigate Positive Psychotherapy (PPT) perspective on Suicide. Are there significant differences between PPT's core structures of adults with or without suicidal thoughts? Are there significant relationships between suicidal probability and PPT structures of adults with suicidal thoughts? 253 volunteers participated in the study. WIPPF inventory and Suicide Probability Scale were used. We conducted Independent T test and linear multiple regression analysis on SPSS. Results showed PPT structures and suicide ideation, and probability are related on various levels and sub dimensions. These core structures differ between adults with or without suicidal thoughts. PPT structures predicted suicide probability for adults with suicidal thoughts. We elaborated on results based on literature and provided some suggestions.
... People who have tried suicide in the past have a 38 to 100 times higher risk of doing so again than the general population [5][6][7]. Researchers also concur that depression and suicidal behaviors are closely associated [8]. Despite the lack of consensus in this area, some investigations discovered that the only trajectory that can predict suicide attempts with the highest mean scores and greatest temporal variability is the depressive symptom trajectory [9]. ...
Background:
Depression increases the risk of suicide. Depression and suicide attempts are significantly impacted by low self-esteem and interpersonal needs (i.e., thwarted belongingness (TB) and perceived burdensomeness (PB)). More research is required to clarify how these factors affected the change from depression to suicidal attempts, which would dramatically lower the suicide fatality rate. We sought to examine the mediating roles of self-esteem, TB, and PB in Chinese young adults, since previous research shows that self-esteem has a strong relationship with TB, while TB and PB have strong relationships with suicide attempts.
Methods:
Measures on depression, interpersonal needs, and attempted suicide were completed by a sample of 247 Chinese social media users who had stated suicidal ideation online.
Results:
The findings showed that people who attempted suicide had significantly higher levels of TB and PB. Suicidal attempts were also impacted by depression via the mediational chains, which included self-esteem, TB, and PB.
Conclusions:
Our findings might contribute to the expansion of the interpersonal theory of suicide and have an impact on effective suicide prevention.
Background:
Currently, there is no comprehensive study focused on identifying what is needed to support ongoing participation within the suicide prevention lived experience workforce (LEW). It is unclear what specific factors may impede or support ongoing participation in the LEW. The aim of this study was to explore the experiences of suicide prevention LEW in terms of its sustainability.
Method:
A qualitative interview method was utilised, with a purposive sample of participants who had engaged in the LEW for at least 12 months. The sample comprised 13 individuals (nine females, four males) who engaged in multiple LEW roles, with over half (54%) working in the LEW for more than 5 years. Data were analysed using thematic analysis.
Results:
Five main themes were identified: support, passion, personal impact, training, and work diversity. Each theme offers perspectives about the challenges participants face within the suicide prevention LEW.
Conclusion:
Challenges faced are both similar to those found in the broader MH sector and unique to suicide prevention. Findings suggest that managing expectations of the LEW is important and can inform the creation of guidelines for a supported and sustainable suicide prevention LEW.
Die Lebenszeitprävalenz der Erkrankung Depression beträgt 16-20 %, infolgedessen ist die Auswirkung auf die Gesellschaft, Ökonomie sowie auf das Individuum selbst enorm. Der Pathomechanismus und die Pathophysiologie sind dennoch nicht vollständig aufgeklärt. Vorangegangene Forschungsarbeiten haben gezeigt, dass die Aktivität der sauren Sphingomy-elinase (ASM) bei Patienten mit Depressionen charakteristisch erhöht ist. Interessanterweise hemmen Antidepressiva vom Typ FIASMA (functional inhibitors of ASM activity) die ASM in ihrer Aktivität durch indirekte proteolytische Inaktivierung im Lysosom. Die ASM katalysiert physiologisch die Hydrolyse von Sphingomyelin zu Ceramid und Phos-phorylcholin. Ceramid und dessen Umbauprodukte wirken als lipid messenger im Zusammen-hang mit apoptotischen, proliferativen und differenzierenden Zellprozessen und beeinflussen die Zusammensetzung der humanen Biomembran. Auch der Transkriptionsfaktor CREB (cAMP respons element binding protein) ist in die Pa-thophysiologie von Depressionen involviert. CREB steht als Zielmolekül zahlreicher Signal-kaskaden im Zusammenhang mit der neuronalen Entwicklung, Plastizität und Protektion. Bei Depressionen sind die Fehlregulation von CREB sowie ein Mangel des durch CREB regulier-ten neuronalen Wachstumsfaktors BDNF (brain derived neurotrophic factor) charakteristisch. In dieser Forschungsarbeit wird untersucht, ob veränderte Aktivität der sauren Sphingomyeli-nase die Aktivität des Transkriptionsfaktors CREB beeinflusst. Als biologisches Modell dienten neuronale H4- und MCF-7-Zelllinien. Die Zellen wurden mit Antidepressiva vom Typ FIASMA und mit Venlafaxin für 26,5 Stunden stimuliert. Zusätzlich erfolgten Modulationen der Aktivität der ASM durch Überexpression, eine inaktive ASM-Mutante und genetischem ASM-Knockout in MCF-7-Zellen. Im weiteren Verlauf wurde das pCRE-Luc Plasmid transfiziert, um die spätere Lumineszenzdetektion als Indikator für die Aktivität von CREB nach Zelllyse zu ermöglichen. Die Messung der Aktivität der sauren Sphingomyelinase geschah über Dünnschichtchromatographie. Im H4-Zellkulturmodell konnten FIASMAs die Aktivität der sauren Sphingomyelinase und die Aktivität von CREB deutlich verringern (Abbildung 11, Abbildung 12). Venlafaxin wird nicht den FIASMAs zugeordnet und zeigte keinen signifikanten Einfluss auf die Aktivität der sauren Sphingomyelinase und auf CREB. Zusätzlich konnte mittels chronischer Stimulation mit Fluoxetin ein reiner Kurzzeiteffekt ausgeschlossen werde (Abbildung 13, Abbildung 14). Im MCF-7-Zellkulturmodel wurde keine signifikante Beeinflussung der Aktivität von CREB durch FIASMAs oder ASM-Knockout bei signifikanter Inhibition der ASM-Aktivität festge-stellt (Abbildung 15, Abbildung 16, Abbildung 17, Abbildung 18). Jedoch verringert sich die Aktivität von CREB bei Steigerung der Aktivität der ASM bei Überexpression (Abbildung 19, Abbildung 20). Das ASM/Ceramid-System moduliert die Aktivität des Transkriptionsfaktors CREB zelltyp-abhängig. In neuronalen H4-Zellen ist der beschriebene Effekt signifikant und Antidepressiva vom Typ FIASMA verändern möglicherweise auch in vivo in humanem neuronalem Gewebe die Aktivität von CREB mit den entsprechenden neurophysiologischen Konsequenzen. Zusätzlich könnte die gesteigerte Aktivität der sauren Sphingomyelinase bei Depressionen, über CREB als Bindeglied, die neuronale Entwicklung, Plastizität und Protektion beeinflus-sen. Die Beeinflussung von CREB über das ASM/Ceramid-System könnte folglich als integra-ler und als einer von vielen sich bidirektional beeinflussenden Pathomechanismen von Depres-sionen angesehen werden und hypothetisch als Ansatzpunkt im Rahmen von zielgerichteter antidepressiver Therapie fungieren.
Though a relationship between sexual assault and suicidal thinking is established, fewer studies explore complex coping mechanisms for these college student treatment issues. We hypothesized that the relationship between sexual assault and suicide ideation was mediated by binge eating concerns and that treatment for recent sexual assault would also result in greater change in eating concerns and suicidal thoughts. An eating concerns subscale and an item assessing suicidal thoughts from the Collegiate Center for Mental Health (CCMH) 2018–2019 data set were completed during treatment (n = 53,016). Results supported the hypotheses, revealing eating concerns as a significant partial mediator. Moreover, recent sexual assault survivors, particularly men, experienced greater changes during treatment than clients with other presenting concerns. Findings suggest problematic coping strategies that may increase the likelihood of suicidal thinking following sexual assault. Practitioners should monitor students’ eating concerns and emphasize emotional regulation strategies to reduce suicidality. Limitations of correlational methodology and small effect sizes are also discussed.
In der Suizidprävention verstehen wir den Suizidwunsch, also den Wunsch das eigene Leben, die eigene Existenz vorzeitig zu beenden, als Ausdruck innerer seelischer Not. Er entspricht der Verzweiflung, die entsteht, wenn ein Mensch mit äußeren Belastungen, schwer erträglichen Gefühlen, erlebten Bedrohungen u. a. m. konfrontiert ist und keine ausreichende Alternative zu dieser Situation sehen kann. Das Erleben des Nichtaushalten-Könnens, von Ausweglosigkeit, Ohnmacht und Hilflosigkeit sind charakteristisch dafür.
Objective:
Suicide and suicidal behaviors are reported to be common in patients with Tuberculosis (TB). This systematic review and meta-analysis aimed to quantitively assess the prevalence of suicidality and identify the factors associated with suicidality in patients with TB.
Methods:
We searched databases PubMed, SCOPUS, Web of Science, PsycINFO, and Google Scholar for studies that reported the prevalence of suicide, suicidal ideations, or suicide attempts in patients with TB. We assessed the quality of studies with the Newcastle Ottawa scale. Random-effects models were used to calculate the pooled prevalence with 95% confidence intervals (CI).
Results:
Nine studies (8770 participants) were included. Pooled prevalence for current suicidal ideations within the last year was 8.5% [95% CI: 5.8%12.3%]. Pooled prevalence for current suicidal attempts within the last year was 3.1% [2.2%- 4.5%]. Suicide was reported in 0.92% of TB patients at the end of 2 years, whereas 2.2% to 8.4% of all TB deaths were reported due to suicide. Factors associated with suicidality were female gender, TB retreatment, comorbid HIV, presence of another chronic medical illness, psychological distress, and comorbid psychiatric illnesses.
Conclusion:
The prevalence rates of suicidal ideation and attempts were higher in patients with TB than in the general population. Integrating mental health services with TB programs will help develop interventions for high-risk individuals. Prospero registration number: CRD42021281849.
Implementation of suicide risk screening may improve prevention and facilitate mental health treatment. This study analyzed implementation of universal general population screening using the Columbia-Suicide Severity Rating Scale (C-SSRS) within hospitals. The study included adults seen at 23 hospitals from 7/1/2019-12/31/2020. We describe rates of screening, suicide risk, and documented subsequent psychiatric care (i.e., transfer/discharge to psychiatric acute care, or referral/consultation with system-affiliated behavioral health providers). Patients with suicide risk (including those with Major Depressive Disorder [MDD]) were compared to those without using Wilcoxon rank-sum -tests for continuous variables and χ2 tests for categorical variables. Results reported are statistically significant at p < 0.05 level. Among 595,915 patients, 84.5% were screened by C-SSRS with 2.2% of them screening positive (37.6% low risk [i.e., ideation only], and 62.4% moderate or high risk [i.e., with a plan, intent, or suicidal behaviors]). Of individuals with suicide risk, 52.5% had documentation of psychiatric care within 90 days. Individuals with suicide risk (vs. without) were male (48.1% vs 43.0%), Non-Hispanic White (55.0% vs 47.8%), younger (mean age 41.0 [SD: 17.7] vs. 49.8 [SD: 20.4]), housing insecure (12.5% vs 2.6%), with mental health diagnoses (80.3% vs 25.1%), including MDD (41.3% vs 6.7%). Universal screening identified 2.2% of screened adults with suicide risk; 62.4% expressed a plan, intent or suicidal behaviors, and 80.3% had mental health diagnoses. Documented subsequent psychiatric care likely underestimates true rates due to care fragmentation. These findings reinforce the need for screening, and research on whether screening leads to improved care and fewer suicides.
INTRODUCTION-Major depressive disorder (MDD) is a serious affliction that affects people of all
genders, ages, and backgrounds. Its most prominent symptoms include relatively persistent depressive
mood and a loss of interest that can range from mild to severe. MDD causes hindrance to the routine
activities and subjective well-being of the individuals. In typical Ayurvedic contexts, Sattvavajava
Chikitsa (SC) is well-known Ayurvedic psychotherapy used primarily to treat and manage mental
illnesses and psychosomatic disorders. The present pilot study aims to investigate the therapeutic
effectiveness of SC on patients of MDD.
METHODS- The present parallel-arm randomized controlled study was conducted on MDD patients,
attending Kayachikitsa Manas Chikitsa (Neuropsychiarty and Psycho-Somatic Medicine) O.P.D.,
I.P.D., and Department of Psychiatry O.P.D., S.S. Hospital, I.M.S., B.H.U., Varanasi from October
2021- March 2022. All the patients who were fulfilling the DSM-5’s diagnostic criteria for MDD were
selected following their consent for the proposed study. The patients age ranged from 21 to 60 years.
The registered cases were randomly allocated into two groups. For Group A (N=15), the patients were given Ashwagandha Churna (Withania somnifera powder) 5gm twice a day whereas, for Group B
(N=15), the patients were given SC along with Withania somnifera powder 5gm twice a day. The
primary outcome of depressive symptoms was measured by the Hamilton Depression Rating Scale. The
pre and post treatments status were assessed.
RESULTS- Both groups showed highly significant differences (p<0.005) when compared to the initial
and third follow-ups. The intergroup comparison was also found to be significant at the third follow-up
(p<0.005). In the third follow-up patienst with normal range of the HDRS were higher in group B (80%)
as compared to group A (33%). The combination of SC with Withania somnifera powder exhibited a
better & clinically significant reduction in the severity of MDD as compared to the effects shown by
Withania somnifera powder alone.
Background:
Suicide is a crucial concern for public health in the world. To date, there is no synthesized evidence about the cross-country impact of suicide risk factors in the Eastern Mediterranean (EMRO). This paper aims to cover the gap and assess socio-economic, health, and environmental (SHE) factors influencing suicide rates among the EMRO countries from 1990 to 2019.
Methods:
This analysis is a cross-sectional time-series design which uses random-effect panel data from 17 EMRO countries. SHE variables are inflation rate, economic growth, unemployment rate, urbanization, and female labor force participation rate, mental disorders prevalence and individuals using the internet.
Results:
The models indicate that male suicide rates was positively associated with inflation rate (coefficient = 0.002, p < 0.05) unemployment rate (0.06, p < 0.01), mental disorders prevalence (0.0008, p < 0.01), and urbanization (0.08, p < 0.05). Conversely, individuals using the internet (-0.019, p < 0.01) was related to a reduction in male suicide rates. Variables correlated with an increase in female suicide rates included inflation rate (0.001, p < 0.05), mental disorders prevalence (coefficient = 0.0004, p < 0.01) and urbanization (0.03, p < 0.01). Individuals using the internet (-0.006, p < 0.01) and education index (-4.8, p < 0.01) had negative effect on female suicide rates.
Conclusions:
This research confirms that SHE factors appear to affect suicide. So policymakers should endeavor to control them if the nations are aimed at preventing suicides. Future researches are essential to scrutinize paradoxes in the field.
Aim:
Bipolar disorder (BD) is a mood disorder with a high morbidity and death rate. Lithium (Li), a prominent mood stabilizer, is often used as a first-line treatment. However, clinical studies have shown that Li is fully effective in roughly 30% of BD patients. Our goal in this study was to use features derived from information theory to improve the prediction of the patient's response to Li as well as develop a diagnostic algorithm for the disorder.
Methods:
We have performed electrophysiological recordings in patient-derived dentate gyrus (DG) granule neurons (from a total of 9 subjects) for three groups: 3 control individuals, 3 BD patients who respond to Li treatment (LR), and 3 BD patients who do not respond to Li treatment (NR). The recordings were analyzed by the statistical tools of modern information theory. We used a Support Vector Machine (SVM) and Random forest (RF) classifiers with the basic electrophysiological features with additional information theory features.
Results:
Information theory features provided further knowledge about the distribution of the electrophysiological entities and the interactions between the different features, which improved classification schemes. These newly added features significantly improved our ability to distinguish the BD patients from the control individuals (an improvement from 60% to 74% accuracy) and LR from NR patients (an improvement from 81% to 99% accuracy).
Conclusion:
The addition of Information theory-derived features provides further knowledge about the distribution of the parameters and their interactions, thus significantly improving the ability to discriminate and predict the LRs from the NRs and the patients from the controls.
Objective
In this study, it was aimed to research the connection between psychological resilience, alexithymia, depression, anxiety and impulsivity in patients who attempted suicide with drugs.
Methods
The patient group ( n = 66) who attempted suicide with drugs and the control group ( n = 66) without any psychiatric diagnosis were examined in the study. Sociodemographic data form, Psychological Resilience Scale, Toronto Alexithymia Scale (TAS-20), Beck Depression Inventory, Beck Anxiety Inventory, Barratt Impulsivity Scale (BIS-11) were used in the study.
Results
It was found that PRS dedication and challenge are significantly higher in the control group ( p = .039 and p = .003, respectively). When the undiagnosed group who attempted suicide were compared with the control group, it was observed that there is a significant difference between BIS-11 total and TAS total after bonferonni correction (respectively; p = .002; p = .001), while, there is no statistically significant difference in terms of PRS total score ( p = .483)
Conclusion
It was observed that patients who attempted suicide with drugs had low levels of psychological resilience, high alexithymia levels. In the absence of an additional diagnosis of depression, psychological resilience did not differ in terms of suicide attempts. In the suicide group, those who did not receive any additional diagnosis were not more impulsive than those who were depressed.
Bipolar disorder (BD) is a highly heritable mood disorder with intermittent episodes of mania and depression. Lithium is the first-in-line medication to treat BD, but it is only effective in a subset of individuals. Large-scale human genomic studies have repeatedly linked the ANK3 gene (encoding ankyrin-G, AnkG) to BD. Ank3 knockout mouse models mimic BD behavioral features and respond positively to lithium treatment. We investigated cellular phenotypes associated with BD, including dendritic arborization of pyramidal neurons and spine morphology in two models: (1) a conditional knockout mouse model which disrupts Ank3 expression in adult forebrain pyramidal neurons, and (2) an AnkG knockdown model in cortical neuron cultures. We observed a decrease in dendrite complexity and a reduction of dendritic spine number in both models, reminiscent of reports in BD. We showed that lithium treatment corrected dendrite and spine deficits in vitro and in vivo. We targeted two signaling pathways known to be affected by lithium using a highly selective GSK3β inhibitor (CHIR99021) and an adenylate cyclase activator (forskolin). In our cortical neuron culture model, CHIR99021 rescues the spine morphology defects caused by AnkG knockdown, whereas forskolin rescued the dendrite complexity deficit. Interestingly, a synergistic action of both drugs was required to rescue dendrite and spine density defects in AnkG knockdown neurons. Altogether, our results suggest that dendritic abnormalities observed in loss of function ANK3 variants and BD patients may be rescued by lithium treatment. Additionally, drugs selectively targeting GSK3β and cAMP pathways could be beneficial in BD.
Suicidality in obsessive compulsive disorder (OCD) is underestimated, and it is important for clinicians to understand the factors that contribute to suicidal ideation. The present study aimed to estimate a network of the core clinical symptoms of OCD including obsessions, compulsions, and obsessive-compulsive (OC) symptom dimensions, depressive symptoms, and psychological traits, and to examine which symptoms contribute to suicidal ideation in patients with a primary diagnosis of obsessive-compulsive disorder.
Methods:
A total of 444 patients with OCD were assessed with the Yale-Brown Obsessive Compulsive Scale, the Montgomery-Asberg Depression Rating Scale, and various other measures. Network analysis was conducted to estimate the network of obsessive-compulsive and depressive symptoms, psychological traits including alexithymia and impulsivity, and demographic covariates. Symptoms directly related to suicidal ideation in the network were examined for their relative contribution to suicidal ideation.
Results:
Suicidal ideation was directly related to degree of control over compulsive behaviors, distress associated with compulsive behaviors, time spent performing compulsive behaviors, and unacceptable thoughts, along with depressive symptoms and alexithymia. In the network of OC and depressive symptoms, the most central symptoms among the former were interference due to compulsive behaviors and interference due to obsessive thoughts, and among the latter were pessimistic thoughts and reported sadness.
Conclusion:
The findings suggest that along with depressive symptoms and alexithymia, compulsions and unacceptable thoughts dimension may contribute to suicidality, and thus, should be carefully monitored in patients with OCD. This article is protected by copyright. All rights reserved.
This is a major international textbook for psychiatrists and other professionals working in the field of mental healthcare. With contributions from opinion-leaders from around the globe, this book will appeal to those in training as well as to those further along the career path seeking a comprehensive and up-to-date overview of effective clinical practice backed by research evidence. The book is divided into cohesive sections moving from coverage of the tools and skills of the trade, through descriptions of the major psychiatric disorders and on to consider special topics and issues surrounding service organization. The final important section provides a comprehensive review of treatments covering all of the major modalities. Previously established as the Essentials of Postgraduate Psychiatry, this new and completely revised edition is the only book to provide this depth and breadth of coverage in an accessible, yet authoritative manner.
While suicide risk following psychiatric hospitalization has been studied extensively, risk following hospitalization for physical illness is less well understood. We used random forests to examine risk factors for suicide in the year following physical illness hospitalization in Denmark. In this case-cohort study, suicide cases were all individuals who died by suicide within one year of a hospitalization for a physical illness (n = 4563) and the comparison subcohort was a 5% random sample of individuals living in Denmark on January 1, 1995 who had a hospitalization for a physical illness between January 1, 1995 and December 31, 2015 (n = 177,664). We used random forests to examine identify the most important predictors of suicide stratified by sex. For women, the top 10 most important variables for random forest prediction were all related to psychiatric diagnoses. For men, many physical health conditions also appeared important to suicide prediction. Among the top 10 variables in the variable importance plot for men were influenza, injuries to the head, nervous system surgeries, and cerebrovascular diseases. Suicide prediction after a physical illness hospitalization requires comprehensive consideration of different and multiple factors for each sex.
Background: Emergency departments (ED) are an important site for screening patients with suicidal behaviors. However, there is insufficient data in low-and middle-income countries regarding the magnitude of suicidal attempts among patients attending EDs. Therefore, the present study aimed to screen suicidal behavior and factors associated with suicide in patients attending an ED of Addis Ababa Burn, Emergency and Trauma Hospital, Ethiopia.
Method: A facility-based quantitative cross-sectional study was conducted between April and June 2018. A total of 398 participants were recruited using a consecutive sampling technique. The collected data collected includes structured questionnaires containing sociodemographic determinants, chronic medical illness conditions, substance use characteristics, social support level, common mental disorders screening, suicidal behaviors assessment and suicidal attempts reason and method
Results: The prevalence of suicidal behavior and suicidal attempts were 8 % and 6.3 %, respectively. Suicide was attempted most frequently in the 18-24 age group. There was no overall difference in sex distribution for suicidal attempts. However, there were sex-based differences when the age group was taken into consideration. The commonest underlying reason for the attempt was social reasons (44 %), while the most frequently reported attempt method was hanging (36 %). No single factor was found to be significantly associated with the suicidal attempt.
Conclusion: Although suicidal behaviors are more common in patients attending the ED than in the general population, these facts have previously been ignored in patient attending EDs. The present findings support the need for a more detailed assessment of suicidal behaviours in patients attending ED.
Recognition of mental state (stress, anxiety, or depression) of a person is an important subject of research to avoid any unfortunate happening. Factors such as the declining economy, fear of the virus, and social alienation have recently affected the spike in depression and anxiety that followed the onset of pandemic. There is mounting evidence that people with mental disorders use social media at a high pace. We therefore explore the prospects of social media in online personas. In this paper, we present a thorough review of various approaches used in literature for detecting depression. It is followed by a discussion on identified gaps and challenges. The presented studies can provide new direction to the researchers who are working in the field of depression detection.
Suicide rates continue to increase globally. The volume of research in this field has also expanded rapidly. In A Concise Guide to Understanding Suicide, leading researchers and clinicians provide a concise review of recent literature, report solutions achieved and give practical guidance for patient care to aid understanding and help prevent suicide. Each chapter is highly focused to provide pertinent information covering all major aspects of the field, from epidemiology and theories of causation through to treatment and prevention. This text will educate practising clinicians (psychologists, psychiatrists, nurses, counsellors, and emergency room personnel) and other health care workers and researchers, as well as providing a pathway for undergraduate and graduate students interested in furthering their understanding of the complexities surrounding suicide. Further, mental health professionals and those in the social sciences will be extremely interested in this monograph, as will the University community, armed forces and interested lay public.
Suicide rates continue to increase globally. The volume of research in this field has also expanded rapidly. In A Concise Guide to Understanding Suicide, leading researchers and clinicians provide a concise review of recent literature, report solutions achieved and give practical guidance for patient care to aid understanding and help prevent suicide. Each chapter is highly focused to provide pertinent information covering all major aspects of the field, from epidemiology and theories of causation through to treatment and prevention. This text will educate practising clinicians (psychologists, psychiatrists, nurses, counsellors, and emergency room personnel) and other health care workers and researchers, as well as providing a pathway for undergraduate and graduate students interested in furthering their understanding of the complexities surrounding suicide. Further, mental health professionals and those in the social sciences will be extremely interested in this monograph, as will the University community, armed forces and interested lay public.
Suicide rates continue to increase globally. The volume of research in this field has also expanded rapidly. In A Concise Guide to Understanding Suicide, leading researchers and clinicians provide a concise review of recent literature, report solutions achieved and give practical guidance for patient care to aid understanding and help prevent suicide. Each chapter is highly focused to provide pertinent information covering all major aspects of the field, from epidemiology and theories of causation through to treatment and prevention. This text will educate practising clinicians (psychologists, psychiatrists, nurses, counsellors, and emergency room personnel) and other health care workers and researchers, as well as providing a pathway for undergraduate and graduate students interested in furthering their understanding of the complexities surrounding suicide. Further, mental health professionals and those in the social sciences will be extremely interested in this monograph, as will the University community, armed forces and interested lay public.
Suicide rates continue to increase globally. The volume of research in this field has also expanded rapidly. In A Concise Guide to Understanding Suicide, leading researchers and clinicians provide a concise review of recent literature, report solutions achieved and give practical guidance for patient care to aid understanding and help prevent suicide. Each chapter is highly focused to provide pertinent information covering all major aspects of the field, from epidemiology and theories of causation through to treatment and prevention. This text will educate practising clinicians (psychologists, psychiatrists, nurses, counsellors, and emergency room personnel) and other health care workers and researchers, as well as providing a pathway for undergraduate and graduate students interested in furthering their understanding of the complexities surrounding suicide. Further, mental health professionals and those in the social sciences will be extremely interested in this monograph, as will the University community, armed forces and interested lay public.
Suicide rates continue to increase globally. The volume of research in this field has also expanded rapidly. In A Concise Guide to Understanding Suicide, leading researchers and clinicians provide a concise review of recent literature, report solutions achieved and give practical guidance for patient care to aid understanding and help prevent suicide. Each chapter is highly focused to provide pertinent information covering all major aspects of the field, from epidemiology and theories of causation through to treatment and prevention. This text will educate practising clinicians (psychologists, psychiatrists, nurses, counsellors, and emergency room personnel) and other health care workers and researchers, as well as providing a pathway for undergraduate and graduate students interested in furthering their understanding of the complexities surrounding suicide. Further, mental health professionals and those in the social sciences will be extremely interested in this monograph, as will the University community, armed forces and interested lay public.
Suicide rates continue to increase globally. The volume of research in this field has also expanded rapidly. In A Concise Guide to Understanding Suicide, leading researchers and clinicians provide a concise review of recent literature, report solutions achieved and give practical guidance for patient care to aid understanding and help prevent suicide. Each chapter is highly focused to provide pertinent information covering all major aspects of the field, from epidemiology and theories of causation through to treatment and prevention. This text will educate practising clinicians (psychologists, psychiatrists, nurses, counsellors, and emergency room personnel) and other health care workers and researchers, as well as providing a pathway for undergraduate and graduate students interested in furthering their understanding of the complexities surrounding suicide. Further, mental health professionals and those in the social sciences will be extremely interested in this monograph, as will the University community, armed forces and interested lay public.
Suicide rates continue to increase globally. The volume of research in this field has also expanded rapidly. In A Concise Guide to Understanding Suicide, leading researchers and clinicians provide a concise review of recent literature, report solutions achieved and give practical guidance for patient care to aid understanding and help prevent suicide. Each chapter is highly focused to provide pertinent information covering all major aspects of the field, from epidemiology and theories of causation through to treatment and prevention. This text will educate practising clinicians (psychologists, psychiatrists, nurses, counsellors, and emergency room personnel) and other health care workers and researchers, as well as providing a pathway for undergraduate and graduate students interested in furthering their understanding of the complexities surrounding suicide. Further, mental health professionals and those in the social sciences will be extremely interested in this monograph, as will the University community, armed forces and interested lay public.
Suicide rates continue to increase globally. The volume of research in this field has also expanded rapidly. In A Concise Guide to Understanding Suicide, leading researchers and clinicians provide a concise review of recent literature, report solutions achieved and give practical guidance for patient care to aid understanding and help prevent suicide. Each chapter is highly focused to provide pertinent information covering all major aspects of the field, from epidemiology and theories of causation through to treatment and prevention. This text will educate practising clinicians (psychologists, psychiatrists, nurses, counsellors, and emergency room personnel) and other health care workers and researchers, as well as providing a pathway for undergraduate and graduate students interested in furthering their understanding of the complexities surrounding suicide. Further, mental health professionals and those in the social sciences will be extremely interested in this monograph, as will the University community, armed forces and interested lay public.
Suicide rates continue to increase globally. The volume of research in this field has also expanded rapidly. In A Concise Guide to Understanding Suicide, leading researchers and clinicians provide a concise review of recent literature, report solutions achieved and give practical guidance for patient care to aid understanding and help prevent suicide. Each chapter is highly focused to provide pertinent information covering all major aspects of the field, from epidemiology and theories of causation through to treatment and prevention. This text will educate practising clinicians (psychologists, psychiatrists, nurses, counsellors, and emergency room personnel) and other health care workers and researchers, as well as providing a pathway for undergraduate and graduate students interested in furthering their understanding of the complexities surrounding suicide. Further, mental health professionals and those in the social sciences will be extremely interested in this monograph, as will the University community, armed forces and interested lay public.
Suicide rates continue to increase globally. The volume of research in this field has also expanded rapidly. In A Concise Guide to Understanding Suicide, leading researchers and clinicians provide a concise review of recent literature, report solutions achieved and give practical guidance for patient care to aid understanding and help prevent suicide. Each chapter is highly focused to provide pertinent information covering all major aspects of the field, from epidemiology and theories of causation through to treatment and prevention. This text will educate practising clinicians (psychologists, psychiatrists, nurses, counsellors, and emergency room personnel) and other health care workers and researchers, as well as providing a pathway for undergraduate and graduate students interested in furthering their understanding of the complexities surrounding suicide. Further, mental health professionals and those in the social sciences will be extremely interested in this monograph, as will the University community, armed forces and interested lay public.
Ninety-seven patients consecutively admitted to a day unit specializing in the treatment of personality disorders were included in a prospective follow-up study. At follow-up an average of 3 years after index admission, patients with borderline personality disorder (BPD) displayed a moderate symptom reduction and a fair global outcome. Patients with schizotypal personality disorder (STP) showed a similar reduction in symptoms but retained relatively poor global functioning. Individuals with cluster C personality disorders, in contrast, showed both a good global outcome and a marked symptom reduction. STP individuals were the least socially adjusted, employed and self-supporting of all diagnostic subgroups. STP and BPD individuals had far more inpatient treatment in the follow-up period than other groups. The overall suicide rate was low compared with most similar studies.
• We located 113 former inpatients with panic disorder 35 years after index admission. According to age-and sex-specific Iowa population figures, patients with panic disorder had significant excess mortality due to death by unnatural causes. Other studies suggest that secondary depression and alcoholism may have had a role in these deaths. Men with panic disorder also exhibited excess mortality due to circulatory system disease. In an age-and sex-matched patient group with primary unipolar depression, both men and women showed excess mortality. Suicide accounted for 20.0% and 16.2% of deaths in the panic disorder and primary depression groups, respectively. We conclude that panic disorder accounted for much of the excess mortality formerly noted in the "neuroses."
Background:
Little is known about the longer-term outcome of bulimia nervosa and the distal effects of treatment.Methods:
Prospective follow-up of subjects from two randomized controlled trials, involving a comparison of cognitive behavior therapy, behavior therapy, and focal interpersonal therapy.Results:
Ninety percent (89/99) underwent reassessment by interview (mean [±SD] length of follow-up, 5.8±2.0 years). Almost half (46%) had a DSM-IV eating disorder; 19%, bulimia nervosa; 3%, anorexia nervosa; and 24%, eating disorder not otherwise specified. There was a low rate of other psychiatric disorders. Premorbid and paternal obesity predicted a poor outcome. While the three treatments did not differ with respect to the pro-portion of subjects with anorexia nervosa or bulimia nervosa at follow-up, they did differ once all forms of DSM-IV eating disorder were considered together. Those who had received cognitive behavior therapy or focal interpersonal therapy were doing markedly better than those who had received behavior therapy.Conclusions:
The longer-term outcome of bulimia nervosa depends on the nature of the treatment received. Patients who receive a treatment such as behavior therapy, which only has a short-lived effect, tend to do badly, whereas those who receive treatments such as cognitive behavior therapy or focal interpersonal therapy have a better prognosis.
Twelve hundred and six psychiatric in-patients, 506 men and 700 women, with severe depression/melancholia were rated at discharge with a multidimensional diagnostic schedule during 1956–1969. The sample was followed up until December 31, 1983. A total of 476 deaths were recorded including 103 suicides. Suicides and to a small proportion diseases of the nervous system constituted the total excess mortality in unipolar disorders. In bipolar disorders there was also an increased mortality from physical disorders, while the suicide frequency was lower (9% versus 4%). Male suicides had higher initial ratings for the items brittle, sensitive, maritial problems, acute onset and lower ratings for psychomotor retardation than other men. Female suicides had a higher frequency of attempted suicides than other women. Acute onset and attempted suicide were associated with suicides early in the course contrary to the other differentiating items. The suicide frequency was similar in admissions during 1956–1962 compared with those during 1963–1969.
ABSTRACT– Ninety-nine patients, randomly chosen among hospital admitted suicide attempters, were initially interviewed at the Department of Psychiatry, Odense University Hospital, Denmark, and then followed up for a period of about 3 years. Half of the patients repeated the attempt in the follow-up period, mostly in the first year. Ten patients committed suicide, half of them in the first 3 months after the interview, shortly after discharge from hospital. The majority of the repeaters were living alone, while those that committed suicide were mostly married women aged 50–60 years. Other characteristic features for the repeaters were previous suicidal behaviour and suicidal behaviour among relatives. Many had a psychiatric record and expressed chronic somatic complaints. Around the time of the attempt, many expressed hopelessness, isolation and suicidal ideation. Pierce's Suicide Intent Scale performed poorly due, in particular, to low specificity. Future work will focus on objective risk factors, those indicated here and others, in order to establish an up-to-date background for assessment and management.
ABSTRACT– The results of a 7-year follow-up study of 50 former psychiatric inpatients with a diagnosis of depressive neurosis (ICD 300.4) who met the RDC criteria for Major Depression are reported. The follow-up assessment of the patients included the use of standardized social, psychological and psychopathological instruments. In addition, the course of illness as well as the utilization of medical services and periods of working disability was evaluated. The results indicate a rather unfavourable course and outcome in terms of symptoms for approximately 40% of the sample, including six patients who had committed suicide after index discharge. Almost 40% of the sample showed mild chronic symptoms with persistent impairments in social functioning especially in the area of social interaction, whereas only 20% of the sample were classified as satisfactorily improved or completely remitted.
ABSTRACT— One hundred and sixty-three individuals in a suburban catchment area of 72,000 inhabitants made registered suicide attempts during 1975–1976 (i.e. 159/100,000 ≥ 18 years). They were followed up by means of the Swedish Register of Death Causes over a period of 8–10 years. Police reports, autopsies and psychiatric records were also studied. Six cases of verified suicide were found and four additional cases were considered as probable or possible suicides. Thus the cumulative rate over 8–10 years was 3.7–6.1%. There was a mean number of 3.5 suicide attempts before the eventual suicide. The most important common factor overall was alcohol or drug abuse with social deterioration (seven in 10 cases). The rest (three in 10 cases) were depressed women with long-standing suicidal processes. The importance of recognizing chronic abuse as probably the most important background factor is stressed. The total group encompasses individuals with longstanding and severe life problems and difficulties in relating to society. The realistic chances of being able to provide effective suicide prophylaxes for most of these patients requires well planned and longstanding treatment and rehabilitation programmes.
We have previously shown that the mortality of patients with recurrent affective disorders in long-term lithium treatment is not higher than that of the general population. In the present study on 471 patients from Denmark and Germany, we examined mortality during the initial year of lithium treatment and during later lithium treatment. During initial lithium treatment, the total mortality was twice as high as in the general population (difference not significant) and the mortality due to suicide 16 times higher. During later lithium treatment, the mortality rates did not differ from those in the general population. Our results indicate that patients with frequent, often severe recurrences, those chosen for prophylactic lithium treatment, are at risk of high mortality, which then diminishes as the prophylactic action of the treatment takes effect.
This study describes 568 individuals who had received a diagnosis of psychotic depression during 1961-1962 and examines their psychiatric experiences through 1966. The diagnosis of psychotic depression was given most frequently to an older, married, white female group, social class seemed unrelated to the diagnosis. Of these individuals, 54% had received psychiatric care prior to the psychotic depressive episode, and the majority had been hospitalized during the follow-up period.
Psychiatric experiences after the initial psychotic depressive episode distinguishes four distinct groups: (1) a single isolated psychiatric contact; (2) a single psychotic depressive episode; (3) multiple psychotic depressive episodes; and (4) a single psychotic depressive episode with different diagnosed episodes. Of the sample, 16% died during the follow-up period with 14% of the deaths due to suicide.
• This study reports a prospective evaluation of 189 patients who entered the commitment process in Oregon. Patients were assessed for commitment status, morbidity, and mortality at six and 19 months. Twenty-nine percent were formally committed. The committed group consisted largely of violence-prone, psychotic patients plus a small number of elderly, demented subjects with serious medical illness. A mortality of 10% included the elderly who died of medical causes and young adult patients who completed suicide. The findings justify psychiatry's concern for patient welfare in commitment systems, especially for the group that is released and not committed. The study is compared with six additional commitment studies, with emphasis on methodology and implications for futher research.
• We investigated the risk of suicide among 705 patients with primary unipolar depression, 302 patients with secondary unipolar depression, and 586 patients with bipolar affective disorder (BAD). The suicide rates among the study subjects were compared with that of the general population of Iowa, the area from which the subjects were selected. An increased risk of suicide was found in all psychiatric groups, except the group of female patients with BAD, which was associated with a lower risk of suicide than unipolar disorders. Thirty suicides (73.2%) occurred during the first two years of followup; this trend was particularly pronounced in female patients with primary unipolar depression and male patients with BAD.
• Causes of death were determined in a cohort of DSM-III schizophrenics and in a group of "other" psychotics (with schizoaffective disorder, schizophreniform disorder, and atypical psychoses), and comparisons were made with the general population. Five causes of death were considered in this analysis: (1) infections, (2) neoplasms, (3) cardiovascular, (4) unnatural, and (5) other. Suicide occurred in excess among other psychotics compared with schizophrenics and with the general population.
• A 42-year follow-up of 76 women with Briquet's syndrome revealed no evidence of excess mortality. A carefully matched group of patients with primary unipolar depression had excess mortality in comparison both with the Briquet's syndrome group and with the Iowa population. Although one of the 30 patients with Briquet's syndrome with available death certificates died by suicide, the rate of death due to unnatural causes in the Briquet's syndrome group was not greater than that predicted by relevant population figures. These findings suggest that some psychiatric illnesses involve excess mortality while others do not. Reasons for this excess likewise may vary by diagnosis.
• Mortality was investigated in 881 male and 450 female formerly hospitalized child psychiatric patients in a four- to 15-year follow-up. Death from natural causes was not increased, but death from unnatural causes occurred at a rate more than twice as high as expected based on age- and sex-matched comparisons with the general population of the state of Iowa. Increased risk of unnatural death was found in five of eight psychiatric diagnostic categories but was significant only for Mental Reasoning, a category that combined patients with organic mental disorders, schizophrenia, or mental retardation. Clinical variables associated with an excess rate of unnatural death included age 15 years or older at the time of admission, the absence of a second psychiatric diagnosis, the presence of previous psychiatric hospitalizations, and the presence of a seizure disorder. Among the 23 unnatural deaths, the 11 (47.8%) suicides were excessive, but accidents and homicides were not.
Suicide behavior in Huntington disease (HD) was assessed by examining the proportion of deaths attributed to suicide among 452 deceased individuals with HD and the number and pattern of attempted suicides among a total population of 831 HD patients from the National Huntington Disease Research Roster. It was found that 5.7% of deaths among affected persons resulted from suicide and 27.6% of patients attempted suicide at least once. Comparison of this group with the general population indicated that the proportion of deaths due to suicide among persons with HD is almost four times greater than the corresponding proportion for the U.S. Caucasian population. Age at onset of HD was not significantly different between HD suicide and non-suicide patients, although suicide occurred more frequently in the early to middle stages of the illness. The ''success'' rate among HD suicide attempters did not differ from the general population rates in several western European countries. The relatively high suicide and attempted suicide rates in HD indicate that thorough psychological testing of at-risk persons and extensive patient support systems must be integral components of a program to identify HD gene carriers using a genetic marker.
The report presents some prospective base-lines for assessing prognosis in alcoholism of various gradations in the gene ml population, each variable measured at the beginning (Time I) and at the end (Time 2) of a 15 year longitudinal study. It shows an inverse relation between the degree of involvement with alcohol and the time course of the syndrome. Alcoholism as a dependency-syndrome is confirmed to be a valid working model for medical and epidemiological use. The findings also give evidence that future problems can be anticipated on the basis of a few general items.
There is accumulating evidence of the clinical effectiveness of selective stereotactic psychosurgery in some severely disabled psychiatric patients who have not responded to other forms of treatment (Ström-Olsen and Carlisle, 1971; Bridges, Göktepe and Maratos, 1973; Kelly et al. , 1973). The risks of adverse effects resulting from operation are now small, and their significance is further diminished when related to the distress over long periods of those patients who are suitable for psychosurgery. The criteria for selection have been considered by Bridges and Bartlett (1973).
Cortical undercutting, as an alternative to standard leucotomy and to the major operation of topectomy, was devised by three surgeons independently. Scoville (1949) published his preliminary results soon after McKissock had begun to do rostral leucotomies. Both have continued to use this type of operation (Scoville et al. , 1951; Scoville, 1954) but Ferey (1950), the third to develop a similar technique, was disappointed with the results and soon abandoned it (Ferey, 1953). McKissock (1951) reported the initial impressions of the results in 100 cases and by the end of 1952 had operated on 240 cases. During 1953–54, 1½ to 5 years after operation, I followed up these patients, visiting 175 of them in their homes, and 35 in hospital. Personal follow up was refused or for some reason impracticable in 17 cases, including 4 whose case notes had been destroyed; 13 others had died before the survey was made.
Partridge (1950) reported a follow up study of 300 cases operated on by the same surgeon by his “standard” technique (McKissock, 1943); he had the advantage, which I had not, of being able to see his patients before operation. I have had to work retrospectively, and the case notes available, whilst often excellent, had usually not been made with the idea that they would be needed for follow-up purposes. I have not, therefore, thought it right to draw more than broad conclusions from this study.
Two groups of patients are presented here, an older group from Birgitta's Hospital in Vadstena admitted during 1900-1910, and a more recent group from St. Goran's Hospital in Stockholm admitted during 1961-1970.
Mortality among the 69 patients in the Vadstena material was increased, by a factor of 1.7 in the case of the men and 1.9 for the women. When applying the method of Sjogren and Larsson the patients were found to show an average expectancy of life that was approximately 30 per cent less than in the general population.
As regards mortality, the 123 patients in the Stockholm material do not deviate significantly from the general population. The observation time is short, however, more than 5 years in only about 45 per cent.
No increase in mortality was evident in the relatives of the Stockholm patients, despite the fact that among the parents and sibs, a greater number of suicides occurred that were expected in comparison with the general population.
The frequency of suicide in both the patient groups was found to be low. In the Vadstena material only 3 patients of the 64 who died committed suicide, and none in the Stockholm material. The regularly controlled lithium treatment, which the majority of the Stockholm patients received, may possibly have had a preventative effect on suicide. Conclusions, however, must be cautious, in view of the fact that the sample is small and the observation time is short. Nevertheless the high frequency of depressions during the control period (see Chapter IV), and the absence of suicide later is remarkable, and it is reasonable to associate this absence with the reduction in both intensity and duration of depressions during the treatment with lithium.
Study Population: Of 9046 consecutive trauma admissions, all suicide attempts (n = 156) were identified: 38 patients (24%) died in hospital; 118 (76%) were discharged and received long-term follow-up (mean = 2.8 years). Factors assessed included suicidal ideation and planning, reason for attempt; number of attempts, methods, dates of prior and subsequent attempts; psychiatric diagnoses, substance abuse history, treatment and medication compliance, hospitalizations, incidence of family depression and suicide; education level, job history, and living conditions. Results: 104 (88%) patients were interviewed and 14 (12%) were lost to follow-up. Seventy-seven of the patients (74%) used guns in their attempt; their mean ISS was 14.2. Seven (6.7%) made repeat suicide attempts (all unsuccessful). Late mortality was 7% (one related to index suicide, five to chronic illness, one to motor vehicle crash). Most patients (96%) had psychiatric diagnoses at discharge, 77 of 93 (83%) had diagnosed depression. Sixty-six percent (69 of 104) had histories of alcohol abuse, 42% (42 of 101) histories of drug abuse. Thirty-five percent (34 of 96) were noncompliant with psychiatric follow-up and 70% (16 of 23) were noncompliant with alcohol abuse treatment. Conclusions: (1) Repeat attempts were rare (7%) after failed suicide attempts. (2) No late deaths resulted from repeat suicide attempts. (3) Risk factors associated with repeat attempts were younger age (p = 0.002), prior attempts (p = 0.02), family history of suicide (p = 0.03), schizophrenia (p = 0.005), and not living at home (p = 0.04). (4) Identifying patients with these risk factors, ensuring that they receive inpatient alcohol abuse treatment, along with sustained psychiatric treatment and help in maintaining home environments, may prevent repeat suicide attempts.
We have analyzed suicide data of the Forensic Psychiatric Program of the Oregon State Hospital in terms of the various ways of expressing occurrence rates that are found in the literature. All of these rates are ultimately based upon either (a) the average daily population, computed from occupancy rates of institutional beds, or (b) a measure of the total number of individuals at risk (that is, all who were in the study population during the time frame of the study). We discuss reasons for the use of these different rates. We have also calculated the risk of suicide for each of two factors: (a) the primary psychiatric diagnosis and (b) the type of legal commitment under which these patients were admitted to the Forensic Psychiatric Program. We discovered that virtually the entire risk of suicide in this program was borne by patients whose primary diagnosis was that of chronic schizophrenia and who were committed there because of diminished criminal responsibility for a crime of which they were found guilty in a court of law. Language: en
This is a study of alcoholic mortality in which time, cause, and age at death were variables of critical interest. Five cohorts of 100 members each were followed 12, 11, 9, 6, and 4 years. A total of 133 cases were located as deceased. The overall case fatality rate (CFR) was 0371. Higher CFR's were observed in years 1 to 6. Cardiovascular disease, violence (homocide, suicide, accidental), cirrhosis, carcinomas, and acute intoxication were the leading causes of death. Violent deaths were more prevalent in younger admission age groups. The cardiovascular/other ratio increased in older admission age groups.
Neurocirculatory asthenia (anxiety neurosis, effort syndrome, neurasthenia) is a common disorder, possibly occurring in 5 per cent of the population.1 Although it has been the subject of many reports, including recent ones from this laboratory emphasizing physiologic abnormalities,2 there is little information in the literature concerning the course of the disorder in patients who have been followed for a period of years. Since there were available from the files of one of us (P. D. W.) records of many patients with such a diagnosis at least twenty years ago, it was possible to do a follow-up study, the purpose of which was to learn more about the course of neurocirculatory asthenia and the state of health of these patients over the years and, in addition, to learn some facts about their psychologic and social adjustment, the diseases they had and the number and manner of their deaths.
METHODS
A five-year follow-up study was undertaken of a previously reported 1968 cohort of 886 people who had attempted suicide. The working hypothesis that those who had seriously attempted suicide (21%) would have a higher suicide rate on long-term follow-up was confirmed. During the five-year follow-up period, a total of 34 suicides were found, which represented 3.84% of the total number at risk. Of those who had seriously attempted suicide, 12 (6.45%) of 186 succeeded later; of the other (nonserious or less serious) attempters, 22 (3.1%) of 700 succeeded. The serious-attempter suicide rate was 2.1 times that of the others, and this difference was statistically significant (P <.05). In addition, patients who made attempts that were judged serious on medical but not on psychiatric grounds were found to have a suicide rate significantly higher (P <.05) than patients who had made suicide attempts that were not a serious medical threat.
(JAMA 235:2105-2109, 1976)
Ninety-one of 100 patients who had participated in a structured outpatient intensive group psychotherapy program for bulimia were contacted and successfully interviewed by phone 2—5 years after treatment. Seventy-nine (87%) had completed therapy. Overall, 60 (66%) were doing well at follow-up, although some had required additional treatment, 8 (9%) were improved albeit still symptomatic, and 23 (25%) were classified as treatment failures.
The death of 218 persons known to have epilepsy in Warsaw was most often due to epilepsy, i.e., death in a convulsion or due to accident related to seizures. Brain tumor and heart disease came next, followed by carcinoma, pneumonia, suicide, and other accidents. In 97 institutionalized patients death in status or with pneumonia or heart disease was most frequent. The mean mortality rate in Warsaw was twice as high for men as for women (10.6 and 5.4/100,000, respectively). The mean life span was 12.5 yr after onset of seizures, an average of 20 yr shorter than in the population. The mortality rate was 3.5 times that to be expected under the age of 50 yr, 1.9 times that expected over 50. Death certificates often failed to give epilepsy as primary or related cause of death. Study of deaths in persons with epilepsy are misleading prognostically since the severe cases are always recorded.
The outcome in 165 subjects with either an unknown (n= 93) or an alcohol-related (n= 72) seizure etiology, admitted to the emergency room of a general hospital in 1977–1978, was assessed after 10 years on the basis of subsequent hospital records and death-certificate-based mortality data. Alcohol and/or drug poisoning was the most frequent cause of death in the group with alcohol-related seizures. Sixty-four percent of the deaths in this group were directly related to alcohol abuse. The crude mortality was 45.8 (expected 8.6)/100 persons/10 years in the group with alcohol-related seizures and 15.1 (expected 6.0)/100 persons/10 years in the other group, the odds ratio between the groups being 4.8. Twenty percent of those with an unknown seizure etiology were found to show alcohol related seizures, while the seizure etiology remained unknown in 59%, and a specific etiology other than alcohol abuse was revealed in 21% during the follow-up period.
We conclude that alcohol abuse is an important, though often undetected, seizure etiology carrying a poor prognosis. The difference in mortality between the groups was due more to alcoholism than to seizures. There was no difference in mortality between those with a first alcohol-related seizure and those with previous alcohol-related seizures.
SummaryA study of mortality among alcoholics was carried out involving patients discharged from the alcoholic ward of a Hamamatsu University-affiliated hospital from 1972 to 1984 (1021 patients). The average age at death was 48,4 years. The causes of death were divided into three groups; ‘diseases, accidents’, ‘suicide and homicide’, accounting for 73.5%, 10.5% and 7.3% of 257 deaths, respectively. Death rates per 1000 persons for the years at risk were compared with the expected rates for the general population. Briefly, the death rates for patients were more than 10 times as large as those in the general population. Our results showed that liver cirrhosis and heart failure ranked high among the causes of death in alcoholics. Among patients who died, only 3.1% were total abstainers after discharge from hospital, which was an extremely low proportion in comparison with the average cross-total abstinence rate of 25.8% among patients after discharge.
The mortality within a cohort of 115 street heroin addicts was studied for 5–8 years using the Kaplan-Meier survival estimate technique. This differed markedly from the relatively low mortality of 166 comparable heroin addicts given methadone maintenance treatment (MT). The street addicts’ mortality rate was 63 times that expected, compared with official statistics for a group of this age and sex distribution. When 53 patients in MT were involuntarily expelled from treatment, due to violation of programme rules, they returned to the high mortality of street addicts (55 times that expected). A group of 34 rehabilitated patients who left MT with medical consent retained the low mortality of MT patients (their mortality rate was 4 times that expected). Despite this great improvement in survival, even patients in MT showed a moderately elevated mortality (8 times that expected), mainly due to diseases acquired before entering the treatment programme. It is concluded that MT exerts a major improvement in the survival of heroin addicts.
The risk of suicide associated with different psychiatric diagnoses was estimated in 80,970 inpatients in Stockholm County (population 1.6 million). All patients discharged with at least one psychiatric diagnosis between 1973 and 1986 were followed by linkage with the cause-of-death registry through 1987. There were 1,115 definite suicides and 467 undetermined suicides among these during the 15-year follow-up. When 12 diagnostic categories were entered in a proportional hazards model, the highest relative risk (RR) of definite suicide, controlling for sex and age, was noted for affective disorders (RR 2.82), followed by unspecified psychoses (RR 2.69), paranoid psychoses (RR 2.60), addiction to prescription drugs (RR 2.38), neuroses and reactive psychoses (RR 1.96), and schizophrenia (RR 1.64). Alcoholism, personality disorders, organic psychoses, and street drug addiction did not have significantly increased risks of suicide. Male sex increased the risk for definite suicide by 1.56, while the risk was somewhat higher among the young. Having more than one diagnosis increased the relative risk by 1.42. When undetermined suicides were included in the analysis, to alcoholism and street drug abuse were attributed significantly increased risks of suicide, probably owing to the greater difficulty of verifying such cases. We conclude that several psychiatric disorders were conductive to suicide, but that the risk did not vary much with the type of diagnosis. Further studies of confounders are needed, such as the reasons for being admitted to inpatient care, and the impact of somatic and psychiatric comorbidity.
In 1974 we started a follow-up of patients with different psychoactive substance use disorders (PSUD) according to DSM-III; 2082 cases out of 2127 were analyzed; 1370 patients had taken legal drugs (i.e. prescription drugs and/or over-the-counter drugs); 444 patients suffered from abuse or dependence of legal drugs alone; 678 combined legal drugs and ethanol, and 248 cases combined legal and illegal drugs, often together with ethanol. A group of 712 alcoholics were included for comparison. Mean time under observation was 6.5 ± 5.4 years, and 269 patients died. Mortality and survival were calculated and compared with expected survival from the normal population of the former Federal Republic of Germany. Mortality in all subgroups of PSUD was increased, the standardized mortality ratio (SMR) for patients on legal drugs alone being 2.1. Patients with legal plus illegal drugs had a SMR as high as 20.7; those with legal drugs plus ethanol 3.4; and alcoholics 4.2. The increased mortality seemed to be constant over the years. Mortality decreased in patients with stable abstinence. There was no clear sex difference. Abuse had a better prognosis than dependence. An estimation of potential life lost by the different PSUDs was attempted. Patients on legal drugs died from suicides, malignancies or accidents (including intoxication). In alcoholics or patients on legal drugs plus ethanol malignoma, liver cirrhosis, accident and suicide were the most prominent causes of death.
Primary affective disorders, depressive or manic episodes in patients who have been psychiatrically well previously, or who have had episodes of mania or depression without other psychiatric illnesses (Robins and Guze, 1969), are associated with high suicide rates. The following data indicate that the suicide risk among these patients is over thirty times greater than that of the population without these disorders, and that the risk of suicide compared to other causes of death may be increased early in the course of the illness.
The association between affective disorders and subsequent death from physical disease is a subject which has received little attention. The present investigation into this aspect is based on a four year follow-up study of an unselected group of 135 patients admitted to a psychiatric hospital. The observed mortality rates for males suffering from simple anxiety state and depression were significantly raised. In contrast, none of the female patients showed a similar increase. Further, deaths from carcinoma among male patients with depression were significantly more frequent than expected.
Certain aspects of the nature of the aetiological relationship between physical disease and affective disorders are discussed. While a depressive reaction to the awareness of physical illness may have contributed to the association between psychiatric and somatic disease in those patients dying from causes other than carcinoma, this does not account for the course of events in the carcinoma group. It is suggested that a form of depressive illness in male patients arising in late middle age without previous psychiatric illness and occurring without apparent cause may be an early and direct manifestation of latent carcinoma. The clinical picture is of a 'mixed' type with features of both reactive and endogenous depression. The immediate response to ECT and anti-depressant drugs is good but transient. Whereas neurological prodro-mata occur more commonly in association with carcinoma of the lung, depressive illness appears to bear no specific relationship to the site of the tumour. It is emphasized that further and more extensive studies are required to evaluate the present findings.
A series consisting of 355 male patients, 187 with definite and 168 with probable schizophrenia, all first admissions during 1947-58, were investigated with regard to the frequency and causes of death. In comparison with the general population there is a significantly increased mortality, and this is found to be due wholly to an excess of suicides. On the other hand, mortality from tuberculosis has fallen markedly since the earlier part of the century. The causes for this and for the high mortality from suicide are discussed.
Over 2000 epileptic patients admitted to the Chalfont Centre for Epilepsy between 1931 and 1971 and taking anticonvulsants were followed up to the end of 1977. Mortality between 1951 and 1977 was greatly in excess of that in the general population of England and Wales in that period allowing for age and sex. Some of the excess was directly attributable to epilepsy, but there were also more deaths from suicide and circulatory, respiratory, and malignant disease than would be expected. Apart from the brain and central nervous system, no particular site had a significant excess of tumours. In particular, there were no liver tumours (and only one gallbladder carcinoma). This makes it unlikely that the liver tumours produced on feeding phenobarbitone to mice are indicators of major human risk.
From a consecutive series of 7000 patients with head injuries admitted to the regional accident service, Radcliffe Infirmary, Oxford between 10 and 24 years earlier, every patient was taken who had been amnesic or unconscious for one week or longer. Of these 479 patients, all but ten were traced, and either the cause of death was established or the survivors examined. Ten years after injury 4% were totally disabled, and 14% severely disabled to a degree precluding normal occupational or social life. Of the remainder, 49% had recovered, and the rest were dead. Additionally, a selected series of 64 patients whose unconsciousness had been prolonged for a month or more were studied. Forty of these had survived between three and 25 years after injury and were re-examined. On the basis of age at injury, the worst state of neurological responsiveness, and the duration of posttraumatic amnesia, the outcome of head injury can be predicted reliably in most cases. Patients and relatives need more reassurance and simple psychotherapeutic support, especially in the first few months after injury. Extrapolation from our figures suggests that each year in England and Wales 210 patients survive totally disabled and another 1500 are severely disabled.
A 10-year follow-up is presented of 484 patients who made serious suicide attempts. Of this group 23% had died, 9% from natural causes, 3% from accidents or from uncertain causes, and 11% from suicide. Suicide frequenzy is highest in the period immediately after the suicide attempt. Especially interesting is the distribution according to sex. During the first 5 years there is a preponderance of male suicides (which is in agreement with the findings of other investigators), but after 10 years this difference in sex disappears. Suicides are found especially among men from 50 to 60 years of age, disabled pensioners, and persons who have attempted suicide several times, and to a lesser degree among persons living alone and criminals.
One-hundred children, diagnosed as having temporal lobe epilepsy and reported on in 1966, have been followed into adult life. In this 1977 survey they have been coded into four social outcome categories, A, B, C and D. A: 33 per cent are found to be seizure-free and independent; B: 21 per cent are socially and economically independent but are receiving anticonvulsant treatment and are not necessarily seizure-free; C: O9 per cent are dependent either on their parents or in institutions; D: 5 per cent died under the age of 15. Biological factors ascertained and coded in childhood are related to adult outcome. Eight adverse factors emerged: an IQ below 90, onset of seizures before 2 years 4 months, five or more grand mal attacks, temporal lobe seizure frequency of one per day or more, a left-sided focus, the hyperkinetic syndrome, catastrophic rage and special schooling. The presence of first-degree relatives with seizure disorders was a good prognostic sign. Disorderly homes in childhood did not significantly affect adult outcome. All but one of those achieving Group A status had received normal schooling. In general, the prognosis for children with limbic seizures is clear before the end of adolescence. A simple count of the number of childhood adverse factors predicts adult outcome at a high level of significance.
During a 5-year follow-up of 154 male and female patients treated for alcoholism at the Donwood Institute, 22 deaths were recorded--almost 4 times the expected number. Typical causes were accidents, suicide, cirrhosis of the liver, cancers of the upper digestive and respiratory tracts and ischemic heart disease. Compared with other samples of alcoholics, unusually few deaths occurred during the first 2 years of follow-up, which suggests the importance of the post-treatment attention given to these patients and the need to greatly extend the duration of aftercare.
This report is a presentation of the results of a 20-year prospective follow-up study of patients who had been discharged during the years 1953-1954-1955 from the Stockholm Municipal Child Guidance Clinics as having received maximal therapy with respect to their need of continued psychiatric care and social adjustment. The report is a continuation of an earlier publication which described a 10-year follow-up period (Curman & Nylander 1976). As the data collected by the authors comprised a very comprehensive and complicated mass of information, this report gives only a summarized account of the findings that are particularly relevant to the following questions. What will happen in the future to the patients who applied to the Child Guidance Clinics for help? How many of them will be in need of continued psychiatric care after being discharged from the clinics? How many of them will become drug addicts or alcoholics, or turn criminal? Is it possible to obtain, on the basis of the investigation technique and working methods that were used clinically in the psychiatric treatment of children and young people, the type of information that will enable us to pinpoint which patient is likely to become a failure later in life? A group among the children applying to the CGC during the 1950's later developed social maladjustment problems or problems associated with addiction. The group comprised children from socially insecure homes who showed 'acting-out' symptoms. Another group required psychiatric care in later years. These children came from home environments that were coloured by anxiety neuroses. Evidence has been presented which provides an answer to the second question. The information gathered during the CGC examinations and investigations did in fact supply indications as to the subsequent fate of the children in question.
By reviewing causes of death among cohorts of various major disease entities or conditions, one may infer that a large majority of suicides are associated with a relatively small number of conditions. From the available follow-up studies, we might estimate that the following percentage of affected individuals will die by suicide: primary (endogenous) depression, 15 per cent; reactive (neurotic) depression, 15 per cent; alcoholism, 15 per cent; schizophrenia, 10 per cent; psychopathic personality, 5 per cent; opiate addiction, 10 per cent or more. Rough estimates of the number of suicides per year in the United States attributable to each condition might be as follows (using low incidence figures): depression, 12,900; alcoholism, 6,900; schizophrenia, 3,800; psychopathy, 2,000 (?); drug addiction, 900.
Mortality during 1946 through 1974 among 4401 US Army servicemen hospitalized for chronic alcoholism in 1944-1945 was compared with that of individually age-matched comparison subjects hospitalized for nasopharyngitis. The relative risk of death from all causes for the alcoholism vs. the nasopharyngitis admissions was 1.87 (p<0.001). The relative risks were significantly high for the following causes of death: alcoholism (12.8), tuberculosis (10.2), alcoholic cirrhosis (3.5), trauma (3.1), non-malignant diseases of the esophagus, stomach, and duodenum (2.5), ill-defined causes of death (2.1), non-malignant respiratory diseases including pneumonia (1.7), and ischemic heart disease (1.4). Significant excess risk was also noted for brain cancer and for diseases of the liver or gallbladder (other than cancer or cirrhosis), but relative risks could not be estimated because no deaths occurred in the nasopharyngitis group. In age-standardized contrasts of the alcoholism admissions to the corresponding individually matched comparison subjects, alcoholics returned to duty or separated from service for disability had greater excess mortality overall than alcoholics separated administratively as having undesirable character traits. The same was true for most diseases, all trauma, suicide and homocide, but not for motor vehicle accidents, other accidents, and unknown causes. The administrative separations appeared to be less medically incapacitated at the index hospitalization. The risk for all cancer combined was significantly related to alcoholism (1.6, p<0.01) only among subjects discharged to duty or separated from service for disability.
In close to 3000 alcoholics followed up from 4 to 24 years after first contact with a treatment facility, the death rate was more than double the expected rate; the rates of death due to accidents and suicides were 4 times the expected rates.
The 10 years' course of a series of 83 moderately severe depressions is presented, as well as factors governing the clinical and work prognosis. Depression was the fundamental disturbance in 75 cases during the index period. The depression was endogenous in 67 cases, reactive in eight, and neurotic in six cases. In the follow-up the drop-out from personal examination was 6.4%. Twenty per cent of the patients had been (almost) entirely free from symptoms of depression during the period of observation, 5% had been continuously depressive. There were no suicides. Twenty-seven patients felt some decrease in working capacity during the depressions, but only seven were unable to continue their previous work and three had changed work to prevent relapses. Fourteen of the patients had been sick-listed for more than 1 year of the observation period. Favourable factors for long-term course were: high intellectual capacity (for work prognosis, W), afraid of hurting others (W), white collar work (W), slight depression of mood during index period (for clinical course, C), favourable immediate outcome after index period (W). Unfavourable factors for long-term course were: low intellectual capacity (W), hysteroid personality (C), syntonic personality (W), asthenic personality, sensitivity to praise (C), tendency to feel under observation (W), and some symptoms during the index period: tendency to seclusion (C), ideas of reference (C), dryness of mouth (C), difficulty in falling asleep (C), dreamlike feeling (C), supplicating attitude (C). The implications of the results for nosology, care, and prevention of depressive states are discussed.